Doctors at Glasgow's Queen Elizabeth University Hospital tell of the toll of coronavirus

By contrast, windows and doors are rainbow bright with hand written cards giving thanks for the work of the NHS heroes.

During the first wave of the coronavirus pandemic public support for the health service was at an all time high, the weekly Clap For Carers a chance to share gratitude for those on the front line.

But that was last time.

"There was a period of time around July and August when the sympathy and clapping had all stopped and we were just noticing huge violence and aggression towards staff in the emergency department," says consultant Alan Whitelaw.

"Thankfully it has very much settled down again over the course of the winter."

It is around 11 months since Scotland's largest hospital accepted its first positive Covid-19 patient.

Having made it through the exhaustion and trauma of the first wave last year, Glasgow is now experiencing a second sharp spike in the virus.

In the QEUH's emergency department (ED), one the surface things appear calm. Of 16 beds almost all are full but this number changes day by day and hour by hour.

A patient in the resus area is critically ill and double doors swing open then shut, showing a doctor in mask and gown rushing past. 

Alan, clinical director of the ED, says numbers of patients coming in are still down overall, with less serious cases redirected to community healthcare teams.

READ MORE: Palliative care consultant Fiona Finlay speaks of pressures of covid on Queen Elizabeth hospital service

But over the past week the number of Covid-19 cases has started to rise. Alan said: "We had a fair number of properly sick young people with covid, people who are not in the target demographic for the vaccine at this time."

The consultant is keen to make very plain that anyone who thinks they might need to attend the ED should first phone NHS24 for advice.

Those who do come to the department but who haven't been through NHS24 are met by a screening nurse who may send them elsewhere, such as their Community Assessment Centre or pharmacy.

"I think it's important to say," Alan added, "That if your presentation here is not life or limb threatening and you could access treatment elsewhere you should do so, because there is a lot of covid here."

For the ED, one of the main differences from first to second wave has been the increase in people attending with mental health problems.

Alan said: "I think patients are still a bit afraid of covid and large swathes of the population are doing what they can to avoid coming to the ED.

"But there's no doubt that alcohol related attendances and trauma related attendances have gone back up.

"And we're definitely also seeing the mental health effects of 10 months of such a different world."

Mental health and wellbeing of staff have also suffered during the crisis and there is a sense that doctors and nurses are exhausted.

Alan said: "During the second wave, the impact on the staff and patients is very similar in that this is not new or novel or interesting - this has been 10 months of the same.

"There is mental fatigue. We also have physical fatigue from running around in layers of PPE all day.

"How long it will take the true cost of this and the true burden of this to become apparent is unknown, and how long it takes us to get back to where we were before is even more unknown.

"Ten months of difficult conditions with minimal downtime it takes its toll on people but I think the team genuinely are awe inspiring and inspirational on a daily basis.

"And I think the public should be reassured that it's clearly taken its toll on the staff but the level of care is still exceptional."

'We knew this was coming'

"WE knew this was coming," says Dr Alisdair MacConnachie. "Humans are not at the top of the food chain, we are somewhere in the middle of the food chain so this, in some ways, was inevitable. 

"We always thought it would be flu, but it turns out it was a coronavirus."

The infectious diseases consultant has been instrumental in helping the hospital draw up plans for the management of the virus, along with colleagues in respiratory medicine and intensive care.

He works on a 28-bed infectious disease ward that is now turned over to coronavirus patients.

At the QEUH the first call about a potential covid patient came in on January 21, 2020.

Before the first UK case the hospital was seeing patients who were returning from China and then elsewhere in South East Asia with illness that might have been covid-19.

The first positive case came in February last year. 

Now, of 46 wards in the QEUH, there are currently six covid-19 hubs exclusively treating coronavirus patients and a small number of wards currently closed to new admissions due to Covid-19 tests returning a positive result.

To give an idea of how busy the hospital is: on September 8, 2020, there were nine covid-19 patients confirmed in the previous 28 days with 39 in total in the QEUH.

On January 20, 2021, there were 170 who tested positive in the previous 28 days and 244 coronavirus patients in the hospital as of midnight on Monday.

"It wasn't really until mid March that it was clear we had transmission in the community in the UK and Scotland and it became everybody's problem," he says.

Alisdair also reflects on how treatments have changed as knowledge is gathered about what was a completely new illness.

Patients who are recovering now, he says, might not have made it if they had become sick in March or April of last year.

An existing drug, dexamethasone, a steroid, is now used with success in covid patients, along with oxygen treatment and proning - turning the patient on their front.

"And it's difficult," he adds, "Because the majority of people with covid who come in are going to get better but the public perception is that if you go into hospital with covid you're not going to do well when the reality is that most patients will be fine with treatment."

And, Alisdair says, a key focus has to be on the patients who don't have covid-19 - people are still having heart attacks and strokes, or falling on the ice and breaking hips.

He adds: "In epidemics and pandemics the people at risk are the people who don't necessarily have that condition because all those other services become much more difficult to maintain."

DURING the first wave, everything bar emergency and urgent surgery stopped. 

This time round, non-essential services are back up and running and patients are being called for cancer screening.

But there is a worry that the sense, from last year, of not wanting to burden the NHS is still prevailing and people with symptoms are avoiding their GP.

"As we moved into the second wave we've not caught up yet with what happened in the first wave and I'm quite worried there are people out there with things that we really should know about but they don't want to be a nuisance," says Helen Dorrance, consultant colorectal surgeon.

"Actually we are here and please do come and bother us."

With certain cancers such as bowel and breast, she says, the chances of survival are much better when the disease is caught early. 

"If you are offered the opportunity to take part in a screening programme please do it," Helen adds. 

Last year's cancellation of cancer services has left physicians with a backlog of cases. 

Patients are being asked to take a qFIT test, which helps doctors assess who needs attention fastest.

In clinic, the surgeon says, the most difficult change has been in communicating with patients. Pre-covid she would see patients with various members of their family but now only one person is allowed in for support.

"It is a much more difficult conversation for people because they have less support.

"Then, as part of an emergency or if someone is in or they have a problem, I find it very difficult because you are in a position where you're trying to explain over the phone that someone's loved one is profoundly unwell.

"Or you find yourself in the position with a family where perhaps their parent is dying and it's very difficult for the family to appreciate that not everyone can come in in the way we would have done beforehand.

"It's very uncomfortable."

'A unity has developed'

CONSULTANT endocrinologist and associate director of medical education Colin Perry was clinical director for medicine at the QEUH during the first wave of the virus.

As he stands in the reconfigured ground floor of the hospital he reflects on the first time, before the building's opening in 2015, he saw the scale and size of the surgical receiving wing.  

At the time he couldn't imagine it full. Now it is full - and full for reasons that would have been unimaginable then. 

In March and April last year major changes were made to deal with the challenge of ensuring patients who may have covid are quickly assessed and moved into single rooms, one of the stand out advantages of the hospital where all wards have private rooms. 

Acute patients come into the building either through the emergency department (ED) or the acute receiving areas, so a specialist assessment and treatment area (SATA) was set up to deal with the relentless flow of new patients.

This time round, the SATA has taken over the surgical receiving areas to cope with increasing demands.

As the surgeons were relocated to another part of the hospital, an x ray machine was redeployed to be immediately by the door of the SATA so patients can be x-rayed in place and not moved through the building to radiology.

Meeting demands has very much been a case of all hands on deck, at least during the first wave.

"We have had increased input in medical high dependency from physicians who were not part of that team before," Colin said.

"We've had huge amount of help from the trainees and chief residents who put in an enormous amount of work.

"The trainees have been an enormous resource. We've also had redeployed trainees - doctors from other areas moving to help us in the QEUH.

"And we've even had help from the oral medicine team from the dental hospital who were a huge help in the first wave."

Colin said "a unity" has developed between specialists with the pandemic response showing how quick and nimble the NHS can be when the situation is as stark as it has been. 

This time round, Colin, said, better understanding of the illness is having an impact on the number of patients needing intensive care support. 

"When there's only so many patients in the world, Colin said, "You're feeling your way but it's extraordinary how far we've come in a year."

This time round, too, staff are bone-tired. 

Colin points out something fairly obvious but which, perhaps, is easily forgotten.

"We totally understand that the public are tired - we're members of the public too and we're tired."

Colin is due to receive his vaccine in the coming days. But, more importantly to him, his 91-year-old father has a date for his jab.

"Honestly, in amongst all of this that is a fantastic feeling and yeah, that makes me really happy," he said. "That is a huge thing for me that he gets his vaccine and that's part of the bigger picture because we all have families."

During the height of the first wave when public affection for the NHS was at a peak, donations of support flooded in.

It was acknowledged that staff needed additional support so R&R hubs were set up to give staff a space to go to away from the wards.

At the QEUH British Airways set up one of its Project Wingman centres - a space where cabin crew and pilots redeployed to serve NHS workers food and drink.

"It was lovely to go over there," Colin said, "Getting a cup of coffee from somebody who was flying you to New York a year ago.

"Extraordinary. And it allowed you to decompress slightly."

Senior NHS staff say protecting staff mental health and wellbeing is vital and there are plans to sustain the R&R hubs after the crisis is finally over, not least in thanks to a £250,000 donation from Barclays bank. 

Like every doctor and every nurse the Glasgow Times speaks to during our time in the hospital, Colin repeats the plea to please follow government advice.

He looks to the silver linings, the positives learned during a hellish time.

Better communication between teams is one, rapid and imaginative evolution of ideas another. The speed at spreading medical learning and the importance of staff wellbeing are others.

"The NHS has probably demonstrated just how flexible it can be," he says. "And there's a lot of pride, a lot of pride in working for the NHS." 

He pauses and takes a moment. 

"Sorry, I start to well up when I think about it.

"The visible caring, the visceral caring people have shown.

"The other silver lining is just more people look out for one another, people do look out for their colleagues a bit more. 

"None of us are indestructible."