Frontline clinicians at Morriston Hospital have given a harrowing account of the impact the second wave of Covid-19 is having on patients and on staff.
The sad reality is that patients coming into intensive care are sicker than during the first wave. And this time around, most of those put on intensive ventilation will not survive.
“Sometimes we’ve seen many patients die in the same 12-hour shift,” said intensive care consultant John Gorst. “In some 12-hour periods we have lost up to five Coronavirus patients.
“Usually we expect to see, on average, one patient a day dying in the intensive care unit. To have five die on one day is unprecedented.
“That’s been a real struggle for their families and for the staff dealing with it. It has been a real challenge for everyone involved.
“We deal with it by having such a strong team. We are able to pull together and get through difficult times for us so we can focus on helping those families who have had such a traumatic time, but also helping the patients who remain with us as well.”
Dr Gorst said the second wave had been a lot more challenging than the first. The biggest difference, he said, was that the patients coming through this winter were sicker than those during the initial wave.
“We do have better treatments for Coronavirus now. They aim to keep people out of intensive care.
“If it wasn’t for the treatment given on the wards, intensive care would have been completely overwhelmed.
“However, when patients have failed on these treatments, sadly the safety net of the intensive care unit, the safety net of getting them on an invasive ventilator, largely doesn’t work.
“Most patients at the moment who come to intensive care to go on an intensive ventilator, sadly will not survive.
“These patients are mostly of working age. They don’t have any significant medical conditions.
“This is alien to us as an intensive care unit. We expect far more patients to survive. Now they are not.
“That’s because we are seeing a different group of patients who are just not responding to the treatment, unfortunately.”
One of the hardest aspects of these tragic losses is the fact that relatives cannot be with patients who are either extremely unwell with Covid or who have succumbed to it.
“Families are not able to see loved ones and we are having to have horrible conversations by phone with them,” said Dr Gorst.
“When they may not have seen their family member for three weeks, it’s a real challenge for them to appreciate what is actually happening, and to understand the gravity of the situation.
“That has been our biggest challenge in this wave, families understanding how severely unwell they are and when they are, sadly, dying it’s really difficult for families to understand.
“The most difficult situation for everyone involved in intensive care is when a patient is dying despite everyone’s best efforts and that patient would potentially be by themselves.
“Obviously, as doctors, nurses and the whole team, we wouldn’t want that and I’ve sat with nursing colleagues with patients in their final moments to make sure they are not alone.
“That is something I can reassure families is that your loved one is never alone on the intensive care unit.”
Senior matron Carol Doggett, head of nursing for medicine at Morriston Hospital, echoed that sentiment.
“The biggest thing for us is the absence of family, particularly at end of life, when a nurse steps in and becomes their next of kin, almost, the person that sits there and holds their hand.
“Which we would do anyway, naturally, but in the absence of family it’s far more profound than supporting them in a holistic way if they were present with us,” she said.
Mrs Doggett said the extreme pressure experienced in intensive care had been felt throughout the hospital.
Four additional medical wards have opened to cope with the impact of Coronavirus and the fact that it has been “business as usual” in terms of other vital services the hospital provides.
Whereas Morriston would usually have around 200 medical patients at any one time, that is now around 300.
“Patients are coming in through ED. They are sicker. The number of sicker patients has definitely increased,” said Mrs Doggett.
“That results in them having an extended period in hospital. They can stay beyond Covid. They continue to suffer with those conditions that present themselves as a result of Covid.
“It’s important we work with families and the patients themselves to look at the best way to get them home safely once they are at the point where they can leave hospital.
“We work with colleagues in social care as well so we can make sure packages of care are available for people to go home, recover safely, and return to the level of independence they experienced before.”
Mrs Doggett said coping with all these pressures had been difficult for staff – but they had really stepped up.
“What we have seen is the workforce coming together – not just nursing but medics, therapists, social services, domestic services, portering, all coming together for one cause.
“We knew it was there before but it’s far more evident at the moment. I think staff take strength from that.
“The health board has put on a suite of services to support our wellbeing, which I know a number of us are accessing as groups and individuals. That is making a difference.”
There are fears the roll-out of the vaccination programme could lead to people letting down their guard – with devastating consequences.
“We are seeing a younger cohort of patients in hospital with us at the moment,” said Mrs Doggett. “That should be a stark warning to anyone not to take chances with this.”
Dr Gorst added that, despite the encouraging signs, staff remained very nervous and apprehensive. “We’re worried about what the new variants might hold for us.
“It wouldn’t take much for all of a sudden for there to be another peak and for services to be overwhelmed again, for us to start losing a lot more life and for us to have to stop doing the life- and limb-saving treatments elsewhere in the hospital just to cope with the surge of intensive care patients.”