Former Altnagelvin director Dr. Catherine McDonnell tells COVID-19 inquiry of staff’s ‘absolute fear’ during pandemic surges

Dr. Catherine McDonnell told the inquiry she believed it was ‘absolutely critical’ sufficient staff and bed capacity are in place the next time we have to ‘launch ourselves into a pandemic’.

The senior medical director was in position between March 1, 2020, and June 23, 2022, at the peak of the coronavirus emergency.

Providing evidence to the inquiry this week she spoke of the fear experienced by staff at Altnagelvin as the virus spread like wildfire in the North West.

“The atmosphere changed with surges. In the first surge there was real challenge because this was a completely new experience for the staff in terms of how they had to work in full Personal Protection Equipment (PPE) in terms of trying to manage to have those communications and relationships with patients with significant mask-wearing and changing how they did things.

“And there was absolute fear. I mean, when you think about the society in general, it was anxious about Covid and we were asking staff to walk into situations where they were actually exposing themselves to it.

"There was an unfamiliarity with actually wearing PPE. So there was - it was a real fear of the unknown and a real unfamiliarity that made that first surge just very difficult in terms of the day-to-day work,” she said.

Dr. McDonnell said Intensive Care Unit (ICU) bed capacity at Altnagelvin stood at ten when the pandemic began. The inquiry heard that the plan had been to increase this figure to 24 beds but this had not been possible.

"We were highly ambitious and we had not truly worked out that the actual bed constraint was not going to be the number of beds, it was going to be the number of staff that could staff a bed.

"So I don't think we actually moved beyond 14 to 16. But we did have some innovative ways of trying to take pressure off our ICU in terms of developing high dependency beds within our respiratory units,” she told the inquiry.

Anecdotally, Dr. McDonnell told the inquiry that she understood a normal ICU stay would have lasted two to three weeks but in Covid times this could have extended to ten weeks and the patients that were in the ICU were ‘extremely unwell’.

"It was highly intensive and patients were there a long time with the additionality of families not being able to visit in the same way and the demands on this team to be providing that component of care that families would and the building of relationships because of that absence.

"It was also more challenging because all of the communication with families was being done by phone or by video links. So the psychological and traumatic impact on staff was definitely highly significant,” she stated.

Altnagelvin, the inquiry heard, faced particular challenges during the fifth surge between December 2021 and February 2022 when the hospital was ‘overwhelmed’ with COVID-19 patients over Christmas.

“When I look back over the two years I think that was the lowest point for the staff group in Altnagelvin Hospital. I suppose we understood that level of concern that a staff felt when both nurses and doctors were coming to us as their directors and asking us about where they stood individually, professionally because of the fact that they felt they were not able to deliver care in the way that they usually would,” said Dr. McDonnell.

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During the course of the pandemic two senior psychologists at the Western Trust ‘took a lead role in helping develop a raft of interventions, some of which were linked to the regional initiative of having a psychological helpline, others that were related to team debriefs, crisis interventions’.

Dr. McDonnell informed the inquiry of the unique challenge facing the Western Trust as a result of its borders with Donegal, Leitrim, Cavan and Monaghan.

“Because we are two different jurisdictions the guidance on restrictions often varied, and that in particular in the first surge, was extremely confusing for staff because there was so much rapid change and they were hearing some conflicting messages.

"I also believe that we were particularly at sometimes not quite in step with the rest of the region in terms of our surges and our spikes and that might have been to do with some of the differences in terms of lockdowns.

"So if we unlocked early we got a footfall of residents from across the border to enjoy our restaurants and pubs and I think that might have contributed to some of our particular peaks,” said Dr. McDonnell.

The former medical director said it is important that the health service is appropriately staffed and resourced to ensure capacity is there to meet any future pandemic when she was asked what lessons should be learned from the COVID-19 emergency.

“I think I'm going to be repetitive and say things that have already been said but I think the most important one is the workforce and the baseline from which we launch ourselves into a pandemic. I think that that's absolutely critical. And I think the second one is, and it's been talked about, pandemic preparedness.

"We need the PPE. We need things like the visiting guide. We need some of that -- those ethical performers that we were speaking about. We need those things in place before another pandemic hits.”

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