NHS under pressure: voices from the frontline of the coronavirus crisis

Doctors and midwives say there aren???t enough masks and they don???t know if they have the virus

Paramedics say they do not have enough time to decontaminate ambulances.
Paramedics say they do not have enough time to decontaminate ambulances. Photograph: Christopher Thomond/The Guardian

A&E consultant, south-west

Who we resuscitate and who will get a ventilator will be challenging. As the only senior doctor on shift in the respiratory zone the ethical decisions will be tricky. I may come into conflict with my intensive care unit colleagues.

We came into this profession on the basis of our goodwill and altruism but that is being put to the test in a very extreme way as we are all really worried about the stocks of PPE (personal protective equipment). I was testing people on an ambulance ramp four weeks ago dressed like I was going to see an Ebola patient, in full PPE with FFP3 masks and visors. I think they realised that wasn???t sustainable as the patients kept coming through. I???m now treating suspected Covid patients with a level one surgical light blue mask and scrubs.

There???s a discrepancy between putting the fear of God into the public about sitting on benches and sharing the same three metre space and NHS workers being expected to sit cheek by jowl writing our notes near all the respiratory patients. We feel like we???re the last on the list of the government???s concerns and people are getting scared now.

The entrance to the Emergency Department at Royal Surrey county hospital the day after the UK was put on lockdown.
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The entrance to the emergency department at Royal Surrey county hospital the day after the UK was put on lockdown. Photograph: Adam Davy/PA

Intensive care nurse, Bristol

We usually get a lot of deaths but I???ve never had a problem. Sometimes we lose three people in a day but this situation is so scary for all of us. I???ve never seen something like this in my 12 years working for the NHS since moving from Kenya. We want the frontline staff to be tested so we know whether we are passing it on.

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A gentleman passed away from Covid where I work. It was heartbreaking, and the whole situation is having an emotional effect on all of us. We are worried about not having enough staff to operate the ventilators as we are already on the brink.

I???m going back to work in the intensive care unit on Tuesday following two weeks in self-isolation. I still don???t know whether I???m infected and I will again work in a high-risk area looking after patients with suspected Covid before going back home to my daughters.

GP, rural south-west

A huge number of second home-owners have descended on the area and it???s put an ever greater demand on our surgery. A lot of them have been quite unpleasant, very demanding and seem to feel their needs are greater than others. Among the locals, we???ve had patients denying they have had contact with anyone with viral symptoms, and have then heard their close relative has the flu; others are returning from high-risk areas and not telling us. If patients are not being truthful, we need to treat everyone as high risk.

We have been contacting the local hospital to get protective clothing sent to us because we just have normal latex gloves and have even had to go on the internet to buy scrubs. I???ve been in isolation for almost a fortnight because my kid has had a temperature and I???ve been doing triage calls from home. Another local GP surgery has a majority of staff off work in isolation.

Meanwhile, normal stuff in communities keeps going on. Wounds need to be dressed, children need vaccinating, infections need to be treated. But that needs to happen in a safe environment, with screening and protection equipment.

A GP surgery in Brighton closes temporarily after a staff member tests positive for the coronavirus
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A GP surgery in Brighton closes temporarily after a staff member tests positive for the coronavirus. Photograph: Will Oliver/EPA

Senior paramedic, East Anglia

We???re receiving infected and non-infected patients in the same ambulance bay until proper measures can be put in place. But the main concern I have is that we don???t have the facility to protect ourselves. Crews have access to only four surgical masks per shift ??? we???ve seen a huge depletion of all our PPE equipment.

It???s almost like crews have to choose where and when and with what patients they wear the equipment. In the A&E recently, they were down to one box of 20 surgical masks for the whole team for the entire day, so they put measures in place where you had to wear the same mask all day between patients. This is reckless. When they become wet they become inefficient.

Our trust guidance lags behind that issued by PHE [Public Health England] and it leads to huge confusion. Ambulances need about half an hour out of service to properly decontaminate, but senior staff limited that time to 15 minutes. My fear is that my staff are going to get unwell and then we won???t be able to offer a service.

All that aside, I???m surprised at how good morale is at the moment. The challenge has really pulled us all together, we???re working as a family.

A paramedic prepares the back of an ambulance at James Cook University hospital in Middlesbrough.
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A paramedic prepares the back of an ambulance at James Cook University hospital in Middlesbrough. Photograph: Ian Forsyth/Getty Images

Pharmacist in Manchester

We???re at breaking point. We are struggling to get hold of common stock like paracetamol and inhalers, and we had four days??? worth of prescriptions to fulfil on Tuesday. One of the wholesalers said they had 15 people off sick in the depot last week and we just placed an order three times the value we would normally have. We???re inundated, and one of my colleagues is off with symptoms. This is my 15th day working on the trot.

I feel anxious that I???m exposing myself to symptomatic people on a daily basis. I couldn???t tell you how many times people have said that they have a dry cough and a fever. At that point I say you shouldn???t be coming here if you???ve got any symptoms. But there???s a lot of ignorance out there.

Quick guide

What are coronavirus symptoms and should I go to a doctor?

What is Covid-19?

It is caused by a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. The World Health Organization (WHO) has declared it a pandemic.

What are the symptoms this coronavirus causes?

According to the WHO, the most common symptoms of Covid-19 are fever, tiredness and a dry cough. Some patients may also have a runny nose, sore throat, nasal congestion and aches and pains or diarrhoea. Some people report losing their sense of taste and/or smell. About 80% of people who get Covid-19 experience a mild case ??? about as serious as a regular cold ??? and recover without needing any special treatment.

About one in six people, the WHO says, become seriously ill. The elderly and people with underlying medical problems like high blood pressure, heart problems or diabetes, or chronic respiratory conditions, are at a greater risk of serious illness from Covid-19.

In the UK, the National health Service (NHS) has identified the specific symptoms to look for as experiencing either:

  • a high temperature - you feel hot to touch on your chest or back
  • a new continuous cough - this means you???ve started coughing repeatedly

As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work, and there is currently no vaccine. Recovery depends on the strength of the immune system.

Should I go to the doctor if I have a cough?

Medical advice varies around the world - with many countries imposing travel bans and lockdowns to try and prevent the spread of the virus. In many place people are being told to stay at home rather than visit a doctor of hospital in person. Check with your local authorities.

In the UK, NHS advice is that anyone with symptoms should stay at home for at least 7 days. If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home.

How many people have been affected?

China???s national health commission confirmed human-to-human transmission in January. As of 31 March, more than one million people have been infected in more than 170 countries, according to the Johns Hopkins University Center for Systems Science and Engineering.

There have been over 50,000 deaths globally. Just over 3,200 of those deaths have occurred in mainland China. Italy has been worst affected, with over 13,900 fatalities, and there have been over 10,000 deaths in Spain. The US now has more confirmed cases than any other country - more than 245,000. Many of those who have died had underlying health conditions, which the coronavirus complicated.

More than 210,000 people are recorded as having recovered from the coronavirus.

At least GPs can decide to close their door and vet people before they come in: we are frontline and there has been no acknowledgement of the dangers we face. There???s not enough visuals saying do not enter if you have any symptoms and we were only given gloves and masks in the last week.

I think the numbers of confirmed cases are going to increase massively. When you???re working in the pharmacy you can see more and more people have Covid symptoms.

People queue outside a Boots pharmacy store in west London where stocks of hand sanitiser are limited to two per person.
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People queue outside a Boots pharmacy store in west London where stocks of hand sanitiser are limited to two per person. Photograph: Martin Keene/PA

Midwife, Greater London

We have been told to use normal surgical masks and a plastic apron. A couple of days ago we still just had plastic goggles from a DIY store that we???re supposed to wash throughout the day. We have also run out of the virus testing kits. They have known this was coming for months, clearly there has been no preparation. At a recent Covid meeting the consultant microbiologist was nearly in tears, if he is that scared already then we all should be.

We???ve only just been given alternative masks to the normal surgical paper ones. We???ve been told to wear them during second stage and delivery, which seems bizarre because you don???t have to wear one the rest of the time you???re up close and personal with the woman in labour.

Everyone???s scared. They???re scared for themselves, scared they???re bringing it home to their family because we???re not properly protected and scared to spread it around the hospital.

NHS hospital trust deputy director of finance, the Midlands

It feels like we as an organisation are waiting for guidance from the next level above all the time. We aren???t used to responding in real time, that???s not how the NHS works, particularly in the back offices. By the time we???ve adjusted to one thing during this situation, we???ve had to change tack.

I don???t know whether Boris Johnson just presumed the public sector would keep paying admin people if schools didn???t take their children and we had to send staff home to look after them without remote work because we don???t have laptops for everyone.

I don???t think there was absolute crystal clear guidance on that. We probably would have paid them, but uncertainty feeds people???s anxiety. Then Boris Johnson told people not to go to work unless absolutely necessary, cue chaos. We spent all of Tuesday getting people out of the office and home with their stuff.

Its all starting to feel more real now. The fear factor is increasing. We could see it coming but we knew it was still a bit around the corner. It???s coming into view now and its about to hit us. Its increased the fear factor.