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‘We learned a lot; we would do things differently if we have a coronavirus second wave’: Intensive care consultant

At the end of the week when Wales saw its first local lockdown and restrictions were reintroduced for social gatherings, the words ‘second wave’ are on most peoples’ lips.

In some parts of Wales, coronavirus cases are rising again to levels not seen since June and hospitals are bracing themselves for a surge in cases as the 2020 summer gives way to winter.

It’s a situation some medical professionals have been warning about for some time, even if they were hoping their fears would prove unfounded.

Dr Matt Morgan, a consultant in intensive care medicine and the research and development lead for Critical Care at University Hospital of Wales, has been at the forefront of the fight against coronavirus since day one.

In March, he saw what was coming and penned a beautiful letter to older people worried about the impending virus.

He was well aware of the risks of this relatively new disease which is why he wrote a letter for his wife titled: ‘In case I die’.



Dr Matt Morgan is ready to face the challenges of a possible second wave head on

In the first week of September, Dr Morgan is once again ready for whatever the virus throws his way, whether that be a second wave, a spike or a cluster of cases. But this time, he is armed with something far more powerful than he had the first time round: knowledge and experience.

“If anyone says they know what’s coming they are probably lying,” he said, speaking on a relatively quiet day at the Heath Hospital in Cardiff. He hasn’t seen anybody coming into critical care with coronavirus for over a month, he says.

The break in patients has given him and his colleagues time to sit down and see what worked, and more importantly what didn’t work, and to plan how they might approach a second wave.

“We have learned a load of things,” Dr Morgan said.

“If we do have any influx we would definitely do things differently.

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“Hospitals all around the country now know the areas they are going to move and surge into if they see an influx of patients.

“We have bigger tanks of oxygen because we know we need to run more machines when people are put on ventilators.”

Dr Morgan believes a fundamental part of his role is providing care. “It’s called intensive care for a reason,” he continued. “Yes, we have science and equipment, but it also comes down to care.

“One critical thing is communicating with families. One in five patients in intensive care sadly die so hopefully we are a lot better at communicating and have time to give family support.”

It’s something echoed by Dr Sarah Aitken, the medical director at Aneurin Bevan health board and the woman in charge of dealing with the response to the Caerphilly outbreak.

Speaking on Wednesday, she said: “We’ve done it before and we’ll do it again.”

The health board has the benefit of knowledge gained during the first wave, Dr Aitken said, and staff have been scrutinising audit data and ways of working to make sure they are better prepared this time round.

Part of this has been rushing to get Gwent’s new super hospital, the Grange, up and running ahead of time. The Grange will help provide a vastly improved oxygen supply and extra capacity for single treatment rooms, both of which were vastly lacking in the early days of the pandemic.

“This time, we know it is spreading and we are ready for it,” said Dr Aitken.

“The pandemic came on the back of winter. Now, our staff are tired. Having to cope with another increase in Covid on top of all this is a big ask. We know it’s starting to spread again.”

Over in the Royal Gwent Hospital, ICU consultant David Hepburn is thinking the same, saying: “We’re strapping in for another wave at the hospital – really, really don’t want to do it all again.”

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Both Dr Aitken and Dr Morgan are taking proactive steps to ready their hospitals for the fight. They won’t be caught on the back foot this time round.

For Dr Morgan, that means he now has three new drugs in his weaponry which have proved much more effective at treating Covid patients.

“We have a different style of treatment based on the outcome of a study, which was based on trials carried out here in Cardiff,” he explained.

“We now have a drug called Remdesivir which can reduce deaths by up to a third. Before we were using steroids, which have the effect of dampening down the immune system – almost effectively setting the immune system on fire.

“It means people won’t get so ill when they fight the virus.

“We now have three kinds of drug in our armour and we know things that don’t work, which is just as important.”

It’s been 21 weeks since the pandemic took hold when we speak and Dr Morgan says amid the PPE scandal that dominated the headlines through the peak of the crisis, there was a lot of good work being done to improve things too.

“We started off with lots of tight-fitting masks that were difficult to work with,” says Dr Morgan. “Now we have different forms – we have moved on to hoods which allow patients to see our faces and hear us talk.

“We’ve long known in healthcare it isn’t just about the machines that go beep. It’s the people too.

“And part of that is the well being of staff as well as the equipment.”

Even so, the Covid crisis has brought about the “ultimate balancing act” says Dr Morgan, with the unwelcome but inevitable trade off between treating Covid patients and those with serious diseases like cancer and heart disease. The coronavirus response has been at the detriment to some for those patients, Dr Morgan admits and the long term implications of that are still unknown.

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“It’s an impossible calculation to balance,” he says heavily. “We obviously have to continue to provide cancer care for outpatients while treating coronavirus cases too.

“This time round we have zones in hospital that can continue elective care, which we didn’t have before. So rather than all Covid, we can do both.”

Dr Morgan is a practical man – he is used to problem solving and dealing with a crisis. But perhaps the greatest challenge of all is making sure the medical community remains strong and united and can remain in the hearts of the public, some of whom seem intent on ignoring the virus.

Back in April, Dr Morgan said: “Intensive care is designed to solve problems quickly and deal with an ever changing environment. It’s less about the acute phase, when adrenalin gets you through it. I’m more fearful for the longer term.

“There will be a much longer slow change to come back to normal and that’s hard because then people will get tired. The reality will be on a cold October morning and the rest of the hospital is getting back to normal, and everybody else is going back to work as usual.

“For now, elective surgery has stopped but when that comes back on line, it will hit home. I have loved the clapping on Thursday nights. But staff need that support more when this crisis has settled down.”

The cold October morning is just around the corner and it seems like the crisis has yet to “settle down”.

“It’s been 21 weeks since the first Covid patient came in,” said Dr Morgan. “The dead don’t care about the why they died, it’s the living that do.

“Science and medicine isn’t about certainties – it’s about uncertainty, much like a weather forecast

“It’s really easy to get polarised when things don’t turn out as we expect. And fear and uncertainty is the best ground to breed conflict.

“I feel as time has gone on the group has fragmented. It is a hard time and it’s only a natural reaction, but we’re all in this together.”

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