Shattered staff in one of England’s largest hospitals say they are working “to the limit” of their ability, battling low morale, exhausting shift patterns, and the prospect that the worst is still to come.
As the number of cases continues to rise across the country St George’s Hospital in Tooting, south-west London, has had to vastly expand intensive care capacity and move staff without specialist training to high dependency roles in an effort to tackle the workload.
The PA news agency was granted rare behind the scenes access to the coronavirus frontline amid confirmation that a further 1,041 people died within 28 days of testing positive for Covid-19 in the UK – the highest daily reported total since the first wave of infection in April.
London has been at the epicentre of the latest wave of Covid-19 cases and St George’s has now seen its number of coronavirus patients at least matching the first peak.
Staff said they were “resilient” to the challenge ahead but conceded there was little room for manoeuvre.
Dr Mark Haden, an emergency department consultant, said: “We make it look like business as usual but it’s very much not – it’s very different to our usual pattern of work.
“Everyone’s stress levels are higher than usual. Everyone is working to the limit, to the threshold of what they’re able to.
“The hospital bed occupancy is very, very high, it has lots of Covid patients as inpatients at the moment. It’s very stressful for staff and that is starting to show.”
St George’s has had to expand the number of intensive care beds for the critically sick from 60 to 120, the vast majority of which are for coronavirus patients. The rest are for those recovering from other serious trauma such as heart attacks or road traffic accidents.
But the expansion has had a real impact on both the staff and patients’ treatment. Nurses who would usually be assigned to one patient are now having to deal with up to four casualties at one time. And they are doing so while wearing uncomfortable personal protective equipment (PPE).
Such is the demand on the intensive care unit that staff from other departments are being drafted in to help – despite not being trained to do so.
ICU consultant Dr Mohamed Ahmed, 40, said: “When a nurse has care of one patient there’s that ratio for a reason – every detail needs to be looked at. When they need to look after three or four patients their standards are lowered.
“They feel they have to do their best but they come away feeling demotivated and demoralised. That’s really apparent. They clearly want to do the best they can.”
Matron Lindsey Izard said pressures on the service were immense. “It’s not just about Covid,” she said. “If you go up a ladder this weekend and fall off it there’s a chance you won’t get an ICU bed.
“People are still getting run over, they’re still self-harming, they’re still beating each other up.”
Ms Izard said staff were so exhausted that she feared “a large number” would quit once the pandemic was over.
She said: “I really do think a lot of people have thought: ‘This is the writing on the wall for me as a nurse, I’m not sure I want to do this again’.”
It came as an NHS England briefing apparently showed London’s hospitals on the verge of being overwhelmed by coronavirus even under the “best case” scenario.
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Staff at St George’s also described the “unpredictability” of the second wave of coronavirus, which has seen previously healthy young patients die with Covid-19.
Coronavirus deaths since the summer have been characterised partly by increased numbers of young adults being admitted to hospital.
And staff at the south London hospital said they are treating patients in their 20s and 30s, many seriously ill.
Salvatore Patinella, 30, senior staff nurse in the hospital’s acute dependency unit, told the PA news agency: “The situation is really serious.
“Initially we saw patients who were older – now patients who are really young are getting sick.
“It requires a lot of attention. You try the best to encourage them because they demoralise themselves, they get down. We just give the best we can, have a chat, and encourage them.
“If they do the right thing hopefully they will get better and get out of this hospital.”
His colleague, medical registrar Omome Etomi, said it was impossible to predict the profile of patients brought in for care – and whether they will survive.
The 28-year-old said: “We are seeing patients across the spectrum from their 20s right up to people in their 80s and 90s.
“It’s so unpredictable – I can’t tell you who’s going to be unwell and not, who’s going to improve and go home, and who’s going to have a longer stay in ITU.
“I have admitted patients to the intensive care unit in their 20s and 30s, people who have no pre-existing conditions.
“There’s almost no pattern to it – we just can’t say.
“That’s why we all have to be so careful – your friend might have a mild illness but you don’t know how it’s going to be reintroduced in you.”
Intensive care consultant Dr Mohamed Ahmed, 40, said: “What’s apparent from the first and second wave is that you have patients in their 20s and 30s now.
“We have a gentleman here in his 30s who is incredibly sick – he had no underlying problems. That’s a bit of a shocker for us.”
Emergency department consultant Dr Haden said families of “otherwise fit and healthy young people” were “distraught” that their loved ones are being admitted to hospital with coronavirus symptoms.
And he warned everyone to heed the advice on keeping safe and not be tempted to break the rules.
Dr Haden, 36, said: “Because a lot of these infections are asymptomatic people may think that by breaking the rules and by mixing and by not washing their hands, not wearing a mask, that has no effects.
“But every time you break a rule, every time you pass on an infection, at the end of that chain of infection someone is going to get it severely and someone is going to die from it.
“Although they may not see the consequences of breaking the rules we see it every day in hospital and these things have very real consequences for patients.”
