As news seeped out from Wuhan in China of a new, dangerous virus in late January, it triggered an emergency plan at a hospital thousands of miles away in Edinburgh. The infectious diseases team at the Western General had practised for a pandemic. Within 24 hours its plan was under way.
By early February, a building with dozens of single rooms dedicated to older people, rheumatology and orthopaedics was requisitioned as an emergency treatment facility, and a community-testing unit and a contact-tracing protocol was trained and mobilised. Full personal protection equipment (PPE) became mandatory and the intensive care unit started to expand, in time tripling its capacity.
And it worked, said Dr Claire Mackintosh, the Western’s clinical director for infectious diseases. “We completely changed the Western. Things which would have previously taken months, within 24 hours we created whole new teams and approaches, with real buy-in from the management.”
Everyone who had come from Wuhan with a cough or fever was tested. Nurses were despatched to people’s homes in full PPE, using a specially equipped infectious diseases ambulance. Routine intravenous antibiotic treatments for ill and vulnerable patients were immediately moved from the hospital into people’s homes, to protect their health. Macintosh also organised drive-through testing in the Western’s grounds – the first in the country.
Dr Rosie Baruah, the Western’s critical care consultant, said this was a first for the hospital, and a first for its teams. “We’re not London. We haven’t had a London Bridge [terror attack] or a 7/7 or had to suddenly look after a huge number of critical care patients. This is pretty much once in a lifetime,” she said.
By the time Edinburgh’s first confirmed Covid-19 case was detected in early March, the Western had tested about 600 people for the virus. Many were quarantined in the newly requisitioned infectious diseases building, occupying beds for at least 48 hours as their samples were dispatched to Colindale in north London for analysis.
The Western was effectively split in two – red wards and units for Covid-19, green wards for non-coronavirus medicine. Wards were emptied in preparation; specialist consultants and nursing staff quickly retrained for critical care and infectious diseases.
Patients on the ID ward: Ann, a suspected coronavirus patient who has now been tested and given the all clear. Above left: recovering coronavirus patient Michael Bowman, an NHS ICU nurse hoping to be discharged soon. He believes he was infected by a family member and not through his work. Above right: recovering coronavirus patient Robin Edwards who has been in hospital for many weeks but hopes to be discharged soon.
Unsure at the time about its infectiousness, virulence or the full range of symptoms, they treated every potential case with great caution. Meanwhile the “case definition”, the factors in a patient’s story that flagged them as at risk for Covid-19, kept on broadening, first to include travellers from China and south-east Asia, then to northern Italy.
After a ward round in the Covid ICU, doctors remove their personal protective equipment in a scripted order. They take off gowns, gloves, hat and visor on the infected side of the exit tent as they leave. Inside the tent they remove their masks and wash their hands before exiting the other side of the tent
That meant lots of locals who had taken February half-term skiing holidays in the Italian Alps and were experiencing shortness of breath and coughs were being tested; by 12 March, the Western had to drop its contact-tracing and community-testing programmes to focus on admissions.
In common with hospitals across the UK, the Western’s ICU had to expand, doubling its normal 16-bed capacity by taking over recovery rooms alongside operating theatres, which in turn became identified as potential ICU rooms if capacity needed to be tripled. In the event, Baruah said, ICU cases peaked before operation theatres were needed. The hospital has treated about 40 patients in intensive care since March, she said, with no cases of her staff falling ill from cross-infection.
Top: the staff entrance to the Covid-19 ICU on the far side of a protective curtain; medication is delivered by injection into a patient’s jugular vein operated by the bedside nurse. Above: each bed has an array of technology. Ventilators, syringe pumps, infusion pumps for drugs and pumps for feeding
But, for now, running two separate intensive treatment units will be the norm. Once the lockdown eases, Baruah expects routine emergencies and surgery critical care cases to rise, while the ICU is still treating a handful of critical Covid-19 patients and braced for a further outbreak. Those cases will need comprehensive separation and infectious disease protocols.
“There are so many unknowns,” Baruah said. And that fed anxieties and a sense of expectation among the staff. “I would much rather plan for a second peak and for it not to happen,” she added. Even so, both Mackintosh and Baruah agreed, this crisis had tested the Western and their procedures had worked. “In terms of our resilience for dealing with future pandemics, this will stand us in good stead,” said Baruah.