Stories from the coronavirus frontline – A Respiratory Consultant on the impact on patients

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. Dr Bennett works in one of the largest respiratory medicine departments in the UK.

Here’s what he said about the impact of coronavirus on patients in the week beginning 23 March 2020.

The tsunami is coming. In the last couple of weeks, we’ve seen the water being sucked up into the wave, but we couldn’t see the wave. This week we can see the wave and it’s huge and about to hit.

Currently on the ward we have at least nine patients who have tested positive for coronavirus. Another four or five patients have the clinical syndrome but haven’t tested positive – in other words, they show all the signs of coronavirus. We have been caring for some very ill patients. They’ve been ill for a number of reasons and then they’ve contracted coronavirus on top and are ill as a direct consequence of coronavirus.

There’s good news

People are thinking coronavirus is like the plague – if you get it, you’ll die. That’s not the case at all; we have been sending people home because they are doing well. There is a range of disease, but the reality is that, at the coal face, we are sending people home.

I’ve already sent home patients in their twenties and an 80-year-old, all with coronavirus. Once they’re stable, it’s better to be home as they have a higher chance of deteriorating in hospital. In the coming days I expect to send home at least four patients who have tested positive for coronavirus and three more who are likely to be positive.

Testing challenges

There are a group of patients who are likely to have coronavirus, as they show the symptoms of the clinical syndrome, but their test results are awaited or were negative. Test results usually take 24 to 48 hours to come through, although I’ve been waiting 96 hours for the results for one patient.

We are finding that between 25% to 30% of coronavirus tests have a false negative result. This can occur because it is too early in the disease process for the test to pick up the virus, or because the virus has moved from the nose and throat into the airways.

It is difficult to identify the clinical syndrome in patients with lots of pre-existing clinical conditions. It is becoming easier to recognise in younger patients, who don’t have cardiac or respiratory symptoms. Most have a cough, fever, and overwhelming fatigue. Some blood markers can suggest it might be coronavirus and chest x-rays may show changes.   

Ultimately, if you don’t test, you just don’t know.

From mild to catastrophic

I understand why people find the messages around coronavirus confusing – a mild illness for many, and yet catastrophic for some. There is something Darwinian about it. It does seem to select people who are more vulnerable due to their age or other health conditions. I look around the wards and hope that certain patients – with heart problems or some cancers, for example – don’t get coronavirus, as they’re only just sustaining life at a debilitated level.

The majority of deaths will be in the vulnerable cohort. But, as with any illness, like influenza or meningitis, for some people it has a catastrophic effect. The worry is that because so many will be exposed to the virus within a short period of time, the absolute numbers for whom it has an unexpected impact will be higher. There will be people in their thirties, forties and fifties who are extremely fit and well, and yet who die from the virus.

Keep in mind that the vast majority won’t have that outcome and even if you need hospital care, there’s a good chance you’ll be going home.    

As told to Sally Williams

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