Meet the intensive care team looking after York's sickest Covid patients

One of the worst things about the Covid pandemic is that the very sickest patients - the ones in intensive care - have had to be kept isolated from family and friends.

At the start of the first wave of the pandemic, the thinking was that families couldn’t be allowed to visit at all, says Elaine Hunter, York Hospital’s lead nurse for critical care. The risk of spreading infection was just too high.

That has now relaxed been relaxed - but only very slightly.

Family members - who will often have had Covid themselves, points out Dr Joe Carter, the consultant in charge of critical care at the hospital - are now allowed in for very short visits wearing full PPE.

But they are only very brief visits - often right at the end of a patient’s life. “It is often the very first time that they have come to see a family member, at the very end of life,” says Elaine. “It can be absolutely heart-breaking.”

Dr Joe Carter and nurse Elaine Hunter examine a patient's records

For most of the time that they are in intensive care, however, critically ill Covid patients cannot see friends or family at all. It is just too risky.

Zoom and video-calls help. But they’re not the same - especially since mortality rates for Covid patients in intensive are high: more than 50 per cent. Many of the patients looked after by Elaine and her colleagues won’t get better.

Elaine has some words of comfort, however, for family members worried about loved ones who they cannot visit. “They are never alone!” she said. “They have always got a doctor or a nurse with them.”

Dr Carter repeats that message. “They are never alone. They may only have us - but they have got us!”

For both Elaine Hunter and Joe Carter, it is that enforced isolation of very ill patients that has been the hardest thing to cope with about the Coronavirus pandemic.

Dr Carter is used to telling grieving relatives that a loved one has died. But in normal circumstance he would do it face to face. Having to break that news over the telephone is ‘very upsetting’. “It is for me perhaps the most heart-rending thing about this whole pandemic.”

But then the whole of the last nine months have been particularly gruelling for staff in the hospital’s intensive care unit. It is not simply the emotional toll of having to see patients die: it is the physical toll too.

Intensive care staff have to wear full PPE - theatre gowns, a tight-fitting mask, glasses, visors and gloves. Once they enter the Covid-secure area, they remain there for three hours. They get hot, tired and dehydrated, Elaine says.

“You cannot take your mask off: you cannot eat, you cannot drink. You often end up with a headache.”

At the end of three hours, they will come out for a short break, and to have something to eat and drink. But then it is straight back in again.

A typical shift will last for 13 hours, Elaine says. “It is exhausting.”

Both she and Dr Carter have families of their own. Both have seen firsthand the impact that Covid can have on families. She is amazed and humbled at how well her team - not only the doctors and nurses, but also the therapists, pharmacists and support staff - have coped.

Yes, hospital staff have long had plans in place for a ‘major incident’ in which it would be all hands to the deck. “But we never thought we would be planning for a pandemic that would last so long!” she says. “We’re nine months in, now!”

Some nurses, she says, took the deliberate decision not to go home to prevent the risk of infection spreading to their families. “We have a couple of members of staff who haven’t seen their family since March.” Camp beds, meanwhile, have been set up so that consultants such as Joe Carter can always be close at hand if needed.

Yet everyone has pulled together. “I have never been so proud to be part of the NHS!” Elaine says.

Nursing patients who require intensive care - often referred to as ‘critical care’ these days - is hugely labour intensive. Patients have to be constantly monitored and watched over, their medication or oxygen adjusted, their bodies gently moved so that they don’t develop pressure sores or other complications.

York Hospitals Trust has two intensive care units - a 17-bed unit in York and a smaller, 8/9 bed unit in Scarborough. A team of nearly 100-specially-trained nurses looks after patients. But at the height of the first wave of the pandemic, York alone at one point had 28 desperately ill Covid patients who needed intensive care. Then there were all the other, non-Covid patients.

“It’s not just about Covid,” says Dr Carter. “We still have to look after all those other patients who need critical care.”

They coped by opening up intensive care beds in the theatre recovery area (where patients usually go to recover from major surgery) for non-Covid patients. In the main intensive care unit, meanwhile, beds for Covid patients were moved closer together so that more could be fitted in.

That is fine when you know patients all have Covid, Dr Carter says. The problem is, until patients have been tested, you don’t always know. And even then, the tests are not 100 per cent accurate. Some patients have all the symptoms of Covid even if their tests come back negative - and then it is hard to know where to put them.

Elaine Hunter putting on PPE before entering the Covid secure area of intensive care

By making use of three single rooms on the unit as ‘isolation rooms’, and splitting the rest of the ward into what was effectively two separate wings, they coped.

More of a problem, if anything, was staffing. Intensive care nurses are highly trained, Elaine Hunter points out. “You can’t just get 100 more nurses when you need them.”

The intensive care team were supported by trained theatre nurses, however - and other clinical staff were also given some basic critical care training so they could help out.

And York, both Elaine Hunter and Joe Carter point out, was always better off than many areas, because infection rates in the city have often been so much lower than other areas.

During the second wave of the pandemic, things have so far not got so desperate as during the first wave.

The real worry is the onset of winter - which traditionally brings a surge of very sick patients.

The hope is that the social distancing we have all been observing will have reduced the number of traditional winter illnesses. “I haven’t even had a cold this winter!” says Dr Carter.

The less good news is that Christmas is coming.

Both Dr Carter and Elaine Hunter are worried that the relaxation of social distancing rules over Christmas could lead to a third wave of infections. “The reality is that levels of the disease are quite high in the community now, even after lockdown,” Dr Carter says. “There is some anxiety about Christmas.”

“We suspect that come mid-January there will potentially be an increase,” adds Elaine.

But at least there is always the hope held out by the new vaccines. “I’m optimistic that at some point some return to normality may be possible,” says Dr Carter.

Let’s hope so.