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Covid Diary of a GP.

Covid in two 50 somethings in North London has gone like this.

One mild. One mild to moderate.

The patients are two 58 year olds.

One of us had a very mild case. The other had a case that, from a doctor’s point of view, was mild to moderate during the second week.

If you feel you are breathless with your Covid, particularly if you are breathless when lying or sitting still, make contact with your health care provider in the way your local systems suggest, and seek advice.

This account is to tell you what Covid is likely to be like for the majority of those who get symptoms but who are otherwise healthy and who are under 60. Most people will experience an illness similar to one or other of the two people described here.

The patients:

Neither of us have the underlying health issues that would suggest susceptibility to this virus. My partner has no issues. I was temporarily vulnerable. I have had pneumonia several times and had fairly major surgery on March 11th when, as it turns out, the virus had probably already started to multiply in me. This means that whilst I am not in a risk group, I was not perfectly well.

Believe me it doesn’t come naturally to a doctor to reveal their medical history. Confidentiality is our middle name, which the vicar thought strange at the font (the only doctor joke I will put here, I swear). I mention it to clarify (in case you think I must be so super-healthy that my experience cannot apply to you) that I have described Covid in a usually fit but not absolutely healthy person.

 

Day Zero Minus Two: Thursday March 12th

Thursday March 12th: Partner is just about to leave work to collect me from hospital when his boss, who recently returned from skiing in Europe and whom I shall call our Contact, calls to say he has just tested positive for Covid with Public Health England. They have been in meetings together for four days since he came back. Only an hour later public testing with PHE (Public Health England) has stopped. I go home from hospital. The two of us commence self-isolation.

 

Day Zero Minus One: Friday March 13th

Partner feels a bit breathless, not quite right but nothing much. We don’t check our temperatures. We don’t expect anything yet.

We wonder if it is real. It must be as several of the ski party tested positive. I am not breathless or hot and do not have a cough.

 

Day Zero. Saturday March 14th

Partner feels breathless and a bit tired. These are unusual symptoms for him, but they are slight.

I too feel a bit breathless. I don’t believe I can be symptomatic already. Perhaps it is the power of suggestion.

 

Covid Day One. Sunday. March 15th.

I have a fever. It does not quite reach PHE’s ‘diagnostic’ level for Covid. My aural temperature is 37.7. PHE say 37.8 suggests Covid. But it is significantly raised. A normal aural temperature is usually around 36.5. I am suspicious that Covid is sneaking about in me. I feel as if I could fry an egg without the oven. I feel a bit breathless. (As the illness goes on my temperature rarely goes above 37.7.)

Partner is just the same as yesterday. Temperature 37.3. Probably very mildly raised. He feels warm to touch. but we are both essentially well. Just a sense that we have something.

We think we are being paranoid.

 

Covid Day Two. Monday March 16th.

Partner working from home. Temperature 37.3. He doesn’t think he can have it. Where is the temperature? I say you are warm, just not very warm. We had a contact. We must isolate. We do.

Today I mostly lie on the sofa in a rather pathetic bring-me-water fashion. Temperature varies from 37.3 to 37.8, hovering mostly at 37.7. No sore throat or runny nose. Eyes feel a bit watery and sore, as if I have had salt in them earlier. Very slight cough. Sense that if I take a deep breath I will cough. But I can suppress it.

Almost wish it would make itself clear. The Contact could not have happened till 7 days ago. The incubation period can be as little as a day, although 5 days is the research-published average.

Talk of calling up doctors who just retired begins. I am only 20 days off the active GP list and still accredited. Emailed to ask about what I need to do for reinstatement. I email everyone I can think of. Nobody replies. I think of more people and email them. Then everyone replies at once. Twice.

 

Day Three. Tuesday March 17th.

The illness feels like a kind of phoney war. Temperature 37.3-37.7. I feel fine, really, otherwise. I wish it would make its mind up.

Slight cough. More than nothing, but only just. A bit breathless if I run upstairs. Weary, really, and quite weepy. But that’s because something huge is happening to the world. This is huge.

All my meetings for next few weeks are now to take place online. Friends in intensive care preparing. Heard I will be reinstated but may take a couple of weeks. It will be a couple of weeks before I know I am not infectious anyway. And I need a couple of weeks to recover from surgery. So, a couple of weeks.

 

Day Four. Wednesday March 18th.

Is it Covid or isn’t it? Definitely have a fever, temperature is still 37.7. Woke today with a Headache feeling Sorry for Self. Eyes sore and watery. Stomach pains, but I have just had surgery. No cough.

Partner does not have much of a Temperature: 37.0-37.2 – but if I have it I caught it from him. So either both of us have it or neither. We hear that all the team members who were with the Contact are the same. Most don’t have a Temperature. Just a bit tired, a bit Breathless. All clearly have the same thing but is it Covid?

Outside people are panic buying toilet roll. You can understand the human instinct to hoard. But why toilet roll? We don’t have a freezer, so we will soon run out of everything but muesli. And wine. And dog food. Order dogfood. And wine.

 

Day Five. Thursday March 19th.

Temperature 37.7-37.8. Feels as if I am perpetually glowing. Slight cough, barely there. Very weepy, a bit breathless.

Partner is at 37.3. We are both still slightly out of breath on the stairs. He keeps saying he isn’t ill. Suspect that means he is.

We are both tired, but it doesn’t feel completely convincing. This must be a mild case. Or are we imagining it? I have heard from other doctors that there often is a week of fever before the cough arrives.

Eyes are still slightly sore. Not like when you get soap in them. Just like after swimming. Partner’s eyes are fine.

They are sending the children home from school. People need much more food when their children are home. There will be more stocking up this weekend.

 

Day Six. Friday March 20th.

Uncertainty rules. Is it Covid?

Partner says he thinks he does not have Covid. His temperature of 37.3 is probably a slight temperature, but he says 37.3 is not 37.8 and so how can it be Covid? He is still a bit breathless but feels he is improving. He says if the government says 37.8 is needed to diagnose Covid then this can’t be.

I don’t share the view. I’ve been a doctor for a very long time. You can’t say a disease is always like this, or a temperature is never less than that. The words always and never do not occur in medicine. Never say never. If Covid can cause a temperature of 37.8 then it can cause one of 37.7. or 37.3. We already know some cases show no symptoms and so do not have a temperature at all. Lots of cases, quite possibly.

Reports from Northwick Park Hospital are that in mild cases the patients have a raised temperature for a week before the cough and breathlessness start, and then the cough arrives. The cough and breathlessness peak on day 8 and 9, and start to resolve (if you remain a mild case) on day 10.

I understand from this that it may be as late as day 8 or 9 that you discover if you are going to need hospital help or not. It seems to depend on how the virus affects your chest. It can cause a pneumonia – an inflammation of the lungs themselves. The vast majority of healthy people, it seems, don’t get this with Covid. A few do, a very few. Some of these are medical staff, as they are infected by so much of the virus at once, repeatedly and all day, from the very ill, who may shed high levels of virus. Many illness are more of a challenge to the body if you get a really big infecting dose.

I am still hot. Temperature, 37.7 – 37.8, slight cough. The temperature has gone on for too long to be anything else. What else could this be if not Covid?

It can’t be flu. Never a sneeze, never a sore throat. There is no rash. There were no real muscle aches as people get in flu. I know flu, I have had it four times. I was much more flattened than this. A new thing has appeared though. There was diarrhoea today. Is that a symptom? Apparently it is.

Joined the Sofa Singers online tonight. Dog also joined in by being horrible flatulent throughout. Sense of smell has definitely not gone, despite reports that some people lose it.

 

Day Seven. Saturday March 21st.

Temperature 37.3-37.7. Slight cough, but hardly any cough. No appetite, but I think it’s the gloom not the virus. And worry about running out of food.

Diarrhoea continues. Sore eyes are no longer sore.

A bit breathless. Tired. Feeling generally a bit better but suspicious it is not over. Will days 8-9 bring a cough?

Partner feels worse again. More tired and a bit out of breath. His temperature still 37.3. His eyes feel sore but they look fine. No cough. He hasn’t stopped working, though.

The published research summarised this week suggests the mortality of Covid-19 is about 10% for the over 80s, and about 5% in the 70s, 1.5% in the 60s, 0.37% in the 50s (including those with health conditions), and even less in younger people. But the numbers needing hospital help are higher than this for all age groups.

So if only the healthy under 60s catch the disease we could surely avoid the huge deaths that are being spoken of. Can we do that, as a country? It will need a team effort, not this every man for himself toilet roll affair. They say people are not staying home. They are not taking this seriously enough. People have come to London to photograph its empty streets, but they are not empty, they are full of people who have come to London to photograph its empty streets.

 

Day Eight. March 22nd. Proper coughing. Normal oxygen saturation. Positive chest signs minimal.

Today hot all day (37.7-37.8) and now I am coughing. I wouldn’t call it a continuous cough but there is a continuous desire to cough, which is sometimes resistible and sometimes not. It’s not a terrible cough, it really isn’t.

More tired than before. Very tired. Not a good day. Tired of being tired.

A friend texts me. His daughter is working in A and E. He says if you are breathless then get your stethoscope out and listen to your chest and check your oxygen saturations. You might be ill.

I don’t think I’m ill. I feel a bit unwell. I wouldn’t go to work like this but I don’t need to stay in bed. With influenza I couldn’t get out of bed, nor did I want to. With this I am out of bed. I couldn’t run up the stairs but I’d give it a try. I’d be coughing halfway up but I’d be able to laugh at myself. Or cry, possibly.

On a scale of 0-10, says my daughter on the phone, with 0 perfectly well and 10 the illest you have been with the flu, where are you? If flu was 10 I am on 4-5.

But I am curious. I measure our oxygen saturation with and without mobilising for five minutes. Both of us are at 98% which is normal. However my pulse rises to 140 when I walk for 5 minutes, and I am quite breathless. That isn’t normal, it suggests a lack of spare capacity in my lungs.

This is an excellent reason, if one were needed, not to do any pushups today.

I listen to both our chests with stethoscope. His is clear. Mine has what doctors call inspiratory fine crackles in the middle and lower zones of both of my lungs. Little crackly noises when you breathe in. They mean my lungs are a bit inflamed, but crucially I am not breathless at rest. Both of us have normal air entry.

As evening comes I am shattered. I go to bed and don’t want to read Hilary Mantel or watch Brendan Gleeson films (the Guard was brilliant). It seems as if I cough all night.

I wake in the darkness. Coughing. My chest feels tight and hot and sore inside. The cough is unsatisfying, by which I mean when a bout of coughing finishes you still want to cough. I scored myself at 4 out of 10 on my flu scale earlier, where 10 is the worst I’ve felt with real flu. Now I am 6.5. Maybe 7.5. I cough and cough. It is still not as bad as the flu but it is uncomfortable. It is like the way I felt the day before I got pneumonia. I am not distressed, I just want to sleep. but I am worried I that will be worse tomorrow. Am I going to have pneumonia tomorrow? This is moderate Covid.

I worry about this for an hour, because we are short of dog food and I ordered some – I want to be home when it comes. I am lying awake at night with Covid and my main worry is dog food. However although I am coughing, I am still not breathless at rest. Just surprised at the suddenness of this intense cough’s appearance and worried it will get worse.

I’m awake for a couple of hours, coughing. It’s not really painful, just sore. My partner has not coughed once.

 

Day Nine. March 23rd. Improving.

I slept. When I wake my chest feels less tight.

The cough is dramatically less than during the night.

Temperature is now 37.6. I have a mild headache. I am having a burst of coughing perhaps every ten minutes. If I sit really still it’s very little. The worries of the night look like a bit of an over-reaction. It is like being a heroine in a Jane Austen novel when there is a dramatic turning point. It feels as if the worst has passed.

I listen to my chest. The crackles are gone. I don’t feel great but I am back to ‘mild to moderate’.

I find the pulse oximeter. 98%. Good. I walk up a flight of stairs. At the top I am breathless and coughing. Oxygen 99%. Pulse 135. Better than before. A bit.

I am coughing less than 50% as much as yesterday evening. My temperature sits at 37.7 all day and I have a headache.

By evening I am the same. Still quite tired. And I feel that, looking back over this, it looks very typical of what colleagues are describing. It was not as bad as a bad flu. Miserable, but never frightening. Apart from the dog food thing.

 

Day Ten. March 24th. Coughing and Very Tired

Improving but not as better as I had hoped.

Feeling hot, but temperature measures 36.9. Awoke 4am coughing. Stayed awake coughing. Very tired. Hot face. Inflamed chest wants to cough all the time. Not even slightly frightening, but miserable.

Cough is every couple of minutes. Chest tight and hot, as if a bit inflamed, (as if someone’s put my lungs in the microwave, actually, then refitted them without me noticing.) I am still breathless.

Dog food arrived.

The falling temperature means it must be getting better, but I feel drainingly tired and the cough is tight and dragging. Still not as bad as my worst flu, but 7.5 out of 10 this morning. Because on top of the symptoms of two nights ago is the throbbing headache. Clinically, however, I think must be improving. I would not be worried about me, as a patient.

Partner is much better than me. His illness has generally been mild. He has never had a cough, and only a mild temperature, tiredness and breathlessness. I hope it’s what most people reading this can expect. But this means you may never be certain you’ve got it. So stay away from your vulnerable loved ones. And strangers whose vulnerabilities may be hidden.

I have been worse. I had a week of mild viral symptoms, and am now on day three of coughing with an inflamed chest, breathlessness on exercise and an almost constant temperature.

Britain is meanwhile in lockdown. The Dog is going spare, he is a high exercise breed and we have no garden. At least I can go back to work when non infectious. Filled out forms for just retired doctors last night. Shouldn’t be long. Immune doctors must be useful somewhere.

By midday gradual improvement takes me to 2 out of 10. Headache is starting to lift. Temperature is 37. (the temperatures from day 4 onwards are without paracetamol as I had had a lot of painkillers and they were causing nausea). Cough is down to a small bout now and again. I am still warm but you couldn’t fry an egg on me now, it would be a culinary disaster. You might slightly melt cheese. Mounted police trot by outside looking for people to send indoors. I am trying to find out how long I will be infectious for, at worst.

Partner feels well. He is working too much to tell me if he is breathless. He should be slightly ahead of me so perhaps his has gone.

Evening update: feeling almost normal. Slightly warm, 37.3. Slight cough but hardly. I am not breathless. Definitely on the mend.

 

Day 11. Wednesday March 25th. Just about over.

Partner completely better. Temperature 35.9 aural (demonstrating that the 37.3 he had for a week was raised for him). No cough. Went for a run last night in the dark. Felt slightly more tired than usual. The affected group that we know of have mostly had the same time course. I seem to be worst, the only one who really coughed.

Me: much better today. Cough has gone. Brain is working again – filed my usual copy for a newspaper column I write. Oxygen saturation, for interest, 98% – it remains 98% after running up two flights of stairs. Pulse after the same marathon effort 115 (compared to 140 three days ago). So very much fitter but not quite the same elite athlete I normally am (second joke. Also a good sign).

Temperature has not quite gone. Aural temperature 37.1 – 37.6. Face still hot. Looking for evidence of when I am non infectious. It appears the consensus is that 1 week post symptoms is required. But this may be updated. Critical for healthcare staff to know. Hoping to head out to work (as an immune doctor) in a week or so, to go a remote location where an immune GP would be useful.

Afternoon update: temperature 36.7. No cough to speak of. My Covid appears to have finished. Today I hear it is likely I can be tested and proved immune to enable me to get back to patient care, 14 days from the day i knew I had had a significant contact and, 11-12 days from start to finished. My partner was, I’d say, completly better after 8 days..

Meanwhile the population has gone from blasé to terrified. How do you put out the message that the disease should not frighten most people whilst also putting out the message that everyone needs to be frightened for other people? If you emphasise how many recover, everyone chats in the park. If you emphasise that some people need hospital in order to recover, even those who are younger and fitter, everyone is terrified. The truth is in between. For most who are healthy and under 60 this is not a life threatening threat. But for our community, our solidarity, our country, our vulnerable, and our world it really, really is.

Today, for my newspaper column, I wrote about Gaza. If my editor accepts it then I will post it when it appears (this won’t be till next week). Covid may be in Gaza, there is good reason to believe that it is. 2 million people. 200 test kits. 65 ventilators, most already in use and in poor condition. We are much more fortunate. This country is facing this pandemic in good shape. If we can face it together, and stop fighting over toilet rolls, and trying to steal other people’s cars (mine last night!) we will come through.

 

Day 12 Thursday March 26th.

It has just about gone. Partner still doesn’t feel he had it, except that he must have done if I did. Says he is glad I coughed as much as I did, since it added a bit of certainty to an otherwise uncertain situation. I say I am glad to have been of service. He says don’t mention it.

I am making another post about Covid, to try to offer a guide to what is meant by mild, moderate and severe symptoms. It will appear today. There are no fixed definitions yet – our understanding of the disease and the way we classify it are still evolving, but I will update it as and when I can. I hope reading this has helped.

Day 14 Saturday March 28th

You cannot tell I have had anything. Pulse is normal. Temperature is normal. When I take a deep breath it still generates a slight urge to cough. I suspect if I did my usual running I would be very out of breath, but because of my surgery I am banned from running for 3 months so I can’t find out. Essentially well. Ready to work. But wanting to go to remote islands and they can’t let me travel unless we know I have had it. If only they hadn’t stopped testing. I was only hours too late!

Categories: coronavirus covid diary Covid-19 GP GP covid diary

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Hergest the Hound

I am a dog of many thoughts.

5 replies

  1. Hello Mary, Thanks for sharing this. Can I post your link on my Facebook page to share with others? Hope you recover soon, Cheers, Karin

    On Tue, 24 Mar 2020, 03:58 Hergest, a Hound’s Philosophy, wrote:

    > Hergest the Hound posted: ” A mild case of Covid in a 50 something in > North London has gone like this. The patients are two 58 year olds. It is > here to tell you what it is likely to be like for the majority of those who > are otherwise healthy and who are under 60. Don’t be afrai” >

    Like

  2. Thank you for sharing, it is reassuring to have some insight into what the infection is actually like. My sympathies re Hergest, I also have a high exercise dog. Don’t even want to think about what she would be like without regular exercise. I work for a university library and as of next week it looks like I will be working from home, we have been trying to keep the physical space open as long as possible but it looks like we might close the physical library to students on Friday, fortunately, I can continue work from home.
    As an immune doctor, I suspect you are going to be very busy. Wishing you all the best. Will look forward to Hergest’s accounts if you and he ever get any time to blog.

    Like

  3. Glad to hear you’re nearly there, Mary. And you’re so right about blase to terrified. Scaring people is necessary, but unfortunately the people who most need to be scared are not listening anyway, whereas my 83yo mother has the TV news on all day long, is seeing all the scariest accounts, and is terrified. Much love to you. xx

    Like

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