01 Apr Viral War: A Local Fight Against It
Once a chaotic and busy city, Plymouth has become an eerie place with very few human activities on the streets to be seen. Dr Amanda Harry is a General Practitioner who works at West Hoe Surgery. Being a doctor for over 30 years she has never had to face an outcry for help quite like this before. She explains the fear, terror and upset she has felt throughout the first few weeks of preparing for the pandemic outbreak, COVID-19 in the ocean city of Plymouth. Whilst the attention from the media is primarily focused on the hospitals and their ITU beds, insufficient ventilators and lack of personal protection equipment, the question why there isn’t the consideration for the people who the patients go to first, the GPs being given?
Following her every footstep, I shadowed Dr Amanda Harry during the first few weeks of preparation of COVID-19 outbreak in an antiseptic and caffeine fuelled GP surgery, a place she now calls the “Ghost Ship”. The usual heaving waiting area is quiet and bare as essential patient visiting rule is applied. Every step echoed through the bare walls and every hand wash could be smelt within seconds on the tap being turned.
Her voice polite yet friendly welcomed me into her room, perched opposite each other. Her eyes appeared tired and stressed but her sunny disposition made me feel comfortable and at ease: a direct comparison to the fear she has felt since the outbreak. As a nation we are heavily dependent on the NHS with many of us abusing the nature of the NHS to cure our woes. Amanda explained, “as doctors we are used to being busy and used to having difficult discussions with patients but COVID-19 is going to stretch our skills to the max”. From the start of the outbreak of COVID-19 in China, nearly every country has been affected with no power to be able to fight the virus and to prevent the number of deaths that increase as the days go on. As the death toll rises in the UK by staggering numbers each day, the pressure is only felt more by the doctors and nurses trying to treat and stay protected themselves. On a daily basis, GPs have to make tough decisions for their patients but COVID-19 has led too many to be fearful of the future. Amanda explains how rather than fearing catching the virus, she fears “the difficult decisions we are yet to face. Asking someone if they want to die in hospital or at home, alone or with their family who could then contract the virus and die. That is what I am scared of and it pains me to think that people understand the emotional distress it has caused on every frontline member of the NHS.”
Starting off at Wuhan in China, the virus has caused global panic and in local areas it has caused local communities to come together and plan a strategy of attack. John F. Kennedy once said “In a crisis, don’t hide behind anything or anybody. They’re going to find you anyway.” Bear Bryant said, “In a time of domestic crisis, men of goodwill and generosity should be able to unite regardless of party or politics.” This could not be truer for some of Plymouth’s head NHS staff who have come together to organise plans of their own, “to get through this as safely as possible”, Amanda said. “There are so many people around and meetings of minds determining best practice for the coming months.” Communication is key in any team, but during a crisis it is found to be crucial in tackling something head on.
Overnight the NHS has seen a drastic change to every sector of the health service. The conventional methods of visiting your GP is out and telephone and video chats used to combat against personal contact. “I have never seen one thing be able to change primary care so quickly and by so much” Amanda said whilst she took a large glug of coffee. “Boxes of surgical masks and aprons and gloves arrived this week yet the use by dates on the surgical masks is 2016 but we have reassurance from NHS England that they have been tested and that they are okay” she said hesitantly as if she doesn’t believe them.
The first load of out of date stock of PPE given to West Hoe Surgery’s doctors and nurses to help protect themselves against COVID-19 patients.
Since the talk of Brexit started in 2016 and the threat of then leaving the European Union, medical supplies have been on a shortage. But although it hasn’t had a direct effect to primary care for GPs it has not made the situation better. Amanda said “We are unable to get hold of important supplies because of lack of stock so have been trying to improvise. Like hand making our own visors from acetate and 3D printing headbands for them; fashioning theatre gowns from surgery curtains, asking hoteliers for plastic shower caps as no surgical hats available. The lack of protection for the NHS staff is astonishing. Would you expect a member of the army to be sent to war without their camouflage uniform, or expect a fireman to not have a water hose to put out a burning building? However, the falsely advertised £350 million on the side of Boris’ infamous Brexit Bus is now desperately needed and being found in other areas of public money to help fund for the essentials for every NHS staff member to protect themselves and prevent spreading the virus even more.
The preparation for something so severe yet with having “no experience of” is daunting and Amanda describes it almost as “enlisting into the army, not believing there will be a war yet then all of a sudden you have been drafted and sent to fight. We are doing what we have trained for, to treat the sick and try to prevent others. This is our war we are fighting”. With government guidelines being to self-isolate if symptoms have become apparent which has left many practices to be understaffed. In Plymouth where recruitment and staffing levels have already been causing issues in the last few years, this has put an increasing strain on the already depleted work force.
Amanda pauses to think, she rubs her temples and describes her constant headache. Unable to sleep during all of this change, Amanda blames it on “COVID-insomnia”, a new term coined by the healthcare staff who are “going to bed exhausted but waking with their brains buzzing of ideas and worries then unable to get back to sleep”.
Inside of one of the clinical rooms in the “Hot Hubs” in Plymouth. Stripped bare and with only the essentials, these rooms have been renovated for easy sanitisation.
In order to combat against the spread of COVID-19, the Clinical Commissioning Group (CCG) have asked GPs to set up multiple “hot hubs around Devon and within 48 hours they had set up a surgery in Plymouth fit for this”. The surgery would have 3 clinical rooms with vinyl flooring, a disrobing room and shower room for clinicians. An outdoor tented area where cars could drive up and basic assessment could be made in cars. However, “within 24 hours the CCG back tracked and now need a Devon wide solution, one massive hot hub in the city. 2 days later and they’re still looking for a suitable site as the local hospital has bagged everywhere. The chaotic manners from the top only resonate to stress and anxiety for the staff on the frontline, who need the support and structure from the top.
In the midst of a national crisis the preparation that Plymouth is doing for COVID-19 has unified the workforce in the area. Being able to multitask has always been a key skill for GPs to have, but now it is ever more so in need. I can’t start to imagine the stress and anxiety that NHS staff like Dr Amanda Harry are under and will continue to be face until there is a plan for the unknown.
