A bus driver who had Covid-19 died after hospital staff used the wrong ventilator equipment, an inquest heard.
Kishorkumar Patel, 58, was admitted to Northwick Park Hospital and died after being transferred to the ExCel Centre in east London, which was transformed into a Nightingale Hospital during the coronavirus pandemic.
The father-of-six, who had no underlying health conditions, spent 19 days in hospital beds before his death on April 26.
Northwick Park Hospital was forced to quadruple the number of ICU beds during the first weeks of the pandemic and was considered the busiest hospital for Covid-19 in north-west London.
The inquest at East London Coroner's Court heard Mr Patel was transferred to the Nightingale Hospital due to the onslaught of Covid-19 patients in April 2020.
Dr Tariq Husain, a consultant in anaesthesiology at Northwick Park Hospital, said: "We had significant challenges. In normal circumstances we have two consultants in intensive care that cover a typical day period.
"During the height of Covid, we had five to six consultants managing the patients.
"We drafted doctors from other hospitals and specialities - even if they had not ever worked in intensive care.
"We had a cohort of intensive care nurses and we had additional support from the theatre staff.
"Normally, the nursing ratio in normal circumstances where this is one for every patient - at its worst we had one intensive care nurse looking after six patients."
The inquest was told the hospital had ordered new ventilators, bringing the total to around 30, before the pandemic as several were about to be decommissioned.
They had also started to use anaesthetic machines, which can also work as a ventilation system, among those who seemed to be more stable than the more serious cases.
Dr Husain said: "There were a group of patients who were physiologically safe. There were also a large group of patients that were unable to be transferred because they were too unsafe and there was a substantial risk they would deteriorate en route."
Mr Patel's sister, Ursha Lee, who attended the hearing remotely, said the family only agreed for their loved one to be removed because they were told the hospital had no beds.
The doctor said: "We had to create capacity. If we didn't, people would have been dying in corridors.
"It wasn't intentional for us to not pay mind to what families wanted, as I know some families didn't want their relatives transferred out. For the greater good, some patients had to be transferred out."
He continued: "We were offered beds at the Nightingale Hospital and we chose patients that were physiologically stable to transfer.
"Our priority was to create ICU capacity. The Nightingale team, over the course it existed, had admission criteria that slightly changed throughout the pandemic.
"But any of the patients that fulfilled the criteria would be considered for transfer.
"A form would be emailed centrally which would involve a list of criteria and then it would be emailed to the Nightingale team for them to decide which patients they would take."
Jon Sweet, Head of Health Safety Risk and Environment at Arriva Bus, said Mr Patel was working in March but it is unknown whether he would have caught Covid-19 at his job.
He also said TfL held daily meetings from the end of March in order to strategise throughout the pandemic and issued up to 20 versions of advice and tips to staff.
But he did admit that at the start of the pandemic and in the weeks before lockdown, there was "not a great deal of guidance around at the time".
He said: "Bus drivers are protected by a screen and while it has holes it offers a degree of protection and they were sealed from April onwards.
"The TFL model is cashless and there's very little interaction between the driver and patron.
"From March we also saw a distinct reduction in patronage across the TfL network that also helped reduce risk to staff."
The inquest has come after Coroner Nadia Persaud sent a report to prevent future deaths to the Royal College of Anaesthetists after multiple incidents of staff using the "wrong filter" occurred in at least two deaths.
She said in her report: "There was a serious incident in which the wrong filter was found to have been used within the breathing systems of the intensive care ventilator.
"It is understood that these two cases came within a cluster of similar incidents.
"No conclusion has been reached as to whether the incident with the filter contributed to the deaths.
"The question of causation will be considered at the inquest hearings."
The report to prevent future deaths refers to an independent expert found non-standardised colour coding had led to an "extremely confusing situation".
Ms Persaud said: "In my opinion, the confusing over breathing system filters and HMEs [heat and moisture exchangers] is widespread among ICU staff (doctors and nurses) and the classification and colour coding of these filters/HMEs is worthy of review, simplification and standardisation.
"The concerns raised by the independent expert are not confined to the Nightingale, emergency provision hospitals, but relate equally to all intensive care settings, particularly when the intensive care provision has to be extended to other areas of the hospital.
"As there are still pressures within the ITU settings and in light of the imminent, planned reduction in Covid-19 safeguards, I consider that action should be taken to address this concern at the earliest possible stage."
The inquest continues.
