One year on: How one London hospital trust coped with the Covid pandemic

Tap above to watch video report by Martin Stew, words by Jonathan Mitchell

On March 10, 2020, Londoners were enjoying their last days of pre-pandemic freedom.  

Thousands crammed onto Tube trains and filled the capital’s bars and pubs, while the UK Government was defending its decision not to close schools, insisting that a “balanced response” was needed.  

The same day, Imperial College Healthcare NHS Trust had just admitted its first coronavirus patient. Covid-19 was not around the corner, but on their very doorsteps. 

Lead critical care nurse Melanie Denison talks to medical staff

“Apart from having a basic understanding of what PPE we should wear, we really had no idea”, lead critical care nurse Melanie Denison says. 

“We were looking at potentially three or four patients per ICU (Intensive Care Unit), but we ended up having over 140 patients in our beds, which came as a definite shock. 

“[There was] the constant worry we wouldn’t have enough nurses, knowing the number of patients we were having coming into our units and just feeling that there just weren’t enough.”

Two weeks later, the realities Covid being experienced on the wards of hospitals such as Imperial’s reverberated around the corridors of Westminster.

On March 23, the Prime Minister announced the UK’s first national lockdown, but by then hospitals admissions were already soaring. The virus had spread uninhibited for too long. 

The day after, Imperial closed all of its wards to visitors. On April 1, bed capacity for Covid patients had almost doubled to 143 beds as pressure grew.

Patient with coronavirus being treated in hospital

Three days later, the trust experienced its darkest milestone as 23 patients died of Covid in a single day. It remains the trust’s deadliest day of the pandemic. 

Staff watched helplessly as dozens of patients, some young and healthy, died hooked up to ventilators, unable to say final goodbyes to relatives.   

But it was not just fear for their patients that staff faced day-to-day, but also fears for their own welfare. As the pandemic raged, stories of the deaths of nurses and ICU doctors falling victim to the virus became commonplace.

“This time last year, several of us made our wills, which I think puts it into perspective”, respiratory consultant Clare Ross says.

Ernie Wong, consultant respiratory physician, adds: “Not only do you think about potentially infecting other patients and other colleagues, you think about your family at home. Is it safe for me to hug my children?” 

Across the NHS, staffing became a major issue. Hindered by a severe lack of testing, healthcare workers were asked to isolate for two weeks if experiencing Covid symptoms.  

Wards already under severe pressure were left without critical staff, and workers from other areas had to be redeployed to Covid wards.

At Imperial, almost 700 members of staff from all clinical and non-clinical groups were trained and redeployed to help the hospital’s Covid response. During the second wave, that number rose to 1,000.

Medical staff wearing PPE as patients with Covid are treated

Among them was nurse Nebil Saad. He said: “My experience of acute critical care was very minimal. And then I came here [Covid ward] and it was just bonkers.

“I wasn’t prepared for what I saw, the life sort of going from patients, it’s extremely harrowing.”

Mercifully, the effects of lockdown did eventually filter onto the wards of Imperial’s hospitals. By the summer months, admissions had fallen and elective care was restarted.

Attention turned to tackling Covid in the longer term, as developments for treatments became the focus of the NHS.

For this, Imperial was perfectly placed. As an NHS trust specialising in research, staff at the hospital threw themselves into the challenge.

Over the course of the pandemic, the trust has recruited 4,640 patients to 31 Covid-19 urgent public health studies.

The research, including the trust’s own REMAP-CAP trial, helped shape national guidance for treating Covid patients, such as the prescription of tocilizumab or sarilumab.

There was also the discovery of the benefits of dexamethasone, a cheap steroid easily available in the NHS, as a treatment which helped revolutionise Covid care just month’s after the disease’s discovery.

Professor Anthony Gordon, chief investigator on REMAP-CAP, said: “We were expecting an illness that would be confined to the lungs, but we learnt pretty quickly that this virus affected more than just the lungs. It affected the whole body.

“Now with these new treatments that we learnt about over the summer, that steroids such as dexamethasone help. Now we’ve got these other two drugs, that helps as well.”

While the summer provided some welcome reprieve for an exhausted workforce, the threat of a second wave loomed large over the NHS.

In September, infection rates rose once again and even though testing capacity had hugely increased since March, the virus spiralled out of control.

The emergence of new, more infectious variants of coronavirus accelerated its spread, and despite the progress of the summer health services faced being overwhelmed once again.

London was the first city to feel the effects of the second wave. Just days before Christmas, Mr Johnson took to the airwaves to order the capital’s residents to stay at home.

Boris Johnson seen during a virtual press conference at Downing Street in December

By January 20, the trust was treating 106 Covid patients on ventilators, more than at any time during the pandemic. But the better treatments has alleviated some of the pressure.

Professor Tim Orchard, chief executive of the trust, said: “The mortality rate is about 13% in our ICU compared to roughly 30 in the first wave, so a big, big difference.

“That was because we were able to pick up the lessons that research, and were able to feed that directly into critical care.”

As with the first lockdown, the pressure on hospitals has begun to fall. Hospital chiefs at Imperial plan to re-start elective care next month, while plans for staff to return to their usual roles has already begun.

For the hospital workers, the gradual return to normality is welcome, but the memories of the last year will linger.

“I think we’ve all been tested in one way or another”, Mr Wong adds.

“I think I’ve learnt a lot. As a team we’ve become a lot closer. We were colleagues, I’d definitely say we’re friends, great friends within the hospital.

“That’s the one thing I think we’re really lucky that we had each other during a really difficult time.”