Sara's story

“I was skiing in Italy at the end of February. I remember wondering why everyone was wearing masks in Milan airport. Back at St Thomas’ infectious disease colleagues were saying [COVID-19] was something we had to prepare for and I went to the meetings a bit reluctantly – they were all about adult services. 

Then, as I listened to people talking about the trajectory of the virus and what it might mean, it became clear we needed to get going to deliver a response. 

Lots of people called me at that point worried about what was going to happen and I remember saying to them I was absolutely confident we could cope and St Thomas’ could cope. We just needed to stop some things we were doing and do other things. I said that over and over again. 

By the 2nd week of March, looking at the numbers coming into the adult services I started saying we were going to have to help. I began thinking about the space – what they had and what we had. 

My biggest concern was that children’s and women’s services would get forgotten and would suffer. Doctors in Italy were complaining they couldn’t get a child into hospital. They had to have a cardiac arrest to get treated.

My second concern was we had to support the Trust. Any adult who had this virus and could be saved should be saved. We shut down planned surgery as quickly as the adult Trust, freeing up space in the paediatric ICU for adults. But then it became clear they were going to have to expand critical care [for adults] really significantly.

Our 6th floor was empty and due to open as a children’s cardiac ward and 10 bed critical care unit. But it was a small space compared to the 2nd floor ICU which is a massive space. It was clear we needed to move [paediatric ICU] out of the 2nd floor and go up to the 6th. We made the decision on a Tuesday and the guys moved the children on the Thursday. They had to stock it, move all the equipment, ensure the safe transfer of the children. They were incredible. One child had to go on ECMO that day. And we were still collecting children from other ICUs [across London] that adults were moving into. 

That was the most stressful time for me – before that decision was made. There were staff who didn’t want to move out of the 2nd floor.  They were arguing we should give (adult ITU) the 6th floor. We were asking them to move to the 6th floor and look after sick children in an environment which was very different and not ideal. 

Inside the Trust the atmosphere was supportive – we were part of its major incident response. But we had battles outside. One of the major things we had to fight was a national plan to close down paediatric intensive care in all trusts. That was not sensible. 

The low point for me, was just before the virus really hit. I was really worried about children [without COVID-19] coming to harm. We did see some children present extremely late. And possibly have preventable consequences. We were going on calls many times a day, trying to convince people in high places there would be bad outcomes, that they shouldn’t close all ICU places. Because we still needed to do urgent cardiac surgery, and also we didn’t know what was going to happen. It was a good job we didn’t close them, because we did not anticipate that this condition would affect children. 

We were up-skilling staff to work in adult critical care. The response was incredibly energising. Everyone had the same goal. We had to deal with a lot of anxiety about PPE – much of it as a result of lack of knowledge and misinformation in the media. 

I had absolute faith in the clinicians on PPE. They were not asking us to do anything they were not doing. I was working on intensive care and wearing the same PPE as everyone else and I felt entirely safe. 

I have been working in intensive care for 20 years. On 14 March I admitted a child to the ICU and I could not work out what was wrong. The child came and went over a couple of weeks and tested negative for the virus. Two weeks later we were getting referrals with a similar presentation – very high fever, gastroenteritis, sometimes abdominal pain – from Woolwich. A flurry of children presented as sepsis or appendicitis and some had features of Kawasaki disease. They tested negative for the virus but their blood test results were similar to adults with COVID-19 although the clinical manifestation was very different.

I can’t think of anything like this – a flood of cases with a new syndrome – ever happening before. We’ve had outbreaks of haemolytic uraemic syndrome related to children going to a farm. But you know what that is and how to deal with it. This was evolving before our eyes.

Sadly one child became extremely unwell, was put on ECMO, had a stroke and died. At post mortem he tested positive though he had previously repeat tested negative. 

We called it Paediatric Inflammatory Multi-system Syndrome temporally associated with SARS-CoV-2 (PIMS-TS). It is now accepted there is a link. Most children have shown antibodies to the virus even though they tested negative.

It was mid-April by this time. We had to work out how to treat them. We had had a young man who had died – did we need to start anti-inflammatory management sooner? And we needed to get the message out to other hospitals. These children were very unpredictable. They could be sitting on their phones and talking to you one moment and hypotensive and losing consciousness the next. 

We stood up a whole team – infectious disease specialists, rheumatologists, cardiologists – to provide 7 day cover. We increased HDU capacity three fold in a matter of days. At one point we had 25 children in hospital with the syndrome.

There was scepticism initially. People in the region and across the world were saying this is not a thing, children aren’t affected by this virus, you are mixing things up. We needed to prove it, work out what was going wrong and treat it. And we needed to get the information out so our colleagues [in other hospitals] didn’t miss these children. When more senior people in academia saw a child who was sick, the narrative changed quickly.

In early May, we had a letter in the Lancet. It said we had seen these children, this is what they look like, we think it’s related to the virus, we think BAME children are more susceptible, look out for them and this is how to treat them.

That provoked an outpouring from around the world. Many had seen similar children but not reported it. We held webinars for the 24 local hospitals we look after in our patch. There were at least 1,000 people on one call, from all over the world. I listened with immense pride. It was amazing.

We had 2 cohorts of patients – before we started telling people about it and after. The 2nd cohort was much less sick – we think because they were being referred earlier.

Things have massively calmed down now. The children have done extremely well. We hope they will be fine.

I did not fear for my own safety. I understand how the virus is transmitted, and so as long as I wore PPE and washed my hands I knew I would be fine and my husband and three children would be fine. I am sad for my parents – not being able to see them.” 

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