Health experts in the north-east had to change and adapt their plans on a near-hourly basis in the early days of the Covid-19 pandemic.
In the first months of last year, before the virus took hold in the region, NHS Grampian’s infectious disease professionals were drawing up plans on what to do when the inevitable happened.
Amid a stream of information from across the globe, measures had to be put in place to cope with a spike in infections.
That included carrying out testing of people arriving in the north-east from high-risk countries and admitting them to hospital if necessary in a bid to contain the spread of coronavirus.
Infection prevention consultant Vhairi Bateman was among the first medics to come into contact with positive cases in the area.
“We always have to be aware of outbreaks of various natures that are happening across the globe and be ready to accept patients if they come,” she said.
“We work quite closely with public health on what we would have called a new and emerging virus threat, which is what Covid was. We were involved in the initial assessments about preparing for it and the initial stages of admitting patients to hospital.
“I work as a consultant on the ward and our initial job largely involved testing returning travellers. Initially we were screening people who had been in areas perceived to be at risk of Covid, and that was an interesting process because we had never had to do it before on that scale or that rapidity. The list of at-risk countries changed hourly some days, and we were having to adapt our processes.
“When we did detect positive results, at that point we admitted everyone to hospital regardless of whether they had symptoms or not or whether they were unwell or not.
“As part of the response at that point, which was containment, the attempt was to identify the disease in the community, bring people into hospital and stop any onward spread.”
Soon after the first cases began to arrive in the north-east, the decision was taken at a national level to move away from attempts to contain the virus, instead focusing on slowing down the rise in cases.
This meant health boards had to change and adapt their plans.
Vhairi admitted that by that point, staff were already running on empty because of the efforts they had put in to bring the pandemic under control.
“There were quite a lot of regional differences and we can see that even now in terms of the infection rates,” she said.
“When we saw what was happening in London and the case numbers there, we knew this was probably going to be big but in the early stages it felt containable with the numbers we had in Grampian, albeit we maybe didn’t know how much the disease had already spread in the community because we were only testing the people who had returned.
“Even when we switched to testing people with symptoms we had quite a slow rise in the number of cases so we were behind the curve of other places.
“It was quite a poignant moment in my career when we got the official message that we were switching from the containment to the delay phase because at that point we didn’t have that many patients in hospital.
“We felt there was scope to continue locally although, in reality, there probably wasn’t. We then knew something big was coming and that calm before the storm was one of the most unnerving feelings I have ever had.
“At that point, we had been working on the response tirelessly for about six weeks so we were already exhausted, and this was before the whole hospital response really took off. It was a big disappointment when we had tried so hard as a team to work with public health colleagues and with the information that was constantly changing.”
I am quite positive about the future”
In the initial stages of the pandemic, Vhairi dealt with the first cases through the doors in the north-east at a time when the full impact of Covid-19 was uncertain.
Although she always felt safe at work, she admitted to having early fears over passing the virus on to family and friends.
“I wasn’t scared for myself personally,” Vhairi said.
“We work with lots of different infections all the time, any of which could have serious consequences for us if we caught them. We’ve just had an alert through about an outbreak of Ebola in DR Congo and Guinea. These things do crop up, but we have to have faith and confidence in our training and our PPE.
“I have always felt safe at work because I felt I could manage the risks and had everything provided that I needed to do that. On a personal level outwith work, when there’s something spreading through the community, the situations that would make me more anxious were what I was doing and where I was meeting with other people, or in situations where we were coming into contact.
“I didn’t feel worried for myself but I felt a lot of responsibility on behalf of others – particularly working in infection control where you have to make decisions and issue guidance on what should be done. That comes with a responsibility for colleagues who are going to be following that guidance in the workplace.”
Despite the turmoil of the last 12 months, Vhairi believes the health service is far better placed to deal with a future outbreak of infectious disease as a result.
She also hopes some long-term lessons remain from Covid-19 – in particular a shift of mentality around taking sick days from work.
“I am quite positive about the future,” Vhairi said.
“Clearly people have dealt with really, really tough times over the last year and some individuals have been really badly affected, either by Covid or by the consequences of measures that have been put in place, and we wouldn’t ever want to make light of that.
“However, there has been some really positive learning. As someone who works in infection control, seeing that prioritised and seeing people aware of the spread of infections in hospital and how we can minimise that is a positive thing.
“A lot of our staff have upskilled in use of PPE and we need to hold onto that so we can enact it if we need to. To be honest it is likely – pandemics come and go. We just don’t know what they are going to be or what they are going to look like.
“There is also the messaging going out to the public, particularly around people staying at home when they are not well. The work ethic in this country has always been to drag yourself to work unless you are physically dying and we see that through flu seasons and other infections.
“People go to work when they really should be staying at home, and I hope there will be support for people to do that because it is really important to curtailing the spread of infections.”
Adam Coldwells, the deputy chief executive of NHS Grampian, also said the organisation had to adapt quickly to the changes made necessary by the pandemic.
However, he says now, officials have learned a great deal about how to look after staff due to the lessons of Covid-19.
And technological advances have also ensured NHS Grampian is better-placed to adapt and deal with a future health crisis.
“We have learned a lot about our staff and how to support and look after them, especially around psychological resilience,” Adam said.
“In terms of different ways to deliver patient care we have learned a huge amount – easy examples would be things like the Near Me software, how we have interactions with patients through digital media. That spanned the whole system from community right through to hospital specialties.
“We have seen a real adaptability in staff to reorganise how they deliver their particular expertise, and I hope one of the things we hang onto is how we continue that.
“At a big system level, we have seen two things – thinking about how we work as an organisation and how we are ready for another event like this and are able to respond even quicker next time.
“The other side of it is about how we learn about leadership for the system and how we keep that, but how we also give really clear messaging from the most senior leadership.
“We have always said we are a learning organisation and we are always thinking about what we can do better.”