Covid — Five years on: ‘There was an air of panic around what was coming'

Looking back five years on from the global pandemic, Cork University Hospital consultant Arthur Jackson says the concern in the early days was that covid could 'overwhelm hospital resources'

Consultant Arthur Jackson: ‘You can’t deny oxygen to the people who don’t have covid. It was that balance to make sure we had enough resources.’ Picture: Dan Linehan

As news about a new virus in China began to spread around the world in January 2020, doctors and other staff at Cork University Hospital met to discuss any potential fall-out for their patients.

Some thought it could take months to reach Ireland, while others looked at the web of international flights into every airport and worried.

They didn’t know it, but they were just weeks away from their first covid patient.

Arthur Jackson, a consultant in infectious diseases at Cork University Hospital and the Mercy University Hospital, was about to enter some busy years.

“There was so little known about covid at the time,” he said.

“People really were confused about the different aspects and not really sure how it was going to go.

“There was an air of panic, especially in the context of seeing what was coming out of northern Italy.”

 

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.

 

He remembers the weeks of January and February to some extent as “a phoney war” situation.

Preparations were starting from the HSE executive down, but nobody was quite sure what was coming.

"There was this whole meetings after meetings and everyone getting that little bit more anxious about what was coming upon us," he said. 

Oxygen suddenly became the word of the day in the Cork University Hospital corridors.

Mr Jackson lists off the concerns that arose.

“[We had] huge discussions at levels we had never thought about before — how much oxygen flow per litre do you need to have per area of the hospital, and are the pipes you have at capacity.

“And do you need to introduce new infrastructure?”

This was at a time when every hospital in Ireland, and globally, was putting in the same requests to suppliers and manufacturers.

Aife O’Connell, Noreen O’Leary, Berni O’Sullivan, and Natasha Lewis get ready to administer the first covid vaccinations in the Páirc Uí Chaoimh vaccination centre in March 2021. Picture: Larry Cummins

The fear was if hundreds of covid patients in Cork University Hospital needed oxygen at the same time the structures would not cope.

“But [there was] also the issue of patients who don’t have covid who also need oxygen,” he added.

“You can’t deny oxygen to the people who don’t have covid. It was that balance to make sure we had enough resources.”

This seesaw was where one of the many new pandemic phrases came from — “flattening the curve”.

These conversations were happening across the hospital, particularly among intensive care unit (ICU) staff.

Mr Jackson remembers “the big discussion about how many ICU beds would we have, how many did we need to have, how could we flex-up and think creatively to create extra ICU capacity”.

Like every hospital in Ireland, they needed more ICU equipment, nursing staff, medical staff, and even physical space.

“There are so many different aspects and stresses involved in preparing for a huge upturn in patients,” he pointed out.

Porters and housekeeping staff also took on new roles, he said, adding: “Everyone was figuring out how to best serve their own section of the hospital.”

He described giving “ a townhall-type talk” to all hospital staff.

One of my messages was that we should not be scared that this was going to depopulate Ireland — that wasn’t the concern

“The concern was that if we did nothing about it, this would overwhelm the hospital resources.

“Basically, what we wanted was not to have a completely overwhelmed hospital with a completely full ICU where people then would not be able to get standard medical care.”

Regardless of what was happening with covid, people still experienced cancer, appendicitis, or gave birth among a range of other everyday illnesses.

This meant for Cork University Hospital, as for all Irish hospitals, keeping all services going where possible would become a major focus.

For Mr Jackson, his infectious diseases colleagues, and the nurses in the unit, covid was about to become their main focus.

It was the same for respiratory teams and the intensive care unit teams.

The city of Wuhan, China, went into a severe lockdown on January 23 — which would remain in place for around 11m people until June.

Covid, however, was already on the move.

Covid patient Salvatore breathes through an oxygen mask in an Italian hospital as part of his treatment. Picture: Alberto Pizzoli/AFP

The first cases were seen in Lombardy in northern Italy around February 23. Within weeks, this region was devastated.

The army was called into the town of Bergamo to transport truck-loads of coffins to towns with space in their graveyards.

One funeral director told France24 that her business usually buries 1,400 people in a year. However, in March 2020, they buried 1,000 people.

Mr Jackson paused as he described the impact those images had on Irish healthcare workers, saying Italy has “a very, very good health system”.

The early Irish cases were linked to travel, but then community transmission started.

“Our first case in Cork, that we identified, was a case that didn’t have links to travel — which was a real concern,” he said.

The man came in on February 25 and soon was identified as a covid patient. He later passed away.

“Those first waves, the first lockdowns, the first presentations, in my memory it seems the people then were sicker [than later waves],” Mr Jackson said.

“And we had some very severe cases of people going to ICU, and huge numbers of people being oxygen-dependent, and requiring hour on hour changes to their oxygen delivery and their management.”

At the time, we had no known treatments. It really was all supportive care and doing our very best

April 2020 was when the infection really began spreading in earnest here.

The volume was such covid tests were being sent to Germany for analysis, while Ireland scrambled to build-up laboratory systems on the fly.

Typical scenes then or during any busy month of the pandemic years which followed were built around oxygen.

“You had wards of people on oxygen, wards of people requiring support,” Mr Jackson said.

“There are different levels — people who were in hospital and maybe don’t need oxygen at that exact moment.

“Some people need oxygen, and then there are people who need a high flow delivery system.”

Those systems are “the really tight masks that make people panicky and make people anxious sometimes”, he added.

Consultant Mary Horgan receives the actual first dose of the covid vaccine at Cork University Hospital. Picture: Daragh Mc Sweeney/Provision

Other people needed more help and were placed on ventilators.

“We had all of that.

“So we were winding the oxygen up and winding the oxygen down as to the patients’ needs — you were certainly seeing huge levels of sickness all at the same time, all in the same area,” the consultant said.

As he spoke, he circled back again and again to the co-operation and teamwork between everyone — from managerial staff and HR to medics, nurses, engineers, porters, therapists, and other staff.

“Everyone realised it was a problem that needed to be addressed,” he said.

During these months, people outside hospitals were struggling with the virus in different ways.

While many people would have said the last place they wanted to be during a pandemic was in a hospital, this was not at all his feeling as a consultant.

“There is no question, we felt that we were where we wanted to be. We wanted to be doing that job,” he said.

“We were working in the hospital, we were at the cutting edge, and it is where all my colleagues and I wanted to be.

“I would far prefer to be doing that work than staying at home.”

He cycled to Cork University Hospital through a deserted Cork City every day.

“I would certainly maintain that lockdown was probably harder for people who weren’t having the variety of experiences, the variety of contacts we were having,” he said.

And [we were] feeling like you were somewhat empowered to deal with this rather than waiting for it all to go away

Despite many lives being saved by oxygen and supportive care alone, the stress came in the limits on treatment during those initial months.

“It was very stressful watching people get sicker, having no management for some of them, and watching people die,” he said.

“Watching people having very slow protracted difficult recoveries, and the difficulty of visiting restrictions in the hospital.

“Patients really barely got engagement with the outside world while they were sick in hospital.”

A lab technician holds a Healgen covid rapid antigen test at RocDoc's testing facility in Gorey, Co Wexford, for lorry drivers bound for France. Picture: Brian Lawless

It was June 2020 when the first “incredible” breakthrough in treatment came.

Use of a low-dose steroid treatment dexamethasone was found to reduce the deaths of severely ill covid patients in a clinical trial in Britain.

“Giving steroids when someone was oxygen-dependent was a major breakthrough,” he said.

This could make “quite a big difference” he said, and they saw it “markedly reduced [patients’] chance of requiring an ICU bed”.

There had been fears in January too of death rates similar to the Great Flu in 1918, but it seemed this was not on the cards by June.

There were a number of factors behind this, he said, with lockdowns playing a role.

“So if we hadn’t locked down, I think we would have seen major overwhelming of the system,” he said.

“It probably wouldn’t have changed the number of covid deaths, but it might have affected the numbers of people dying from a road traffic accident, or appendicitis, or requiring urgent cancer care and all of these things.”

He added: “I know that some people will have issues with me describing it as a success because there are different retrospective views on it.”

Gamechanger vaccine

As 2020 passed and medical staff moved into 2021, they became used to seeing covid patient numbers rise in a wave between lockdowns and easing after restrictions were re-applied.

The real gamechanger, however, came in late December 2020 from scientific minds putting their heads together around the globe to find a covid vaccine.

In contrast, the first flu vaccine was not developed until 1945 — almost 30 years after the great epidemic following the discovery that flu was caused by a virus.

Mr Jackson remembers his first shot clearly as the Pfizer–BioNTech vaccines were rolled out.

“I was just delighted, extremely happy that this was rolling out,” he said.

“I was definitely very privileged. I was in the first wave of people to be vaccinated. I was just very, very happy to be getting it,” he added.

It removed a personal worry for him, he added, saying: “I had young children at home, and I didn’t want them to be exposed.”

The vaccines were another area where co-operation was vital, he pointed out, saying it was “marvellous” to see.

I knew the data behind them was extremely solid and good, and the subsequent data has backed that up, they are among the safest vaccines we have

The jump forward in research across many areas was one positive he took from the pandemic, thanks to high national and international levels of cooperation.

“We were all just doing our very best and trying to figure it out,” he said.

Cork was the hub or lead site for the Solidarity group of studies in Ireland in the EU Solid-Act project investigating treatment for covid.

Joe Eustace, a University College Cork professor, led on this chairing the regular Zoom meetings.

Now, some five years on from those early days, covid is still around. However, the crisis has passed for most people.

Then 16-year-old Ciara Brady, from Clonakility, after she received her vaccination at the walk-in vaccination centre in Clonakilty GAA Club, Cork. File Picture: Jim Coughlan

“We’re still seeing people coming to hospital with it, but we’re seeing very few people end up in ICU or requiring high levels of care,” Mr Jackson said.

“There has been a legacy of psychological trauma on some people too and long covid for some people as well.”

People who are immunocompromised, a group which includes transplant patients for example, also remain at risk.

Mr Jackson’s hope now is the skills and research developed during 2020 and the following dark years can be useful.

It trained us for the next pandemic, dare I say it

However, his main takeaway is clear from repeated comments as he speaks.

“That whole build-up and the meetings and the bringing people together, it was amazing to see all layers of the hospital working together,” he said.

“It was really eye-opening, interesting, and you might say inspiring to see everybody working together,” he added.