With an ordinary beginning to the year, little did I suspect a virus pandemic and a near future bleak reality awaiting. The earliest cases detected in the UK were in late January. Despite not belonging to any vulnerable group at that time, exaggerated media reports of young individuals rapidly deteriorating, requiring ventilator support and some even dying did cause fear in our minds. Unsurprisingly, crowding being the most common risk factor for spread, London soon saw exponential growth in its COVID-19 cases. Simple public health measures like frequent hand sanitising and avoiding frequent touching of the face failed to reduce the virus spread, and the increasing case load led to full blown lockdown in late March. The parliament of the UK granted the government emergency powers to handle the pandemic and police were empowered to enforce lockdown. Fear of disaster and supply shortage led to panic buying. The situation slowly started improving in May and the government is looking at gradually relaxing lockdown measures.
Major and drastic changes were made in the NHS. The health trust I work in is one of the five most affected trusts in the whole of UK. Diagnostic radiologists started working from home exclusively, including attending multidisciplinary meetings via online conferencing softwares. Interventional radiology services fell overnight to an emergency-only service. An experienced radiologist colleague was designated the Radiology COVID lead who collaborated with the other departments and hospital management to bring about necessary changes in Radiology to meet the demands of this pandemic. Vetting of planned cases and categorization into various classes of urgency and severity ensued.
Musculoskeletal interventions involving steroid injections, outpatient angioplasties, elective EVARs, oncology related interventions including biopsies were stopped. Angioplasties were restricted to in-patient critical ischemic limbs. EVARs were restricted only to aneurysms that presented with rupture.
Musculoskeletal interventions involving steroid injections, outpatient angioplasties, elective EVARs, oncology related interventions including biopsies were stopped. Angioplasties were restricted to in-patient critical ischemic limbs. EVARs were restricted only to aneurysms that presented with rupture. Despite a significant reduction in the number of interventional radiology procedures, isolation of symptomatic staff kept the functional staff busy almost all the time. Also contributory was an increase in procedural times due to time spent in donning and doffing a complete PPE attire for every suspected or confirmed infected patient and a high level clean of the procedure room between every patient. There was also a significant increase in the number of bedside procedures to avoid moving infected patients within the hospital.
Plans to involve private hospitals to provide ‘green’ pathways, particularly targeting oncology and trauma services for patients tested negative for COVID have been successfully implemented, though these areas do not have the capacity to bear the full NHS case load. Despite having a designated ‘green’ hospital in central London for vascular interventions, wait times increased significantly. We recently saw a a patient for EVAR with rapidly increasing abdominal aortic aneurysm wait for 3 months. Such patients are now counselled about the dangers of deferring treatment balanced with the dangers of acquiring COVID in our hospital if treated, and if patients agree, every measure is taken to provide as ‘green’ a pathway as possible, with the least in-hospital.
Major structural changes are being made to hospitals, dividing them into various colour coded zones – green, yellow and blue, to serve confirmed negative, untested and confirmed positive cases respectively – with restrictions in patient and staff movement between different zones. For example, movement from green to yellow to blue zones would be permitted but and not the other way. Outpatient clinics are being held over the phone. Critical care capacity has been increased five-fold. A team of psychologists were assigned for psychological support for our staff in person and over the phone. The present challenge in our department is to manage interventional radiology services over the different hospital zones, which may involve an unwelcome split in the entire department staff retinue, being designated to work in different zones.
This COVID pandemic has shown us how an organization can step up and give a remarkable display of innovation, collaboration, dedication, decision-making, service reconfiguration and workforce re-design. With a hope that an effective treatment or vaccine will emerge eventually, we are preparing to live with the impact of COVID-19 pandemic for the foreseeable future.
Dr. B. P. Krishna Prasad
Consultant Radiologist, BHR Hospitals