On the morning of 31st January, 83 British nationals arrived in the UK from Wuhan, China and were transferred to Arrowe Park in the Wirral. They were joined by 11 more on 2nd February.
Arrowe Park became the first quarantine unit in the UK since 1978, when 260 people were kept at Catherine-de-Barnes Isolation Hospital to prevent the spread of Smallpox.
It was clear that a multidisciplinary team (MDT) would be needed in order to provide the quarantined guests with support medically, socially and from a concierge perspective. A plan needed to be put in place rapidly. This presented a challenge, requiring vast resource, support and experience.
While all the guests were fit and well on arrival, their demographics, past medical history and pharmaceutical needs varied hugely. Guests ranged from infants to people in their early eighties, meaning the medical support required was diverse, including for chronic respiratory disease, pregnancy, vaccinations and dental pathology.
The staffing model developed included a 24-hour a day on-site GP, nurse, health visitor, mental health worker, and on-call pharmacy support. These staff were sourced from local service providers, and worked with a dedicated on-site team from Public Health England (PHE). Additional expert support was available from the infectious disease team (IDT) from the Royal Liverpool University Hospital (RLUH), one of the four hospitals in England commissioned to look after patients with high consequence infectious diseases (HCID). Public Health England and the Royal Liverpool’s IDT worked together to train the clinical staff who would work in the unit in ‘donning’ and ‘doffing’ Personal Protective Equipment (PPE) and swabbing technique.
This multidisciplinary team created a strategic operational plan (SOP) based on the logistical requirements of a functional quarantine unit and the potential actions required in the case of positive swab results in both symptomatic and asymptomatic guests. This SOP was later distributed to other units in the UK set up to quarantine returning travellers.
The mental health team aimed to promote a normalising, practical and human approach without medicalising people’s natural responses to a challenging and unusual circumstance. This approach was underpinned with general emotional and wellbeing support offered through general daily interactions with the guests rather than a formal structure.
Not every guest had all their medicines with them due to the shut-down in China and this had raised anxiety levels. The pharmacy team worked hard to ensure regular medicines were continued during the period of quarantine and to ensure that there was a complete record of medicines routinely prescribed to ensure any subsequent medicines required were clinically appropriate.
An overwhelming sense of pride, achievement, support, and enjoyment was expressed by the multidisciplinary team members involved when describing their experience in the unit.
As a GP I was exposed to scenarios both clinically and managerially that I never anticipated. I was asked to contribute to the SOPs and prospective planning exercises by PHE and operational executives and managers, detailing how easy plans would be to implement on the ground and how it might be easiest and most practical to undertake certain operations. With the help of the IDT we coordinated the successful and safe screening (swabbing) of our guests.
The clinical team were responsible for the management of acute and chronic medical issues unrelated to covid-19, in addition to the assessment of any symptom that may represent developing covid- 19. Then a decision would be made regarding the need to test and isolate a patient in bays we had created for this purpose. Support was always on hand from the local infectious disease team consultant and PHE in these scenarios. Fortunately, we never had to swab a guest due to the suspicion of covid-19 and therefore never isolated a guest.
Clinical scenarios were variable and the biggest challenge was not in the management of the guests, but the logistical planning of delivering that management plan.
A 37-week pregnant guest presented a challenge, as it was necessary to form a birthing plan to cover multiple scenarios (first national SOP for ‘labour in a HCID respiratory virus outbreak’). Firstly, a normal delivery plan if no other guests were positive or symptomatic, this involved working with the Wirral University Teaching Hospital (WUTH) obstetric team to check they had capacity and adequate training in order to deliver the baby in their unit. A plan to monitor the foetus whilst in the unit was developed, and we assisted the obstetric team in scanning and observing the guest in the unit. A further plan covered the eventuality of another guest becoming unwell or testing positive, as well as if the expectant mother tested positive. Fortunately, the guest left the unit having had an uneventful stay.
Other clinical challenges included dental issues when dental care was not initially considered, this was quickly rectified by the ‘clinical cell’ in charge of the provision of services. A dentist visited the guest and temporary measures were put in place.
Interestingly China’s childhood immunisation schedule is different to the UK’s with children receiving their vaccination much sooner; this meant that based on the Chinese schedule some childhood vaccinations were due during guests stay. A decision was made to postpone these until guests were allowed to leave because we did not want to risk a reactive pyrexia meaning screening for covid-19 may be warranted.
Staff and guests had varying understanding about covid-19, and a considerable amount of time was spent ensuring that everyone understood the basic epidemiology of the virus so that they could understand why we were recommending certain preventative measures, as well as their own personal risk of contracting the virus while in the facility.
Specific infection control issues considered included management of the water supply to control Legionella and an understanding of the ventilation system within the building. Other key issues that had to be addressed included: procuring, receiving and storing supplies; food safety management; provision of cleaning and maintenance services to the site; use of personal protective equipment by staff and guests; provision of hand hygiene stations in key areas; waste storage and disposal; and movement of staff and guests within the building.
The infectious disease team also had to address wider concerns about the unit such as non-clinical staff’s fears regarding the transfer equipment to and from the unit. This was overcome by sharing SOP, which had proven evidence-based cleaning instructions, and providing a visual of the cleaning process.
In only days the Arrowe Park team created a unit that worked efficiently and gained exceptional guest feedback. We were able to offer this service secondary to the dissolution of boundaries between care providers and focusing on patient experience and care. We can be very proud of this unit and should take new found professional relationships forward into day to day NHS service provision.
James Perry is a GP for Primary Care Wirral GP Federation
Patient consent obtained for all patients mentioned in this piece
Competing interests: None declared
Other members of the multidisciplinary team:
W Shepherd is a Public Health Registrar for the North West Health Protection team (PHE)
R Huyton- Health protection nurse practitioner for the North West Health Protection team (PHE)
M Hoyle is the High Consequence Infectious Disease (HCID) Lead Nurse for the Royal Liverpool University Hospital
M Beadsworth is the Clinical Directory of Infectious Disease and HCID for the Royal Liverpool University Hospital
P Roberts is the Directory of Pharmacy and Medication Optimisation at Wirral University Teaching Hospital
G Jones is the Wirral Liaison Team Manager for Chesire and Wirral Partnership NHS Foundation Trust
M Gibbs is a Divisional Manager for Wirral University Teaching Hospital
M Fildes is Managing Director of Sodexo Concierge Services
S Owen is a GP for the Primary Care Wirral GP Federation
D Hogg is a GP for the Primary Care Wirral GP Federation
M Dunn is a Comminity Matron for Wirral Community Trust
T Shepherd is a Divisional Manager for the Wirral Community Trust
L Costello is a Team Leader for the Wirral Community Trust
L Quirk is a Senior Manager for Adult Social Care for the Wirral Community Trust
J Allinson is an Adult Social Worker for the Wirral Community Trust
N Stevenson is Executive Medical Director for Wirral University Teaching Hospital