‘Everybody’s just tired’ - inside the Covid-19 ICU in Edinburgh where staff are still under pressure as cases fall

With Covid-19 case numbers falling, schools slowly reopening and care home visiting returning, the worst of the pandemic appears to be easing.

But the respite is yet to be felt by many healthcare staff, and those in the Covid-19 Intensive Care Unit at Edinburgh Royal Infirmary are still feeling the pressure.

One year on from the first cases in Scotland, the unit has shrunk from a peak of 23 beds to just four. But while staff are contending with fewer Covid patients, they have seen spikes in non-Covid intensive care admissions, and are having to cope without the influx or extra staff and support which was drafted in during the first wave.

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“Everybody is really tired,” said charge nurse Gill MacLean.

Staff must wear full PPE while in the ICU. Picture: Lisa Ferguson

“It’s been a long, hard year, and to be back a year down the line still with Covid areas… Nurses are always cheery folk - we’re trained to get by, aren’t we? But staff are definitely tired and weary.”

Lisa Blues, also a charge nurse, added: “The last time there were a lot of people redeployed to help us from other areas, now that’s not there.

“I think at the start there was a feeling of everybody mucking in together and getting on, and there is still that, but when it’s a much smaller group of people to share it amongst, the load is heavier, there aren’t as many people now.

“In the ICU as well, we have Covid but the other patients who need ICU still come - it’s not just Covid, it’s also all the non-Covid things which continue to come through. Everything just feels a bit tight now - staffing is tight, beds are tight…

Staff attending to a patient in the ICU. Picture: Lisa Ferguson

“Everybody’s just tired, I think that’s the best way to describe it.”

Ms MacLean added concern that some staff are leaving due to the pressure - not necessarily caused by the pandemic - a warning echoed by doctors’ union BMA Scotland last week.

Ms MacLean said: “People are tiring of it, we see people leaving. We’re losing senior staff, and obviously they’re replaced with quite junior people, who have got to be trained up.

“I’m not saying they have specifically left due to Covid reasons, but I think there is a percentage of staff in critical care who are moving on to do other things just because of the intensity of the workload.”

Staff attending to a patient in the ICU. Picture: Lisa Ferguson

Some aspects of work now are much easier, both nurses said, including being more used to wearing PPE, as well as the PPE itself being more comfortable due to policies which have evolved based on more knowledge about how the virus spreads. Having fewer patients also makes life easier, but there is more non-Covid work to be done.

“During the first wave we didn’t have the same flow of non-Covid patients - there weren’t the same trauma patients coming through because people weren’t driving, or doing extreme sports et cetera,” said Ms MacLean.

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“We didn’t have the same cardiac arrests, or even overdoses, we didn’t have the same flow of that as now, and it’s because people are going about their normal business really now.”

Stephen Walls, Senior Charge Nurse. Picture: Lisa Ferguson

Staff are working longer hours now, said senior charge nurse Stephen Walls, as during the first wave the extra staff brought in from other departments, or out of retirement, meant people could take much-needed longer breaks.

“Now we’re trying to keep business as usual, so all of those teams are now engaged in their normal role, because there are other things to be done,” he said.

“So that level of assistance isn’t there.”

Mr Walls calls the pandemic a “major incident that has lasted a year”, with staff who a year ago were being fuelled by adrenaline now being waylaid by fatigue.

Covid ICU numbers have been falling more slowly than during the first period of lockdown begun in March 2020.

According to Professor Mike Gillies, Associate Medical Director and ICU Consultant, this has led to a “more sustained” busy period than in the first wave.

Charge nurse Gill MacLean entering the ICU. Picture: Lisa Ferguson

“The hospital at large is still very busy with Covid too. I think the signs are encouraging that cases are starting to fall, but it’s definitely got a much longer tail this time,” he said.

“That might just reflect more people getting it in wave two than in wave one, but also the sort of patients which come to ICU now, compared to where we were in wave one, are patients who haven’t responded to some of the treatments that we have - steroids and other drugs that we can use now to treat Covid, so they’re probably the sicker patients now that tend to stay in ICU for longer, and they also have a higher risk of having to come back into hospital after they’ve been discharged.”

Professor Gillies has noticed a difference between the relief and possible relaxation around Covid-19 of the general public, and the pressure which is still on in the ICU.

“I think the staff are probably exhausted, it’s been a long year,” he said.

“Critical care has been quite badly hit with Covid - it’s been at the centre of the response, a key battleground.

“Staff have had very little respite, and have had to cope with the same restrictions as everybody else, so there is a sense that staff are getting quite tired with this.

“Hopefully things will continue to improve and we won’t be faced with another wave, but I don’t think we can underestimate the effect this has had on the staff. We need to be mindful of that.”

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