Our Covid-19 dilemma: how do we prepare for the worst without making things worse?

There may come a time to escalate, but prematurity risks increasing the sense of threat to no good purpose.

A sign directs patients towards an NHS 111 Coronavirus (COVID-19) Pod, where people who believe they may be suffering from the virus can attend and speak to doctors, is seen outside University College Hospital in London on March 5, 2020. - The number of confirmed cases of novel coronavirus COVID-19 in the UK rose to 90 on Thursday, with fears over the outbreak delaying the global release of the new James Bond movie and causing lack of demand for air travel that has proved the final nail in the coffin for British regional airline Flybe which went into administration on March 5. (Photo by ISABEL INFANTES / AFP) / The erroneous mention[s] appearing in the metadata of this photo by ISABEL INFANTES has been modified in AFP systems in the following manner: [University College] instead of [St Thomas']. Please immediately remove the erroneous mention[s] from all your online services and delete it (them) from your servers. If you have been authorized by AFP to distribute it (them) to third parties, please ensure that the same actions are carried out by them. Failure to promptly comply with these instructions will entail liability on your part for any continued or post notification usage. Therefore we thank you very much for all your attention and prompt action. We are sorry for the inconvenience this notification may cause and remain at your disposal for any further information you may require. (Photo by ISABEL INFANTES/AFP via Getty Images)

Our preparations for the arrival of Covid-19 have thus far been concerned with balancing public information against unnecessary anxiety. The practice’s website now has a standard coronavirus information box superimposed on its homepage.

We have put the regulation posters on the surgery door exhorting anyone with a relevant travel history to go home and phone NHS 111. Unlike some of our neighbouring practices, though, we have yet to send out a mass text to all patients.

There have been no known cases in our decidedly provincial area, yet there is palpable concern among patients. There may come a time to escalate, but prematurity risks increasing the sense of threat to no good purpose. There are still a lot of winter viral infections around with symptoms identical to coronavirus. NHS 111 is already buckling under the pressure; we have no desire to add to their load.

We’re talking about it daily, though, among the doctors and our practice manager, keeping a weather eye on the situation. In the UK there have now been several cases without a relevant travel history or known contact with Covid-19, implying the virus is escaping containment measures, which is why the government has up-rated its risk level from low to medium. The government’s chief scientific adviser, Patrick Vallance, and England’s chief medical officer, Professor Chris Whitty, greatly impressed with their calm and authoritative performance flanking Boris Johnson. When, as most people expect, sustained person-to-person transmission starts to occur, the revised goal will be to dampen and spread the peak, so that the NHS has the best chance of coping with the surge in demand.

Our chief difficulty lies in not knowing what will be expected of us. In this containment phase, our role is entirely focused on keeping any suspected cases at barge-pole distance. Testing is being conducted in isolated pods outside A&E, or at home by community teams. But if and when we’re getting thousands of cases nationally every day, we GPs are going to be in the thick of it. It would be great if somebody could give us some sense of what we’ll be doing. We’ve just been sent protective clothing. But will we be out there swabbing? Should we be segmenting our team into Covid-19 and non-Covid-19, trying to keep some semblance of normal health care going alongside the coronavirus work?

In the absence of information, imagination takes over. Our retired senior partner, who still does a few sessions a week as a retained doctor, is buzzing with excitement. He has ordered two big yellow plastic signs to place outside the surgery entrance to draw attention to any instructions we need patients to follow. He has ideas about assessing people in their vehicles in the car park. The government talks of bringing health-care professionals out of retirement to bolster numbers, but I’m not sure it’s realised quite what it might be letting itself in for.

One of my partners is approaching it with weary cynicism. The system is going to become gridlocked with worried but fit people for whom Covid-19 will be nothing worse than a bout of flu, while we’ll be left coping with the housebound frail elderly who are truly at risk of life-threatening complications. While she radiates sangfroid about it all, she has also admitted to having started to wash her hands more frequently: a perfect illustration of the ambivalence many of us currently feel about a virus that is simultaneously trivial and grave.

On the home front, I have a daughter due to take A-levels at precisely the time we’re expecting any epidemic to peak: what will happen to her plans for university if her school has to close, she wants to know. And my family has detailed me to talk to our elderly mother, most definitely in the at-risk population, about self-protection measures. The clouds are gathering, but no one knows quite how bad the storm is going to be.