What does that look like from your perspective as an intensive care consultant?

What's what's it like in there?

Right there?

We are definitely seeing a large number of cases.

I've spoken to colleagues up and down the M four, and I think we are definitely ahead by a week or two in terms of the rest of the M four corridor.

In cases that we're seeing, we've actually filled our intensive care unit now above our normal capacity.

So usually we have 13 ventilated patients, what they call level three patients, patients who need maximum organ support.

And that's our usual maximum number that we can take.

So we've got 16 ventilated patients in the intensive care unit of the minute, which has led us to completely run out of space.

So we've taken over theater recovery and we've got a further eight there.

I think by the end of today we will fill recovery, so that will bring us up to 25 patients on.

Then we have another area prepared, which is the old high dependency unit and coronary care that we've taken over as well.

We can fit a further 22 patients in that area.

The way things are going in the minute, the rate of growth in the amount of admissions that we're seeing, I would say we will fill that by the end of the week, probably by the end of the week.

So we're looking at by the end of the week, we probably would have quadrupled our capacity here.

And then what?

And then we'll have to find somewhere else to wear.

At the moment.

We're we're trying Thio identify other areas that we can put patients.

Can you paint a picture if you lying off what it's like right now inside your critical care unit?

If I was to walk in, what would I see?

What would I hear?

It's controlled chaos at the moment, just in the spaces of Premium.

All of the patient normally are.

Our patient population is made up of people who are acutely unwell who are on ventilators, kidney machines, strong drugs to support the blood pressure.

They'll always be a few of them.

There'll be a few people who are recovering, getting ready to leave the intensive care unit.

And then there'll be a few patients who just need a bit of supportive care who maybe aren't as sick as the others.

The difference at the moment is everybody is desperately unwell.

Everybody is on a ventilator, so the acuity or the or the severity of illness that we're seeing is very high.

This star for wearing full peopIe.

So what I'm wearing now, but with this gown the other way around, plus goggles, plus respirator masks or F P three masks.

Ah, nde, two pairs of gloves.

It's very hard to identify which staff members a witch, so we've taken to writing our names and rolls onto the front of the gun so that we can easily identify people.

How would you describe the atmosphere?

The atmosphere is we're doing what we're best at doing.

So morale is high.

There's a great deal of camaraderie with everybody is aware of the severity of the situation, and I think everybody is focused at the minute on delivering the best care that we possibly can to these patients.

They are the patient population.

There are a lot of people who are in work.

There are a lot of people who are younger.

It's certainly the pattern of illness that we've seen in Gwen and I can't speak for anywhere else is much younger patients than we were expecting.

You know, when the reports started coming out of Wuhan, we were led to believe that this was something that was particularly dangerous for the more elderly patients.

But I would say a ll The patients we've got an intensive care are in their fifties or younger at the moment.

Really, I think that was surprised, but a lot of people on it surprised us.

My youngest patient is in their early twenties, Um, and there are, you know, there are patients who have very well, you know, chapters of fitness professional that, you know, there are a lot of patients who are not do not have any pre existing medical conditions.

They're not diabetic or anything like that.

If it's difficult sometimes to identify your colleagues in the unit, presumably there is a real challenge of communicating with with patients as well.

Yeah, and that's a huge that.

That's probably the biggest challenge that we've found so far.

The patients themselves on the whole or unconscious we anesthetized most people on ventilators just because it's very unpleasant.

Having a foot long plastic tube through your mouth down the back of your tongue and into Europe, where Upper Airway So most people will need some degree of sedation to tolerate that.

It also means that they will synchronize better with the ventilators.

They're not fighting the ventilators.

They'll allow the ventilators to do their job.

So the vast majority of patients are fast asleep in the moment, mainly for their comfort and also to facilitate that care.

Can you have any visitors in the in the unit of the moment?

Not at the moment.

Logistically, it just isn't possible at the moment.

And that's partly for public safety.

Onda.

How difficult is that for everyone involved?

Given that some of these patients will be, perhaps, you know, close to that their last days, it's it's incredibly difficult.

We are updating people as much as we can.

We're way.

We've got dedicated people who are phoning and updating relatives every day.

We're also using email on were able to use video calling, but it's a poor facsimile of actually sitting down in a room with proper human contact to be able to give someone a hug or, you know, offer them a hand if they're if they're upset.

Um, can I ask you if, if you have a patient who is in an end of life situation, can the family come into the unit?

Thankfully, we haven't been in that situation much yet.

Um, we are looking at potentially finding a way to allow family members to come in accepting the risk and wearing full PP.

I mean, the last thing we want to deny anyone time with their family member of if they're going to die.

But the practicalities of that we haven't ironed out yet.

The danger is that then, you know, particularly if you've got more elderly patients who have come to the disease if their relatives of similar age, which they often are wives, spouses, et cetera.

You know there's a real intangible risk that if the disease is transmitted to them that they could end up in the same situation.

So have you had patients dying in the unit from current of ours?

Yes.

Can you explain to me why someone could die after having contracted Corona virus?

What we know is that primarily the Corona virus causes respiratory failure.

So when it spreads to the lungs that causes air, what we call a Newman itis, where the lungs become very wet, waterlogged inside.

So the normal mechanisms that keep fluid in the blood breakdown so the little membranes and tissues in the basis of the lungs become porous.

And that allows fluid to leak in from the circulation into the lungs, almost like drowning.

One of the things we provide with the ventilators is weaken right pressure, which pushes some of that fluid out and helps to keep the lungs open.

So one of the mechanisms that people become exhausted is because the work of breathing is so great that they basically become exhausted and die.

So if you imagine your lungs and normally like a nice light sponge light, easy to move.

If you've ever pulled a sponge out of a bucket of water, you know how heavy and wet sponge could become exactly the same thing.

If your lungs are absolutely sudden, then it's very, very difficult to breathe.

And what happens over time is people's oxygen levels for the levels of carbon dioxide, which is a gas you normally breathe out rise in the blood.

That makes you even more drowsy as a narcotic effect.

And then people will slowly develop worsening respiratory failure, and eventually they become unconscious and their breathing will get more shallow and they will die.

So that's what would happen if you were left alone.

Thankfully, we can intervene with a ventilator and prevent that from happening.

But the deaths vary from multi organ failure, which is basically a progressive shutdown of all the different organs, including your kidneys, your circulation failure of your liver as well as your lungs.

We've seen that, but we also see patients who develop a thing could admire card itis latte lately in the you know, often when they're starting to recover, the heart could become very adversely affected by the virus, and they develop heart failure.

And that's Bean, probably the leading cause of death in the cove.

In patients that we've seen you had Corona virus, what was that experience like?

But what I'd like to repeat started off.

Quite innocuously, they have a burning sensation in my nose.

I lost the ability to smell even that my nose was clear.

It wasn't banged up.

I didn't feel too bad for the 1st 3 days, and I thought, Well, if this is bad, it's gonna be then okay, should be okay.

But actually, as the as the week went on, I felt worse and worse and worse developed terrible muscle pains, joint pains.

I was exhausted just on minimal exertion, even walking up the stairs.

I was getting short of breath and having to lie down for awhile afterwards, just on the subject that we were talking earlier.

I spoke to one consultant in Swansea yesterday who said the worst thing is for patients who are in there later faces of their illness where they can't have visitors around the bedside.

And that's heartbreaking for staff and for for families, he said.

When these patients are on their own during the last hours of their lines, that's awful, and it flies completely, flies in the face of everything we've ever done.

You know, a lot of patients will not survive intensive care even, you know, in the middle of epidemic.

Andi, we are very used to providing a good environment for people to have a comfortable and peaceful death with their families around them, and we have psychologists we have excellent nurses were specialists in end of life care.

Um, and we you know, although it's a high tech environment, we can provide a really peaceful and compassionate end for people.

We really pride ourselves on that this is completely disrupting our ability to deliver that, and no amount of video calling or phone calling can can make up for that.

And that's something I'm very worried about.

We're very lucky that we haven't had many deaths tour yet.

Our intensive care strategy is working, but in coming weeks, this'll is gonna be a huge, huge problem.

And I have to be honest.

It's not one that we've cracked yet.

You know, the sensible thing to do is for Steely, polite.

Yeah, how are you feeling about about that?

There are huge number of things that are not normal about this situation, and that's one of them.

And I will do my level best that the one thing we can do that we are able to do and that I will do is we can Even if the patient's family can't come in is we can be there, you know a doctor will be That noose will be their team of very caring.

And I will, you know, if necessary, we will sit with those patients and hold their hands on I.

No one should die alone, and no one should die without someone holding their hand talking to them.

Ideally, it would be the family.

But as they say at the minute, we haven't quite got to that stage that we can facilitate that.

Are you envisaging a moment where you might have to two Russian health care?

In a worst case scenario at the moment, we've got sufficient capacity to deal with the demand.

But as weeks go on, if we don't see a slowing down in the infection rate and we don't flattened the curve, then we are going to run, start running out of space.

And that's when very difficult decisions are gonna have to be made.

I hope to God that I don't have to do that.

But it may happen.

And we've seen it happen in Italy as well.

Access to ventilators, for instance, for instance.

Yeah, but is much more than just ventilators.

Its its staff A cz well, so you.

But there will be enough ventilators of one shape or form, but you need a whole gamut of staff.

At least five staff to safely look after someone on a ventilator.

And if you don't have a big problem, you don't have that resources in terms of staff available.

If you don't have enough staff, what happens is that your outcomes start to get worse.

Can I ask you what were your message to the public would be now, from your perspective inside?

Yeah, my message My to mess to the public of the minute would be one.

Keep doing what you're doing.

Please support the chest.

We really, really appreciate it.

And it's all the thanks we need.

But the other thing that this massively important is Please, please listen to government advice on staying in.

Don't go out unnecessarily.

Don't pop to the corner shop just to buy some milk.

Please, please adhere to the advice.

Because at the minute we got things just about under control in two weeks time.

If infection rates rise even further with this is gonna be a very, very different situation, and it's gonna be very frightening.

And people really need to heed the advice and be aware that you can get this any age on in any degree of health.

Don't think that you're so young and healthy, but you won't get it because we've seen people again and again developing this illness when they've had no medical problems before battle.

You've been working in the N h s.

For how long?

20 years.

Do you think that this particular experience will change you?

Yeah.

I don't know how yet Because you never know in the midst of it, do you?

But I think it will change.

I think it's going to change the whole world.

But I think that it will change the n hs massively in terms of the way we do certain things, I think then it just will become more efficient in some respects.

Uh, what about you?

What about you?

Your view.

Now, on the profession you joins, that hasn't changed.