From the Guardian of 11 April 2020:
Matt Hancock says NHS staff death toll at 19 amid PPE row
Health secretary pledges investigation after telling staff not to overuse equipment

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This is an email I received a few days ago from London, UK.  She’s working difficult hours at the moment and very front line.

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Dear Robert,

I am a staff nurse working in the Emergency department of a large London hospital. I thought I could share some thoughts about how things have begun to change on the frontline in the past few weeks.

In the beginning we were aware of more patients arriving at the emergency department (ED) although these patients were tending to self-refer and were well. The hospital set up a hello system whereby it became much more organised. Patients presented to nurses outside the hospital and described their symptoms in a streaming service. Without banging on the doors and windows which was a little disconcerting!

As the weeks have gone on our whole department has had to evolve to try and cope with the growing number of attending patients who are presenting with covid19 symptoms and all the London Ambulances (LAS) arriving as Blue lights with symptomatic patients from their homes.

Initially our resuscitation area was designated ‘dirty’ ( = cover 19) along with our waiting area which was split in half, cold and dirty areas.  Soon I think they realised it was a bit like segregating smokers on a plane and entire areas had to be designated as ‘Hot’.  We had to progress to all of the waiting area being “Hot’ and now all of our ED using our paediatric areas to cope with the growing demand.

In these times our nursing duty of care really does remain the same. We have always cared for poorly patients and that is exactly who we are still seeing. If I think too hard about the sudden increase in this one symptomatic type of patient then it can become overwhelming but essentially I am still doing the same job that I have always loved.

The donning and doffing of our PPE wear was a bit challenging in the beginning but we’ve all become very quick at donning and although some times there is not all the right equipment this has improved and we have always had the correct facemasks for the areas where our patients are being ventilated. I know that our team of management really are doing their best to ensure we have all the right equipment.

When working the other night we were expecting another resuscitation blue light call. All staff were prepared and wearing our PPE, resembling a little like the scene in ET with the tents and forensic suits. We have taken to writing our names and roles on each other’s gowns (some nurses are now Lords and Ladies) importantly so we can tell who is who and give the patients a chance to know our positions. I realised as I greeted a new patient that they could not see any of us smiling. It’s terribly difficult to hear us talking through the face masks and that we couldn’t make them feel instantly better by smiling was a real low point. Of course we all do our best and talk and care but this lack of human contact is so scary.

I understand how crucial the protection equipment is and the lockdown but it has made the importance of human contact even higher in my world. I really look forward to when I can be close enough to someone in the street to rub shoulders and to be able to smile at everyone without worrying.

Many smiles!

Caitlin Jones staff nurse

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