Broken sleep & Coronavirus (Bruce Lee, the philosophy of time and space and this week)

Saturday morning. 2am.

Normally , now, I would be fast asleep;

The Covid… What to call it? Crisis? Situation? Pandemic? Is a moth battering at the inside of my head, tapping for attention.

This week has been stunning; not least because of, let’s call it ‘CV’ – we need to own the infection rather than as it does now, have us. We need to understand and overcome our fears and worries.

As a potted summary – here is how it looked; Monday – usual day in Manor Field, patients, thoughts of what might be, Tuesday, teaching junior doctors Quality Improvement in the morning and annual lecture for medical students in the afternoon; about all ageing, Wednesday in Manchester, World Delirium Day – nose-bleed on the podium and updating a roomful of people about our network (Yorkshire and Humber Strategic Clinical Network), then, in the evening announcing my plan to step-down as chair of B:Friend, a charity I have supported since its inception, Thursday was teleconferences and working from home in the morning and Manor Field in the afternoon and our first ‘lock-down’ following the attendance of a suspect patient, followed by deep-clean and further information which made our actions feel a little like an over-reaction, although all agreed better safe than sorry; Friday morning, the cancellation of my trip to Wakefield, instead beaming-in to Mid Yorks Hospitals via Microsoft Teams (technology worked flawlessly) to give another talk on delirium; the rest of the day trying to understand next steps – testing digital technology, clarifying how we will support patients and staff.

And now, having seen, not heard, the chorus of Italians singing from their flats, these are crazy times.

What will be?

So many, too many questions.

It seems that still, there is both too much and too little guidance. Some of what comes-out doesn’t fully make sense, other information is superseded. (NK). The Public Health England website is full of withdrawn guidance and links that don’t connect – there is a fixed rate at which national documents can be published and released, regardless of our degree of preparedness.

When you listen to the professors, the UK has been planning for this event for years and is in a good and resilient position to keep us going; again, no one knows. It is probably better to have faith than fear.

And, what is the fear?

Mostly, I imagine, the unknown.

For those in healthcare it is the potential impact on us and our work; healthcare workers are at risk, yet, what is the risk? Will the flimsy apron and mask keep me safe? 99% of people who contract CV recover. This percentage is dependent on many factors;

If you look at the number of cases even in Italy, with a population of 60 million, the stats of today, 14/3/20 are 18,000 cases identified, that is .03 percent of the total population with the number of people who have died at 1,300 or 0.002 percent. I don’t want to make the mistake others have made of comparing this with seasonal flu, yet, I am not entirely sure of the difference other than the mortality rate being higher, and, a raft of other reasons – lack of herd and personal immunity for example, absence of vaccine or medicines.

It is a mishmash of thoughts, worries and conjectures.

I heard yesterday about an Italian doctor who had died from CV. This is very, very sad. Yet, on a daily basis, how many doctors die of infections (or other incidents) during their day to day work? Likely more doctors committed suicide yesterday than died from CV (somewhere around one person a minute kills themselves globally each year).

Statistics was never my strong point, although perhaps this was one of the reasons they made us open our books at medical school; in order to gain a degree of proportionality.

Sure, this is massive; this disease is resulting in sickness and deaths globally beyond what would normally be expected at this time of the year, we already have seasonal flu, the common cold, measles, chicken pox, mumps, good old fashioned pneumonia and a host of other viruses and illnesses; CV is the new one and it is adding to the mix.

There has already been discussion about the opportunities that CV has provided, particularly for the NHS; the potential to cut down on the non-value adding steps in the everyday lives of patients and staff. We are arranging phone follow-ups and review by hospital doctors and nurses – that anxious trip to the hospital, the early start, battle to find somewhere to park all avoided by a quick call, or the introduction of video consultations; we have had the technology for years, yet the standard until now, if you had the flu was to wait in a GP surgery for 40 minutes, spreading germs to others, to be seen by a doctor or nurse who you may well infect. Now we can Facetime, Skype or use any number of other technologies to overcome this. Sure, it is difficult to sound a chest or check blood pressure or pulse remotely, yet, we can likely address many of these complexities – most phones are able to check heart rates – some can measure oxygen saturations. Mine can do my ECG.

Getting rid of the routine allows people to focus on what is important. (Bruce Lee said this in the 60’s – ‘Hack away the un-essential’)

Will, this lead to an unsustainable backload of other stuff? We will face that when we come to it.

It was interesting; on Thursday, in the surgery when we had our ‘scare’ everyone went from calm/business as usual to worry/angst/anxiety in a flash. Some focused on solutions, others chose to communicate their nerves by talking non-stop.

The time before hearing of the possibility and afterwards was the matter of a moment; nothing had really changed, yet everything felt different. Our heads filled with thoughts, ideas, solutions, steps, a sense of urgency appeared, yet, nothing was different from an hour before, before we knew or had heard.

In a couple of my talks this week I discussed an acronym we use in the world of delirium; it is called ‘Time and Space’ each letter standing as an aide memoire for the causes of delirium and ways to help people – check, T, Toliet (bowels and bladder), I, Infection, M, Medication, and so on.

We chose to use Time and Space as not only was it a better phrase than the one previously in use ‘Pinches Me’ which I have always hated, it also conveys separately the guidance for any crisis situation – take some time and give yourself and others some space to pause, to think, reflect and gather your thoughts.

I am sure we could all use a little time and space.