- Does that feel secure? - Yeah. Have you got a grip on the coronavirus? How worried are you? Will the measures be dramatic? So, what I'm gonna do is run you through seven exercises. Mr Speaker, with your permission, I'd like to update the house on Covid-19. Start with five pumps. We're gonna do deep breathing now, so that's with your tongue out. As of this morning, 7132 people have been tested for the virus. Just speak as clearly as possible. Don't worry about getting the words wrong. "When the sunlight strikes raindrops in the air, "they act like a prism and form a rainbow. "The rainbow is a division of white light..." The public can be assured that we have a clear plan to contain, delay, research and mitigate and that we are working methodologically through each step to keep the public safe. www.able.co.nz Able 2023. No. No, I can still taste it. Yeah, that's a fail. These FFP3s are made for wider jaws. -So lifesaving for men basically. -Yeah. You might need a powered respirator when the time comes. -OK. -But we've run out of those. -OK. -To be honest, I think they're being reserved for the staff, who are, you know. And what kind of doctor are you? Acute general medicine. I'll be in the Cold Zone, so... Yeah, so not you. Staff in your areas won't need that level of PPE, but if you really want one, you can get them on Amazon. I mean, I wouldn't worry about it, but if you want to-- -Amazon? -Yeah. They're about 300 quid, but... Great. We are increasing our stocks of equipment. We are accelerating our search for treatments, we're pioneering work on a vaccine. How deadly is it? How fast can it spread, and how prepared are we in Britain? -Oh, you can't come through this way, love. -I'm a consultant. I work here. Oh, well, you'll want the service entrance, then ` that's the new way in. And I know the people of this country will rise to that challenge, and we will come through it stronger than ever. We will beat the coronavirus, and we will beat it together. Thank you. -Morning, Abbey. -Morning. Hiya. -Hi, Abbey. You all right? Yeah. How are we looking? So, 26 overnight, 12 in the corridor, a couple in resus, eight still waiting to be seen, and two pre-alert ED have told me about. "Cold Zone." LOL. Aye. Nice mitral stenosis in three for Emma, though. -Yeah? -Yeah. -Can you come and help me, please? -Yeah. OK. What do you need, Emma? I have a patient really sick in the cupboard. I don't know what to do. -OK. Hello, sir. I'm Dr Henderson. I'm one of the consultants. I'm just gonna pop you a bit more upright. OK, great. OK, what's the story? He has ischemic heart disease, a CABG in 2011, um, but well since. Walks every day with his wife. -Start with ABC, Emma. You seem very breathless, Mr... Williams. Stats and obs? Where's the monitoring? I dunno. They just told me to come and look at him in the cupboard. OK. Emergency buzzer and call for help, please, Emma. I'm just gonna have a little listen to your breathing. Emma! -Yeah. -Yeah, yeah. OK. OK, we're going to take very good care of you, Mr Williams. I'll be right back. I'm just gonna pop this mask on for you. It's gonna help your breathing. OK, can you pop your head forward? Morning. -Hi. -Resus? Yes, please. 81-year-old male. No travel history. Flash pulmonary oedema. CABG 2011. Otherwise well, walking 3 miles a day till last week. We're gonna need suction, please, then non-rebreathe, 15 litres. Neil, could you do an ABG? -Yeah. -Frusemide, GTN? -If his BP can take it. -Yes, please. Have you got this? -Yeah. Go, go. -This take's wild. Thank you. Hey, Emma. Could we please stop using that bloody cupboard? Complaints go up, not sideways. Emma, have a doughnut. Hey. Hey, you did really well, OK That shouldn't have happened. -Yeah, but it always happens. -Abbey? Can we use you? -Yeah. What's up? It's happening. Just had a call from LAS. Might be the first one. Blue-lit from Heathrow, flew in from China. OK Could you tell Ant, please? -Yeah. -OK -Yeah. Failed my first fit-test a week ago. -Oh? -Yeah, thanks. Failed my second one as well. Oh, well done. Straight to this one, please. OK tell me about the patient, please. This is Tony. DOB 3/12/65, picked up from Heathrow, blue-lighted here. -Get ready to move. -Airway open, no airway assists in. -Ready, steady, roll. -Rest rep rate is high at 40pm. -Ready, steady, slide. -Sats low throughout on oxygen. Let's make some room. He's completely obtunded. -ABG, please, and can we get some monitoring? -Yeah. -Do we have access? -Just a pink. He's completely shut down. -Not shifting much air. -OK can we do an urgent chest X-ray in here, please. -On their way. -Crep throughout. Neil, do you have an airway? Yeah, but I'm having to help. Sats are in the 70s. OK he's tiring. We need to get on and intubate. -Yeah, agreed. -Drugs from the fridge, please. -Go. -Sats are 52. -Barely breathing now. -Suction's there. -Are ITU on their way? On their way. OK drugs going in, bougie ready, please. We're gonna need that ABG as soon as we can, guys. Gonna need suction. Tube, please. He's arresting now. -Chantelle. -Abbey, you and the team have got to let me know if you're sending unstable patients up to the wards. -I know ` I'm sorry. I wanted to give you a heads up, but the take's been crazy. Archie Williams. He should really be in ITU, but no beds. We just lost the first one in resus. Shit. -He doesn't have it, does he? -No, he's flash pulmonary oedema. Are the ITU outreach team still gonna come and see him? Yeah, I know it's not ideal, but they're rammed. The whole network is. We just can't be taking high-dependency patients on to the general ward. -I mean, it's not safe. -I know, but he's gotta go somewhere. All over Lombardy, we are overwhelmed. Emergency, full, intensive care, full, theatres, corridors. It arrived so fast, we were not prepared. You must prepare and find a way to double, triple, more than triple the beds you have. All the ventilators you have. You will need more than that number. By how much more would you say? How many more ventilated beds? Minus a small unit here, 15 beds, but we need we need 60, 80 more so you can do the sums. We're working 18, 20 hours, our medical students are manually ventilating patients. Prime Minister, just two weeks ago in Italy, there were 153 cases of coronavirus and just three deaths. Now, 16 million people have been quarantined. The reflection, if you like, of the public health challenge we are all facing globally. We are rationing the ventilators. At the moment, we have no choice. Over 65, no ventilators at all. Oxygen, too, we are struggling with our supply. The thing is, it doesn't matter how much you can plan. Doesn't matter how much you are reading the news or whatever, the virus is always going to be ahead. You can never be prepared enough. I'm sorry, guys, but that's the way it is. Thank you, Doctor. There's been a bit of confusing advice about things like shaking hands. Yes. And I'm intrigued to know whether you've developed a personal policy yourself. I'm shaking hands continuously, I was at a hospital the other night where I think there were actually a few coronavirus patients, and I shook hands with everybody, you'll be pleased to know, and I continued to shake hands. and I continued to shake hands. Mr Ahmad. I'm Doctor Vyas. How are we doing? All right. Let's just lift you up, slightly. There we are. Are you a smoker? -No. Let's see. Let's take this off. You're not feeling breathless? -No. -Have you been exposed to any chemicals at work? -I work in IT, mate. Right. I'm just gonna stick this back on, yeah? What's your high score? -556,000. -What? You need to get out more. -Yeah. What's yours? -About 10,000 something. -Terrible. I think we have a hot case in bed one. -Everyone's triaged on the front door. -Yeah, I know, but I need the side room. -I can't just give you-- -Clare, please. Can you just please get that done for me? -Please? -OK. Sure. -Thanks. Hiya. I need some masks. Please, some FFP3s. -Why? -Query positive in the Cold Zone. -But... -Can I please just take some FFP3s? -I don't think it's allowed. We've been told Hot Zone only. -OK, why? We've just been told. Well, I need an FFP3. We've been told. Right. OK. -Emma? -Yeah. -Will you take one of these and stick it on for me? -Yeah, sure. -Who's that? -Oh, that's Mrs Ahmad, his wife. Is everything all right? -Ant? Yeah? -I'm not sure. -Should I scrub up? -Yes, please. Hi, Mr Ahmad. We're just gonna move you to a little side room. One's just become available. Sorry, can you make some room there, please? Would you mind just moving to one side, please? Can you get the door for me, please, Clare, and then step away. Just leave that there for me, please, Emma. Can I just get you to stay outside for a sec, please, Mrs Ahmad? -Why, what's going on? -No, no, no, she's gonna stay. Yeah, I'm fine here, thank you. Have you been with him all day? -Yeah, of course. -Why? What's wrong, Doctor? -What's going on? -That's really weird. He's just sat there happily on his phone, but his sats are in the 60s on room air. What's his chest X-ray like? Virtual whiteout, bilateral infiltrates, a really odd-looking X-ray. -You said sats in the 60s? -Yeah, but ID won't let us test him. No travel history. -And the Hot Zone won't take him. -'No travel history, no coronavirus.' OK. Everybody stay out. -Where you going? Just stay out. I'll call you. Look, I need a coronavirus test for a 45-year-old patient. -I know he has no travel history. -Right. But there is the highest index of clinical suspicion that this is an undiagnosed coronavirus case. Absolutely, Abbey, but the guidance says with no travel history, we can't authorise testing. But I was just standing there watching a patient playing a game on his phone with his sats sitting in his boots, so the guidelines need to go in the bin for a moment-- We have to follow guidelines. We have no choice. Huw, you know this thing is spreading all over Italy. This is national guidance, OK? It's from Public Health England. Talk to Mike and make sure your patient's in a side room. He's crashing. He's crashing. -What's going on? -I need help in here. -He's arresting -Ant, Ant, stop! Stop! Can we all glove and mask, all of you, straight away, please. -Adult cardiac arrest. -I'm already exposed, I'm getting started. -Shouldn't we have FFP3s? -Hot Zone only. -Jo can't come. There's a query coronavirus. -Emma, no, please. Please. Step back. Thank you. Mrs Ahmad. -I need you to pop this back on for me. -What's wrong with him? Where's the defib? Where's the crash trolley? -Is he gonna be OK? -No, guys, stay out, please. We're gonna wait for ITU. Thanks. -Abbey? -ITU on their way. Abbey, back, please. This is Yussuf Ahmad, 45-year-old, admitted with mild breathlessness. Febrile, bilateral creps on examination. Sats in the 60s on admission. Total whiteout on chest film, but sat up chatting on oxygen. Laryngoscope and a size 8 tube. Pause. Pause. Laryngoscope. Tube. I'm in. Restart compressions. Why are you guys in PPE? -Just a precaution. No travel history. -We should all be in full PPE. -Becky, you can take over? -Five, four, three, two, one. -Look, I think... -I was clerking him earlier without a mask on, Abbey. -I think you need to isolate-- -I didn't even put gloves on. -Ant. Ant. -But he seemed fine. -Go home. -They said the Cold Zone was clear. Listen to me. You've been exposed. You need to go now. -What about...? -Please. Just go. I'll call you later, OK? -Yeah. -It's OK. How is that feeling, huh? Good? Better, Mr Williams? -New man. Thank you, Divina. You're welcome, Mr Williams. -Hi. Hi, hi. -Hi. Yeah, yeah. You OK? Sorry I didn't get a chance to call sooner. No, no, it's fine. It's all good. It's all good. -Everything OK? -Yeah, Yeah. Just wondering what's going on, though. We're not sure yet. Nothing's been confirmed, you know, with testing or anything. But, well, Robyn doesn't really tolerate the nebuliser, so if she would get coronavirus, she'd end up going straight into kids' ED, and I really wouldn't want that to happen right now. But, I mean, she's been-- he's been pretty good recently, you know? Guys, guys, please. I don't think there are many cases yet, are there? I just-- I don't want it getting to her. Even if I've dodged it, it's gonna be in the schools now. You all right, though? When do you finish? Not for a while. Here you are. Do I get a hello? -Hello, Mum. -Hi. I'll call you when I'm heading home. -Sorry. Sorry. You're OK, though? -It's fine. Yep, yeah. I better go, OK? -Bye-bye. -Bye. Bye-bye. PPE to the max in here. I'm not saying he's got Covid, but we're suspicious, OK? We've swabbed him, so we'll see. "No travel history, no coronavirus." Well, he's sick enough for a test now. Where are these rules coming from? If he has got the virus, it's coming in through the front door. Anyone with a chest history could have it. Or just anyone. ...fantastic NHS, fantastic testing systems and fantastic surveillance. We will make sure the NHS gets all the support it needs to continue their brilliant response to the virus so far. But at this stage, with the exception of all the points that I have just mentioned, I want to stress that for the vast majority of the people of this country, we should be going about our business as usual. Okay, folks, we now have our first two patients with suspected coronavirus isolated in ITU. Both travel history from China. Both tested, but results not back. We've been told to double, possibly triple our ITU footprint, and anticipate suspending all elective surgery and redeploying staff. We're contacting dental colleagues. We're bringing back clinic-based SPRs and research SPRs, and redeploying them to Cold Zone wards. We are following the Public Health England guidance and in daily contact with NHS England. Yeah. Questions? Yes, Mike... There are actually three suspected COVID cases, not two. My team saw a case in the Cold Zone presenting with no travel history. He experienced a respiratory arrest, and he is now in ITU. So, what's your question, Abbey? My concern is the Cold Zones where there's currently no PPE at all. I'm worried this puts my team, all the teams, at risk. You know we're beginning to see patients on the take presenting-- I do hear you, but there really aren't any serious concerns about community transmission coming through to us from PHE. I'm voicing that concern, Mike. All right. OK. OK, Look, everyone. This is the national guidance. -Based on what? -On containment. The working assumption is that the few cases here in the UK are contained. And for now, there's no reason to assume otherwise. OK. Thanks so much, everyone. These will be daily briefings from now on. I hope that's OK. So I will see you all tomorrow morning. All of us just packed in here again, all together like this. It's just temporary until things get back to normal. I hope that's not a problem. Mike. Mike. We're all packed in here with no masks or social distancing. I've already had to send my reg home because I think he may have been exposed. -No, no, not if he's Cold Zone only. -But I think we're getting coronavirus cases in the Cold Zone. Look, like I said, this has come straight down to us from-- -From Public Health England. I know. -I don't think they're making it up on the spot. But what if they're out of date and it's already spreading. Abbey, this is their lane. I just think we need to have faith in their ability to assess the epidemic. -Mike, my staff on my ward have no PPE. -Because they don't need it. In the Cold Zones, they don't need it. That's the guidance. I'm sorry. I have to take this. -How's he doing? -His gas exchange is deteriorating despite maximal ventilation. Yes, put her through, please. That's his wife. Dr Ozkul here. Everything we're trying just isn't enough. I'm sorry to say he's not going to survive. No! Can I see him? I'm so very sorry, but we cannot let visitors inside. The risks at the moment are just too... I am very, very sorry. So, in summary, Mr Williams is doing brilliantly when you think about what he was like when he came in. You're doing so well, Mr Williams. Hopefully, hopefully home to Florence soon. She'll be pleased. Thank you. -Thanks, Emma. I'm glad you're feeling better, Mr Williams. -Bye-bye. -Where's Ant this morning? I sent him home from the take on Friday. He did CPR on a patient who went straight to ITU. -What, in the Cold Zone? -I was concerned about the possibility... -Is there anything I should be doing? -It's just a precaution. Right. -Hiya. -How you feeling? Shite. Look, Ant... Mr Ahmad, the patient you were exposed to he... he didn't make it. I'm sorry. -All right. -The results of his test still aren't back. Don't ask me why. Have you had yours? Nope, I am not unwell enough and no travel history. -I'll get you one, OK? Well, I'll try. -Here you go, Abbey. Forget it. I've got to go. Where have you got to be? I've got to call Mum. OK. You take care of yourself, yeah? Bye. So we'll try taking him off the nasal canulae, and then we'll see how you get on. OK? -When did you get back? -Excuse me one second. Guys, guys, guys, what are you doing? Anyone on here could have it, they're saying, -Who's saying that? -Chantelle told me you had said it had got in the Cold Zone, so... I'm not sure we can start making our own kit. We don't wanna panic people. -Well, then, no one's looking out for us. We don't know which one of our patients have got it and which haven't. Be honest, Abbey, do you think we're safe? That's what we're being told. That's the advice from Public Health England. But you would tell us if you weren't sure, no? That's the national guidance, so... -Can you come take a look? -Yeah. Got three query coronavirus in resus. ITU's with one of them now, the other two looking like they're heading that way. These are out of date. -Says 2016 underneath. -Seriously? Sorry, not the FFP3s, Doctor. There's been a downgrade. -Excuse me? -New guidance. You can just use the basic stuff. Apron, surgical masks. What? You need to be doing aerosol-generating procedures to get full PPE. Well, I've touched this one now. Shall I just use it? This is insane. Mike Prentice was just here. I'm sure you can catch him. Thank you. One of them is already dead. He never got out of resus. Another's on his way to ITU, the third's about to be. I am not going in there again in a plastic pinny, and neither is my team. Yeah, the downgrade is new national guidance. It's a three-line whip. Are you running out? -Look, Joe, I know it may seem-- -Who are you saving it for? Please, just tr-- Just trust the guidelines. The downgrade means restricted use of Level 3 PPE. There's a perception on the floor that there's a mismatch between the new guidelines and reality based on Italy. But that's Italy. We're not on the same curve. Well, we're definitely behind them, but we are on it. There's only one curve. OK? Sure. So, what? The Department of Health are saying that you don't need Level 3 PPE. And you think... I think the concerns around the Lombardy experience are real. -I've just got off the phone from the DoH. -So, my question is, why are DoH saying that Level 3 PPE isn't required in the face of that experience. They're very clear about the state of things in the UK. -So... -No, no. Sure. I mean, I've got the secretary of state on speed dial here if you want to take it up the line. ...and we'll talk about next steps. Could you grab me a red form, please? Ros, could you pass me Mr Bailey's notes, please? I just want to check the next of kin details. Thank you. That's great, thanks. Divina, what's the matter? -39.1. -I can't stop coughing. I'm going home. -Right, let me try and get you a test. -The guidance has been changed again. Now no one can get one unless you're sick enough to be admitted. Divina... It's OK. -Could you grab me that form, please? -Yes. Yeah. Hey, Mummy's home! -Mum, Mum! -Mum, Mum! -Hey. No, no. Remember, Mummy's gonna have a shower. -No, but I wanna show you something. I know, but I'll be back down in a minute. Just stay in the kitchen, okay? -I won't be long. Love you. -Mum! Five minutes, love. And it's clear that coronavirus, COVID-19, continues and will continue to spread across the world and our country over the next few months. We've done what can be done to contain this disease, and this has brought us valuable time. But it's now a global pandemic and the number of cases will rise sharply. Indeed, the true number of cases is higher, perhaps much higher than the number of cases we have so far confirmed with tests. Let's get you into bay 3, please. I must level with you, level with the British public. More families, many more families are going to lose loved ones before their time. Okay, let's move that oxygen over, thank you. Brakes on. Relax as you are for a second. Let's get that side down. You're doing really well. ...need to be seen first, and there are three ducks in resus already. Thanks, mate, well done. Right, everyone. It's going to be a hard night, but we have more FFP3s from a building firm, from some vets and dentists and school kids, amazingly, have made some visors. Hannah's been on the phone all afternoon. -Here we go. -Ah, here they come. -Cheers, guys. -Thanks, lads. This one has your name all over it, Neil. Very fancy. And we have around 2 million pizzas from the public. So no moaning, even if they do all have pineapple on them. Just kidding ` they don't. So heads down. Stay safe. Speak to me if it gets too much. OK? Sure. Hey. Didn't think I'd be seeing you tonight. Med reg off sick, all the locums off sick, so... Bad luck. -What's a "duck"? -A patient with Covid lungs, Covid bloods, Covid plain film, but no Covid test result back. If it looks like a duck, walks like a duck. -Yeah, got it. My F1s will help you out. What about their PPE guidelines? We only get Level 3 for resus. It's obvious they're just short of kit. -Yeah. -Are you OK in hot resus? You know, Divina's... Yeah, yeah. Hello, Divina. -Hi, Doctor. -Do you want to bring me up to speed? We've been tweaking the high flow since this morning, but she's on 100% now, and sats have dropped to 87. Here's her gas from 20 minutes ago. OK. Thanks. Divina... I can see how tired you are getting. I think we should take you to ITU, OK? And if we have to move to a ventilator, I will do the intubation myself. All right? I promise you, we will take the absolute-- -What's that? -It's the low oxygen flow rate alarm. Button on the wall, please. Are we running out of oxygen? I'll see you shortly, Divina, all right? -OK. -I'll call you as soon as I've got a bed. Let's go for a trial of CPAP in the meantime. Hi, guys, I might need a bit of help, even if it's just for a few hours. We're... running out of beds, vents... Maybe even oxygen. -Look, I'm not going to make it home this weekend. Sorry, it's just... It's just exploded, they-- they just keep coming. Don't take the children anywhere this weekend, it's not safe. Home or the park, but nowhere else. OK? -OK, OK. Are you all right? Ambulance bay, please, Abbey. -Yeah. -I've gotta go. I'll call you in the morning. -OK. -OK, bye. What's going on? Guys, why aren't you doing CPR? -We've been told not to. -Where's your PPE? He arrested en route 20 minutes ago. We're just in aprons. We can't do CPR. It's droplet-generating, we just had to let him go. You're gonna have to call it in the back of the truck, and we need to get back out on the road. Look, I'm really sorry to do this to you, but we need to get back on the road. Yeah. 8.32. 8.32 p.m. I'm sorry, guys. I am so sorry. The country has a perfectly adequate supply of personal protective equipment, PPE, at the moment. There have been, I think, some differential deliveries if you like, in some areas, which has caused a degree of concern recently, that is completely resolved now. And in fact, what we've done in the last 36 hours is set up an entirely separate PPE... They just keep on coming. It's madness. I'm so sorry. We tried everything we could en route. If you call the number I've given you in the morning... Hi, Jo. Obviously, staff sickness is through the roof. -Because of the PPE situation. -We're also having questions raised about oxygen delivery. There's clearly extreme pressure on beds. So Gold Command have decided we need to declare a critical incident. Really? Took you long enough. Hello, Divina. Welcome to ITU. We're gonna take good care of you, all right? We're just gonna put a little tube. It's gonna take a minute or two. It's gonna be very quick, OK? I'm gonna do it myself. Nice and gentle. We're right here with you. All right? Drugs are going in. You'll start feeling it in a moment. OK, just relax. Nice. That's it. That's it. The World Health Organisation said test, test, test. If the NHS became overwhelmed, then people would die from indirect deaths because they did not have the ability to get medical care. The rest of the world is providing staff with full protective gear, and we are restricting it. -What's your name? -I do think, looking at it all, that we can turn the tide within the next 12 weeks, and I'm absolutely confident that we can send coronavirus packing. I need some help here. Do you not think it is now right to move to a more substantial lockdown of the capital, like they have in Italy, in Spain...? Captions were made with the support of NZ On Air.