Published: 03 July 2020
Keith Hugill, Research Coordinator, Critical Care Unit, James Cook University Hospital, Middlesbrough, tells us what it has been like on the frontline during the COVID-19 pandemic. Part of the COVID-19 Research Voices series.
The COVID-19 pandemic - the biggest global health disaster since the Spanish flu pandemic over a century ago - has hit the North East of England particularly hard.
First COVID-19 admissions to critical care
At James Cook University Hospital our first COVID-19 patient was admitted to critical care on 20 March and numbers began to rise, including a peak of 11 admissions on one day on 29 March. Of the ventilated patients in the early stages, 50% of them unfortunately died. This disease was one of the most frightening I had ever experienced - not just affecting the elderly population with significant comorbidities, but also those who were previously fit and well. It was striking down people at an alarming rate and all we could provide for them was supportive treatment such as sedation, ventilation and dialysis treatment.
The cases proved an immense challenge as we had no effective treatment to offer, just having to watch and wait to see if the patient would recover or succumb to the disease.
Recruiting patients to studies
I’ve been a Research Coordinator for over 11 years, following 15 years as a critical care nurse. Our Trust has an excellent record of research activity in our department often in the top recruiting sites in the UK for many studies. Before COVID-19 we had recruited to more than 20 studies, including our own research studies and I was actively involved in recruiting to a wide range of critical care research studies
When COVID-19 research took centre stage, research nurses within the trust were assigned to three studies with Urgent Public Health (UPH) status - REMAP-CAP, RECOVERY and GenOMICC - or asked to return to clinical frontline nursing duties. Initially I was asked to return to clinical frontline duties, but senior managers agreed that my research position is essential to maximise our recruitment to all three studies. One research nurse and a data-inputting clerk were allocated to assist me, to help obtain clinical samples, and family, consultee and retrospective consent. This was a crucial move to support us in recruiting patients in critical care to UPH studies.
Being involved in COVID-19 research is very challenging due to the patients’ clinical condition, but also because relatives are not allowed to visit the hospital. Currently, all consent for the REMAP-CAP study is initially by professional consultee, which means that the decision as to whether a person lacking capacity takes part in the research, is made by a researcher. Despite our best efforts, many participants will die from this horrible disease. However, I feel that these studies will, hopefully, result in effective treatments to control the spread and effects of the virus, ultimately benefiting others. I believe it is therefore our duty to offer any potentially beneficial treatments where we can.
Doing my job
My role in these studies is to screen, identify, consent and, if necessary, randomise participants to the study domains. Working with the clinical doctors and nurses I then ensure that the appropriate interventions are delivered to patients. The clinical teams have worked incredibly hard to ensure that these interventions are delivered in an extremely difficult environment considering the restrictions with having to wear full personal protective equipment (PPE). I am in a high-risk group, so have been lucky to have a designated nurse to take the patients’ samples for me to send to the sponsor or to our laboratories for processing, meaning I don’t have to enter the room. This was a key element of our success and clinical nurses were simply too busy tending to very sick patients, and being slowed down by working in full PPE.
I sincerely hope that the results of the research will allow the NHS to identify the causative factors that make this virus so deadly to certain individuals including those from BAME communities, and that the effective treatments identified will allow as many patients as possible to make a quick and full recovery from this terrible disease. I hope the REMAP-CAP study shows beneficial drugs and holds the key to treatment combinations that may improve survival. I consider it our duty to our patients to offer these.
I keep asking myself what the future holds for the world; will we develop a vaccine? How soon? I know that billions of pounds are being spent worldwide and hopefully we will find one. However I know that for other coronavirus diseases such as SARS and MERS an effective vaccine was never produced. If the vaccine is not developed, will we ever be completely safe?
On a brighter and final note the world will return to some semblance of normality ultimately, although not the world we once knew. Until we can all return to some level of normality, keep well and stay safe.
Find out more about the NIHR's response to COVID-19.
Read more in the COVID-19 Research Voices series.