Everyone in my walk-in centre is getting a bit twitchy. Coronavirus is spreading, and we are waiting for our first case to arrive after the initial ones became known outside of China, in Singapore and Macau. After January 27, some of the receptionists – understandably nervous about getting infected themselves – begin to flag anyone travelling from a country where there has been a case.
A couple come in who had already spoken to 111 because they were afraid after having travelled to such a country. They were told by 111 not to worry, but they still came to the urgent care centre wearing masks.
I don’t understand why we haven’t had a widespread public health information campaign about coronavirus yet, because misinformation is spreading undue alarm and hysteria. This is not Ebola or Mers; nothing on that scale of scariness. More than 4,500 people in England have been tested for the virus and nine have been positive. No one has died or even been admitted to intensive care, and those who have died elsewhere have often had multiple existing conditions.
After the national guidelines are updated to include a range of new countries, I realise we had sent home a patient who fitted the criteria. I struggle with whether to ignore it or not, but decide I do not want to be responsible for an outbreak.
The patient was only in our entrance lobby and one clinical room, but we decide to clean the waiting area and public toilet as well, and the health centre closes for part of the morning for decontamination. Public Health England wants to test the patient but it is too busy to organise it. It tells me to call a particular hospital which does not want to do it because the person does not live in its area, and after a couple of hours of trying to arrange a test, my incident team tells me I must get on with running my health centre, which has opened for business as usual.
Although we are used to dealing with terrorist incidents, rogue viruses or bad weather – and are always periodically preparing for something – the health service is now functioning at or beyond maximum capacity all the time. Public health funding has suffered dramatic real-terms cuts and historically low investment. We do not have enough staff, budgets are tightly controlled, and capacity issues create bottlenecks throughout the massively stretched system.
The patient’s test result is negative, but the relief is short-lived. On Sunday 9 February we have another patient in our isolation room who also needs to be tested. Then 111 decides to transfer the patient to hospital by ambulance, the safest way to mitigate the risk of spreading anything. We wait all night for the ambulance to show up. I have no blankets or food to offer as we are a day unit and have never had to do this before.
My patient is not a priority for the ambulance service as theirs is not an immediately life-threatening problem, and the dispatcher must consider it will take 90 minutes to deep-clean the ambulance after transporting my patient.
I don’t get home until a colleague comes in at 7am on Monday. I had been at work for 19 hours, for the first time in my 20-year career. Nobody should be working for that amount of time, but it wasn’t anticipated that my patient – who subsequently tested negative – would have to wait 15 hours for an ambulance.
At the end of last week our personal protective equipment training was cancelled due to a shortage of kits to carry out the testing. Other preparations continue and we are buying new supplies, yet most of the world’s face masks are produced in China and Taiwan and they are being reserved for their own residents.
Staff are soon being sent home if they have inadvertent unprotected contact with a patient who needs testing – three people so far. They are ordered to remain at home until the patient’s test result is confirmed. This is an extreme precaution as it is highly unlikely anyone could pass the virus on in the 48 hours or so it takes until we get a result. In a worst-case scenario this policy could lead to the closure of services due to staff shortages. We contact Public Health England for advice, but it is utterly swamped and can’t give us an immediate response. We haven’t tested any staff, and would do so only if we have a positive test in a patient.
People need to know that the best way to access help is from home if they are not seriously unwell. Not enough is being done to get this message across.
There are systemic issues which mean the system could collapse if the national guidelines do not keep up with the evolving situation. If three or four patients who need testing come into my walk-in centre, which is in an urban area, I do not have the space to isolate them. I’ll have to wait for ambulances and half my consultation rooms will be taken out. This is before you even start taking into account the impact on hospitals.
Also, we do not have the authority to send samples off to a lab, they must go through the local hospital – that’s why people are being referred to hospital from primary care even though it is easy to take samples. By Tuesday 18 February however, I am told of sensible plans to train community swabbing teams to visit people at home and in walk-in centres.
This is so important because although people should stay on the sofa with a blanket watching TV if they are not acutely unwell, they will always rush to the nearest point of care during an outbreak like coronavirus unless there is home testing and a public health information campaign.
• An anonymous lead clinician at an urban walk-in health centre in the south of England was talking to Mattha Busby