been a lot of discussion about the Gwent
area having a very high number of
coronavirus cases what does that look
like from your perspective as an
intensive care consultant what what's it
like in there right now we are
definitely seeing a large number of
cases as I've spoken to colleagues up
and down the m4 and I think we are
definitely ahead by a week or two in
terms of the rest of the m4 corridor in
cases that we're seeing we've actually
filled our intensive care unit now above
our normal capacity so usually we have
13 ventilated patients or what they call
level 3 patients so patients who need
maximal organ support and that's our
usual maximum number that we can take so
we've got 16 ventilated patients in the
intensive care unit of the minute which
has led us to completely run out of
space so we've taken over theater
recovery we've got a further eight there
I think by the end of today we will fill
recovery so that will bring us up to 25
patients and then we have another area
prepared which is the old high
dependency unit and coronary care that
we've taken over as well and we can fit
further 22 patients in that area the way
things are going at the minute the rate
of growth and the amount of admissions
that we're seeing I would say we will
fill that by the end of the week
probably by the end of the week so we're
looking at by the end of the week we
probably will have quadrupled our
capacity here then what happens and then
we'll have to find somewhere else to
we're at the moment where we're trying
to identify other areas that we can put
patients can you paint a picture if you
like of what it's like right now inside
your critical care unit if I was to walk
in what would I see what would I hear
it's controlled chaos at the moment just
in that space is a premium all of the
patient normally our our patient
population is made up of people who are
acutely unwell who are on ventilators
kidney machines strong drugs to support
the blood pressure there will always be
a few of them there'll be a few people
who are recovering getting ready to
leave the intensive care unit and then
there'll be a few patients who just need
a bit of supportive care who maybe
aren't as sick as the others the
difference at the moment is every
body is desperately unwell everybody is
on a ventilator
so the acuity or that or the severity of
illness that we're seeing is very high
the staff are all wearing full PPE so
what I'm wearing now but with this gown
the other way around
Plus goggles plus respirator masks or
fp3 masks and two pairs of gloves and
it's very hard to identify which staff
members are which so we've taken to
writing our names and roles onto the
front of the gang so that we can easily
identify people how would you describe
the atmosphere the atmosphere is if
we're doing what we're best at doing so
morale is high there's a great deal of
camaraderie we everybody is aware of the
severity of the situation and and I
think everybody is focused at the minute
on delivering the best care that we
possibly can to these patients they are
the patient population there are a lot
of people who are in work there are a
lot of people who are younger it's
certainly the pattern of illness that
we've seen in Gwen and I can't speak for
anywhere else is is much younger
patients than we were expecting you know
when the reports started coming out of
Wuhan we were led to believe that this
was something that was particularly
dangerous for the more elderly patients
but I would say all the patients we've
got an intensive care are in their 50s
or younger at the moment really yeah I
think that was surprised what a lot of
people know it's and it surprised us our
youngest patient is in the early 20s and
there are you know there are patients
who are very well you know a chap who's
a fitness professional that you know
there are a lot of patients who are not
do not have any pre-existing medical
conditions they're not diabetic or
anything like that if it's difficult
sometimes to identify your colleagues in
the unit presumably there is a real
challenge of communicating with with
patients as well yeah and that's a huge
that that's probably the biggest
challenge that we found so far the
patient's themselves on the whole are
unconscious we anesthetize most people
on ventilators just because it's very
unpleasant having a foot long plastic
tube through your mouth down the back of
your tongue and into your upper upper
airway so most people will need some
degree of sedation to tolerate that
it also means that they will synchronize
better with the ventilators they're not
fighting the ventilators they'll allow
the ventilators to do their job so the
vast majority of the patients are fast
asleep at the moment mainly for their
comfort and also to facilitate their
care can you have any visitors in the
unit at the moment not at the moment
logistically it just isn't possible at
the moment and that's partly for Public
Safety and how difficult is that for
everyone involved it's given that some
of these patients will be perhaps you
know close to their last days it's it's
incredibly difficult we are updating
people as much as we can we're we're you
know we've got dedicated people who are
phoning and updating relatives every day
we're also using email and we're able to
use video calling but it's a poor
facsimile of actually sitting down in a
room with proper human contact to be
able to give someone a hug or you know
or offer them a hand if they're if
they're upset it can I ask you yeah if
if you have a patient who is in an
end-of-life situation can the family
come into the unit thankfully we haven't
been in that situation much yet we are
looking at potentially finding a way to
allow family members to come in
accepting the risk and wearing full PPE
I mean it's the last thing we want to
deny anyone time with their family
member if they're going to die but the
practicalities of that we haven't ironed
out yet the danger is that then you know
we if particularly if if you've got more
elderly patients who have succumbed to
the disease if their relatives are of
similar age which they often are wives
spouses etc you you you know there's a
real intangible risk that if the disease
is transmitted to them that they could
end up in the same situation so have you
had patients dying in the unit from
coronavirus yes can you explain to me
why someone can die after having
contracted coronavirus what we know is
that primarily the corona virus causes
respiratory failure so when it spreads
to the lungs that causes a what we call
a pneumonitis where the lungs become
very wet and water
in sight so the normal mechanisms that
keep fluid in the blood breakdown so the
the little membranes and tissues and the
basis of the lungs become porous and
that allows fluid to leak in from the
circulation into the lungs
almost like drowning one of the things
we provide with the ventilators is we
can provide pressure which pushes some
of that fluid out and helps to keep the
lungs open so one of the mechanisms that
people become exhausted is because the
work of breathing is so great that they
basically become exhausted and die so if
you imagine your lungs are normally like
a nice light sponge lightly easy to move
if you've ever pulled a sponge out of a
bucket of water you know how heavy and
and wet they can you know a sponge can
become it's exactly the same thing if
your lungs are absolutely sodden then
it's very very difficult to breathe them
what happens over time is people's
oxygen levels fall the levels of carbon
dioxide which is a gas you normally
breathe out rise in the blood that makes
you even more drowsy as a narcotic
effect and then people will slowly
develop worsening respiratory failure
and eventually they'll become
unconscious and their breathing will get
more shallow and they will die so that's
what would happen if you were left alone
thankfully we can intervene with a
ventilator and prevent that from
happening but the deaths vary from multi
organ failure which is basically a
progressive shutdown of all the
different organs including your kidneys
your circulation failure of your liver
as well as your lungs so we've seen that
but we also see patients who develop a
thing called a myocarditis lot lately in
you know often when they're starting to
recover the heart can become very
adversely affected by the virus and they
develop heart failure and that's been
probably the leading cause of death in
the in the Kovac patients that we've
seen you had coronavirus what was that
experience like
not one I'd like to repeat started off
quite innocuously I had a bit of a
burning sensation in my nose I lost the
ability to smell even though my nose was
clear it wasn't bugged up I didn't feel
too bad for the first three days and I
thought well if this is as bad as it's
going to be then okay should be okay but
actually as that as the week went on I
felt worse and worse and worse
I developed terrible muscle pains joint
pains I was exhausted just on on minimal
and even walking up the stairs I was
getting short of breath and having to
lie down for a while afterwards just on
the subject that we were talking earlier
I spoke to one consultant in Swansea
yesterday he said the worst thing is for
patients who are in their later phases
of their illness where they can't have
visitors around the bedside and that's
heartbreaking for staff and for for
firmly as he said when these patients
are on their own during the art the last
hours of their life it's awful
and it flies completely flies in the
face of everything we've ever done you
know a lot of patients will not survive
intensive care even you know not in the
middle of an epidemic and we are very
used to providing a good environment for
people to have a comfortable and
peaceful death with their families
around them and we have psychologists we
have excellent nurses who are
specialists in end-of-life care and we
you know although it's a high-tech
environment we can provide a really
peaceful and compassionate end for
people and we really pride ourselves on
that and this is completely disrupting
our ability to deliver that and no
amount of video calling or phone calling
can can make up for that and that's
something I'm very worried about and
we're very lucky that we haven't had
many deaths at all yet our intensive
care strategy is working but in coming
weeks this is going to be a huge huge
problem and I'll have to be honest it's
not one that we've cracked yet that you
know the sensible thing to do is pull
away yeah how are you feeling about
about that there are a huge number of
things that are not normal about this
situation and that's one of them and I
will do my level best the one thing we
can do and that we are able to do and
that I will do is we can even if the
patient's family can't come in is we can
be there
you know a doctor will be that nurse
will be there our team of very caring
and I will you know if necessary we will
sit with those patients and hold their
hands and I no one should die alone and
no one should die without someone
holding their hand and talking to them
but ideally it would be the family but
as I say the minute we haven't quite got
to the stage that we can facilitate that
are you envisaging
where you might have to to russian
healthcare in a worst case scenario at
the moment we've got sufficient capacity
to deal with the demand but as weeks go
on if we don't see a slowing down in the
infection rate and we don't flatten the
curve then we are going to runt start
running out of space and that's when
very difficult decisions are going to
have to be made I hope to god that I
don't have to do that but it may happen
and we've seen it happen in Italy as
well access to ventilators for instance
for instance yeah but it's much more
than just ventilators it's its staff as
well so you there will be enough
ventilators of one shape or form but you
need a whole gamut of staff at least
five staff to knit to safely look after
someone on a ventilator and if you don't
have the prompt you don't have that
resource in terms of staff available if
you don't have enough staff what happens
is that your outcomes start to get worse
can I ask you what were your message to
the public would be now from your
perspective inside yeah my message is my
two message to the public of the minute
would be one keep doing what you're
doing please support the NHS we really
really appreciate it and it's all the
thanks we need but the other thing
that's massively important is please
please listen to government advice on on
staying in don't go out unnecessarily
don't pop to the corner shop just to buy
some milk please please adhere to the
advice because at the minute we've got
things just about under control in two
weeks time if infection rates rise even
further with this is going to be a very
very different situation and it's going
to be very frightening and people really
need to heed that advice and be aware
that you can get this at any age and in
any degree of health don't think that
you're so young and healthy that you
won't get in because we've seen people
again and again developing this illness
when they've had no medical problems
before at all you've been working in the
NHS for how long 20 years do you think
that this particular experience will
will change you yeah I don't know how
yet because you never know in the midst
of it do you but I think it will change
I think it's going to change the whole
world but I think that it will change
the NHS
massively in terms of the way we do
certain things I think the NHS will
become more efficient in some respects
and what about you what about your view
now on the profession you joined that
hasn't changed that hasn't you know I
joined in intensive care to save
people's lives and that's what we're
going to continue to try and do I just
wonder if if you have a message to the
families of those who are in this unit
and who perhaps can't be with their
loved ones yeah yeah and I can't imagine
how awful it must be to not be able to
sit with your family members when
they're this unwell please please
believe us when we said we will do
absolutely everything we can to get them
through this and we understand we
understand how difficult this is please
bear with us but we you know the one
thing I can absolutely promise is
irrespective of what happens to your
family member we will always be there
and we will always do our best to make
sure they're comfortable and that
they're not on their own we are all
there and this is the reason we chose
this job is so that we can you know give
comfort to people who are critically on
well and we'll continue to do that I
mean you're immersed in this in the
midst of this outbreak at the moment how
are you feeling at the moment
emotions emotionally we're very you know
I guess it goes with the territory you
become very good at putting these things
in a box they all go in a box somewhere
and one day they'll come out of the box
but now it's not the time so we'll
address that when we come to it but at
the minute it's just to focus on um you
know the tasks that we've got at hand
which is absolutely Herculean task what
are you finding
currently the the most difficult
decisions that you're having to make in
the unit as I say so far because we've
we were very very aggressive very early
on in the outbreak that we have still
got capacity to take patients who will
benefit from intensive care we haven't
had to make any decisions based on
availability of equipment and I am
dreading if we ever get to that stage
what do you find the most striking
difference
about treating patients with this virus
then you would normally be in an
intensive care unit role the the biggest
thing is lack of contact with people's
families that's the one thing that is
really playing on my mind and it's the
one thing that I know my colleagues are
very worried about as well is that we
you know we we don't just treat patients
we treat patients and their relatives
and their families and we provide them
with support and it's very very
difficult to do that remotely I think
that's got to be our biggest our biggest
worry I mean they all they can do at the
moment relatives of patients we've got
is trust us that we will do everything
that we possibly can don't listen to
adverse media reports talky of rationing
or or lotteries or people making the cut
to come into intensive care if your
relative will benefit from intensive
care we will bring them in but that's
not to say that we will bring everybody
in because some people will not benefit
and that would be the same if we had if
we didn't have a pandemic do you think
you're going to weather the storm here I
hope so I hope so it really depends on
the next few weeks if you look at the
picture I've seen some of the public
health projections and there are two
sets there are there's a set if we
flatten the curve I think we will deal
with what comes in as long as we can
keep patients flowing through the
hospital and get them out when they
start to get better I think we will
weather the storm
if particularly if the public ignore
distancing advice and people you know
it's this is going on for a while there
there may come a point where people
think actually do you know what I've had
two weeks at home I'm gonna start with
venturing out again if that happens that
the the rate of infection will rise
again and we cannot take another spike
in infections if we can flatten the
curve we've got that young for you here
well that would mean that we would run
out of space we would run out of staff
we would run out of equipment and we
will have to you know the rationing that
you spoke about will have to happen and
that's the one thing we don't want to
happen if people get bored and they
leave the house and then the infection
rates start to spread if we it will be
like a wave and it will wash the
hospital away and you know the fallout
from that will be absolutely
catastrophic and I can't emphasize that
enough
it must be particularly difficult for
you and your colleagues seeing that
quite a few NHS workers have have died
from this now yeah yes absolutely
terrifying and again it's a reminder
that you know the NHS staff you know
there is a reason why we all do this and
there's a reason why people are willing
to willing to risk their lives to look
after patients with coronavirus and it's
because that's what we all signed up for
but it's the last thing anyone wants to
see as health care workers losing their
lives but it again it's a reminder that
the virus does not discriminate on your
status on your age on your job title and
actually it doesn't care that much
whether you've got pre-existing medical
conditions you know these some of these
health care workers are healthy people
and that's absolutely you know that's
terrifying I think that everybody who's
working here would try not to think
about that too much but everybody's
aware of it which is why we're doing so
obsessional about making sure that we
you know check our PPE check each other
and keep each other as safe as we can
but I'm afraid that won't be the last of
it we will see more health care workers
dying with this
you