Professor Adele Fielding
President, British Society for Haematology
As COVID-19 almost overwhelmed the capacity of our NHS, people were reluctant to bring their health issues to medical attention. However, acute leukaemia rapidly becomes hard to ignore, so our service did not see any slowdown in activity.
Hardly anyone suspects they have acute leukaemia. Symptoms often include fatigue, breathlessness, fever, aching bones and lingering infections, so it’s easy to see why so many people diagnosed by University College London Hospital’s leukaemia service last year thought they probably had COVID-19. Indeed, some had both.
Adapting in-patient treatments
None of us had experience of protecting people from infection with a newly emerged virus during a global pandemic. Leukaemia had already suppressed our patients’ immune systems, but they needed immediate, intensive in-patient chemotherapy treatments, which would make them even more vulnerable to infection.
At first, separating non-infected patients and staff from those with COVID-19 was not straightforward. There was limited capacity for COVID testing and the correct personal protective equipment for staff took time to define. The cosy rooms into which doctors and nurses crowded to write patient notes and take breaks were now terrifying.
Ward rounds incorporated frantic loved ones electronically, wherever possible, but FaceTimes and empathy were muted by masks and visors.
The cost of keeping people safe
As reality dawned that many patients were going to die of COVID-19, it crossed our minds that we could be among them. Many of our team became infected. I am haunted that I could not hug my nurse friends when I met them, ashen-faced and tearful, outside the hospital after one of our departmental nursing colleagues, a mother of two young children, had just died of COVID. We all exercised extreme caution, at the expense of what we had previously considered humanity.
The same limitations on personal contact were imposed on our patients. Once admitted, they were not allowed out of their single rooms and could not receive visitors—this felt like a cruel and unusual additional punishment to a diagnosis of leukaemia. Ward rounds incorporated frantic loved ones electronically, wherever possible, but FaceTimes and empathy were muted by masks and visors.
One year on, my hospital has offered vaccinations to all staff, who are also regularly COVID-tested. Our vulnerable patients with leukaemia have been vaccinated too, but many will not get adequate protection because of their condition or treatment. They can now get a visitor once per week, but mostly they are dependent on the staff for comfort and support when they are afraid. Most of what we do to help people still feels much less human than it was.
I imagine it’s no surprise to readers that I remain the person in the supermarket queue reminding you to pull your mask over your nose.