You know, from the patients I saw today,
some of them came in clearly unwell,
but within a couple of hours of me ordering
investigations and blood tests
were in a lot worse condition.
This is a nasty, nasty infection.
And when you get relatively young and fit people,
they’ll compensate for a long amount of time.
Their lungs and heart are strong,
so they’ll keep going for a long amount of time
until it can’t go along any further.
And then we’ll see that deterioration in things like their oxygen levels.
So it was a bit of an eye opener today.
I think this day is definitely more of an indication
of what I’m going to see going forward.
[Frontline of COVID-19 Diary of a Doctor]
[Tuesday 24th of March]
OK, so I’m just off on the night shift
and Sonia’s finished the day shift.
What’s this?
“To Sonia and the medics lodging with you,
a very small gesture to say a huge thank you
for the incredible work you’re all doing to combat this horrible virus.
No one will take our wonderful doctors and nurses for granted.”
Can I have a bottle now?
No, not till you’re back from work, mate.
Later on.
So we’re at the hospital, ready to get going.
That message that Sonia got sent,
I’ve had so many similar things
from loads of my friends and family as well.
I’ve even had messages off ex-girlfriends
that I thought absolutely hated me.
And not only that, the hospital sent a message around to say
they’re not going to give any staff any parking tickets
for parking in the wrong areas.
It’s all those small battles you’ve got to be thankful for.
Good evening. Or should I say morning?
The time is 3:23, pretty much halfway through this night shift.
Seeing loads of patients with COVID-19
giving all the classic symptoms but presenting in different severities.
People are coming in and are really struggling from the disease.
Most of the time, if people do need some supplementary oxygen
I’ll be referring them to the medical team,
and so far there are beds available.
However, things might fill up very quickly.
We’ve all heard the statistics that it tends to affect elderly people
and more vulnerable people more.
But we are seeing younger people with the condition,
people in their 30s and 40s.
Well, I mean, you don't like seeing anyone with the illness.
Got a few hours left.
I’m going to recharge my batteries, have a bit of a snack,
and then crack on with it.
And I'll speak to you guys in the morning.
What some of the patients on the ward are going through, it is...
a horrific scene.
I caught up with some of the medical doctors,
the ones working on the wards,
and generally speaking, the patients that I see will go one of two ways:
they’ll improve on the ward and be discharged
or they’ll deteriorate.
Many of them will die.
So imagine being on that ward...
where people are dying every single day.
Death happens on a medical ward,
but not to the amount that we’re seeing at the moment,
in those kind of numbers.
It’s like...
It does feel like a war zone.
[Wednesday 25th of March]
I’ve woken up from the night shift
or should I say, the day sleep.
And Sonia’s off this evening as well.
It’s probably our first evening off together.
-I know! When did you move in? -I know!
Like a week and a half ago or something?
We’re ships in the night.
-Sonia is a huge fan of LEGO. -Yeah.
Do you know if there’s a nickname for that, now?
An AFOL, an Adult Fan of LEGO.
You’d like me to make a coronavirus out of Lego bricks?
Let’s do it.
So, here we go.
This is our protein capsule of the coronavirus.
These are the spike glycoproteins.
So this outer layer is what is killed when we wash our hands.
That’s right. You don’t need alcohol gel for that,
soap does just fine.
But the important bit is what’s inside,
RNA.
One little virus here can go into a cell
and replicate a million times, in that one cell.
And when it’s full, it pops.
And as it pops and bursts, it releases all that virus again,
and then you cough it out.
OK, so that’s how you infect other people.
And we’ve got the coronavirus in our house now.
We do. Do we need to get rid of it?
-I think we need to, like... -Smash it against the wall.
Shall we make it die?
Right, that’s the soap, see? Let’s just bash this bug, right?
[Monday 30th of March]
The first doctor in the UK to die was Dr. Amged El-Hawrani,
a 55-year-old ENT surgeon.
Clearly a huge, tragic loss to their family and...
a huge loss to the many patients that he would have looked after
and would have continued to look after.
One of the concerns that is coming up
in amongst the doctor circles I’m talking about
is the idea of healthcare professionals being subjected to
an increase of viral load,
and therefore does that equate to complications?
The viral load is how much virus someone has on them,
and is then therefore able to infect someone else.
There’s also the idea of the infectious dose,
how much of a virus you need to end up getting the illness.
But one question on every healthcare professional’s mind is:
if someone has got a very high viral load and you’re subjected to that,
does the amount of infectious dose you get off that
correlate to the disease you get?
And that’s a key question I don’t think we have the answer to.
I think many of us doctors are assuming
that the higher the infectious dose you get exposed to,
the more likely you are to get complications and a severe disease.
I mean, that’s certainly true for viruses such as influenza,
SARS, and MERS that have shown that to be true as well.
When I was auscultating, so listening with my stethoscope
to the patient’s back,
the patient’s got a mask on and they’re breathing into that mask,
and the air’s coming back at you as you’re listening.
That did not seem like a suitable thing for me to be doing.
You have to be sensible with these things.
Here we are in the wellbeing room.
I’ve been on the COVID side today,
and yeah, it’s a lot more full-on than yesterday.
Seeing loads of patients, a variety of ages,
and they’re all coming in with those chest X-ray signs, all hypoxic,
that means you’ve got very low oxygen levels.
Pretty heartbreaking to see so many patients coming in
and being at the start of their journey,
and not knowing which way they’re going to go.
We’ve already had some that need to go straight to intensive care unit,
and we’re trying to limit the amount of staff that go in to see them,
so it’s taking a lot longer to see patients.
When I came on shift, they took our temperatures before we started.
So if we did have a fever,
they’d send us home.
And also what’s really good is testing is happening now.
A couple of my colleagues that have had symptoms are being tested,
which is absolutely brilliant,
because if it comes back negative then they can get,
when their symptoms are off,
can get straight back onto the shift
rather than having to isolate for an extended amount of time.
Another shift has come to an end.
Probably the hardest one to date, so far.
It’s all the changes that are brought about by trying to stop
the staff being infected and to stop the patients with it
from infecting other patients and other people in the hospital.
Actually, now we need to protect the workforce.
Otherwise, who’s going to look after the patients?
One scary thing is how rapidly patients can deteriorate
right in front of you in A&E.
I know a lot of health care workers around the world and in the UK here
are going through a hell of a lot worse than we’re seeing
at my hospital.
I’ve got a day off tomorrow, so I’m going to kick it back,
take it easy, and I’ll see you later on in the week.
[Monday 6th of April]
We’ve had a few patients in
that didn’t have obvious symptoms of COVID-19,
but then after we take a history and get our bloods back,
there was a suspicion of it,
which suddenly means you’ve got a bunch of patients in a bay
with one person with possible COVID.
And that's why the advice to stay away from the hospital, if possible,
is good advice.
When I’m on the non-COVID side, I’m seeing much more complex patients
than I normally would because they’re presenting late
or they can’t get access to things like palliative care services
or GP services for a while, and then they come in really as a crisis.
This is just a knock on effect that we have to deal with.
So I’m off out. Sonia’s just come in from a busy day in ICU.
-How are you doing, you well? -Yeah, it’s busying up.
It’s starting to get to be what we thought it would be.
The region’s getting very busy, our hospital slightly less so.
But yeah, it’s feeling very real.
I mean, hospitals not very far from us
are seeing five times as many ICU patients as they would normally have.
And that’s been a serious strain on their services.
-You personally, you well, you good? -Not so bad.
Difficult when you lose patients,
today wasn’t a great day from that point of view.
I’ve been on the COVID side, I don’t know if you can tell,
it looks like I’ve got some goggle burns.
That’s just from the tightness of the mask you have to wear.
I’ve been seeing patients with COVID today.
Most of the people really struggling with their breathing from COVID
will come in by ambulance and the ambulance will pre-alert us,
so they’ll call the hospital and we’ll allocate a bed
for them to bring the patient in.
That stops the patients cohorting,
so waiting in the triage area
and then potentially infecting people there.
We then get in our full protective gear,
and normally we go in as a team to assess a patient,
but it would just be one of us.
In the area I’m working in, we have the mask on the whole time
and the gown on the whole time.
And we actually just change our gloves and goggles
when we see the patient.
Before stepping out, you have to kind of check yourself
that there’s nothing you miss because the last thing you want to do
is take things off, wash your hands, step out
and realize there’s something else you need to do,
which I haven’t done on this shift yet.
But I did a lot last time.
One of the things you forget as well, from a patient point of view
it’s pretty scary us all wearing masks, gowns, and goggles.
So we're trying to find ways to make it more friendly.
I tend to say to patients that...
apologize for the get up
and say, “I’m smiling beneath this mask.”
But we’re also writing our names across the front.
And I’ve seen pictures of other doctors on social media
having photos stuck on the front.
I think that type of thing is a really good idea
because people are naturally... going into hospital is bad enough,
going into hospital in a pandemic, being very worried, is even worse.
And then seeing everyone gowned up and these scary masks
is even worse on top of that.
But feeling good for all the patients that came
we did a good job for, so...
going to end on a high there.
So thanks again for all the support and I'll be back soon.