All medical advances since Spanish flu pandemic wiped out by COVID-19

There is an eerie silence about the world.

I love the clear sound of birdsong without the noisy cars and planes

But hate the distancing we all have to practice

I have for the past five weeks been repeatedly reminded of a different time, a different place
Of the 1980s war the silence after the sirens went off as we waited for the sounds of the fighter planes overhead

Of the months spent at home when university was closed during a particularly hideous battle and all male students where drafted in and taken to training camps

Of Dhuha my very first patient with acute leukaemia, trying my best to treat her during a war, under-treating because to give full dose would render her so ill and we didn't have what we needed to support her through, two months of directed transfusions from staff and family fresh blood when platelets were not available, taking her into the office in "isolation" every day when the hospital became full of visitors to protect her from catching an infection

I am on the face of it coping better than my peers I feel that I have been through this before and know that somehow we will find the inner strength to overcome

Other younger colleagues are in a state of shock at how quickly the world has changes
At how fragile our existence and all we take for granted really is

It will take many months to recover I say to them....
It is going to get a lot worse, before it gets better.....
It is best that we stay in the hospital for a week at a time and alternate rather than all be here at the same time....

We have like every other hospital lost around half of our staff through prior ill health meaning people are at risk of working, through illness, or the illness of someone in their family.

We have discovered the joys of zoom meetings (and got to see other people in their kitchens and what art people have on their walls)

We have brought in a temporary mortuary, ours has even been in the news after the team from podiatry were redeployed and had the duty of moving 40 patients into the new premises after a particularly bad weekend and published details online

We have wards that you can only enter after you have donned goggles, mask, full gown and gloves, and where everyone looks the same and it is difficult to speak, or be heard

We have five times as many ITU beds as we used to, with ventilators in surgical wards, in cardiac wards and in theatres

We have at last count 200+ COVID patients, nearly 60 in ITU

We have daily meetings where a team go through the list of thirty or so admissions from the day before and assign for or not for ventilation decisions based on risk factors (age over 65, diabetes, high blood pressure, prior lung disease, smoking, obesity) if you end up being ventilated and you have these risk factors there is a 70% chance you will never wake up, and when ventilators are scarce and patients stay on them for weeks a decision is made on admission that ITU will not be called even if you deteriorate

We have rows of patients all with the same disease, pale, hot sweaty with purple lips gasping for air in bays of six beds separated now from the corridors and nurses' areas by rapidly constructed temporary walls of plywood and plastic windows

We have patients ventilated on their stomachs losing blood from somewhere who cannot be investigated

We have patients going into cardiac arrest on the ward and a five to ten minute wait for the team to don the PPE before they can attend

But what we do not have is people with heart attacks, people with strokes, people with a whole long list of other conditions, they are staying away from hospital for fear of being a burden and for fear of becoming infected

What we don't have is the ability to treat patients with appropriate treatments

Patients with heart attacks no longer have emergency angioplasty, instead they are having bedside thrombolysis, something I remember doing in the 1980s

Patients with cancer have their treatment stopped or not started if their life expectancy is less than one year, they have their treatment delayed if their life expectancy is five years

The only cancers being treated are those with >50% chance of cure, and even then they are being treated with reduced doses, less frequent courses and with everyone wondering if they will survive until their next course or if they will succumb to pneumonia, there is of course no ventilation for cancer patients

And if they get admitted for any other reason they die of COVID in hospital possibly from someone else or from one of us untested doctors or nurses who might have a very mild or symptom free disease