John Brush

Frontline Former Pupil Discusses Covid-19 Challenges

Following the news of a novel, dangerous virus from Wuhan, China in late January 2020, it triggered emergency planning in many hospitals worldwide, including my place of work – Western General Hospital in Edinburgh.

As a Consultant Radiologist, our Imaging Department serving the local Infectious Disease Unit, had to plan to deal with the arrival of patients known to have the virus, suspected of having the virus and not known to have the virus. This involved a huge amount of logistical reorganisation and individual change in practice.

Prior to coronavirus

Western General Hospital serves as a tertiary referral oncology centre for the Southeast of Scotland. My subspecialist skills at normal times provide uro-oncology cover regarding prostate cancer diagnosis and treatment for the East of Scotland, from Inverness to Berwick.

Prior to the pandemic, we had provided by far the largest number of curative prostate brachytherapy implants in Scotland (over 1,200 patients treated). As a Consultant Radiologist specialising in prostate cancer, I provide diagnostic MRI scans, targeted biopsy and subsequent therapeutic radiation therapy.

In other areas of oncology work, I provide interventional and diagnostic procedures, both regarding common emergencies but also providing palliative image guided treatment, designed to improve quality of life.

Arrival of coronavirus

In March 2020, as we realised this new virus had the potential to overwhelm NHS services, including acute admissions, imaging and intensive care, plans were rapidly drawn up. The hospital, including radiology, was effectively split in two – red and green – red for coronavirus related treatment and green for non-coronavirus medicine. Intensive care capacity was expanded, doubling its normal capability.

All areas of the hospital followed similar rules and all medical staff had to follow strict guidelines to protect themselves and anyone close by who could be affected by this virus – known to be spread by close proximity to others via droplets. In Radiology, this meant adopting full personal protection equipment (PPE) for procedures deemed to be high risk for transmitting the virus (referred to as aerosol generating procedures or AGP). The tendency was very much to regard a procedure as an AGP until proven otherwise, hence initially large parts of a working day in radiology were spent in full PPE.

As you can imagine, this is not a comfortable environment to work in, particularly on top of the lead protection coats we wear in Radiology to protect against radiation. We also provided a first line diagnostic service regarding suspected viral cases. Unfortunately, the swab test for coronavirus is not always accurate and many patients would present to Radiology with symptoms thought to be viral related but produced a negative swab test. We realised that there were findings on chest x-rays and CT scans that suggested the presence of the virus, allowing appropriate and early management to change.

Regarding presence of work, the hospital never stops, but in order to minimise potential risk for cross contamination, we spilt into pods, working 3 days on and 3 days off. Undoubtedly normal radiology services for oncology at Western General Hospital took a hit, with many standard scans and procedures being significantly delayed or even cancelled.

Eventually in early summer, the number of hospital admissions due to the virus began to drop significantly, allowing us to reopen standard imaging for almost all patients.

Post coronavirus

Of course, we cannot yet say that we are post coronavirus, but our experiences of dealing with positive viral cases and suspected cases, combined with the need to continue urgent cancer activity, has allowed us to reopen imaging services, while at the same time continuing strict measures to prevent viral transmission. Appointments are spaced out, waiting rooms are re-organised, and procedures are conducted following strict protocol. This is in addition to the regular handwashing and mask wearing that the general public is encouraged to follow.

While the last few months have not been easy within the hospital, there are now undoubtedly green shoots of recovery and many lessons have been learnt. For this reason, it should be possible to manage viral admissions but also continue urgent standard care going forwards.

John Brush, Class of 1984