25/3/20

I’ve just finished my first shift back at the small community hospital where I work four days a week. And things have definitely changed.

The hospital is being radically reconfigured for the coming Covid tsunami. As I was going in the main entrance at the start of my shift I was accosted by our reception/triage team who have now been relocated to a room just to the side of the foyer at the front door.

Their job was to now screen and assess all those seeking to enter the hospital for signs/symptoms of Covid-19, be they patients or visitors. The visitors are no longer allowed in, except for imminent death of loved ones. Patients not in extremis are being turned away. This of course makes a lot of sense.

Everybody is now dressed in scrubs whereas before we could wear uniforms or civvies. There are plans to separate the hospital into Covid and non-Covid sections. The final plan from the bigwigs is to be finalised in the next twenty four hours. We all hope there is enough PPE.

The shift was eerily quiet today and all the more unnerving for being so. I think many of would-be patients are staying away and hopefully looking to take on more self-care. GP practices locally have been switched exclusively to telephone triage. This might mean their capacity to manage minor illness has increased, so the patients are less likely to come to us. I’m sure some pateints are simply staying away out of fear.

We did see some of course. Several minor injuries requiring imaging and treatment. I also saw a couple of patients with serious illness – one with a rip-roaring pancreatitis, the other with suspected appendicitis – both required onward referral to the main hospital.

I had the luxury of admitting them today. But when soon there are no more beds to be had, these patients will come to represent the collateral morbidity and mortality to Covid-19. These numbers will not be in the headline daily Covid fatality reports, but will deserve to be just the same.

It begins to hit home the difficult, if not impossible, decisions that will have to be made in the near future. There is no doubt about it. Patients presenting with conditions that would routinely have been urgently conveyed to the main hospital by ambulance will be simply be sent home with the next best option to take their chances. “Minor” heart attacks, suspected PEs/DVTs, severe headaches with absent neurology……… the testing facilities and investigations of these patients will not be available and it is inconceivable that deaths will not occur in this group too.

There is consideral angst amongst colleagues what this will mean for us medicolegally when this is done. The GMC is making reassuring noises that the exceptional circumstances surrounding these risk-laden clinical decisions will be considered in mitigation in the future. No-one is comforted by this. When this event passes, and it will, for how long will relatives be in a forgiving mood? How long before they pick up the phone in response to the no-win-no-fee legal service advertised on daytime TV?

A colleague I worked with today is heavily involved in the current frantic reorganisation. She tells me the current projection is that we are in week two of twelve. It is going to get “very bad” in the next three weeks. It will then get “unspeakably bad” for another three weeks, before hopefully just getting back to “very bad” again for the following three weeks. The numbers expected to die in our area are truely staggering, but it is also that they will do so in an incredibly short space of time.

I’d like to finish by saying something pithy here. But I can’t.

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