I Saw a COVID-19 Patient Without PPE

It happened last week. I signed up for locum shifts in AMU during my annual leave to get out of the house (I live alone and couldn’t deal with a week of being in my flat, so thought I would help out in AMU over the weekend).

During one of my shifts, I was asked by a nurse to review a patient who wasn’t responsive – they had been admitted with reduced eating and drinking, which had worsened their Parkinson’s symptoms. I must stress that this patient had no respiratory symptoms – no cough or fever, so we were treating them for acute kidney injury caused by dehydration.

As a result of this, I examined this patient like I would any other patient without suspicion of COVID-19, so I wore no gloves, or apron or mask, and got quite close to them to do a full ABCDE assessment, then called my Consultant for help when I couldn’t quite figure out what was going on. Like me, the Consultant also didn’t wear any PPE, and we re-examined the patient together, and came up with a management plan.

After the shift, I thought no more about it and had forgotten all about the patient, until I got a call from one of my F1 pals in AMU, who told me that the patient had been tested for COVID-19 and came back positive. My friend had called to let me know because she knew that there would be no contact tracing done, so wanted to make sure I was aware.

As you can imagine, this was quite unsettling news for me to hear. Since my AMU shifts, I had been in contact with many other patients, not to talk about my fellow colleagues on the ward, so I started freaking out about the possibility of me being an asymptomatic carrier and spreading it to people.

I called Occupational Health for advice, because surely I shouldn’t be working if I’ve been in contact with a confirmed case without protection, right? Wrong. They said that as long as I had no symptoms, hospital and government policy stated that I should keep going to work as normal. Yupp. I emphasised my concerns about being an asymptomatic carrier, but they said that patients and staff in “high risk areas” are current priorities for testing, so I should carry on as normal.

So here we are. A week on and I still have no symptoms, and I won’t be tested. Hospital PPE guidance has now changed though:

Long story short, we are now to see every patient wearing PPE, regardless of whether or not we’re suspecting COVID. In my opinion, we should have started doing this weeks ago, but atleast we’re there now. Here’s hoping I don’t develop symptoms…

Anyways, today’s good news? Shout out to Uber Eats for the free meals for NHS staff this week! I have definitely had too many takeaways, but at least I didn’t have to cook as much… ALSO, I had my end of rotation catch up with my clinical supervisor this week, and it went really well, so grateful to God for that, yay! 🙂

COVID-19 and PPE Anxiety

In a hospital context, PPE stands for ‘Personal Protective Equipment’ and covers things like masks, gloves, aprons, gowns etc, which are quite important right now when seeing patients with confirmed or suspected COVID-19.

So the initial guidance we received was that all suspected or confirmed patients were to be seen with overshoes, fit tested FFP3 mask + hood + face visor/shield, long sleeved gown, and two pairs of gloves:

Turns out all my worrying about failing my fit test was for nothing, because new guidance is that unless we’re doing “aerosol generating procedures”, a simple surgical mask and plastic apron with gloves are enough.

An aerosol generating procedure is one that stimulates coughing/release of airbourne particles, so things like chest physio, suctioning, bronchoscopy, NIV, intubation, sputum collection etc.

As you can imagine, this new guidance has been met with anger from NHS staff, because we all know that nothing could stop COVID patients from coughing around us (seriously, unwell patients have coughed in my face many, many times) so this aerosol vs non-aerosol generating procedure differentiation doesn’t really make sense. The sceptic in me thinks it’s pretty interesting that the guidance has suddenly changed just as PPE has started running low nationwide… worrying.

Also, I really do feel that hospitals need to start putting visitor restrictions in place. It makes me super nervous at work when I see patients’ family members/friends in groups as they walk into the ward, who knows if they’ve got COVID-19? It’s not just a risk to patients, it’s not fair on staff either as it puts us all at risk, and work is tense enough at the moment without the added worry of visitors bringing in infection.

But what about patients who are end of life, you ask? Shouldn’t they be able to have loved ones with them? This is the current ethical dilemma on my ward. At board round today, I felt like an absolute monster for saying that suspected COVID-19 patients who are end of life shouldn’t be allowed visitors until their tests have come back negative, as their visitors could then spread infection if the patient ends up being positive.

I came home and cried a bit because I felt so insensitive and heartless for suggesting it, but I just keep thinking of our limited resources and how vital it is that we reduce the number of cases, because things could get seriously bad if we don’t put harsh restrictions in place now. I’ve told my family that if I get COVID-19 (God forbid!) and end up needing ICU support/deteriorate, I want them nowhere near the hospital, and I wouldn’t want them to come see me. These are the kind of measures Italy are doing right now to reduce spread, and we need to learn from them.

All sounds very doom and gloom from me today, so I’ll end on something positive- I’m off work for the next week due to annual leave (was supposed to be going to Morocco, #peak), so will spend the next couple of days catching up on sleep and resting before starting work again, so yay for some down time!

I also bought sunflowers to cheer myself up today. I love sunflowers 🙂

I Failed My Fit Test

Apparently my face is too small, so none of the masks I was fit tested with made a tight enough seal around it, and this is slightly worrying.

For anyone who doesn’t know what I’m talking about, a fit test is done to check that masks worn by healthcare staff in hospital fit properly, to make sure that they’re fully protected from infected patients. It involves being tried with masks and different things being sprayed in the air, so you fail if you can smell/taste them, because that means your mask isn’t tight/secure enough.

I didn’t even get to the spray part of the test because all the masks were too big #peak

So what does this mean? At the moment I have two options:

1. Be tested with another mask a.k.a ‘The Hood’ – these are more secure but expensive though, and there’s been supply/funding issues with securing these nationwide, so we’re not sure when they will come.
2. Be moved to work in a ‘lower risk’ ward to avoid contact with COVID-19 patients.

Really hoping we get more of those masks, because I really really don’t want to get moved. I know it would make you feel better, mum, but I love my team and I love working in Respiratory, so it would suck to leave them for another ward.

In other news, a quick rant on the importance of social distancing:

Seeing people on social media still going out unnecessarily has been frustrating and quite concerning. Hopefully this will become less of a thing with the Government closing things down today, but I can’t stress enough how vital it is to stay at home if you can. I understand that not everyone has the privilege to be able to work from home, and that there are many key workers who need to still go out, but if you can, STAY AT HOME.

“Why?” you ask- “If I’m young and healthy, surely I’ll be fine” is what a lot of people must be thinking right now, and yes, COVID-19 will most probably not affect you severely if you do get it, but that doesn’t mean there isn’t a chance it could, because it could be you or someone you love requiring ventilation to help you breath. We’ve heard scary rumours of F1 and ICU doctors in London dying, and new data is showing that more and more young people are getting really ill with it, so please take this more seriously.

You see, the aim of social distancing is to reduce the number of people who get infected, because that will reduce the burden on the healthcare service, and make more ICU beds and ventilators available for the people who get really sick. Because if you require ventilation to help you breathe and can’t get it, chances of survival are very slim.

Some numbers to drum this in a bit more:

• There are about 3000 ICU beds with ventilator capacity in the whole of the UK.
• My hospital, one of the biggest in my area, has around 30 ICU beds.
• My ward is a specialist Respiratory ward, and we have 6 ventilators. SIX.
• My hospital’s mortuary has been told to expect at least 4000 additional bodies.

I’ve accepted the fact that I will probably not see my family and friends at home for a long time, because I need to stay away from them to make sure I don’t infect them and vice versa. Many of my colleagues have said their goodbyes to their parents and families and moved closer to the hospital, because they know social distancing is one of the best ways to reduce the impact of COVID-19.

So, PLEASE, be a bit more considerate and just stay at home.

I’ll conclude with something uplifting: feeling so grateful to all the restaurants and stores showing support for NHS staff with free food, drinks and discounts at the moment. It really does feel like the whole country is rooting for the NHS right now, and it’s really heartwarming.