One doctor’s story: ‘We don’t have the masks, goggles – or the staff’
NHS staff are asking the same questions as everyone else about coronavirus. How deadly is it? How do we protect ourselves? Are the government’s tactics right? And how will the health service cope when – and it is when – it leaves large numbers of people seriously ill, many fighting for their lives? These questions are even more pressing for us because within two weeks we will be part of the frontline against a threat that we’ve never seen the like of before.
I’m worried that our hospital’s beds are already 98% full. We are full of “social patients” – people medically fit to go but who can’t be discharged because there isn’t a place in a care home for them, or the care package to allow them to go home hasn’t been sorted. So where are all the people needing life-ordeath care from Covid-19 going to go?
We’re barely two weeks from being in the same situation as Italy, with huge numbers of people needing to be in hospital. Yet we don’t have enough protective equipment like masks and goggles. And the NHS is under-staffed. We have to haggle with management about a minuscule pay rise for doctors willing to work extra shifts and expose themselves to danger.
We don’t have enough isolation rooms or ventilators, which will be vital. Intensive care units will be the NHS’s most precious resource, but ours are close to full most of the time. We’re told of plans to increase ICU capacity. Yet you need a specially trained nurse for each ICU bed. Where will the extra staff come from?
Too few beds, staff and equipment; I’m worried that the NHS is completely ill-equipped to handle Covid-19. When Boris Johnson talks about our wonderful NHS and how well-prepared it is, that’s bullshit. He either doesn’t have a clue or is trying to falsely reassure people. The NHS has been hit hard before, by underfunding, terrorist attacks and tough winters. But usually crises are stretched over a period of time. With coronavirus it will all come at once.
The virus’s effects can vary from a mild flu-like illness to severe pneumonia in both lungs, meaning they no longer provide enough oxygen for the body, so organs get deprived of oxygen and start to fail – your kidneys, brain, heart. Many people die of acute respiratory distress syndrome. Dying because you are struggling to breathe is a horrible way to go; it’s very distressing for the patients, their family and the staff treating them. Relatives will not be able to kiss loved ones goodbye. In Italy, doctors and nurses are videocalling people so they can say farewell. And when staff are overwhelmed emotionally they will not be able to give each other a hug or even put a reassuring arm round the shoulder because of the infection risk.
I’m amazed it has taken the NHS and the government so long to get ready to deal with a crisis. We need to free up doctors and NHS staff to prepare for what’s coming. We should be cancelling outpatient clinics, suspending waiting-time targets, like the four-hour A&E wait and the 18-week target for outpatient treatment, until this is all over - and be open with the public about why this is happening. Soon the NHS is going to be faced with a huge amount people with Covid-19. So we need to urgently ensure all doctors, not just A&E, intensive care and respiratory doctors, are trained to at least perform the initial assessment and treatment of someone suspected to have the virus. Otherwise we will burn out from overwork and stress; specialists can’t do it all ourselves. Not to mention that many of us will get the infection ourselves and fall ill or even die, further depleting the workforce.
We need doctors and managers to go to hospitals and identify where extra ICU beds can be created. Which operating theatres, anaesthetic rooms and resus areas can be used? And what does doing that mean for patients who come in with cancer, serious injuries or heart disease? What about them? The NHS also needs to get people out of hospital who don’t need to be there and buy find lots of extra ventilators, though Italy and other countries want them too.
We may be lucky. But I fear and expect that we are going to end up in the same situation as Iran and Italy, where health services have struggled to cope. Hospitals have been overwhelmed, unmanageable and unsafe. If that does happen here, doctors will have to decide who is worth saving: an 80-year-old or someone in their 30s or 40s? Those will be impossible decisions. The NHS will have to ration healthcare that could mean the difference between life and death.
The virus has wreaked havoc in the north of Italy, the richest part of the country. The health service there – one of the best in the world – hasn’t been able to treat everyone who needs care. Some, particularly the elderly, have been left to die. Doctors and nurses have ended up in tears because they can’t do the job they were trained to do, because of the sheer scale of the crisis. They feel helpless.
I’m worried about a lot of things, especially our ability to care for all the people with severe infections who will need treatment; not just by saving their lives but by ensuring dignity and comfort for people who are dying. I worry that staff will be working flat out, with too few resources, and end up fatigued, sick and broken. And I’m worried that many people are going to die – many avoidably. I’m appalled and frightened that this might be coming our way. It’s a catastrophic situation in Italy and Iran. We need to take drastic measures now, and do everything we can, to stop that happening here.