The inside story of the NHS’s struggle against coronavirus From 1843mag
n the evening of Friday March 6th, Nicola Rudkin, a senior nurse at the Royal London Hospital in the East End of London, met two colleagues in her cramped office. A whiteboard, still covered with scribbled plans for making operating theatres more efficient, seemed like a relic from another time. The virus was now their most pressing concern. Rudkin had spent the first week of March “frenzied”.
Understanding of the new disease was still patchy. Scientists knew that the novel coronavirus attacked the lungs, that people often experienced difficulty breathing and that the worst-affected patients needed ventilation. But most medics thought that treating covid-19 was akin to treating other respiratory illnesses.
“People use the term now ‘to do stuff at covid pace’,” Thomas says. A number of weeks later requests would be carried out almost instantaneously, but in those early days, Thomas says understatedly, there were “a couple of people who didn’t seem to get the idea”. By the beginning of April, the National Health Service had added 2,500 intensive-care beds to its initial tally of 4,000. Staff were drafted in from different specialties. Wards were given a makeshift makeover for their new use. At the Royal London, incident tape donated by the police was used to demarcate covid-contaminated zones from covid-free ones. Doctors were deluged with official and informal advice about treating the disease and protecting themselves.
There were niggly problems to solve along the way. One Friday night, Rudkin found herself standing on a chair removing children’s mobiles from the ceiling in what had previously been a paediatric ward. A contractor failed to install the right plugs for ovens to cook patients’ meals, assuming that all intensive-care patients were fed by tubes. When Rudkin had encountered this problem before it had taken weeks of endless pleading to fix. Now the correct plugs were retrofitted in half an hour.
Nick Bunker, an intensive-care consultant at the Royal London, was on duty early in the outbreak when a 19-year-old was admitted with complications from covid. He was placed in a bay with five other people. Normally each ward is host to patients with a range of complaints. In a pandemic, when everyone is suffering from the same disease, you gaze at your neighbour and imagine your own fate.
The origins of intensive-care medicine lie in the treatment of polio, which was endemic in Western countries until the 1950s when a vaccine was introduced. From the late 1920s onwards, doctors used “iron lungs”: primitive ventilators that kept alive people whose own lungs had been paralysed. The machines encased the patient’s body and forced air in and out of the lungs by lowering and raising the surrounding air pressure.
Even those who leave intensive care alive may never make a full recovery. Both covid itself and weeks of mechanical ventilation can inflict fibrosis , which may leave patients breathless for life. The psychological trauma is significant too. Doctors compare the experience of intensive care to torture. There’s no day or night under artificial lights. Patients can’t move but their minds rove deliriously under sedation. Afterwards many suffer hallucinations, terrifying flashbacks and delusions..
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