It was February and Cherian Koshy was on the beach in Kerala with his wife and two sons. He was taking a week off from his job as Chief Biomedical Scientist at King George Hospital, Ilford, when he realised what a serious impact coronavirus was going to have on his life back home.
However much his family were enjoying the beautiful scenery and long sunny days of southern India, he couldn’t ignore the stories about the virus splashed all over the Indian papers and on loop on every TV screen he walked past.
“I’d been following Covid-19 since it broke out in Wuhan and when I heard it was in Europe I knew we’d have a lot of work to do; people would get ill really quickly,” says Koshy, 55.
“I started reading everything I could about it while I was on holiday.
“The world was going mad and I knew I was going to have to act quickly when I returned to implement a new testing programme.”
Koshy’s job is to test tissue samples and fluids to help diagnose and treat diseases, as well as to evaluate the effectiveness of treatments.
When he got back from his holiday there were already suspected coronavirus samples from nasal swabs waiting for him in the laboratory.
“It was a stressful time,” he says. “There was a global demand for kits and equipment and companies couldn’t give us a date they would deliver them so we had to look at what we already had that could work.
“At first we used BD MAX machines, which can detect the virus, but in a few weeks we got the testing kits approved by NHS England, which helped. We prepared as much as we could but it hit us big time.”
Koshy — who earned the nickname Mr Covid from colleagues because of how quickly he became an expert on the disease — adds: “I felt a lot of responsibility at work and at home. I didn’t want my family to be exposed to the virus, especially my 79-year-old mother, who is diabetic. She lives alone in east London and I’ve been taking her food and medication after work.
“There was one day where I went to work in the morning and felt so tired I had to go home. I just slept and slept.”
King George is part of Barking, Havering and Redbridge University Hospitals NHS trust, (BHRUT) which also manages Queen’s Hospital in Romford. Together they serve three quarters of a million people in three north-east London boroughs — including the large elderly population in the borough of Havering, who staff feared would be hard hit by Covid-19.
Queen’s alone has about 900 beds and King George around 450. Both have busy emergency departments in normal times — the A&E at Queen’s deals with 150,000 cases a year, its counterpart at King George, 70,000 a year.
When Covid-19 broke out, staff at the two hospitals found themselves at the centre of a rapidly evolving, high-pressure global emergency with no certainties. Here, seven of them tell their stories.
Koshy and his colleagues sound shell-shocked when they talk about the past few months. Everyone from the mortuary worker to the porter describes how anxious they felt dealing with a new virus; not knowing how it would affect their jobs, or their health and that of their families, and with no idea of how long the pandemic would last.
Suhier Elshowaya, consultant in acute medicine at Queen’s, saw her first Covid patient in March — a 72-year-old American charity worker who had been travelling through Europe.
“He had all the symptoms — cough, fever. We did a chest X-ray and sent him to the high dependency unit. He survived, but he will always stay in my mind because he was so ill.
“That first week we were so unsure about what to expect. We were very keen to have full PPE and masks. It quickly became clear that we were in a fast-changing dynamic situation and we had to adapt quickly.”
Elshowaya, 58, is expecting a grandchild, and was worried about whether she would live long enough to meet them.
There was a pervasive sense that the spread of the virus was accelerating, and that going to work meant inevitable exposure to a dangerous and contagious disease.
Porter Ray Peters, 58, remembers packages of PPE arriving in March. “We were told we were going to work on swabs, taking them from the testing pods to the labs,” he says.
“I was transporting so many, which made me realise how intense it was. It was all new and scary and sometimes I’d think, ‘If I go to work, will it kill me? If you dwell on it, you wouldn’t come in, and if you keep thinking about it 24/7, you will have problems.”
“We started preparing the hospital mortuary for Covid early on,” adds Gemma Norburn, an anatomical pathology technologist — her job is to prepare bodies for burial or cremation.
“At first I just thought it would be like winter, which is our busiest time. But it ramped up quickly and became very busy. We had non-stop phone calls from families asking what they could do about funerals, and we could only advise to a certain extent as government guidelines developed.”
They changed their process, outsourcing post-mortem examinations to nearby mortuaries so they could focus on managing capacity.
“We didn’t have time to think about it, we had so much to do,” says Norburn, 32. “The uncertainty was the hardest thing. I’m a bit of an over-thinker anyway, my brain never switches off.”
In March, management divided the hospitals into Covid and Non-Covid wards, with separate staff and separate entrances – each hospital effectively became two hospitals.
By the end of that month both King George and Queen’s had closed to non-Covid patients, except for those in exceptional circumstances, and staff quickly familiarised themselves with new technology to carry out appointments over the phone.
Elective surgery and non-urgent cancer treatment were moved to nearby hospitals, which caused concern but meant staff could be diverted to work on Covid.
The one area that couldn’t close was Queen’s maternity ward. About 8,200 babies are born there each year — the third highest number in England and Wales. The maternity ward stayed open and staff tried to do all they could to reassure new parents who were surrounded by people in masks and PPE.
Elsewhere across the trust, the immediate challenge was caring for the soaring number of seriously ill patients. “I feel like I’ve been living in this for a long time even though it’s only been four months,” says Asha Bhulia, a 31-year-old palliative care nurse.
Normally Bhulia’s job is to make life as comfortable as possible for patients reaching the end of their lives, controlling their symptoms and pain with the help of drugs, and providing psychological and emotional support. Covid meant that she was doing this on a scale she had never expected.
“I’d be on call with a list of patients to see but by the time I got to the ward those patients had died. We were learning on the job as the disease escalated fast. That was emotionally difficult, the amount of people that were dying, and the symptoms they had.”
According to NHS England, there have been 400 Covid-19-related deaths and 1,114 cases recorded at the trust since the pandemic began. (The worst-hit London trust was Barts, which runs five hospitals across the City and east London, with 621 deaths, including four employees.)
The last patient death at the trust was on the 8 June, and since the start of the pandemic two members of staff have died from covid. While staff mourn every life lost, they are now coping, and trying to prepare for the future. Since the start of the pandemic there has been a fivefold increase in critical care capacity across BHRUT.
Staff have been fuelled by adrenaline. Bhulia says: “You want to power on and see as many patients as possible. It only hits when you get home and you sit down and realise how exhausted you are. That’s how it was for most of my colleagues too.”
At first, she watched the news a lot. “Everybody’s fear was that the NHS would get to breaking point. But then I became so busy at work that I watched less because I was living it.”
She adds: “We know how to deal with breathlessness and help with pain but we didn’t know this disease and we didn’t know whether there would be an end point. It’s not just a physical strain, it’s an emotional strain. It changed everything about how we do our jobs.”
Bhulia and her team have daily huddles, “to update us because otherwise if you’re working all day you miss the new guidance that’s constantly coming in — things like advice from PHE [Public Health England] about everyone wearing masks — that changed quite a bit.”
She describes how they provided support for patients and families — and how Covid presents special difficulties when doing this: “As it went on I learned how to alleviate the physical symptoms — but it’s also that the patients are scared and want their families.
“If we break bad news to a patient or relative and they are upset, usually you hug each other or hold hands. You can’t do that now. There’s always a patient that touches your heart and my colleagues and I usually cuddle too. Social distancing was difficult because we had to change the way we worked so much.”
As the pandemic developed, she and her colleagues made more use of technology to communicate with patients’ families. “We were given iPads for video calls, which were a godsend,” says Bhulia.
“I did one last week, which was lovely. A gentleman about to go to a hospice called his son, who he hadn’t spoken to for weeks. The gentleman’s voice was hoarse, he’d whisper in my ear and I’d relay it. He said: ‘Son, I love you and I’m so proud of you, there’s nothing I’d do to change you,’ and his son said he loved him so much.
“The gentleman blew kisses to the iPad and his son blew kisses back. The son said I should come on the call too, they wanted to see what I looked like. I had PPE on so they could only see my eyes but it made me well up with tears. Relatives appreciate it so much when you make a call — they’ve been at home worried sick and watching the news just wanting reassurance.”
Family and friends are sending in messages that staff laminate, so they can be cleaned and stuck up around patients’ bedsides.
“The virus doesn’t discriminate,” says Elshowaya, who was alarmed at seeing young, healthy people deteriorate rapidly. “Every patient we lost, regardless of their age, made us very sad and tearful. We made a huge effort to communicate with their families who couldn’t visit on the phone.”
Charlotte Griffiths, 41, is one of many staff at the trust whose job has changed.
Before the pandemic she was a trauma rehab co-ordinator and physiotherapist, working with patients to optimise their recovery and help them move normally again. But when Covid struck she was redeployed to make sure patients in intensive care were resting in a position in which they could breathe as easily as possible.
She had been working part-time but when the pandemic hit she took on extra hours “to do my bit, as admissions went up”. Her husband, a retail manager, was furloughed so he looked after their two children.
She told how before switching roles, “the run-up was the worst bit. The stress of the unknown, wondering how am I going to manage being in critical care. I wasn’t sleeping well then, and felt anxious, but, it turns out you manage.
“I’ve done this for 20 years but I’ve never been in a situation with so many unstable people all side by side. There are simply so many patients needing care that there’s no room in your brain to start analysing the emotions at the time. You have to stay focused on working with them, making sure they don’t become breathless. You have to keep your head in the game.”
She continues: “Covid has its own timeline. It will resolve when it wants to resolve — it’s whether the patient can weather the storm. There was a point after the peak [of cases] where I was tired and wondered how it would end. The patients were treading water — they weren’t getting worse but they weren’t getting better. They didn’t need more oxygen but we couldn’t reduce it either. It’s hard to gee yourself up when you don’t see an end point.”
Vital experience was gained as they worked. “We discovered that when the disease develops, patients need to be turned onto their sides to breathe — at first Covid dries the lungs, but the longer you’re on a ventilator the more you produce phlegm, so we turn the patient to loosen it and then suction it out.
“You don’t want them to talk too much because you can make them breathless. Normally in graded rehab you push them to get maximum gains, but with Covid you dial that back 20 per cent. You can have someone able to sit on the end of the bed and think they are doing fine, then if you add something like asking them to brush their hair they are breathless again.”
Seeing what the virus could do, and coming into contact with it every day, meant that throughout the pandemic all staff worried about their own safety and that of their families. Many still aren’t sure if they have had the virus or not.
Elshowaya developed Covid symptoms at the end of March. “I lost my sense of smell and was off work for a week. By that point I wasn’t terrified, I wasn’t anxious — I was exhausted. My mother in Sudan rang me every day to make sure I was ok. On my days off I jog and garden a lot, my garden is beautiful now. I have to continue doing my job with pride and helping others, because being a doctor is the job I always wanted to do.”
Her friend, a surgeon who she had worked with as a registrar, died of Covid in April. “I was at home on a day off when I heard. I cried. We will have a memorial service later but for now I’ve written a few lines about him and I keep ringing his family to offer support.”
When Griffiths comes home she has a new routine to lower the risk of contaminating her family. “My children run up to greet me but they know they have to stay away and can’t give me a cuddle and I can’t give them a kiss until I’ve had a shower. So I go up, wash my hair and then we have cuddles. I think I’ve had Covid but I can’t wait to have immunity testing to know for sure.”
Her friends and family were worried for her at the start, but when workers were given the right PPE “everyone felt less stressed, I was never in a situation where I didn’t feel safe.”
She’s adapted to working in it. “You steam up and it’s hard to hear each other but you get used to shouting at each other and there’s a sense of camaraderie. I’ve been trained in donning and doffing it so you don’t spread infection. The one thing is you can’t go to the loo when you’re in PPE because you have to change it and that’s a waste. You become a bit dehydrated. Normally I have a few coffees in the morning but I can’t do that now.”
Peters — who gardens, plays the ukulele and tends to his tropical fish in his downtime — says: “From the start, if there wasn’t the right PPE I pushed back. You’d go in to the room where it’s kept and someone would have taken the last mask, or the one that’s there isn’t the right one for the job you’re doing. It only takes one bit of contact to catch it.”
He was taken aback at how quickly the virus spread. “I’d never seen anything on this scale, with rooms that Covid patients had been in marked as dirty. I’d go into ICU [the intensive care unit] to move patients who were ventilated and it looked space-age — all the patients look the same ventilated so you have to search for their name tag or do some guesswork.”
Peters hasn’t seen his two grandsons, baby Bobby and three-year-old Mason, for “what feels like an eternity”. He says: “It’s what you’ve got to do, it’s for their protection. Mason keeps asking when I’m coming over, Bobby was three months old when this started and is now six months old — I’m missing him growing up.”
On his rounds, he tells patients the wifi password and helps them set up their phones. “Lots of patients look bored. I might buy them a newspaper or a magazine, their eyes light up. I try to make their day a bit better.”
He doesn’t know if he has had the virus. “I was ill at Christmas with symptoms before they said it was here. It would be nice to know if that was Covid. I’d feel safer but I still couldn’t let my guard down. Even now I don’t know whether the Government is letting people out back to normal too early.”
After three months of working amid the pandemic, Griffiths is now processing the data she’s collected on the disease. “It’s still an unknown entity. If there was a second wave this data would be useful. What we haven’t got to grips with is how much fatigue patients have afterwards.
“We are trying to work closely with communities to make sure people who have been discharged from hospital can ask for help as they start to be able to walk again and then function independently.”
The pandemic has transformed the way doctors do their day-to-day jobs. Consultant Gideon Mlawa, 55, who specialises in diabetes and endocrinology, has revolutionised his method of working, seeing all his existing diabetes and endocrine patients by video call. “Covid is a disease with many faces. No one is an expert in it,” he says.
Across both Queen’s and King George there were 5,700 telephone appointments in April, and this practice is set to continue, partly to protect vulnerable people who would be in danger if they came in. Staff say they are pleased that older patients have been able to follow the video call appointments, such as a 90-year-old woman with a fractured wrist who was able to see a specialist and be guided through how to care for it on the phone.
Norburn makes innovative use of technology in another aspect of her job — running Death Cafes. The regular events, facilitated by the palliative care team, aim to make people feel more comfortable talking about death, and normally involve people meeting up to enjoy a cup of tea and a slice of cake. Now the service has moved to Zoom, and this will continue alongside physical appointments, when these restart.
“Death is a taboo subject and people avoid it, which I think is unhealthy,” says Norburn. “Even when I told my parents I wanted to work in a mortuary — after studying archaeology and then doing a variety of jobs I wasn’t happy in — they weren’t sure. We’ve seen in an increase in younger people wanting to talk about death after Covid.”
The trust has set up “wobble rooms” where people can go to reflect on what’s happened. “It’s a relief to be able to talk to colleagues about it,” says Bhulia. “We have a WhatsApp group and doctors are in it too. It’s nice to speak to people who understand what I’m going through.”
Before the pandemic, Bhulia was studying to be an advanced nurse clinical practitioner. “When Covid first broke out my studies continued,” she says. “I was preparing for an exam and it was difficult to juggle that with the increased workload. At that point I felt I didn’t have any chance for a break or time to myself — I’d work, go home and revise. But now the exam has been deferred and it’s on hold.”
She knows she will go back to her studies one day and is relaxed about when. “This will stay with me forever,” she adds. “I’m getting through it by hoping it was all temporary and we can go back to how we did our jobs before. Hopefully I won’t experience anything like this again.”
Koshy’s team have been volunteering to work late. “You are stressed, then you realise that every single staff member is stressed too. You have to look out for each other. We need more people coming into science, this will encourage them.”
He has been touched by the kindness of his friends. One night during the peak of the outbreak he came home from a shift to find that his neighbour had cut his lawn. “He’d seen that I’d been working so many hours that I didn’t have time to cut it, so he did it for me. That was the nicest moment.”
The hospital has been inundated with care packages from local businesses — drinks, pizzas, curries and snacks. Peters feels that his job matters more than ever and the pandemic has made others appreciate what he does.
It all helps, but Koshy’s workload shows no sign of diminishing. This week he has started on staff antibody tests. More than 2,000 employees have been tested.
The pandemic has been grim but working together in its shadow has elevated the feeling of camaraderie and pride among staff — and expanded their skills and experience, which can now be drawn on to help others.
This month Mlawa is sharing his hospital’s experience with doctors in Tanzania, where he is from. “The countries which dealt with Ebola have dealt with Covid well, they have the organisation and know the power of teamwork,” he says.
“We got through it by working together as a team; cleaners, nurses, physiotherapists and doctors. Now, if one good thing is to have come out of this, it’s that I know more people in the hospital so if I want to refer a patient to, say, the neurosurgeon, it’s easier.”
Griffiths adds: “So many random people have been redeployed to critical care, you get to mix with so many new people. We’re all trying to do our bit and pushing ourselves out of our comfort zones. There are nurses who had never done critical care before — they’re upskilling on the job.”
Peters agrees that “the people make the job. My porter job was meant to be temporary after I was made redundant as an engineer but six years later I’m still here — I work with a great bunch of blokes.”
At the peak in April there were 20 Covid wards across the two hospitals. Now there are nine.
Griffiths says it feels like she is she is “in this weird limbo. We’ve learned so much from each of the patients we’ve had and we’re now stuck between the Covid and non-Covid world, where we don’t really know which direction we’re moving in.
“It’s definitely not over yet, we still have cases, and you have to stay ready in case it all happens again.