David Oliver, a consultant geriatrician, compares teams of medics entering Covid-19 wards to “frightened young conscripts” going daily into war, fearful that inadequate protection leaves them vulnerable to coronavirus.
NHS staff on the front line of the UK’s coronavirus epidemic have paid a physical and emotional price most are only now starting to compute. Yet just as they process the experiences of the past three months, another fear is emerging: the prospect of a second wave of the virus testing a workforce too depleted to cope.
The NHS has survived the past three months in far more robust shape than many had initially feared. A massive operation to create more critical care beds meant hospitals were never overwhelmed, as happened in parts of Italy and Spain at the height of the pandemic. However patients have also paid a price, with much routine treatment and screening delayed to ensure ample capacity for virus patients.
Recalling the most testing period of her professional life, Jessica Potter, an intensive care doctor at a trust in London, said in normal circumstances she was “not an anxious person at all”. But as coronavirus cases spiralled in the UK, threatening to overwhelm the NHS, she developed an almost-constant “banging headache, which was a mixture of dehydration and anxiety”.
Her worst moments have been having to speak to patients’ loved ones over the phone or on video apps, passing on the worst news through the impersonal prism of technology.
“Hearing the stress down the other end of the line, it is awful not being able to reach out and hold their hand, pass them a tissue, give them a hug,” she said, noting that many of the communication skills doctors develop to help the bereaved are non-verbal.
The stress she and her colleagues have suffered has been exacerbated by longstanding workforce shortages. Even before the pandemic struck, the NHS was severely under strength, with an estimated 100,000 vacancies for clinical staff. As the UK hit its peak of coronavirus infections in April, Dr Potter’s caseload rose from about 12 patients a day to at times double that figure.
By mid-April, almost half of UK doctors were suffering from burnout, depression or anxiety, a British Medical Association survey showed.
Dr Oliver, who works for a trust in Berkshire, said that a particular concern was the adequacy of personal protective equipment.
He had entered March feeling confident he was armoured against the virus, having been fit-tested for top-grade kit such as FFP3 respirator masks. But on March 7, Public Health England, the health agency, ruled that workers on Covid-19 wards needed only plastic aprons, surgical masks and eye protection.
This, according to Dr Oliver, made his team feel like “frightened young conscripts going into war . . . When you are grabbing a plastic apron that only covers half your torso off a roll, and the flimsiness of it means it breaks in your hand, you are scared,” he added.
Helen Parker, a consultant in emergency and acute medicine in east London, was responsible for training and communications around PPE in her hospital as the government guidelines on what to wear and when “changed daily, sometimes almost hourly”, she said.
The shifting strictures affected team morale and her confidence as a manager. “You lose authenticity when [colleagues] are saying ‘how is this good enough yesterday but not today’.”
Shortages of PPE have eased in recent weeks but remain significant. A survey by the British Medical Association showed steady improvement, but even at the end of May about 20 per cent of doctors reported no, or inadequate, supplies of eye protection, with about 15 per cent facing shortages of face masks and gowns or aprons, and about 4 per cent not having enough gloves.
As doctors attempt to process the experiences they have undergone, the threat of a resurgence in the virus is never far from their minds.
“I am extremely worried about doctors’ mental health,” said Dr Julia Patterson, a psychiatrist and founder of NHS advocacy group Everydoctor, whose online and social media forums have 25,000 UK members.
“There’s definitely an awful lot of trepidation about a potential second peak,” she added. “Doctors have endured an awful lot and there has been very little let-up for the past few months. What I’m hearing from doctors a lot is that they feel very low, or anxious.”
Black, Asian and minority ethnic doctors had felt particularly vulnerable — and still do — said Sohier Elneil, a consultant in a London teaching hospital, because the vast majority of medical staff who have died from the virus in England were non-white. A report published last week found that Bame groups were twice as likely as their white counterparts to die of coronavirus.
“It created a sense of fear as we didn’t know why it was happening and still don’t,” Dr Elneil said.
Worried present and former colleagues had contacted her, explaining they were unsure how to approach managers to get the support they needed. “They have been super anxious about [whether], if they raised their head above the parapet, that made them a target,” she said.
Physicians are not simply preoccupied with fears of a second surge of coronavirus cases. Another challenge for NHS staff will be to deal with what Dr Potter called “the hangover from Covid”, as procedures that were put on hold to free up bed spaces for virus patients ramp up again.
Everydoctor’s Dr Patterson said many doctors and nurses “say this means they are not even thinking about taking annual leave”.
The Financial Times is making key coronavirus coverage free to read to help everyone stay informed. Find the latest here.
Dr Oliver, a former Department of Health national clinical director, said the twin burdens of trying to resume normal hospital services while worrying about another coronavirus peak could result in many doctors becoming exhausted. “That first, adrenaline phase of dealing with an emergency”, where some doctors from his hospital rested between shifts in tents erected on a nearby school’s cricket pitch, “is over”, he said.
He and his wife have lived separately in their own house for the past few months, occupying different bedrooms and using different crockery to minimise the risk of transmission.
Dr Oliver added: “Now the fatigue has set in, our lives are lived in a loop of hospital and home, with none of the teaching, meetings or networking we usually do, and I just do not think many doctors have the energy for this to go on.”
Letter in response to this article:
Get alerts on Coronavirus treatment when a new story is published