Notes from my sick bed

The simple answer is, I don’t know. The guidance to self-isolate if you are showing symptoms came at the same time as the guidance to only test people who are hospitalised. I have had a persistent dry cough, difficulties breathing and a mild fever. But I will never know whether it is COVID-19.

I don’t know why testing is being restricted to hopsitalised patients, but I suspect it due to limitations on testing capacity. This is currently being ‘ramped up’ [1], and if my theory is correct then it is absolutely right to reserve the limited resources for those who need them most. But you can’t treat COVID-19 anyway, so what’s the point of testing for it?

Well, what are the implications of people self-isolating and not knowing whether or not they have been infected with COVID-19?

My symptoms started on Monday 9th March, with a very sore throat followed by a cough and a tight chest. The sore throat was short-lived, but as the cough got worse my breathing difficulties followed. By Wednesday evening I was struggling. I had very little energy, even walking around the house felt like a lot of effort, and my blood oxygen level was only 90%. Being an asthmatic, a chest infection like this over winter isn’t unusual for me, so I was working on the assumption it was fairly routine. In usual circumstances, by this stage I would go to see my GP to have my breathing assessed and appropriate treatment given.

However, as I was about to do this, the guidance came for everyone with symptoms to self-isolate. I was stuck, I needed medical assessment but I wasn’t allowed to go anywhere. The lack of testing to either confirm or deny my diagnosis left me at risk. I called 111 and was escalated through the call centre to a paramedic, GP and then her supervisor as to what action should be taken. The end result was that I was issued antibiotics and oral steroids to boost my usual inhalers (that I had already doubled the dose of). Neither of these would be effective against COVD-19.

By Saturday afternoon, I was starting to feel a little better. This is most likely to be a response to meds, which would indicate I was negative to COVID-19. Or maybe it was COVID-19 and I was over the worst of it – the NHS guidance suggests you should start feeling better with 7 days[2], and Saturday was day 6 for me. My improvement has done nothing to confirm or deny a COVID-19 diagnosis.

Why does it matter that I don’t know?

  1. If it was COVID-19 then everyone I have been in recent contact with should have been self-isolating too. Because it hasn’t been confirmed this hasn’t happened, and these people could be walking around spreading the virus to anyone around them. This includes the elderly, vulnerable, or those in high risk groups, which is why isolation is so important in the first place.
  2. If I have had it, it would mean I could help others as they isolate. I have no doubt that isolation guidance is going to get a lot more stringent, and if I have already been exposed I could be one of few people able to get out and about to help friends, family, the vulnerable and the wider community A small number of people have been be re-infected [3], but that is by far the minority. The early-exposed will be those we come to rely on as movement of people becomes even more restricted.
  3. If we don’t test everyone with symptoms, we can’t know how many people are infected and therefore don’t know where we site on the infection curve. Sure, we can estimate it by extrapolating the data back, but that is an estimate and may lead to incorrect strategies being put in place if we falsely estimate the stage we are in.
  4. People who need medical attention are unable to seek it unless it becomes so ill that they need to be hospitalised. If a hospital is the only place they can be assessed, this puts added strain on the hospital system, which we know is already under huge pressure and drastic measures are being taken to plan for worse to come. Early assessment in conditions like asthma is designed to prevent exactly this – people ending up in hospital who could otherwise have managed their symptoms to prevent escalation. That is bad for a system under pressure, and bad for people who have to endure life-threatening symptoms for a disease we should, by and large, be able to manage through early intervention. At the time of writing there is no specific guidance for those with COVID-19 symptoms and underlying asthma [4]. I am sure parallels could be drawn to other conditions on the at-risk list.

In my view, we have to hope for wider testing of those with symptoms so we can overcome these issues. That is easy to say, and there will be a million priorities fighting for time, resource and budget among this crisis. As for me, I am getting better, my isolation ends tomorrow and hope I have had it. If I haven’t, then surely it is still to come.

I can’t even begin to comprehend the impact this is going to have on the world, a true human tragedy. Stay safe everyone.

PS. Random coronavirus fact. Corona means “crown,” and the viruses are named for the proteins on the outside of the viruses that look like crowns. [5]