On 13 January, a bulletin from Health Protection Scotland was sent to all GP practices in the country describing a “novel Wuhan coronavirus”. I work in a small clinic in central Edinburgh with four doctors, two nurses and six admin staff. It was the first time I’d heard of the virus. “Current reports describe no evidence of significant human to human transmission, including no infections of healthcare workers,” it said reassuringly.
I cast my mind back to the Sars coronavirus of almost two decades ago, and briefly wondered how quickly the spread of this coronavirus would be stopped, as Sars was. A seafood market had been closed and sanitised. The bulletin said that although Wuhan was a city of 19 million people, there were only three flights per week from there to the UK, and the likely impact was “very low”. I shrugged, and carried on with my work.
Scientists had already discovered that the new virus was fundamentally different from Sars, though still within the family of coronaviruses. “Corona” refers to the spiky little packets of sugared protein stuck all over the surface of the spherical virus, like fleurs-de-lys sprouting from the band of a crown. Under an electron microscope they look like tiny planets, each one buzzing with angry satellites. They’re a similar size to flu viruses – 0.1 microns – and are widespread among many different mammals. Sars came to humans from the Asian civet; Middle East Respiratory Syndrome (Mers) came via dromedary camels. It seems likely that the new virus has its origin in bats, but whether there was another mammalian intermediary between bats and humans is still uncertain.
That evening I met up with a friend, a consultant physician who had recently come back to work after a period of time doing research. She had been stationed at a general hospital around 30 miles from Edinburgh, and was enjoying being back in the thick of clinical work, though startled at how stretched her medical colleagues were. “It’s the same every year,” she said. “I wonder when health boards will realise how many winter beds we actually need.”
A week later, Chinese infections stood at 550, and the death toll was 17. A new bulletin arrived reassuring me that the risk of infection was still low, but attaching a specific form to be completed should I suspect someone of having the virus – specifically anyone flying in from Wuhan. I was disgruntled but not alarmed when one university asked worried Chinese students to seek GP attention. “By phone!” I wanted them to add, “tell them to seek attention by phone!”
On 30 January, the World Health Organization (WHO) announced a global health emergency. The death toll in China reached 170, and the cases that had tested positive there reached almost 8,000. Further cases were reported in India and the Philippines.
Coronavirus infects and irritates the lungs. Most cases are mild. In severe cases it leads to breathlessness as the lungs struggle to do their job of oxygenating the blood – something that can be relieved with oxygen delivered by mask. A proportion of those patients who require oxygen will go on to need ventilation in intensive treatment units. In these early days of the outbreak, I still thought of the virus as something that, like Mers and Sars, would be contained. As GPs we are accustomed to dealing with an annual spike in flu – the “swine flu” of 2009 turned out to be not much more dangerous than seasonal winter flu – though in its severity and prevalence, this new virus seemed worse.
That same day, another message came in, this time from Lothian health board. It instructed me that masks “and other personal protective equipment” would be sent to the practice shortly, prompting the usual jokes among the staff that we would be sent a paper bag and some of those clingfilm gloves you get at petrol stations. Surgical masks did arrive later that week, along with a roll of tear-off plastic aprons.
During the week, I work at my small Edinburgh practice, but at the weekend I sometimes work evening GP shifts at an “out of hours” (OOH) centre in the city, covering a much larger population, with a team of other doctors and nurses. I had an email from the clinical director of the centre advising me to tell any patients from mainland China that they would only need to self-isolate if they had symptoms, adding that those symptoms did not include a sore throat. Until then, I’d been assuming that a dripping nose and a sore throat would be the herald of coronavirus infection, the way they are for most respiratory viruses. My practice started a WhatsApp group to keep one another updated. It proved as good for sharing joke videos as for the latest governmental advice.
On 4 February, I flew to the US to give a talk at the New York Academy of Sciences about science, medicine and wonder. United Airlines warned me I would be turned back at the US border if I had been through China. There were a few face…
Source Website ‘We’re clearing the decks’: a GP on watching the coronavirus pandemic unfold | World