26 September 2020 | New Scientist | 11Field notes
Diary from the covid-19 front line
The coronavirus has posed many challenges to doctors, the
latest being “long-tail” symptoms, says doctor Selma Stafford
THE first confirmed case of covid-
in Brighton was around 1 February.
I know this because I had been to
a friend’s 50th birthday party that
night. Having left early, I didn’t know
anything was wrong until I received a
cryptic text from the host, something
about us meeting up “when this is
all over”. I disregarded it.
I later discovered that somebody
at the party had been in contact
with this first confirmed case, so
several guests had to self-isolate.
Many were doctors.
It soon became clear that letting
“hot” patients – those with a
potential covid-19 infection – see
their general practitioner (GP) might
take many surgeries out of action,
and money was made available
for new solutions.
That is how my organisation was
tasked with setting up a “hot-hub”
for the area. The challenge
was: how can you see patients
who aren’t sick enough to go
to an accident and emergency
department but who might have
covid-19, yet make it as safe as
possible for healthcare workers?
What if someone has covid-
symptoms, for instance, and is
OK, but also has appendicitis?
Our idea was to keep a patient
in their car. You could recline them
in the passenger seat and carry
out a basic examination.
So we decided to set up the
hot-hub in a car park, inside a
huge drive-in marquee. We paid
scrupulous attention to infection
control and conversations took place
on the phone before and after the
physical assessment, to minimise
face-to-face contact. All the practices
in the area were signed up, covering
about 350,000 people.
When we started, it felt as though
every person we spoke to had
covid-19. We didn’t have access
to testing, but would advise patients
on the basis of the phone call and
physical examination. I became
adept at recognising the
“covid cough” over the phone.
Some days were especially
difficult. I remember one
60-year-old man in particular.
He had driven himself in, with
his wife, but when we measured
his oxygen levels, they were
surprisingly and dangerously low.
I asked why he was driving, and he
told me that he was fed up with his
wife missing the turning so had
taken over at the wheel. He was
clearly unwell, so we called anambulance, and 19 minutes later
he was taken away.
I suddenly became very aware
of his wife in the passenger seat.
She wasn’t allowed to accompany
him to the hospital, but had to
drive home alone with the very
real possibility that she wouldn’t
see her husband again.
During my career, I have seen
many patients very ill and dying, but
this sudden aloneness without any
ability to say goodbye or accompany
the loved one affected me more than
usual. After that, we made someone
responsible for staying with the
person accompanying the patient,
to make sure we could respond
to their needs as much as possible.
After a few weeks, the number of
patients like this fell and we started
to see people who had finished
self-isolation but were still unwell.
The common feature was a residual
lethargy, with some people reporting
a persistent dry cough or intermittenthigh temperature. Their managers
expected them back at work and
they simply felt unable to go, or
they worked for a few days then
were incapacitated afterwards.
GPs had little to offer – encountering
patients who continue to have
physical symptoms where there
is no clear course of treatment can
make doctors feel uncomfortable
and impotent – and were unable to
see them in person anyway, so we
would assess them at the hot-hub.
We would check their breathing
rate, oxygen saturations,
temperature and pulse. These
were usually normal, but the patient
was still effectively disabled by
symptoms. We don’t have any
medicine to offer, so all we can give
is reassurance that this isn’t unusual,
advice to rest and hope that it will
pass as the weeks go by.
This is a new illness, so we lack the
evidence that is available for other
areas. This long-tail disease seems
similar to chronic fatigue, but can
also have a periodicity like a tropical
disease – some people feel better for
a while, and then it hits them again.It also seems as though those with
prolonged disease are more likely to
have initially had milder symptoms.
In fact, the majority of people I have
seen in this camp are fit, active people
in their 20s and 30s. Some of them
would go on 30-kilometre bike rides
three times a week. Now they get
breathless going up the stairs.
It isn’t clear whether this will
become a chronic illness or get
better over months rather than
weeks. We are very far from
understanding the long-term
consequences of covid-19 and
now need to support and advocate
for people who are affected. ❚“ They used to go on
30-kilometre bike rides.
Now they get breathless
going up the stairs”A patient being
assessed at a drive-in
clinic in Dover, UKANDREWAITCH
ISON/
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AGESProfile
Selma Stafford is a GP and
educator in Brighton, UK,
and clinical director of the
Sussex MSK Partnership