In a series of posts giving a frank account of experiences on the NHS frontline, Sally Williams hears from Dr Jonathan Bennett, Honorary Professor of Respiratory Sciences, University of Leicester, Respiratory Consultant at Glenfield Hospital and Chair of the British Thoracic Society. Here’s what he said on 20 April 2020.
The test I took for COVID-19 came up negative, but I think it was a false negative – perhaps because I took the swab myself. I am sure I’ve had the disease. Lots of other people I know, similarly, have had bad muscle aches and pains, fatigue and a cough. I am generally much better. I still feel fatigued and I have a very irritating cough, but I’ve come through it. You do spend time waiting to see what happens, because it’s not the first few days when problems occur, but days 6 to 10.
Virtual medicine
I’m back at work but working very differently. I’ve been conducting virtual clinics. My NHS computer doesn’t have a camera, so it is all done by telephone. Mainly it’s about calling people to see how they’re doing, to follow-up after treatment, or to reassure regarding test results. The telephone calls are helpful in triaging referrals – identifying those patients who are a priority. For example, one patient had a five-year history of intermittent cough but no other symptoms. The chest x-ray was normal and I reassured the patient that there was unlikely to be any reason for worry, and this was done without the need for a hospital attendance.
It isn’t always straightforward though. Some calls I make to patients go straight to voicemail and it can be particularly difficult where there are language problems. And it isn’t possible to deliver everything virtually. There are some patients you really need to see face to face or who require further tests.
The type of tests we conduct in the respiratory department are potentially aerosol generating procedures. This means they create a risk that droplets of COVID-19 could be released from infected patients and expose staff performing the tests. We have had to really limit the number of face to face breathing tests we conduct therefore; mainly to patients with cancer and a few others. This is obviously having an impact diagnostically. Our approach for many patients is simply ‘wait and see’.
We are seeing a much-diminished footfall in terms of emergency care work for non-COVID things, and there is a risk that some people are staying at home inappropriately when really they should be seeking treatment. This might show in the mortality rate over time.
I expect we will be doing more virtual clinics and for some time to come. The COVID environment will last until there is an effective vaccine, which is probably 12 to 18 months away. There will probably be different levels of waves and underlying disease activity, depending on the degree to which social distancing is sustained.
Positivitree
There are still terrible things happening, and people are dying from COVID-19 on the wards and in intensive care. But we are seeing some ITU patients stepped down. A few patients that I sent to ITU three weeks ago have come back to the respiratory ward and a couple have been discharged home.
One of the things that is helping staff is our ‘Positivitree’. Each leaf on the tree carries the first name of a patient who has been successfully treated and sent home. For one ward we have 70 leaves. Each death is heart-breaking, but it’s important to keep staff focused on the patients we have been able to return home to their loved ones.
Other positive news is that, for the last few days, the number of COVID-19 patients we’ve been treating has stopped increasing and may even have decreased a little. There’s a sense that it may be plateauing. The whole hospital has been focused on coping with the spike in infections. Once we see numbers fall, attention will need to turn to getting normal services up and running again. There will be further COVID spikes, and the planning for a second or subsequent surges is unlikely to be as rigorous, so we will have to work out how to accommodate that.
There’s a long road ahead, and staff need to focus on the positives in order to build resilience. Celebrating our successes is one step towards this.
As told to Sally Williams
Image: The Positivity Tree by Belinda Northcote