'I feel a bit apprehensive, but ready': nurse Michael Mawhinney

The nights are drawing in and - at a time when hospitals would normally be bracing themselves anyway to deal with a surge of winter flu - Covid is stalking the land again.

After a long period over the summer when no-one died of coronavirus at York Hospitals Trust, the number of deaths is creeping up once more.

At the time of writing, there were 33 patients with coronavirus at York Hospital. That number will rise. So how are staff feeling as they prepare themselves for the second wave?

Apprehensive is probably the best word for it, says senior nurse Michael Mawhinney. But ready, too.

“Yes, there’s an element of the unknown (about how bad the second wave will get),” he admits. “But we have the right skills and equipment. The whole workforce is ready to go. So I feel a bit apprehensive, but not too anxious.”

Apprehensive - but ready: Mchael Mawhinney at York Hospital

Staff across the hospital trust learned a huge amount about how to deal with coronavirus during the first wave, says Michael, 32, the Matron (senior nurse) in charge of cancer and support services.

They learned how to apply effective isolation and protection protocols to ensure Covid positive patients didn’t come into contact with other patients; how to best manage the disease itself; how to protect themselves and other staff.

And they had to learn quickly. At the height of the first wave of the virus earlier this year, no fewer than 11 of York Hospital’s wards had been converted to Covid wards.

As a senior nurse manager Michael, who at the time was managing a couple of acute elderly wards, was involved in preparing the hospital to take coronavirus patients.

Many wards - such as a hip fracture ward that he was responsible for - had to be quickly ‘reconfigured’ to take Covid patients. The idea was that all patients who tested positive for the virus would be brought to these dedicated wards, and kept well away from other areas of the hospital

That meant transferring patients who were already on these wards to other wards in the hospital, or discharging them altogether.

The number of beds on Covid ward bays was reduced from five to four, so that they were further apart, for social distancing reasons; air flow units were introduced, to control the flow of air and reduce the risk of infection spread; and arrangements were made to fill the wards in a planned way, with a single patient in each bay until the number of Covid patients became too large.

The number of beds in each bay is reduced on Covid wards, says Mr Mawhinney

Protocols were also set up to ensure that all Covid-positive patients were sent direct to the newly-reconfigured Covid wards - and to reduce the numbers of staff who would visit these wards. “On a normal, pre-Covid ward you’d have teams of therapists and occupational therapists and the like coming in and out,” Michael says. “With Covid we wanted to minimise that.”

A number of non-Covid wards were kept running throughout the first wave of the pandemic - a general medical ward, a general elderly care ward and a surgical ward among them. But inevitably many of the hospital’s more routine activities had to be slowed down or suspended in readiness for the anticipated surge in Covid cases.

This meant that staff from a range of disciplines could be reassigned to Covid wards.

That in itself was a challenge, Michael says.

“It meant bringing together different staff with different skills. You had sexual health nurses who hadn’t worked on a ward for years. So you had a big mix of staff coming together.

“It was challenging. But you had these strong teams forming really quickly. Working in the NHS, you want to care. Everybody wants to be here, wants to care for patients.”

Staff assigned to Covid wards were provided with special hospital scrubs, full PPE (including eye protection: if you’re close to someone with Covid it is possible for the infection to spread through the eyes, Michael says) and on-site showers to use before and after shifts.

Staff not detailed to Covid wards, meanwhile, were expected to keep away from them as much as possible. And it was also decided that, except in exceptional circumstances, no visitors would be allowed. The only exceptions, Michael says, were when a patient was nearing the end of their life. In such cases, visitors would be provided with full PPE.

So the hospital and its staff were as ready as they could be.

“It was obvious that Covid was going to be really challenging. It was unknown, there was changing advice. But you could see people coming together really quickly.”

Then came the news, on March 11, that the first Covid-positive patient had been brought into emergency.

It was evening. Michael had already been on duty that day since 8am. And while he wasn’t personally involved in dealing with the patient, he did help arrange for their transport from the emergency department up to a newly-configured Covid ward.

Again, there was that feeling of expectancy and apprehension. “It was that feeling of the unknown. But there was also a sense of readiness,” he says. “There had been talk. Now the staff were ready to go.”

The first patient was moved up to the Covid ward through corridors that had been especially cleared.

Michael, who as a senior nurse managing or acute elderly wards had not been designated to a Covid ward, nevertheless helped arrange that. "It was about reducing footfall - we didn’t want lots of staff going past - but it was also for the patient’s dignity,” he says.

That first patient went on to recover. But as more and more patients were admitted, the hospital began to have its first Covid-related fatalities. By October, more than 220 Covid-positive patients are known to have died at York and Scarborough hospitals - the two York Hospital Trust hospitals that take Covid patients.

At the height of the first wave, it became gruelling. Staff were working long hours: and sometimes, as the number of cases continued rising, there seemed no end in sight. “There were times when you got really tired, and you were thinking to yourself ‘how is this going to end?’” Michael says.

The need to wear PPE made things worse. It is hard to feel as close to a patient when you are wearing a mask, Michael says. Staff had to learn to ‘smile with their eyes’.

Worst of all, as always, was when patients died. The PPE and strict social distancing protocols made it hard for staff to show the same levels of intimate and personal care - the sheer human warmth - that they normally would. “That was really difficult. I know a lot of staff felt that. It was horrid,” Michael says.

But their team spirit, and the sense of all pulling together, got them through.

And so did the very public appreciation for health workers expressed through the Thursday evening ‘claps’. “That really meant the world, and kept you going,” Michael says. “Sometimes I would be at home, and I’d go out on the street and join in. And I had neighbours who were dropping around offering dinner.”

The Thursday evening claps helped lift staff, Mr Mawhinney says

Now it looks as though we’re going to have to go through it all again.

So yes, there is apprehension. “But there’s also a deep sense that we’ve been here before, and we can do it again,” he says. “We will be OK. We’re still smiling with our eyes."

And what would he say to members of the public worried about what the future holds? “It’s so important that people socially distance to try to minimise the spread,” he says. “If we don’t keep social distancing, it will infect vulnerable people, and we’ll get a lot more patients.”