COVID facemask

Published June 2, 2022 | Updated January 10, 2023

MedCourse Blog

By MedCourse

Useful, relevant, and interesting content for UK Junior Doctors.

Written By Dr Besu Asfaw

Clinical Fellow in Medical Microbiology, Stockport NHS Foundation Trust

On the Second Anniversary of the Beginning of the UK’s Pandemic Response

I considered myself a capable, responsible, and well-travelled international humanitarian medical emergency worker. I have often worked in resource-constrained settings in post-conflict nations in sub-Saharan Africa and fought against epidemics in the trenches, some that are still decimating the region despite significant investment and progress.

In my own way I had done a bit of Témoignage, a French expression used by Médecins Sans Frontières. It does not translate well into English, ‘bearing witness’ is as close as I can get to describe it. 

In Mozambique and Liberia, I had the privilege of working alongside tireless national and expat staff even under the most difficult circumstances. In Sierra Leone, I was inspired by the courage and tenacity of Ebola survivors. During my travels in South India, I acquired insight from people who live with dignity amidst deprivation and poverty. I also visited with interest the Genocide Museum in Phnom Penh without flinching. I do not have a morbid curiosity, but had seen similar atrocities in my ancestral land of Ethiopia when I was growing up.

COVID antigen

Now that we have established my credentials let us discuss COVID, during the outbreak of which I was in Addis Ababa on holiday. My friends and family were concerned, but I was not particularly alarmed. Checking in at Bole Airport on my way back to England, I was interested to see the locals complaining about the presence of so many masked Chinese nationals. The ever-expanding Ethiopian Airlines had daily flights to mainland China, and if you know anything about Africa these days, you should know that the Chinese are ubiquitous, helpfully building roads and casinos.

Upon returning to Manchester after a few weeks of bliss in Africa, I landed in a nation in the grip of the pandemic and was struggling with comprehensive public health messaging. Driving to the epicentre Oldham hospital, I listened to BBC’s Radio 2 in disbelief as an experienced GP dished out daily doses of erroneous advice regarding masks. Masks!

Oldham has a large BAME community that seems to be particularly vulnerable to severe COVID. During the Holy Month of Ramadan, we once had three generations of the same family on Non-Invasive Ventilation with poor outcomes. It was all very sad.

Later I moved on to another hospital in Manchester, where staff were working valiantly despite reports in The Guardian about fatal outbreaks of hospital acquired COVID. The bad publicity and fall out was not at all helpful.

hospital coridoor

Things were settling in November 2020, with hopes of vaccines coming out when I caught COVID, probably the deadly delta variant, from an agitated, anoxic patient. I felt like a soldier in combat who was shot by a sniper just before the end of the war.

My friendly local hospital ‘admitted’ me to the virtual COVID ward, which meant they sent me home with a nice shiny pulse oximeter and had one of the nurses calling to check on me every day. I knew that oxygen levels can drop significantly without the patient experiencing discomfort, and that people in China have been reported to drop dead on the street. So I kept a close eye on my oxygen saturations and eventually made a full recovery to get back to work on day 12. We did not have home Lateral Flow Test kits in those days.

Of course, far too many people lost their lives to COVID, not even getting a chance to say goodbye to their loved ones. Most who died in the hospital fought bravely to the end. Two patients remain etched in my memory because they were terrified of dying. One elderly gentleman was the sole carer of his wife that had cognitive decline, and knew she would end up in a care home if he was not looking after her. The other patient was a lady who had similar issues with her adult son who had special needs. They desperately needed to get back home, and one of them did not manage to do that.  

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Eventually, with the sacrifices paid by ordinary people, advances in molecular biology that led to the creation of vaccines, and the great work of NHS staff, the pandemic curve was flattened and life got pretty much back to normal.

Then a personally distressing event occurred when a stupid, fratricidal war broke out in the North of Ethiopia, wiping out years of steady improvement in infant/maternal mortality rates, health service coverage and other indices of development. The civil war predictably led to accusations of atrocities and destruction of the health system, which had never been robust in the first place. The conflict even metastasized to the west and fractured the huge close-knit Ethiopian diaspora communities along ethnic lines. Life-long friendships were lost. It was heart-breaking, as this particular tragedy was completely avoidable. 

Just before Christmas the highly transmissible Omicron arrived. We were all careful in my family, as the kids were looking forward to seeing their grandparents in Cambridgeshire. We had a wonderful Christmas followed by our customary walk in Platt Field. On Boxing Day, I woke up with a bit of headache, not really unusual, but did a Lateral Flow Test just to be sure. Reassuringly negative. In the afternoon I did another test when I developed a sore throat, and watched with fear and bewilderment as the two lines became more discernible. How could this be? No doubt I put my kids in harm’s way, but also scuppered their trip. Fortunately, no one else got it from me and I only had a mild illness. I even managed to work from home, but to come down to earth with a bang after the Christmas high left me shaken.

Lateral Flow Test

One particularly gruelling day at work, it came to pass that I was sitting in the tiny doctors’ room to take a breather. I pulled down my mask and was enjoying a cup of Costa’s fine cappuccino when I was joined by a genial locum consultant who took off his mask to help himself to the ever-present snacks. We chatted away until a cardiac arrest call came in. I grabbed my stethoscope and mask from the table and ran out.

The patient was in peri-arrest and we quickly stabilised him. At some point, one of the outreach nurses wanted to know why I was wearing two masks? Not sure what she meant, I ambled over to wash my hands and looked at myself in the mirror. My mask was now covering my chin, as I had pulled it down to drink my cappuccino, and my nose and mouth were covered by the locum consultant’s, which I had grabbed in haste and now actually smells different. That’s when I lost it, and had my meltdown. Inconsolable, who me?  Nowadays I am inclined to think of it all as a cathartic moment. 

But what of the ‘long haulers’? Those people with lingering symptoms that never fully recovered while some never ever seem to catch the disease despite being in high-risk categories? COVID left the nation dazed and suspicious, and some learned folks will always question the long-term safety of vaccines.

But life goes on, and with the easing of restrictions I was able to attend in-person services at my local church, the ever so wonderful Holy Trinity Platt. As part of a series, the earnest young minister was explaining away the first few chapters of Genesis, the entire congregation listening with rapt attention as if they had no clue what happened during that busy week, rejoicing in the comforting familiarity…and behold, it was very good.

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