Covid — Five years on: ‘We did our best, but we need an inquiry to plan for the next pandemic’ 

Many of the actions taken: lockdowns, social distancing, hospital cancellations, and school closures should be questioned in hindsight, writes Dr Catherine Motherway

Dr Catherine Motherway says the covid lockdowns and visiting restrictions were not only very hard for families but were also hard on staff in intensive care units. Picture: Ray Ryan

Five years on from the start of lockdown in 2020, I find myself sometimes wondering if the pandemic really happened, and at the enormous changes we endured as a society. 

I believe we did the best we could at the time, but hindsight is a 20:20 vision. Looking back, we must remember to judge our actions in the context of what we knew at the time - and knowing that the death toll worldwide ended up at more than 7m people.

In late 2019/early 2020 the WHO was notified of an outbreak of pneumonia in Wuhan, China, initially of unknown cause. By January 7, 2020, the cause was identified as a coronavirus initially titled as SARS-CoV-2 subsequently renamed covid-19.

A pandemic was declared on March 11, 2020. While we had relatively recently had a pandemic in 2010 (H1N1), that disease did not threaten the entire population as covid did, and comparisons were being made with the Spanish Flu a century ago.

 

This article is part of a series looking back at the covid-19 pandemic, five years on from when restrictions were first introduced in Ireland.

 

A temporary hospital converted from an exhibition centre in Wuhan in central China's Hubei province in February 2020. The hospital, one of the dozen of its kind built in Wuhan, hosted covid patients with mild symptoms. File picture: Chinatopix via AP

We watched on TV as China built entire hospitals, but it became far more real when the disease hit northern Italy in February, overwhelming their hospital systems and with very significant loss of life. The pictures of coffins carried by military trucks will live long in my memory. Our colleagues in Italy through the ESICM (European Society of Intensive Care Medicine) wrote to us all in Europe, urging us to prepare.

We knew in the ICU community we had fewer than half the beds per capita than northern Italy. We spent what time we had talking with colleagues abroad who were being hit before us to learn about the disease, its presentation, treatment strategies, and organisational tips. In ICU terms we were under-resourced, so we had to plan how to expand quickly, use other spaces, ensure continuity of oxygen supply to the entire hospital, redeploy staff and upskill — fast.

Muster the agenda

We had experience with bird flu in 2010 managing viral pneumonia, but this was a completely new virus and everyone was susceptible. At first, we were able to muster the energy needed, but coping with repeated waves became exhausting.

From the second wave on the virus became more infectious and there were more hospital outbreaks which were very difficult for patients, especially vulnerable people who had to attend hospital for other conditions.

The wave in January 2021 was very challenging, but the introduction of the vaccines signalled hope and a chance of an eventual return to normality. The development of the vaccines so quickly was an example of science in action and the mRNA vaccines continue to offer enormous benefits to mankind in terms of potential treatment for cancers as well as for other vaccines.

Along with helping very sick patients, we needed to communicate directly with the public. We knew from what we had seen abroad that without public health measures to flatten the curve no hospital system could cope. We also had to expand our capacity.

Intensivists, critical care nurses and anaesthesiologists worked together to ensure accurate information about what was happening was readily available. People needed to be aware of how we were coping, and how they could help us and themselves. 

That media role was new for me and carried its own stress, but I always aimed to answer questions honestly and to admit when I did not know the answer to any query. I tried to prepare as much as possible for interviews and I was always very relieved when they were over.

I still had no concept of how life was going to change with lockdown. In a way I felt lucky that I could go to work each day and that I still had a job unlike so many in hospitality, travel and other industries. In addition, I could go home when work was done.

Our trainees were in a difficult position, living away from family, unable to socialize with their peers and many from overseas unable to see their families. Many of our staff had vulnerable family members or were themselves vulnerable.

Death is no stranger to those of us who work in intensive care where lack of bed availability is an ongoing significant source of stress and anxiety.

Hospital work is at the best of times stressful and death is no stranger to us in the ICU so we rely on support from each other, and this is frequently given at work but also socially. Going out together for a meal, a drink and a good chat or moan about work is therapeutic. 

The restrictions and the fear of becoming infected and passing it on to the family, colleagues or patients severely impacted on our normal support mechanisms for each other. In future, specific psychological support in these situations would be a good thing.

Our covid patients stayed with us a long time, we frequently got to know them extremely well via their families telling us about them and also from working with them. I think that during the pandemic many of us were affected more than usual when we lost a patient. 

I have always maintained that one should only cry about a patient once in a few years; more often means one is not protecting oneself and less often means we don’t care enough.

I have always had occasions where the sadness of a particular patient will upset me, but I know many of us shed tears for our patients on multiple occasions during covid. The loss of life in patients who had fought long and hard, their families frequently unable to visit, hit hard. Some patients had acquired the disease in hospital, which was very difficult. All of those who died were lost to their families before their time.

The other effect of lockdown and visiting restrictions was very difficult. End-of-life care both inside the ICU and in the wider community was affected. In Ireland as we come to the end of life, we gather to be with the dying person; to offer company and solace, tell a story, remember a kindness and celebrate a life. 

ICU staff pride themselves on good end of life care. This was severely limited initially during the early days, but it is important for people to know that in the absence of family, we were with the patient holding a hand, saying a prayer, perhaps singing a requested hymn. We ensured that they were not alone.

Last year in Limerick the ICU staff organized a service for those we lost during those years. Over 800 people attended with 100 more joining online, many expressing gratitude to know that their loved ones, our patients were not forgotten. Coillte were kind enough to donate a native Irish tree for families to plant in honour of each life lost. 

Dr Catherine Motherway says that the lack of bed availability is an ongoing significant source of stress and anxiety.  Picture: Ray Ryan

I believe it was of great comfort to both families and staff that we gathered to remember them. Pictures were blessed and shared with us, and we swapped stories with each other. 

Outside hospitals, we also adapted to lining the streets or roads to send our neighbours on their way, and let families know the community still wished to offer sympathy and support.

The pandemic put significant focus on Ireland’s lack of critical care infrastructure. We started the pandemic with approximately 257 beds. This severe lack of beds certainly contributed to decisions made about lockdowns and their length and severity. Numerous reports had highlighted this problem prior to 2020 but the pandemic firmly brought this to the public eye. 

For many of us working in ICU, lack of bed availability is an ongoing significant source of stress and anxiety. We want sufficient bed capacity to treat all who need ICU care and also ensure that we have the capacity to support high-risk scheduled surgery despite the demands of emergency admissions.

We have a firm commitment from the government to continue to expand ICU capacity to 430 beds. It is my understanding that there is now circa 6.1 beds per 10,000 population. 

The ICU BIS system run by NOCA gives a daily tally of beds open and staffed, beds occupied and beds free. That number is frequently lower than the number of beds funded which reflects challenges in recruitment and retention. 

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Beds staffed and open are required to give timely critical care to our patients. If the system is under pressure, admissions will be delayed, and we know that means poorer outcomes.

Hospitals are run and staffed by human beings doing their best in most instances. The support and kindness shown to us during the pandemic was immense. People sent food, letters and prayers and we had public support from our colleagues across the political spectrum. 

We met with management frequently and changes were made quickly. It would be good if we could continue with some of that urgency to address the many problems we have. 

Meeting of minds

Remember Mike Ryan of the WHO saying “perfection is the enemy of the good”? The Medical Leaders Forum founded during the beginning of the pandemic was an excellent place to discuss problems and was a meeting of minds. Perhaps our new minister could consider reconvening it to assist with the work we have yet to do?

Many of the actions taken, lockdowns, social distancing, cancellation of significant amounts of scheduled medical care, lack of daycare for vulnerable patients, school closures and a health service focused predominantly on covid should be questioned in hindsight.

Inquiries should look at both the positive impacts in terms of decreasing spread of the disease, flattening the curve and avoiding the health services being overwhelmed. But also we need to look at the negative outcomes, lack of socialisation for children, isolation in certain groups especially older people, lack of resources, and delays to scheduled medical care. 

Findings should assist in future planning, but of course, new diseases will be different. My hope is that they will lead to future-proofing and planning for our country, our health service and the wider world in the event of future pandemics.

The seanfhocail “Ar scáth a chéile mhaireann na daoine” is much quoted during hard times but was truly applicable to the covid years. My sympathy to those who lost loved ones during those times. Ar dheis Dé go raibh a n-anamacha dílse.

• Dr Catherine Motherway was president of the Intensive Care Society at the beginning of covid and worked in the Intensive Care Unit at University Hospital Limerick throughout the pandemic. She retired from clinical practice in 2022 and now works part time with ODTI supporting and promoting organ donation.