I had the strangest sensation this week.
A creeping, prickling, lurching fear. Sitting at my desk, I had logged into our imaging system and opened the scan of the patient I’d been asked to review. He had come in with fever and a cough and – crucially – no recent travel or contact with anyone unwell. The characteristic pattern of speckled whiteness, akin to powdered glass, was sprinkled around the outer part of both his lungs. For the first time I could no longer pretend that the disease I had read so much about was in China, or Iran, or Italy. It was here, and spreading. In my city. In my hospital. On my screen.
We have been planning intensively for a month or so, hoping against hope that it would all be a waste of time. At our daily meetings, my colleague from A&E would inform us about plans to split up the department to isolate suspected cases. The lead for our intensive care unit talked about reallocating anaesthetists from planned surgery and scavenging ventilators to expand their capacity to care for the very sickest. We physicians made plans for designated wards to cohort patients and examined the detail of how to take them to intensive care or the CT scanner without contaminating other areas. Fittings of protective masks took place and colleagues shaved off their beards in preparation. We checked that the hospital’s oxygen supply would not be exhausted if a surge in cases arrived.
What has blindsided us is the speed at which the hypothetical became the real and then the rapidly obsolete. A few days ago, we implemented our cohort ward plan; the capacity was exceeded the same afternoon as the government expanded testing criteria. Halfway through our mask-fitting programme we have run out of the type of mask that was most commonly being fitted, rendering two weeks of intensive training useless. A steady stream of cases continues and we have already had to change our approach from planning ahead to simply reacting to changing pressures, isolating patients wherever we can and struggling to stay ahead. We are fortunate to have strong leadership within our hospital but sometimes there is little we can do in a system already so brutally overloaded.
The knock-on effects of this are unimaginable. We are cancelling operations and outpatient appointments, but how will we ever pick up this work again? There is already a seven-month wait for a simple follow-up appointment in my clinic. Medical education has been put on hold and our students have been withdrawn from their placements. Their exams may be cancelled; will they be able to graduate this summer? How will we staff the wards from August? All of our plans for developing our services, improving the hospital, making things better for our patients, have had to cease.
Our NHS will be affected for years to come, probably for ever.
That same creeping sense of dread I felt is consuming the hospital and its staff. People are frightened in a way that I have not seen before. Senior consultants have been in tears. Our junior doctors, desperate for guidance, look to a consultant body that does not have the answers. Friends in other specialties and hospitals contact me for information, wrongly hoping I may know more than they do. We are all worried about our young families, our elderly parents. We will carry this disease home to our loved ones on our clothes and in our own lungs. How can we not be scared? I know I am not the only one plagued by insomnia.
This is just the beginning. I have privately estimated our peak caseload and if 60% of our local population does indeed become infected, the number of cases coming through our front door every few days could become greater than the entire bed capacity of our hospital. That hospital is already full and our staff have begun to get sick. A hastily convened ethics panel will try to offer us some guidance on how we ration our limited resources and to whom we will be forced to deny lifesaving treatment. The numbers imply that this will not have to happen in the summer, or in a few weeks, but in a few days. And yet I cling on to the hope that my calculations are wrong, that somehow we will avoid the grim situation we have seen elsewhere, however unlikely this is.
But despite all of this we are still here. I have true faith in my colleagues and I take heart from their calm determination and quiet courage. The usual petty grumbles and disagreements have been put aside, hopefully for good. We will need each other in these times to come and I know that we will work together to the last of our ability.
We are scared. But we are here.