CATHIE HULL. COVID-19 Infection, Isolation and Action

I was caught unawares by being exposed to COVID-19, despite thorough knowledge of the online medical research. I am now in home isolation. If I can be caught unawares, you can too.

I am an emergency doctor working at Ryde Hospital in Sydney. Highly motivated in a frontline job, I have devoted at least an hour a day to journals and reports on coronavirus since early January 2020.

Our community demographic includes a large Chinese and very mixed migrant population. The news worsened in the Christmas-January holiday, before Chinese New Year. We had bushfires at home, and a new virus in China. I know that many in our local community travel overseas frequently. Some leave their young children to be cared for by relatives in China.

When my own daughter returned to London via Hong Kong on 13th January, I was concerned but not anxious.

Not long after, I was exposed to the virus: on 23rd February, in my own department.

A colleague was ill that Sunday 23rd evening and he was encouraged to leave work early. He was subsequently tested for COVID -19. His nasopharyngeal (nose and throat) swab was negative. Twice. He deteriorated and was admitted to ICU that week. His chest CT was consistent with reported COVID-19 findings.

The negative results on a sick patient were falsely reassuring. I was perfectly well. I worked another shift a few days later. I went out with friends.

Then suddenly everything changed. Later testing by different techniques proved he was positive for COVID-19.

I was called and went immediately into isolation, seven days after I’d last seen him. So did others. We were anxious for our sick friend in ICU.

Those who had shared that shift were quarantined. Because we were very busy and working in separate spaces that evening, I did not have much exposure to our sick doctor. But how much is enough?

Health workers understand quarantine and take its restrictions very seriously. We did not go out to shop. We did not get close to others. But this was only possible once we knew!

Isolation after exposure is scary because there is time to consider the risks. That leads to worrying days of information gathering, sharing and overload, pondering any slight change in our bodies and enduring long anxious nights. We call each other and talk. We worry about our families, our friends and our future, our sick doctor, our hospital colleagues, our responsibilities, and our community. Over 60, I have lifelong asthma and I’m allergic to medications that may be needed for secondary infections. I packed a bag ready for hospital.

Once media revealed the story, we added the anxieties of family, friends and patients, with constant calls, texts and questions, worrying about us, worrying about themselves, asking for advice and for the knowledge we don’t have.

We’ve been monitored each day by the Public Health Unit of our Local Health District. They check that I’m well, and that I’m isolated. Yes, and yes, I say.

I need fresh air and exercise, meticulously avoiding others if I leave home. Night walks with the dog. Thank heavens for the dog. And for friends and family who leave my coffee and the shopping on the yellow chair outside the front door.

We are watchful for new cases at work and elsewhere. Obsessed. We are amazed we have NO spare time!

The Ministry has tried to explain and update transparently. However, preparations for more and more cases are already behind the need for them.

Workers are ill, or in isolation, or worried to go to work. Healthcare workers have died elsewhere. Facilities are short-staffed. Work safety, especially in smaller institutions or general practice, is threatened by lack of consistent guidelines, inadequate protective clothing, design of safe places for changing gowns, and by not knowing with which patients protection is needed. Retired doctors can’t fill gaps in service. Already out of practice by definition, at least by age they are in a high-risk group.

Among reasons for potentially under-diagnosed community spread, this is a new disease that is unfamiliar. We know that COVID-19 illness can be mild or asymptomatic. Not all people have fever. Not all people have a cough. Some have abdominal pain. Those infected don’t know they have it. We know people are not necessarily honest or careful about their travel history. (In Singapore, lying about travel history has been made a criminal offence.) As I write, we still don’t know how hard it is to catch, how my colleague became infected, whether people are infectious before showing signs of illness (we think they are: 1 day? 2 days? More?) Other unanswered questions: Are they infectious after they “recover”? Can they get it again?

To protect everyone, especially the elderly and vulnerable, we should right now isolate people at home for two weeks, to try to contain spread. Two weeks now will be difficult and expensive, but at least most people will be well. Taking this action later will be much harder. People half-expect strong government action similar to other affected countries. We should close schools, universities and many businesses to reduce new cases, enable preparations, ramp up arrangements for protective and supportive equipment, increase capacity in hospitals, free and create ICU beds for life support. We are teaching people how to keep as safe as possible. We can isolate returning travellers, work from home. Most of all we must properly guide and protect our health workers.

Already we advocate avoiding unnecessary travel and close personal contact, efficient hand-washing and responsible cleaning of surfaces and body fluids, and for health workers and carers, using masks, gowns, gloves and eye protection of high quality. These are our current defences.

Committing to isolation to slow spread at this critical stage, and reducing close contact when possible, may help us to manage the weeks and months before we have a vaccine, or forms of treatment, to lessen the impact of COVID-19 disease.

Let’s do it!

Cathie Hull is a Career Medical Officer in Emergency in clinical practice and an Associate of the Menzies Centre for Health Policy, University of Sydney, with a background in public health, medical education and health promotion.

print

This entry was posted in Health. Bookmark the permalink.

10 Responses to CATHIE HULL. COVID-19 Infection, Isolation and Action

  1. Vacy Vlazna says:

    Cathie, a description of the symptoms you have would be helpful. I hope you colleague has recovered.

  2. Hi Cathie,

    I worked with you at Ryde in 1998. Thank you for everything you are doing – I completely agree with your sentiments. I am concerned governments won’t take the steps you recommend now and we will be in a position in a few weeks in Sydney that Italy is facing right now.

    Please do let me know if there’s anything I can do to help.

  3. It’s so so important that the fact early swab tests said negative – twice – this is crucial information… are blood tests not available yet?
    Thanks for this very informative letter

  4. Daniella Adam says:

    Be PRO-active.
    Not RE-active.
    We are chasing our tails.
    The only example of moderate success has been displayed by the extreme actions by China. That is the ONLY approach that has worked when we do not have a vaccine available.
    Being shutdown for two weeks creates a goal that we can all work towards…. the alternative is a situation spiraling into something unquantifiable.
    Now is the time to act with this extreme measure while it is still effective without being completely dire.

  5. Anthony Pun says:

    Dr Cathie Hull: On behalf of the Australian Health Reform Association Inc (AHReform), I wish to thank you for your honesty, sincerity and commitment to contain the spread of COVID19. The latest data showed that the elderly group are most vulnerable to infection and the mortality rates for them is high. Your call for self-quarantine should be commended. With this virus, the Wuhan reports tend to agree with you that a better containment strategy is that a potentially infected person makes a volunteer action not to spread the virus around rather than the convention thinking that health people should avoid being infected. Enforced population lock down and travel bans may be difficult to enforce in a western democracy hence, volunteerism is the next best policy.
    I share you concern being infected as I remembered the HIV and HepB epidemics in Sydney in the 1980s and the numerous accidental finger pricks with the needle. Hope you will recover soon and back into the front line. Good luck.
    PS -Coronavirus: Why The US Is In Deep Trouble

  6. Kien Choong says:

    Thank you to all our public health practitioners for their dedication and work to protect the rest of us from public health threats. We honour them along with the soldiers who risk their lives to protect us from security threats.

  7. Irene Penney Franco says:

    Excellent article and quite frankly an excellent idea for all of us – everyone – to self isolate for 2 weeks. This would greatly reduce the unnecessary panic behaviour and reduce the panic reactions of the now volatile market!!

    • Jo Swan says:

      We might follow these procedures soon. NYC is containing the virus in the New Rochester area of NYC. It has already set a precedent for rest of the global cities particular in the west to follow suit. I guess people would brush of China and Italy a bit, but with USA doing this, NSW health has no excuse to do these quarantine measures in Sydney if local transmissions increase in the next few weeks.

  8. Ian Webster says:

    Dear Cathie,

    Thank you for your personal and empathic account of what it is like to be a health care provider at the front-line dealing with this infectious but not fully understood disease.

    The predicaments and complexities you describe are magnified in the population of disadvantaged and homeless people, as in this environment there are no real ways of self-isolation or indeed ensuring access to and follow-up or diagnosis or public health issues.

    Perhaps one idea would be to set up accessible testing units or even mobile units which could be made available to assist primary health care centres and some of the hospitals as appropriate.

    Thanks for your account of your experience and concerns,

  9. Warren Lippiatt says:

    Yes we must get this message out to the wider media, to the public as whole community and stop the procrastination by current Government to close schools and universities. We must act now!
    I am a parent and small business owner, I have already advised my daughters school, they wont be returning for awhile and as a business owner advised my employees to work from home…..but we are one family and only one business, it is not enough. We must all do this, to slow the spread of the COVID-19 virus. We must as a Nation of Australians protect our Health Workers, they are human too and allow the Health System time to catch up, they too can’t and are not designed to cope with this outbreak.
    The Governments concern is more of economics than health, I understand that too, but they have it wrong. If we don’t start to isolate as a community and nation now, there will be much more at stake with a greater negative impact to both the economy & health. Act now Government, with forced closures of our schools and universities for two weeks as a minimum.
    Or for God save the Queen, for no one or no thing will save this Nation of Australians
    without action now!

Comments are closed.