Critical Care with Covid-19: Here Come the Nuns
The second peak has officially begun. In the space of a week the number of patients admitted to our Covid ITU more than doubled. At the time I write this we are into double figures and looking at spilling into our thirdCovid bay. We’re back in our converted emergency department (ITU2), which is split into four bays and the main ITU is nearly full. It has been mentioned that we might open the final bay in ITU2 as a non-Covid area because its more separate from the others and it keeps us operating two distinct units. Managing multiple satellite areas around the hospital was logistically challenging last time. With the way the numbers are increasing, I don’t know if using the final bay for non-Covid patients is still the plan… everything is moving so quickly you really just have to make the best decision you can at the time and be aware that things may have to change.
I wondered if the patients we got in might not as sick this time around…maybe masks would have reduced their viral load (the amount of virus they were exposed to)? Based on what I have seen so far…Nope. They are extremely unwell and for the majority, they get intubated, are challenging to ventilate and frequently need proning (lying on their belly). When I say the majority — I mean of those sick enough to be admitted to ITU. Don’t forget that most people who catch Covid experience a mild illness. So not much has changed in terms of patient condition on arrival. Two major things have changed.
Firstly, we have new PPE. Our trust purchased respirators and hoods in an attempt to avoid the pain of the FFP3 masks. In this respect we have had great success. They do not physically hurt to wear. Unfortunately, they make you almost entirely deaf! Handovers are now conducted practically nose to nose (excepting the face shields) at the top of our voices. And as anyone who has actually met me will tell you — that’s LOUD! It’s because we are competing with the noise of the fans. The respirator pack (which you wear on a belt) supplies filtered air to the hood continuously. The constant noise in your ears varies from mildly irritating to intolerable depending on how noise sensitive you are. Couple this with a white full head covering, and the overwhelming impression is of deaf, inflatable nuns.
Secondly, we are shorter of nurses. Much shorter. Over the summer we had lot of senior nurses leave us. Some were overseas nurses returning home, some looking for new opportunities and some retiring. And to be fair, a new junior nurse is not the same as an experienced ITU nurse. It takes time to train people and for them to gain experience in what is a pretty unique area. Staffing was already tight before this peak happened. It’s not for lack of trying, we’re asking for agency nurses, but the shifts aren’t getting filled. My guess is that they are in demand everywhere. We have literally gone from 0–100mph in the space of a week, and you have to bear in mind that emergency plans cannot be enacted overnight, so hopefully it’s not that help isn’t ever coming. But now we’re trying to keep most services open, the sheer quantity of nursing support that came last time isn’t likely to happen again. Unless we are completely swamped and the trust’s hand is forced. It’s not looking great from my perspective. Either we continue to provide other services and we don’t get as much help, or we are forced to stop routine services, in which case it will have reached pretty dire already.
It’s OK though. You still have us. The question is what’s going to keep us going? MP’s voted against a pay rise, so that should give you a decent idea about how much they care about healthcare workers. (For perspective, let’s not forget that they have endangered an entire nation’s health and wellbeing in order to protect what they really care about.) The applause (much as I wasn’t a huge fan) has run its course. Donations to the hospital have ceased, media coverage of what it’s like for health care workers has reduced. Forgive me if I sound a bit bleak. I am tired. I’ve had a couple of shifts in the past two weeks which definitely make my top five worst ever shifts and I’ve beaten my personal best for most admissions in one shift (6!). Even if things improve somewhat from this last week, and I don’t think they can get a lot worse, it’s going to be a long winter.
