Frontline UK medics have spoken of how they prepared for the Covid-19 pandemic when the rest of the world was still working out what to do.
The infectious diseases unit at North Manchester Hospital had already begun making preparations for Covid-19 to hit the UK in around January 2020. At this stage, the virus was still very much isolated to the Wuhan province in China.
Helen Riley, 38, the matron on the unit told the Manchester Evening News : "We were having conversations and then I recall being called to a meeting with our executive team in mid-January and it was kind of ‘so what are our plans?’”
Due to the team’s understanding of Ebola and other tropical diseases, the unit already had a specific range of procedures for contagious viruses such as Covid-19 at their disposal.
But Helen, a mother of three, had no experience of a global pandemic reaching British soil and neither did the rest of her team.
They were also under pressure as the only infectious diseases unit in the whole of Greater Manchester.
This meant that when the first cases of coronavirus reached the North West in early 2020, Helen and her colleagues were called on by health professionals from across the region for their expertise.
Infectious diseases consultant, Leann Johnson, 45, who has worked on the unit since 2008 explained that the “strict procedures and protocols” the unit had in place, for example for Ebola potentially spreading beyond West Africa, stood them in good stead.
She said: "That in a way made us make sure we were ready for times like this. We made sure our processes were all in place to make sure we could manage a situation like this."
But even with the immense planning undertaken by the unit, nothing could have prepared the team for the gruelling, and at times unrelenting pressures they would face over the next year and a half.
Helen said: "Even back then I think we completely underestimated the situation. Nobody could have foreseen the twelve months ahead of us."
Most normal services including elective surgery came to a halt, as North Manchester became the first screening centre in the region for people with symptoms of Covid-19.
The hospital received and treated the first coronavirus patient in the country, outside of the dedicated isolation units at hospitals such as Liverpool, Sheffield and London.
Very quickly, a ward that had previously been used to care for people living with HIV, those with Hepatitis, or general infections, was overtaken with Covid cases.
Up until the pandemic, Consultant and Deputy Medical Director for North Manchester, Katherine Ajdukiewicz, 47, would primarily care for people living with HIV.
She said: "Going into the pandemic, things changed very quickly. The whole way we worked changed rapidly and in terms of out-patients - it went almost completely virtual overnight.
"We utilised the use of an infectious diseases consultant who had retired who came back to help, and our specialist nurses were mobilised and put on the Covid unit.
"It ramped up very quickly. Initially, there was one ward, then two, and so on."
At the beginning of the pandemic, any patients with coronavirus in the region would be taken to the infectious diseases ward at North Manchester Hospital.
Within a few weeks, it became apparent that other hospitals across the region would need to brace themselves for an influx of Covid patients.
Since the pandemic was declared in March 2020, Greater Manchester's hospitals have seen three so-called 'waves' of the virus, tragically leading to the loss of thousands of lives.
Reflecting on the patients she had treated over the past 18 months, Katherine said that in the first wave of the virus it was “often patients who were older or who had other co-morbidities going on with them.”
But this has changed.
"It was awful but in a way what was even worse was in subsequent surges, and even now, we are seeing young people who are normally fit and well getting Covid and becoming very sick or going to critical care and not making it," she said.
"With many infectious diseases we treat, the patients almost always get better. But with Covid, especially in the early days, there was nothing we could do except give oxygen.
"It was really emotionally draining and psychologically and physically [draining] because the hours were really long."
Now the infectious diseases unit is the only ward at North Manchester Hospital with coronavirus patients - excluding critical care.
But patients continue to come through the doors, with the numbers 'trickling up,' as infection rates across Greater Manchester and the North West continue to rise well above other parts of the country.
Katherine said: "We are seeing largely unvaccinated individuals, mostly younger, fit and well coming in. Aged between around 20 and 40.
"Some have been offered the vaccine but some are just on the cusp of being offered."
The uptake of the vaccine has been low in some communities in Greater Manchester and is an issue the infectious diseases team is attempting to tackle.
As Katherine explains: "This is a hugely important part of us overcoming the disease."
For those hesitant about having the vaccine, she says she tries to reassure people citing the “huge amount of research” that has been done.
A good deal of this research has taken place at North Manchester Hospital.
Andy Ustianowski, 52, runs the research unit at the hospital. It is thanks to some of the studies carried out by his team, that effective vaccines have been rolled out across the country.
The hospital has recruited just over 1,500 people to various treatment and vaccine studies during the course of the pandemic, and during its height, was in the top 15 hospitals nationally for the number of studies undertaken.
The research team also led treatment studies on the drugs Remdesivir and Tocilizumab, which have both been used to successfully treat coronavirus patients.
North Manchester Hospital was also the lead for one of the Covid-19 vaccination programmes, which led to the licensing of some jabs including AstraZeneca and Janssen.
Andy and his team are also working on two new studies which look at the way monoclonal antibodies could be used to prevent the virus from spreading.
He said: "It’s an injection into the muscle of antibodies targeted against the virus.”
"We don’t know the data but they would either be given to prevent Covid generally but also specifically a separate study was looking at giving people the injection if they were a contact of someone with coronavirus.
"If we think about vaccines - there are some people who can’t have them or they might not work well because their immune system isn’t good.
"So having this injection which is giving people antibodies against the virus is a way of protecting the remaining bit of the population.
"The other thing about vaccines is they take a little bit of time before they make you immune. That might be two weeks or so.
"These jabs work almost instantaneously. You don’t have to wait for the immune response; the protection is almost immediately."
The results of the study have not yet been published, but if the data is positive, it could mean the UK is equipped with yet another way of minimising the spread of coronavirus in the community.
He said: "I have never worked so hard and I've never been so tired but it's been rewarding to see the difference the vaccine has made in a relatively short period of time.
"I think we've learnt a lot over the last year and a bit and I think we will be in a better situation for another pandemic as long as the lessons now are learnt.
"What would be nice is to try and convert some of that learning to other diseases whether that’s infections or other diseases."
Now the focus of their research will move to how people's immunity to the virus can be boosted in the autumn and winter and how they can change the vaccines to work against new variants.
The infectious diseases unit is already preparing for the winter.
As Katherine admits of the virus: "It’s not gone away for us. I know a lot of people feel they have got back to some normality but it has not gone away for us.
"It won’t be going away for us for a long time."
"I would love to have a crystal ball. It's so difficult to anticipate what is around the corner," said Katherine.
"The kind of things that go through my head are; are we going to get another surge? Could that be related to people's response to the vaccine becoming diminished.”
During the pandemic, attendance at emergency went down significantly but now like most hospitals they are seeing a huge rise again in people attending.
Katherine said: "As we move into the recovery phase, there are individuals who need hip replacements and lumps that need to be biopsied. But already we are under a lot of pressure."
As the country begins to resume to something resembling normal life, for the staff on the infectious diseases unit, the fight against coronavirus is still a long way from being over.
"It’s not gone away for us. I know a lot of people feel they have got back to some normality but it has not gone away for us.
"It won’t be going away for us for a long time."
