Prakhar Srivastava is a medicine graduate from the University of Manchester who is currently undertaking his first year as a junior doctor in a hospital in London. Below, he talks us through in depth how his hospital is dealing with the current coronavirus pandemic and give us his thoughts, in a professional capacity, on the ever-changing situation…
Cases of COVID-19 are starting to grow in the UK and there is certainly a concentration of cases in our capital. This post and those to come will share my experiences, thoughts and outlook on this bubbling epidemic.
What have I seen so far?
In recent weeks, an incredible amount of restructuring has occurred in my hospital. We have a dedicated respiratory assessment centre where new patients arriving with breathing difficulty can be seen, entire wards have been reserved for cases of COVID-19, and many of our Intensive Treatment Unit (ITU) beds have been relocated to the infectious diseases ward. Our emergency, acute medical, infectious diseases, respiratory, intensive care and anaesthetic teams have been seemingly working around the clock to draft new policies, frameworks and pathways.
All other departments have also been working tirelessly, aiming to safely discharge as many patients as possible and arrange alternative means of care in the community in order to free up hospital beds in preparation for an exponential rise in cases of COVID-19. Examples of how my General Surgery department has approached this:
- All elective surgeries cancelled, except cancer surgeries;
- Many outpatient clinic appointments have been cancelled;
- Staff who were otherwise scheduled for services which have been cut down or cancelled have been re-allocated to teams looking after current surgical inpatients;
- Greater daily focus on discharges.
A failure of intuition
Humans have an amazing capacity, both as individuals and as a society, to understand the natural phenomena which surround us. However, there are several areas in science where our natural intuitions fail us dramatically. Whether it is climate change, quantum mechanics or artificial intelligence, without sustained and detailed study, it is difficult to understand concepts from these fields, perhaps because they deal with processes at a scale we don’t experience in our daily lives.
Epidemiology and outbreak science are slightly different. I think many of us can appreciate and believe that diseases can spread in a population and at exponential rates, initially at least. However, what I’m finding is that this initial theoretical revelation isn’t matched with an equivalent level of concern, until we start to see the evidence with our own eyes. I wonder how I would have felt if I had happened to visit Italy or Iran a month ago, or even China back in January.
At times like this, we must absolutely place our trust in those who have devoted their careers to the relevant fields of science. There has been repeated criticism from the scientific community of the UK government’s approach, albeit only a few of these scientists are epidemiologists, but frankly, I don’t think anyone is better qualified for these decisions than our current team headed by Prof Chris Whitty and Sir Patrick Vallance. They will not have perfect data or perfect models and they will need to make decisions anyway. I can’t imagine how they are handling such uncertainty when the policies they propose will affect our entire population.
My concerns – waves of potential consequences
It’s critical to emphasise that the majority of people who are infected with this virus will be absolutely fine. In fact, many of us will not even manifest any symptoms. Those with risk factors such as age, high blood pressure, chronic lung disease, heart disease and diabetes need to be protected but there is still great variability in disease severity even when such risk factors are present.
However, I am still stressed about the impact this epidemic will have on the NHS. The obvious burden is simply the fraction of COVID-19 cases which will require hospitalisation, critical care or invasive ventilation. That alone may overwhelm our healthcare service which is not designed, funded or equipped to accommodate such a sudden increase in patient load. Another more pressing issue is the inadequate supplies of personal protective equipment and testing kits for healthcare staff across the country. I sincerely hope the UK government has a plan to mass produce and distribute these as soon as possible.
I also can’t help but look forward to the secondary and tertiary issues which might cripple the NHS if they aren’t anticipated and addressed. This includes the supply of key supportive treatments such as oxygen, intravenous fluids, painkillers, intensive care drugs, and so on. There is a great focus on making more ventilators available, but I struggle to imagine how we will adequately manage these without a similar influx of highly trained nursing staff.
Finally, the rates of common medical emergencies such as heart attacks, strokes, head injuries, seizures and more will largely stay the same, so I worry about how treatment for these individuals will be complicated by a hospital burdened with COVID-19 and possibly understaffed considering the probability of several healthcare workers being ill themselves.
A silver bullet – vaccines and re-purposing old drugs
As much as I feel pride in being a doctor at this time alongside the full landscape of healthcare professionals, I am incredibly humbled and in awe of the scientific community for the breakneck speed at which they are conducting research. Countless early phase clinical trials are planned to test potential vaccines and to evaluate old drugs for their activity against Sars-CoV-2.
I have absolutely no idea what probability these interventions will have of working, nor any clue about how quickly they can be distributed in the masses. What gives me great hope is the intensity of global collaboration between research groups and the collective drive to bring a viable treatment from bench to bedside as soon as possible.
A strange feeling of affirmation
Overall, this epidemic has left me incredibly worried about how healthcare services across the globe are going to cope and the collateral economic and social damage which may be incurred. Of course, I am also concerned for my immediate relatives and friends who are at risk, as well as my colleagues at work given our heightened risk of exposure as frontline staff. However, I have never felt more motivated to go into work and I no longer view myself as someone with “only” seven months of professional experience.
I chose to pursue medicine primarily out of interest in the medical sciences and the unique way in which we interact with the full spectrum of society. Those reasons have been amplified to say the least and I am inspired by the immense efforts that so many of my colleagues have already expended. I aim to maintain my own health as best I can and truly hope the same for my peers.
To read more from our students about how the coronavirus pandemic has affected their studies click here
For the latest information on COVID-19 please visit the official government website