During a recent session at the Covid inquiry in a typically understated hearing room in West London, Professor Kevin Fong became visibly emotional on five occasions while recounting his experiences, highlighting the profound impact the pandemic had on him.
At 53, Prof Fong possesses an impressive and diverse professional background, serving not only as a consultant anaesthetist in London but also playing a crucial role in the air ambulance service and specializing in the demanding field of space medicine, making him a sought-after expert in emergencies.
In response to the rapidly escalating crisis in 2020, he was urgently seconded to NHS England, dispatched directly to the most severely impacted regions, where he provided vital support and assistance to struggling frontline medical teams battling the relentless tide of Covid-19 cases.
The strain on hospitals during this unprecedented health crisis has been well documented. For instance, in January 2021, former Prime Minister Boris Johnson issued stark warnings about the NHS, stating it was facing “unprecedented pressure” as the healthcare system risked being overwhelmed.
The inquiry’s extensive testimony this autumn is shedding new light on the inner workings of the healthcare system during the peak of the pandemic, providing invaluable insights into the circumstances that healthcare professionals faced.
This week, the inquiry resumes its live hearings, anticipating crucial evidence from doctors and patient advocacy groups, with health ministers and top NHS officials set to give their accounts before the year’s end.
During the inquiry, Prof Fong presented a detailed narrative of his over 40 visits to various intensive care units, his voice reflecting the emotional toll as he recounted the harrowing situations he encountered.
He conveyed that the painful truths he uncovered about hospital conditions during his rounds were starkly absent from the official NHS data and mainstream media reports at the time.
“It really was like nothing else I’ve ever seen,” he stated, capturing the gravity of what he witnessed.
“These individuals were professionals accustomed to the realities of death, but the scale and brutality of what confronted them were unprecedented,” he continued, articulating the emotional weight of his experience.
In late 2020, he was dispatched to a midsize district hospital in England, which, at the time, was overwhelmed as the second wave of Covid reached its zenith and the nation poised for its third national lockdown, with vaccine distribution just beginning.
At this facility, every corner was filled with Covid patients—intensive care units, overflow areas, and respiratory wards were all at capacity.
The medical staff were emotionally and physically exhausted, with some nurses resorting to wearing adult nappies or using patient commodes due to overwhelming workloads that precluded taking regular breaks.
One nurse expressed despair, stating, “It was overwhelming; the interventions that typically provided comfort and healing were simply not working. It felt insurmountable.”
That night, Prof Fong and his team undertook the unprecedented task of transferring 17 critically ill patients to alternative NHS facilities, a drastic measure that illustrated the dire state of the situation.
“It is the closest I have ever seen a hospital to being in a state of operational collapse,” he remarked gravely.
“The scene was nothing short of hellish,” he recalled, providing a visceral account of the chaos and despair faced by healthcare workers.
The pandemic revealed the hidden challenges within the healthcare system, including reports of hospitals nearing capacity yet failing to convey the urgency of their struggles.
Despite figures suggesting a bed occupancy of around 90% in January 2021, it masked the profound strain felt within the main wards and particularly in intensive care units, where thousands of critically ill patients required immediate respiratory assistance.
“At our peak, we ran out of physical bed spaces and had to resort to putting two patients into one space,” shared an ICU nurse who collaborated with Prof Fong.
“Patients were succumbing to the virus daily; families were receiving devastating news through phone calls or iPads,” she added, reflecting the emotional toll of the crisis.
Research conducted by the Intensive Care Society indicated that, at the peak, ICU occupancy soared to 6,099 beds across the UK, surpassing pre-Covid levels and demanding the equivalent of constructing an additional 141 intensive care units to meet patient needs.
The length of treatment required by Covid patients, averaging 16 days in ICU under ventilatory support, severely impacted the availability of care, especially when compared to the four to seven days typically needed for non-Covid admissions.
Consequently, hospitals rapidly repurposed operating theatres, side rooms, and other wards into makeshift intensive care units while grappling with equipment, medication, and oxygen shortages.
Finding additional skilled healthcare personnel to adequately staff the newly created beds proved to be an insurmountable challenge for NHS trusts.
Prof Charlotte Summers, who led the intensive care unit at Addenbrooke’s hospital, affirmed, “We can’t just magically create specialist care staff, as training typically requires a couple of years at the minimum.”
“What we had was all we had, and we had to stretch our resources further and further,” she explained.
NHS staff were pushed to their breaking point in an environment where critical care nurses, normally responsible for just one patient, found themselves responsible for up to six, many of whom were on ventilators.
“Staff didn’t have time to process or accept the losses; as soon as one patient passed, they had to prepare the bed for the next,” recounted the lead ICU matron at one prominent teaching hospital.
This extraordinary strain affected everyone within the ICU environment, spanning across doctors, pharmacists, and dietitians, all of whom saw their workloads escalate beyond safe levels.
The result of this staffing crisis meant that the ambitious temporary Nightingale hospitals, constructed during the first wave of Covid at a staggering cost of more than £500 million, managed to treat only a handful of patients, illustrating the disparity between infrastructure and available personnel.
To mitigate the staffing deficits, hospitals frequently recruited volunteers from other departments, many of whom had no prior experience in intensive care or managing such traumatic environments.
“These individuals were exposed to situations that they may not have encountered in their normal roles, witnessing patients deteriorating and dying in front of them, leading to significant emotional distress,” remarked Dr. Ganesh Suntharalingam, an ICU doctor and former president of the Intensive Care Society.
An anonymous ICU doctor from Wales described feeling as though junior staff members were “thrown in at the deep end,” with inadequate training and little say in their placements.
The ongoing inquiry revealed how these dire circumstances inevitably impacted the care provided to some of the most critically ill patients.
While the NHS never had to resort to a formal ‘national triage’ system, where patients would be turned away due to a lack of space, such measures seemed simplistic given the complexities on the ground.
Prof Summers emphasized that viewing healthcare failure as a binary switch fails to capture the nuances; instead, it is a pervasive dilution of care across numerous small yet significant compromises.
Under immense strain, healthcare workers felt they were failing patients, unable to provide the kind of care they would wish for their own families.
Emerging research indicates that hospital units under exceptional pressure also reported heightened mortality rates for both Covid and non-Covid patients.
Difficult choices had to be made regarding which severely ill patients would be prioritized for intensive care admission.
Those Covid patients who required CPAP (Continuous Positive Airway Pressure) treatment often had to receive care in general wards where staff members may have lacked the necessary familiarity with the technology.
An ICU doctor in Wales conveyed the sentiment, stating, “We lacked capacity to ‘give people a go’ when they had only a remote chance of recovery; had we more resources, we might have been able to attempt treatment.”
The inquiry disclosed that at least one NHS trust, overwhelmed by circumstances, resorted to implementing a blanket “do-not-resuscitate” order during the height of the pandemic, indicating a dire state within the system.
In ordinary circumstances, such orders should only be enacted following thorough clinical assessments and discussions with patients or their families.
Prof Jonathan Wyllie, a former president of the Resuscitation Council, acknowledged awareness of a trust that instituted a blanket policy based solely on age, health conditions, and disabilities.
Advocacy groups representing families of those who died expressed their outrage, asserting it served as “irrefutable evidence the NHS was overwhelmed.”
Health services across the entirety of the UK began the pandemic already struggling with insufficient ICU bed numbers and staffing levels when compared to other affluent nations.
Five years later, the NHS still contends with approximately 130,000 unfilled positions. Furthermore, sickness rates among the 1.5 million NHS employees in England have surged above pre-pandemic figures, with days lost to stress and mental health issues rising dramatically.
As the healthcare system continues to grapple with the repercussions of Covid, waiting lists for essential surgeries and planned treatments remain at alarmingly high levels.
“We coped, but only just,” affirmed both Prof Summers and Dr. Suntharalingam in their testimonies.
“We would have failed if the pandemic had prolonged another week or if a larger portion of NHS personnel had succumbed to illness,” they reiterated emphatically.
“It is vital to comprehend just how perilously close we were to encountering a catastrophic failure of the healthcare system.”
As the inquiry proceeds, various agencies currently remain silent, refraining from comment.
Additional reporting and research by Yaya Egwaikhide
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**Interview with Professor Kevin Fong on the Covid Inquiry**
**Editor:** Thank you for joining us today, Professor Fong. You’ve recently testified at the Covid inquiry, where you shared some deeply emotional experiences from your time on the frontline during the pandemic. Can you describe what compelled you to become so emotional during your testimony?
**Professor Fong:** Thank you for having me. It’s difficult to put into words, but witnessing the sheer scale of suffering and the relentless pressure on my colleagues really took a toll on me emotionally. The stories I shared are not just numbers or statistics; they’re real people, their struggles, and the heartbreak that healthcare professionals faced every single day.
**Editor:** You have an impressive background as a consultant anaesthetist and an expert in space medicine. How did your diverse experiences prepare you for the unprecedented challenges of the Covid crisis?
**Professor Fong:** My experience in space medicine taught me a lot about critical decision-making under pressure, which certainly helped. However, nothing could have prepared me for the reality of Covid-19. The sheer number of patients needing care, the emotional exhaustion of the staff, and the chaos I witnessed in hospitals was beyond anything I had encountered.
**Editor:** You mentioned your over 40 visits to various intensive care units. Can you share some specific instances that stood out to you during these visits?
**Professor Fong:** One particularly harrowing instance was in a midsize district hospital that was overwhelmed with patients during the second wave. Every available space was filled, and the staff were at their breaking point. I remember one nurse saying, “It was overwhelming; the interventions that typically provided comfort and healing were simply not working.” That really captures the situation – everything we thought we knew about managing critical care was being challenged.
**Editor:** You also highlighted a troubling issue where hospitals were nearing capacity, yet the data didn’t fully reflect the situation’s urgency. Can you elaborate on that?
**Professor Fong:** Absolutely. Officially, bed occupancy might have suggested that we were managing, but the reality was much grimmer, especially in intensive care. There were instances where we had to place two patients in one bed due to lack of space, which is unimaginable in normal circumstances. The frontline staff were stretched thin, and decisions were made that had life-and-death consequences.
**Editor:** Your testimony indicated that some trusts resorted to implementing “do-not-resuscitate” orders during the crisis. What does that say about the state of our healthcare system during the pandemic?
**Professor Fong:** It’s a stark reflection of how overwhelmed we became. It’s important to note that such decisions should never be made lightly or without thorough assessment. The heartbreaking reality is that, due to the sheer volume of patients and lack of resources, some trusts felt they had no choice. It’s a warning sign that we must reflect upon and learn from to ensure we avoid such scenarios in the future.
**Editor:** As we look back, what do you think are the key lessons we should take from the pandemic experience for the future of healthcare?
**Professor Fong:** We need to invest in our healthcare infrastructure and the wellbeing of our staff. The ongoing shortages and mental health issues within the NHS need to be addressed urgently. We must also improve our data transparency to ensure that the public and decision-makers have an accurate picture of the state of healthcare. we must never forget the human stories behind the statistics — they deserve to be recognized and honored.
**Editor:** Thank you, Professor Fong, for sharing your insights and experiences with us. Your testimony is vital for understanding the profound effects of the pandemic on both healthcare workers and patients.
**Professor Fong:** Thank you for having me. It’s crucial we have these conversations moving forward.
Were difficult and often heartbreaking. The statistics did not capture the emotional and physical toll on the healthcare workers, nor did they convey the dire need for more resources.
**Editor:** It sounds incredibly challenging. You also mentioned that some hospitals resorted to measures such as blanket “do-not-resuscitate” orders. What implications does this have for ethical standards in healthcare?
**Professor Fong:** This situation raised serious ethical questions. In normal circumstances, such decisions require careful consideration and discussions with patients or their families. However, during the pandemic, some trusts were overwhelmed to the point where decisions were made hastily, often based solely on criteria like age or existing health conditions. This is deeply concerning and indicative of a system under extreme duress.
**Editor:** Your testimony also revealed the severe emotional strain faced by healthcare professionals. How did this impact the care provided to patients?
**Professor Fong:** The impact was significant. In an environment where staff were overwhelmed, they struggled to cope with the increasing loss of patients. Healthcare workers often did not have the time to process these losses before moving on to the next case. This led to a dilution of care, where staff felt they were failing their patients by not being able to provide the high-standard care they aspired to.
**Editor:** With the ongoing inquiry and the insights you’ve provided, what changes do you believe are necessary to prevent similar situations in the future?
**Professor Fong:** Crucially, we need to invest in the healthcare workforce and improve the capacity of our NHS. This includes not only recruiting more staff but also providing adequate training and support to handle crises. We also need better mechanisms for communication and data sharing, ensuring that the reality of hospital pressures is accurately reported. Lastly, fostering a culture that prioritizes mental health and emotional support for healthcare workers is essential, as they have borne the brunt of these challenging times.
**Editor:** Thank you, Professor Fong, for shedding light on these critical issues. Your insights will certainly contribute to understanding the profound challenges faced during the pandemic and how we can collectively work toward a more resilient healthcare system.
**Professor Fong:** Thank you for having me. It’s vital that we continue these discussions to honor the experiences of those who lived through the pandemic and to ensure better outcomes in the future.
