What it's like in a British emergency room fighting the coronavirus
- Jack Manley is a surgeon who volunteered to transfer to a London ER as the coronavirus hit the UK.
- Hospitals have adapted thoroughly to face the emergency in the space of a few short weeks, Manley told Insider.
- But it means tough decisions - patients are sent home who would usually be admitted, and ER is now issuing more Do Not Resuscitate (DNR) orders than normal.
- At least 70 frontline workers have died of coronavirus in the UK, and the country is struggling to get enough PPE to them. Yet Manley said the crisis has given him an overriding sense of purpose.
- The outpouring of public support for the UK's National Health Service inspired Manley and his partner to start a nonprofit that brings fresh takeout food to frontline workers.
- Visit Insider's homepage for more stories.
Four days after the UK confirmed its first cases of the coronavirus in late January, 29-year-old surgeon Jack Manley made a decision: He would transfer to the emergency room - in Britain known as Accident & Emergency (A&E) - to fight the growing threat.
"I was pretty blasé about it initially, and that has totally changed over the past weeks," he told Insider. "I was thinking I'll be fine, I'm indestructible."
In the weeks that have passed since, the world has changed enormously.
The UK has been in lockdown since March 23, and more than 125,000 people in Britain have been reported as infected. The figure, unavoidably, is an underestimate due to a lack of testing.
Prime Minister Boris Johnson is still recovering from a serious infection that saw him admitted to a London ICU.
By Friday, 19,506 people had died in hospitals, at least 70 of whom were frontline medics and social care workers, according to The Telegraph.
And so the UK's frontline medical services have had to change, too.
The UK's National Health Service (NHS), divided into regional trusts, has adapted to a reality in which most people will not be tested.
The A&E, as the eventual destination of anyone with severe Covid-19 symptoms, is at the forefront of this reality.
"I've been so impressed by how quickly my trust has been able to roll with the punches, adapt and make sure they're ahead of the game," said Manley.
Manley works a 4-day-on, 3-day-off shift pattern at University College Hospital A&E, in central London. Things are moving so fast that any doctor returning after their days off gets a 30-minute reintroduction to the system.
At A&E, the system is now arranged to prevent serious cases from getting too physically far into the building.
"We're triaging people much closer to the front door than we have in the past, and we're making decisions a lot quicker than we have traditionally done," said Manley.
Suspected Covid-19 patients - which Manley said are the vast majority now - are placed in a 'corona zone' and divided by levels of seriousness via a traffic light system.
Doctors, working 10 to 12 hours a day, hope to see at least 15 patients in that time, listening carefully to decide if the symptoms are serious enough to admit the patient, or if they can safely return home to try and ride it out.
Manley described it as making "almost binary life decisions."
"We are ending up sending people home that we almost know might come back two or three days later, but worse," he added. "In the past, we may have admitted them, but because the admission criteria is now set quite high, our hands are tied."
He added: "From an ethical standpoint, or actually from an emotional standpoint, that's really, really tough."
- In early April, the British Medical Association - the union for UK doctors - revised its ethical guidelines for how medics should legally and ethically prioritise treatment in the face of shortages.
Manley said the Do Not Attempt to Resuscitate (DNAR) form was a rarity in A&E. But, he said, "it's now happening more and more at the front door."
"We're now filling out those forms more and more frequently on people [for whom] previously it wouldn't even be a question whether they're for resuscitation," he added. "You know, a 48-year-old with high blood pressure."
Speaking about making that decision for people in their 60s with only mild conditions, he said: "Emotionally, that's really challenging because you're like: 'Oh, this would be the same for my parents.' So that kind of hits me personally."
He also worries about the non-Covid-19 patients, who are scarce now. "Does this mean that we're missing people who are actually very, very sick but scared to come to hospital because of the coronavirus?" he asked.
He described one patient who had avoided coming into the hospital, suffering pain for weeks because they were "terrified of coronavirus." That person was diagnosed with an advanced-stage life-threatening disease.
The government admitted on April 18 - after Insider spoke to Manley - that many parts of the country are running out of vital PPE, The Guardian reported.
Manley wouldn't comment on the overall PPE situation, but described "struggling" to find the right equipment at times. Each morning there's a "little battle" for scrubs, he said.
Manley's attitude to the risk he is taking has changed since he first volunteered to move over to A&E, especially as he witnessed colleagues become ill.
"Having three or four of my colleagues come through, not as staff but as patients, who I was working with maybe two or three days before, who are now profoundly unwell and require oxygen therapy - seeing that is absolutely terrifying," he said.
"It's really in the last two weeks it's really hit home that the risks are pretty real."
It means going to work is a "double-edged sword," Manley said, giving him the focus of a mission but the risk of one, too.
"I think for me, what makes it all worth it for me is first of all, recognising that you have a unique skill set and ... if there's any time in life to be able to use it, now is the right time," he said.
"I wouldn't say that I'm enjoying it more. I feel like I have more of a purpose now."
Camaraderie has increased between medics, and departments that don't normally interact are talking to each other, he said. And this extends to the public.
- "[There's] not just camaraderie amongst colleagues, but a heightened generosity amongst the patients," he said. As panic buying hit the UK towards the end of February, and frontline workers found it harder to get groceries, people started bringing in shopping for hospital staff.
"I actually greeted an elderly lady who decided to bring a bag of canned food in for us," he said.
Moments like that inspired Manley and his partner of seven years, Charlotte Butter, to found a nonprofit, DeliverAid.
On Thursday evenings, the UK public has formed a habit of coming to their doorsteps to applaud frontline workers.
But as Butter, 26, pointed out, people stuck in lockdown often feel powerless, wanting to be able to do more to support the NHS.
- "Meanwhile we were noticing a lot of our local favourite restaurants and independent spots having to turn their lights off," she said.
So DeliverAid uses public donations and volunteer drivers to get well-thought-out meals to hospital staff, who are often too tired to shop at the end of a shift and can face long queues at the canteen.
There's a small profit margin for local businesses, and a fresh and nutritious choice for medics.
"I think part of the reason why DeliverAid was so important for us because it can empower people to stay at home, but still have that feeling like they're helping," said Manley.