It’s time for an update on what it’s like in Intensive Care right now. Apparently we are past the peak, everything is alright…. Right??

Well, not so fast…

I’ll take you through the predictions, the changes we made, the reality and what the future may hold [1/n]

The predictions were terrifying and depressing. Based on modelling from other countries, NHS England told us to prepare for 140-280 ventilated patients.

Is that a lot? Is it a little? We need some context…. [2/n]

We usually have around 22 general ICU beds. And, like most ICUs, run at >90% capacity.

Even if we assume those 22 beds are empty, that leaves somewhere between 118 & 258 extra beds, ventilators, staff etc to find.. That’s a lot.

Even 118 extra is probably unmanageable. [3/n]

We squeeze in more beds, and look at what other areas we can use.

We have two other specialist ICUs that usually care for specialist cases from across the region.

We will have to cancel their usual surgery cases and take over their beds. [4/n]

Patients start to arrive.

The time pressure is immense.

We need to get things sorted NOW or it will be too late. [5/n]

We still don’t have nearly enough beds.

We take over a paediatric ICU. Can we put patients into theatres on their ventilators?

Our Emergency Department will be swamped – where can we intubate all these patients? [6/n]

We re-deploy staff from other areas.

We set up skilled teams to intubate the patients, insert the lines and drips they will need, to turn them onto their fronts.

Anything to lighten the load on the ICU staff. [7/n]

More patients are arriving. Our general Intensive Care Unit is full.

We start filling up one of the specialist ICUs.

The other one is taking every patient that doesn’t have likely Covid – head injuries, heart attacks, they still need Intensive Care too. [8/n]

We’re up to about 40 ICU Covid patients.

The work is so different from normal. Everyone is hot, tired and uncomfortable from the PPE meaning everyone needs more regular breaks than normal, so the specialist ICU nurses are having to care for more patients than normal. [9/n]

Staff come back from retirement, ex-staff return, medical students come and help us. Everyone gets trained up as quickly as possible.

This is definitely not normal. [10/n]

We still have the same number of patients. The date of predicted peak has been and gone. The increase is happening slowly.

Is social distancing and the lock down working? [11/n]

Or maybe we’re not through the worst yet?

What about when social distancing restrictions are lifted?

So many unknowns, leading to so much constant anxiety and stress. [12/n]

We don’t dare say it. We don’t dare even think it.

Could this be manageable?

We are seeing patients recover and be discharged.

For the first time, our ICU patient numbers go down... [13/13]