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COVID-19: Why does this unpredictable killer affect similar patients in such drastically different ways?

Two patients, same ward, same time, same virus. But two very different outcomes - Ashish Joshi returns to Warrington Hospital.

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'I feel fortunate to be here' - COVID survivor
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Mark Anderson-Hammersley was one of the few patients not behind a screen.

He was lying in bed, breathing heavily with the aid of a CPAP machine.

The oxygen mask obscured most of the 57-year-old engineer's face but his eyes were open.

Unlike many of the other patients on Warrington Hospital's intensive care unit, Mark was fully conscious.

This was back in October 2020 when the second wave of COVID-19 infections was sweeping across England's North West.

Mark told me he had spent most of the year shielding.

"I've got diabetes and I'm overweight so they're my risk factors. So to be honest for me it's still early days," he says.

More on Covid-19

Mark Anderson Hammersley's pre-existing conditions make him particularly vulnerable
Image: Mark Anderson Hammersley's pre-existing conditions made him particularly vulnerable

Mark, a father to two, thinks a house move exposed him to the deadly virus. I ask Mark if he's concerned about being in an ICU with COVID.

"I'm worried yes," he replies. "But I'm feeling safe if that makes sense."

It did make sense. Coronavirus was completely unknown when it was first identified in Wuhan, China in December 2019.

That was the beginning of the pandemic.

But by the time Mark became infected and hospitalised, scientists understood much more about the novel virus.

Doctors were making great advances in treatment and interventions in critical care were saving more lives. There was, however, a great deal they had yet to learn.

Why did the virus affect similar patients in such drastically different ways? I did not know then, but I was going to see the devastating, indiscriminate nature of the virus first hand.

"I've done everything that I've been told. Social distancing and the rest of it, but I don't think people should take it lightly, Susan said.

In the bed next to Mark was grandmother Susan Bostock. And like Mark, Susan was also awake and being helped to breathe using her CPAP machine. Without it, Susan told me, she would be dead.

"I've done everything that I've been told. Social distancing and the rest of it, but I don't think people should take it lightly," Susan said.

She tapped her finger on the mouthpiece she was wearing and said: "I know how far I can breathe at the minute. And I know I can't survive without this."

Despite that grim prediction, Susan struck me as cheerful, optimistic even. She was smiling and quite animated.

Apart from the doctors and nurses treating her, because visitors are not allowed during the pandemic, I might have been the first person she had talked to since being admitted.

I left the intensive care unit hopeful that both Susan and Mark would soon be discharged and return to their families.

I was wrong.

Susan went into hospital on the 7 October and on the 22 October she died
Image: Susan went into hospital on the 7 October and on the 22 October she died

Last month, Sky News returned to Warrington Hospital. Throughout the pandemic we have tried to stay in touch with the healthcare workers and the patients who have shared their stories with us.

For me, it is important to record the impact the pandemic continues to have on the lives of the people we had spoken to last year.

The effects of COVID-19 will continue to be felt long after patients return home. Spending any amount of time in an ICU is a traumatic experience.

We arranged to see Mark in the hospital where I had seen him last. But this time we met in a quiet part of the hospital set aside for staff counselling.

Mark was hardly recognisable from the patient struggling for breath we had last seen in October. You could not tell by looking at him that this man was fighting for his life a few months ago.

"I feel very fortunate to be here," Mark said almost without being prompted.

"It's quite a frightening time really. You don't know how it is going to evolve or which way it was going to go."

Mark was full of praise for the healthcare staff who saved his life. And there was an acknowledgement of their bravery.

"I was very well looked after here at Warrington.

The rise in infections is affecting the hospital at every level
Image: The hospital has been under huge pressure during the pandemic

"They clearly knew what they were doing. There was confidence and comfort at how you were treated and they are obviously at risk themselves."

Mark has some scarring on his lungs. This is quite common for people whose bodies have been attacked by the virus. Tests are continuing to see if there is any other long term damage.

He does, though, feel "a lot better".

"I think one of the challenges of COVID is it goes on for quite a while and the reality is you have good days and bad days."

On the same day Mark was discharged, Susan, the patient in the next bed, died.

Clare described her mother as a fun, loving and sociable woman.
Image: Clare described her mother as a fun, loving and sociable woman.

Her daughter Clare Winship told me her mother "never thought for one minute she was going in there to die".

Clare spoke to me via Zoom from Switzerland where she lives. She described her mother the way I had seen her in hospital.

"Initially I thought they'd take her in, give her some help with oxygen.

"She's happy, she's upbeat, she'll get through this."

The one thing that really struck me was how different the photos of Susan looked compared to the patient in hospital.

Clare described her mother as a fun, loving and sociable woman.

Clare described her mother as a fun, loving and sociable woman.
Image: Clare described her mother as a fun, loving and sociable woman.

It must have been heartbreaking for Clare and her family to know their mother was in hospital, fighting for her life without her loved ones around her.

"She liked to joke, she liked to have a laugh. She was very happy-go-lucky and she had a lot of friends. She put a lot into life.

"It's been difficult," Clare said. "I'm coming to terms with it. There are days that even now I still go 'oh I'll just tell mum that' and then 'oh I can't do that anymore'. She went into hospital on the 7 October and on the 22 October she died."

Many doctors have told me one of the most difficult things about the virus is its unpredictability.

Dr Mark Forrest, clinical director, Critical Care and Medical Care at Warrington hospital treated Mark and Susan.

"I've been doing this game a long, long time," he said.

"You inevitably identify key risk factors, but as you've highlighted you can get two patients that are virtually the same on admission. One does well and survives and one does very badly and sadly doesn't make it. And that's been COVID all along."

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The indiscriminate nature of this disease does not make it easier for Clare to accept her loss. But she knows Susan would want her daughter to move on with her life.

I broke the news of Susan's death to Mark.

"It just shows you," he said. "First of all, there is an element of feeling lucky that I've come through it. I think that the one thing is clear with this virus that I've seen myself how variable it can be."

Two patients, same ward, same time, same virus. But two very different outcomes.