LIKE anywhere else in the country, doctors fighting the coronavirus pandemic in Salisbury faced a situation they had never seen before.

But thanks to the amount of preparations that took place beforehand, staff at Salisbury District Hospital managed to cope with the worst of the pandemic without ever being overwhelmed.

Members of the public who complied with the lockdown helped keep the number of admissions down, preventing the deaths of further patients and possibly members of staff.

As the peak of the pandemic has now passed, a front-line doctor looks back at the steps that were taken to cope with the outbreak and how everyone played a part to contain the impact of the virus across the city.

'Planning'

Splitting the hospital in two, increasing patient capacity, and preparing early are just some of the ways medical teams at Salisbury’s hospital have so far managed to contain one of the worst viral pandemics the modern world has ever seen.

Having already taken the lives of 48 city patients since the start of the outbreak in March, the virus now seems to be subsiding, with Prime Minister Boris Johnson announcing last week that the UK is “past the peak”.

Locally, doctors and nurses have been working around the clock to make sure the number of victims stays as low as it can.

At the heart of this was early contingency planning which began as early as mid February.

“By this point we had seen what happened in China and Italy, particularly Lombardy and we were advised early on to start planning,” said Clinical Director for Medicine Stuart Henderson.

“In essence, we never really faced anything like this before so we had to reconsider our entire medical operation.”

This meant changes to staff’s rotas but also to the layout of the hospital, which was effectively split into two parts, one to manage Covid patients “or those who we thought might have Covid” and one for those “who we thought didn’t”.

Increasing capacity was also key and by relocating the stroke unit and redesigning the elderly medicine department, a total of 60 beds were added to a respiratory care unit dealing purely with Covid patients.

As Dr Henderson explained, preparations were based on best and worst case scenarios.

“In the worst case scenario we could potentially have 180/200 patients at any one time with Covid and 40 ventilation patients in intensive care at the peak. We normally have 27 beds for respiratory care so that’s almost 10 times the number we have capacity for.

“For intensive care we have a maximum of 10 beds so that’s four times that number.”

Had that prediction become reality, it is likely staff would have run out of PPE, he said, and the risk of in-hospital transmission of the virus (from patients to staff and patients to patients) would have increased.

However, thanks to the introduction of social distancing measures, the situation began to improve just as ICU capacity was reached in the first two weeks of April.

“Here in Wiltshire the lockdown was introduced exactly at the right time and it was followed really well by the local population. The fact that it was so well adhered to made a massive difference.

“The number of infected patients was going up the curve pretty much day by day until a week after lockdown. It’s at that point that admissions started to plateau and we deviated and moved along our best case scenario so all that talk about flattening the curve was absolutely true.”

Looking back, the front-line doctor says planning and the knowledge gained by observing the behaviour of the virus in other countries prepared them for what was to come.

“We weren’t taken by surprise and we weren’t overwhelmed. As a trust we worked really well and I don’t think there’s anything we would have done differently.”

'Easing lockdown'

Since the city’s own peak at the start of last month, staff have noticed a “slow but steady” decline in hospital admissions. The focus now will be on redeploying medical staff, many of whom left their wards to help on the front-line, and going back to “a new normal” through a “phased approach”.

Looking at the numbers, Dr Henderson says easing lockdown measures in Salisbury seems “reasonable”, however, due to the unknown impact this will have, “we will keep the escalation response [in place] so if needs be we can revert to it”.

Although it is hard for people who self-isolate to notice the impact their actions are having, Dr Henderson is urging everyone to keep going and keep following the government’s rules.

'Recoveries'

Although 48 patients have so far lost their lives, many others have recovered instead while the vast majority never required hospital admission in the first place.

According to Dr Henderson, patients who have been admitted to hospital with Covid-19 are only “10/15 per cent of cases” and by definition, “85/90 per cent [of those who get the virus] will

recover without ever needing medical attention”.

Although recovery figures are not formally disclosed, as they are harder to compile compared to deaths, “it’s not all a negative story”, the doctor insists, adding that “a decent number [of patients we have seen] haven’t died”.

As far as patients who are still in hospital, Dr Henderson revealed: “I’m hopeful that all of them will be going home”.