If my pupils get ill, the parents will bring out the flaming torches and pitchforks
Headteacher of a primary school in Nottingham
A lot of the kids had already heard about Covid-19 because it’s been on the news. I invited a member of staff for Public Health England to come into my school last week to give an assembly on cleaning hands. To ensure the pupils didn’t feel worried, we were careful to stress that good handwashing is what they should be doing anyway, to avoid getting colds and tummy bugs.
The reality is, though, I’ve got 200 children at my school and about 20 sinks. Making sure each child washes their hands for 30 seconds four times a day (after they arrive, before snacktime, before lunchtime and before they go home) is quite a big ask. If we really try to enforce that, we will cut into learning time and break time. It’s very hard, logistically, to get them all to the sinks and back quickly.
A number of families at our school have recently returned from holidaying in Italy. None of them are feeling unwell and none are self-isolating. They did ask me for advice on what they should do. But there’s a reason it’s called “self” isolation. It’s a tricky question for me to answer. First, I am not allowed to say you should keep your kids at home. Second, missing two weeks of school is massively detrimental to someone’s learning. But on the other hand, we have immunocompromised children, parents and grandparents in our school community.
If staff or children fell ill, I’d feel awful and to some extent, responsible. On top of that, all the parents would be up in arms, criticising my decisions, bringing out the flaming torches and pitchforks, and the names of the children who didn’t self-isolate will be mud. Already I’ve had parents emailing, saying we should be bleaching the desks after every lesson. No matter how well we follow Public Health England’s guidance, if someone does contract the coronavirus via a school, headteachers are liable to get the blame.
My pharmacies are getting a hundred requests every day for hand sanitisers
Olivier Picard, owner of four Newdays pharmacies in Berkshire
We are getting about 100 requests every day for hand sanitisers, but we ran out of stock more than a week ago. We are also getting 20 people a day coming in to buy face masks, and we still have some of those left.
My advice to people who come in for hand sanitisers is that washing your hands with soap and water is just as efficient as using the alcohol-based gel. Anxiety levels are definitely rising, because more people are talking about it, especially in the media. I have patients with long-term conditions and respiratory diseases who are genuinely worried that the coronavirus might infect them, and are thereforelooking for professional advice. A pharmacist is available to them without an appointment, in a way that a GP isn’t.
We’re getting lots of information from NHS England and the National Pharmacy Association, which has been very helpful. But seeing an extra 100 people a day who need reassurance about the lack of hand sanitisers means we are very busy. For the past few weeks, I have been working 12-hour days, six days a week, staying for hours after the pharmacy closes to dispense prescriptions and do work I would normally have been able to do in the daytime. Then, at the end of the day, I make sure I catch up on the news about the virus and NHS emails.
I am most worried about how the coronavirus might hit my staff, particularly the pharmacists who dispense the medicines. There could come a point when I and other pharmacists across the country can’t operate and that would affect the health of many people. I do find it very difficult to switch off from it all. But when I finally get home and put my key in the door, I try to put my phone down and give my young family the little time I have left in the evening. We tend to avoid conversations about the virus.
Residents of our care home are in their 80s and frail. An outbreak would be catastrophic
George Coxon, director of Classic Care Homes Devon
We have been gearing up for an outbreak since initial reports of the virus, primarily by redoubling our basic everyday good hygiene practices. I have also been reassuring staff, and sharing public health updates from the government. We are reasonably well-stocked with hand sanitiser and disposable waste bags, although panic buying is giving us the biggest cause for concern at the moment.
Most of our residents are in their late 80s or older. They are living with advanced frailty and many have dementia. If they are exposed to this highly contagious virus, the consequences would in all likelihood be catastrophic. But while it’s right to be vigilant and aware of the risks, at the same time I’m trying to keep up morale and make sure everyone feels safe. If we all started wearing masks and gloves all day, it would cause a huge amount of anxiety among our residents. It’s also unrealistic to expect that people living with advanced dementia and frailty are going to wash their hands between five and 10 times a day.
Similarly, banning visitors is an absolute last resort, because I know how important it is to our families to be able to come and see their loved ones. We want to have a proportionate response to what is going on.
I am most concerned about the consequences of a blanket school and transport closure. Many of our staff have school-age children and don’t drive. So there’s anxiety about whether staff are going to be able to get to work and whether food and medicine supplies will be disrupted. But I’m trying to keep myself feeling bubbly and buoyant, so I can keep up morale and lead by example.
I can’t wait for this to be over. I hope I never have to wear another face mask again
Staff nurse from an A&E department in south-west England
I spent last weekend as the designated CV (coronavirus) nurse, and we were inundated with referrals from 111 calls and patients self-presenting. The protective equipment we’ve been given is very uncomfortable to wear, and just being in it for about 15 minutes feels like a lifetime: you find yourself sweating and you cannot wipe your brow. The patients I saw just wanted reassurance: despite their signs being mild they wanted to know they were going to be OK.
I reiterated the Public Health England message that self-isolation is key and meticulous hand washing is the best course of action. I also reassured them they would get their test results within an average of two days – with a phone call if they were positive. That classic “no news is good news”.After one day off from CV duty I was back to it on Tuesday: another day working long hours, but at least there was a positive side: I was working with my favourite doctor. We had a relatively pleasant morning and I got my lunch in good time.
Later in the week we were advised by our managers that the general public were bulk buying hand-sanitiser and we needed to be mindful they might come and target our department looking for some. An additional lock has been placed on our store cupboard – I don’t know whether to laugh or cry.
Last Thursday we had a total of 16 patient referrals, a mixture of 111 referrals and people who were self-presenting. I think that is the only frustrating thing about all this: people who are not following the public health advice, which is to call 111 and stay indoors, not come to hospital, where you are putting many more people at risk. We will not get pre-alerted that these people are on their way and subsequently they end up mixing with the general population that attend our department. It is important we educate them, and don’t get too frustrated, as they tend to be anxious and are simply seeking health advice. Anyway, I cannot wait for this to be over – I hope I never have to wear another face mask or goggles again.
We are now screening all patients, and segregating any with respiratory problems
Dr Jane Wheatley, a GP in North London
Although we are still in the early stages of the Covid-19 outbreak it has already had a major impact on the surgery where I work.
One of our receptionists told us that her younger brother had become unwell after returning from a school skiing trip to Italy, as had several of his friends. One of them got tested for the virus. When our receptionist’s mother rang 111 to see if her son needed to be tested too, they said someone would come out to do that.
When we heard that, we sent our receptionist home as a precaution. Public Health England said she should self-isolate and be tested and we should deep clean the surgery. That was done– overnight, so we didn’t have to close – and our receptionist self-isolated. But despite several more calls to 111, her brother was never tested – his friend tested negative – and neither was she, so she came back to work. But the incident did raise concerns for us as a practice about how 111 are handling things.Last Wednesday we were told that one of our patients had been admitted to hospital with Covid-19. The next day a local primary school emailed parents of its pupils to say that a parent had tested positive for coronavirus. The parent is not in hospital, though; they are self-isolating at home. That’s in line with the new policy announced that day that Professor Chris Whitty, the chief medical officer, Public Health England (PHE), the NHS and ministers have agreed, that if people who have tested positive have mild symptoms then they can stay at home as long as they isolate themselves to reduce the risk of onward transmission.
Also on Thursday a parent at the school who had received its email rang our duty doctor to say that they had a child who had been unwell for a week with a temperature and dry cough but had no history of travel to any of the high-risk areas. 111 had advised that the child should see a GP. But after consultation with PHE (three phonecalls) it was decided not to see the child in our surgery and that the father should ring 111 again, with our duty doctor reviewing the child again by telephone.
As GPs we do have questions about the advice NHS111 are giving some people. So far I have seen two possible Covid-19 patients, both at the GP extended hours service where I work on Saturdays. The first had symptoms of a mild viral illness and wanted a test for the virus. He had recently come back from a conference in the Far East, but not a country with a high incidence of cases, which meant he could not be tested. NHS 111 booked him in. I feel that he should have been told to self-isolate at home and not been booked in to a GP appointment, because he was not unwell enough to be seen by a doctor. I think he just had a cold.
The second patient had a temperature and dry cough but no recent history of travel to an affected area overseas but had been in touch with two people who had been to a Category 1 (high-risk) country. Again he was worried about infecting family members and wanted a test. Again he had been booked in by 111. That’s a concern, though, because the official advice is that anyone who may have Covid-19 should not go to a GP surgery. Generally patients worried that they may have the virus are phoning us for advice. But we’ve also had two patients with symptoms come into the surgery asking to be seen, both after being told to come by 111. Neither was very unwell. We appreciate that 111 services are very busy just now, but why are they sending people who may be infected and who want a test to a GP surgery?
We are now considering or have already implemented steps in line with the government’s strategy of “contain” and then “delay”. That includes screening patients when they book an appointment by asking about travel and potential symptoms of Covid-19, and segregating patients who have any respiratory symptoms – such as babies with bronchiolitis and viral-induced wheeze – in our isolation room, so we keep them out of our waiting area. We’re also dealing with more patients on the phone, through home visits and by issuing longer prescriptions to reduce the need for people to come in to the surgery. Older doctors and pregnant doctors may also concentrate on doing lab results, paperwork and telephone consultations rather than seeing patients, as we have to look after ourselves as well as our patients.
But we also need PHE to takegreater account of GPs’ clinical judgements about who needs to be tested, as too many people are finding it impossible to get a test, and 111 to be more consistent and not send possible Covid-19 patients to GP surgeries like ours, just because they haven’t travelled or are not very sick. And importantly, we need the NHS to ensure that every GP practice has the right Personal Protective Equipment – an FFP3 respirator mask, full-length gown, long gloves, head cap and goggles or face visor – to deal with any patients we may come across who we think may have the virus. That has taken far too long to happen, which has also been an issue for GPs.
