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The impact of Covid-19: A view from an intern

IMO NCHD committee member Dr Amy Worrall discusses her experience facing Covid-19 as an intern on the infectious diseases team at Beaumont Hospital, Dublin

I decided early on during the Covid-19 response to learn as much as possible from the experience of working in our healthcare system as it faced a pandemic. How convenient to be an intern on the infectious disease (ID) team, which amalgamated into the Covid-19 team.

I saw up-front the impact it was having on staff, patients and the hospital that housed us all. I was on my third rotation in February when Covid-19 arrived, just starting the Academic Track internship, where I was balancing clinical work on the ID team and my academic research project. Three weeks into my new rotation, it became clear that the ID team was seeing the signs that the ‘novel coronavirus 2019’, as it was called early on, was moving our way. Then the numbers increased and the spread began.

The hospital shifted and we were redeployed — I was moved full-time to the ID team and put the research on the back-burner. Hospital protocols were made, revised, updated, almost daily. New contingency plans were set up, stocks were counted, clinics cancelled, elective surgeries postponed without a future date for patients to even look forward to.

The hospital grumbled as its engine was put into a lower gear; wards emptied, all stable patients discharged to their homes, long-term care centres, or rehabilitation facilities, and the emergency department became worryingly empty.

Beaumont Hospital, Dublin

Hospital reconfiguration

The hospital as we knew it was no longer the same, and a few wards saw an immense increase in activity. There were isolated ward breakouts of Covid-19, and the most vulnerable patients on the geriatric medicine wards were isolated to protect them. Covid-19 wards, the Covid-19 assessment unit, and a specialised respiratory ward were all expanded. The ICU sprawled out into the high dependency unit, recovery and theatre (with contingency plans for further spread).

Rumours circulated every other week of a shortage of this and that: Swabs, masks, oxygen, staff. Isolated outbreaks on wards decimated entire teams: Healthcare assistants, nurses and doctors from entire wards were out sick after testing positive. A mix of these were symptomatic and asymptomatic, the latter fuelling the spread without ever knowing it. Daily CEO briefings, emails, updates from the medical director and all hands on deck were the order of the day.

In adapting to all these new challenges, hospital staff always maintained the greater good, putting the safety of individuals and the collective at the forefront of their work.

Burnout

Working during the pandemic has brought new knowledge and skills, but this came at a cost. Our registrars were exhausted — for weeks they were running Covid-19 call. They worked tirelessly before they were supplemented by more medical registrars. The entire NCHD service was reconfigured, each tier self-rostering to account for absences, and research physicians pulled back into the clinical fold. Interns were brought back from specialised rotations, some drafted to busier rosters, supporting a seven-day service, or pulled in when interns were out self-isolating. Burnout was here before the Covid-19 pandemic, and it will not have gone away. While everyone willingly rowed-in during this national crisis, the exhaustion was and is palpable.

The personal toll of the workload, the inability to see family, friends, and confide in the upsets of daily difficulties has affected many of the NCHD workforce. The guilt and fear of junior doctors who may live with parents or elderly relatives, the need to move out of your own home to protect those who are immunocompromised, the inability to see your newborn child because you’re working on the frontline, and the discrimination you might receive when house-hunting (because you are a frontline worker) continue to weigh heavily on NCHDs nationwide.

Deaths

Death was inescapable, but Covid-19 accelerated the death of many. I have confirmed more deaths during these last 10 weeks than I had in the previous six months, and it is similar for others. It will have had an alarming and as yet unknown cost on the mental health of individuals who lost family and friends, but also on the individual healthcare workers who worked on wards with high numbers of those who succumbed to Covid-19.

Nurses, porters, healthcare assistants, catering staff, NCHDs, and consultants on those wards have been deeply affected by these deaths. Saddened at the number of them, saddened at the personal stories behind each of them, at the inability to have families in with our patients, the loneliness of their deaths. We know the mortician’s name — who could ever say that they routinely got to know the mortician during internship? While community and family support will carry many of us through the pandemic, there will be significant psychosocial needs among healthcare professionals in the aftermath that we cannot ignore.

Although healthcare workers remained working, and thankfully most fully paid during the last three months, many were redeployed, had hours limited, or rostered to work less than normal.

This created a significant burden for family units, with new financial stresses such as childcare needs and maybe supporting partners who were out of work, while the same rent, loans, and mortgages still needed to be paid.

For most medical and surgical trainees, the impact of Covid-19 has been felt. While continuing professional development has been frozen, research projects were halted, exams have been suspended, with new dates for sitting memberships only confirmed very recently.

 Surgical lists depleted to emergencies have left many trainees without operating time, and clinical and scheme requirements unfulfilled. Courses, conferences and even basics like ACLS have been on hold. Colleges have assured trainees that while no consequence for missed deadlines and requirements will occur, the lost training will need to be made up at some point.

The changeover in July comes with huge relief for many who wish to see progression, to move on with their careers. Those added pressures to catch up on missed curriculum are just another burden to add to next year’s workload. That is not to say that this experience hasn’t been its own learning journey; we too have adapted to virtual clinics, to distance teaching and learning, to learning skills we didn’t have before, to being challenged in new ways.

Pulling together

One of the greatest learning moments I took from this time, though, has been to see how everyone pulls together. Yes, there were complaints about service delivery, hospital politics, and minor tiffs. But what I have chosen to focus on is that people bail others out and offer relief when signs of need are shown.

From where I stand, the impact of Covid-19 has been pretty vast; it has been physically, emotionally, personally and professionally testing, and that’s just the single view I represent here.

We each are immensely affected by it and as a national health service, we will need a serious debriefing. The HSE’s Workplace Health and Wellbeing Unit is both welcome and much needed, but we should not forget burnout is still there, we are still in breach of the European Working Time Directive in most hospitals and there will be long-standing ramifications for NCHDs once we come out of this. There has never been a better time to use the impact of Covid-19 to change our health service for the better.

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