We are two infectious disease hospital doctors working in the city of Liverpool. Over the past year, we have witnessed first hand the devastating impact of COVID-19 – on us, our families, our colleagues and the people under our care.
During the first wave, we wrote about the risk of mental illness and moral injury among healthcare workers. During the second wave, we reported on the realisation of our fears of healthcare worker fatigue and burnout.
At the start of the UK’s most recent wave, the most severe and arduous yet, we did not find the time to write.
While 2020 was a horrendous year for healthcare workers, the first few months of 2021 were worse. It is clear there have been both national and global failures to respond to the pandemic. These failures require both reckoning and redress.
In January and February 2021, the NHS was overwhelmed. As the third wave rolled on, exhausted healthcare workers up and down the country carried on. We tried our hardest to provide the best care in dire circumstances. There wasn’t an alternative.
As we write, COVID-19 infections, hospitalisations and deaths in the UK are in continued decline. A damaging yet necessary national lockdown coupled with rapid vaccine rollout have succeeded in turning the tide. For now.
Scenes on the frontline
During a “typical” weekend on-call shift in January at the peak of hospital admissions in our region, we experienced a bewildering array of medical, social, and ethical challenges.
The following is a journal extract describing the scenes:
This was the busiest weekend of the pandemic for me so far. It came, predictably, a few weeks following household mixing over Christmas. Our hospital had over 500 people with COVID-19. Over 40 had been admitted in the preceding 24 hours. Twenty-two were so sick they needed review by the intensive care team.
I was on call for two infectious disease wards that had been converted into critical care areas offering “CPAP” ventilators. These areas are staffed by infection and respiratory specialists and are an adaptation to cope with COVID-19. Although they offer an enhanced level of care with specialist CPAP service, the staffing levels are much lower than ICU and the shifts intense.
The morning started badly with a 44-year-old man collapsing unresponsive on the floor. Simultaneously, a confused older man and a man with learning difficulties in his 30s were pulling their CPAP masks off causing their oxygen levels to drop to dangerously low levels. This set the tone for the rest of the weekend.
Throughout the day, across the two wards, I was moving constantly from patient to patient as people deteriorated. Two younger people in their 30s needed to be intubated and go to intensive care. After being cleaned, their beds and rooms were immediately taken by more sick people who needed review.
The team worked tirelessly that day to keep everyone on the ward safe. Not to mention the myriad calls received and made to update people’s relatives and loved ones.
It was impossible to do all we would have wanted to for everyone and for their relatives waiting at home and unable to visit the hospital due to COVID-19.
Across our two wards, about a third of our patients had family members admitted elsewhere in the hospital with COVID-19. These were husbands, wives, sisters, a heavily pregnant daughter. Organising wheelchairs, portable oxygen and staff time for family members to safely see each other, getting translators, face-timing loved ones, and picking people up were small things that mattered.
It felt like juggling. Constant juggling. And it was hard. Too hard.
And yet, despite the challenges, it was also a weekend full of compassion. Full of compassionate individuals and actions. Nurses, healthcare assistants, cleaners, porters, junior doctors, radiographers – we all somehow found time to give every patient attention and kindness.
Scenes like this played out across the UK in early 2021. The impact of these experiences on people with COVID-19, their families, and healthcare workers has been traumatic and the repercussions will continue to be felt for some time to come.
This also raises individual issues around the prevention, treatment, and care we offer to people with COVID-19. Is a compassionate approach to COVID-19 – and to any other illness for that matter – even possible within our understaffed, resource-constrained health system? And will that system show compassion not only to those for whom it cares but also the carers who work within it?
A mortal betrayal
During this pandemic, the lack of protection from harm for the world’s healthcare workers has been described as “a mortal betrayal”.
There have been reports of restricted access to personal protective equipment. Meanwhile, infection control measures against airborne transmission have been inadequate.
These shortcomings have had a real impact on our health. In 2020, sickness absence rates were much higher than previously seen, with doctors particularly affected.
Among doctors, those who had the highest risk of death due to COVID-19 were from ethnic minority backgrounds.
In a survey by the British Medical Association, less than a third of black, Asian and minority ethnic doctors reported feeling fully protected from the risk of coronavirus infection compared to nearly two-thirds of white doctors. Even more tellingly, one third said they had either not been risk-assessed at all for the virus or that a previous assessment needed updating.
This cannot continue and COVID-19 vaccination strategies must ensure improved access for black, Asian and ethnic minority healthcare workers. Indeed, we need an objective review of infection prevention and control guidance.
The disregard for healthcare worker welfare leads to an ethical conflict between our sense of duty towards our patients and our understanding of our own risk of contracting a life-threatening illness.
Alongside the legal obligation to keep healthworkers safe at work, wouldn’t it be refreshing if governments also felt a moral obligation to do so?
If that is not enough reason, improving the working lives of people who deliver care can also improve the outcomes of the health system itself.
As the third wave abates, the country emerges from lockdown and healthcare workers like us come up for air, we can start to reflect on what care for people with COVID-19 and their carers might look like beyond 2021. It has to be better than it has been so far.
This is part one of a series of two articles on COVID-19 care in 2021 and beyond.