Day 11

Friday 13th March

Mornings are definitely getting lighter…Before I went on self-isolation, the drive to work was in the dark…that will not be so next week! Its light at around 0615 now….I decide that I will have a lie in and get up at 0800hrs. I note the usual 50 texts from the Whatsapp Self-Isolation Group and one from the PHE, saying,

“We have now moved into the delay phase of the coronavirus response. This means that you no longer need to self-isolate and no longer need to reply to daily messages, but please look out for the new guidance for what to do if you become unwell. Thank you for all your help”

I have to admit, I missed the fact that I did not have to type “NO” today…. However, I suddenly feel like Andy Dufresne from Shawshank Redemption https://www.imdb.com/title/tt0111161/ and the bit where Andy crawls to freedom, through “a river of s**t and came out clean on the other side.” As he stands in the pouring rain, removing his shirt, and lets the storm wash him clean….On another note, want an interesting fact about the film Shawshank? Clint Eastwood, Harrison Ford, Paul Newman and Robert Redford were all considered for the part of Red. In the original novel, Red is a middle-aged Irishman with greying red hair. However, Frank Darabont (director) always had Morgan Freeman in mind for the role because of his authoritative presence, demeanor and deep voice. In the movie, they left the line, “Maybe it’s ’cause I’m Irish,” in as a joke, even after they had cast Morgan Freeman as Red https://www.factinate.com/things/facts-shawshank-redemption/.

Anyway, back to the PHE text I got this morning, I am still not sure what this means. The guidance is that although I am unlikely to infect anyone after day 12, I could still be a carrier until day 14. I have just been called by the Post Graduate centre asking how I am, but they cannot confirm when we can come back to work. I work on intensive care they suggest that I wait for the department to contact me. In terms of that, I am now getting lots of emails about what PPE we should be wearing and what antimicrobials we should administer to patients being admitted with suspected or confirmed COVID19….so no information about whether we come in or not….all adding in to the logistical chaos…PING…someone from the group chat sends me a clip of a fight occurring in a supermarket over toilet roll https://news.sky.com/video/coronavirus-brawl-over-loo-roll-in-sydney-supermarket-11951615. This is really sad. A friend makes light of this, commenting that this could be a pilot for a new series of ‘Supermarket Sweep’…sorry, I know we shouldn’t poke fun, but this is madness.

PING, another few messages come in asking about whether we should be coming in? There is the same confusion I am experiencing as to whether we can go out or not. I have my usual nutribullet breakfast with a pint of water and fresh lemon…I have come this far and so I definitely do not wish to get unwell now.

PING…message from one of the Groupchat members to say that they had a text from one of the bosses at work confirming that, as far as they are concerned we should remain in self isolation….Noooooo…meanwhile in the world,
1200hrs…the Premier League and English Football League (EFL) fixtures are postponed until April 3rd whilst UEFA has suspended the Champions League and Europa League. Scottish football is suspended until further notice. This, is, I presume in response to the various Premier League clubs actioning in a self-isolation because of previous contacts the players have had with other players etc who have been found to test positive for COVID19….I do wonder about the smaller clubs who will have little or no income for the next month. I guess like any business they will have to find a solution, but I do feel that the EFL has to be supportive here and avoid any heavy handedness. I certainly hope there will not be lots of points deductions. This also has an impact on whether the Euros are played. I think at this rate, this will surely be delayed…and this is pretty much what has already been said in the media….Heads will now turn to other sporting events, The London Marathon, Wimbledon, the Olympics (Tokyo).

PING…more messages from the Groupchat…now the reality is setting in, we are going to be able to go to work…ok, not just yet, but someone has sent a letter from Professor Chris Whitty, Chief Medical Officer. This outlines the new advice for the management of Coronavirus in England. I find it amusing that I did not receive this through the formal channels, but via a WhatsApp group. Essentially it confirms that we are now in the “delay” phase and that if you have symptoms then you should self-isolate for 7 days. But what does this mean for me? Should I come into contact with someone …well here are the all-important sentences,

“Healthcare workers who come into contact with a COVID-19 patient whilst not wearing personal protective equipment (PPE) can remain at work. If they display any symptoms of lower or upper respiratory tract infection then they must immediately stay at home for the duration of the illness or 7 days, whichever is longer”

And

“Healthcare workers do not need to be tested for COVID-19, prior to returning from work”

Plus, the usual stuff about wearing appropriate PPE etc. This is all very different advice from what we were told literally 11 days ago. No reason has been provided why this has changed but I cannot but help feel that the powers at be are concerned that if everyone followed what we have just done then this would have a major impact on the workforce within work….the focus has gone from preventing spread but to accept that spread will occur…and if we get it?…then we should just manage that by self-isolation and hope that we do not suffer with some of the more severe symptoms….But then what about my colleagues who are in their 60’s with multiple co-morbidities, or a young healthcare professional with cystic fibrosis? What should these people do? There is no advice for these people? I look up the web and literally found this…

https://www.cysticfibrosis.org.uk/news/coronavirus-qa It is a Q&A published by the Cystic Fibrosis Trust. It provides some good advice like avoiding places where there is likely to be an increased risk of exposure such as crowds – especially in poorly ventilated areas…but then they do acknowledge that they do not know how the infection will affect people with cystic fibrosis and that In those who are well it may be a mild illness, but people with significant chest problems are likely to be at risk of more severe illness. My suggestion would be to speak to your assigned cystic fibrosis nurse and keep checking the accredited websites. This I would advise anyone with a medical condition.

With regards to the NHS document I received via WhatsApp, and the conversations on Question time yesterday etc, I couldn’t help but think of a tweet sent by a friend which stated,

“Y’all wanna know how it feels to be a nurse during this Coronavirus pandemic? Remember when the titanic was sinking and the band continued to play, well that’s us”

Anyhow as I work on Intensive Care, I thought I would look up some pertinent advice for me. Judging by how much advice has changed over the last 11 days, this will probably change too. There are a lot of advice posters being shared on the twitter world but as I have already said, I am as yet to receive anything like this from official channels. From the Intensive Care Society, there is a really good poster on how healthcare professionals can manage their mental health during this challenging time, https://www.ics.ac.uk/ICS/ICS/Blogs/Blogs2019/Keeping%20your%20head%20above%20water.aspx?utm_source=hootsuite&utm_medium=&utm_term=&utm_content=&utm_campaign=. This has been tweeted many times. I like this advice….as it is okay, not to be okay, and to talk to someone about it.

The General Medical Council now has an active web section providing updates on our advice to doctors and medical students during the coronavirus outbreak. They have updated, today, to reiterate advice in the joint letter to trainees sent earlier this week….so… some advice has stayed the same https://www.gmc-uk.org/news/news-archive/coronavirus-information-and-advice. The document goes on to explain the usual stuff on how they “expect doctors will behave responsibly, reasonably and will be able to explain their decisions and actions if they’re called on to do so”…but….they do ” understand that this is a challenging time.”…and that, they will “continue to provide information and advice for doctors as the situation develops.” They acknowledge the issue COVID19 has become and that the “pressure will inevitably be exacerbated by staff shortages due to sickness or caring responsibilities.”, and, that doctors may end up “working in unfamiliar circumstances or surroundings, or working in clinical areas outside of their usual practice for the benefit of patients and the population as a whole.” What does this mean for me? Well I would like to think the hospital I am working in will recognise this and not ask me to do something I am not familiar with, thereby putting patients’ at, risk. It is reassuring to see that the GMC will take into account the challenging times we are in especially in light of the recent publicised cases. Take the case of Bawa-Garba https://www.bbc.co.uk/news/uk-england-leicestershire-47859826. In the document published today, the GMC advises that we, as doctors should consider the following factors when deciding the best course of action when managing a patient with coronavirus outside of their clinical practice,

• what is within their knowledge and skills
• what support other members of the healthcare team could offer
• what will be best for the individual patient given available options
• the protection and needs of all patients they have a responsibility towards
• minimising the risk of transmission and protecting their own health.

I would like to think I practice as recommended by the above all the time, but then we are in unprecedented times and things can take their toll. I wonder about other healthcare professionals. What about them? Pharmacists, Nurses? So, I look this up and the Nursing and Midwifery Council do have a general statement that has been agreed to by the following regulatory bodies,

• General Chiropractic Council
• General Dental Council
• General Medical Council
• General Optical Council
• General Osteopathic Council
• General Pharmaceutical Council
• Health and Care Professions Council
• Nursing and Midwifery Council
• Pharmaceutical Society of Northern Ireland
• Scottish Social Services Council
• Social Work England

They too recognise the challenging circumstances that healthcare professionals will be working in and “encourage health and care professionals, working in partnership with each other and people using services, to use their professional judgement to assess risk to deliver safe care informed by any relevant guidance and the values and principles set out in their professional standards.”. They go on to state,

“We recognise that the individuals on our registers may feel anxious about how context is taken into account when concerns are raised about their decisions and actions in very challenging circumstances. Where a concern is raised about a registered professional, it will always be considered on the specific facts of the case, taking into account the factors relevant to the environment in which the professional is working. We would also take account of any relevant information about resource, guidelines or protocols in place at the time.”

I really hope that will be the case….well I would like to think that they will be supportive. With regards to the pressures on staff, there has already been talk about how the government may call in retired doctors to help with the outbreak http://www.pulsetoday.co.uk/clinical/clinical-specialties/infectious-diseases/government-may-call-in-retired-doctors-to-help-deal-with-coronavirus-outbreak/20040233.article. As you can imagine there were many questions raised about this in terms of revalidation and ensuring that these retired individuals could adequately perform their duties as outlined above. It appears that the first group of retired healthcare workers to be given temporary registration would be those who have recently relinquished their licence to practice. It was emphasised that these powers could be activated by the health secretary, in the event of an emergency. But then would some of these retired healthcare professionals want to come back?

PING…this time from my wife, Ann…who has been amazing to me during this period. She sends me a poster from the Cleveland clinic. It’s on this website https://health.clevelandclinic.org/the-new-coronavirus-what-is-it-and-should-you-worry/. It compares the symptoms between coronavirus, the cold and flu. I like it as it dispels some of the myths that have been flying around. (see below) The major take home is that most of the time, you will get a cough and fever. Sometimes you may get other symptoms but nothing like the flu. As most data has now shown, greater than 80% of cases are mild

Meanwhile, back on the news….and as of 9am today, a total of 32,771 people have been tested. 31,973 came back as negative, 798 positive…up from 590 yesterday. 10 patients who tested positive for coronavirus have sadly died. This information from the Department of Health and Social Care. Belgium, France, parts of Germany, India and some US states become the latest places to close schools, Czech Republic and Slovakia close borders to foreigners except those with residence permits and Malta announces mandatory quarantines for new arrivals, whilst in China, just 8 new cases…does this mean that we are really 2-3 months behind China? The Chief Medical Officer says that the majority of people in the UK need to get a mild dose of coronavirus for “herd immunity”

So why are schools shutting? To be honest, I have now heard both sides of this and I still genuinely do not know. With the polarisation of Brexit between the ‘Remainers’ and the ‘Brexiteers’…we now have the “Delayers” and the “Quarantiners’…I guess we will have to see what the government decides.

1500hrs Multiple PINGS….I start to receive various messages of thanks from the Groupchat as people say their byes…and head on back into their non-isolated lives. We have been a source of strength for each other. The solidarity has been immense whilst we have been on our journey…I am feeling a sense of melancholy that in due course this group will have to cease…There is some conversation about meals and debriefs…I wonder if there are other groups across the UK experiencing what we are going through now….I know there is the nurses group…so I will be interested to see what they have to say. I am still awaiting to hear what our department’s standpoint is. I have not heard anything yet….although

PING…one of the bosses at work has texted a WhatsApp colleague to let them know that “We are Free”…and that the team at work are looking at the rota and will get back to us. I have to say I am glad.