March 2020

This is where it started. Initially just answering questions before it became a daily blog….

March 8

Did you see the British Medical Association spokesman on Television discussing the Corovid 19 situation this morning ? Dr Tom Dolphin, a Consultant Anaesthetist, gave a solid sensible assessment of what the NHS will be facing. Many of my friends will remember him as an enthusiastic young member of the Greenbelt Medical team many years ago. He cut his teeth doing contingency planning with us at Greenbelt. Long before he started Medical training. I am sure he will remember the storm that flooded the festival out ! I am proud to think his career began in a Northamptonshire muddy field . Well done Tom.

March 16

Covid 19 Pandemic. My personal Contingency PlanIntroduction:There are two strands to my planning, firstly to avoid catching the virus, and secondly if catching it becomes inevitable to delay catching it and then be able to react and treat myself effectively whilst self-isolating. This will be achieved in the following way.1) I wish to keep both my car and my house free of the virus. I will endeavour to do this by scrupulous hand hygiene. When getting into my car I will unlock the door so I can get in, but before I do I will use my alcohol based hand gel as widely advised. I will wear short sleeves wherever possible to enable thorough hand washing. I will then only touch the car on the inside. Any passengers I take will go through the same process. When I get out of the car I will touch things as little as possible, avoid lifts, using stairs without touching hand rails. When I get back into the car I will go though the same ritual using the hand sanitizer. On arrival home I will remove myself and shopping from the car using my body to push the doors shut . Once inside I shall change my footwear, remove top clothes and then wash my hands with soap and water for at least 20 seconds2) Any visitor arriving at my home will be asked if they are well and without a recent new dry cough and fever. Those who seem unwell will be advised to go home, self isolate and report to NHS 111if they significantly deteriorate or do not get better in 7 days. Those whom I allow in will be asked to remove, shoes, jacket, coat etc and to go through the hand washing ritual. I will prefer them to wash downstairs to avoid them touching the stair rails. There will be no handshakes or hugs and they should attempt to stay 2 metres apart from me on different chairs.3) Visitors leaving my home will go through the process in reverse, washing hands, putting on outdoor clothes and shoes . I will open the front door and they will leave without touching it on the inside.4) There will be no value in my wearing a mask or disposable gloves. I will carry a supply of tissues and have them strategically placed at home for any one to use. They will be binned and later burnt.5) I will ensure I can be self sufficient for 14 days if necessary. Existing food in my food cupboard and freezer will nearly be enough but I will add some milk eggs and cheese to the reserves6) I will avoid eating out as much as possible but if I do I will use hand sanitising gel on my hands once seated at a table before and after I handle cutlery and crockery. I will endeavour to avoid touching my face nose and eyes as much as possible. I may consider eating in my car if the shop is too crowded to stay well apart.7) I will do my weekly supermarket shop at off peak times, My best option would be about 7am as the shop will be quiet and the shelves restocked over night, whereas later in the day shelves are likely to be empty. I will not stockpile or bulk buy.8) Wherever possible I will pay for goods using a contactless debit card, if not possible new notes from a cash dispenser could be used. Lose change given by the cashier can be tipped into a small plastic bag to avoid touching it. It can be cleaned later at home. Cash machines can be wiped before having to touch the screen.9) My mobile phone should only be used by me but it should be cleaned regularly using an alcohol-based wipe10) Deliveries and the daily post can be left at the front door so as not to have human direct contact. Having dealt with the delivery I will wash my hands in the approved way.11) I will put shopping away using the refrigerator as much as possible. The virus will not survive freezer temperatures or refrigerator temperatures for very long12) I will keep in daily contact with my neighbour by telephone. We can do one another’s shopping sometimes to avoid us both having to go out. Similarly, I will have regular contact by phone or social media with family and friends. A few key people will know how to get into my home if no reply from me.13) I will not be attending any large mass gatherings but may well still attend important planning meetings if easy to stay a distance from others 14) If my efforts to delay catching this virus fail I will ensure I take my temperature regularly, drink plenty of fluids maintain good control of my diabetes and take regular Paracetamol. I will then self isolate and inform NHS 111 of my situation if I am not getting better within 7 days, 15) I will maintain self isolation at home but this does not mean I need to stay indoors. I have a large garden I can use to get fresh air and a change of scenery. The UV light is beneficial . I will get out of a chair at least every hour and exercise core muscles to maintain physical fitness. Mental fitness will be helped by the judicious use of social media, television and radio. I have signed up to take a short Coursera educational course to maintain a personal development plan.16) These measures will regularly be reviewed as the risk assessments change and will be amended or updated as required based on science and best medical practice as well as the CMOs advice and Government directives.Dr K C Hines 15 March 2020.

March 18

As we know the vast majority of people infected with Covid 19 get better and after being infected should be immune from catching the same strain a second time. Does any one know if there are yet facilities to do titre testing to demonstrate their immune status? A certificate of immunity should be a passport back to work and provide strong reassurance that such persons are safe to be with. It is also believed there may be many who have had a mild infection without realising it, and many more may have an immune level of anti-covid antibodies.

To those who say the covid 19 pandemic is un precedented, this picture is from the USA in 1918. A field Hospital in Brookline Mass.

March 22

José Ameal Peña was four years old when the 1918 flu tore through his small fishing town in northern Spain, its deadly path narrated by the daily ringing of church bells.More than a century later, Ameal Peña – believed to be Spain’s only living survivor of a pandemic said to be the deadliest in human history – has a warning as the world faces off against Covid-19. “Be careful,” he said. “I don’t want to see the same thing repeated. It claimed so many lives.”The 1918 flu, known as the Spanish flu after the country’s press were among the first to report on it, killed between 50 and 100 million people around the world.In Ameal Peña’s town of Luarca it claimed 500 lives – a quarter of the town’s population of 2,000. He watched from his window as a steady stream of funeral processions made their way to the cemetery.In autumn 1918 he became the only one of his seven siblings to catch the flu. “I still can’t figure out how I’m here,” Ameal Peña, now 105, told the newspaper El Mundo. “When I woke up I could barely walk. I had to crawl on my hands and knees.” As he wrestled with a relentless fever, a doctor prescribed vapours of boiled eucalyptus and seaweed.

March 23

Being positive. In 9-12 months time there will be a big rise in the birth rate and the most popular name will be Quarantine

This is a good article – very detailed but also very readable

Article link

Well, called back to work unexpectedly this morning. I was out buying potatoes and milk and came across a serious road traffic collision where a car had rammed the back of a lorry at 60mph. A good job most of my kit and PPE was still in car. Spoke to Ambulance control and identified my self. Told they had no resources for a long time. It was over an hour before one arrived to assist. To be fair 3 stopped to check I was all ok and managing but all had patients on board, so drove away. It even took police 40 minutes to get there. Excellent help from 2 truckers who helped, and protected me. Just like old times really!!

March 24

A longstanding friend, an ITU anaesthetist, points out the upward curve between Italy and the UK is just beginning to separate. This means there are encouraging signs that we just might be flattening the curve and pushing it to the right. We can get through this but its vital we stick absolutely to the rules being laid out for us

Image may contain: text that says "6,000 5,000 Cumulative deaths (actual) for UK vs. Italy UK first death on 6/3/20 Italy on 21/2/20 UK tracking 14 days days behind. 4,000 Kaa 2,000 3,000 1,000 10 10 15 20 Days from first death 25 30"

March 25

Another positive thought for the day. Staying home saves lives. It also, for very many of us, saves money. Can I suggest we put those savings aside each week for the time being. When this is all over perhaps we can donate some to our favourite charities or perhaps help out those self employed who are losing income, as well as rewarding ourselves with a party. I am sure the logistics of government support for those losing money will be addressed very soon.

March 25

Many of you are “dog people” who are used to training dogs to sit and stay. Why can we not train humans to do the same?

March 26

I remain cautiously optimistic that the early figures suggest some limited success in “flattening the curve” and “pushing it to the right”. See my post of a few days ago. It will be about another 10 days before we can verify this but the early signs are encouraging BUT it will only work if we all obey all the guidance for the foreseeable future. I am happy to try and assist any one with issues or concerns. Please text email or phone me.

March 27

Well Clap the NHS certainly focussed the nations attention on the work of the NHS. I want now to change the focus to counting the daily numbers that are declared fully recovered. 140 since this was first reported on 5th March. As the virus takes on average about 3 weeks to fully recover from we will see this number steadily rise over the next few weeks. These people will be a very important group, as we fully expect that when the antibody tests become available they will be immune from further attack of the disease and therefore a safe workforce to assist in the care of new cases in the weeks to come. Stay safe, stay at home and keep communicating with one another.

March 28

I am not really disappointed by the rise in fatalities in the last 24 hours, it was to be expected and still well short of the worst case scenario. The rate of rise is slowing slowly we will see real changes in about 2 weeks. My estimate is that deaths in the UK will not get much above 6000, bad enough but could be a lot worse. More people are recovering every day. Testing this week will be very helpful in our ongoing assessments Keep safe, Stay at home, actively plan new activities in home or garden. I have constructed a bookcase kit today. I remain very well.

March 29

There is a very amusing spoof Ladybird book on Covid 19. Its well worth a read, it will make you chuckle as you remember the ladybird books that you read to your children. Unfortunately I haven’t been able to post it here. You will find it if you use a browser looking up Ladybird and Covid 19. it will be about 3-4 on the list you will find it . My skills with the computer are lacking! If anyone else can do it please post it for me. My skill with the computer are lacking! If anyone else can do it please do. so

The spoof book

March 30

I have just listened to the daily briefing and I continue to be cautiously optimistic that this pandemic will not be dreadful as first feared. Bad enough for sure, and we will not be certain for another few weeks. I continue to read absolute rubbish on social media, one such comment was that no one sporting a beard would be ventilated if they needed it after contracting Covid 19. I strongly suggest you find two or three sources of information you trust and ignore the rest. So called experts are cropping up all over the place. I have said before I am no expert. I am not a public health physician and not a virologist. My knowledge is around emergencies and contingency planning. As a GP I needed to explain thing simply with language most can understand. The complex graphs you are seeing are very difficult to interpret as different countries report data in different ways. At least one country does not report Covid 19 deaths in the community, only those in hospital being reported. The good news is that the daily increase in number of deaths is improving. the figures are 260 for Saturday, 209 for Sunday and 180 today. When things are bad they are doubling every 2 days, We are running much better than that now and it seems to be about every 4-5 days it doubles. As testing starts we may see more cases detected so there may be a rise in the numbers but do not worry about that. The vital facts are that we must continue to socially distance ourselves and to stay at home. This is what is working. We must not under any circumstances relax the rules until the expert Gov. scientific advice tell us. The best Scientific advice is coming from Imperial College London.

March 31

Today’s briefing by Michael Gove continues to be encouraging. Every single one of us can contribute to saving lives by staying at home and maintaining social distancing. We must not reduce this in any way at all, or we risk ruining all the good work that has been done. Stay home, Support the NHS and Save lives. We can all try to reduce the risk of accidents whilst we are at home. The garden is a source of hazards so be careful up that ladder, using a garden fork in plimsols etc. Do not add to the NHS work unnecessarily. The number of new cases reported shows early signs of flattening out which is good news but this needs to continue over the next week before we can accept this as definitive. So no complacency, but as it was put tonight some early green shoots are there. There will inevitably be daily fluctuations in the numbers as the accuracy of collecting will vary. I am not too alarmed by the rise in the number of deaths reported. The primary reason for this is probably a change in the way they are being counted. Deaths reported in primary care that may be associated with Covid 19 are now being reported. Looking at regional figures people seem concerned that London has the highest number of cases, of course it will ! It has by far the highest population . A much more accurate picture would be available if we looked at the prevalence of the disease in terms of the percentage of the population. The same is true if we compare the figures of different countries. The vast difference in size of the population in the USA compared to the UK means we cannot compare figures but the media and some of or experts do not seem to grasp this. There is further good news on ventilators, and CPAP machines. Our incredible NHS has stepped up to the mark. They still have a way to go before we run out of ventilators and hopefully that crisis will be avoided. Finally a thought for the day. Why are men both catching and dying of Covid 19 more often that women, Is it just man flu or is it we just are the weaker sex ! I am interested in your thoughts on this. I will address it in a later post. Remember your contribution is to stay at home whenever possible and stay 2 metres apart. Together we will win this battle. Ignore many self appointed experts. Remember the definition of an expert is; ex means past it and a spert is a drip under pressure!

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