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Going Viral

Still practising

Chris Preece

Tuesday, 04 February 2020

AdobeStock_319497976_coronavirus.jpgI’m going to be briefly self-indulgent and pull back the curtain on the process behind writing these blogs. Right now, I’m sat typing on a lazy Sunday morning, whilst the rest of my family enjoys a lie in. At some point today I’ll email this off to my editor, who will review it and then likely post it up on Tuesday morning. 

For the preceding week I’ve spent idle moments wondering which of the various breaking medical stories should inform this blog. Should I write about the latest instalment in the ongoing PCN debacle? Or perhaps I should pen a rant about Matt Hancock’s speech regarding the need for better technology in the NHS? Both were tempting, but let’s be honest, there’s only really been one big story in the last few days – and that’s been the coronavirus.

Which is my problem. I want to write about it – indeed, I am –but it’s hard to know the tone to take. That short delay between writing and publication mentioned above is usually no issue at all, but with this, everything could have changed by the time it appears online.

I could, for instance, submit a tongue in cheek rendition of “My Sharona”, with the words cunningly changed to fit the outbreak. Something like….

“Ooh, my infectious one, infectious one.

Are we gonna stop you in time? Corona.

Will we get a vaccine done, vaccine done?

It’s further off, it’s down the line, Corona.”

However, in the event of full Coronageddon, is that going to look insensitive? In fact, shouldn’t I avoid the use of terms like “Coronageddon” entirely? On the other hand, maybe a little bit of humour will help diffuse people’s anxieties a little. Certainly, based on the phone calls I was getting at work on Friday after a couple of cases were confirmed in nearby York, people are terrified – yet at present they should probably be more worried about regular flu.

At present.” There I go again.

However, the issue isn’t simply one of tone, it’s about getting the facts right – with the reality being that it’s still a rapidly changing situation. We’ve already had to change our message to patients from “don’t come to the surgery if you’ve recently been in Wuhan” to “don’t come to the surgery if you’ve recently been to China”. By the end of the week, this could well have changed to “don’t come if you have symptoms of a viral illness”, or we may have dropped all the warnings entirely as the incubation period from the lock down of flights from Wuhan passes and no new cases emerge.

There are some statements that now seem to be largely agreed – the mortality for the virus, for instance, seems to have settled at about 2% - but this remains an estimate at best, and who knows whether it will quietly mutate in the meantime? Besides, that number’s largely irrelevant unless you actually catch the virus, and it’s thus still not terribly helpful in terms of understanding risk. Not that explaining risk to the public is easy in any case – we’re collectively terrified of things that are extremely unlikely, whilst simultaneously accepting movies in which 50% of the world’s population dying isn’t that big of a deal.

It was only when I turned to the World Health Organisation’s publications on all this that I realised that there are a whole bunch of basic, seemingly immutable facts which I may have taken for granted, but which are apparently news to some. They have, for instance, gone to the effort of producing a poster advising people that, no, garlic isn’t going to stop you from getting coronavirus. Nor, for that matter, does lathering yourself in sesame oil.

So, instead of fretting over what may have changed by the time of publication, here are some things that I’m fairly certain will not have stopped being good advice with respect to coronavirus:

  • It’s not a “Chinese thing”. Avoiding people you think look vaguely Chinese does not make you immune from coronavirus, just racist.
  • Nor is it an “old people” thing. Whilst it’s true that its effects seem to be more severe in the elderly, and those with other medical conditions (asthma, diabetes etc), infection doesn’t discriminate based on age – so everyone needs to do what they can to minimise risk.
  • Speaking of which - the usual advice for preventing spread of viruses applies to this as much as any other. Wash your hands, cover your mouth and nose when coughing or sneezing and bin any tissues immediately.
  • If you’re planning on donning a face mask, make sure you do it properly. It should cover your mouth and nose and should be thrown away immediately after use. You need to avoid touching it once it’s on, and wash your hands immediately after you’ve taken it off.
  • Whilst there are lots of anecdotal reports of people catching the virus from asymptomatic carriers, the WHO reports that the “main driver” of transmission is symptomatic cases. So avoid close contact with people suffering from cough and a fever. If that person is you, stay at home.
  • On that note – as mentioned before, please don’t go to see your GP and announce you think you might have coronavirus. Ring 111, and they’ll go through your travel history and risk factors and tell you what to do. If you get into a GP surgery with coronavirus the guidance is literally for the doctor to leave the room and shut you in there, alone, until the guys in Hazmat suits arrive. No-one wants that.
  • No, antibiotics won’t work. Obviously.
  • That parcel you ordered from China is fine. (Or at least, it’s not carrying the virus.)

All of which is great, but I know what you really want to know.

Is this a fuss about nothing, or is it the end of the world?

Certainly, from a lot of the media reports these are apparently the only two viable positions, so which is it? The real answer, as ever, is that it’s neither – with the irony being that from a Public Health perspective you need to treat it as if it will be the latter, in the knowledge that doing so successfully will result in the rest of the world announcing it was the former. (Think of it as the Y2K bug for humans.)

Yet, for some, it’s already the end of the world. 304 people have died from this particular virus at the time of writing, a number which is guaranteed to have risen by the time you read this. We’re usually told such statistics, not as a reason to reflect on individual tragedies, but as a way to break us out of our contented reveries, and sell us some fear. “It’s there,” the papers tell us, “and it’s coming for you.”  After all, it’s not really the end of the world we fear, simply the end of ours.

So what can I tell you, sat here on a Sunday morning, that is true and unchanging about this virus? I can say that it’s there, and that it’s probably not coming for you - but that something, viral or otherwise, will do one day. So maybe we should take the Public Health approach and act like this could be The One. Not so much with lockdowns and face masks (though, you know, no point asking for trouble) but by getting on with the stuff that matters.

The kids are getting up. It’s time to stop writing, walk the dog, and enjoy this planet - Coronageddon or not.

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Chris Preece

Chris has worked as a GP Partner in North Yorkshire since 2004, and still relishes the peculiar challenge of never quite knowing what the next person through the door is going to present with. He was the chair of his local Practice Based Commissioning Group, and when this evolved into a CCG he joined the Governing Body, ultimately leaving in April 2015. He continues to work with the CCG in an advisory capacity. When not being consumed by all things medical, Chris occupies himself by writing, gaming, and indulging the whims of his children. He has previously written and performed in a number of pantomimes and occupied the fourth plinth in Trafalgar Square. Tragically, his patients no longer tell him he looks too young to be a doctor.
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