While the flow of information and medical journal publications (be it from China, Italy or WHO) could not have been any better starting from the backend of 2019, nothing could have prepared us for what hit us in late March 2020.
My hospital serves an inner city, a diverse population with high levels of social deprivation. In a matter of days, our hospital’s acute portal was overwhelmed by both the number and severity of the COVID cases. The medical and nursing staff had to reckon with the uncertainty of the management of the disease compounded by the fear of contracting the disease and putting their loved ones at risk. Addressing the issues, with access to PPE and daily briefing of clinical teams, helped allay some anxieties of the early days.
A system of education, training and up-skilling of a diverse nursing and medical workforce was rapidly developed and implemented. Redeployment of workforce to the ever expanding COVID critical care beds and COVID medical wards were achieved in a matter of days to weeks.
Clinical care protocols and pathways for a range of non-COVID illnesses had to be revised in the context of rising COVID infections in the community. Patients were contacted with instructions on shielding and follow-up protocols. Our pre-existing links with the community respiratory services and primary care came in handy in ensuring a smooth transition of care for patients upon discharge from the hospital.
The adrenaline rush and a mentality of responding to the ‘call to arms’ allowed many of my colleagues to work non-stop for what seemed an eternity. We changed the work patterns and rotas many times to suit the changing demands. Wards were reconfigured to provide CPAP, high-flow nasal oxygen and non-invasive ventilation. This allowed us to support the intensive care teams who had drafted anesthetists and nurses from other areas to support the expanded bed base. The contribution of trainee doctors and nurses deserve a special mention, as they went that extra mile at every step in providing the best care humanly possible to our patients.
We had set up a COVID Therapeutics Committee, which met weekly to sift through the emerging evidence and provide clear guidelines for clinical teams to follow. A COVID Ethics Committee and a COVID Support Group provided the much needed advice on some of the difficult cases to navigate scenarios and provide support to the redeployed nursing and medical work force.
As I write this piece, we are experiencing the second wave of COVID infections. My hopes are that consistent and clear public health messages backed by political and societal will, distributive leadership, shared clinical goals, open channels of communication, and a well-supported clinical team will be seen as critical elements in our continued fight against the pandemic.
Dr Aravind Babu
Consultant Pulmonologist, UK
