As an intensive care nurse in the UK during the first and second waves of the pandemic, New Zealander Caitlin Allen witnessed first-hand the carnage Covid wrought on an unvaccinated population. Aotearoa has a rare opportunity to avoid that, she writes.
Impact stories from Covid-19 have been shared the world over, from people who have lost a loved one, their career or business, to mums who birthed alone during intense restrictions, to healthcare workers who desperately tried to save strangers as the virus took over their body.
In the UK where I currently live, there is no one who hasn’t been touched in some way by this highly contagious virus. It’s safe to say that we are all different now to the people we were 18 months ago.
As an intensive care nurse, I never could’ve envisioned how this pandemic would change the look of an ICU ward. My first day stepping into a Covid ICU still haunts me, and I will never forget how I felt leaving at the end of that shift. I’ve dealt with grief and death before, and while it’s an inescapable part of the job, it’s something you hope to rarely come across. But this day, seeing death was unavoidable.
At a hospital in London, a 12-bedded ICU now had 50 beds and resembled something you see in a war movie. That first day, in my first eight hours, six people died. This ICU was filled to the brim with extremely unwell patients who required complex care, 90% of whom didn’t make it back out the hospital doors. The mortality rate was so overwhelming that a makeshift morgue was set up in a large tent outside the hospital.
My most harrowing memory in this ward was of a 60-year-old man being told he needed to call his wife as he was now at the point of needing a breathing tube. His oxygen saturations were very low, and he was breathing as if he’d just run a marathon. I saw the fear in his eyes as he asked me if he was ever going to wake up again. I couldn’t bring myself to answer him; I didn’t know how to reassure him – he’d seen the news. He’d seen the morbid figures that were broadcast at six o’clock every night, telling us how many hundreds of people had died alone of Covid-19. I don’t know if he ever woke up again, but I do know that the two patients I was also looking after opposite him, patients in their 30s and 40s with young children at home, didn’t.
This was how my next two weeks at this hospital went – caring for patients who had been in the ICU for a while already, and a constant stream of new patients coming in. In my time there, I saw only one person having their breathing tube removed, who woke to a nightmare of beeping machines, hazmat suits (the PPE available at the time) and gravely ill Londoners. The patient-to-nurse ratio was much greater than what was usually allowed. Pre-pandemic it was a one-nurse-to-one-patient ratio; now at least three patients per nurse. Even then, we were short on ICU nurses. We did get help from incredible nurses who were called in from different departments, each of them trying to learn as quickly as possible in this foreign and stressful environment.
As the pandemic progressed, the NHS had to change its approach to managing this worsening health crisis – I was moved to a larger hospital across London, which is where I then spent the remainder of this wave and the following wave. The ICU ward here had 70 beds, 40 more than “normal times”, accommodating Covid patients by closing down other wards and turning them into makeshift ICUs. Even then, there simply wasn’t enough room for the increasing volume of sick people who needed intensive care treatment, and at times they resorted to putting beds between beds.
At this time, emergency departments across the country were having to make unthinkable triage calls on who was eligible for ICU care and whose treatment was limited to oxygen via face masks. Around this time I looked after a young mum whose baby was delivered early due to how severely Covid-19 had ravaged her body. She suffered clots in her lungs and brain, and required a tracheostomy due to long-term ventilation. Two months on when I was caring for her, her baby was still to meet their mother.
Over this very dark time, I held up cameras so that families could offer strong words of encouragement. Or so families could say goodbye to loved ones whose fight for their life was over – they weren’t going home. I can’t describe the feeling of having to do this – no one should have to die alone. I remember being outside on my lunch break one day, crying on the phone to my friends because I’d just seen a woman talk to her daughter for the first time after weeks of unrelenting uncertainty. These happy memories are unfortunately few and far between.
By July 2020, the hospitals had settled, and exhausted healthcare workers could then turn their attention to patients with other conditions, left behind from Covid. My colleagues continued to work tirelessly even though we were burnt out and traumatised. The guilt I carried for the patients unable to go home was extreme and I became intensely scared that every patient I had was going to die, to the point of panic attacks, which I’d never experienced before.
Due to lack of action from the UK government, in December we entered our second and most deadly wave of the pandemic so far, accelerated greatly by the new variant, delta. Christmas was spent in a hurried and last-minute lockdown. New Year’s was spent hearing that a hospital down the road was almost out of oxygen. Fear filled me as I knew this time was different and sadly, that fear wasn’t misplaced. The month of January 2021 saw the ICU surge in capacity, almost doubling the amount of patients seen in the peak of the first wave. The hospital now had a three-storey ICU, which still wasn’t enough. Army medics were brought in to assist the nurses who were now almost certainly taking care of four ICU patients each per shift. Four patients each on multiple life-supporting infusions and ventilation, each requiring complex care.
As of October 2021, the death toll in the UK stands at 142,000. This number represents only the patients who died within 28 days of their diagnosis and not the people who died of causes unrelated to Covid, but couldn’t receive the life-saving treatment they needed. To look at this in terms of per capita, if Covid-19 had entered New Zealand pre-vaccination and without strict border controls in place, the death toll could have been upwards of 10,500. And with fewer than 340 ventilators in the country, one could assume that number would have been much higher.
Vaccinating as many people as possible against this brutal virus is one of the greatest and most important public health campaigns the world has experienced, and New Zealanders have a unique opportunity to get vaccinated before Covid-19 can cause widespread loss in their communities. In London, healthcare workers I know cried tears of relief when they received their vaccine, knowing that this could be a light in what was a very dark time.
It may not be a golden ticket to eradicating Covid-19 altogether, but if you follow trends from previous waves, it’s clear vaccination has saved tens of thousands from hospitalisation in the UK alone. It has freed up vital hospital beds again, and given healthcare workers a chance to breathe. It has given us freedom and the chance to spend time with those we love. There are people in the world less fortunate than we are, who haven’t had the option of receiving the vaccine due to their location. I remember feeling the deepest sense of relief when each one of my family members and friends in NZ was fully vaccinated, while also being acutely aware of how fortunate and privileged we are.
Vaccinations aren’t new, and neither is the concept of the government putting rules in place to keep us safe. By law, we have to wear a seatbelt because of the protection it offers us, and nurses are all required to be vaccinated against hepatitis B to protect ourselves and our patients. While this vaccine is new, lending itself to many anxieties, the mRNA technology behind it is not, and it’s by far the most studied and watched vaccination of all of time.
So now is the time to trust the extremely intelligent scientists who have dedicated their life to this kind of work. Get vaccinated to reduce the chain of transmission, and you’ll be guaranteed to save lives.