Coronavirus: Nagging doubts fill hospital staff’s heads

In the first of an occasional series, Dr Muiris Houston reports from the coronavirus front line.

It’s been a busy time for doctors, nurses and other healthcare workers as the coronavirus pandemic gathers pace. GPs and practice nurses took the first hit as testing for the Sars-CoV-2 virus kicked off. Practices were turned upside-down as they moved to a telemedicine model and face-to-face consultations all but disappeared. They had to grapple with a testing request e-link that crashed. And patients were left at the butt end of a rapidly changing testing regime in which GPs were neither half in nor half out. Now there is worry about non- Covid-19 cases: where are the heart attack and kidney stone patients?

Hospital doctors’ professional lives have been upended also. Surgeons are being trained up to become intensive care doctors; they and others are formed into ICU teams with an experienced intensivist nurse or doctor leading each one. Intensive care specialists have been busy expanding ICUs to accommodate additional beds and ventilators. But as the number of Covid-19 patients admitted to hospitals requiring intensive care increases steadily, a new reality sets in. How will we cope if we run out of ventilators? And what if the much needed personal protective equipment that is on its way from China doesn’t arrive ahead of a big surge in patients? These and other nagging doubts are a constant background noise in hospital doctors’ and nurses’ heads.

The feeling that Covid-19 is spreading while people are still pre-symptomatic is getting stronger. Some evidence to back this up has emerged from the US but it will take larger studies to confirm. In the meantime it’s certainly a valid argument in favour of the even tighter physical isolation measures introduced at the weekend.

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Loss of smell

The other chatter on the front line involves an unusual symptom that seems to be emerging in Covid-19 patients. Loss of smell (anosmia) is a known post-infectious feature of viruses such as the common cold. Now evidence is emerging from South Korea, China and Italy pointing to significant numbers of patients with proven Covid-19 infection who are developing anosmia. In South Korea some 30 per cent of patients testing positive have had anosmia as their major presenting symptoms in otherwise mild cases. And there are a growing number of reports of a significant increase in the number of patients presenting with anosmia in the absence of other symptoms of coronavirus infection.

Many of us feel more reflective during this period of social isolation. Prof Frank Sullivan, director of the Prostate Cancer Institute at the Galway Clinic, shared this thought: "I'm having a little difficulty with the use of the 'war' metaphor in the context of Covid-19. Viruses were here long before us and in fact viral DNA comprises almost one-tenth of our human genome. Coronavirus on its own is a deceptively simple thing– essentially it is a packet of RNA (cell code script)."

“That is all it is. As such, and on its own, it has no power whatsoever. What turns coronavirus into ‘kryptonite’ for us . . . is us. Without us, coronavirus is useless. If we want to think in terms of war, we are the ones who actually ‘weaponise’ this virus.

“Perhaps it makes more sense to make our peace with this little packet of RNA and not war.”