A close encounter with COVID - one doctor's experience
Less than two months after being redeployed to the Royal London Hospital as an acute medical consultant, Old Citizen Dr Arjun Ghosh, Consultant Cardiologist, Barts Heart Centre and UCLH, woke up one morning with a fever.
“Novel corona virus” was a term that entered the mainstream in January 2020. The first images that beamed into our living rooms came from China. The initial feeling was that it was another respiratory viral illness potentially similar to the SARS corona virus from the early 2000s. However, things then seemed to take a turn for the worse with reports of Chinese medical staff being censured for alerting local colleagues via a chat service about this new and deadly virus. Dr Li Wenliang a young ophthalmologist became one of early faces of the disease – he had been one of the doctors warning colleagues. He died soon after, having contracted the novel corona virus himself, the first of many healthcare professionals across the world to die helping patients infected with the virus.
At the time, like most people, I was uncertain of the magnitude of what was to come. I was doing my normal day job as a consultant cardiologist at the hospital closest to CLS - Barts Heart Centre, St Bartholomew’s Hospital and also at University College London Hospital. I specialise in cardio-oncology (the cardiac care of cancer patients) which is a highly specialised new area within cardiology. However, my day-to-day work routine would soon change soon into something very different but more on that later.
The disease had started spreading across the world. Confirmed cases were in the tens of thousands and the death toll in China was rising. There was clear evidence of spread in Europe. We knew that something was coming, that something was going to happen but, at that stage it still seemed to be an event that was distant and somehow remote to us. Perhaps as healthcare workers, we felt or maybe hoped that the novel corona virus outbreak would be a regional epidemic rather than a global pandemic.
Doctors on the whole are an inquisitive lot. This situation was no different. We tuned into webinars (then a novel way to discuss contemporary events, now seemingly ubiquitous) from Chinese cardiologists on how COVID-19 affected the heart. It was doing strange things – mimicking heart attacks but the coronary arteries were actually clear on examination. The cardiologists explained how they had to change local practice and shut down routine and elective cardiology work to enable hospital capacity to be freed up for managing COVID-19 patients.
This was the month that we realised things were about to change in a big way. Harrowing reports from Italy showed how quickly a health service could be overwhelmed. I spoke to cardiologists in Italy who confirmed that things were as bad as depicted in the media.
Massive planning was underway across the NHS on how best to reconfigure services to deal with the expected explosion of cases in the UK and increased health care demand. These were uncertain and unsettling times for most healthcare workers. We were seeing what was happening elsewhere and we realised that we were just 2 weeks behind mainland Europe. A lot of staff were volunteering for a crash course in managing patients in the ITU (intensive therapy unit) setting given that the most seriously COIV-19 patients ended up on ventilators in ITU. I was told that I would be “redeployed” to one of the other Barts Health NHS Trust hospitals – the Royal London Hospital. However, I would not be doing cardio-oncology and not even cardiology! I was to work as an acute general medical consultant seeing any patient admitted via A+E (Accident and Emergency/Emergency Department) with any medical (as opposed to surgical) problem (the expectation being that these would nearly all be COVID-19 patients). I, along with many colleagues, were definitely being thrust out of our comfort zones and being asked to do a type of work some of us had not done for many years. For me personally it would be a big challenge - the last time I had seen general medical patients was in 2008…
My feelings at this stage were mixed which was a recurring theme for many of many colleagues throughout this experience. I was apprehensive of what was to come but also proud that I would be involved in the global effort against COVID-19.
Lockdown was announced on 23rd March. More facets of normal life changed for me - a cardiology conference that I was due to attend in Chicago was converted into a virtual event. I also started driving in to work which was a novel experience and also a lot quicker than my usual underground journey. The roads were quiet on the drive in and made driving in central London a very different experience to the norm. I would still see the odd person or couple out and about especially on sunny days. I used to wonder if their behaviour would change if they saw what was happening to people of all ages affected by COViD-19 in hospital.
The apprehension started increasing. The death toll was rising dramatically. Doctors, nurses and allied health professionals were also dying in rapidly increasing numbers. Startlingly, while the majority were older than me, the vast majority were of a BAME background. This really brought home the literally deadly effect of a lack of PPE (personal protective equipment). The rules regarding what was sufficient PPE were regularly downgraded in the UK, seemingly in line with diminishing supplies of PPE. Far less PPE was being mandated in the UK than compared to most other countries or the World Health Organization. The daily bombardment of negative news was amplified by numerous medical WhatsApp groups I was a member of. Similar tales of woe were coming in from across the UK. This had a significant impact on the collective mental health of the healthcare workforce. Hearing of people you knew getting infected or worse dying just while doing their job had a big impact. Many hospitals and Trusts including Barts Health rolled out wellbeing services. A relaxation room (see picture) was created for staff as an oasis away from the rest of the hospital which had been consumed by the pandemic.
NHS Nightingale London also opened in April. Staff at Barts NHS Trust who were not already allocated to COVID-19 rotas were asked to help cover the new hospital. It was inspiring to see the hospital come up so quickly and being staffed by colleagues.
It was also interesting to recognise the same sequential range of emotional responses that I had to COVID-19 in friends and colleagues abroad who were some weeks behind the UK pandemic trajectory. The initial dismissal or ignoring of my warnings of what was to come was followed by apprehension and then an acceptance of the new reality. Again, it was interesting to note that despite evidence of a dramatic situation elsewhere there was a real lack of appreciation of what was to come. Maybe this was a normal response to something that none of us had faced in our lifetimes – a global pandemic which would change everyone’s lives.
I completed a COVID-19 ward week in April. This meant overseeing a ward where all the patients had COVID-19. While I took the mandated PPE precautions (gloves, sleeveless plastic apron, simple surgical mask and goggles) I felt very unprotected compared to doctors in China, Italy and elsewhere who were wearing full “hazmat” style PPE for all patients. My normal routine changed in many other ways. I bought new clothes to wear to and from work which were to be washed on a daily basis. I showered after changing out of scrubs at work. Once I reached home, I would put my clothes into a bag and then hop into the shower again all the while maintaining a suitable distance from my wife and children. After my shower I would put my clothes in the washing machine and also wipe down the bag I put my clothes in as well as my work bag, belt and shoes.
It was a stressful week not knowing if I was going get infected or if I was going to pass it along to my family. Some colleagues had decided to move away from their families temporarily to prevent spreading the disease as to many it seemed inevitable that you would get COVID-19 as a healthcare worker.
There was some good news towards the end of April - the number of admissions of COVID-19 patients seemed to stabilize. Patients with non-Coid-19 related problems were attending hospital again as emregencies. Cardiology patients were returning back albeit in small numbers. Many patients had unfortunately been staying away from hospital as they feared contracting COVID-19. These patients were now however beginning to re-present to hospital and the wards finally started having some non-COVID-19 patients on them.
Saturday 2nd May. I thought I would have a bit of a lie-in after another week on the wards. I woke mid-morning and was burning up. Like many doctors, I am a bit blasé about my own health and the only thermometer we had at home was an old baby thermometer which did not work. Despite the lack of measurement, it was clear on touch that I had a high temperature. Additionally, I felt very weak. I ran through the other COVID-19 symptoms in my head – I didn’t have a cough and wasn’t short of breath. I fell back in bed. I remained more or less bed-bound for the next 10 days. The first few days were the worst – I was delirious but strangely aware enough to know that I was delirious! I was having vivid dreams about a television series we had recently been watching but had not finished. I was imaging what was going to happen next, but it seemed that I now had a role to play in the story. I had never been delirious before and I was conscious that if things worsened, I would need to go to hospital. At this stage, I was worried enough to ask my wife to check in on me every couple of hours while I was banished to a bedroom to quarantine in.
Early on, I developed a pain in my chest on breathing. While this can sometimes be a sign of a clot in the lungs, I did not feel short of breath and thankfully this pain disappeared after a couple of days. While I was not able to find a thermometer on the internet, I did order a pulse oximeter (to measure oxygen levels which typically fall if COVID-19 affects the lungs) as well as flight stockings to prevent clots in leg veins associated with immobility. While my oxygen levels remained normal, I never got to use the stockings. My feet and legs swelled up and became discoloured on around days 3-4. This was then followed by exfoliation of the epidermis (superficial layer of the skin) of my hands, legs and feet. While this can happen is some florid bacterial and viral infections, I had never seen it in a patient myself. This brought home how strange a disease COVID-19 was and how little we knew of the myriad clinical presentations.
Although I was too unwell to drive down to a nasal swab testing site, I gradually improved over the course of around 2 weeks. I manged to see more films that I would normally watch in a number of months and exhausted the movie catalogues of a number of providers.
It was hard on my wife, working full time from home and looking after me and our two young children. It was also hard on my children. My 7-year-old had a better comprehension of what was happening than my 3 year old who just wanted to come and play with me. I finally came out of quarantine 14 days after I first came down with symptoms. I was still not fully back to normal and worked the next week from home and even managed to do a webinar for cardiology trainees!
Work has not yet got back to normal. We have changed a lot of working practices and hopefully some of these changes may be sustainable. We have managed to drag parts of the NHS IT system into the 21st century. Videoconferencing has now become the norm and seems to work reasonably well. More patients are being seen via video and telephone appointments than face-to-face visits to decrease the risk of spreading COVID-19. The feedback regarding this has been good and clinicians who are often reluctant to change working patterns have on a whole embraced this new way of working. The downside has of course been many patients having their routine appointments and investigations either delayed or cancelled. While this was unfortunately an expected outcome of freeing capacity for COVID-19 related work, we are slowly trying to get back to pre-COVID-19 levels of routine activity.
We do still however need to remain cautious about a potential second wave of infections later in the year and this will mean retaining some slack in the system for now to allow for re-configuration of services once again if required. The future in terms of CVOID-19 unfortunately remains uncertain. The infection continues to rage in parts of the world (e.g. USA) as I write this. A vaccine is not immediately on the horizon and its efficacy on release will be unknown. Antibody-testing is not infallible and of uncertain significance with many colleagues having negative antibody tests despite positive swab tests while infected.
We have all been though a whirlwind of emotions in the midst of this pandemic. I have seen things from the viewpoint of a healthcare provider and patient. We have seen the worst of human nature (hoarding, medical staff being assaulted for their ID cards to allow preferential access to supermarkets etc.) but also the best. Some of the most uplifting stories have been the small acts of kindness that have happened on a daily basis across the country and world. Captain Tom’s efforts to raise money for the NHS touched us all. I personally got through things only with the help of my family.
I hope that at some point we can say that the pandemic is over. I will be grateful and proud at that time to say that I played a part in the fight against COVID-19.