On the frontline of a pandemic: an essay by an Auckland hospital doctor
"As a hospital doctor, I know that I will begin to be exposed to patients who don’t even know they are harbouring the virus," writes Auckland novelist Eileen Merriman.
Last Sunday morning, I went for a run. I went early, as I was due at the hospital for a ward round around 8 am. The air was autumn-crisp and the sun was breaking over the horizon. There was hardly anyone around. It was a moment of serenity in an otherwise very stressful week. The calm before the storm.
On Sunday morning, we had six confirmed cases of Covid-19. By the end of the day, we had eight cases. Towards the end of last week, I had to cancel trips to both Dunedin (for a haematology conference of around 120 people), and Melbourne (for a meeting of around 10 people). At the beginning of last week, my registrar and one of our senior nurse specialists (with 50 other staff) were stood down from work, after being identified as contacts of a potential case at our hospital, putting additional stress on our already very busy team. The patient has since tested negative.
While on call last weekend, I received calls from concerned patients asking if they could travel to Sydney, if they should have infusions of vitamin C and if there was anything extra they could do to prevent Covid-19 infection while on chemotherapy. The answers were no, no, and not really, but wash your hands and avoid crowds and sick people. My niece arrives back from boarding school in London tomorrow morning, and will commence her mandatory fourteen-day self-isolation period. Her London to Doha flight was shared with 13 other passengers.
At home, I have no hand sanitiser. I have adequate amounts of toilet paper. I have six chickens and a geriatric dog with a leaky bladder. I am not afraid.
But I am a little worried. I've never seen the effects of a pandemic before, and hopefully never will again. Covid-19 is a novel virus. It's more infectious than the standard influenza that does the rounds every year, with each Covid-19-infected person infecting another 2.2 people on average (influenza cases infect, on average, only one other person), giving the potential for exponential spread. In addition to this, there is no vaccine available yet (and likely won’t be for several months), so the susceptible population is far greater. At the time of writing of this article, there are 169,610 coronavirus cases (www.worldometers.info) and 6518 deaths, for a death rate of 3.8 percent, although this varies by country. Singapore has no deaths, but only 226 cases. Italy, which went from 224 cases to 17,660 cases in the mere space of 20 days, has a death rate of 7 percent. In Italy’s overwhelmed health system, which has been likened to a war zone, some regions have been forced to prioritise who will be treated by age. This is because they need to guarantee that those patients with the highest chance of recovery will still be able to access intensive care, and a ventilator. Sobering times.
As a hospital doctor, I know that I'll begin to be exposed to patients who don’t even know they are harbouring the virus yet. I'm in my 40s and healthy, so the virus is unlikely to make me seriously ill. However, it will mean time off work in an already stretched health service. In addition to this, we've been advised not to come to work if we have symptoms such as a fever, runny nose or sore throat. This is of course essential to prevent spread, but will put further stress on our hospitals over winter as we all succumb to the inevitable competing causes of sore throats and runny noses, such as the common cold. So, fewer staff to see more patients over the winter months. As cases begin to fill our hospitals, elective surgery and routine outpatient clinics will be cancelled. If we can't contain the spread, it'll be followed by triaging of more urgent cases above less urgent cases, including new cancer diagnoses.
And yet I have hope. The government has taken the essential steps needed to reduce the rate of rise in new cases, or in epidemic-speak, "flattening the curve". It seems that the answer lies in social distancing. It's why conferences and other gatherings are being serially cancelled, why air travel is grinding to a halt, why cruise ships are not allowed to dock in New Zealand until the end of June. It's the reason why many work places, especially those providing healthcare, are instructing their workers that they may not even travel domestically unless it's deemed essential. The economy is hurting, and this has only just begun. A pilot friend tells me that the airlines have no idea where they are going to store all the unused planes. The Australian desert has been suggested as one potential plane parking lot.
It affects me as a writer, too. Yesterday we received the sad but unsurprising news that the Auckland Writers Festival in May has been cancelled. Book launches are next, with at least one friend’s book launch cancelled, and more to follow. The London and Bologna book fairs have been cancelled. Fewer festivals + fewer fairs + fewer visits to bookshops = fewer sales. And yet, with more time at home and self-isolation, perhaps more books will be read and sold. What else is there to do when one cannot go to the malls, theatres, concerts, restaurants and sports matches?
It's at times like this that we see the best and worst in human behaviours. A relative of mine witnessed a woman emptying a newly stocked supermarket shelf of hand sanitiser. When my relative asked, why did you do that? the woman replied, because I could. Xenophobic comments abound. Overseas, some Asian people have been attacked for wearing masks, and others have been attacked for not wearing masks. Viruses are always someone else’s fault. It’s always someone else’s cold or flu.
But there are others who are generously offering their time and expertise, such as the healthcare workers working around the clock in countries such as China and Spain. Closer to home, poet and children’s author Paula Green has offered virtual book launches via her website. I’m alternately reassured and alarmed by posts coming through from medical friends on Twitter and Facebook. Dark humour helps - eg, the Covid-19 quarantine party playlist, featuring tracks such as "Made in China", "Can’t Feel My Face", "Somebody That I Used To Know" and "You Sound Like You’re Sick". A more sobering tweet from a doctor in Seattle tells of elderly patients beginning to recover from their pneumonia, only to die of cardiac arrest. Another post from an intensive care specialist tells us why we need to flatten the curve: if 50% of my city gets infected, that’s 75,000 people. If 5% of them need life support, that’s 3750 people… for 25 (ventilated) beds…. so it’s up to you… wash your hands. Stay home.
Me, I’m resigned to hunkering down in Auckland for the next six months with my ration of toilet paper and free-range eggs, while trying not to touch my face and singing Happy Birthday every time I wash my hands. I’m hoping the epidemic will be curbed so that I won’t be spending every waking hour at the hospital, treating the victims of Covid-19. Perhaps, if I’m lucky, I’ll finally get to decimate that stack of books beside my bed. Perhaps I’ll have more time to write and spend time with my family. Air pollution will plummet as everyone’s carbon footprint reduces. But if the epidemic does take hold, then I’m prepared. It’s what I’ve trained for, after all. Meanwhile, those of you quarantined at home may wish to read my Ockhams Acorn Foundation Fiction Prize longlisted book, Moonlight Sonata, as well as my published YA thriller, A Trio Of Sophies (#shamelessselfpromotion #becausemyAWFsesssionisn’thappening).
My hope is this: that the restrictions on travel and social gatherings will allow us to treat the inevitable cases of Covid-19 in a controlled manner, and to allow scientists time to develop a vaccine. This will end. The economy will, eventually, recover. But it is going to take time.
There is a Chinese curse that says: may you live in interesting times.
Moonlight Sonata by Eileen Merriman (Penguin Random House, $38); A Trio of Sophies by Eileen Merriman (Penguin, $19.99)
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