Welcome. 23.03.20
Welcome to the first issue of The Plague Pit, a blog all about COVID-19. It’s written with A-level students in mind. Anyone else is welcome to read it, offer corrections, ask questions or join the conversations that follow.
In The Plague Pit, I’ll be trying to cover as many different aspects of the pandemic as I can, inside and outside hospital. Some subjects I know a good deal about, like critical care medicine and mechanical ventilation. For others – epidemiology, history of infectious diseases, health politics and economics – I’ll be building on what knowledge I have as I go along. So I’d particularly welcome comments and contributions in these areas, from experts or anyone else.
I hope to bring you first-hand stories of day-to-day life in the NHS as we deal with the challenges the pandemic brings. My hospital Trust is treating many COVID-19 patients. The Wuhan experience suggests that about half of them will end up in critical care on mechanical ventilators. [1]
Before COVID-19, we had more than 80 critical care beds. Typically, 80% of these were full at any one time [2] with patients receiving treatment and life support after heart attacks, major surgery, overdoses, serious infections and so on. On 14th March, 20 of these critical care beds had COVID-19 patients in. Today, nine days later, it’s 60.
All non-urgent operating has been stopped for over a week now. In the physical spaces made available as a result, we have created 20-odd additional critical care beds. Within a few weeks, we expect to have capacity for several hundred ventilated COVID-19 patients. They will be looked after in all kinds of unusual places in and around the hospital – surgical admission clinics, operating theatres, anaesthetic rooms, postoperative recovery wards.
Each ventilated patient requires one-to-one nursing, 24 hours a day, with a specialist doctor immediately available on site at all times. To make matters even more difficult, many COVID-19 patients are so sick they need to be turned on their front regularly to increase the amount of oxygen getting into the body from their damaged lungs. I’ll be writing about this technique, ‘prone ventilation’, in a future issue.
All my departmental workmates and I were critical care doctors at one point. Our senior clinical and management colleagues have been arranging the necessary re-training to enable us to return there.
Many of us have not held critical care posts for many years (20, in my case). We have needed to get up to speed on recent clinical developments in the specialty, computer software, the application and removal of COVID-19 personal protective equipment (PPE) and simulated endotracheal intubation and cardiac arrest drills in full PPE.
In 48 hours, most of us will effectively change jobs from giving daytime anaesthetics in the operating theatre, with a night on call every couple of weeks, to running ICU areas in shifts, all day and all night. Seven anaesthetists to each shift rota, nine shift rotas to cover the nine different ICU areas. Doctors from lots of other specialties are having to learn new skills too.
And all the while, the regular stuff will be carrying on. People will still be getting cancer, strokes, appendicitis, pneumonia, kidney failure and having babies. We’re not going to be out of a job any time soon.
The Good Soldier
[1] Meng L et al. Intubation and Ventilation amid the COVID-19 Outbreak: Wuhan’s Experience. Anesthesiology. 2020 Mar 19. doi: 10.1097/ALN.0000000000003296. [Epub ahead of print]. PMID: 32195705
[2] NHS England and NHS Improvement. Critical Care, NHS organisations in England. Number of Available and Occupied Critical Care Beds on the last Thursday of the month (January 2020). https://www.england.nhs.uk/statistics/statistical-work-areas/critical-care-capacity/critical-care-bed-capacity-and-urgent-operations-cancelled-2019-20-data/. Accessed 23/03/20