The Daily Telegraph - Saturday - The Telegraph Magazine
‘I was preparing for Armageddon’
The timing was impeccable. Rónan Astin became head of UCH’S respiratory department in early March 2020. Days later the softly spoken consultant realised that Covid-19 was heading for London, and that the hospital would face a ‘tsunami of patients’.
On Friday 13 March, he was given a week to set up a 45-bed unit to treat seriously ill Covid patients with continuous positive airway pressure (CPAP) machines – glorified oxygen masks – because the hospital had too few ventilators. ‘In normal times that would take something like 18 months… so the oneweek time frame was almost unbelievable,’ Astin says.
His first problem was ethical. There was no guarantee that CPAPS would work. But he had no choice. Without a new ‘high-dependence respiratory unit’, intensive care would be overwhelmed.
Over the next few days Astin had to commandeer and convert a ward used by the hospital’s stroke unit. He had to write guidelines and operating procedures, including a policy in case the hospital’s oxygen supply ran out. He had to recruit and train roughly 120 doctors and nurses, plus support staff, from other departments. There was also an acute shortage of proper CPAP machines.
It was a frantic, sleepless week – the most stressful and surreal of Astin’s career. ‘I was preparing for Armageddon,’ he recalls.
The unit did open on time, but with just seven proper CPAP machines. Thereafter it was a ‘race against time’ to find more. He was convinced that sooner or later ‘we were going to fail’. But in the event the lockdown suppressed patient numbers until, three weeks later, he secured 50 good-quality machines from Japan.
The use of CPAP machines was a ‘leap in the dark’, he says, but it worked. Despite moments when Astin’s unit came dangerously close to running out of oxygen, even triggering alarms, it treated more than 60 patients during the first wave, three quarters of whom avoided intensive care. It even saved some patients who were put on the machines after being deemed too sick to be saved by ventilators.
The use of CPAP machines has now become standard throughout Britain, freeing up thousands of intensive-care beds. Astin is too modest to claim credit. His team answered a ‘call to arms’, he says. On 7 March 2020, Pia Larsen, an energetic Australian, was told to prepare for a ‘tidal wave’ of very sick Covid patients within 20 days. ‘I was truly mind-blown,’ she recalls. As the trust’s procurement director she had to source huge quantities of masks, gowns, gloves, ventilators, syringes, infusion pumps and much else besides.
She felt an ‘immense responsibility’ because staff would depend on her for the equipment to protect them from the disease. ‘It was a life and death matter. I felt it was my responsibility to keep safe every single clinician in the hospital.’
She and her team secured what they could from the NHS supply chain and the Government’s pandemic stockpile, but that was not nearly enough. They went to any supplier they knew with links to China. They approached suppliers of PPE to the construction industry. They had to think ‘creatively and laterally’, she says.
It was a day-to-day race to keep up with demand even as their usual supply chains broke down. Instead of the 600 high-grade FFP3 protective masks the hospital’s critical-care department normally used each day, it suddenly needed 2,500. Instead of 500 gowns a day, it was using 2,500.
She also had to contend with soaring prices. Suppliers were asking as much as £12 for gowns that normally cost £2, or £1 for 5p masks. ‘There were people who saw this as an opportunity to make significant amounts of money,’ she says.
For months, Larsen worked 16-hour days, but against all odds, she and her team have prevailed. Since the onset of the pandemic they have secured 71 million items of PPE. Looking back, she feels ‘a huge sense of achievement’ and pride that they dispelled the myth that non-clinical units are peripheral to healthcare delivery. ‘We have been absolutely fundamental. And to be part of the solution has been a privilege.’