Coronavirus medical journal: making quick decisions about life and death

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A doctor stands outside the red zone

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John Wright

Legend

Dr Dinesh Saralaya at the entrance to the red zone


In his first newspaper for the BBC, published on Monday, March 30, Dr. John Wright of Bradford Royal Infirmary reported on his hospital’s preparations for the coronavirus storm. In the past few days, the storm has started, putting all the participants under great pressure.

April 2, 2020

Not too long ago, the hospital had only a few Covid-positive patients, isolated inside the rooms. At the start of this week, we had two full rooms designated as “red” or infectious areas. And two others turned red a day later.

One of the most used phrases we use as doctors is, “It’s just a virus.” This reassures our patients and hides our own uncertainty. So, for many, the devastation caused by the coronavirus has been so unexpected.

As of Wednesday, 14 of our patients have died.

This is one of the big problems around Covid-19 – its high death rate. So while less than one in 100 of those who get it will die, when you are hospitalized, it will increase to one in five or one in four.

We are used to people who die in the hospital, because it is often a place where people die. But normally, we reflect in our practice, we give time, and time is a great tool for us in health care. But in the hospital today, we make quick decisions about life and death – decisions about ventilation, escalation care, and when to make the decision about end-of-life care.

As Dr. Clare Rayment, a palliative care consultant, says, none of us want to be wrong.


Frontline newspaper

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Victor de Jesus

Professor John Wright, physician and epidemiologist, heads the Bradford Institute for Health Research. He has treated patients in epidemics around the world, including cholera, HIV and Ebola epidemics in sub-Saharan Africa. Over the next few weeks, he will report to the BBC how his hospital, the Bradford Royal Infirmary, copes with Covid-19.

Read his first journal: Why do people steal hospital supplies?


“There is a lot of concern in making these rationing decisions because it is not something we are used to in the UK,” she said.

“I think in other countries, this is something they might be more used to having conversations. We are used to people who die in the hospital, but we don’t usually say, “You’re going to die because I can’t give you this fan because someone needs it more. “”

Many of us have parents and we are concerned that decisions like these will be made based on the age of the patient.

But age is only one factor.

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John Wright

Legend

Hospital staff trained for redeployment in intensive care


“We have to recognize this as a society, because so many 80-year-olds are actually in better physical and mental shape than some 65-year-olds. This 80-year-old should not be struck off, “said Dr. Alex Brown, senior care consultant.

Another feature of Covid-19 is that people die alone. Almost no one is allowed to enter the hospital to visit.

The challenge, therefore, is to “think about the best way to ensure that these people die well in an environment where their family members are probably not,” said Clare Rayment.


Find out more

  • John Wright records from hospital wards for BBC Radio 4 NHS on the front line
  • You can listen to the next episode at 11:00 am on Tuesday April 7, catch up on the first two episodes online or download the podcast.

Technology is part of the answer.

“If someone wants to be there when someone dies, can we do it in a video call? It’s out of everyone’s comfort zone, but in fact, it could be very important for a patient, if he’s awake enough, to be able to see their wife or anyone on the phone, “she said. “And also for this woman, husband, daughter, whoever she is, to see that their beloved, you know, is comfortable, not in distress. “

Emma Barnes, the elder sister of respiratory services, tells me that while family members cannot enter the hospital, some still drive to be close to their loved ones.

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John Wright

Legend

Elder sister Emma Barnes


She also noted the emotional strain on staff – people who cry in the corner, or admit that they cry when they get home and have to hide it from their children. She raised the idea of ​​designating a room as an “oscillation room” where hospital staff can go for a moment if they feel emotionally wobbly.

I think there is mass insomnia among the staff, because our normal routine was suddenly completely disrupted. I woke up all night thinking about it myself.

So much has changed so quickly. It has been barely two months since the first Covid-19 patients were diagnosed in the UK. And yet the number of cases now exceeds 30,000.

In the 16th century, measles and smallpox were spread by the Spanish conquistadors to entire communities who had no prior immunity. These viruses took 100 years to conquer the Americas. Covid-19 took 100 days to take over the world.

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