‘People dying in the ICU is not new, but dying without family and friends around them is very unusual’

‘Working in an NHS intensive care unit, I know that coronavirus is far from over’

An emergency medicine physician on the terrors of Covid-19, and why lockdown is being lifted too soon

Staff in Edinburgh’s Western General hospital ICU ventilate a coronavirus patient.




Staff in Edinburgh’s Western General hospital ICU ventilate a coronavirus patient.
Photograph: Murdo MacLeod/The Guardian

My impression is that the population thinks that it’s all settled down now and everything’s OK. And that’s not true. Every time you go on to the intensive care unit you get a visual reminder of why it’s not, because of the amount of equipment that you have to put on to just go and simply say hello to a patient.

Seeing the images from Italy had been terrifying. We were all wrestling our own demons, organising our personal affairs, getting wills done that we’d put off for years. When the worst of it hit it was really hard watching the team cope with the rush of reality. I think the new additions to the team that we had built were hit the hardest. People dying in intensive care is not new, but dying without family and friends around them is very unusual. This was a another new normal to adjust to; phoning family to tell them their loved one was dying, or dead, but they could not see them.

At the same time, there was something uplifting.

Everyone had a kind of common focus and a common goal – normally everyone just gets on with doing their own thing – but we had large teams of people working together with the one focus. There were so many people. Everything was masks and sweatiness. When people took their gear off they had deep marks around their faces and that kind of matted look to their hair.

We’re still admitting patients with Covid-19 although obviously not as many as at the peak. We are currently getting about 200 patients a day coming in through A&E. About half of them have symptoms that are related to Covid, so they’re sent to the Covid side where they can be assessed and treated. All the medical staff are fully equipped with PPE because we’re anticipating that the patient has Covid until the tests prove they don’t.

It slows everything down. Everything has changed. I get a bun on my way to work – it’s my Friday treat. When you go in, you’ve got to put alcohol gel on your hands, so that’s the end of the bun. To walk through the hospital you have to put a mask on. Nobody lingers in the corridors any more. When you go into the ICU, there’s more PPE – a new mask first and more alcohol gel. Going to see a patient in a side room you’re getting on a plastic apron with arms, two pairs of gloves, a different face mask, face shield.

At the peak, we made space for about 300 Covid beds on our two sites. Now we’re back down to our normal 100 or so.

The real difficulty now is that we know full well there’s a bunch of patients out there who need management of their underlying conditions, such as operations or transplants. We’ve been working towards starting that up again but it’s difficult. It’s not a tap you can turn off and on.

If someone has been waiting years for a kidney transplant, and an organ became available, how would we get them into hospital in a safe way? We can’t ask them to self-isolate for two weeks – that’s not how organs appear. We’ve been trying to set up a system to make sure the transplant recipient is safe, because they’re immuno-suppressed.

That’s why I’ve been worried about ending the lockdown, and people going back to how things were six months ago. That needs to be pushed back against, we can’t go back.

We’ve been preparing for this weekend as if it’s New Year’s Eve. We’ve discharged as many people as we can. We’ve had to bulk up the daytime shifts, the evening shifts and the night shifts. I’m just hoping that people are sensible.

Dr Steve Jones is a consultant physician working in Manchester and a regional chair of the Royal College of Emergency Medicine