“There are no grades to survival. You just survive or you don’t”
These are the words of my friend from medical school when we used to talk about night shifts. You cannot survive a night shift with style or with flair; you cannot make it looks good; you just make it to 9 am with (hopefully) no one dying on your watch. I used to repeat this phrase to colleagues tongue-in-cheek at the evening handover meeting to make light of the battlefields that we were about to enter – a typical medical trait of using humour to avoid emotions, especially of anxiety and fear. These words feel really poignant right now as we face the start of the what-feels-like the never-ending night shift.
The new variant of Covid-19 is supposed to be more transmissible with an R number 0.7 higher than the previous variant. Public Health England, in a grand exhibition of the British stiff upper lip, has named this new strain the “Variant of Concern 202012/01” or VOC. Hospitals are calling ‘major incidents’ and staff are being pulled right, left and centre to man the front line. We are expecting the worst to hit in two to three weeks. Each area is different but elective surgeries have been cancelled, paediatric and surgical beds are being adapted for adult use, and junior staff are being redeployed to ITU once again. There are rumours that portable oxygen canisters are scarce. We have better treatments now and better survival rates due to the rapid advances of knowledge and this new variant doesn’t seem to be more deadly but it runs a real risk of overwhelming resources.
It is a real battle against time to get as many people vaccinated as quickly as possible. The mass vaccination programme, rolled out by GPs, has meant that 1.1 million people have been vaccinated in England in the first month – only 12.8 million left of the target. There are 10,000 care homes for older people in the UK and the aim is to vaccinate the 248,000 care home residents by the end of January. In one clinic I work in, one of the receptionists has been tasked to call the patients on the priority lists but she was telling me that most want to speak to their family before getting it. The reticence of getting the vaccine is probably more common than we think.
At the moment, I work a couple of days a week at a rehabilitation ward for patients who have been discharged from hospital with Covid. I also work at an urgent care centre in a major London hospital and I also fill up the rest of my time covering shifts in GP community clinics. Next week, I will be joining a team to assess possible Covid patients in the community who are the same team who are delivering vaccines. Overcommitted? Yes.
In my GP clinics, I am seeing a rise in consultations for mental health and for general advice about Covid after a positive test. I can see that people are not coping with the isolation and the uncertainty. London has been in Tier 4 (local lockdown) since mid-December and we have entered a national lockdown again this week. The government line had been that we would be out of this by Christmas and many are feeling isolated in this large lonely city. The ‘cancellation of Christmas’ and the continuous moving of the goalposts have left many struggling to stay optimistic. I suspect that many are breaking the rules which are not strongly enforced here anyway and I am entirely expecting the surge in the coming weeks to reflect this. This lockdown may be extended to February until we can get the balance between patients and hospital beds under control. My biggest headache is logistics. Ambulances are struggling to keep up with emergency calls and, in a city where most people don’t own cars, trying to help a Covid-positive patient get to a hospital without using public transport or a taxi is nigh impossible. With this particular patient, the husband had to insure himself on someone else’s car to drive her there. I’m not sure how long we would have had to wait if we had called 999.
My rehabilitation ward has been expanded from an 11-bed unit to 24 beds this week. We used to get daily phone calls before the New Year from surrounding hospitals who were desperate to discharge their patients to us – those patients who were medically well but in need of physio and occupational therapy before going home. Essentially, they needed to clear the space. I imagine that the extra 13 beds were filled immediately on opening. We have always been short of nurses on that ward which is probably an indication of their long-standing poor working conditions and pay. I will be back there next week and I am intrigued to see if we have managed to find the staff to run it.
The last time I worked at the urgent care centre was Boxing Day (26th December) and I will be back there this Saturday. This is a walk-in clinic which is run by a mix of GPs and emergency doctors for patients without Covid symptoms. It was definitely getting busier before Christmas and I was seeing more advanced pathology as more people were waiting until their symptoms were worse. I’m seeing people who are frustrated with not being able to see their GPs face-to-face – perhaps they’re not very good with technology or English is not their first language that meant that remote consultations were too hard. Sitting in the same room with a doctor can sometimes be irreplaceable. I will find out this weekend but I suspect it will be quieter again like in previous lockdowns. “Stay at home, save lives, save the NHS.” The public health service (the NHS) is like a religion in the UK and everyone is doing what they can to stay out of hospital and reduce the pressures, sometimes to the detriment of their own health. The balance between continuing routine care and making space for Covid has always been the biggest challenge and it looks like hospitals are preparing to pause routine care once again.
And how about the morale amongst staff? Like everyone, we are tired. But I love the British because I love the ‘keep calm and carry on’ attitude. We revert to humour to keep us going; we remind each other that we will get through this; we don’t talk about the elephant in the room. We are an extremely resilient workforce. I have had so many patients express their concern about my wellbeing this week. I see restaurants who are still supporting NHS and emergency staff with free food despite their own challenging times. The island mentality and Blitz spirit mean that we pull together in times of crises. I have been writing about family doctors during the times of Covid from across the world over the last year. I will continue to keep writing during this surge in London because, for the first time, the spotlight is on my own doorstep and I owe it to our international community to let you know that we are ok.