Northumbria medical chief reveals the huge challenges of working in intensive care unit during Covid-19 pandemic
The stark realities of working on the frontline in the battle against Covid-19 in Northumberland and North Tyneside have been revealed.
Tragically, there have been more than 500 Covid-related deaths in the Northumbria Healthcare NHS Foundation Trust area since the pandemic began, along with over 2,000 covid-related hospital admissions.
The sickest are managed at the Northumbria Specialist Emergency Care (NSEC) Hospital in Cramlington. Those who are less sick, recovering or who have other health care needs are treated at general and community hospitals.
“The current situation is serious but stable,” said Dr Rob Whittle, head of critical care.
“Between our critical care and respiratory support unit we have in the order of 20 patients at any one time who are requiring support with their breathing. That is a high number but it’s been a relatively stable number over the last few weeks."
Covid has presented the team with unique challenges in both looking after the patient and also managing the infection process and preventing cross-infection. On top of that, there is the usual non-Covid workload.
"Covid itself is very tiring and hard work and to have that burden of around 20 patients at any one time who are requiring mechanical breathing support – which is the tip of the iceberg in regards to the number of patients in the hospital – but also making sure we deliver top quality care to people who don’t have Covid is a huge challenge,” he admits.
"Our normal workload for looking after patients with breathing machines would be around 10 in total so we are double what we normally do and we have been running at that level for many months.
"That means a whole lot of staff redeployment and changes to the way we work… but I am very satisfied that we are able to deliver care to all the patients who need it. Some hospitals have been really struggling to do that. But to say it’s straight-forward isn’t true. We are still working extremely hard.
“The first wave was very hard work but it was short and sharp and within a month or two had settled down but we’ve been working on this surge since October/November in the North East."
His job has involved preparing for various worst case scenarios should there be a further increase in admissions.
“I don’t think we ever reached a level where care was compromised but that is always the concern,” he admits.
Close partnership working with the region’s other NHS Trusts has also helped to ‘share the burden’, while a critical care transfer system has been introduced to relieve pressure on North East Ambulance Service.
At the centre of the storm are the staff who look after the sickest patients in intensive care.
"It’s what they do but they are also human beings,” said Dr Whittle. “They have been challenged, they’ve been upset and they’re tired because they have been working extremely hard.”
Patient outcomes have improved as knowledge of the virus has increased.
Dr Whittle says: "Lots of my nurses and colleagues say the feel of looking after C ovid patients compared to how it was last April when that first wave came is totally different.
"That’s not to say the patients are any less sick. We get the sickest patients and there’s a threat to their life.
"Their care is challenging and distressing but we’ve learnt an awful lot about what medicines to give them, what settings to put on the various life support machines to give them the best chance of recovery.
"A lot of the distress early on when treatments weren’t working was learning how to look after people appropriately when they were dying.
"We now have treatments to save more people, which is hugely rewarding, but we’re also learning how to care for people who we can’t save and minimise that burden on families.”
Covid risk factors include: being older, male, obese, diabetes or a member of the BAME community.
Dr Whittle says: "From an intensive care point of view the message I always give to people is follow the rules, minimise your risk of infection, get a vaccine if you are offered one and, if you can, lose a bit of weight and stay healthy.
"Undoubtedly the people who get the sickest from this disease are patients who are overweight.”
He is also well aware that non-Covid patients have had a different experience of hospital over the past year.
"Ultimately there are hospitals which are having to postpone and cancel operations that would have normally happened,” he says.
"Sometimes those are elective operations which can wait but sometimes there are urgent operations and we are spending a great deal of our time and effort making sure that if you have a serious diagnosis like cancer that you can have your operation as soon as you would have done without Covid being there.”
There are signals from the data that the Covid situation is beginning to improve, but Dr Whittle says his crystal ball is ‘broken’.
“I think it will settle down, but I don’t know what timescale and there is this great unknown about the effectiveness of the vaccines,” he says.
"If the vaccines are highly effective and everyone gets one, I am hoping we will be able to have a summer holiday and everything will be much better by the end of this year but, of course, there are the threat of new variants and the vaccines not being as effective in which case things would look very different.
“I strongly believe it’s everyone’s responsibility to follow the rules because we’re all in this together and I’ve seen the consequences of people not following the rules. Those can ultimately be lethal and I’ve seen people die.
“If everyone follows the rules to the best of their ability we will get out of this faster and quicker with fewer deaths so we all need to take responsibility for what’s happening.”