As the UK watched the barrel of a coronavirus epidemic in early March, the biggest fear was that hospitals would be overwhelmed and incapacitated by a patient tsunami. This has happened in Wuhan and northern Italy. The NHS has been largely successful, but there were still times when hospitals were overwhelmed. One of them happened when a London hospital was suddenly engulfed in casualties.
On March 19, night staff at Northwick Park Hospital in north-west London woke up to discover that their workplace was so swamped with Covid patients that a critical incident had been reported.
“I saw it in the news and thought‘ oh my god, “said consultant Tariq Husain.
“I had received messages from colleagues during the day saying it was getting very busy, we needed more help, we have such a large volume of patients.
“It was this realization that everything we feared was coming true.
“It was shocking and almost unbelievable that it happened. “
Watch and wait
Six weeks earlier, in late January, Brexit was the only story in town. Coronavirus was still a mysterious disease circulating silently in China.
Northwick Park, which specializes in tropical diseases, was soon asked by Public Health England to start screening people from Wuhan in the UK who were showing signs of coronavirus.
The hospital’s location provides easy access from Heathrow Airport – similar protocols were used during the Ebola outbreak five years earlier.
By mid-February, the extent of the global spread of coronaviruses was impossible to ignore. In Italy, the number of cases increased slowly at first and then quickly accelerated – a classic epidemic curve.
Northwick Park staff watched the news from abroad.
“I love Italy and I go to Italy several times a year – I actually canceled a holiday that we had booked for the end of March,” said Yvonne Smith, facilities manager.
“So to be particularly interested in that and to see the photos of the intensive care units there was quite disappointing, and you knew you were going to have to prepare for something like that.”
Yvonne, from Kent, takes care of non-clinical roles within the hospital – security, cleaning, porters, patient transportation and launderers are all her responsibility.
“It has been extremely difficult because it is so new and you don’t know what to expect. It was a challenge to manage all the groups of staff I keep in terms of safety at work, but giving them confidence in the roles they had. “
Battle plans have been drawn up should Northwick Park be attacked similar to that in northern Italy.
A capsule was placed outside the hospital and all patients with symptoms of coronavirus were evaluated there. A specialist from the infectious disease department would put on a full PPE and come and test them.
Inside the hospital, training exercises and preparations were just as rigorous. Some daily tasks had to be reduced.
“We have mapped an incoming patient as a live scenario and how we should adapt,” said John Ross, nursing consultant A&E. “Then we just trained, trained and trained for 10 or 12 days. So everything we did had to change because of the threat from Covid. “
John, from Inverness, said the initial precautions against the virus focused on identifying patients who had traveled from China, Iran or Italy.
“For us, it changed every day. What region of the world they came from and how much they were at risk. I think Italy was when we really needed to focus and prepare even more – we kept saying in our training sessions that it is unlikely to happen, but let’s get ready. ”
John knew that if a wave of coronavirus was destined for the capital, the boroughs served by Northwick Park – Harrow, Brent and Ealing – would probably be badly affected.
“We saw what happened in Italy,” recalls John. “We know there is a very dense population here, we know the demographics, we know that a lot of our patients have heart and respiratory problems – a lot of diabetes – so it was always in mind. “
“You hope it doesn’t happen, but you have to prepare for it. “
All of their intense training was about to be put to the test.
“It hit us like a ton of bricks”
On March 3, “wash your hands” was the mantra for the Downing Street briefing – although Prime Minister Boris Johnson said he had kept shaking hands with people. It was on that day that the government released a detailed action plan on coronaviruses.
Ten miles from Downing Street, a patient came to Northwick Park, who had just returned from Iran in London.
“We knew Covid was coming,” said respiratory medicine specialist Dr. Rachel Tenons. “It has been in the news since January and we are preparing for February.
“Then he hit us like a ton of bricks. It hit us hard and quickly – the epicenter of the UK epidemic. “
When two other patients tested positive for the coronavirus, the hospital initiated a series of rapid changes.
Surgeons were forced to give up space so that patients could be assessed safely, and the A&E department was split up.
“I remember meeting here on Sunday March 8 – how are we going to keep staff and patients safe? Said Rachel. “We decided to create different, negative routes going to one area of the department and people with respiratory problems that could be positive in the other.
“We had to move a lot of services and staff – things that usually took six months to a year to happen in a week. “
The number of critically ill patients admitted to Northwick Park was increasing and, within days, the staff had to deal with a crisis.
“We have seen an exponential increase,” said Rachel. “On Monday March 9, we opened our respiratory control rooms and in two days, these rooms were full.
“Then, on the third day, another room was opened, and then we started cohorting patients with respiratory problems in the side rooms. At the end of this second week, we were in a full room and then another full one. “
The coronavirus was declared a global epidemic by the World Health Organization on March 11.
The virus was now spreading in London and modeling from Public Health England suggested that cases doubled in the capital every five days.
At Northwick Park, they saw the number of cases double every two days.
“It has increased at a very, very rapid rate,” said Rachel, adding that the new advice from China was that early patient intubation was the way to go.
Risks are attached to each intubation as the procedure projects the virus into the air, further exposing personnel.
At this point, the 44-year-old consultant, Tariq Hussain, had a difficult conversation with his family after being asked to play a leading role in the critical care response from Northwick Park to Covid-19.
“It was not an easy call to make. You end up sacrificing a lot, “said Tariq, even though he knew taking on the role was the right thing to do.
The severity of the situation was clear at this point, with confirmed infections in Harrow, Brent and near Ealing increasing from five to 112 in a week.
“We saw all kinds of patients – the patients who were admitted to intensive care were relatively fit and healthy, with a few cases of diabetes, high blood pressure, but otherwise reasonably well,” said Tariq.
“But certainly not just the elderly; we had people in their twenties, thirties and beyond.
“There have been relatively few Caucasians and a high proportion of Asian patients, which represents the cohort of people here. “
“Everyone had read the newspapers and seen the news about the scale of the pandemic, especially in China.
“We never thought that we would quite reach the point of such a large volume of patients requiring admission to intensive care. “
“Patients would initially go to the adjoining rooms,” said Yvonne Smith, service manager. “Whenever a Covid patient left this room, he needed a thorough cleaning.
“So our normal terminal cleaning will cost an average of 20 or 25 a day. At our absolute peak which increased to 96 terminal cleanings per day. “
Tariq described the wave of patients at this stage as a “tidal wave”. He was about to crash because Northwick Park lacked space for the sick.
‘We need help’
On March 19, the Prime Minister said it would take 12 weeks to reverse the trend against coronaviruses.
At the same time, a management meeting was held in Northwick Park, where a critical incident was reported.
“We have had many patients and more patients than we could meet the demand for what we could actually do,” said head of nursing Trish Mukherjee.
As part of the critical incident protocol, patients were transferred to other hospitals to relieve pressure.
“The bulk of the critical incident concerns this aid in the region,” said Dr Rachel Toulez.
“You don’t want people to die in a busy hospital when 30 miles down the road nobody has it, so the goal is to share access to the ventilators. “
Northwick Park became the first UK hospital during the pandemic to report such an incident – only Watford General took the same step, although Weston General also saw its resources stretched to the limit.
Medical director Dr. Martin Kuper was one of the people responsible for the decision to declare an emergency at Northwick Park.
“I think it was good for us to do it,” he said. “We have had a lot of patients and we need help here. “
Front line heartache
To stem the flow of coronavirus cases, the UK was detained on March 23.
Restaurants, pubs and tourist sites are emptying, while hospital beds and morgues continue to fill.
At the height of the crisis in Northwick Park, 126 patients in the hospital’s NHS confidence zone died from coronavirus within a week – each without family.
“Yes, the deaths were increasing,” said chief nursing officer Trish Mukherjee, “but the hardest part was that the parents weren’t there and we had to stay with the patients and hold their hands and be there for their children.” last moments – I think it was difficult in itself. ”
Emma Leahy, a nurse from Limerick, is responsible for using a touch pad to connect patients with loved ones at home.
“We continue to take care of all the different parts of their ICU stays,” she said.
“Seeing a patient we have been taking care of for a month so that we can wake up and say” thank you for taking care of me “, and see his children say” I can’t wait to see you, Dad “- that’s why we let’s do this work. “
One of the people Emma cared for is Jal Makai, a father of four from Northolt, who was taken to Northwick Park on April 3 after collapsing in the toilet.
At the hospital, his condition worsened and within three days of his admission, he was connected to a ventilator. He spent a month there.
His kidneys failed and he could not walk or hear with one ear.
But Jal survived.
“Without these NHS guys, I would have left, very simple,” he said. “At one point my wife thought that was it, I was gone. “
He added, “When you open your eyes, there is someone here. Always – maybe even more than one. They are angels. They put themselves in danger – they should be paid more than footballers.
“If it was not for them, I would not see my children again, very simple. “
Around the same time that Jal was admitted, 35-year-old NHS veteran Chris Bown took over the management of the London North West University Healthcare NHS Trust, which is responsible for Northwick Park.
“What is striking to me is that after I finished working in the NHS as CEO in mid-January, it was that the NHS that I left in mid-January was not the NHS I went back to in late March, “he said. .
“He fundamentally had to change and change to cope with this devastating pandemic.
“I was really shocked to see the impact it had, but just as reassured that, despite the enormous pressures, the staff here in this trust were doing everything they could to handle very difficult circumstances with great compassion . “
Each story of survival during the pandemic has given much needed morale boost to the staff – and they even had one of their own.
Nurse Alicia Borja spent a month in hospital with a coronavirus and was finally applauded outside Northwick Park by colleagues who helped save her.
Alicia is recovering at home but will be back to help treat others with the virus that almost killed her.
“We have had 900 Covid patient discharges and it is incredible,” said Trish. “It was nice to see Alicia recover so well and see her go home.
“I have to take care of her, I have to talk to her, hold her hand and talk about normal things.
“Seeing her applauded was just overwhelming joy. “
Second wave fears
There is now relative calm in Northwick Park. Covid patients are still arriving, but far from the volume recorded a few weeks ago.
In the coronavirus service, Emma Leahy takes a break to discuss with patients and families in order to reflect.
“The past few weeks have been moving,” she said.
“It has been a roller coaster and it made me realize that we take things for granted – and that is something I will not do anymore. “
“Our work is recognized,” added Emma. “I never really knew my neighbors, they didn’t really know me. “
“They didn’t know I was a nurse and in the past few weeks I saw my neighbors and we cheered for the caregivers every Thursday together and it just brought that sense of community and the feeling that we are all in this together. ”
“North West London is where the wave crashed in Covid and we have been hit the hardest,” said medical director Martin Kupar.
“The reasons for this, our boroughs, Brent, Ealing and Harrow, have a high Covid rate.
“We don’t know why it is – it is certainly a diverse and multiethnic region and then there is also a lot of travel. There are also socio-economic reasons. “
He said the number of patients had no longer doubled in Northwick Park after the declaration of the critical incident. More than two months later, staff now fear a second wave.
“We were the first place hit, but it would have continued – locking was essential. Nothing else can help you reduce the numbers, “he said.
“It seems likely that there will be waves of waves as the lock is relaxed … the rate of increase will likely be slower than the first time, that is, when there was no restriction on people.
“I don’t think we have had a similar crisis in my life in the NHS and I think the staff has been amazing. “
Many employees are encouraged to take time off.
“Of course we are waiting in case something goes up,” said CEO Chris Bown. “But we see that the number of admissions and deaths by Covid-19 has dropped significantly.
“Obviously we all learn a lot from this and we always have to be prepared if there will be a second wave – which we really hope there is not – but we are now making sure that the staff take as many annual leaves. and training because we are a little diving right now. “
It has now been almost three months since the first confirmed coronavirus patient was admitted to hospital.
Although the past few weeks have been traumatic, there is a feeling of triumph in the unity, compassion and resilience shown by the staff at Northwick Park.
Nurses, doctors, housekeepers and exhausted porters are cautiously optimistic that they have overcome the greatest challenge of their professional lives – but remain cautious in the face of a return to the devouring struggle against an invisible enemy.
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