To mark the one anniversary since lockdown, Chief of Medicine for the South Sector, Dr Wesley Stuart, shared the following reflection piece:
"We had anticipated the arrival of this disease for several weeks. The devastating advent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19) in Italy dispelled any misapprehension that we might be spared. We had Health Board pandemic influenza planning documents and we had a regional Infectious Diseases team based in the Queen Elizabeth University Hospital. We used the available time and expertise and prepared to face a new infectious respiratory disease.
"We redesigned processes throughout the hospital. We needed to physically separate those with respiratory illness suspected to be Covid-19 from those arriving with “normal” emergency conditions like heart attacks, strokes, abdominal pain and trauma.
"We wrote pathways and changed the layout of most areas, separating streams of patients based on symptoms fitting the case definition, and the virology laboratory tests that at first seemed in such short supply, and so slow to yield results. We opened a specialist assessment and treatment area (SATA) for patients coming from the GP community assessment centres (CAC) with Covid-19 symptoms. We divided the Emergency Department and other places for emergency patients into red and green areas. Critical care areas were similarly split, and dramatically expanded. Staff were redeployed from departments where activity diminished. Training, orientation, induction and pastoral care was required for all. Planned treatments were curtailed, not least because theatre teams were now working in critical care. Surgery became limited to life and limb-saving work.
"We needed to protect staff. In the absence of a vaccine, we looked to basic principles of infection prevention and control, and personal protective equipment (PPE). We made special arrangements to protect against the higher-risk aerosol-generating procedures (AGP). This was a respiratory illness so many of the supportive treatments used enhanced oxygen delivery, and many patients needed maximum support on breathing machines carrying aerosol-generating potential. Colleagues required training, education and reassurance. Anxieties persisted, particularly around the supply and effectiveness of PPE, and personal risk of Covid-19 infection.
"We rapidly learned two of the most important clinical lessons of the first phase. Firstly, best care required a multi-disciplinary clinical team, including specialists in palliative care, to plan treatment goals and limits, involving patients and relatives as much as possible. Communication was so difficult. Secondly, there was significant personal cost to staff caring for patients with this illness. This continues to be the case; high rates of staff absence persist.
"The disease ebbed and flowed. We looked to treat as many non-Covid-19 patients as possible during periods of disease abeyance. We repeatedly modified pathways. We innovated and redesigned models of care for many conditions. This dynamic change continues and part of the Covid-19 legacy will be better services.
"After a year we see the cost to the health service and those who have worked for it, and also to patients impacted directly and indirectly by Covid-19. We have also seen so much of the best from colleagues throughout the health and social care system: courage, commitment, compassion, resilience and innovation – the bedrock of our NHS. "