A Primary Care Physician
Covid-19 - Thoughts from the front-line
My name is Laura, I am 34, I am a GP trainee and I am expendable.
I have given up the best years of my life training to do a job to help others, to make the world a better place. I used to have a different job, a better job that paid more, with better hours and where our managers thanked us for a job well done. 10 years ago, I gave that all up because I wanted to make a difference. Along the way I have sacrificed many thing - money, happiness, friends, hobbies, time with family and a family of my own. I have missed Christmas’s, birthdays, weddings the list is endless. I have never regretted it - until now.
The NHS and social care have for as long as I can remember been abused and undervalued - by patients, by politicians, by the system. We are in the middle of a worldwide pandemic and now suddenly we are being applauded. Yet where was that appreciation when Dr Bawa-Garba was charged of manslaughter after being forced to work in an overrun, under supervised position the day after returning from maternity leave – a situation Doctors up and down the country feel could have happened to them. Where was that support when the Junior Doctors contract was unilaterally imposed upon us by Jeremy Hunt in order to meet a ‘manifesto promise.’ Where was that love for the NHS when our current prime minister and his top officials voted against a pay rise for nurses and cheered when their side won?
How long will the public stay good spirited and understanding of the pressures we currently face? When waiting times go up, GP appointment are impossible to obtain, when cancer survival worsens and patients health deteriorates, will people remember the fantastic brave staff who went out to work while they stayed at home? And when the dust settles and we realise the extent of mistakes made and things missed whilst we tried to practice in a way we are not trained to do, all the while trying to protect our patients and ourselves from a deadly disease will you remember us then? Or will the temptation of that no win no fee advert be to great? Will our regulators, indemnity providers and medical colleges stand by their promise to take into consideration the unprecedented times in which we are working? Even if they do, will I still have the challenge and terror of being stood in front of a judge explaining my actions?
Everywhere you look people are thanking the wonderful NHS staff for fearlessly going into work. But I do not feel fearless. I am terrified. For my own life and health, my husbands, my colleagues, my patients but also for the future of the world I love and for the onslaught as a GP I will face when all this is over.
The health secretary says we need to treat PPE like the precious commodity it is. But am I not a precious commodity? The UK government and Public Health England have continuously downgraded our personal protective equipment. This is not driven by hard science or facts but by availability. From the very start the UK has had lower standards for PPE than those recommended by the WHO, and both European and American guidelines. A 2008 document produced for the health and safety executive following the SARS outbreak to prepare us for future viral infections concluded that surgical masks are inadequate to protect the user even from a sneeze. Yet suddenly in the midst of an outbreak where the required FFP3 masks are in short supply we are expected to believe that the position on this has been changed based on new evidence. I did not get to where I am today by being naïve – at least have the courage to stand in front of us and be honest.
And what if we do not feel adequately protected based on these new rules? If we disagree with the government advice and refuse to put our lives at risk in this way – what happens then? I’d probably still treat my patients, but surely that is my choice after I have been presented with the all the facts not the watered-down version that someone else has decided upon for me. I am not cannon fodder. This government seems to have forgotten the people it needs so desperately are the people it is letting down the most.
We are seeing around the country many health care workers already affected or sadly succumbing to this illness and yet now once again the rules for PPE are to be downgraded. 9 days ago, my colleague developed a fever, he didn’t meet the government arbitrary defined criteria of 37.8 celsius but thankfully I work for a fantastic team who value their staff and sent him home. The following day our senior partner also developed a fever and I followed 2 days later. Luckily the rules have changed, and we can now get swabbed. We all have Covid-19.
When a different colleague had become unwell with the same symptoms some weeks before lockdown, she was told she couldn’t possibly have Covid-19 as she had not travelled anywhere or been in contact with a confirmed source. We all knew this was a nonsense. Our local community already had positive patients who hadn’t travelled. Community transmission was rife but a lack of testing allowed it to propagate in silence while people carried on about their daily life. Like wildfire we watched it spread amongst our patients, our staff, our care homes; like standing on a beach waiting for the tsunami to hit – powerless to change its course and screaming at the government to do more. Each step of the way we have seen on the community front line that this government and its experts have been weeks behind the curve – with testing, with lockdown, with care home protection and now with PPE.
So why test healthcare workers now? Because they want us back at work. The prime minister has been told he must take time to rest and recover but there is no chance of that for health care workers. We are told that we can be back on the front-line 7 days after symptom onset if our symptoms are improving. But what if we are physically or emotionally unprepared for that. The UK is an outlier on this. The WHO recommend 14 days isolation after onset of symptoms, the US and European disease control centres recommend 8 days and 72 hours with no fever with Australian guidelines suggesting 10 days. They also all recommend retesting staff to ensure they are no longer infectious, as studies suggest most patients are infectious for between 8 and 37 days. I have looked at the science and I know that when I return to work, I risk infecting my colleagues and my patients.
My husband now has fever, it’s a waiting game to see how it might affect him. But I must go to work and trust that when I return each day his condition has not worsened. His occupational health department told him the good news is now he has symptoms he can be back at work in 7 days not 14. They also carefully explained that around day 7 is when he is most likely to develop breathing trouble and need intensive care. So, if he is not in intensive care he will be back at work – how reassuring. The guilt of having passed this killer on to him is like a heavy weight on my heart. How would I feel if something I have caught from work seriously harmed someone I love? How might you feel?
Had my swab been negative and my fevers ended, I could have gone straight back to work. This is despite us knowing that around 30% will give a falsely negative result. In other words, if I follow government advice, I could knowingly go back to work with symptoms of Covid-19 and infect those I come into contact with based on a test that will be wrong 1 out of 3 times. Is the workforce in such dire need that we think these odds are acceptable? Where do we put the price of a life?
I have not heard any official say they want to test NHS workers to protect them or their family, solely that we need to get the workforce back in work. It is not driven by compassion for our wellbeing but as though we are cogs in a wheel that must keep turning.
We have not told our family about my positive test or my husbands’ fevers. My family are already scared I may contract this at work and worried I could end up in intensive care. My pregnant sister in law has spent nights crying worried that she may never see her brother again. We all share this fear, but in our case the risk is from our work, something we chose to do, something that puts us at increased exposure compared to the general population. We do not want to burden them further with the worry that we are now ill and may deteriorate. I had hoped we would reassure them on the other side that we were now out of danger but new suggestions from WHO are that immunity may only be shortlasting. We are not out of the woods. I never thought when embarking on this vocation I could be putting mine and my family’s life at risk.
So, all in all I am a GP trainee, If I survive this virus I will be back at work soon and this government with its mistruths believes I am expendable. I won’t hide or shirk from this responsibility but please appreciate the NHS in years to come. Don’t let our sacrifices be in vain, because next time the world is at war against an invisible enemy, I might not be there to fight it for you.