MEDISCOPE | ISSUE 2 | 02 DECEMBER 2020

elective procedures and clinics were cancelled,
and we were encouraged to work from home
where possible. We went to a skeleton rota with
just one consultant covering the wards and one
covering an emergency clinic which ran all day
every day. I was working from home as I am
asthmatic (we now know that isn’t as great a risk
factor, but at the time a colleague who was
asthmatic had ended up ventilated with COVID, so
I was being very cautious). We had to triage all
our patients; they were divided into those who
had to be seen face to face (e.g., they needed an
echocardiogram or were fragile), those that could
be deferred by three to six months, and those that
could have a telephone consultation. As well as
triaging all the patients already known to us, we
had to triage all new referrals, as well as all new
incoming referrals. Our emergency clinics were
fully booked very quickly! Additionally, we had to
field numerous calls about shielding as letters
were being sent to patients, many of whom did
not need to shield. Furthermore, many families
were too anxious to come to appointments, which
meant a lot of reassurance was necessary if we
really needed to see the child.
The other significant change was that the Royal
Brompton Hospital (RBH) became a COVID
hospital, and all their paediatric cardiac surgical
patients were operated on at ELCH, with one of
their surgeons coming to operate. We had been
due to open a new cardiology ward and PICU on
level 6, but there had been numerous delays.
However, during COVID (around the time Boris
Johnson was admitted to St Thomas’), PICU
moved to the new floor to give their second floor
PICU ward to adults. Though this created some
logistical challenges, everyone successfully
pulled together and we were able to continue
operating on all children that required surgery
from both RBH and ELCH catchment areas.
We were beginning to feel a little happier – some
of our congenital patients had had COVID and not
been significantly unwell, and internationally this
is what the data had also suggested – but then, a
few weeks after the ‘adult’ peak, we started
seeing children presenting with a
hyperinflammatory syndrome (PIMS-TS, testing
negative but positive on antibodies). A call was
put out in London, then nationally and
internationally, and it became apparent that this
was being seen worldwide, with the same
ethnicities disproportionately affected. These
children were often coming to us desperately
unwell, with some even needing life support.
With an international multi-disciplinary strategy,
treatments were implemented, and the majority
of children made a good recovery, although they
will need ongoing follow-up as there is potential
for longer term effects on the heart and blood
vessels. At the height of this, we had to double
our team, having one cardiology team for the
PIMS-TS patients and one for the congenital heart
disease patients. We are currently waiting to see
whether we get a further influx now as cases are
increasing again.
An unexpected advantage of this unprecedented
situation has been the opportunity to review our
entire outpatient strategy. As a result, we have
realised that for many families a telephone
consultation would be appropriate (even as a
screening in the initial situation), and, for some,
follow-up would be better and more conveniently
done by telephone. This is a change that will
definitely be continued post-COVID. The COVID
pandemic and the health inequity it has revealed,
alongside the Black Lives Matter movement, has
also made us realise we all need to do better, and
has spurred on very constructive and important
conversations about race and inequity. I am eager
to work with the whole multidisciplinary team as
well as families, to improve access and outcomes
for all people, regardless of their ethnicity or
socio-economic status.
A picture of Dr Hannah Bellsham-Revell - a
Consultant Paediatric Cardiologist and
former Newstead student
6
A DAY IN THE LIFE OF A CARDIOLOGIST