Four years ago, the UK identified its first cases of a new, highly infectious disease. Within two months, Covid-19 had claimed the lives of thousands of people and the country found itself in an eerie lockdown.

Behind closed hospital doors, the scene was very different: it was one of chaos, as an unprepared and overwhelmed health service struggled to keep people alive.

In ITV’s new factual drama Breathtaking, three writers – NHS doctor Rachel Clarke and former doctors Prasanna Puwanarajah and Jed Mercurio – take the British public for the first time into a closed Covid ward. It is a harrowing but necessary watch.

The drama’s source material is Clarke’s book Breathtaking, a searing account of life on a Covid ward that began as a personal diary during the pandemic’s first wave in spring 2020.

“With the drama, I wanted to honour the bravery of the staff I worked with and the courage of the patients I cared for, many of whom died; the dignity of the families who did obey the rules, who didn’t party in 10 Downing Street, who had to sit at home on a Zoom call while I held up an iPad to their loved one who was dying,” Clarke says.

“I wasn’t writing for public consumption to begin with; I was literally writing a diary for myself because it was a really traumatic experience. I find it therapeutic writing things down,” she tells Television.

That all changed when news broke in May 2020 that Boris Johnson’s senior adviser, Dominic Cummings, had driven to County Durham, breaching lockdown rules. “I was incensed. For the past couple of months, I’d been surrounded by people who had followed the rules at enormous cost to themselves,” she says. “I realised what I had been writing was important – I had been witness to the truth of what was really happening inside hospitals.”

Clarke started writing the book that first summer of Covid, “fast and furiously… heavily fuelled by a big glass of wine.”

Puwanarajah met Clarke more than 15 years ago when she was a medical student and he was working as an NHS doctor in Oxford. “We stayed in touch and were talking about adapting another book of hers when the pandemic struck,” he says.

By then, Puwanarajah had left medicine, building a career in theatre (acting and writing for the National Theatre), film (his directorial debut, Ballywalter, was released last year) and as a TV actor (he recently played Martin Bashir in The Crown).

Puwanarajah had worked before with Mercurio, as an actor in his medical drama Critical and Line of Duty, and co-authored a graphic novel, Sleeper, with him.

“When I introduced Rachel to Jed, there was a real sense that we could put something together. The spine of [the drama] is Rachel’s book Breathtaking, but Rachel and I also pulled together testimonies from other healthcare professionals… then we invented characters to crash all of these stories into,” he says. “Breathtaking uses character composites and the dramatisation of journalistically sourced material, rather than fictionalisation.”

The drama’s main protagonist is acute medicine consultant Dr Abbey Henderson, played by Golden ­Globe-winning actress Joanne Froggatt. Clarke says: “In many ways, Abbey is me: her reactions to what unfolds, her growing sense of anger and her desire to do something about that.”

She and Puwanarajah worked on the scripts for the three-part drama, which chronicles the pandemic from the very first Covid cases to the devastating second wave in January 2021, fuelled by a new variant and Christmas socialising.

“When we were happy with each script, Jed did a revision of his own, which, in typical Jed style, was very efficient in terms of word count, but sharpened what we were doing,” says Puwanarajah.

Clarke and Puwanarajah believe in television’s enduring power to change history, pointing to the extraordinary political impact of Mr Bates vs the Post Office, which forced a hitherto reluctant government to say it would quash the convictions of hundreds of sub-postmasters.

“I was a TV documentary-maker before I became a doctor,” says Clarke, so I know how powerful a story unfolding on screen can be. “There has been a lot of talk post-Mr Bates about why it has taken an ITV drama to make people care – the answer is that telling a story well on the screen is the way to capture the hearts and imaginations of the public.”

Puwanarajah adds: “It’s heartening when you see a nation pull together and say we want justice to be done. But we’re a long way off that, post-Covid.”

Breathtaking may provide the impetus. Viewers see in graphic, documentary detail the distress of health professionals, patients and their relatives, and are not spared harrowing deaths. There is also fury at the impossible working conditions medical staff had to endure, largely the result of the Government’s inadequate response to the pandemic. To drive home the point, the drama is peppered with archive footage of the folly of Boris Johnson and his ministers.

Clarke makes no apologies: “To this day, I seethe with rage about the lies that were propagated to the British public about the pandemic. Matt Hancock sitting before the TV cameras saying he had thrown a protective ring around care homes and that there were no national problems with PPE when we had nurses in our hospital dying because they couldn’t get proper equipment.”

Breathtaking, though, offers more than polemic, it also presents a hugely optimistic view of people’s bravery and generosity in the most awful of circumstances.

“It felt incredibly important to show the light as well as the bleakness of that time,” says Clarke. “I was surrounded by people who were displaying the absolute best of humanity, whether they were patients, relatives or staff. Overwhelmingly, people were courageous, dignified and kind.”

Is Puwanarajah concerned that some viewers will find it too tough to sit through? “I fully expect that there will be people who won’t want to be taken back. The level of national mental and spiritual injury from Covid is just colossal.

“But if we had made a programme that everybody felt they would be able to watch, we probably wouldn’t have ended up asking hard enough questions.”

As the Covid inquiry continues to show, there is no consensus on either the errors made during the pandemic or the lessons to take from it. Incredibly, there are still many who deny the very existence of Covid-19.

Clarke says: “Four years down the line, we now inhabit a world where lots of people, including some MPs, argue ferociously that the lockdowns did more harm than good. That is just terrifying misinformation – about 230,000 people died of Covid, even with lockdowns. I can’t bear to think what the number would have been like without [them].

“Disinformation, Covid-deniers and anti-vaxxers who want you to believe that the pandemic was a ‘scamdemic’, that Covid was no worse than the common cold, that hospitals were empty… those individuals are disgraceful and spreading dangerous disinformation.

“This is a public interest drama… you might not want to look at this, you might want to move on… But we need to look at it and remember, in order to do things differently and better next time – because there will be another pandemic.”

Breathtaking, made by Jed Mercurio’s production company, HTM Television, airs on ITV1 on 19, 20 and 21 February.

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Realism on the Covid ward

‘We were striving to achieve a level of authenticity [without] dramatic embellishments; we had to present a story that was honest,’ says Breathtaking’s director, Craig Viveiros.

‘Rachel, Prasanna and Jed’s script was amazing… I felt like I was in a war zone, on the frontline, which was exactly their intention.’

Before the shoot, Viveiros ‘steered clear of watching medical dramas because I didn’t want to fall into those tropes… no other medical drama could compare to Breathtaking…. I had a look at war dramas; being on the [Covid] frontline, feeling you’re overworked and under-resourced is similar to being in a war zone.’

Medical staff, extras and cast spent a week at a boot camp before the six-week shoot to prepare ‘the major medical scenes; that’s not just the main actors but any porters or additional staff needed to manage a procedure. On my many visits to hospitals for research, I realised how many members of staff are required to deal with a medical issue. What you often see in medical dramas is one doctor and a nurse dealing with everything.’

Designer Ashleigh Jeffers built a set in just three weeks inside a disused university building at Jordanstown outside Belfast, which enabled Viveiros to move ‘freely throughout the space… allowing the camera to naturally catch what’s going on’.

Takes were frequently long and complex to reflect the chaos of the Covid ward. ‘I wanted the drama to seem fluid… we were running real-time sequences together for 10 to 12 minutes, which meant we were co-ordinating up to 70 to 100 people [at a time].’

The production employed a medical team, principally Dr Thom Petty and Dr Andrew Cinnamond, to ensure clinical processes were accurate. ‘We always had three medical advisers on set at any one time,’ said Viveiros, ‘Jed and Prasanna were on set, too, so we often had five medical heads in the room.

‘The level of medical specificity had to be so fine. One of the things Rachel, Jed, Prasanna and I all agreed on was about terrible medical dramas from the past. To favour melodrama over authenticity was something we were never prepared to do – [we wanted] a clear and straight telling of the story.’

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Doctors of literature

There is a long tradition of literary doctors, from Keats, Conan Doyle and Chekhov through to Khaled Hosseini, author of modern classic The Kite Runner.

British TV is a home from home for medics: The Good Karma Hospital’s Dan Sefton, This Is Going to Hurt’s Adam Kay and Malpractice’s Grace Ofori-Attah – and the three writers behind Breathtaking, Jed Mercurio, Prasanna Puwanarajah and Rachel Clarke, who continues to practice in palliative care.

Before qualifying as a doctor in 2009, Clarke worked as a TV current affairs journalist; subsequently, she penned a bestselling memoir about life as a junior doctor, Your Life in My Hands.

‘It’s not by chance that a lot of doctors have become writers and vice versa,’ says Clarke. ‘Writers, journalists and doctors are fascinated by people.

‘At the heart of being a good doctor is, strangely, storytelling; paying attention to the story that the patient in front of you is telling and interpreting that story. Sometimes it’s about conveying a story to the patient. That involves listening intently with empathy and building trust.

‘A good doctor is endlessly curious about people because the patient is not a constellation of diseases; a patient is a human being and, if you don’t care about your patient as a human being, you will not be a good, empathetic, healing doctor. All those skills, which are often neglected in medical school, are also the skills of being a good writer.’