COVID-19 has raised unprecedented issues in the provision of healthcare. Therapy for COVID-19 respiratory disease encompasses various methods of oxygen delivery, with some using flow rates in excess of 100 l.min-1. Hospitals’ capacity to deliver a consistent oxygen supply has been a major concern, and in certain hospitals supply would have been exceeded without significant changes to the infrastructure.
In the August issue of Anaesthesia News, Dr Lim highlighted the impact of COVID-19 on novice anaesthetists. With a second wave predicted, we should again anticipate disruption for our novice trainees and be prepared to adapt our approach in order to maximise their experience. Here are some of the main challenges faced by new novices, with some potential solutions.
During the pandemic, elective surgery postponement, emergency rotas and the formation of intubation/ proning teams proved challenging for all members of our department, but in particular for trainees.
In March 2020 we received notification that all upcoming Health Education England meetings would be postponed until further notice because of the coronavirus pandemic. Our department’s education team removed the usual protected teaching time, and focused instead on ensuring our workforce were suitably upskilled to care for the anticipated influx of patients with COVID-19.
In spring, NHS staff responded to the looming COVID-19 pandemic with an impressive level of strategic planning. However, a small and unknown number of these doctors were issued with stark instructions from the government to shield themselves from the crisis. Facing an unexpected disruption to careers and training, shielding doctors found themselves confined to their homes. This disconnection from the frontline created significant practical and psychological challenges.
"Early on in the crisis, our department had the foresight to purchase 30 iPhones to enhance communication between ‘yellow’ and ‘green’ zones. When they hit the floor, my colleagues were quick to introduce new uses, of which the best was video-calling relatives."
This includes a response from the Association's Trainee Committee
"As the hospital Trust serving the region at the centre of the UK’s cluster of COVID-19 cases, it is fair to say that the management of these patients has generated a great deal of discussion within our anaesthetic department."
On 28 February 2020, the first case of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originating from Wuhan, China was diagnosed in Wales. The patient contracted the infection during his visit to Lombardy, where the outbreak in Northern Italy started to get a foothold. At this stage, the official Welsh strategy was containment and preparation for a potential outbreak, in line with the rest of the UK.
Institution of one-lung ventilation using a double lumen tube (DLT) or bronchial blocker in a COVID-19 suspect or positive patient might increase the risk of staff exposure to a high viral load, through shedding into the theatre atmosphere. ACTACC-UK recommends that it is vital to occlude access to the non-ventilated lung. However, the lung needs to be deflated before occluding the tube, and advice on how to do this safely is lacking.
Concerns around personal protective equipment (PPE) availability are headline news. The Health Secretary’s comment that ‘some staff may be mis-using’ PPE received sharp rebuke from the Royal College of Nursing. Public Health England (PHE) has struggled to offer consistent guidance on which type of PPE to use, and this in turn has led to some of the Royal Colleges issuing their own variant guidance. All this reflects difficulties in understanding some of the core issues.
The COVID 19 outbreak has posed many challenges for anaesthesia and critical care. Apart from the clinical burden, one of the biggest problems is getting hold of accurate information. There are many infuriating social media experiences of information from untrusted, and occasionally unnamed, sources being shared widely. Even though these might not be enough to persuade us clinicians to change our current practice, they can create anxiety about how we manage our patients. To combat this, Cochrane has put together some resources that bring together the best evidence-based practice.
Northwick Park Hospital in North West London has been one of the hospitals hit hardest by the COVID-19 pandemic in the UK. Having one of the busiest emergency departments in London, and a tertiary infectious diseases service, we were designated as an additional high consequence infectious disease ICU. During the transitional phase, we became one of the busiest hospitals in the UK with COVID-19 ICU admissions, reaching this at an earlier stage than others and with a greater mismatch between baseline-funded ICU beds and surge capacity beds, requiring a proportionately much greater and more rapid expansion. We write to offer some insights from the frontline about our management of hospital surge capacity.
Maximise your day while shielding
The current international pandemic is an unprecedented situation for our generation. It has changed our lives drastically in both personal and professional spheres. Who would have thought that working from home could be so hard?