Nightingale Hospital and this is what you REALLY need to know

Ok, so Coronavirus is a species of virus that has been infecting humans for thousands of years – tens of thousands of years. This Coronavirus, called SARS-CoV-2 (Covid-19 is the disease caused by SARS-CoV-2), happens to be a new variant that humans aren’t used to.

First off all, remind us how the hell we got here in the first place?

Wherever it came from, bats or otherwise, this specific virus was born out of a random genetic mutation that shows a strong biological affinity for our cells, specifically those in our lungs and our throats. It is so contagious, so there is almost no conceivable route by which anyone could be innately immune to this bug, unless you’re literally going to live in complete isolation from the outside world. It would be like trying to avoid air.

Or sunlight. It’s technically feasible but ludicrously hard. So what we’re trying to do is to limit it. But, as Jeff Goldblum says in Jurassic Park: “Life finds a way”.

Do you think we’ll have a second, more forceful lockdown? If so, what can we all do to prevent this?

It is most unlikely there will be a tightening of the current lockdown. The next few weeks will likely see a gradual lifting of restrictions, starting with the least vulnerable (young, fit people living independently) undertaking low risk activities that do not involve large numbers of people in close proximity. The risk is that if we lift restrictions too soon, people who have been successfully isolating could be exposed to the disease ‘en masse’ and we could then see a second peak of infection, which could necessitate a re-introduction of lockdown measures. Worryingly, those countries who enforced lockdown earliest and most strictly are at greater risk of this secondary exposure as their populations are largely naïve to the virus.

And what’s your medical background?

I’m a Consultant Pathologist; that means I’m a trained medical doctor who has chosen to work in laboratories (rather than on wards) to diagnose cancer and to run mortuaries. I also do non-criminal post-mortems and go to the Coroner’s Court to investigate unexplained or unnatural deaths. I have an interest and experience in end-of-life care and I’m a trained Medical Examiner, so my team and I make sure any deaths in hospitals are independently scrutinised to identify any errors, missed opportunities or areas of potential learning.

How come you were seconded to the Nightingale Hospital?

I was called by a colleague to set up their bereavement service and act as Medical Examiner, to oversee the legal certification of every death – all in a hospital that’s never existed before. This means teaching our volunteers how to tell families their loved one has died, what to do next, that to explain why they won’t be allowed to see their loved one, which funeral home to contact – if there even is a funeral home for them to go to. Because unfortunately many are at full capacity or have closed due to staff safety and self-isolation. And since we’re in London, we have many international patients whose families want them to be buried back in their own country; logistically this is tricky, because there aren’t many transport systems that will take a Covid-19 infected body right now. I personally don’t have any contact with patients (living or deceased); my team does, so I deal with all the managerial and legal stuff to make sure they can do their jobs happily and efficiently.

Why are the Nightingale wards so empty? Around 50 patients have come in, yet there’s capacity for over 3,500.

A few reasons. We haven’t seen the huge spike in admissions we were expecting, which is a good thing. Normal hospitals have massively increased in capacity to look after Covid-19 patients, because before we opened on April 3rd there was no other option. Unfortunately this means they’ve had to stop virtually all other care, from cancer screening to curative surgery and IVF clinics in order to focus on Covid-19 victims. The wards in which these things would be done, including operating theatres, have all been converted into intensive care units (ICU) and Covid wards. All the people who usually work in cancer, clinics or surgery (and anyone with basic medical skills) have been seconded to Covid care. If the Nightingale had been built earlier, it would probably be more full and we could have helped sooner.

So why aren’t hospitals transferring their patients, or diverting their ambulances, to the Nightingale now?

The Nightingale is not an acute hospital; it doesn’t have an A E so it can’t take patients directly from the community. It’s essentially an enormous ICU, so we only take patients who have confirmed Covid-19 and who have been sent to us from local hospitals that don’t have space for them. They arrive already intubated and unconscious (you have to be unconscious to have a tube down your throat) and we support them in a highly specialised way that’s also safe for staff. We communicate with their families and manage their end-of-life care if they don’t survive.

We can’t admit patients who have certain underlying illnesses (such as heart conditions or cancer), because we don’t have the specifically multi-trained staff or facilities to treat them. This is what’s getting negativity from the media, that our wards are ‘empty’. The truth is Covid-19 overwhelmed the entire NHS system: there simply aren’t enough ICU trained staff in the UK to handle this pandemic. You can get Maclaren and Dyson to make as many ventilators as they want, but they’re useless if you don’t have the staff with the knowledge and experience to use them. Meanwhile, NHS hospitals continue to train their own staff to work in ICU because we know this is still going to go on for some time, and we need to ensure there’s staff cover for those who go off sick.

What’s the Nightingale Hospital like?

It’s based at the ExCel Centre in East London, which is 100,000sq m (imagine 14 Wembleys football pitches). It is divided into South and North wings by a massive central corridor that runs the length of the building. Each wing is partitioned into groups of self-contained wards, and there is strict separation between the wards and general areas to prevent spread of infection. To look at it’s very simple, because it was built by the military to be highly efficient. It is so large that even when we admitted our first patient at one end of the hospital, the finishing touches were still being put to some of the wards at the other end of the hospital almost half a mile away. It has a Docklands Light Railway station at either end! It has the capacity for about 3,500 patients. Although most patients are brought in by ambulance, and they’re all coming direct from another hospital, not from the community. They come alone, intubated and unconscious, in a hospital gown with their notes.

What happens when they wake up?

They’re given clothes. Marks Spencer provide free packs of essential clothes for every patient that leaves the Nightingale. They’re usually sent back to their local hospital from which they came, where all their belongings are securely held. But sometimes if they’ve come in with those possessions (such as dentures and jewellery) we have a standard operating procedure on what to do with them and how to store them. And that’s something we’ve had to teach and set-up, because many of the staffers and volunteers here are non-medical scientists or nurses or healthcare workers who may never have had to do this kind of thing before, or have never seen a dead body before.

What’s the mood there like today?

The mood is purposeful, which in the NHS is a great feeling. It can be draining and of course, sometimes it can be difficult to see the good in what you do and what you achieve. But the Nightingale is a place where each member of staff has chosen to do a job and to make a change. It reminds me of being on the medical ward on Christmas day. Sure, you’d rather be at home with your family but there’s a job to do so everyone pulls together and brings the best of themselves.

How do you feel to be working there?

I feel proud! The hospital is getting stick from the media, which upsets me; that’s no reflection of the people working there. There is an argument that if we had built the hospital sooner we could maybe have helped more people, but as a contingency plan I think it’s a success if it never fills up. The hospital is a good example of what we can achieve if the chips are down and there’s no Option C. If anything, it’s a great wakeup call and good experience for the future if we were to once again be confronted with a new untreatable illness.

You’re not ‘frontline’, but you know loads of people who are. Give us some insight into how they’re feeling right now?

Many are worried about catching it, but mostly about spreading it to other people and their families. So to be asked to work in intolerable conditions with a serious lack of PPE protective gear makes it really hard to feel positive and confident in your work. Right now there are people in suits who have never seen a patient, going on TV saying ‘we have everything we need, they should be fine,’ and quite clearly the wards don’t tell the same story.

If your shift manager says to you: ‘here is a person whose life depends on you’, and they don’t give you the tools or items you need to get the job done, you get angry. It’s like cooking with oven gloves on; it doesn’t just give you a physical barrier it gives you a psychological knowledge that you can do what you want to do naturally – like reaching into an oven and touching something boiling hot without a second’s thought. But imagine if you were a head chef and asked your team to cook for 300 people, but you only had enough oven gloves for two sous-chefs. It brings uncertainty and mistrust into a situation that doesn’t need either.

Be honest: is the entire general population likely to catch Covid-19?

Yes. Left to their own devices, everyone will catch this. There is no mechanism by which people won’t get it.

Have you had Covid-19?

I have tested negative for the virus once, although the test is imperfect and shows a false-negative result in around 25% of cases. I have most certainly been exposed to it through confirmed family and work contact and it’s most likely that I’m one of the many people who showed no symptoms when infected. Exactly how many people were infected, but showed no symptoms or knowledge of carrying the virus, is one of the most interesting questions we hope to answer in due course. Understanding this group of people is very important if we are to control the next large wave of infection in years to come.

How do you feel when you walk out onto the street on a Thursday at 8pm and everyone’s clapping?

I can see how unifying and comforting it is – people feel helpless right now and acknowledging key workers is a brilliant thing to do. But I have to be honest, I feel embarrassed when standing in the street and people are clapping in my direction. It’s a job. I don’t do it for applause. You become a healthcare worker because you’re either good at science, you have an innate need to help people, you want a solid career or you have a high tolerance for pretty gruesome things (or all, like me). Then it becomes your life and it’s a responsibility. The clapping is very kind, but it feels strange. That’s just my personality; pathologists are generally not chosen for their people skills.

Can you give some examples of tangible things the general public can do to help frontline NHS workers?

I think clapping for the NHS is a great start. It gets everyone together (but not too close!) each week to think for a few minutes about something they might not otherwise think about for the rest of the week. We should not, must not, idolise the NHS. It is not free; we pay for it through our taxes. But we must not forget to recognise it for the great work it does for all of us irrespective of who we are, where we came from and how much cash we have in our pockets.

If you have an NHS worker in your family, street or social circle, offer your help. Ask if they are doing shifts that prevent them shopping. Offer to feed their cat, get them milk or wheel out their bins. A little token of friendship goes a long way. Draw something on the pavement to make them smile when they’re leaving the house at 5am to go and look after 20 unconscious patients.

If you are feeling very unwell, call NHS 111 or 999. There is evolving evidence to suggest that very sick people are avoiding coming to hospital and that this is resulting in an increased number of non-Covid-19 deaths.

Fast-forward to Spring 2021. What do you think life will look like, and how will hospital care change?

It is likely the human effects of this infection will have decreased by then. What is not known is if there will be a second wave of infection, much like seasonal flu occurring every winter in the UK. If we develop a sensitive test for the infection or immunity from it, it is possible that an ‘immunity passport’ system would allow us to get back to normal before then. This is what scientists are working night and day to develop right now.

The idea is that if a person can be shown to have had the disease (by developing antibodies to the virus) and, if only for a few months or so, be immune to re-infection, that person can enter society safely to go about their lives knowing they can’t catch the virus and are most unlikely to spread it to other people. Conversely, if we identify people who have never contracted the virus, we can focus all efforts on keeping them isolated and safe until a treatment or vaccine is developed.

I think hospital care will have to change significantly over the next year. We have to catch up on several months’ inactivity in the NHS; for instance, there are an awful lot of cancer patients we have not been treating. I suspect we will create a two-stream system through which people will pass for their serious treatment and surgery only if they test negative for Covid-19. That’s the only really safe way to do things.

Give us one piece of good news to make today feel less rubbish?

The environment is getting a breather! The decimation of industry and air travel, for example, have resulted in measurable improvements in global air quality together with a relaxation of the UK’s dependence on non-renewable coal energy. Scientists are seeing a snapshot of what the world would look like without human interference. This could provide an important benchmark against which to compare future environmental science, expanding the understanding and acceptance of climate change.

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