“We’re preparing for another spike”: A London NHS hospital chief reflects on the peak of Covid-19

A diary by Royal Free Hospital chief executive Kate Slemeck, reflecting on Britain's first coronavirus cases, hosting camera crews and the prospect of a second wave.

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Kick off

Iremember vividly my day on 29 February. I was just leaving the London Stadium having seen my football team, Southampton, beaten by West Ham. I trudged to the station with my son, feeling a bit miserable. My phone rang, and it was our infectious diseases consultant lead at the Royal Free Hospital, Mike Jacobs – the doctor who led the team that treated Ebola at the Royal Free in 2015. He doesn’t usually ring me at the weekend unless he has to. “Kate,” he said, “this is really stepping up now. We’re going to have to look at how we manage our capacity so we can accept more patients – the numbers are increasing.” 

I spent the rest of that weekend at home on the phone as we planned for the following week. We would turn the infectious diseases unit – the whole of the 11th floor at the hospital – over to patients with suspected Covid-19, and move other patients out.

There weren’t many Premier League games after that, because the season was soon brought to an abrupt halt, but that was pretty much the end of football for me.

The first patients

Our first patient, on 9 February, was part of the skiing party in the French Alps with the man who, having caught the virus in Singapore, was later described in the press as a “super spreader”. The Royal Free was one of five hospitals first designated to take people with suspected Covid-19. I say “people” rather than patients, because the first patients we had were well – they were brought in for testing because they had been part of the skiing group. It was only through testing that they were identified as having Covid-19.

Later in February, as the weeks progressed, we started seeing people very ill with Covid-19. Staff were frightened. They were reading the papers and there was still an anxiety and lack of understanding about what Covid-19 did to the body. We could just see the numbers rising fast.

On 4 March we pulled staff together for a Q&A; it shows how the world has changed since then, because we held it in a big room at the Royal Free Hospital called the Atrium, which loads of people attended. You could sense the fear in that room. It sticks in my mind.

One of our infectious disease doctors explained what we knew, and what to think about: washing hands, trying not to touch your face and not being in packed rooms, shoulder-to-shoulder. We said we probably wouldn’t be doing this in future. It seem strange looking back on that day, knowing what we know now.

Scaling the peak

The week lockdown began on 23 March, we saw the numbers increasing significantly. The super surge was in Easter week, beginning 6 April. At that point, 80 or 90 per cent of our beds had patients in them with Covid-19 or suspected Covid-19. The only people coming in were those with Covid symptoms. It was quite extraordinary.

I’ll never forget that week because Easter didn’t happen in the NHS. People were amazing – we didn’t have a bank holiday, everyone shifted into seven-day working, and nobody complained.

Just as Covid-19 was surging in the population, it was surging in our staff as well. We had more than 10 per cent of our staff off sick at the time when we were busiest, and that percentage is probably an understatement.

Plotted on a graph, data for the number of hospital admissions is the shape of Everest, and it felt like we were climbing it. We were running a “major incident” – which hospitals call any event whose impact cannot be tackled within routine service – day after day after day. Personal protective equipment was a big source of anxiety, too. Sometimes we only had one or two days’ supply available, and we were never quite sure when the next batch was coming in. At the height of our Covid-19 admission numbers, we were using such high levels of oxygen that we were worried it would run out.

It was traumatising. The shifts for all staff were very tough and quite frightening. At the beginning, supermarket shelves were being emptied, which added stress for people. We provided free hot food to staff and opened up a free shop of donated goods for them. We also set up an advice line, and sent a psychological support team to help debrief staff before and after shifts.

It was extremely full-on for four weeks. I was working six days a week, and often spending the seventh day on the phone. I used to go running – exercise helps me clear my head – and I’m lucky that my husband works from home. He has dealt with our two sons, an 11-year-old and a 16-year-old (who’s delighted he doesn’t have to do his GCSEs). It was nice to go home to them at the end of the day, and I also feel blessed being able to go into work when others cannot.

Transmission

We started filming with a TV production company that made Hospital, the BBC Two documentary, on the day lockdown began. We’ve never courted that sort of thing before at the Royal Free London, so we were very uncertain whether it was the right thing to do. We checked with staff about how they’d feel having camera crews around. They were comfortable with it and felt this was a real opportunity to record the moment: history in the making.

The film-makers were very discreet. Talking to the services most involved, such the ICU, where they spent a lot of time filming, it seems staff have made lifelong friends with them.

I first watched it with my family; I had them all sit down on the sofa five minutes before it started, shouting "Come on, come on!" because I wanted to watch it right from the beginning, live. I don’t think the boys really understand what I do for work, they just know it often involves discussing beds! They were really moved by the staff’s commitment and the patients’ stories.

One story that sticks with me is Hussein’s: a patient who caught coronavirus shortly after his kidney transplant – the last transplant we did before lockdown. On 22 April I had done a shift on ICU alongside the nurses to see what it was like caring for patients and wearing PPE for 12 hours. The team I was working with was caring for Hussein. When I saw the programme, I felt a real connection with him and found it quite upsetting seeing how he was prior to becoming so ill. When I did my shift, he already had Covid-19 and had been fitted with a tracheostomy tube to help him breath. But it was also so uplifting knowing he was discharged safely home.

Phase two

We officially exited phase one of the pandemic two or three weeks ago, and now we’re planning for phase two – stepping up activity we had stopped, and prioritising patients who really need surgery and other clinical interventions that could affect long-term life expectancy or quality of life.

With lockdown easing, we’ve got to be ready for another spike. We did have a flu pandemic plan, but a Covid pandemic plan didn’t exist, so we are writing that up now. If and when we do have another spike, we are making sure we know what to do.

Kate Slemeck is chief executive of the Royal Free Hospital and leads its Covid-19 response.

As told to Anoosh Chakelian.

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