'There was a lot of fear' - Royal Free marks one year of Covid-19
- Credit: Royal Free London NHS Trust
The first coronavirus patient arrived on Dr Sarah Bigham’s intensive care ward in early March. Within 24 hours, he had to be sedated.
He would be the first of many, but not the first Covid patient the hospital had to treat. They arrived a year ago on February 9. He survived - but to date, the Royal Free trust has seen more than 1,000 Covid-19 deaths.
“It's a very nasty virus,” says Dr Bigham. She has seen it affect patients’ brains. Some suffer strokes or heart attacks, or need dialysis.
“People have been in for months,” she says.
The Royal Free was one of the first UK hospitals to accept Covid-19 patients. As a specialist infectious diseases centre, it could put them in high-level isolation.
The UK's strategy at that time was containment - to try to prevent an outbreak by isolating people with infections. The first was admitted on February 9.
Most were not seriously ill. It wasn’t until March 1 or 2 that one deteriorated so badly that he required organ support.
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At first, he and others like him were put into side-rooms. But soon there were enough of them to fill the ward.
Dr Bigham remembers the first wave as a time of fear.
“The patients were very scared,” she says. “We were all concerned about the high mortality rate that was coming out of Wuhan and worried about what was going to be happening to our patients.”
Staff were also scared of infecting their own loved ones.
“There was a lot of fear about how the virus got transmitted,” says Dr Bigham. “I didn’t see my daughter for at least eight weeks. She stayed with my parents.”
Staff feared for the NHS too.
“It seemed to be spreading across the country and we were reaching beyond what we thought was our capacity, working – all of us: the nurses, the therapists – all working well beyond our hours, and the intensity of the work was very, very high,” she says.
The second wave has been even worse, with more and younger patients needing intensive care. Other parts of the hospital have had to be converted into additional intensive care areas.
In November 2020, the trust had 59 intensive care beds. By January 31, it had doubled to 119 – and 118 were filled.
Most were at the Royal Free, with the rest at the trust’s Barnet Hospital.
Finding enough staff is a challenge, she said. Around 200 nurses have been redeployed to intensive care and the army has been called in.
Recently, there were around 92 intensive care beds filled at the Royal Free. It has fallen in the last week, but remains in the high 80s.
"The majority are intubated and ventilated," says Dr Bigham.
Last month, 341 patients died with the virus - the most since April 2020, when 349 were lost.
One of the worst parts is not being able to speak to patients’ relatives face-to-face.
“We do ask families to come in, usually towards end-of-life care, but a lot of conversations are done over the phone or on video call,” she says.
“When your relative or loved one is sick and you can’t be with them by the bed, when that’s your visceral need, it must be incredibly difficult. I think staff members have found that, and I have found that, very difficult – trying to bridge the gap which is never going to be bridged.”
One surprising phenomenon has been that even when people are battling Covid-19 in intensive care, staff are confronted by loved ones who insist the virus is not real.
Dr Bigham believes this is, in some cases, a coping mechanism for people who cannot accept what is happening.
“I think it’s just difficult for them,” she says. “I look after patients in intensive care. I know they’ve got coronavirus. I know they’re incredibly sick... When we have relatives or next of kin who don’t believe in it, we just try and communicate with them openly and honestly and hope they will come around and realise how serious it is.”
Throughout the crisis, she and her colleagues have been buoyed by community support. Children have sent in drawings and gifts.
“We’ve all been really uplifted by that and feel like we weren’t forgotten about,” she says. “That’s been really touching and helpful. I want to thank the community, because they’ve been so supportive and we really do appreciate it on the ground. Their messages are coming to us.”
Is Dr Bigham confident the second wave will be the last? Vaccines give hope but new variants are a concern, she says.
“I think we just have to be prepared for the worst,” she concludes. “There are too many unknowns to predict.”