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The government must provide clear instructions to the public and make messages “more personal” in order to avoid hospitals being overwhelmed by a second wave of Covid-19, according to a senior infectious diseases nurse.
Cindy Marudamuthu (pictured above), who was the matron for infectious diseases at London North West University Healthcare NHS Trust during the first wave of the pandemic, spoke of her frustration that not everyone in the local population was following social distancing and other safety measures.
“It was very difficult especially when we saw people coming in and we couldn’t save them however much we tried”
She said her main concern was that hospitals would struggle to cope amid a perfect storm of seasonal flu and a national surge in Covid-19 cases and warned there was only so much hospitals could do to protect people.
“It is summer now so everybody is a bit more relaxed but in the blink of an eye it will be winter so they need to know what they should be doing to protect themselves,” she said.
“We are ready but I am not sure how ready we will be if we have influenza and Covid mixed together,” she added.
The infectious diseases team at the trust was the first in the country to do community screening for the virus in the very early stages of the pandemic.
Protocols developed by staff and lessons learned there influenced the way community testing was subsequently rolled out across England.
Ms Marudamuthu, who recently became lead nurse for operational and professional standards, said her team’s experiences had highlighted some of the challenges in getting people to follow official guidelines.
“We were not 100% sure people were staying at home. I know we had a few cases where we called and said we were coming and we’d knock on the door and they were not there when they were supposed to be self-isolating,” she said.
“My worry is that when we tell people you need to self-isolate for 14 days because they are infectious or waiting for results is making sure this is actually happening,” she added.
She said information given to the public by government tended to focus on figures but she felt messages needed to be more personal and highlight the dangers to family and loved-ones in order to really hit home.
“A lot of people have had family members who have been unwell or have lost family so we need to make it a bit more personal when we are out there and say ‘Listen, I have been through it’ or ‘You have got family’ and then they take it a bit more seriously,” she said.
She described the frustration and despair experienced by nurses and other professionals as they battled to save patients who were critically ill with the virus.
“It was very difficult especially when we saw people coming in and we couldn’t save them however much we tried – our number of deaths was so high,” she said.
“It makes you a little bit angry and you say ‘you know these people were someone’s mum or grandma who you might have gone and infected’. It was very frustrating for me and my team because we worked so hard to try and contain it and then to see it all fall apart.”
She said a key concern was whether exhausted and burned out staff would be able to cope with a major second wave of Covid-19.
“I am not sure they will all have the same resilience to face another surge,” she said.
“Everybody responded amazingly the first time because this was something new and this is what they do. But knowing what happened and how difficult it was leaving their family, I’m not sure we will have the same response,” she added.
This was why her trust was putting a lot of effort into workforce planning for winter and Covid-19 including providing intensive care training to many more nurses.
“We know workforce was one of our major issues because a lot of staff went off with symptoms so we are trying to mitigate that now,” she said.
“We’re working on workforce a lot so we don’t put that much pressure on staff again,” she said.
“I am not sure they will all have the same resilience to face another surge”
Ms Marudamuthu was herself off sick with the virus and said this had given her an insight into how ghastly it could be for patients and their families.
“I was pretty unwell for the first seven days and it knocked me back because I am somebody who is quite strong usually. You have a residue of tiredness that it is hard to shift,” she said.
“I was somebody who just needed a couple of reviews in hospital but didn’t need an admission. You wonder ‘If I was feeling like that then how did it feel for the ones who needed oxygen or intensive care?’ It is unimaginable and horrendous to think about it.”
She said the trust – which was forced to declare a critical incident fairly early on in the pandemic due to an influx of seriously ill patients – had since seen a dramatic decline in cases and severity.
“People who are coming through the door may have a swab that comes up positive for Covid but they are not unwell with Covid,” she said.
“We have seen a massive decline which is good because we have time to reset and prepare in case we have a second wave and it also allows staff to get their resilience back because it has been non-stop for four months,” she added.
She said the trust had staged a series of listening events with staff aimed at capturing what had gone well during the first wave of the pandemic as well as things that had gone wrong.
A key issue nationwide was the supply of personal protective equipment (PPE).
Ms Marudamuthu said supplies and stores of PPE at her trust were currently fine but it was hard to predict what would happen if there was a major national spike in Covid-19, which could affect availability of PPE across the country.
“I am more confident now because we have clear guidance on what type of PPE we should be wearing. It changed so much,” she said.
“Now we have clear guidance we know what we are supposed to be wearing in each department and can prioritise where equipment should go,” she added.