COVID-19: How far we’ve come, and where we need to go
“For so it had come about, as indeed I and many may might have foreseen had not terror and disaster blinded our minds. These germs of disease have taken toll of humanity since the beginning of things – take toll of our prehuman ancestors since life began here.”
War of the Worlds, HG Wells 1898
We have now lived with COVID-19 for more than a year and I have just had my first free weekend since the beginning of 2021.
As a clinician at Salisbury Hospital in the UK, I’d like to share my experience working in the Emergency Department (ED) over the last couple of months.
At the beginning of January, our ED wasn’t busy. The UK was, as it still is, officially locked down, and despite the normal traffic on the road, we are supposed to only leave the house for specific reasons, such as going to work or hospital appointments. The ED felt very different compared to a year ago. There were now established processes in place, such as what PPE level you should wear, and proven workflows for patients with COVID-19. Putting on PPE has become second nature – in fact, I almost feel naked without it. That is not to say it is comfortable; after running out of the initial stocks of masks, aprons and gloves, we now seem to have PPE from a different supplier every week. Comfortable masks, the ones with filters, are long-gone for staff in my ED, though we still wear enhanced masks when involved with a patient who could need an Aerosol Generating Procedure, such as intubation or chest compressions.
The one thing that I seem to be pointing out in each of my blogs over the last 12 months is how tired we are. I use the term “we,” but I accept that I am very lucky in being clinical on weekends only. My colleagues, however, do not have that choice.
What has changed over the last few months?
First of all, the space. While we used to have “open cubicles” with privacy curtains, now all cubicles have a door – the only open space is in our resuscitation room. Although understandable, doors feel like an additional barrier between us and the patients, a barrier that did not seem to exist before.
Also, patients with COVID-19 symptoms seem to be younger. We were treating, and continue treating, older patients, but we are also regularly seeing younger patients in their 40s and 50s with shortness of breath who end up being admitted to ICU. Of course an increasing number of patients did, and continue to, survive and go home, but significant numbers do not.
A sad day in January
For me, the experiences and emotions from my clinical and non-clinical perspectives are encompassed in one particular shift at the end of January. By the time I arrived in the department to start my shift, there had already been one death, that of a relatively young patient.
Mid-shift, I saw a sick gentleman in his 50s who had been taken straight into the resuscitation area. Although young, he did have lots of significant co-morbidities. He presented with shortness of breath and the x-ray and other tests confirmed he had COVID-19. Unfortunately, after a review with the medical and ICU teams, we all concluded that there was little we could do for him. I spoke to his wife at home and asked her to come in straight away. Over the next hour the gentleman drifted in and out of consciousness, asking repeatedly if his wife was there yet. The gentleman’s wife arrived and following a five-minute animated conversation to say good-bye, he passed away as she held his hand.
Emotions were exceptionally high following the gentleman’s death, with tears from seasoned nurses to the medical doctor who was writing the gentleman’s notes in the corner.
In the bay next to the gentleman was a lady in her 90s who had been on the floor for a long time following a fall. Whilst we tried all day to warm her up and rehydrate her body, we were unsuccessful. She gently passed away, just as I was finishing my shift.
For me, this describes what it has been like to work on what is known as the “frontline” during the last year.
What has happened since?
The vaccination programme in the UK has gone very well and we are now seeing the benefits. In the ED, we still see patients with COVID-19, but they are usually quite well. Instead, we are seeing lots of mental health issues, as mentioned in my previous blog, mostly patients with existing issues, though I have seen a few presenting for the first time.
We are also seeing quite a few patients who present with non-emergencies; these tend to be younger and feel that they are unable to see their primary care/family doctor during this pandemic, so they are presenting to us with minor conditions. Although not serious, patients with minor complaints add to our increasingly challenging accident and emergency workload.
As is the case everywhere, the ED is also short-staffed on a regular basis. As I am writing this blog, I have been sent the daily status email from my ED stating that between the hours of 1400 – 2200, the department will have to close half of the beds due to a lack of nurses. The patients will continue to arrive, but they will now be looked after by fewer nurses working twice as hard. In addition, fewer beds means that patient waiting time increases. Unfortunately, I think this will continue.
As things move on, healthcare around the world will need to pick up the pieces from the last 12 months. This includes canceled operations, treatments that were not given and diagnoses that were not made. All of which may now require more significant interventions.
This is where I see technology making the huge difference. It has made a difference already, supporting the disconnected care with telehealth and helping control the spread of infection with data sharing. Going forwards, I believe it will be imperative in supporting the increasing workload by improving and maintaining efficiency whilst not compromising safety.
As my third and final blog on “my clinical experiences during the pandemic” concludes, I would like to share some final thoughts on what I have learnt. First, it has been wonderful being at home with my family, all together for so long. But, conversely, it has been challenging not being able to travel for work or pleasure. It is also clearer now than ever before how important support has been and continues to be, between individuals, whether family or coworkers or neighbours you see occasionally. I’ve been honoured and privileged to be able to give something back at a time of need. And, last but certainly not least, I am constantly reminded how fortunate I am to have two careers: one enabling me to help on the “frontline,” and the other supporting the digital frontline both now and in the challenging future ahead.