The UK has been hard-hit by COVID-19 and its National Health Service inundated with patients requiring treatment. Matthew Xuereb compiles the experiences of two Maltese doctors on the frontline in London hospitals. 

Dr Edward Despott

Clinical Head of Endoscopy at the Royal Free Hospital and Hon. Associate Professor at University College London (UCL) Institute for Liver and Digestive Health in London. He is a world-renowned expert in small-bowel endoscopy and minimally invasive endoscopic resection.

The COVID-19 pandemic has hit London hard. Like an unseen enemy in the fog of war, this minuscule infectious agent threatens us daily and has flipped the way we practice on its head. Our large teaching hospital has had to restructure all its medical teams into mega-firms for the care of the vast number of patients afflicted by this deadly disease.

Most of our wards have now been converted to ‘COVID wards’ and our already large intensive care unit has had to expand several-fold in order to keep our capacity ahead of the ever-increasing demand for ventilator-equipped beds.

From a busy interventional endoscopy unit, we are now only performing lifesaving emergency procedures, mostly in patients affected by COVID-19; all while fully-clad in personal protective equipment (PPE) – which also adds layers to the surreal experience. The global shortages of face-shields has also driven me and my team to publish step-by-step instructions on how to construct single-use, disposable face-shields using simple, universally available and inexpensive materials.

Apart from its devastating direct hit, this pandemic is causing an indirect, albeit equally massive, impact on patients with other diseases, including potentially malignant conditions which until now would have been treated very urgently.

Another consequence of the pandemic is its cruel psycho-social effect, which is becoming even more palpable with time.

For us healthcare professionals living abroad, the complex dimension of dealing with patient-related tragedies daily is compounded by the distant separation from our loved ones. This has put our lives ‘on-hold’.

This unique virus is remarkably contagious, and no measure to reduce its spread appears to be too cautious.

The very fact that most community infections cause very mild symptoms, or even no symptoms at all, just continues to fuel its spread, to the great peril of others in whom it is proving to be rapidly fatal.

Although many of these unfortunate fatalities occur in older persons, it is also proving to be deadly even in the young. The ultimate outcome is very much dependent on precious supportive care and on how the individual’s immune system reacts to the virus.

This precarious situation highlights the ongoing requirement for the public’s strict adherence to social distancing measures and fastidious attention to vigilant hygiene.

Prof. Ludvic Zrinzo

A neurosurgeon at The National Hospital for Neurology and Neurosurgery in London. He is renowned for his pioneering work in deep brain stimulation in Parkinson’s disease.

Ludvic Zrinzo fully-clad in personal protective equipment.

My career took me down the path of super-specialisation. My fantastic team delivers excellence to neurosurgical patients undergoing deep brain stimulation and microvascular decompression procedures. I also found fertile soil in Malta and, as visiting consultant, with amazing support from Mater Dei, these specialist procedures were also made available to Maltese patients.

And then, just like that, it all ground to a halt. A tiny particle, less than a millionth of a millimetre across, disrupted our world. Most of the neurosurgical operations I perform are elective so they can wait.

Our teams rose to this new challenge. Our specialist nurses still support patients and we have embraced the gruelling, long hours in personal protective equipment, taking care of the sickest COVID-19 patients.  Many of us have contracted COVID-19... and returned to work as soon as they were able.

Our teams rose to this new challenge

With my fellow consultant neurosurgeons, we spend time in weekly blocks, conducting telephone clinics from home, covering urgent neurosurgical referrals, emergency neurosurgery in hospital and blocks of days or nights helping out in ITU.

Handover and ward rounds identify problems early so they can be tackled before they escalate. Difficult ethical decisions are taken to stop escalating treatment when a positive outcome fades from sight. Then, with COVID-19 patients, the cerebral decisions have to be acted upon through a barrier of protection.

Donning and doffing PPE is time-consuming. Eight pieces of equipment are required before entering ITU and another three used per patient encounter. Five staff members are needed to turn a very sick, unconscious, ventilated patient onto their tummies to help their lungs get a bit of extra oxygen into their blood.

I shift my gaze from our patient’s swollen, unconscious face to the beaming smile it wore when surrounded by loved ones, in the picture beside the bed. My gloved hands cannot be allowed to brush away the tears from my masked, visored face. At the end of the session, we give a muffled cheer from behind our masks.

Leaving the ITU and carefully doffing all the PPE, I wash my hands, yet again. Then I head towards my office to call relatives with a daily update on how their loved ones are faring, and to inform one family of a journey that has all too soon come to an end.

Forced disruption is a time to contemplate. I hope those times will return soon so I can help those very patient patients whose lives have been put on hold – in London and Malta.

(read the full journal on Professor Victor Grech's website with daily updates on the COVID-19 situation in Malta and around the world - http://www.ithams.com/covid19/LZ.html#content4-76)