It’s hard to know how many infections resulted

Friday, March 19th, 2021

A junior doctor in the UK explains that the Covid pandemic didn’t feel real there in the first few months of 2020:

Then in early March it began to feel far more real. We’d had one confirmed Covid case in my hospital so far when I went to review a patient in Accident and Emergency. He’d had a fall here in England while on holiday from Milan — the epicentre of Europe’s outbreak — and needed an operation to fix a fracture.

I asked the A&E consultant if he had screened the man for any Covid symptoms and he laughed, admonishing me — semi-jokingly — for my “racism” against Italians. I suggested that we should isolate him until we had tested for the virus, to be on the safe side.

At this point I was told sharply “whatever next? We test everyone who walks through the doors for covid?” Looking back, that comment feels entirely absurd — today, of course, every patient has a rapid Covid swab before they are admitted to the hospital — but a year ago such an idea didn’t even occur to anyone.

While it was not within my powers to question a senior A&E doctor, I was able to suggest to my surgical consultant that the patient should be isolated “just in case”. We moved him from the open ward, alongside all of the other elderly patients with fractures, to a side room.

At the time tests were hard to get and results took 48hrs, although our hospital had developed a more informal 24-hour test which was “not yet clinically validated”. The result came back negative, although in block capitals underneath the result was written DO NOT DEISOLATE PATIENT UNTIL FORMAL 48h TEST. And so… we deisolated the patient immediately, because, so I was told, “He has a fracture that we need to fix. He’s got no symptoms anyway!”

The following day the result of the clinically-validated second test came back — the patient had coronavirus. By this point he had already been intubated and ventilated in theatres, itself an aerosol-generating procedure, and on several separate open bays full of patients. It’s hard to know how many infections resulted; how many deaths.

It’s worth remembering at this stage that masks were strictly Not Allowed when reviewing patients, unless they had either tested positive or had symptoms, and had also recently returned from China, Italy or Iran. When we were assessing our Italian patient in A&E, we were told sternly to remove our masks, lest we “scare the patients and other staff”.

My colleague, who had reviewed the patient with me, developed a cough several days later. Initially she stayed at work, since she had neither shortness of breath nor fever; when she called in sick the next day, many of the consultants laughed at how she had clearly been scared by her Covid contact, and was being ridiculous to not work through her “mild cold”. She was later admitted to our hospital with moderate “Covid pneumonitis”, as we would now say, requiring oxygen to help her breathe.


  1. Gavin Longmuir says:

    What would have been the UK hospital’s procedures for dealing with an incoming patient with a bone fracture and flu? After all, flu is very common in cold damp England during the wintertime, and those National Health Service hospitals have been providing free care to every Brit for decades.

    We know that the mortality rate associated with Covid is comparable to that of the flu. We know that the same group of people are particularly susceptible — the old & infirm. And we know that the transmission mechanisms for flu and Covid are similar. So whatever precautions the hospital took for patients with flu would seem to have been adequate for patients who tested positive (whatever that means) for Covid.

    Just asking!

  2. Kirk says:

    Friend of mine who was an epidemiologist by training spent some time inside the NHS because his English wife insisted on going into that system instead of the military one at the Air Force base he was stationed at in the UK. His description of NHS sanitation and general biological controls was epically obscene, and if his wife hadn’t insisted on the more congenial atmosphere of the NHS hospitals, he’d have never let her inside the doors of one. Her complaint was, and I quote, that US military hospitals were “…too antiseptic and sterile…”.

    Hand-washing standards and all the rest of that sort of rigid protocol were not followed to his satisfaction–Which, admittedly, was true for a lot of US facilities, as well. His take on ER procedures in a lot of military facilities was equally obscene, because all too many use the ER as a substitute for making an appointment and/or going on sick call. If it had been up to him, there wouldn’t be any ER facilities at all–You’d wait in your car for someone to bring you in for triage, and you’d be the only person in the room when it was all done. Which, if he’d had his way, would have been able to be sterilized with fire.

    Apparently, there had been a MRSA outbreak at his hospital when he was doing some level of his training, maybe residency. He had a horror of infectious disease because of it, and he was telling me in the 1990s that we’d be facing the total loss of effective antibiotics by about… Now. So, he may have been a tad on the paranoid side, I dunno.

    He did not have much professional respect for the NHS system–Thought it was a lovely idea, but the execution was undisciplined and slack, with not enough attention paid to sterility and all that. A factor in his opinion may have been the MRSA outbreak that took place in the facility nearest his residence in England, which tended to get him frothing at the mouth outside the hearing of his wife, who’d hear nothing said against the NHS.

  3. Altitude Zero says:

    National Health systems seem to become a religion for some people,lots of Canadians are the same way. You can criticize their cops, their military, their politicians,their trains and roads… but when you criticize their health care – well, that’s pure calumny. It’s odd.

  4. Kirk says:

    Having lived under what is effectively a “national health care system” with military medicine, about all I have to say about that is “WTF?”. The number of horror stories I have observed with people under what amounts to low-budget socialized medical care leaves me with zero desire to see that spread out across the entire nation.

    The “budget triage” performed by the military system is incredibly destructive–I had guys whose injuries from normal peacetime training left them unfit for service, and yet who could not get either the necessary care they needed, or medically retired. One suffered a spinal injury that literally took most of a decade to resolve, and which the civilian doctors his family finally hired fixed with two surgeries and a year’s worth of physical therapy. After the Army finally forced him out…

    He’s running triathlons, these days.

    The problem with anything like health care winds up being with the administration of it all. You can’t run something as wildly variable as medicine with a few simplistic rules and expect it to work for everyone.

    What kills me is that all these people that are pining for “free medicine” fail to see the downsides of it all: Once you sign over all that to the bureaucracy, the bureaucracy decides everything, and if the bureaucracy decides you’re too expensive to fix and/or keep alive…? Guess what, baby? You’re gonna die. No recourse, either, if they can manage to suck in that sort of power.

    The other aspect to all of this is that America is uniquely horrid at bureaucracy. I’d say that the Germans are a lot better at it, and their medical system shows that–Our bureaucrats and time-serving do-nothing hacks that wind up working in government would turn the German system into a nightmare of Kafka-esque horror, were we to try to copy it here.

    I don’t know why it is, but somehow… We always manage to make a hash of these things. To a nightmarish degree–I think a lot of it has to do with the fact that in the US, your bureaucrat types are not given the least respect, and the entire profession is seen as being for losers. There’s no social status to it, no social prestige. Because of that, nobody goes into government service who isn’t basically a loser doing it for the wrong reasons. It’s not always a truth, that, but… Overall? I think it is, and it plays into why the American bureaucracy is so damn incompetent, venal, and insufferable. You can also read “teaching” and “police” into that description, and get a solid grasp on why those professions are filled with losers that won’t teach and like to abuse their authority while their peers stand by and just watch. No standards really enforced, no prestige… No professionalism.

    We treat these functions as though they’re not really that important, and the results we get show what that gets us. Where is the well-administered government program that actually does what it is supposed to, and comes in under budget? I honestly have a lot of trouble thinking of any, although I know there must be some, somewhere…

    I hate to say it, but American culture basically encourages bad governance in all too many spheres–Look at our unions, for example: In Europe, I watched a union blackball an employee for life because other employees caught him stealing from the company they all worked for. That guy was never going to work in that industry again, ever, once the tribunal was done with him. And, the employer wanted to look the other way because “wife’s nephew”. Here in the US, there’d have been a strike by the union to keep that thief on the job, regardless of how it affected the company.

    Different mentality, different culture. We don’t do that kind of thing very well, at all, and it’s about time we recognized it and started trying to figure out how to compensate for it and work around the problem.

  5. Altitude Zero says:

    Agreed. This is one reason that taking stuff that seems to work in Europe or Asia and implementing it in the US is almost always a mistake – the US is a different country and culture, and people are not fungible, no matter what dumbass economists think. Of course, we’re not the only ones – British Leftists imported the Scandinavian welfare state into Britain, and were appalled when it produced an undeclass of lazy, violent, drunken football hooligans, rather than well-behaved Scandis. They simply never learn…

  6. Kirk says:

    It’s almost like every culture and country is different, or something…

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