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Royal Free consultant on 12 months since first Covid patient admitted

The intensive care doctor kept a diary of his hopes and fears during the first coronavirus 'wave'

11 February, 2021 — By Tom Foot

Dr Mike Spiro at the Royal Free in Hampstead

A ROYAL Free intensive care consultant has reflected on the fears that were felt by staff on the front line, one year after the first Covid patient was admitted to the hospital in Hampstead.

Dr Mike Spiro has been keeping a diary of the most challenging period of his career and this week spoke to the New Journal about the importance of PPE (personal protective equipment), innovations in treatment and new variants of the virus, while thanking the army for sending in personnel to help out.

He revealed some encouraging signs with new patient admissions down and some non-emergency procedures starting-up again for the first time in several weeks.

Dr Spiro said: “I kept the diary in the first wave and it makes amazing reading. I had written about how terrified I was intubating that first intensive care patient, which I did with one of my colleagues.”

The first Covid patient was admitted to the Royal Free in Pond Street on February 9, 2020. “I remember travelling in and the fear I had about my own safety, and if my own family would be ok if I was to contract this illness, which we knew very little about,” he said.

“I have young children. Was there a risk I could transmit it? Would the PPE work? Was this something I should be doing?”

Despite being “im­mersed in a sea of Covid” for 12 months, Dr Spiro has not tested positive for the virus. He puts this down to the effectiveness of good quality PPE, adding: “Looking back in my diary, there was a great fear of running out of PPE. We are all very grateful we didn’t. That would have been a disaster – a disaster on top of the disaster.

“PPE makes everything more difficult. Whether that is communicating with a mask, being unable to see facial expressions. Back then we had two pairs of gloves, then we put another pair of surgical gloves sterile gloves over the top. Doing any procedure like that – well, it was a shocking way to work, a huge change from normal practice.”

Changes to the way patients are treated in intensive care now compared to back in February last year include better monitoring of potential blood clotting and being “careful about the way we ventilate patients so as not to damage the lungs”, said Dr Spiro.

While he did not get sick from Covid, many other hospital workers have done, leading to severe rota shortages particularly in nursing. With all London hospitals stretched, there was no way of bringing in extra staff.

The New Journal revealed last month how more than 70 army personnel had been sent to the Hampstead hospital to help, with 40 working with the Intensive Care Unit.

Dr Spiro said: “You have to think we have gone from having 34 patients when we’re really full, to having, at the peak, 95 intensive care patients. That’s a 300 per cent expansion without any ability to increase staffing very much.

“The army has provided some support. They are not intensive care nurses, but we are phenomenally grateful for any assistance.”

He added: “We are no longer seeing a large number of admissions, but we still have an awful lot of patients in intensive care. That’s because people are in intensive care now for weeks, not days. We are busy, very stretched particularly from a nursing perspective.”

On the rollout of vaccines, he said: “We can’t honestly answer whether there will be a strain that comes out that is resistant to vaccine. We know that social distancing and hygiene and masks reduces the spread of the disease.

“The mistake is to be vaccinated and think you are immune and stop being careful.” Dr Spiro’s specialism is liver transplantation, a crucial field that he said had been “very badly” affected by Covid because there were no beds free in intensive care and because so many potential donors had Covid.

He said it had been “wonderful” that two liver transplants had been carried out this week at the hospital in Pond Street, as the service took small steps to starting up again following the current wave of coronavirus infections.

Asked how he calmed down after a shift, Dr Spiro said: “In the first wave I’d go home and not be able to sleep. I’d be mulling over the events of the day, worrying about what the following day would hold. “This wave, I have been able to sleep better. I’ve found physical exercise is important and family time is my release, so to speak.

“Children keep things simple. That’s very refreshing when you come back from a high intensity professional life. The kids are like: ‘yeah but we’re still going out on the bikes aren’t we?’”

And he added: “We are all being reserve teachers in our days off, and doing homeschooling. I’m not sure which I prefer: home schooling or my intensive care round. Both are equally stressful in many different ways.”

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