Jon's story

Jon Findlay
Chief Operating Officer

“We were following media reports of the outbreak in China through January. We had our first suspected case that month – a young boy – but it turned out to be a false alarm. He tested negative but it took 72 hours to get the result back and for that time we had to treat him as a potential case. I was on leave on 30 January, waiting for a ferry to the Isle of Wight, when I got a call to say the first confirmed cases had been detected in the north of England. They went to Newcastle.

We admitted our first patient, from Brighton, on 6 February. One of the biggest challenges was we had no idea where this was going to go. During the 2009 Swine flu pandemic we had relatively small numbers but some were very sick. We had started the ECMO service but we had limited capacity and the challenge was: who got access to ECMO? A number of young people tragically died at that time.

The first COVID-19 patients were well and didn’t require critical care or much treatment. But towards the end of February we were getting high numbers of very sick patients who deteriorated rapidly. They could be quite well in the morning and on a ventilator by the afternoon. That was scary – scary for everybody. There was a sense we could be overwhelmed.

South east London was hit worse than the rest of the country and we had to stop a lot of routine activity to cope. We were still being asked to hit our waiting list targets for the end of March and we had to say there was no way we could do that. There were some difficult conversations.

We declared a critical site incident on 12 March. We had to create the physical capacity in critical care and the staffing resource with a 2 week lead-in from stopping operating to opening the new capacity. We normally run 74 critical care beds and we were asked to expand four-fold. We overspill most winters but this went beyond anything we had previously done. We developed a surge plan to take us to 194 beds which meant creating capacity in areas we had never considered. Patients had to recover and be discharged and clinical staff had to be re-trained for work in intensive care. We even had a super surge plan to go up to 270 beds, though it was not needed.

There is always a challenge in these cases of how to balance the immediate needs of the critical incident and the ongoing needs of the population. There was and still is a real dilemma of how much to prepare for a contingency. Do you cancel cancer and cardiac surgical cases to create capacity for patients who will die if not put on a ventilator?

There were lots of stories, especially from Italy, of post-op patients contracting COVID-19 who did very badly. We concluded the risk was too great. We cancelled all surgery other than emergency surgery. But there was no international evidence – we had nothing but anecdotes to go on. That was another of the challenges.

The next challenge was how to get hold of the equipment – ventilators, PPE, etc. Cases were doubling every 3 days and we were looking several weeks ahead. We have a very good procurement team – they scoured the world. We placed speculative orders on the assumption that many would not come through.

We did what we had to do – looking to Canada, China and elsewhere. We ordered 500 ventilators on the basis that if we got them and didn’t need them, others would.

PPE was even more challenging. Most of it is made in China and accessing it was very difficult when the whole world was looking for it. We organised a flight to China with Virgin to pick up ventilators and PPE. None of us had ever done anything like this before – chartering planes.

We went heavy on this because we wanted control of our own destiny. We were determined it was not going to be the rate-limiting factor. Also, what we didn’t need we could pass on. We have given large quantities of PPE to other organisations across London.

Although we never ran out of PPE, it has been an absolute nightmare. The first patients were mainly well but were treated as High Consequence Infectious Disease cases – basically by staff in space suits. Then we had a lot of very sick patients but the risk was notionally downgraded so we were told we don’t need to treat them in space suits. It was a very difficult message to give to staff. Here was a disease we didn’t know much about, we had stories from Italy of staff getting ill and dying, and we were having to tell staff that while the first patients had been treated in isolation with full protective gear, now it was safe to use a surgical mask, gown and gloves to treat these sicker patients.

This was very difficult. There was greater anxiety among staff than I have ever seen. In critical care there was a lot of debate about what was an aerosol generating procedure, for example, when putting a patient on or taking them off a ventilator. Only those staff would need full PPE while others would have a surgical mask, gown and gloves. But at any point an airway can become disconnected. So we decided all staff in critical care would need full PPE. It created an atmosphere of fear and made working quite difficult.

We were guided by our Infection Control Team. We got their assurance it was safe and we made videos about how to use PPE.

I have dealt with major incidents before. I was Gold Commander for the Westminster Bridge and London Bridge terrorist attacks and they were very intense periods for 24 or 48 hours. The difference with this is its ongoing. How do you maintain that level of working? It has an impact on everything. Managing the fall out has been incredibly challenging and remains so.

I have been coming into work from Leigh on Sea in Essex, often the only person on the train. I have not been worried for myself. My working assumption is I have had the virus – it was the way I could cope. We have been working 7 days a week. It has been relentless. My wife and children have been very supportive.

We had guidance – hundreds of documents – but it was often too late for us as here in south east London we were hit hard and early by the pandemic.

What has been a relief is that things have not turned out as badly as they might have done. Towards the end of March the numbers were really escalating. There was a sense of impending national catastrophe. It looked as if we were going to have to make decisions over who would be treated. That would have been terrible.”

The photographs in this story were taken at different stages of the COVID-19 response when guidance for personal protective equipment (PPE) and social distancing varied.