Day 2

Wednesday March 4th

Wednesday… It was a strange day today with lots of twists and turns. I got up much later than I usually would…Ann had already left for work…contacted 111 to confirm what we had discussed yesterday and that it was safe for her to be in work doing a baby clinic…after being told that they can’t talk to her whilst driving (despite hands free)…Ok good point…She finally got round to discuss the issue at hand confirming that as I do not have any symptoms then it is ok for her to be in work….Despite this…a few hours later she gets a call from her own General Practitioner (GP) to advise that she must go home…How her GP knew about this I do not know but my guess is that there must have been some communication between the team from 111 and her GP. Ann just reiterated the advice from 111 and section 5 of the gov.uk website https://www.gov.uk/government/publications/novel-coronavirus-2019-ncov-guidance-for-healthcare-providers-with-staff-who-have-travelled-to-china/guidance-for-healthcare-providers-healthcare-workers-who-have-travelled-to-china to the GP team. She said that the person who rang her did not seem to be sure with what was going on herself…but then advice was rapidly changing. She decided to stay and complete her days job. I on the other hand got up at around 0800hrs thinking about the previous evening’s events. I rang my parents to tell them what had happened. They naturally were concerned but I reassured them. I guess they have been watching all the news unfolding over the media. They are Indian so they also watch Indian news outlets like NDTV. I had visited them recently as my dad was poorly so got to appreciate what was being broadcasted. It seemed very different from the British media…very sensationalist journalism but then as I live in the UK I did wonder whether my ears had become immune to the constant drip feeding on coronavirus. I actually stopped listening to Radio 5 Live to work and switched to Talk Sport (I am a massive sports and Liverpool fan)….although with recent events I probably should have paid more attention… I was however aware of the cruise ship passengers who had been flown to the UK and beginning a 14-day quarantine at Arrowe Park Hospital in Wirral https://www.bbc.co.uk/news/uk-51606368 …. Anyhow back to today…
I got up and noted around 100 texts on my phone from various people…most from our ICU WhatsApp group. Many of my colleagues were wondering whether things might change in that people who did not have direct contact with the patient can come into work. The ICU team were still trying to sort the rota out with anyone who was still in. We all felt a sense of togetherness and felt for the people who were not self-isolating who had to pick up the rest of the work….I however also thought about the colleagues who were directly in contact with the patient, especially the Critical Care Outreach nurses, the team in ED and on the ward. I hope they were ok. I also felt for the ICU team who were being supportive and efficient…for which I was really grateful. I did wonder about how this was going to impact on the NHS and intensive care units. I came across an excellent article on twitter https://www.theguardian.com/commentisfree/2020/mar/03/icu-doctor-nhs-coronavirus-pandemic-hospitals Although this was intended to be a balanced piece about the current situation, many in the NHS are working extremely hard to ensure we are as prepared as we can be for a situation for we are as yet uncertain. I can honestly say that I have been well supported. I am awaiting for a team member of Public Health England to get back to me….especially as I was in direct contact with the patient.

1102Hrs….One of the senior consultants on the unit informs us that Only people who have had direct contact (within 2 metres) of the patient need to self-isolate. This means that if anyone has reviewed, examined or had a conversation with the patient then we would have to self isolate…that meant me. At the moment I still was not exactly aware of how many of us there would be. There was complete coverage at the moment. As the WhatsApp messages came flooding in it became apparent that only a few of us would have to remain self-isolated….The team would get back to us if anything had changed. Unlike recent weeks, this time I was paying attention to the media and what the current updates regarding coronavirus….Radio 5Live firmly on…..By 1418hrs, I saw in the media that there were now 82 confirmed cases of COVID19…..I wondered if there were any other self-isolating health care workers around the country…surely there would be. I looked on twitter but couldn’t find much. I wrote a tweet with all the usual hashtags thinking that might start a debate….clearly not…but then I do not have many followers…Surely there must be others….and not just in the corporate world…I did find it amusing that various ‘professionals’ and employers were advising people “just to stay at home and self-isolate”…saying that they could work from home…this then started a whole debate on how working practices could change because of this episode meaning that employers would be open to flexi-working. This maybe so however for us in the front line it is not as easy…we have to be on the shop floor.

1647Hrs….We have been informed that we only need to now only self-isolate if we came within 1 metre of the patient we assessed. This means those who conducted a clinical assessment or managed the airway. Additionally, the contact exposure should have been greater than 15minutes. Suddenly more people were being released from self-isolation…sadly for me I had to remain self-isolated. Despite being in an unfortunate situation, I understood the rationale…If it meant slowing down the spread of the virus…then surely that is a good thing. The team was trying to make sure that the virus is contained…As of yet it really was not clear how the virus was transmitted. The virus could be airborne or passed on by touch…meaning that the individual could be incubating the virus over the next week.

So by 1700hrs I find out who of us will be self-isolating for the 2-week duration…One of my colleagues decides to set up a “Self-Isolation” WhatsApp group so that we can be of support to each other…I feel like we are in the Big Brother house except quarantined within our own homes. We talk about our gardens, what we are going to do with our time, how we will do the shopping etc. One guy is a keen cyclist and has a bike at home that is linked to an app to assist with his cycling, he also likes gardening….Another colleague talked about learning Spanish, whilst another wanted to learn yoga….The last time I probably had this much time on my hands was probably when I was a kid…although I have many things to do administratively, I do not have exams to study for…so technically I could watch lots of box-sets on Netflix or Amazon….I have to say I have never been a box set person….I do like guitar and so I will be practicing that…

Anyhow I thought now would be a good time to read up on coronavirus to make sure I have a good handle of this. I thought I would begin with the following article, ‘Outbreak of a new coronavirus: what anaesthetists should know’ https://bjanaesthesia.org/article/S0007-0912(20)30098-2/fulltext…. I also thought I would ask…in another WhatsApp group (Anaesthetists and ICM trainees in the North West Region) whether they had any experience of self-isolation etc….Turns out no one has, and we are the first…although it has started a snowball of messages coming through on the group chat with various similar questions being asked to what people based at my unit were asking the day before. I submit some of the gov.uk websites onto the group chat to help with information dissemination….

So, what is Coronavirus? The BJA (British Journal of Anaesthesia) article describes it as an ‘enveloped RNA virus that belongs to the Coronaviridae, a family of viruses that can infect humans and several animal species’. It is not clear how it was introduced to humans…however human to human transfer occurs primarily through respiratory droplets that travel up to 2m and may enter the respiratory tract of individuals within range or contaminated surfaces, leading to infection through contact transmission. The average incubation period is 5 days, but it ranges from 1 to 14 days….Now this is the interesting bit….Whilst asymptomatic transmission (during the incubation period, before onset of symptoms in infected individuals) has been suggested, it remains controversial and currently does not appear to be a major factor for infection transmission. I am currently asymptomatic…and so may not be able to transfer anything…but then there is an incubation period that ranges to from 1-14 days…Whilst the incubation period is 5 days, I can see why work have taken a tough stance with this necessitating me to have a 14 day self-isolation period

So, what do I need to look out for? According to the article, the individual can suffer from a mild upper respiratory tract infection, mostly ‘characterised by fever (82%) and cough (81%), to severe respiratory distress syndrome and sepsis”. The fatality rate is estimated at 2%…but these are based on confirmed cases…People with milder symptoms are under-reported so the 2% fatality rate is probably an overestimate. People with comorbidities, such as diabetes mellitus and cardiovascular disease, appear to be at higher risk for death

The article goes on to discuss precautions that can be taken peri-operatively whilst managing patients who are suspected or are positive for COVID19…The usual PPE as per the hospital policy, hand hygiene, minimal staff members to be involved, wearing masks, eye protection, and when you are all done, dispose the PPE as per hospital policy. Airway management has been advised which essentially suggests processes to minimise aerosol transmission…Whilst managing the airway the most experienced anaesthetist should perform the intubation, avoid manual ventilation and only use awake fibreoptic intubation if specifically indicated.

It seems, however, the main issue at work…and even when I was in was masks. There has been much debate about masks…Has everyone been fit tested? Do we have enough masks? What about those individuals who have been fit-tested and require a hood? Does the hospital have enough hoods? What do we do if we have no hood and a COVID 19 +ve patient requires attention? From the hospital’s perspective I guess…like in an ALS situation you ask, is it safe to approach? Which clearly it is not…I guess I would have to ask a colleague who does not need a hood to attend the patient…This is clearly a difficult area…as if a patient is arresting, what do you do? It seems like hospitals need to have clear instructions on this….One hospital in the North West has advised that ‘under no circumstance, the trainee should attend a suspected or COVID19+ patient unless the trainee is fully protected…and that the consultant should be attending”….but then surely this rule should apply to them as well…..maybe the rota could be looked at where people who have been fit tested and require a hood in an organisation lacking the appropriate equipment, should temporarily not be on the on-call rota until the equipment is available. Additionally the time it would take to dress up in full protective gear whilst a patient is arresting is something to think about…From one of the group chats, it appears that the BMA recommends getting it in writing from the trust about not being able to attend patients who are suspected or COVI19+ve….This is clearly a challenging area….Then there is the issue about beards….This has opened a can of worms on twitter….Some departments have asked men to shave so masks can fit well…The Centers for Disease Control and Prevention have published a poster depicting men with various types of foliage with advice on what is acceptable or not when putting on masks…then there was the whole issue about whether it is PC to ask men to shave except those who grow beards for religious reasons….surely these guys are on call too and precautions are taken too…. as I said…one can of worms…All this conversation reminded me about my experiences a few years ago when working in the ED around the time of the Ebola outbreak. We had to dress up in the full PPE (white suit etc) for a patient who came back with? Ebola symptoms…They asked for volunteers to examine the patient….as you can imagine not many hands went up…My colleague changed his mind halfway getting dressed up…and someone else replaced him…This is such a sensitive area

Anyhow….it’s now 1830 and Ann has just come home…I have been a rubbish husband and not made anything for dinner…So I quickly rustle up some pan-fried chicken, steamed vegetables and salad….and catch up with the day’s events….after appropriately washing my hands and keeping everything in separate pans and using separate utensils….well obviously separate plates… and we are talking to each other from separate rooms with the door open….what the hell? Yes, I know…this is really silly, I do not have any symptoms and not being able to be with my wife has really affected me.

In the twitterverse, one of the Groupchatee’s is putting up football shirts for every day we are self-isolated…cool idea…so today’s shirt was St Pauli (Bundesliga Team).

I find out that the next James Bond film is going to be delayed because of coronavirus fears… https://www.bbc.co.uk/news/entertainment-arts-51744374 …couldn’t help but think of the Quantum of solace… and that I am in a “Quarantine of Solace”! Finally, get to watch Aeronauts on Amazon…wanted to watch that when it was in the cinema last year but didn’t get a chance to…Its about a scientist James Glaisher and a balloonist Amelia Wren mount an expedition to fly higher than anyone in history…I really enjoyed it but was disappointed to find out that Amelia Wren was a fictitious character, and that Glaisher actually flew with a guy called Henry Coxwell…They set world flight altitude record, reaching 9,000 to 11,000 m (30,000 to 36,000 ft). Tom Harper explained that “whilst the film was inspired by a number of historical flights, the intention was never to make a documentary” and he wanted the film to be reflective of a contemporary audience. He also commented on gender bias in science, stating “There were female scientists around at the time, but not in the Royal Society… to this day, only eight percent of the Royal Society is female.

It has been a wierd day today…trying to get a sense of perspective of what went on…how things rapidly changed in terms of who can come back to work and who cannot. I actually know more about coronavirus than I ever did and I have got to know some people…through WhatsApp.

Anyway…as Day 1 comes to an end, I bid you adieu…Oh… I still had no contact from PHE