Rosie Baruah
Dr Rosie Baruah is a Fellow of the Royal College of Physicians of Edinburgh. She is a Consultant in Intensive Care Medicine and works at the Western General Hospital in Edinburgh.
Details
- Date of interview: 13 October 2020
- Archive reference: RCP/RES/2/12/13
- Interviewer: Daisy Cunynghame
Timestamps
00:00 Introduction
00:23 The effect of coronavirus pandemic on working hours and practice
03:05 Comments on availability of medicines, medical equipment, and Personal Protective Equipment (PPE)
03:55 Treating patients with coronavirus and the long-term effects of the disease on health and mental health
06:08 Long-term effects of the pandemic on the NHS
10:15 Government response to the pandemic
11:26 Public response to the pandemic
13:43 Personal experiences of coronavirus
15:00 Effect of the pandemic and lockdown on home-life routines
17:32 Wellbeing and mental health support given to medical professionals
18:01 Views on finding information surrounding the pandemic
23:32 Closing comments on team spirit and morale during the pandemic
Transcription
Interviewer:
Could you please start by introducing yourself by telling me your name, your college (Royal College of Physicians Edinburgh) membership status and your medical specialty please?
Rosie Baruah:
My name is Rosie Baruah and I'm a fellow of the college and I'm a consultant in intensive care medicine here in Edinburgh.
Interviewer:
Thank you. So, could you describe how the coronavirus pandemic has affected your working hours and your medical practice?
Rosie Baruah:
Coronavirus has profoundly affected the way that we work since March of this year. I work at the Western General Hospital, which is a teaching hospital in the northwest of Edinburgh, and we are home to the regional infectious diseases unit. So, the very first patients in Edinburgh to be hospitalized as a result of coronavirus infection were hospitalized at the Western General. And we as an intensive care unit (ICU) had to generate plans to both admit and cohort these patients safely within our intensive care unit to be able to provide them with advanced ventilatory therapies in a way that didn't risk the health of other patients and staff. We also had to make plans with relatively little notice on how to expand our ICU capacity to at least three times its normal capacity, at the request of the government, in anticipation of a surge in the number of cases of patients needing to come to intensive care.
That happened in March 2020, and over March, April, May, we filled our normal intensive care unit with intensive care patients with coronavirus infection, and we had to expand our intensive care to a separate area of the hospital in the theatre suite-the recovery area-which is where we kept our non-coronavirus patients because at that time we were a neurosciences intensive care unit, plus all the other specialties we looked after, and we still had an ongoing need to provide intensive care to patients who were not infected with coronavirus. But that had the knock-on effect of affecting the throughput of patients coming through theatres, having emergency and elective operations. And the increase in number of beds, which was well over 50% of what we normally provided, meant that we had to draw in medical nursing, pharmacy, physiotherapy, speech and language, dietetic therapy, staff members from all over the hospital to look after these patients. Which was possible because of the slowdown in um clinical activity in other areas of the hospital, but led to its own challenges in terms of teaching, training, and staff well-being for these people who were not used to working in a critical care environment having to do so with very short notice and the physical constraints of PPE (personal protection equipment) and so forth.
Interviewer:
Well, you've almost touched on my next question at the end there, which is: have you experienced shortages of medicine or medical equipment such as PPE?
Rosie Baruah:
We were very fortunate in having managers from nursing, medical, pharmacy um procurement departments, all of whom predicted that there would be a very increased demand on the medicines that we needed, the equipment we would need. They tried to pre-empt and predict this as much as possible to ensure we had stockpiles as so far as we could, and also have in place contingency planning, should we run into shortages. We were fortunate that we did not, but we did have the reassurance that if we did, we had plans that we could fall back on so that we were not caught short.
Interviewer:
Thank you. Without giving individual names, are you aware of any particular patient’s experience you could share which illustrates the complexities of treating coronavirus patients?
Rosie Baruah:
So, for example in the press in the last fortnight one of our patients was featured who was with us for 172 days with coronavirus. This patient was admitted with shortness of breath, cough, the standard features of coronavirus, but coronavirus is not just a respiratory infection, it can affect all systems of the body. It can cause kidney failure. It can cause severe delirium in our ICU patients, and the process of being critically ill is an intensely catabolic one, it uses up the body's energy. It weakens the body's muscles, and this particular patient unfortunately had to spend a lot of time ventilator dependent before he was in a position to breathe independently and [he] still has a very long way to go to actually regain the ability to complete the sort of basic, what we call activities of daily living, just washing and dressing and feeding.
So, it's a disease that not only requires intensive treatment when you're in the hospital, but it creates a burden of longer-term disability, and also psychological harm, that will, I think, unfortunately linger with our patients for a long time. One of the things I'm also involved in is critical care follow-up. So, seeing our patients in an outpatient setting [when] they've been discharged from the unit, and it is almost uniform in this patient group that they have psychological issues, with flashbacks, with poor sleep. They have poor appetite, they have muscular aches and pains, they have reduced mobility, they have shortness of breath. It's really a very disabling thing to have had and it's by no means a benign infection that's just a severe version of the flu, it really is a very serious disease to develop both in the short and longer term.
Interviewer:
Thank you. What long-term effects do you foresee the pandemic having on the NHS, thinking in terms of structures of care and funding? Do you think it will change the way things are done?
Rosie Baruah:
I think, right now, we are still in the in the thick of it. Certainly, one of the big concerns that we all share is that there is a backlog of patients whose routine investigations have been delayed, and we are still trying to catch up with that even though the second wave is upon us. There will be patients who have not even presented to medical services because they have not been able to get appointments with general practitioners, because general practitioners are having to change the way that they work in a way that makes it a lot harder for them to see patients. So, I think there will be, for many years, an ongoing hangover if you like of chronic illness and delayed diagnosis which can be traced back to this pandemic, because our health system has never seen anything like this before that has so disrupted our normal procedures and protocols for management of chronic disease and diagnosis of new disease.
Interviewer:
Those are largely sort of negative impacts. Do you think there are any positive outcomes that the NHS can learn from the coronavirus pandemic about how to improve services?
Rosie Baruah:
I think in the short-term, in terms of our acute services planning, we in Scotland have never had much in the way of critical incidents in the way, for example, hospitals down in London have had, with various terrorist incidents, when they've had to invoke their plans for critical incident planning. So, we now know that if we had to, we are able to increase our critical care capacity many times in excess of what its baseline numbers are, and I think that shows that organizationally we do have a state of preparedness for that kind of event.
I think we are learning to work remotely more effectively, which, I think that's a benefit, both for staff in terms of utilization of time. For example, if I were to attend a meeting at the Royal Infirmary it would be an hour there and an hour back. Whereas now I think everyone is getting far more effective at meeting using video conferencing platforms, which I think the NHS has very much not utilized that that capability until now. I think from my colleagues who conduct clinics, they say they've actually had very positive experiences in running these clinics using video conferencing technology. And again, I would hope that that's something that can be integrated into ways of working going forward. Although, I think that will never be a full substitute for being able to see patients in clinic who need to be seen. I think it could be a very useful adjunct to what we do.
I think in terms of research there have been some very high-profile trials in coronavirus management which have been based in the United Kingdom, and the speed and efficiency within which they were set up, and the research infrastructures supported again is unprecedented. I think that's something that should absolutely be recognized and lauded, and again education has, I think, for medical schools and for postgraduate education teaching, training, and examinations, these systems have been forced to really dramatically change the way that they work. And the Royal College for instance, has done very well with its online COVID-19 e-learning modules, which I believe have been accessed by a six-figure number of users across the world. And that is incredible to get that standard of teaching online to be accessed by anyone free if they need it. I think these are really positive examples of the medical profession and nursing and other professions using a crisis to move the way we deliver our services in a positive way.
Interviewer:
Thank you. Do you have any comments on how the government has responded to the pandemic? Either the UK government or the Scottish government.
Rosie Baruah:
I think with the Scottish government, I felt personally and professionally, that what we've been told is very clear. I think this has been the first time I personally have noticed such a discord between the four home nations, taking different decisions about the direction in which they want um the public to behave and the way in which they want the hospitals to provide services in the wake of changing demographics of coronavirus infection. I think that that has been less helpful. But in in terms of our guidance from Health Protection Scotland, I think yes, at the beginning it was changing all the time, but that's because they were learning things all the time. The four home nations all having different rules, I think, we all thought was slightly strange, and possibly unhelpful and confusing for people.
Interviewer:
Thank you. In a similar vein, do you have any comments on the public response to the pandemic, in terms of compliance with all the regulations that were coming out, and that sort of thing?
Rosie Baruah:
The initial response to lockdown, I think, was incredible in the sense that everybody just stayed at home and they did what they were asked. And I will always have these memories of driving to work in April, and it felt like when you drive to work on Christmas day or New Year's Day, when the streets are just deserted and it was very strange, but it was so quiet and people were taking it incredibly seriously. I think lockdown fatigue is a real thing. I think the fact that face masks have become compulsory in a greater number of environments is something that people find very scary, because face masks have an association with medical treatment and having to wear them in your normal life, I think, is something that I think people have found just existentially quite upsetting. And I think that's contributed to some of this push back against lockdown and coronavirus restrictions that we're seeing.
I think lack of coherency in decision making around, for example, allowing students to return to halls of residence but then confining them to their bedrooms. These kinds of things, I think, can contribute to an undermining of the faith of the public in the government guidance as regards lockdown, and I think that's an unfortunate thing. I think it's very, very, very difficult to make decisions on absolutely everything the way that the government have had to as regards to school exams, going back to university, reopening schools, reopening entertainment, and hospitality venues. I think it's so challenging to balance controlling the virus with keeping an economy going, because after all, we have continued to be paid, we haven't had to worry about paying our mortgage. So, I don't envy them their decisions, but I can see public [Pause] willingness to go along with coronavirus restrictions waning as time goes on, because people are tired and they're scared.
Interviewer:
Thank you. The next questions I'm going to ask are about the personal impact of COVID on you. And just a reminder that if there are any questions that you don't want to answer, please do just say. Have you had or do you know of any colleagues, friends, or family members, without giving names, who have personal experience of contracting coronavirus, and if you're comfortable doing so could you describe those?
Rosie Baruah:
So (crosses fingers), none of my friends, colleagues, family members have contracted coronavirus. In our ICU, we haven't had a single staff member contract coronavirus, and that has been a source of great reassurance to us, because the PPE we are wearing must be working, because we are involved in patients who have , you know, the highest viral loads in the hospital, because that's why they become so sick. So, that has been um psychologically, for our team, incredibly important. I cannot imagine how hard it must be to care for one of your own in intensive care, as I know many of my colleagues, particularly down south, have had to. Again, personally, I think this just must be good luck, I haven't had any friends or family develop coronavirus. I think had I had, my emotional and personal resilience in going into work and dealing with these patients would have been tested to a far greater extent than it has been.
Interviewer:
Thank you. Could you describe how your home life, routines have been affected by lockdown?
Rosie Baruah:
Initially in lockdown my daughter, who was thirteen at the time, she's now fourteen, was, you know, sent home from school and-a week before the Easter holidays? And didn't go back until the end of August. At the age of thirteen she was capable of going along with all the homeschooling provided by her school, which was very comprehensive and followed the pattern of the school day. She had a structure to her day, but of course that didn't involve the same kind of social interactions by any stretch of the imagination that school would normally have. So that was a huge disruption for her. It was reassuring to me to know that she was safe at home. But at the same time, knowing that she wasn't amongst her friends enjoying what a normal thirteen-year-old should enjoy. She didn't mind because she meant that she didn't have to get up early in the mornings and things. But I do wonder, long-term, the effect that [lockdown] will have on this generation of school children.
I wasn't able to see my extended family. My sister lives just a mile and a half away, but again in the initial phases of lockdown, we couldn't even meet out of doors. The same with my mother who’s only in Glasgow, but you know, we weren't able to see. Again, you know, we've got video calling, we have means of staying in touch, but it's not the same. As lockdown loosened over summer, that was really lovely actually, just being able to see people out of doors and in each other's homes. But now we're kind of heading into winter, the clocks are going to change, in what, two weeks? Nobody knows what Christmas is going to hold. We're not going to have the Edinburgh’s Christmas and Edinburgh’s Hogmanay, which you'd always think you'd be delighted about, but actually you think it'll be quite sad, not to have all those lights and all that kind of festive stuff that you're so used to and almost take for granted.
So, from a personal point of view, it's like you're constantly standing on shifting sands, and you can never really plan, ‘Oh, should we have a birthday party? Should we have this celebration? Should we do this? Should we?’. But I'm also very aware that we're very fortunate, in that nobody in my family has been in any financial difficulty or has been close to losing their job or facing that kind of insecurity because of coronavirus, which I'm sure is affecting a huge number of people. So, in some ways we're actually relatively unscathed, but it's a lack of certainty going forward that is very challenging.
Interviewer:
Thank you. Given everything you've said about changes within your work, and also your personal life. Do you feel that the mental health support for medical practitioners is sufficient, and do you think there's any improvements that need to be made in that area?
Rosie Baruah:
I'm very fortunate, in that I work in a group of nine consultants who are all very supportive of each other, and I think there's a huge amount to be gained by having people who are in the same situation as you, in literally the same situation because you're in the same department, who can speak honestly with each other, and that is probably my main source of support. We also had psychiatry colleagues who came every week and held a talking group, to allow us to informally discuss the issues we were experiencing as a result of coronavirus, and they implemented that throughout the first wave, and that's restarting again this month with the onset of the second wave.
So that was a more formal setup but an informal discussion group. The faculty of intensive care medicine, which is the faculty that is responsible for standard setting in intensive care, set up a telephone counselling line for any consultant in ICU who felt that they may need that. That wasn't something I utilized, but I know of colleagues who did and they found it incredibly useful, because these were psychologists who were briefed in the difficulties we might be facing as intensive care consultants. So, we were very aware that we should expect to find this difficult, and if we did there were opportunities available to us to seek help should we need it. Again, I think there is a kind of doctor personality who does not want to seek help because they see it as a point of weakness. And, I guess, how good we are really at spotting those colleagues and almost, sort of, directing them more robustly towards those sources of help, because I think that it's always the quiet ones who are getting on with it that are the ones to worry about.
So, there was help available, but I think, again there's always a risk that people will not avail themselves of that and be silent about the struggles that they're facing. I think that is something that very much affects the medical profession all the time and that's no doubt been exacerbated to a huge degree by the situation where we are in, especially now that there doesn't seem to be an end to it.
Interviewer:
Thank you very much. Where do you look for accurate information on the pandemic, and do you have any comments on the use of social media and the internet to share information, both within the medical profession and with the public?
Rosie Baruah:
In terms of statistics, I would go to government websites. For intensive care utilization, we have SICSAG, which is our Scottish Intensive Care Society Audit Group and ICNARC (Intensive Care National Audit and Research Centre), which is the England group which gives us accurate real-time data of critical care utilization. So, there are lots of official sources of information that we could go to. Health Protection Scotland is where we go to get information on how we should be treating these patients.
I think your question about social media is very interesting. In the first wave there was an almost intolerable amount of traffic on social media discussing treatment of these patients and predictions of how the pandemic was going to play out. All from liable (reliable?) sources, these are often colleagues who I know, so this isn't like conspiracy theorists or people just making stuff up. But, I think, doctors do not respond well to insecurity, and in any other disease state we can turn to traditional methods of knowledge acquisition be that journals, textbooks, online resources that are well established for this. We did not know what we were dealing with. We did not know how best to treat these patients and that led to a huge amount of, I think, insecurity amongst doctors, because we don't like to know not knowing what to do. And we filled that insecurity gap with a lot of discussion, a lot of supposition, a lot of hypothesizing, some of which was repeated enough that it became fact. And, I think, looking back now, to a degree the intensive care community kind of lost it a little bit just over extrapolating hypothesis, generating ideas into actual facts, when what we should have done is just relied upon the fact that we know how to develop and deliver good quality intensive care and we should concentrate on enrolling our patients into as many good quality randomized control trials as we should.
And in the sort of two months of the first wave, I think we went from this wild scrabbling about for any information we could get to the stage where we really were generating good quality data for randomized control trials. And so now going into the second wave, we have treatments, such as dexamethasone, which all of our COVID patients are getting. We have drug regimens, such as giving people double the amount of prophylactic anti-clotting medicines that we should, because we know from postmortem studies that were done as official clinical trials that clotting throughout the body is one [symptom] all severe COVID patients had. I think we are now, going into the second wave, in a much better state where we're actually implementing evidence-based medicine, which is something that makes us feel very clinically secure. But social media, personally, it was just relentless non-stop. There were these national WhatsApp groups that were getting in excess of 500 messages a day. And, I think, that was quite detrimental to our ability just to calm our brains down and think rationally, because it was just information overload.
Interviewer:
Thank you. We're about to finish up, but before we do that, is there anything that you'd like to discuss or would like to say that you haven't had the opportunity to do already?
Rosie Baruah:
Uh I think it's difficult to express in words, but in many ways, even though coronavirus is an ongoing issue, as I've said, there's no end in sight to it. In my intensive care unit, it's been one of the best examples of teamwork and team support I think I'll ever see in my professional career. In the sense that we had about a three-week heads up to put everything together to deal with these patients and to expand our ICU capacity and we did that as a team, and we supported each other as a team, and we kept each other's spirits up as a team. And I'm incredibly proud of how everybody worked together to achieve that, because keeping each other's spirits up is, to a degree, a choice and requires work and we put that work in, in addition to the work we put in to actually deliver our services. I'm very proud to work for the team that I work for, and even though I know that there are many, many challenges ahead, looking back on that first wave I think that's something I will always be proud of.