‘It’s not over’: Fight goes on for critical care heroes inside coronavirus ward

Inside the intensive care unit at the Royal Liverpool Hospital (Image: Andrew Teebay/Liverpool Echo)

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For Liverpool's critical care doctors and nurses, the past nine months have been an extraordinary and exhausting challenge.

The city was devastated by the first wave of Covid-19 in the spring and just a few short months later weary staff at Liverpool's main hospital trust found themselves in the eye of the coronavirus storm once again.

The second wave struck here first and it struck hard.

Suddenly the critical care team at the Royal Liverpool Hospital were starting to be overwhelmed with the number of very sick Covid patients arriving at their door and they had to carry out difficult transfers of deteriorating patients to other units in the region as they desperately fought for time and space.

While there has been an improvement in numbers in recent weeks, this tight-knit unit are still seeing desperately ill people arriving with the virus every day, many of them will never leave.

Critical Nurse Sarah Lawson is helped into her PPE
(Image: Andrew Teebay/Liverpool Echo)

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I was also able to sit down with them and hear about the impact the second wave of this pandemic has had on their unit, their patients and themselves.

Dr Peter Hampshire is the critical care director for the Liverpool University Hospitals Trust – which covers Liverpool's main hospitals of The Royal, Aintree and Broadgreen – he said that while things have started to improve in terms of the the Covid pressures – things are far from normal.

"The numbers we are seeing in critical care on both sites have improved, the pressure is less than it was a couple of weeks ago when it was very difficult and very challenging", he told the Liverpool Echo.

"We had to keep moving patients from the Aintree site to the Royal every day, from one ICU to the other, just to relieve that pressure.

"We have seen things get a bit better but the situation is still unusual, to have ten or 12 patients in one ICU with the same disease is extremely unusual.

"It hasn't gone away, we are still seeing patients that are very sick with Covid coming into ICU every day."

Dr Peter Hampshire is the critical care director for the Liverpool University Hospitals Trust
(Image: Andrew Teebay/Liverpool Echo)

It was in October when Liverpool was at the centre of the national Covid story once again, with the Trust in danger of being overwhelmed by the sheer volume of people arriving at the hospital who were very unwell with the virus.

Critical care consultant Dr Maryam Crews spoke about the huge concern and anxiety within the team as they watched the numbers rise.

At this point scientists advising the government had called for a circuit breaker national lockdown but it was not clear to the worried critical care team if or when this was going to happen.

Dr Crews said: "For all of us in October, we were very concerned, we didn't know whether a national lockdown was coming and we could see the numbers escalating.

"For me as a consultant on the shop floor, there was a period of about a week where things suddenly changed.

It's unusual to have so many people in ICU suffering from the same thing, says Dr Peter Hampshire
(Image: Andrew Teebay/Liverpool Echo)

"We were really well prepared at this hospital and we know what we're doing but to see that happening again was really, really challenging.

"I think we all felt a lot of sadness about that."

Pausing to reflect on that hugely challenging moment, she added: "We prepared even better because we knew more about what was coming – but to see the numbers escalating and escalating was just met with incredible sadness by the staff.

"We couldn't quite believe what was happening."

Of course the lockdown measures did eventually come.

NHS staff at work on the intensive care ward
(Image: Andrew Teebay/Liverpool Echo)

At first Liverpool was placed into Tier 3 restrictions before the government imposed a national lockdown at the start of November.

Sadly with the city's infection rate having reached around 700 cases per 100,000 by mid-October – the worst in the country at the time – some of the damage was already done.

Dr Crews explained: "The lockdown measures did come but we know there is a time lag and there was a two week period of real pressure when critical care started to get very full.

"At one stage we were starting to see a lot of moves of critically ill patients, not just between us and our sister hospital at Aintree but across Merseyside and Cheshire.

"We do that very safely, but its not normal, it is incredibly unusual for us as a hospital to have to move those patients – again we were very sad to be having to do that."

Patients are being moved between intensive care units in the surrounding areas to help staff cope with the numbers
(Image: Andrew Teebay/Liverpool Echo)

For Dr Crews there is no doubt that the recent improvements are because of the measures taken.

She added: "We have seen a reduction in cases because the people of Liverpool started doing the right things, keeping their distance where they could, washing their hands and using masks.

"I think the vast majority of people doing all that is what has allowed us to provide safe care for the people who are coming through our doors, which is something we always want to be able to do.

"But it is certainly not over yet – personally I was hoping the slowdown would be quicker but we are still getting people through the door every day.

"We know that very sadly, a significant proportion of those people will die."

Critical care consultant Dr Maryam Crews said "it is not over yet"
(Image: Andrew Teebay/Liverpool Echo)

"It is a really cruel disease, I understand that none of this is easy but for me as a critical care doctor of many years, seeing people with Covid-19 who are so very sick and deteriorating, it takes an emotional toll – it is very sad."

That emotional toll is evident, it is etched on the faces of this team who have been through more than most of us could ever comprehend this year.

As critical care nurses Sarah Lawson and Rachel Wain explained, in some ways the arrival of the second wave was more difficult.

With the adrenaline of the March spike having faded and the grim knowledge they had gained from those early months at the front of their minds, they were acutely aware of what they were up against once again.

Ms Lawson said: "It was disappointing to have to face it again and in some ways it was worse because we knew what was coming, the long shifts in the PPE – the first time there was a lot of adrenaline.

Critical Care nurse Sarah Waine
(Image: Andrew Teebay/Liverpool Echo)

Ms Waine added: "That adrenaline did keep us going in the spring, but this time we do feel drained, emotionally and mentally because we know exactly what is happening.

But both nurses pointed out how much support is on offer for the team and how much they lean on each other to get through the tough times.

"This unit has held ourselves together, everyone is supporting each other all the time", added Ms Waine, '"and we there's a lot of psychological support from the Trust."

The second wave of the virus has been longer and slower and the team have actually ended up treating more patients than during those first few frenetic months of the pandemic.

The hardest parts of the job haven't gone away, with staff spending long shifts in uncomfortable PPE and forced to have incredibly difficult conversations over the phone with families, rather than face to face.

Critical Care Nurse Sarah Lawson
(Image: Andrew Teebay/Liverpool Echo)

Dr Hampshire explained: "It is not normal to talk to people on the phone about their loved ones.

"You will see the virus take out families, you will look on the computer and there will be two people with the same name, a patient in ITU and their husband or wife is on the ward – that to me is just devastating."

"We have seen families doing zoom calls with a relative who was at the end of their life, it just seems totally wrong and unfair."

Dr Crews agreed, adding: "As an intensive care team we absolutely pride ourselves in not just looking after our patients but their families too.

"Our patients are often unconscious and cannot advocate for themselves, so in more normal times we would spend a huge amount of time in the ward speaking to families.

On people protesting against lockdowns Dr Crews says all she can do is to keep saying, "The disease is very real"
(Image: Andrew Teebay/Liverpool Echo)

"To not be able to do that face-to-face is alien to us, phone calls are not the same – you lose the ability to show this isn't just another patient and that it is someone you really care about and that really takes an emotional toll on staff.

"The conversations we have are not nice, they are often telling people their loved ones aren't getting better and are likely to die – we will do everything to make that conversation fair but to be receiving that news on a phone call just feels cruel."

This team are still having to have these conversations every day because people are still dying lonely and painful deaths because of Covid-19 in Liverpool's ICU.

So how does it make them feel to see hundreds of people gathering in protest at the very measures taken to try and lower the number of seriously ill people coming through their doors?

Yesterday a second protest in a week saw large crowds of unmasked people gather without social distancing in Liverpool, with some pushing conspiracy theories and challenging the reality of the virus.

The team say "it's disappointing" they are going through the same thing again as they did earlier this year
(Image: Andrew Teebay/Liverpool Echo)

"All you can do is point out what the reality is", said Dr Hampshire.

"We see survivors of this illness and what it has done to them, we see bereaved families and we see people die – we just keep pointing out what is happening."

"People in Liverpool look after each other, its only a small minority (protesting) – but if you want to look after your family, your friends, your neighbours – you know what you need to do."

Dr Crews added: "Nothing about this is easy, you are going to have a personal reaction to seeing a protest but all we can do is come to work every day and try to keep patients safe and try to get people better.

"The vast majority of people in Liverpool know exactly what to do, they know how we can get over this and we just have to keep explaining the logical situation.

Staff say it's hard to predict what will happen in December and January with regards to the number of coronavirus cases
(Image: Andrew Teebay/Liverpool Echo)

"The disease is very real, we now how to reduce the numbers in our local community, we know how to look after each other but we can only do so much as an intensive care team.

"By the time you get to intensive care, sadly for some its too late – but even if you survive Covid-19 critical illness, you are likely to be left with significant physical or psychological damage.

"This virus is very dangerous and I would just urge people to do the sensible things because we can only do so much."

The loud and clear message from this team is that we are not out of the woods yet – and the threat of the virus remains.

They really, really don't want to have to go through this again.

"We don't know what December and January will bring but that's why its so important for people to help keep their loved ones safe, because if you can help stop the community transmission and stop people coming in then it just makes things safer and easier in terms of treating the people who are here," explained Dr Crews.

Ms Waine added: "People say the NHS is the front line but actually the public are the front line, if they do everything they are meant to do, washing their hands, keeping their distance then it will put less pressure on us and we wouldn't need to be on that front line as much as we have been."

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