As a GP, I’m expected to diagnose coronavirus without ever seeing a case

If I suspect my patient could have the virus, I must not examine her and I must not touch her. I have to leave the room immediately – and shut the door behind me

Coronavirus cases: The spread outside China

The woman in front of me is Asian and has a cough and sore throat. I freeze in my seat, the government’s coronavirus directive rushing through my mind.

Should I ask if she’s Chinese? Is it OK for me to ask?

I sit tight. Symptoms plus travel history. I need to ask her if she’s had any contact with Wuhan province. If she has, I must not examine her and I must not touch her. I have to leave the room immediately, shut the door and continue the consultation – by telephone, if necessary.

In the last three weeks, everyone has suddenly become an expert on viruses. For myself, apart from having a generally good knowledge of viruses already, I have a special reason for wanting to know more about this outbreak. As a GP, I am expected to be able to diagnose a coronavirus infection without ever having seen a case before.

This week The Lancet published an analysis of the first 40 patients identified with Wuhan novel coronavirus infection and it had me glued to my screen. Bravely authored by Chinese doctors working with the cluster of severe respiratory illness cases first identified on 1 December last year, the calm neutral tone of the paper belies the fact that 16 health care workers have since contracted the virus. Reading through the paper, I am not interested in the blood tests or the cytokines (although the chest CT catches my eye; it has a ground glass appearance) – that’s for the hospital doctors. I want the presentation: the symptoms the patient actually comes in with and describes.

A cough, a temperature, aches and pains, and a respiratory rate of over 24 breaths per minute after seven days of symptomatic infection. That’s what I need to memorise.

Part of the reason the government says the NHS is well prepared for an outbreak of coronavirus in the UK is because it has launched an “email cascade system”, communicating directly with every GP in the country. It has emailed us all a letter and attached official guidance. The guidance this time round is clear and has a simple aim – to isolate cases. If I suspect a case of Wuhan novel coronavirus, I am instructed to simply walk out of the room and leave the patient sitting there. It actually specifies shutting the door behind me.

I have worked through an epidemic before: the swine flu pandemic of 2008. I remember the first cases breaking out in public schools, the flowering of infections in cities throughout the UK, the daily updates on the TV and speculation on the death rate. I was a younger doctor then, and I was frightened. If any doctors refused to work and the pandemic was severe, we were to be physically escorted to the surgery by the armed forces. Infecting my family was the thought that dominated my mind. I planned to check into a hotel if I developed a temperature so that I wouldn’t bring the infection home.

Back then, the government expected GPs to take swabs from suspected cases. On one occasion I went on to the street to take a swab from a patient through his car window in order to limit contact. I remember sweating with tension standing by the side of the car, wearing “personal protective equipment” – a disposable plastic apron which would tear, a paper mask with plastic eye visor, hat and plastic gloves. Putting it on felt over the top and hysterical, but taking it off trying to minimise virus exposure was worse. Mask first? Gloves? We were asked to “deep clean” our clinic rooms, but had no equipment to use between patients except antiseptic room wipes.

I never caught swine flu but my children did, probably from school. They came down with it all on the same night with high temperatures.

Twelve years on, this time the threat of a UK viral outbreak feels different. I am older, more experienced as a doctor, and the guidance I’ve been given from the NHS is better. It seems to understand the conditions I work in as a GP. Its simple instruction not to examine the patient, although counter to my whole medical training, makes much more sense. If I am exposed to a life-threatening infection through work, I might catch it and some people might die. This time, however, I haven’t made any crazy plans of work refusal or self-isolation.

And the patient in front of me? She is Chinese. She quite understands my asking, when I do so with an apology. She is not from Wuhan province and she has not had contact with anyone from Wuhan province. In fact, she has not been to China for 10 years.

I put a stick on her tongue and look closely at her throat. I lift up her clothes at the back and use my stethoscope to listen to her chest. Then I wash my hands and tell her that she has a virus but will get well soon.

And I keep the coronavirus guidelines close by my desk, in case I do eventually need them.

Berenice Langdon is a GP working in south-west London

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