the times | Monday August 3 2020 1GM 25Comment
Longer self-isolation may do patients no favours
The ‘happy hypoxia’ experienced by some Covid sufferers means that extending quarantine rules brings its own risks
Buy prints or signed copies of Times cartoons from our Print Gallery at timescartoons.co.uk or call 020 7711 7826chance that this prolonged,
unmonitored stoicism did him worse.
This makes me wary of the new
ten-day rule. We now know one of
the disease’s idiosyncrasies: that it
can damage you badly in the second
week without you perceiving that
breathlessness is getting worse. We
have expert doctors worried about
late presentation. Yet the
government not only repeats but
extends the instruction from the
early days of meagre knowledge and
desperate hospital-building: stay
alone, see no doctor, don’t worry
until your lips are blue.
Admittedly as a nation, we have
been too apt in the past to take our
hangovers and paper cuts to A&E.
Of course, curbing the virus is
necessary, whatever it means in
tedious mask-erades and
cancellations. Of course, many cases
are mild and brief. But when a new
disease has clearly demonstrated a
tendency to turn suddenly feral in
the second week, the instruction
feels misguided, even dangerous.
Hospitals are not overwhelmed at
present; online consultations ease
the GP burden. Not everyone is as
lucky as Mr Rosen in having a doctor
neighbour. If anyone near me gets it
I shall shove a (well-sanitised)
oximeter through their letterbox and
shout that anything near 90 means
for God’s sake pick up the phone!little jaw thing hospitals put on your
finger to read your blood oxygen
levels. Dr Levitan had said that every
first-aid box should have one next to
the thermometer, so you could ring
your physician with, “Hey, these are
my numbers.” They might be fine, but
if not the doctor would sit up sharply.
There are no shortage of
anecdotes about this week-two
Covid-19 escalation, though not, alas,
from those who quietly died at home.
The children’s author Michael Rosen
relates that he thought he had a mild
dose but “things started moving very
quickly” when a GP neighbour
happened to check his blood oxygen.
He was whisked off with failing
lungs, liver and kidneys and spent 47
days on a ventilator.
Another example is a certain
patient left alone for nine days in a
room in Downing Street, food left
outside the door, nobody seeing him.
He claimed to be in “good spirits”,
“hand on the tiller” and said by
smartphone “I’ve done my seven
days of isolation but alas I still have
one of the minor symptoms... So in
accordance with government advice
I must continue my self-isolation
until that symptom itself goes”.
Well, Boris Johnson didn’t even hit
ten days before he needed intensive
care. It saved him, just. He now
prefers to put his narrow squeak
down to fatness but there’s a racing“happy hypoxia”, in which patients
don’t feel very breathless even
though their blood oxygen level is
creeping lower. In New York Dr
Richard Levitan flagged up a
vascular effect that “causes collapse
of air sacs in the lungs. Patients
‘tolerate’ this because it takes days:
their bodies accommodate. We’re
seeing low blood gases that rival the
summit of Everest, but [patients] are
sitting there on their cellphone. So
they all present with what has
become an advanced disease.”
This means more ventilation,
which immobilises patients, triggersother problems and sometimes fails
to save them. Days earlier they might
have been given direct oxygen — as
in the new Formula One-developed
CPAP machines — and remained
able to move and pronate. One
Italian doctor told him that once the
numbers dropped and fear abated
there, patients who did appear were
“coming earlier and doing better”.
On hearing this, though not from
government, I joined many others
(including savvy NHS friends) and
ordered a £30 pulse oximeter, theI
n the flurry of government
instructions, one change is being
too little noticed. Previously, in
the first panic to protect the NHS,
people isolating with proven
coronavirus symptoms were told not
to go to A&E or the GP’s surgery but
to self-isolate for seven days. This
has just been extended to ten days.
The advice is to take paracetamol
and look after yourself. Only if you
are severely breathless, pass out,
have blue lips or an enduring rash
should you call 999. Stay alone “until
all symptoms are gone”.
Overwhelmingly, people will obey
this. With few exceptions, Britain has
proved remarkably compliant, to the
point that the worried well are now
slowing the country’s recovery.
Obedience was salutary at the start,
as austerity left us with fewer
intensive care beds than almost any
civilised country: “Protect the NHS!”
But now, with more knowledge of
the disease, there is a chance that
lonely obedience to the ten-day rulewill cost lives. Eight million people,
remember, live alone with nobody to
blow the whistle.
Here are some publicly available
facts, hard not to put together even
as a layperson. First, Britain scores
high globally for “excess deaths”.
Many reasons have been suggested:
urban geography; a late lockdown;
the Cheltenham festival disgrace;
people not seeking medical help for
other illnesses. But another reason is
surfacing: that many Covid-19
victims sought medical help too late,
when the disease had already
damaged vital organs. Of course,
many simply get a mild, brief dose,
but others suffer a second phase: the
“cytokine storm” reaction.
On Friday, Devi Sridhar, professor
of global public health at Edinburgh
University, said that late presentation
could be a cause of our high death
rate. As long ago as April, Dr Bharat
Pankhania at Exeter University
warned that home isolators didn’t
report early enough with breathing
difficulties and were “soldiering on”
unmonitored. By contrast, in
Heidelberg, Germany, once this
eighth-day phenomenon was
noticed, the local authorities ran a
“corona taxi” of paramedics to check
up on self-isolators.
The second fact is biological and
may explain the soldiering-on.
Doctors have reported the oddity ofI ordered a £30 pulse
oximeter, which reads
blood oxygen levels
Libby Purves
@lib_thinks