Rosie Baruah
Dr Rosie Baruah is a Fellow of the Royal College of Physicians of Edinburgh. She is a Consultant in Intensive Care Medicine and works at the Western General Hospital in Edinburgh.
Details
- Date of interview: 4 May 2021
- Archive reference: RCP/RES/2/12/18
- Interviewer: Daisy Cunynghame
Timestamps
00:00 Introduction
00:37 Changes to work patterns
01:47 Long-term impact of COVID on physical and mental health
04:40 PPE and equipment
06:12 Long term impact on NHS
09:57 Government response to pandemic
11:28 Public response to pandemic
13:15 Vaccines
16:24 Personal experiences of coronavirus
17:42 Effect of the pandemic and lockdown on home-life routines
19:28 Wellbeing and mental health support given to medical professionals
22:06 Misinformation on the pandemic
24:23 Concluding comments
Transcription
Interviewer:
Could we start off by you please just introducing yourself, saying your college (Royal College of Physicians Edinburgh) membership status, your medical specialty, and where you work, please?
Rosie Baruah:
My name is Rosie Baruah. I'm a fellow of the college, and I’m a consultant in intensive care medicine at the Western General Hospital here in Edinburgh.
Interviewer:
Thank you. The last time we spoke, six months ago, we talked about how the pandemic was affecting your working hours and your practices, and I just wondered has that changed over the last six months?
Rosie Baruah:
We've had a further wave of coronavirus in Edinburgh, affecting us mainly over the winter period, but by some dint of fortune, we managed to stay within our ICU (intensive care unit) capacity throughout and didn't have to open a second ICU the way we did in the first wave. So, very fortunately, we haven't had to modify our working patterns the way that we did in the first wave. And even more fortunately, pretty much all of the hospital's normal elective work has managed to continue over the winter and we haven't had to cancel, for example, urgent cancer surgery because of lack of hospital capacity due to coronavirus. So, that's a big difference to the first wave last April.
Interviewer:
Thank you. Something else we talked about six months ago was your thoughts on the long-term, both physical and mental, impact of the pandemic. I wondered if your ideas or your thoughts had changed at all since then, or developed in terms of the impact?
Rosie Baruah:
Is that on patients or on staff?
Interviewer:
Sorry, on patients, I mean.
Rosie Baruah:
Since we last spoke, we've set up in Lothian uh an ICU follow-up service, which is something that already happens in a lot of organizations across the country, but we haven't had a permanent service in Lothian before now. And we're seeing patients with coronavirus who have survived their stay in ICU, and many of the survivors were the fitter patients that came in, but having been in ICU, even the ones who weren't ventilated are still suffering from quite considerable restrictions in their daily activities.
They they're very weak. They often have damage to their nerves from having been positioned on their tummies, even the awake patients we encourage to lie on their tummies. They’re very short of breath on fairly minimal exertion, and a lot of them have quite severe psychological symptoms in terms of traumatic flashbacks to their time in ICU and particularly memories of very, very unpleasant, delirious hallucinations and thoughts that they had when they were under sedation, which is very much sort of affecting their quality of life. In the sense that it's something that comes back to them whenever they're trying to relax or trying to sleep.
One thing that was particularly interesting, which made me really quite angry really, is all of them said that they get so incredibly upset when they hear coronavirus deniers on TV or on social media saying that this doesn't exist, “This is a hoax, this is a disease with a really low fatality rate”. And they sort of say, “I'm living proof that coronavirus is not a hoax and is an absolutely serious disease”. And they're working so hard psychologically to try and get themselves back to the best state of health that they can, and then they hear this kind of thing on the TV or on Facebook or Twitter and it's really a kick in the teeth for them. So that was a very interesting thing that I didn't expect to hear from them, but it was quite a consistent account from the survivors that came back to clinic, how much they struggle hearing those things.
Interviewer:
Thank you. Something else that we talked about before was the shortages of PPE and equipment, and I think, if I remember rightly that you said you had to buy your own scrubs at one point?
Rosie Baruah:
Not in Lothian no, we didn't, perhaps outside of ICU they did, but not in Lothian ICU.
Interviewer:
I wondered if you were experiencing any sort of shortages or issues in that area now, and what the setup is in terms of PPE?
Rosie Baruah:
PPE usage is changing all the time. For example, in my anaesthetic practice we have patients who are coming in for elective surgery who have been isolating for 14 days before coming in, and then all we need to wear is a standard surgical mask, but patients who come in with symptoms that perhaps could be coronavirus, or of course with confirmed coronavirus, were still wearing the full PPE either in theatre or in ICU.
Supply lines are a lot more reliable now, I think. Manufacturers, I imagine, are back up to full speed, and certainly our charge nurses and our managers aren't feeling the same degree of stress and/or mild panic thinking we only have, you know, 36 hours left. And there's less in the way of emails going out saying, “if you fit this kind of mask, can you urgently get refitted, because we don't know when we're going to get stocks of that mask back in”. So, I think we've hit a bit of a steady state right now where supply and demand seem to match each other a lot better than, understandably, the first wave of the pandemic where we were starting sort of from the back foot.
Interviewer:
Thank you. I wondered if you had any thoughts on what the long-term impact of COVID will be, in terms of how the NHS is organized, how you interact with your patients, or will it have significant changes to the way things operate, do you think?
Rosie Baruah:
It's a huge question. I think there's so many things that will have changed forever. We were talking at work the other day how we would all travel internationally to airports and wander around breathing in the exhaled air of people from all over the world, just breathing in and breathing out, and how culturally travellers from East Asia would always wear face masks and you think, "Oh my goodness, how paranoid". And now I can't imagine going into an airport or an airplane, or indeed intubating somebody, when you know all of their kind of aerosolized gases are passing out and I'm just breathing them straight in again. So, I think in terms of just ongoing practice, I can't imagine doing any kind of airway procedure as an intensivist without wearing a face mask for instance, but this is a very minor thing, I guess. But it's also a major thing, I think, for our patients who in ICU are often very confused, patients in hospital are usually of an older age range who may have hearing impairments. I think the use of face masks does have a negative impact on patients too. I guess the next thing is going to be how we downgrade our use of PPE when the level of coronavirus in the community has fallen to an incidence where it is unlikely that any given patient has that because, I think, there is a cost to our faces being hidden as well as the pure human cost of never seeing a human face when you're in hospital.
I think in terms of general organizational aspects, this isn't something I'm directly involved in, but I think the idea of resilience and the idea of being able to respond rapidly to a major increase in resource utilization. Now that we've all done it for real, I think that's given us a degree of psychological preparedness that will mean that if it happens again, we'll be in a better state to think, “Right, okay, there's been an incident. We need to double our ICU capacity in 48 hours, let's go”, because we all know what it feels like to do that now. I think there have been developments with IT that happened in a very short space of time, much shorter than things normally happen in the NHS.
Again, remote clinics, which again I don't do clinics as an ICU consultant, but my surgical colleagues, for instance, say there are a number of patients who don't need to come into hospital for follow-up clinics. And to save them that that bother of traveling to hospital and perhaps increasing clinic efficiency, that might be a permanent fixture for a select number of patients. So, more remote medicine, and for us as clinicians holding meetings, we're able to meet remotely which when you work in somewhere like NHS Lothian that has many different hospitals, again it increases our working efficiency. So, I think those are positive things, but again not being part of NHS management I can't speak to quite how many delays there have been in cancer services or other services like orthopaedics, where they're saying there's going to be five year waiting lists and things like that. That's obviously pretty disastrous for patients who are waiting for care and that's an overwhelmingly negative aspect of coronavirus, which, I guess, you have a workforce that's already pretty tired, who's now going to have to try and step up and address that delay and that's going to be a decade's worth of work, I think, to kind of catch up to where we were in those halcyon days of innocence in 2019.
Interviewer:
Thank you. I wondered if you had any thoughts on the government response to coronavirus, and obviously we talked about this six months ago, but over the course of the last six months, do you have any thoughts or opinions?
Rosie Baruah:
As an intensive care consultant who is dealing with incredibly sick patients, many of whom have died and seeing the way they have struggled and their families have struggled and the survivors, the way that they continue to struggle, I'm very pleased that our road map out of lockdown in Scotland has been very, very cautious. I think that has felt appropriate, to me, that we’re always a little step behind the actual incidents rates of coronavirus in the population in terms of opening things up. But, as I said in my previous interview, I am in steady employment. I know I'm going to get paid at the end of every month and I know that there are huge numbers of people out there who do not have that security and the ongoing lockdown has been disastrous for them both financially [and] personally. And so whilst it suits me in terms of my professional responsibilities, I'm aware that it is not necessarily the easiest situation to be in for a lot of the Scottish population, but had we come out of lockdown more quickly, I think we would not have seen coronavirus rates being as low as they are right now.
Interviewer:
Following on from that, do you have any thoughts on the public response to coronavirus? Particularly, of course, over the last six months, and how that has changed people's opinions about mask wearing and social distancing and things like that?
Rosie Baruah:
I mean, I remain astonished about how people have complied with the regulations despite the, you know, probably overwhelming fatigue we have right now. I was talking to my daughter yesterday. I don't think either of us have been outside of the Edinburgh bypass since last August maybe, and everybody has, I think, done their best. And even though we do see these end lockdown marches, we do see people you know there- We were crossing the road going up to George Street for our first shopping trip of 2021 and somebody had written on one of the sorts of signs and a crossing “COVID vaccine equals 666”. And you just think, you know, there's people out there who clearly do not believe in the response. But, I think, overwhelmingly the public have been supportive and, I think have complied with what's been asked of them. And I just very much hope this genuinely will be the last push and we'll continue to see a loosening of restrictions and moving into the latter half of 2021 we’ll deal with COVID the way we do with seasonal influenza. That we'll expect to see some of it, and those patients will come in and be isolated and be in side rooms, but we'll not see the mass infection rates and the mass hospitalizations and the huge numbers of deaths that we saw in 2020 and early 2021.
Interviewer:
Thank you very much. Of course, the big change that's happened since we last spoke six months ago are the COVID vaccines. And I wondered how that has impacted on you in your work having these vaccines available, and do you have any comments on the roll out of the vaccines and how that's been carried out?
Rosie Baruah:
From a personal point of view, I was part of the AstraZeneca vaccine trial, and when I was offered a vaccine through my employer as a trial participant, I was able to be unblinded to find out whether I'd received the AstraZeneca vaccine or the control vaccine, which [was] the meningitis C vaccine, I think. And this was just before Christmas. And when I was told by the trial nurse that I'd received the AstraZeneca vaccine, it was honestly the most almost euphoric feeling, knowing that actually I've been protected since September, which is when I'd had my second booster and that, you know, the possibility of me carrying it was so much lower. So that, you know, the times I seen my mom, even though I stayed two meters away, out of doors, I was very unlikely to have to have affected her. And that was just an amazing feeling.
I think for us seeing people responding so positively to vaccination, I don't know if you remember seeing on the TV. It was around, I think, January. Queues in the freezing cold in Fife and places like that, people queuing up to get their vaccine and people just trying so hard to do their bit to get to that stage of herd immunity and protect themselves and others.
In terms of the vaccine roll out it was a huge project, and organizationally I think it was very difficult to get it really efficient right at the beginning but, after some bumps in the road, it did become easier for people at work to get their first dose of vaccine. When the decision was made to delay the second dose, again, there was a bit of consternation about how well we'd be protected as healthcare workers and for our family members who are only going to be receiving a second dose. But then because more evidence was coming out all the time about the persistence of immunity after a first dose and that immunity being of fairly good magnitude, I think people felt it was appropriate to try and vaccinate as many people as possible and then move on to the second doses. And so, all things considered, from my perception, I think people are pretty happy with the roll out of the vaccine, and most importantly with people's willingness to take it, bearing in mind that it that it is new and doesn't have the history that so many other vaccines that we have. Uh and I think without the vaccination, we would not be in the stage that we are now. I think it's been absolutely crucial to getting to the stage where we can really move to the lowest levels of lockdown.
Interviewer:
Thank you very much. The next questions I'm going to ask are more about the personal impact of COVID on you. Just to remind you, of course, that if there is anything that you don't want to answer then then please do say. So, without naming individuals, since we last spoke has anyone in your family or your friends or colleagues contracted coronavirus, and if you're comfortable talking about it could you talk a little bit about that experience?
Rosie Baruah:
No, my sister was on maternity leave and came back to work as an anaesthetist and has managed to stay coronavirus free. Nobody else in my family in the UK has contracted coronavirus. In India right now there's a horrific second wave of coronavirus throughout the country and a very sort of distant cousin of mine has died and as several of my sort of peripheral family, their whole families are infected with coronavirus, and I think that's going to get a lot worse before it gets better. And looking at India that's, I think, very much where the UK could have been, had we not had the lockdown restrictions that that we had. So, in terms of my family having escaped unscathed, yes, my UK family have, but I remain watchful of my extended family in India to see what's going to happen there, because I think that is a story that has not yet finished unfolding.
Interviewer:
Thank you. Something else that we spoke about six months ago was how your home life routines were impacted by coronavirus, and I'm interested to know, has that changed significantly over the last six months in terms of your personal impact?
Rosie Baruah:
Because we were able to stay within our usual numbers in ICU, I didn't have to work any extra shifts which, you know, is always good. My daughter was off school for the whole [pause] of the winter/spring term. So, she finished school, I think, the 19th of December and only went back two and a half weeks ago. For her, you know remote learning is never ideal, even though she's of an age where she can motivate herself and didn't need me to do anything for her. But she's back at school now and I think had not really realized how much she missed the physical presence of her friends. So, her return to school has been a lot easier than she thought, which has been a joy to see actually, because I think for our young people and our children this has been extraordinarily challenging and as hard as it is for us, you know, we had all the normal routines and rituals of childhood that they missed out on and can never really go back to. So, it’s been a minimal impact on my personal life this time compared to the first wave. But of course, if we compare this to May 2019, you know, there's no way I could list the ways my life is different. So, I guess our idea of what is normal has changed so much.
Interviewer:
Thank you. So, it sort of follows on quite nicely from that the next question which is around the mental health impact on medical staff or medical professionals. Has that changed over the last six months? Have the support networks that you have in place changed at all?
Rosie Baruah:
I think for our nursing staff, the runup to the potential second wave was very challenging because London, for instance, had an absolutely terrible time. They had, I think, in many ICUs, you know, two patients to a bed space, one trained ICU nurse looking after four or five patients, with perhaps other nursing staff to do some tasks, but they would be the only trained ICU nurse. And the mental fatigue of that, I just don't know how they kept coming back to work, day after day. And seeing that unfold, thinking that could happen here, knowing how difficult the first wave was. I think there was a lot of unresolved fatigue that suddenly came back, and you know it's so cold and wet and miserable, because it's winter anyway. But fortunately, because our second wave was relatively modest in magnitude, I think the resilience of the staff managed to see them through. For the medical staff as well, I think given that we didn't have those huge numbers that that did help us a lot.
But of course, I think sometimes things like this happen and you don't know how they've affected you till something happens that challenges you and you suddenly realize, "Oh my goodness, I got really upset at something that wouldn't have upset me at all normally." Or "Oh my goodness, I just feel so tired and I don't know why." And I think in the next twelve, eighteen months, those may become more manifest. Fortunately, we're hopefully going to be able to get help from a staff, a clinical psychologist who can come and run regular sessions with our staff, just to help support them through the recovery phase, because you can hunker down and be in attack mode for so long and then, I think, it's when things level out that the changes in your life and the things that you've seen and experienced really begin to hit home. I wonder if actually we haven't really seen the emergence of the majority of the psychological [unclear] that the staff may have suffered.
Interviewer:
Thank you. This is my last question, and you sort of touched on this before, but I'm interested in your thoughts on the information that is available, online or elsewhere about the pandemic, and whether you feel there's been a shift towards disinformation, and the impact of that on the, kind of, people's feelings or ideas around the vaccine or the pandemic more generally.
Rosie Baruah:
It's interesting that, I feel that once the vaccine actually started being rolled out, the vaccine disinformation thing kind of got a lot quieter. When it was just being introduced, there was so much on Twitter and so much on the news about people saying that they were going to refuse the vaccine. But then I think, when I mean, maybe this is just my perception, but when people realized it would actually afford them freedoms, that all seems to quieten down a little bit. And I think vaccine uptake rates have been far better than people may have thought. And there are professional disinformation spreaders who monetize their spread of disinformation, and that's how they make their living and they will be as vocal as they always will be, because that's kind of what they have to do to continue in their chosen specialty of spreading disinformation. But I think in terms of widespread public engagement, I think people are on board.
I think in terms of the medical profession, I think we now have so many really good, randomized control trials running. In terms of potential therapies for COVID, again, we're feeling that we're on much more solid ground in terms of prescribing evidence-based treatments for our patients and that is a very different position to where we were a year ago in terms of dealing with this disease. And now everyone's getting their dexamethasone, and everyone's had their tocilizumab, and the patients in the second wave were much less sick than they were in the first wave. And again, although, of course, there were there were many deaths, there were not anywhere near as many [as] in the first wave. So, all things considered, I think the disinformation could have had far more of a negative effect, and I'm not sure why it hasn't. Maybe in the UK we trust authority more than they do in other countries, when push comes to shove.
Interviewer:
Thank you. So, essentially, we're done now. But before we stop, is there anything else that you would like to say that you haven't had the opportunity to?
Rosie Baruah:
[Pause] I guess, we're moving into a phase now where we don't really know what the future holds. As I've said earlier on, when you're in that kind of adrenalized attack mode and your goals are very clear and they're very narrow, it's just, “Let's get through this”. And then everything loosens up and all of a sudden, your afforded liberties to do more things and make more choices. I'm going to be really interested to see how we all handle that, both in terms of the wider population, and in terms of those of us in hospital, because our worlds have been so constrained in a way that's simplified them in a way. All we've had to do is get up, go to work, come home again. And now that normality is coming back, yeah, I'm not sure how I feel about normality actually. So yeah, we'll see, we'll see what it's like in a year's time.