A nurse opens a hole in the oxygen hood to feed a patient with a straw. Thick bandage gloves cover the hands of a patient to stop them, bewildered and sedated, from tearing out uncomfortable tubes. A nurse says loudly to one Covid-19 sufferer on ventilation: “Do you remember me?” The focus and dedication is as overwhelming as the silence, broken only by the bleep of pagers and ventilators, calling the somber rhythm of the hospital’s ICU.
Weeks into Britain’s pandemic, the agony of Covid-19 is still lethal and urgent in the General Critical Care unit of University Hospital Coventry (known as UHCW). During the 24 hours we spent in the hospital, two patients died and two recovered enough to leave the intensive care unit (ICU). But every day, more come in. And the fear of a second wave, once the lockdown ends, hangs over an exhausted, yet resilient staff.
“For the next six weeks, we’re on standby,” said ICU consultant Roger Townsend. “For another one.” Aoife Abbey, another consultant, agreed. “I feel like one will come and I think we’ll do what we’ve done before, which is our best, and hopefully we’ll get through it.”
UHCW is one of the largest hospitals in the Midlands, the worst-hit area of the UK after London. It offers two global warnings. First: Doctors fear that a second wave could be just weeks away, if the lockdown lifts and Britons again begin to move around and infect each other at higher rates. And the second? Just because a country’s capital city is seeing the virus ebb, doesn’t mean it is not still ravaging the regions. In UHCW, the ICU has more than a dozen patients and over 170 people have either tested positive for Covid or possibly been infected. Since the pandemic began, about 170 have died from Covid there.
The pain of UHCW’s exposure to Covid-19 hasn’t brought the comfort of knowing it better. “It’s like nothing we’ve seen before,” said Townsend. “We don’t really understand it. Most respiratory failure manifests itself in a text book way, but these patients? It doesn’t manifest like that.”
But they understand too intimately the agonizing solitude the disease imposes on its victims. To prevent infection from spreading, patients must live their last hours without their family nearby, and only doctors and nurses with them as they die.
“I’ve held a telephone to the ear of a gentleman who was dying, so that his wife could speak to him,” said Townsend. “He was sedated, but we would always assume someone hears you. The nurses looking after the patient will sit and hold their hand as they pass away as well. So they’re always with someone.”
Another consultant, Jonathan Paige, said: “We’re talking to people who are breaking down in tears on the other end of the phone.” The unpredictable nature of the disease – mostly hitting elderly men, but sometimes killing fit, young patients with no other health conditions – is also harrowing, Paige said. “Everyone’s finding it quite hard especially when you see someone who’s young fit, in the prime of life, get struck down and – despite everything we can do for them – losing their life.”
The nurses gather in hallways, removing protective gowns as a grueling 12-hour shift ends, showing nerves of steel. The moments when the relentless suffering, or discomforting heat of protective gear, gets too much, are gently referred to by staff as “wobbles.”
They look out for and comfort each other. Amid a nationwide controversy about the availability of personal protective equipment (PPE) for the UK’s healthcare workers, nurses at UHC broadly said they have the protective gear they need, and seemed properly equipped. But that doesn’t eradicate fear and despair at the end of a long, bleak night shift.
“There have been really difficult shifts where I’ve just cried in the shower”, said Nerissa Cifra Manalad. “Cry in the shower, I cry at night, I’m going to cry again now,” she said, welling up. “I’m just scared and I’m just basically [wondering], ‘When am I going to catch this?’ Despite having all the PPE, you still don’t know. If you go by the book, there are people still getting infected, so… I’m just so scared.”
Adding to Manalad’s concerns are her elderly parents being alone at home in the Philippines, where she cannot travel to help, in the event they fall sick. “I pray before coming to work. I pray before going to sleep. It’s just not only for myself, I’m scared for my husband as well. It’s just really scary…”
Fear at first caught Townsend – fear of the unknown and of failure to combat the disease – but now he says they focus on getting through and being ready for another wave. “When my colleagues confessed that they were scared, I confessed – I said, ‘I’m scared, too.’ Now this has gone on, I think the best we can do is wear the PPE, keep our fingers crossed that we don’t get it. Yeah. So am I scared? No. Not scared like I was when I started.”
Back inside the ICU, the team continue “proning” patients – turning them on their fronts to ease breathing. Townsend admits they still don’t fully understand why the palliative technique works. “It changes the distribution of air within the chest”, he said “but also changes the way the blood is distributed.”
Sometimes, no level of care can alter the trajectory of a patient, and the team must make the difficult assessment as to whether they are only prolonging a patients’ pain. Townsend said: “If people pass away it’s more often because we’ve come to the conclusion that they are not going to survive whatever we do, rather than them dying suddenly.”
The fear of a second wave is tempered by the hospital knowing how they braved the first. “I think we all fear that potential second wave and possibly even further waves as we move into winter if we find this becomes a seasonal disease,” said Andy Hardy, CEO of University Hospitals Coventry and Warwickshire. “We have to keep the public onside, by being honest with [them], and the government giving clear direction as to why, for example, an extended lockdown might be necessary for certain types of vulnerable patients.”
But at the back of the hospital, the new normal is already visible. Patients come off a stream of ambulances into one of two channels: Covid-19 possible, if they have any breathing symptoms, or a separate channel if not.
Inside is Brian Forster, who recently suffered from cancer and has been shielding himself at home as per government advice. But recently it became too hard for him to breathe, and he came in for a test. His first night in hospital was a struggle. “Because with my breathing being so tight, it was hard to get comfortable,” he said. “So I’ve not had a lot of sleep.” Movement had become a struggle. “As soon as I get out of bed to go to the bathroom or do anything like that, I’m completely out of breath. I break out into a sweat and I just have to come back and have a sit down.”
In another ward lies Jacqueline Smith, a grandmother of five, who delayed coming into hospital when she fell ill, as she feared catching the virus she didn’t know she already had. She half-laughs through a cough: “They called the ambulance three times and I kept refusing to come in.” The disease itself was deadly serious. “Oh my goodness. It’s so tight.” She pushes down on her pyjamas and adds: “You’ve got somebody sitting on your chest. And you’re trying to breathe and you’re not getting anywhere. It’s really frightening.”
One peak behind them, and the lull before a possible second wave, is not a place for fear, said consultant Abbey. “I am not sure that fearing it is helpful.”