Whilst the COVID-19 situation has not yet fully gripped Dorset I’ve spent this weekend on-call for trauma in the NHS and I’m already beginning to see the impact it is having, quite aside from the empty supermarket shelves and palpable sense of anxiety outside of the hospital. There is a strong feeling that we are bracing ourselves for a very challenging time.
I treated my first suspected COVID-19 patient today who came to the hospital with a serious knee problem, but also all of the signs of COVID-19 infection. This coincided with reports of the first doctors dying in the UK as a result of COVID-19 infection. Tests were sent, but it will take days for the results to come through. As such all interaction had to be done whilst wearing Personal Protective Equipment (PPE). It was a somewhat frightening and sobering experience, balancing the contrasting needs to protect my patient, my excellent team, the other patients for whom I am currently caring, and not forgetting my wonderful family at home. I'm sure many doctors around the world are feeling the same.
Whilst PPE is not terribly different from the ordinary equipment I use when carrying out surgery the magnitude of the potential consequences can provide a degree of mental distraction. Speaking in the special PPE masks, for example, is very anxiogenic as it represents an opportunity for the seal on the mask to fail, potentially allowing contamination. It will be difficult to safely carry out surgery in such equipment.
Many patients were admitted under my care this weekend with the ordinary range of injuries that people come by from being out and about and enjoying themselves. These patients will be in the hospital for several days, if not weeks, following these injuries at a time when the hospital is likely to face extreme pressures and become a high-risk environment for disease transmission. This is another key reason why people should stay at home and avoid anything that may lead to injury even when at home. I've personally stopped my passion of cycling outdoors, and banned the children from their trampoline, because a trivial injury now could have very serious consequences.
All three private hospitals that I work in (all in the area) have now announced that they are handing over their facility, staff, and services to the NHS as of the 15th of April, or sooner if required. This has naturally impacted any planned surgery.
National guidance has now come out advising that steroid injection should be avoided for fear of increased death rates if one does get infected with COVID-19, and the potential need for hospitalisation in the event of problems.
For anyone seeking private care at this difficult time, the outpatient department in the private hospitals rwill subject everyone (me included) to a mandatory risk screening and temperature check, with anyone deemed ‘at risk’ denied entry. That said, I suspect these departments will soon close. I still expect to be able to see patients this week.
Going forwards I am also offering video and telephone consultations which can be booked in the usual way. There are also a few temporising measures for those who are struggling, such as braces to prevent knees from giving way and braces to help with the pain of arthritis, whilst we all modify our lives as a result of the current situation. I have a growing list of patients who will be operated on as soon as it is safe to do so.
Do stay safe, stay at home, and avoid anything that could possibly lead to ending up in hospital!