‘Steady as she goes’, advises local doctor
Nothing, however, that has gone before needed the attention to detail that the current situation is demanding of us.
Foot and mouth reinforced the importance of managing risk to protect livestock but we could not have foreseen it as a practice run for protecting each other.
We can rise to this, not least because our lives and the lives of family, friends and neighbours depends on us all doing it successfully. Urban settings with high population densities and a dependence on crowded public transport systems may have greater potential for disease spread and deaths but we need to realise that it is already in our midst.
Many cases have gone unnoticed, with minor symptoms in the young but unknowingly it has been spread to older people with fatal consequences despite hospital treatment. The NHS staff have been applauded but we in turn would want to acknowledge with immense gratitude the contribution made by all those who are links in the chain and have made life’s essentials - food, heat and water - available to us all and have allowed communication, transport, energy sources and essential repairs to continue. Thanks to all of you who continue to do essential work. You too are saving lives both now and into the future.
What needs done?
1. Social distancing: If we have legitimate reasons to be out of our own environment we should not be within 2m of another person. It would be sensible to take air flow into consideration too as the virus is carried in the air as well as by direct contact.
2. Coughs and sneezes spread diseases: Droplets emitted from our mouth and nose should be caught in a disposable tissue which is then either burned or placed in a closed bin. It would also be wise to wash your hands after it.
3. Hand washing: Touching an infected person or surface contaminated with the virus means that you can acquire the infection or transmit it to another
person or surface. Thorough hand washing (sing Happy Birthday twice!) with soap and flowing hot water followed by air drying or using disposable paper towels will save lives.
4. Be aware: As surfaces can retain the virus for some time we need to be aware that tools, door handles, steering wheels and other vehicle controls, in a shared work environment, can be a source of infection.
5. Social isolation: Those of us who are particularly vulnerable should have no direct contact with anyone outside of our immediate household and follow the guidance sent to us or as listed on the government “111” website.
We can help others maintain their isolation and safety by not entering their house when making essential deliveries to them and ensuring they don’t need to leave the home for food shopping or medication.
6. Stockpiling: We have seen human nature at its worst and at its best. People have let themselves down badly and others have excelled in generosity. There is provision for our needs and will continue to be so. Doctors and pharmacists like the supermarkets, are not allowing the greedy to accumulate an excess of supply of medication so please don’t embarrass yourself by asking for a quantity different to your usual supply. It is also inappropriate to ask for medication “just in case”. We will not be giving out paracetamol, antibiotics or inhalers on this basis as such a change in approach is unnecessary and wrong.
What is happening in GP surgeries?
To an extent it is business as usual but not in the same way. Our staff, including doctors, nurses and administrative support are coming to work as usual. They are taking what steps are available to them to protect you, themselves, each other and their families. We are ensuring that medications are being prescribed as needed and patients who need to are being seen in an appropriate place, by an appropriate person and avoiding unnecessarily being within 2m of both staff and other patients.
The following processes are a resume of how our practice is managing and may will be similar to other practices, including yours.
1. Patients must phone the surgery and not just “drop-in”.
2. Patients who just turn up are turned away and told to phone for guidance.
3. GPs are discussing with patients over the phone how best their needs can be met.
4. If a face-to-face consultation is needed that is arranged in a way which will minimize risk to the patient and staff.
5. If a prescription is needed it will be sent to a designated pharmacy and the patient or their representative then collects the medication in accordance with the chemist’s safe processes ensuring social distancing.
6. If patients have a query about issues relating to the coronavirus or work they are directed to the government web site “111” or to phone “111” as this is the same advice we rely on.
7. District nursing and treatment room services will prioritize demands according to the staffing levels they have and in a way to reduce risks to themselves and patients. If family members can complete a task it will be safer for the patient.
8. Procedures and tests that have no clinical urgency will be delayed until a safer time.
9. Antenatal care details can be discussed with your midwife by phone and face to face contact arranged if necessary.
10. Patients with symptoms suggestive of Coronavirus who need seen may be seen in a locality centre separate from GP practice premises or referred directly to a hospital based centre specifically set up for those who are more seriously ill and may need hospital admission.
What about other emergencies?
Life goes on and life happens. Babies need to be born, people have heart attacks and strokes, bones get broken, tooth aches happen, seizures occur.
1. Symptoms suggestive of a stroke or heart attack still should be dealt with by a 999 ambulance.
2. A patient in labour still needs to telephone the maternity unit followed if necessary by a direct attendance avoiding other parts of the hospital en route.
3. Dental emergency services can be contacted although treatment will not involve use of the drill, air/water irrigation tool or scaler.
4. Emergency departments are separating patients with respiratory symptoms from other patients with fractures and the like.
5. Sick children are unlikely to have coronavirus related illness as we are told they are less likely to be made unwell with it than older people, so an ill child may still need seen by a GP or hospital doctor.
Your country (-side) needs you! (all of you).
Thank you for keeping food production going this springtime. I will endeavour over the coming weeks to update and inform you on what is going on in my world from the other side of the fence.