Heartbeat: Tackling COVID-19 – reflections from the medicine cross-site team

July 29, 2020

By Dr Edward Fogden, Consultant Gastroenterologist, Clinical Lead for Gastroenterology

A lot has happened since Nick Sherwood, Joint Clinical Lead, Critical Care Services came to our joint gastroenterology and acute medicine QIHD in February to talk to us about how to deal with a viral pandemic. Since then COVID-19 has changed so much of how we live and work that it is difficult to predict what life will be like even a few months ahead.

Looking back, I feel we need to give credit to the positive approach shown by our teams despite the underlying anxiety about coming to work in the midst of a pandemic, getting used to the PPE that has become familiar to us all, and the impact of lockdown removing the usual pressure valve of social interaction with family and friends. Everyone’s working lives changed rapidly with different rotas, changing job roles and often different departments.

It has been a huge team effort – in medicine where I work, our EDs, AMUs and all the inpatient wards had to rapidly and fundamentally change how they worked. We have matrons and ward managers leading new teams with redeployed nursing staff, often on different wards to usual; medical specialty colleagues joined the wider medicine and emergency care team to cover wards and expand the on-call team to provide expanded hot and cold seven day cover across both sites; within days all grades of medical staff were on new rotas, and operational colleagues worked long hours alongside clinical and nursing leadership teams to make all of these major changes happen, whilst keeping everything running in the face of a what felt like an ever-changing situation.

As medicine reconfigured itself ahead of the surge, the whole patient-facing workforce needed to have been FIT tested, trained in PPE use and educated in how to treat a new disease. This posed its own challenges, particularly how to distil down the volume of clinical research that was being published on a daily basis, but also to ensure that everyone was able to access this.

Government guidelines also changed as often, and the Trust comms team had the unenviable task of trying to get this everchanging information to everyone in the organisation. We also saw the birth of our very own Youtube star, the trust’s face of PPE “Dr Mark says…” rivalling Joe Wickes for public service broadcasting.

There has been, and remains, understandable anxiety about the risks to patients and individual staff from COVID-19, given the impact of COVID-19 on our population and how hard Birmingham and the Black Country have been hit by COVID-19 relative to other parts of the country outside London. Better data to help us understand the risks to staff, including regarding ethnicity and underlying health conditions, has guided the development of risk assessments which are now available for all staff via occupational health. I’m very grateful that we didn’t experience the significant gaps in PPE reported in other trusts across the country, credit to the hard work of Dinah McLannahan and her team.

Every available person in my specialty (gastroenterology) worked in the Trust in the response to COVID-19 including many staff redeployed into the wards or ITU, or working from home due to shielding, leaving our mainly outpatient-based services running at a tiny fraction of its usual service. We had started a team WhatsApp chat a few years ago during heavy snow to help coordinate work, and found it really useful during Unity go-live – it proved helpful again to keep in touch with everyone as did the weekly Zoom call. I think it has allowed us to keep everyone informed as best we can about all the changes, support staff who have been redeployed across medicine including ITU and the wards, as well as colleagues working from home.

Patients definitely do worry about coming into contact with COVID-19, both in the community and in hospital, and are concerned about the risk of getting ill and dying from it. The press have reported NHS figures of 10-20 per cent of inpatients with COVID-19 have caught it whilst in hospital – this is a necessary reminder of the need for PPE to protect our patients, colleagues as well as ourselves. Nationwide the NHS has seen a steep drop in attendances to ED, referrals from GPs, and also GP attendances. This worries us, as large numbers of patients are not seeking medical attention for symptoms that need investigating urgently. We are going to see a rise in referrals as the lockdown eases and are working hard to deal with the challenges posed by the backlog of elective work across the NHS (outpatient clinics and endoscopy procedures in gastroenterology) and the impact this will have on our patients. The press are reporting on NHS-wide delays to elective care including outpatients, procedures and operations, and the impact on cancer care during the pandemic and afterwards.

One of the greatest changes due to COVID-19 has been around visiting, with only a very small number of patients able to have any visitors at all. Telephone calls and video calls have provided a link to family at home, and allow updates and discussions. Unfortunately the visiting restrictions have meant that patients have died in our care without their loved ones being with them, for example when relatives were themselves at risk, shielding, or living with elderly relatives and therefore unable to safely visit the hospital. This is such a difficult thing for staff as it is so alien to us as a society, yet was the reality for patients whose relatives were unable to visit or had to stay away after balancing the risks to them and their loved ones if they contracted COVID-19 whilst visiting.

As we re-form our teams, as life returns to the new normal, we need to recognise that everyone will have their own experiences from the past three months, from work and home. Now that the clapping has stopped, and the dust begins to settle from the past months, it is important that we support each other as we work to get back to a more normal existence and run our services post COVID-19. We need a continued focus on, and investment in health and wellbeing services to support staff. Some of us will experience mental health issues as a consequence to our experiences over the past months; we have seen great support for trainee doctors through Mike Blaber and the Three Squares Club and I encourage colleagues to seek the support that’s available for all staff via the health and wellbeing pages on Connect.