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Mark Conrad talks to senior staff about the risks faced by NHS workers tackling the Coronavirus – and precisely why hospitals become virus “hotspots”.
Boris Johnson’s admission to the intensive care unit (ICU) at St Thomas’ Hospital is a sharp, shocking reminder that nobody is invulnerable to COVID-19 – including the highly-skilled staff treating the Prime Minister.
The decision to move Johnson to hospital would not have been taken lightly, and not merely because he is in charge of Britain’s response to this global pandemic. The grim reality of Britain’s hospitals is that they have now become the biggest Coronavirus “hotspots” in the country – places to avoid unless you fall seriously ill during this unprecedented period.
As one senior consultant told me this week: “Hospitals can be dangerous places.”
While the quality of medical treatment and care inside NHS hospitals is generally world-class, it is the environment in which that care is provided that can become the cause for concern.
Since the first cases of the Coronavirus were diagnosed in the UK, 14 frontline medical staff have died after contracting COVID-19, while one national newspaper poll recently suggested that 14% of NHS staff are currently either off sick or self-isolating amid escalating threats to their health.
With continued evidence that many NHS and care staff are still not receiving adequate supplies of personal protection equipment (PPE), hospitals are now alert to the risks posed to their dedicated employees, in whose hands so many of our futures – including that of the Prime Minister – now rest.
There has been wider public recognition of these risks, too. The country has celebrated the role of the NHS through the national #clapforcarers campaign, and one of the most common discussions we now have with family and (remotely) with friends is to recognise the extraordinary contributions of health and care service workers. But why, exactly, are frontline medical, nursing, paramedic, hospital, policing, care and ambulance staff so vulnerable to COVID-19?
This may seem like a basic, almost rhetorical question. Yet a few myths and half-truths have already developed around this issue. So Byline Times this week spoke to several senior hospital consultants and nurses, who asked to remain anonymous while they continue with their work, to help explain exactly why the risks to staff are so much higher than your average member of Britain’s (broadly) patient public.
Viral Loads
One senior hospital consultant said that the best starting point is to consider the evolutionary “purpose” of a virus. These things exist to find a host, replicate and then be transmitted to another host.
Contrary to a wonderfully prosaic – but hopelessly unscientific – tweet from the former Sunday Times editor Andrew Neil, viruses are not sentient and do not “decide” who to attack, when and how. They simply attack cells once they have found a host. People’s bodies respond differently to that attack and a host of other factors – such as pre-existing respiratory conditions – can significantly affect a person’s ability to overcome the virus.
As with all viruses, including those in the Coronavirus family, when people are seriously unwell – for example, feverish and in need of hospitalisation – they have what is referred to as a higher ‘viral load’. That term is a way of describing how much active virus a person has in their body.
Hospitals rarely measure ‘viral loads’ routinely during outbreaks of acute viral illnesses. It is more regularly done during the management of chronic, long-term viral conditions, such as HIV or hepatitis. And a high viral load does not necessarily translate to the severity of a COVID-19 sufferer’s condition (another of the unproven claims found circulating on social media).
Nonetheless, when viral loads are at their highest, any carrier is generally ‘shedding’ the virus – through excretions, coughs, sneezes and other methods of transfer.
By definition, therefore, when somebody is ill enough to be hospitalised – especially during this pandemic when those with minor or mild symptoms are encouraged to stay at home and self-isolate – they tend to ‘shed’ more of the virus.
So what is happening in and around hospitals, the very places we gravitate towards when ill, is that those present are in closer proximity with patients who are most infective and who are ‘shedding’ higher viral loads.
Where the Risk is Greatest
Of course, hospitals have incredibly high hygiene standards and cleaning teams are employed around the clock to keep wards, corridors, treatment rooms and public places as disinfected as is humanly possible.
But frontline NHS staff, particularly nurses and doctors, are in near-constant proximity to those ‘shedding’ the highest viral loads. While the rest of the country is rightly encouraged to self-isolate and undertake social distancing measures, frontline NHS and care staff are paid to maintain physical contact with those made most ill by this awful condition.
Frontline staff are within inches – not meters – of the country’s most ill patients who are coughing, sneezing, spluttering, drooling and sweating this potentially deadly virus. All-day, for days on end.
The volumes of this virus that many NHS, care and public sector staff are now exposed to does not bear thinking about on a human, health level. That is why six doctors, five nurses, and other frontline staff (including a midwife and a pharmacist) have died. And it is why, unfortunately, more will likely lose their lives during this epic public health battle.
I write this not to scaremonger or fetishise the horrific effects of COVID-19. The vast majority of people in the UK, and around the world, will be mostly unaffected health-wise – and will understandably become frustrated with ongoing lockdown measures.
And some doctors have been surprised at the relatively low number of medical and nursing staff who have died in the UK, considering their proximity to the virus. One told Byline Times: “While each loss of life is tragic and nobody should become complacent, it’s noteworthy that, to date, few frontline workers have died considering the severity of this virus.”
But if you want to understand why oft-related mantras about self-isolation, social distancing, emergency-only hospital admissions, PPE and ventilators matter – and why complacency cannot be allowed to creep into our lockdown mentality – just remember how and why hospitals have become the viral hotspots they are.
And think of the incredible staff putting their health and lives at risk to save us all – including the Prime Minister.