COVID‐19 in a UK neurology hospital

Working in the UK's National Health Service (NHS) as Australasian overseas fellows during the coronavirus (COVID‐19) pandemic has been a new and rewarding experience.

Without doubt, COVID‐19 has hit the UK harder than Australia and New Zealand. As of 14 May 2020 there have been over 33 000 deaths in the UK compared with 98 and 21 deaths in Australia and New Zealand respectively. ¹

Although the realignment of healthcare provision (e.g. cancelling clinics) has been similar worldwide, changes here have also reflected the scale of the pandemic, with the opening of new ‘Nightingale’ hospitals and redeployment of academic clinicians to rejoin the NHS frontline.

One feature of the NHS is the decentralisation of departments, particularly in London. For example, the National Hospital for Neurology and Neurosurgery (NHNN) at Queen Square functions as a quaternary referral centre for neurological diseases with no general medical patients, other medical specialties or emergency department. In ordinary times, patients at NHNN who develop significant medical problems are transferred to the relevant subspecialty facility for further evaluation.

Having patients with COVID‐19 at NHNN and having to deal with its myriad multi‐systemic complications has hence come with its own unique challenges. Unquestionably, the solid grounding in physician training we have received through the Royal Australasian College of Physicians has held us in good stead managing neurological, but moreover, the non‐neurological issues that have arisen in our COVID‐19 patients.

The scale of the pandemic has meant hospitals must be flexible and find new solutions. An excellent example of this is when the hospital trust moved the acute stroke unit from University College London Hospital to NHNN, and created a mini‐emergency department at NHNN for stroke, all achieved in less than a week. NHNN has also cared for many patients with severe COVID‐19 infection and no neurological issues, as our intensive care units received transfers from district general hospitals that were hit hard by the sheer number of severely unwell patients.

At the outset of the pandemic in the UK it was tempting to pack our bags and fly home. Yet the prospect of being in a position to support hospital colleagues on the NHS frontline and lend assistance where it was most needed appealed to the part of us that made us become doctors in the first place.

Seeing the way people in London have pulled together behind the NHS, with clapping on the streets, food delivered to hospital and dedicated shopping hours for healthcare workers has been deeply warming, and make it that much easier to brave the rain and cold to work on a ‘COVID ward’ all day.

While this has certainly been an unexpected London healthcare experience, as Australasian fellows we have felt well trained and ready to contribute to the COVID‐19 response alongside our UK colleagues.