NHS WORKERS BATTLING THE CORONAVIRUS PANDEMIC HAVE BEEN THROWN ONTO THE FRONT-LINE OF THE BIGGEST HEALTH CRISIS IN LIVING MEMORY. NOW A NATIONAL SCANDAL HAS BEEN EXPOSED, WHERE A LACK OF TESTING AND INADEQUATE PROTECTIVE EQUIPMENT HAS LEFT THEM EVEN MORE VULNERABLE. MANY WORKERS ARE EXPOSED TO LETHAL DOSES OF THE DISEASE AND RATES OF INFECTION AMONG HEALTH WORKERS ARE DISPROPORTIONATELY HIGH. SEVERAL HAVE DIED.
WE HAVE INTERVIEWED THREE NHS WORKERS FROM DIFFERENT HOSPITALS IN SOUTH WALES. THESE WOMEN WORK AT VARIOUS LEVELS OF THE HEALTH SERVICE WITH COVID-19 PATIENTS. NONE HAVE BEEN TESTED FOR THE VIRUS. UPON REQUEST, AND DUE TO PRESSURE FROM HEALTH BOARDS*, WE HAVE PROTECTED THE IDENTITIES OF TWO WORKERS, ‘ANNA’ AND ‘AMY.’
11th April 2020. Words by Faith Rhiannon Clarke @frclrk & SC Cook @s_cook
All Images: Copyright Steve Eason (Taken during the junior doctors strike , 2016*)
A junior doctor in her early 30s, Anna never thought she’d be discussing her will right now. But with her and her husband both doctors on the frontline of the Coronavirus crisis in Wales, it seemed a necessary conversation to have.
“Every day we’re reading that nurses and doctors are dying. And that’s definitely become more frightening over the last two weeks,” she says.
“I’m confident I’d keep doing it no matter what. But I was shocked that there was never a question of… whether we were up for this, whether we felt psychologically or physically strong enough to do it. That was never questioned. It was just, this the job in hand.”
When cases of Covid-19 first appeared in Wuhan, China, in December last year, none of us could predict we’d be living in the midst of a global pandemic just months later.
Fast forward to March and the world outside of our homes seems like one described in dystopian fiction: make-shift hospitals in sports stadiums here in Wales, temporary morgues set-up in Italy, elderly people dead and abandoned in care homes in Spain, and the creation of mass graves in New York, one of the richest cities in the world.
The Coronavirus pandemic has seized the world. At the time of publication, there are more than 1.4 million recorded cases worldwide – but this rises by the day.
Yesterday, a record 980 daily deaths were reported in UK hospitals, taking the total figure of the last 3 days to 2,779. The true number for this period could well exceed 3000, as many deaths that occur in homes and care facilities are not recorded in the official figures.
The numbers on any given day now dwarf historic disasters such as Aberfan, Hillsborough and more recently Grenfell. But in many ways, the scale of loss often seems downplayed by government and much of the press. “The media sort of kept on selling this to us as the old and vulnerable that are going to die while it was coming across the shore to us,” Anna says, pointing to the fact that many younger people are also among the growing list of fatalities.
In Wales, 4,073 people are currently infected – though this figure is expected to be far higher due to a serious shortage of testing.
As the NHS prepares for a predicted peak in May or June, health workers are becoming increasingly anxious and worried about how an already underfunded and understaffed NHS will cope at the height of Covid-19.
For Anna, a BMA member and junior doctor working at a major South Wales hospital, she’s seeing patients with Coronavirus every day.
“I’m actually working pretty much in the main bit at the moment…” she says as we talk over the phone. “Lots of people are coming in with Covid….The numbers [are] definitely increasing very fast.”
She says she’s been “unlucky” – ending up working in general medicine while she completes her training as a GP. Her rota has been changed from a normal 9-5 with additional on-call hours, to a pattern of three on, three off, often working long and laborious night shifts.
30 new Coronavirus patients were admitted to her hospital over the weekend, and while Anna says that doesn’t sound like many, she stresses that these are only the serious cases – many who aren’t sick enough stay at home or in nursing homes, where the virus continues to spread.
“The numbers are gonna be so much higher than we’re ever capturing – because we’re only ever capturing what’s in hospital.”
The caseload, she says, is “doubling every three days… it’s gonna be a tougher shift every single time we go in.”
She goes on to say the next month “will be really the testing time, because we’re expecting, around the 18th of May, for things to really peak in the case numbers…Staff sickness is going to be at its worst when case numbers are at [their] highest. And that time is going to be so tough.”
“When the nurse starts to panic, then everybody should panic.”
Now in her mid forties, Amy has been a nurse for 25 years and works at a hospital in Cardiff. When we first speak to her, on 18 March, she’s calm and collected. No Covid patients have been admitted in her wards yet.
“We’re not panicked at the moment,” she tells us over the phone. “[But] I think the saying is, when the nurse starts to panic, then everybody should panic.”
It was clear that Amy was cautious about becoming complacent.
“I think one day we are going to be going into work and we won’t know what’s hit us,” she says.
When we catch up with her again in early April, a few days before publication, it’s clear the situation has changed.
“There’s two wards full nearly [of Covid patients],” she tells us. “… Some are palliative care. Some are actually rehabilitating.”
This will soon be Amy’s working environment – wards full of around 30 Coronavirus patients. Her mum, she admits, is “very worried” for her safety.
“Because you’re seeing stuff in the press that people are dying because they haven’t got the right equipment. You know, the PPE.”
“But [hospital management] are telling us that that is the right equipment – just the gloves, apron and masks.”
Lack of Personal Protective Equipment – or PPE – has sparked a wave of anger in Wales and the UK as a whole; with reports of GPs buying their own PPE or having to wear disposable items more than once. Both the UK and Welsh Government have been heavily criticised by workers and their unions for failing to provide adequate PPE despite promises. At the end of March, the Welsh Health Minister Vaughan Gething caused anger when he dismissed people’s concerns about PPE as ‘localised challenges’ in an interview on Politics Wales.
“I mean, where were the preparations for this?” asks Becky, a healthcare assistant at Heath hospital, Cardiff and UNISON member.
“If we’re preparing for war, we’ve got all the money for that. But where’s the preparation for this? I mean, we’ve got nothing.”
“We’re not given [gowns],” Becky – her real name- continues. “we’re given pinnies – [we’ve] still got, you know, wrist-length gloves…They’re telling us… the surgical masks will have to do…even if we work around the corona patients.”
This is something Anna, the junior doctor, can relate to, telling us that she is given almost the exact same type of PPE that Becky describes.
“I don’t think our local area is doing anything wrong,” Anna says, explaining that they’re just following “government guidance.”
“I just can’t get over how different the government guidance is from the WHO. The WHO have been very clear about the types of masks, the types of gowns…..we’re given an apron… It’s just a pinny.”
She tells us they were recommended to buy their own scrubs, “because they said don’t wear your own clothing in there, wear scrubs. But the hospital isn’t supplying scrubs.”
“We did get given a poster which basically said…empty your washing machine without touching anything…and wash it on 60 you know? It was all good advice, but… I’d be amazed if Italy, France, Spain are doing the same.”
Anna’s even brought a pair of goggles, but the advice over how to keep these clean has been confusing.
“They’re just advised us to wipe [them] down after we’ve been in to see the Covid positive patients…Again, that’s something I’m taking home, keeping in my bag. I don’t really know if that’s right but we’re not being given any other advice.”
When local builders offered her proper FFP3 masks – the international standard – Anna felt unable to accept because not everyone could get hold of them and work has said they’re not necessary. But she knows this could put her at greater risk of getting lethal doses of the virus.
Perhaps most shockingly, Anna says the guidance around PPE seems to have changed based on availability of equipment rather than medical need.
“When this first started,” she explains. “That was the type of gear that we were originally given [full PPE]. But they scaled it back…. the advice is pretty flexible really.”
It’s clear that many frontline workers are feeling completely unprotected in the fight against the virus. In Wales, 1216 NHS workers have signed an open letter calling on the Welsh government to take immediate action to fix the situation. A crowd-funder has even been set up to provide equipment where government has failed.
The trade union UNISON has set up a dedicated whistle-blowing hotline for workers to report lack of PPE in their hospital or care home, and says thousands have contacted them with ‘harrowing stories.’ On Saturday, the union in Wales wrote an open letter to First Minister Mark Drakeford, saying they were “being inundated with very scared and anxious workers” who had still not received PPE. “This is killing our people,” the letter said.
In Detroit this week, workers protested at their own hospital with a sit-in because they had to deal with 20 or more Covid patients each, and were not allowed to change their protective equipment for an entire 24 hour period. There are reports of workers taking similar action in Greece and New York.
Earlier this week a care home owner warned of mass deaths of residents from Coronavirus due to a lack of PPE and funding. On Friday, the deaths of two nurses, Aimee O’Rourke and Areema Nasreen – who had both tested positive for Coronavirus – sparked a furious backlash over the safety of frontline workers.
There is not only outrage over lack of PPE in general, but also how medics from Black, Asian and Minority Ethnic (BAME) are being disproportionately affected by the shortage.
This week, a senior heart surgeon at Cardiff’s heath hospital, the 62 year old Jitendra Rathod, became the first health worker in Wales to die of the virus.
“Some of my junior colleagues are quite frightened because they don’t feel that the PPE that we’ve got is adequate with the diagnosis of Covid,” Amy tells us.
Her ward is next in line to deal with a predicted influx of Coronavirus patients. They’ve got gloves, aprons and basic surgical masks available but she tells us they won’t be given FFP3 masks, which provide respiratory protection against viruses.
“We’ve got some in stock but what they’re telling us [is] we don’t need them unless you’re actually dealing with [the] air way,” Amy explains.
“But…one of my colleagues worked on one of the wards and… she said they were coughing and there was phlegm everywhere.”
“They want the proper masks and the proper gowns and the, you know, the caps to put over your head… the goggles,” she says. “They want it all.”
“I mean, we’re going to be working in a 30 bedded ward. And our main Nightingale Ward is full of 18 patients coughing and spluttering. That’s why they’re frightened…you’re probably gonna be in there about two hours at a time. You know, not coming out.”
“I try to reassure them,” she says, composing herself. “25 years I’ve been a nurse this month..it’s very hard to reassure people.”
In a sign of how desperate the situation is, a local high school, Ysgol Bro Morgannwg, have supplied them with plastic visors – presumably made in the school tech department – which they’ve been extremely grateful for.
But for young NHS workers at the start of their careers, it’s hard not to feel vulnerable when you’re relying on a local school to make PPE on 3D printers.
“…care workers and surgeons even, they’re dying – so they are going to be frightened,” Amy admits.
“I’ve asked for a test daily, practically begged”
In a sign of the chaos at the heart of Welsh Government’s response to the crisis, work only began last Tuesday on the first of four drive-thru test centres to operate in Wales, with plans for key workers to be tested only. But this comes just weeks after testing centres in Wales were shut down, as Welsh Government followed Westminster in the adoption of the now discredited ‘herd immunity’ strategy.
In South Korea, “convenient” testing points have been operating for weeks, where around 20,000 people are being tested for Coronavirus every day in “drive-thru” and “telephone booth” style testing centres.
At the moment, Wales is only testing around 1,100 people a day. First minister Mark Drakeford said last Friday that the NHS is on the “way” to have 9,000 tests a day over the rest of April. According to the BBC though, this isn’t necessarily the case, and Welsh Government is now understood to be planning for 8,000 to 10,000 tests a day by mid-to-late May. Scores of health workers remain untested.
When we caught up with Becky a week after the initial interview, she told us she’d been isolating for nearly a week with Covid symptoms, though was starting to feel better.
“I’ve asked for a test daily, practically begged,” she said. “I was ignored for a few days…then a deputy manager rang me Tuesday and informed me that I could not be tested because I was displaying symptoms.”
Becky tells us that her partner – also a health care assistant but on a Covid ward – was told she wouldn’t get a test as she is not considered “essential staff.” Because of Becky’s symptoms, her partner also has to stay off work for fourteen days. With a test, the two could still be working if their results came back negative. The experience brings up a wider issue however. The politics of this crisis is one played out in a society already riddled with class inequality. While Becky and her partner cannot get tested as frontline workers – leaving them more vulnerable – the very richest can.
“You know it’s gonna last for years – this trauma.”
For Anna the junior doctor, Covid-19 is like a wave – forever edging closer to her.
“I found myself looking at numbers all the time,” she admits. “[I’m] doing that when I’m away from work, all the time, because it’s how close to the tide are we now? How close is this wave to us? It’s frightening.”
As a trained psychiatrist, Anna is concerned not only about the physical health of workers, but about the mental health of those on the frontlines.
She explains how many mental health professionals have been moved away from mental health services to help with efforts to treat Coronavirus patients – but this has consequences.
“I was pretty upset to see how many doctors have been pulled from mental health particularly,” she tells us.
“We all know that the trauma that our staff and patients are going to go through in the next few months is massive. You know it’s gonna last for years – this trauma.”
These issues are compounded by the inability of Anna and her colleagues to have a sustained amount of time off from work. It’s a big stress factor.
“None of us can go anywhere at the moment, that’s fine,” she says. “But to be able to take time off… just to refresh your mind and say I’m actually away from that place for a few days – it’s so important, and that mechanism for whether that can happen hasn’t been discussed.”
On top of this, medical staff are faced with, quite literally, life or death decisions, on a daily basis. The shortage of ventilators due to funding cuts means doctors have become arbitrators of who deserves to live based on age, fitness, and so-called “quality of life.”
“Having discussions about resuscitation and saying, normally you’d spend 45 minutes over this, but I’m doing this in five minutes – particularly for many junior doctors it’s gonna be heartbreaking, however strong and determined they’re feeling at the moment,” Anna says.
“I think there’s a lot of doctors that are approaching this as “I’m strong. I’m going to fight this, it’s novel and it’s exciting and all of that ego,” she says.
“But there’s gonna be people that are floored by it afterwards. You know the trauma, particularly of sending people away that we can’t help and saying ‘you won’t survive’.”
“Staffing levels were at breaking point before Corona.”
Impossible decisions are now having to be made with staff and resources already stretched to the limit. Many working in the NHS will tell you that years of austerity have had a devastating effect on the health service.
“Staffing levels were at breaking point before Corona,” Becky points out. “You know, the staff were at their own breaking point before Corona came into play. We were understaffed anyway.”
“I politically feel like it’s an underfunded service,” says Anna. “it’s [been] a neglected service for so much time and social care is much of that… I was pretty devastated to hear the Tories got in last time because you think well, they’re not the ones that are going to be looking after everyday people.”
These workers are now faced with the immediate and daunting task of fighting the biggest pandemic in anyone’s lifetime. But despite living in one of the richest nations on earth, they are often turning up to work without adequate equipment or even knowing if they have the virus.
It’s impossible to comprehend how they must feel about the days, weeks and months ahead of them.
“I suppose this is just my rotation,” Anna says, almost matter of fact. “This is just the next step that I have to go through, you know, this six months for me to complete my GP training and it’s just what I need to do.”
But at the same time, she admits feeling almost jealous of colleagues on maternity leave who don’t have to face this. If the situation was different, she “wouldn’t be having to deal with the sickest patients in the hospital” in what are extremely dangerous circumstances.
“I know colleagues that have said: ‘I actually want to contract it [Covid-19]… for a little while, just so I can have a break,’ which is phenomenal, you know.”
Anna pauses for a moment. “But I think we just… it all gets flattened out by this feeling of this is our duty and this is what we do.”
This sense of duty can seem all encompassing, but Anna is deadly serious about the long term consequences of this crisis.
“The bit that worries me,” she says, “is the colleagues that are maybe less aware of how risky it is for them as well.”
“The colleagues that really are approaching this as ‘I’m going into war and I’m going to knock this for six and we’re going to win.’ If those guys get very poorly, or have to leave their job, or even die, I think it’ll be even more of a hit. Because those guys are the ones that are so determined at the moment, you know, so certain that they’re in the right place and they’re doing the right thing…”
As Anna contemplates the severity of this moment, and prepares herself for the worst, I can’t help but think back to comments made by Prime Minister Boris Johnson on the sofa of ‘This Morning’ in early March.
“One of the theories,” he said, “is that perhaps you could take it on the chin, take it all in one go and allow the disease, as it were, to move through the population.” As the UK’s death toll reached a horrifying 5,000 in just the last week alone, the strategy outlined by the Prime Minister in this interview must never be forgotten.
Now, as the situation deteriorates yet further, with daily death tolls and hospitalisation at intolerable rates, the physical and mental effects on health workers cannot be underestimated. This is the true consequence of Johnson’s words.
“I mean, there’s doctors and nurses holding patients’ hands when they’re dying because their loved ones can’t be there,” Amy says.
In some cases, doctors may have to decide who’s life is more of a priority.
“I think that’s coming into you know, they are thinking of that,” Amy tells us, struggling to find the words to describe a scenario many would have thought unimaginable a few months ago. “Then who, you know… the fittest person I think will get the respirator, unfortunately. I know… I know the other day that ITU was full.”
The idea of seeing people die who may otherwise live, or holding the hand of a person who can’t say goodbye to the people they love, is understandably not something Amy wants to dwell on. Because not only is she risking her own health, she and her fellow workers are now facing a period of real trauma and pain as they look after those most in need.
“That’s what you’ve come into the profession [to do],” she tells us. “To care for the sick. And they are people that need you the most, and you’re the ones that can help them. You know, that’s what we all realise. And that’s why we are turning up every day to do it.”
As this article was due to be published on Saturday 11 April, we heard from Becky, who we hadn’t been able to get in touch with for the last few days. She apologises for not responding to calls, and sends a message instead: “Things have gotten really crazy at work. ITU filling with our own. Our staff dropping like flies. I’ve just heard of the loss of a truly wonderful nurse.* Everyone is very scared.”
This is the reality of the Covid-19 crisis in Wales and the workers who have been put on the frontline.