President’s Blog: Covid19 – up close and personal!

Look, let’s get the “u” words out of the way first of all –unique, unprecedented, united, unswerving, unbelievable – utterly brilliant healthcare scientists!  Are you not all bowled over by the brilliant responses our Healthcare Scientist teams/colleagues have delivered fighting COVID19; pulling together, reformatting services and duties, re-training, re-purposing and becoming central in the NHS family fighting COVID19?

Many of us have moved far from our “comfort zones” of routine clinical care, daily diagnostics, standard treatments, research, procurement, national professional duties and usual training programmes.  However, we have all found in the depths of our experience, training and professionalism that have transcended the “normal” and are enabling up to achieve incredibly rapid change and new roles.

I was actually on ward ventilation duty at QEHB on a Thursday night when the 8pm “Clap for Carers” applause was apparently taking place.  With full PPE, including ventilated hood, we were settling in our first CPAP/Oxygen patient on our new Level 2 area within our respiratory ward – we were oblivious to the public applause.  Nevertheless, our wards are covered in hundreds of (laminated) rainbow pictures from schoolkids and others. The out-pouring of public appreciation is very kind and almost shocking, since much of the last decade it feels like the NHS has just taken for granted.   It’s many decades since I’ve worked nights in hospital, but how my own hospital QEHB runs at night is truly amazing. The donning & doffing routines, the patient monitoring and care are all done with generally plenty of staff and PPE available.

Spending hours with a sick, scared and lonely patient, who is struggling to come to terms with their predicament, brings out our innate humanity, caring, empathy and humour, all of which is fundamentally essential for their very well-being.  What has made this particularly rewarding was that our patient was herself a patient-carer and had probably contracted COVID19 from her workplace.  What a privilege to be able to help her – one of the truly unsung heroes. This has all made me reflect on how we have got to this point in the COVID19 story.

There have been many phases of this COVID19 pandemic; the early days of planning, stepping routine services down, training and general preparation for something which was sometimes enormous and unmanageable, and at others achievable when done a bit at a time.

Next was the uncontrollable increase in ICU patients and wards filling with actual and suspected COVID19 patients. When would it stop? The No 10 briefings, the Trust bulletins, the media tsunami of information, comments, statistics and endless graphs all made us feel we were all playing a small part in a blockbuster disaster movie!  What has been hard to handle has been the constantly changing expectations, setting and re-setting the new realities of what we’ll be doing.

However in recent weeks, the changes; the empty hospital atria, the silent wards and corridors, the air of calm serenity and trickle of healthcare staff belie the frenzy that continues on ICU units and selected respiratory wards. Rainbows, food treats, gloves, gowns, FFP3 masks and aprons have become our new normality.  Elsewhere, labs are beavering away crunching thousands of swab samples, other immunology, microbiology and biochemistry and skeleton crews deliver routine care often in new ways to ensure patients can be seen remotely/virtually as the lockdown continues.

Some HCS are quarantined at home, shielding family or working from home where this is possible.  Not travelling to the hospital is supporting the “Stay at Home, Protect the NHS, Save Lives” government campaign. Contributing to saving lives – just look at the “change in the curves” as evidence of stopping/slowing the spread of the virus!  We all play different parts in this war on COVID19, but the fact that we do this together as professionals, citizens and neighbours, makes the joint effort all the more amazing.

Human stories

Working in the hospital each day, as you meet colleagues, or staff who you’ve smiled at before, but never really spoke to, you begin to pick up the human stories, the reality of this dreadful pandemic and how it changes and wrecks people’s lives, but also makes us be achieve the amazing too.

There is the cleaner whose wife had COVID19 and was poorly and on oxygen as he worked on the opposite ward each day. How must that feel?

There is the husband who has been “tubed” on ITU for 2 weeks who doesn’t know that his wife has died – when do the clinical team break that news to him?

Then there’s been pregnant consultant who was intubated for >20 days, but who has just delivered 2 healthy but premature babies and is now weaned off the ventilator.

The doctor in his 30’s, who said goodbye to his children and wife on Skype on a tablet before being sedated and ventilated on ICU. Fortunately, he has now also been weaned off the ventilator.)

There is the story of the woman who was put on CPAP/oxygen treatment as her ceiling of care by an intensivist. She was looked after by physiotherapist/physiologist ventilation team for 24 hours.  When the team approached the then on-call intensivists the next day regarding her care plan, that intensivist insisted that the treatment be stopped immediately as it wasn’t clinically appropriate. This is a tough message to take on board, but especially when sadly, she died 3 days later. Rationalising the right clinical decisions with how you feel can be really difficult.

I have been lucky and helped to set up ventilation on several patients on the COVID19 wards, but fortunately, although most only had suspected COVID19, and turned out to be negative.  Both have gone home, safe and reasonably well.  How they must have felt with two physiologists dressed like something out of a sci-fi film, mumbling through our masks/hoods/visors!  Patient resilience is itself inspiring and drives us all on to do our best from them.

How many of us have experienced the range of personal emotions, sometimes within the same day from “oh we’re just doing our jobs” through “well I need to take care here”, “God, I wonder what we’re going to witness”, and up to, “Grief I’m going to catch COVID19 and end up intubated!” We have a much distorted picture of the worst COVID19 can do – remember 80% of the public get this, and then have 1-2 weeks laid low and then gradually recover.

I have also met so many healthcare staff that I would never usually meet.  The problem is if I ever had to identify them in a photo-fit exercise they’d all look the same (apart from height, eye colour and shape) – FFP3 mask, visor, apron, gloves.  Other distinguishing features……….er  scrubs? It amuses me the process for getting donned according to social media – gown, gloves, FFP3 mask, visor, obligatory photo with option video dance!

The press and media highlight the negative parts – the lack of PPE, lack of testing, lack of vaccine and medication, but you have to push all this low-level angst deep down, because otherwise you’ll not be able to do your job as easily.  That’s not to say we don’t all have an occasional  “wobble”, lose our composure, get into a tizzy and (as in my case) go on a pointless, unkind and unfair social media rant late at night.  This may be at colleagues, politicians, family or even friends. We are all human, we can and do make mistakes, but it is in learning from those mistakes, reflecting, considering, realising and correcting them that we become better people and better professionals. We may not feel proud of our behaviour/actions after them, but we need to pick ourselves up, dust ourselves down, and get back to it. One lost battle in a war of promoting our wonderful professions with kindness and measure.

The nature of the severest manifestations COVID19 is such that, there is sudden catastrophic hypoxaemic events where patients go from unwell/stable to critically ill and in need of intubation in 30 minutes. (These patients probably die from a pulmonary embolus.) It is a traumatic and shocking event to witness and something that may affect staff for possibly years afterwards.  It is really important to talk with colleagues, mentors, family, friends or professionals or anyone you feel comfortable with about what you’re seeing and experiencing.  We have all joked in the past about the “touchy feely” aspects of healthcare, but this COVID19 situation has brought out how important it is to be confident to display our humanity and vulnerabilities. This is the “care” of the healthcare scientist which we should nurture, develop and improve to be better professionals.  Learning from our nursing, allied health professionals and medical colleagues, who have enormous experience of these aspects of healthcare is a unique and fantastic opportunity for us all.

Low levels of stress over many months, changes sensibilities, drains emotions, triggers an underlying fatigue and is perhaps an element of PTSD (outside my scope of practice here!) and needs to be addressed in all staff whether they’re on the COVID19 frontline or not.

Add to this, the shock of hearing of the death of a family member, friend, colleague or well known personality, it all chips away at our life confidence and security. Remember, we wear “scrubs” not lycra!  We’re not super-heroes/heroines, but ordinary people who chose to work in public service, as part of the NHS, in a collective of like-minded carers, who generally speaking love their jobs and working for patients. Just as we look after our bodies through exercise and healthy diet, so too we need to look after our minds.

Regarding working in extraordinary ways, the Nightingale Hospitals are a case in point.  Oh, how we marvelled as hundreds of Chinese diggers threw together a prefabricated hospital in 2 weeks! Did we believe then, what we know now – that we could transform our large exhibition centres in purpose made hospital extensions with capacity for thousands of patients?

NHS Nightingale Hospital London at ExCeL London

NHS Nightingale Hospital Birmingham, at Birmingham’s National Exhibition Centre

NHS Nightingale Hospital North West at Manchester Central Convention Complex,

NHS Nightingale Hospital Bristol, University of the West of England

NHS Nightingale Hospital Exeter at Westpoint Arena near Clyst St Mary,

NHS Nightingale Hospital Yorkshire and the Humber, Harrogate Convention Centre.

NHS Nightingale Hospital North East at the CESAM, in Washington, Tyne & Wear

Each one of these “pop-up” hospitals has required the input of healthcare scientists in designing and planning of each facility.  HCS in Medical Physics and Bioengineering , Life Sciences and Physiological sciences have either been delivering their own expertise, or re-training and supporting nursing and medical staff to deliver the care required.  I totally admire and must thank all those HCS involved in these astronomical ventures. The NHS has made an exhibition of itself – in the best possible way, by working with the military and private companies to provide this essential safety net for this unknown contagious enemy.   Whilst they have not yet been used in large numbers, we have a long way to go with COVID19 and to have such an important “safety net” for our population is absolutely right and proper. The willingness of people to cooperate and make this all happen restores faith in humankind.

Please carry on being brave, brilliant and the best.  Whilst the curve may be flattening, COVID19 will become a long “slow burn” in our health system until we can get the vaccine and medications in place to reduce its ferocity and its indiscriminate selection of patients.  We will soon turn to “living with COVID19” and begin to return to our previous work – but by no means “back to normal”.  We have learned so much about who we all are (and can be) in the NHS now. So we may be HCS, but we are also a part of the NHS Family.  COVID19 may produce a lot more positives than the doom laden media are trying to make us believe. Finally, don’t “take care” (I hate that phrase now!), but “take risks carefully” by using PPE, hand-washing and support for each other.

As stated before, the pandemic has changed the way the NHS can work and can make bold/radical changes to the services we have known for decades.  In that respect the pandemic has acted like a catalyst, for change. Central to that change will be the HCS teams.  What we have all learned is how to be flexible, hot to adapt, “think outside the box” and deliver new ways of working so that after COVID19 we won’t return to “normal” but to a new world of innovative services. Virtual clinics, reducing hospital footfall and treating patients remotely will be the new norm. We look forward to the stories of innovation which we can share with one another to inspire others both within and across our professions.

Most importantly will be our ability again to support the wards and patient facing services by working alongside our nursing, medical and AHPs colleagues when “winter pressures” or other “pinch points” happen in healthcare. It’s not just COVID19 that has become “up close and personal”, it’s what healthcare scientists have done and continue to do across the UK.

Prof Brendan G Cooper
President, AHCS
2nd May 2020