Join Hafta-Ichi to Research the article “As a sense of normality returns, we must not forget what this last year has been like for the NHS | Coronavirus”
One year ago lockdown had just come in. A creeping sense of dread was spreading across the hospital. We were focused on the first wave of admissions, the peak of which for us occurred in early April. We were desperately learning how to keep people from dying due to this new disease. The longer-term consequences were the last thing on our minds.
Now, a year on, there is a superficial sense of normality returning. Our respiratory support unit, for so long hidden behind closed doors with “STOP: CORONAVIRUS” signs and staffed by hooded figures in head-to-toe PPE, has turned back into the bright, airy ward it used to be. Nurses, doctors, porters are back in their usual clothes instead of uniform scrubs; conversation has replaced the incessant hiss of Cpap machines. Our ITU is shrinking back to its normal size. It is easy to forget how things were even a couple of months ago.
Normality is a long way off for one group of Covid patients, however. These are the ITU survivors, those who have come as close to death as is possible without succumbing. We receive them on to our wards, damaged and broken by their time immobile on ventilators for weeks at a time. Some have been left with tracheostomies, unable to speak; others have suffered strokes or have peripheral nerve damage so severe they can barely move at all. Most are still on oxygen and many must be fed by a tube while their swallowing recovers to a point that food doesn’t simultaneously trickle down into their lungs and cause pneumonia. We are used to managing one or two patients in this situation, but to have five or six at once on our ward is unheard of. The strain on our nurses and therapists is intense, yet I know that there are more coming our way who are still in intensive care.
These people face recoveries that stretch into weeks and months. The lucky ones will improve enough to go home directly, often needing care packages or oxygen concentrators. The others join waiting lists for inpatient rehabilitation centres where they will then stay for further weeks or months.
To us this feels like success; patients that we last saw in January as they were moved to intensive care, returning to us alive and then leaving hospital. But these people, often only in their 50s or 60s, were healthy before they got Covid. They will not work again for many months, if at all. About a third will end up back in hospital, often recurrently, and I suspect many will not survive in the long term.
And they are miserable. I’ve lost count of the number of times these patients have told me that they wish they hadn’t survived, that they would be better off dead. We have had patients effectively on suicide watch on our ward, having to request extra shifts for 1:1 care because of their risk of self-harm, although these shifts often go unfilled because of staff shortages. I offer reassurances that there’s plenty of improvement to come, that they’re still early in their recovery, but I do so with a certainty I don’t feel and my words feel hollow. In their situation I think I might feel the same.
Although these patients are the worst-hit, the emerging longer-term picture from the first wave is that of people hospitalised with Covid, 70% have not fully recovered even five months on. The second wave was worse, with more survivors, and we do not yet know how many people this affects. What is even less well understood is the number of people suffering with long Covid, most of whom were never in hospital at all. Estimates suggest the number with long Covid symptoms is over 1 million in the UK and even the small fraction of this number that are likely to need urgent specialist assessment and treatment is frighteningly large. I have seen these patients in clinic; they have complex, debilitating symptoms and are often feeling scared and alone. It is not possible to assess or treat them in a standard 20-minute general clinic slot, yet for months this has been the only way to see them.
While there are now dedicated long Covid clinics set up, that is only the start. Multi-disciplinary teams of specialists and therapists will be needed but there are very limited resources for this, not to mention that the people with the expertise to do it are already employed elsewhere. Our backlog awaiting lung function tests, clinic appointments, investigations are already much higher than normal and this additional demand is further stretching our resources. We have also had key members of our team off work with long Covid themselves.
In short, this is a disease with long-term consequences for its survivors. The psychological, social, economic and medical costs of this remain completely unknown even without accounting for any future surges. The problem is that Covid is not going away. It will presumably remain endemic with periodic surges, most likely during winter when our hospitals are already on their knees. We only have to look to mainland Europe for a warning against complacency.
Do not forget the large-scale cancellation of elective work that already happened most winters even before Covid, as the NHS struggled to cope with predictable emergency admissions. Now add to that the demands of an unprecedented backlog caused by many months of near-complete shutdown, the need to care for the current Covid survivors, the likely need for an ongoing vaccination programme to combat emerging variants. Our thinly spread resources are getting ever thinner. And yet the purse strings have tightened again. Our financial deficit has again become the concern and all but emergency funding has been put on hold. We have been told in no uncertain terms to make do with what we already have.
This is why I viewed the recent outrage over the 1% pay rise for NHS staff as missing the most important point. Yes, our workforce are exhausted and deserve better. This is beyond doubt. But Covid has brutally exposed the structural inadequacy of the NHS to keep people alive and maintain routine care at the same time, let alone meet new demands such as long Covid. This is the natural consequence of a system that is deliberately resourced to barely meet normal demand; any small increases in pressure cause the system to fail.
There was a time last year, when we were being clapped on the streets and Boris had recently survived his own Covid experience, when I thought Covid might actually spur us on to deliver real, lasting change within the NHS. My optimism is fading as I have yet to see any urgency or coordinated planning to address this.
We must not forget what this last year has been like.
Without immediate action and a complete change in attitude from our leaders, we are accepting an NHS which will always cancel its planned healthcare at the first sign of trouble. We all deserve better than this.
Source: The Guardian
Keyword: As a sense of normality returns, we must not forget what this last year has been like for the NHS | Coronavirus