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Families say goodbye over Skype and doctors are in tears - Birmingham Covid-19 medic

Too many people are dying from Covid-19 to provide the end of life care doctors want to – with families saying their final goodbyes over Skype, a West Midlands intensive care consultant has said.

Dr Ron Daniels

Dr Ron Daniels, who works at Birmingham hospital, told the PA news agency that doctors, nurses and support staff are in tears on every shift as they pull together in a “war effort”.

They are also unable to offer some of the usual bedside comfort to dying people, in part because they need to wear personal protective equipment (PPE).

Dr Daniels said his own hospital is allowing one relative in when it becomes apparent that a coronavirus patient is towards the end of their life in intensive care.

“Other family members, in consideration for their safety, are encouraged to say goodbye over Skype,” he added.

“There are nurses and doctors and healthcare assistants in tears on every shift, because they care.

“Usually, end of life care involves face-to-face discussions with family, spending time with the patient and for example, being able to touch them and show empathy.

“But wearing PPE has created a barrier to that and there is simply not the luxury to be able to do that, with too many people dying and close family unable to be there.”

Most hospitals around the country have at least doubled their critical care capacity in response to Covid-19 – with the West Midlands, which has seen a spike in cases, increasing capacity by about 250%.

“In the West Midlands, we were lucky to have a degree of warning from London about what might happen,” Dr Daniels said.

“We are running at about 90% of our capacity at the moment. It’s busy, it’s challenging, it’s hard work but we’re coping.”

He said only half of all people on intensive care units are surviving, with the prognosis much worse among older people.

“The outcomes for Covid-19 are worse than for normal pneumonia. This is a condition unlike anything else we’ve seen before,” he added.

Initially, intensive care consultants were treating the illness as if it were Sars or Mers and as if patients had acute respiratory distress syndrome (ARDS).

But it has become apparent that the virus does not behave like ARDS and there is a possibility some early patients with Covid-19 were unwittingly harmed as a result.

“We now think the rapid deterioration some patients experience is down to blood clots,” Dr Daniels said.

“This information has been shared pretty widely now across the UK, critical care networks have shared this information.”

Dr Daniels said when patients develop clots they can be treated with some clot-busting drugs, but there is a huge risk of bleeding.

In his experience, patients in intensive care are “very, very sick” but they remain static in terms of how they are doing, often for a long period of time.

After this time, some of them “get better and some of them get catastrophically worse”, he said.

He added: “We’ve got people who have been on ventilators for 21 days and there’s no sign of them leaving anytime soon.

“What we’ve learned is that Covid-19 patients don’t wean quickly from ventilators.

“We’ve learned to wait, to take a slow approach. It’s the right thing to do but their rehabilitation period is obviously going to be longer.”

Those with underlying conditions such as heart disease, high blood pressure or diabetes do less well than others, Dr Daniels said.

“Men also do less well,” he added. “We see that in multiple conditions but it’s more marked in Covid-19.

“High blood pressure and obesity are partly to blame for this difference, but not all of it.”

Across the West Midlands, there are currently more than 1,000 patients on ventilators.

“There is a skew towards older people but broadly the majority of people ventilated are between about 45 and 75,” Dr Daniels said. “Most of our patients are within that age range.

“We are ventilating some people over 75 but they have to be pretty fit to justify that, though we don’t turn people away based on age.

“It is slightly surprising – compared to what we are expecting – that we are getting younger patients.

“Most of them are obese, have diabetes, or high blood pressure but occasionally we are seeing those who are lean and fit.”

Around one third to half of patients in intensive care with coronavirus are put into a prone position for the majority of the day to release pressure on their lungs.

Dr Daniels, who is the founder of the UK Sepsis Trust and its executive director, said staff absence due to illness or self-isolation was impacting on hospitals.

“Staff absence is hitting us,” he said. “I tested positive and needed a week off.

“And we’ve heard reports from that one in four nurses are off – we are getting towards that situation in the West Midlands.”

As staff absences bite, more senior intensive care doctors are becoming strategic decision-makers, helping to direct other staff who have been brought in to help, he said.

“What’s incredible is the collaboration between the health professions and between professional disciplines,” Dr Daniels added.

“This really does feel like a war effort with everybody stepping up to the plate, operating outside their comfort zones, and working together in the patients’ interests.”

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