The waiting room was filling up when the Hospital Trust informed us that all elective treatments and procedures were to cease. One by one the patients were led to a private room and gently told the news that they dreaded: that their planned IVF and frozen embryo treatments would be suspended. Their hopes of becoming parents were sadly halted as the NHS underwent complete reconfiguration to combat the novel coronavirus, SARS CoV2, and care for COVID-19 victims.
The following fortnight allowed us to complete those IVF treatments already in progress, alongside drafting contingency plans to maintain essential functions of the Gateshead Fertility Unit, including the maintenance of our precious frozen embryos and sperm tanks. Our focus was communicating with our patients, hence we rapidly established Instagram and Facebook pages as a means of sharing information, including avenues of support.
The majority of our fertility nurses and admin team were redeployed to the NHS frontline in critical care. Our laboratory team was requested to join the COVID-19 screening programme at Queen Elizabeth Gateshead Hospital's state-of-the-art Pathology Department. As the only laboratory in the area with a large analyser capacity capable of delivering 6300 tests over a 24-hour period they were grateful for additional scientific staff.
We were all trained to prepare the coronavirus nasal and throat swabs for real-time polymerase chain reaction (PCR) testing. This type of test is looking for the genetic material from the virus (RNA): firstly, by converting the viral RNA into DNA, then amplifying this DNA to detectable levels using specially-designed primers to latch on to certain genetic targets within the viral DNA. This test will detect if a patient is currently infected.
As the testing involves handling potentially infectious material, all processing was performed within a controlled-access room using a microbiological safety cabinet that protects the operator from the sample, while wearing the appropriate PPE of a full-length gown and double-gloves.
Each test requires multiple steps: debagging specimen tubes, disinfecting, labelling appropriately, removing and discarding the swab and adding a reagent to deactivate the virus. The PCR process was fully-automated and a result generated within three hours.
The plan was to run a 24/7 operation enabling continuous testing of coronavirus specimens, however the expected 'ramping up' of screening was slower than predicted. We continued to maintain the IVF lab, volunteered to be on the general redeployment database and work from home, becoming proficient users of Microsoft Teams and Zoom and regular participants on the CPD webinar circuit.
When we were eventually needed, we found that the work was meticulous but repetitive, and the environment is restrictive. We are used to working carefully within safety cabinets so this was familiar to us, however the constant air flow and noise became rather unpleasant by the end of an eight-hour shift!
I worked a late shift on 30 April, the deadline for the Government's goal of achieving 100,000 daily tests. The specimens arrived continuously and in bulk from our region and from other national laboratories without capacity. It was non-stop and by the time I left at 9pm, Gateshead had performed well over a thousand coronavirus tests. It was an enormous team effort involving multiple departments including our IVF scientists. The following day, Matt Hancock announced that over 122,000 tests were performed nationally.
We have all enjoyed working with so many different scientists and seeing their dedication and teamwork gives me confidence that these backstage heroes will help our country combat and come back from this virus.
We are now thankfully in the position of planning to reopen our fertility unit and offering some hope to our patients. This requires redesigning the way we deliver the fertility service to ensure the safety of patients and staff. Social distancing and infection control measures have necessitated creative approaches to our patient pathway, with a move towards virtual information sessions and remote consultations, and changed working patterns to allow on-site appointments to be spaced out. However, it is an opportunity to look at our processes with fresh eyes and perhaps, once this pandemic has passed, we will retain some adaptations in our 'new normal' fertility clinic.