Exhausted heroes - the Covid fight for life inside overstretched and claustrophobic intensive care
Hundreds of non specialist staff are being drafted in to prop up the critical care effort in hospitals across the West Midlands
Jane HaynesPolitics & People Editor
Doctors have today described life inside intensive care units, with staff under incredible emotional and physical strain as the numbers of very sick and dying patients with coronavirus stretches services to breaking point.
One consultant who works in hospitals in Birmingham said the pressure was beyond anything he had ever seen, adding: "We are doing the best we can, but that is not the same as doing the best."
The dreadful situation was now occurring daily of having to contact family after family by phone to share devastating news, with the death toll in the city's hospitals reaching double figures every day.
Birmingham hospitals prepare emergency plans for '1,000 Covid patients'
'People in their 20s struggling to breathe' - city medic reveals A&E horrors
Often families could not be at the bedside in those final hours because they too have the virus or are isolating.
"They hear a disembodied voice on a phone telling them the worst news imaginable - it is truly awful," said one consultant intensivist.
There are now more people in intensive care beds in the region than at any point during the pandemic - but even that does not truly reflect the crisis, said one doctor, with patients who would normally be in intensive care units being treated in normal wards.
The situation is acute in every hospital in the region.
University Hospitals Birmingham (UHB) which runs the QE, Heartlands, Good Hope and Solihull hospitals, has activated emergency plans including redeploying around 500 staff from around the trust - including 200 doctors - to support critical care and stopping all but the most time-critical surgery.
It currently has over 800 Covid-positive patients, including more than 125 in intensive care.
Nitin Arora, bottom left, with images from intensive care units showing a patient being 'proned' and staff supporting a patient
Sandwell and West Birmingham Hospitals NHS Trust now has more sick Covid patients than at any time; and the situation is also bleak in Dudley, Walsall and Wolverhampton.
Dr Brian McKaig, deputy chief medical officer for The Royal Wolverhampton NHS Trust, said: "It is exceptionally busy at New Cross Hospital. We are very used to looking after critically ill patients, but we are now having to increase our intensive care capacity up to 200 per cent to cope with the volume of very, very sick people coming into hospital."
Still rising community infection rates mean there is no immediate hope of a turnaround, with the pressure expected to stay high for several weeks yet.
Consultant intensivist Nitin Arora, who represents the Intensive Care Society, said the whole system was under intense strain.
"At the moment ICUs in the West Midlands, much like in London, are under huge pressure and have been for months," said the medic, who represents intensivists across the country.
Busiest day EVER for ambulances as coronavirus surge gets worse
Urgent SOS to doctors across city hospitals as sick and dying fill intensive care beds
He described a typical day on one unit including:
drafting in help from colleagues in other departments to help 'prone' nine patients in critical conditions - a life saving treatment which involves turning the unconscious, ventilated patient onto their front to aid ventilation, a potentially risky procedure involving a mammoth physical effort
supporting nursing colleagues brought in to provide care, but unused to the intensity of working in critical care, where death rates are incredibly high
breaking the worst news to heartbroken relatives, often over the phone - a situation he described as 'truly awful'
dealing with a two- and three-fold increase in referrals for intensive help every day
supporting colleagues facing their own private trauma of having relatives and friends dying or killed by the virus, then having to confront that daily at work
staff working in 'claustrophobic' PPE for hours at a time
extra beds crammed in, with two beds filling a space intended for one
He said: "In the last two weeks the situation has worsened incredibly fast. Many of our ICUs are working at double baseline (200% of normal capacity) - but this doesn't present a full picture.
"Normally patients requiring oxygen via high flow nasal and CPAP (high flow oxygen delivered via a nasal tube or mask) are cared for in our ICU, alongside those who are mechanically ventilated.
"But currently our medical colleagues are looking after many of them on the wards."
This is putting enormous pressure on staffing, as those patients still require higher levels of nursing care than on a typical medical ward.
Said Dr Arora: "In ICU we normally have one nurse to one ventilated patient. In many ICUs we are down to a ratio of one nurse to two or 2.5 patients - that can mean two nurses looking after three patients, or even five patients. They are supported by non-specialist staff.
"They are still delivering a good standard of intensive care but it is not the standard of intensive care that we would like to deliver. We would like to work at a much higher level.
Covid vaccine fury as care home boss admits giving jab to friends
Gavin Williamson issues update on whether nurseries will shut during lockdown
"But with staff stretched, and non specialist staff, it is difficult and that is causing even more stress.
"We are looking after twice as many people, taking two or three times as many referrals as we can normally.
"We are also proning a lot more patients (this is the method of flipping them onto their fronts to help their breathing.)
Intensive care staff manually 'prone' a patient with coronavirus - picture taken in a hospital in Brazil (Image: Getty Images)
"This would take half an hour or so - now we do it so often we are very slick at it and it takes 6-8 minutes. We call in colleagues from anasthesia and theatres to help us to prone, we need their help.
"Yesterday I had nine patients that needed proning; our theatre staff came in to support that. That kind of help is incredibly useful."
But he said the impact on exhausted staff was now taking a toll, with fears that staff would pay a price for months to come.
"Everyone is tired, the whole country is tired, we have had nine months of this. Everyone is feeling the stress."
A new study, published this week, reveals nearly half of intensive care staff reported symptoms of post-traumatic stress disorder, severe depression or anxiety, with one expert describing them as "suffering more than combat troops".
The findings, based on responses from 709 doctors, nurses and other clinical roles across six NHS hospitals in England, date back to June and July - and, said Mr Arora, the prolonged impact of the virus since had likely worsened the situation.
About 45% reported symptoms consistent with a probable diagnosis of PTSD, severe depression and anxiety.
More than one in seven clinicians and nearly one in five nurses working in ICU reported thoughts of self-harm or suicide, according to the study, published in the journal Occupational Medicine.
Said Mr Arora: "I have colleagues who have lost relatives and loved ones to covid, who have not been able to visit them due to distance or visiting restrictions. They have had bereavements of people in their families that they have not been able to see, and then they have to come in and treat other dying patients. It is very hard."
The Intensive Care Society is currently fundraising to provide group therapy sessions and psychological support to intensivists. Find out more and donate here.
Mr Arora said the lack of access for families had been "one of the hardest things to bear".
UK coronavirus death toll rises by 1,564 - the highest figure ever
Boris Johnson announces vaccine programme will run 24 hours day
"Normally we have open visiting to intensive care, we see the family members every day, we develop relationships.
"Instead we now have to ring them once or twice a day to keep them updated and it is not the same at all. It is very hard for families. They then hear a disembodied voice telling them the worst news imaginable - it is truly awful.
"We offer end of life visits but sometimes the next of kin is themselves isolating or ill with Covid. People get understandably angry, their frustration and grief spills out.
Clinical staff wear Personal Protective Equipment (PPE) as they care for a patient at an Intensive Care unit (Image: Getty Images)
"I am not blaming the families one bit, it is not personally directed but it is awful to know we are not delivering the best service that they all deserve."
Across the regions, hospitals are reporting that 70-75% of those admitted with coronavirus survive their ordeal. The mortality rate is highest in intensive care, where fewer than half of patients survive.
Pre-pandemic, a typical ITU would suffer a death rate among its patients of around 18%, with the vast majority surviving their stay, including post operative patients and trauma victims, said Mr Arora.
During the first wave that rate reached around 40% and is understood to be much higher now, in part because ICUs are now only seeing the most critical cohort.
"There is a lot of attention on the situation in ICU but this is only one part of the story," added Dr Arora.
"Our colleagues in medicine and A&E see many more patients with Covid and are also working flat out.
"This is a difficult point.
"I hope we can cope and will not see the worst case scenario and will see a more reasonable number of admissions in future. We will do our best to deliver safe care as much as possible."
And he added three vital messages, which he urged all residents to follow:
1. Follow national guidance - stay home if you can, wash your hands, wear face coverings, keep your social distance at all times
2. If you are sick, please get help
3. If you are offered a vaccine, go for it.
We have asked NHS England for an update of its plans to address the mounting crisis in the region's health services.