Two nurses who were at the epicentre of the Covid-19 outbreak have spoken about their experiences four years on.
Cindy Marudamuthu and Trish Mukherjee were both senior nurses working at Northwick Park Hospital when Covid-19 first struck.
“Every day it felt like you were on a [treadmill], and I was running faster and faster”
Trish Mukherjee
The hospital, part of London North West University Healthcare NHS Trust, was the first in the country to declare a critical incident due to Covid-19. Before that, as a hospital with a large infectious diseases specialty workforce, it was tasked with screening Heathrow Airport arrivals.
Ms Marudamuthu, who was an infectious diseases matron at the time, recalled the initial response in January and February 2020, before the pandemic hit the UK in earnest: “We were the screening hospital for London, I remember in those days we were still calling it the Wuhan virus.
“We would take patients who met the case definition from Heathrow, and screen them. It took a long time for us to get a [Covid-19 test] result, and the positive pathway was they would then go to Royal Free [Hospital].”
This, and the community Covid-19 swabbing service, were Ms Marudamuthu’s chief responsibilities at the time.
She said it was a tense period, and remembered the day the first positive case was recorded: “I just came back from swabbing with one of our doctors, and my nurses were at the nurses’ station telling me we just had a call from Public Health England [now the UK Health Security Agency].
“The consultants and everyone stayed around, and we found out that one patient we swabbed came back as positive.
“In one way we felt a bit like – ‘Oh, yay, it’s working, we can actually screen and get results.’ But then it wasn’t good, because someone came back as positive.”
She said there was not a particular sense of worry for what would happen next, and that they – like everybody – underestimated the infectiousness of Covid-19.
Once cases began to come in thick and fast, Ms Marudamuthu and her team were “taken aback”.
“We had an Ebola outbreak a few years before, and had the same patient pathways and screening process. We were used to screening high risk viruses, but then this was something we never expected,” she told Nursing Times.
She added: “If it followed our thought process, then we would have kept control of it. But because [Covid-19] decided to do whatever it wanted, that virus transmitted in ways that we never anticipated.”
Ms Marudamuthu said patients began to fill up inpatient wards at her hospital from early March, and within a few weeks it was the first to declare a critical incident as a result of Covid-19.
As part of her infectious disease responsibilities, Ms Marudamuthu was tasked with keeping nurses up to date with the latest guidance, research and best practise coming from the government, the NHS and the global healthcare community.
She said she was finding out new information each day, even before the critical incident was declared in late-March, and that the news would sometimes contradict what she had heard 24 hours previously.
Meanwhile, Ms Mukherjee, head of nursing at the time, was drafted into intensive care due to her background in that specialty. By that stage, it had become clear Covid-19 was more serious than first thought.
The sheer caseload was a challenge both due to the practicalities of treating people, and the obstacles that caused to improving care for patients with a novel virus.
“By the time you’ve written something, the fifth, sixth patient was coming through and you didn’t have time for that reflection and [learning],” she said.
Ms Mukherjee continued, referring to the shortages in equipment: “We had to think about all the equipment and machinery, to keep these patients ventilated and alive and about the logistics which go with it.”
As with many other wards across the country throughout the pandemic, Ms Mukherjee’s began to bring in non-specialist critical care nursing staff to bolster the workforce.
She recalled the additional challenges this brought: “Everything was difficult, not just creating space and capacity for patients – which was fast – but the staff who had no understanding of critical care.
“You had to give them the support and training needed to ensure a patient was kept safe.”
Ms Mukherjee recalled the scenes inside the hospital as the wards began to hit capacity. She said her nurses became “invincible” after a few weeks but, at first, the reality hit hard.
She described March 2020 as a treadmill: “Every day it felt like you were on one, and I was running faster and faster.
“There wasn’t a moment where I felt [the hospital] didn’t need more help, I’ll be honest.”
She added that the crisis management during the early emergency period made her thankful for her years of experience, and that it felt like a return to the “basics” of nursing in the old Nightingale wards in which large numbers of patients were nursed in one area.
Ms Mukherjee continued: “I knew the staff extremely well, I hired half of them and so I knew their capabilities, I knew their strengths. They were all amazing nurses, who were very tough.”
However, she said at the end of her first shift in intensive care, “there was no one who was not crying, or so emotional that they could not […] speak or convey how they felt, they were just so emotional”.
“That happened every single shift, but at the end of that week, they realised things aren’t really changing, this is going to be our reality,” she added.
She praised the strength of her nurses, but said it emerged out of a need to keep going with no end in sight.
“That was really, really hard,” added Ms Mukherjee.
Both she and Ms Marudamuthu said they had buried the emergency period in their memory due to the heavy emotional burden it carried.
“How I dealt with it was I parked it, tied it up and drowned it,” Ms Mukherjee said.
“It’s been difficult because I had to pay the emotional price at home. I spent something like 18 hours every single day for that entire first wave at work, sometimes even though it was a weekend.
“My family told me – that’s enough, that they had hardly seen me. What I can’t underestimate is how much I neglected my family.”
The nurses spoke with Nursing Times ahead of the fourth anniversary of the first lockdown being called in the UK, on 23 March 2020.
Other nurses have also shared their memories of the early pandemic period, to mark the milestone.