I remember this feeling from years ago (i.e. last month) The effect of curve-flattening is amazing and so much to be desired compared to other colleagues' experiences.

It does produce a peculiar rapid cycling of stress though - which changes, but doesn't go away. https://twitter.com/cjpoynter/status/1253183586833846273

First, the knowledge of impending doom. Something awful was about to descend on our heads & there was nothing we could do to stop it. Hours and hours spent simplifying guidelines, re-organising rotas, trying to imagine what daily armageddon looked like and how to plan for it.

I have never felt anything this all-consuming before and I hope never again. You know you should enjoy days off while you still can, but you literally can't bear not to know what's going on because things are moving so fast that a year's worth of decisions happen every day.

WhatsApp and Twitter is both blessing and curse.

Shout-out to the ICU trainees here - F2s, ACCS and others - as well as the anaesthetic juniors. They all completely stepped up without hesitation into new rotas and roles - and the only thing I ever heard from them was "How can I help?"

The workplace we knew rapidly changed. Rest & study areas were moved, theatres filled with storage. Colleagues previously seen daily - admin, pharmacists, specialist nurses - vanished and became voices over telephone and email.

Our hospital became rigidly 'zoned' into colours according to PPE requirements. Corridors which used to be straight are now mazes with many detours leading you through donning/doffing, changing areas. You get your 10,000 steps just making it out the front door.

You constantly find yourself asking is this amber...or is this red now? If a patient is on AIRVO, Covid status unknown, but they are a Sagittarius from Banbridge, can we keep area amber rather than convert whole place to red??

It's intensely uncomfortable for a while - until 'new normal' kicks in.

Initial surge - and relief that in the end, they were just patients. We know patients. Relief that we could practically do this & cope. Non-stop referrals at start. Some shock at how sick all of the patients were and how for a while, it seemed none of them could survive.

We were in a hotspot, surging earlier than others in our region.
So while coping with this, some panicked and badly communicated regional strategising caused a lot of additional worry for staff who really didn't need it, especially nursing cohort.

Don't do this, folks.

Curve flattened. Admissions slowed to trickle - with help of amazing respiratory colleagues.
Original surge patients (tragically not all) got better & extubated.
No tracheostomies or reintubations for us.
Survival rates better than expected.

At this point (only days but felt like weeks), 24 hours would pass with no referrals/admissions. We were still poised in readiness for more action that seemed to be a bit shy showing up. Lots of uneasy talk about relaxing rotas a bit. There was lots of knocking on wood.

It was sunny outside and there was lots of kindly donated food in the tearoom.

Now... we're in limbo.

ICU is full of Covid-19 pts but not overloaded (knock on wood, pinch of salt over shoulder etc.)

Until ?early 2021.

If plateau continues, we have 'luxury' of worrying about things beyond overwhelming surge & disaster medicine.

If our ICU is still full of C-19 patients, how do we safely accommodate normal 'business' when it inevitably restarts?

EDs won't stay empty forever, & transfer out was never viable plan.

How & when do we restart major surgery? That needs ICU beds.

How do we open up hospitals which have been so drastically geographically and logistically rearranged? For outpatient appointments? And visitors?
How do we protect members of the public from this virus that will be an ongoing feature in healthcare institutions for some time?

We'll need ongoing enhanced consultant coverage. How do we keep that going while preventing burnout? We're going to get busier, and attention is going to be split between competing priorities.
Normal in medicine but on this scale?

Junior rotas. Starting AL/SL/EL again. Making things officially 'educational'. Continuing additional coverage for multiple critical care areas.

AUGUST CHANGEOVER.

The winter...

So yeah, the stress doesn't go away, it just changes focus depending on where you are in the timeline. I am still very thankful to be where we are though, and many thoughts are with those who aren't there yet....
Apologies for thread length.