I am a GP, and a single mother, and the events that have unfolded over the past few weeks have rattled me. Life as I knew it has stopped while nothing seems to have changed when I look outside. I’ve stopped socialising. I’ve been devouring information on social media trying to learn and prepare. I’ve had to make very difficult family decisions. I really don’t know where to begin, but I’ll start at the beginning…. On 25 February, all the GPs at my practice sat in silence in our lunch room, glued to the Four Corners COVID-19 documentary describing the sheer horror that was occurring in China.
There were distressing images of bodies in the hospital hallway, forced quarantine with police carrying screaming people into vans, and welding apartment building doors closed. Murmurs started amongst us that day, but we continued, it was business as usual. It felt so very far away.
But in a world linked by global travel, it inevitably reached our shores.
The game had now changed. Slowly, returned travellers started presenting to us – one, maybe two per week, then one to two per day. By the week of 2 March, there seemed to be a steadier flow of high-risk cases, who we saw outside in the car park. We had to analyse conflicting guidelines from various sources. We had to find out where to send these people for testing. We were calling the Public Health Unit almost every day for real-time updates and advice.
The rising pressure we felt came to head on Friday, 6 March. A GP from Melbourne had been diagnosed with COVID-19, and the entire clinic was now closed. A Member of Parliament was quick to criticise our colleague when in fact, he should have been praised for using his clinical judgement to test himself outside of the testing guidelines. Doctors felt angry and vulnerable. I also felt uneasy. I wondered, how many other infected people were roaming in our community undetected? The Government’s reaction was to order mandatory testing in all health care workers who displayed symptoms of a sore throat, fever or a cough. The following week at work, 4 of our 17 doctors called in sick, unpaid, for 48 hours while waiting for test results. Unfortunately, I was one of them.
Two days after returning to work, despite our large visible signs, and screening by both a receptionist and a nurse, a high-risk patient managed to make her way into my consulting room. Growing panic rose within me and I immediately left the room, put on Personal Protective Equipment (PPE), and completed the consultation. After I notified the Public Health Unit, I thoroughly cleaned my equipment, moved rooms and continued seeing my mounting queue of patients. I tried to push my anxiety aside and attempt to focus on the patients’ concern about their high cholesterol or their sore knee. It really didn’t seem to matter anymore.
That night, before I entered the house, I removed my clothes and went straight upstairs and showered before I hugged my children. Luckily, the patient’s test was negative, but I remained deeply unsettled.
Following the social distancing announcements, the worried well began flooding our practice with their minor respiratory symptoms. And now that community transmission was confirmed, the reality was that ANY viral upper respiratory tract infection could be COVID-19. We just weren’t able to test for it. The child with a mild cough or the request for medical certificate from a mildly unwell worker began to worry me. I started wearing a mask, I hoped luck was on my side. I felt like I was playing Russian roulette. You see, while I would have previously classified myself as a healthy person, it dawns on me that I am an asthmatic. Mortality rates of 6% swirl around in my head, and combine that with the natural anxiety that comes with being a mother with children so young that they still need me, fear rose from the pit of my stomach and engulfed me.
I spent many days pondering how to make this work. I knew I had to remove my children from day care for a few reasons. One, children are vectors for disease transmission. They could easily bring it home to me, probably more likely than I was to bring it home to them.
But who could look after my children? All I had were my parents who really needed to be kept out of this scenario. However, it was early days, there were only a few confirmed community transmissions in Queensland. If they were to mind my children, it was now or never. I made the gut-wrenching decision to send them to the country with my parents, while they were still low risk. When I said goodbye I honestly didn’t know when I would see them again, but I told my 4 year old it was “just for a week” and that I loved them.
I focused on work and immersed myself in learning more. I began to be very vocal about my concerns of seeing respiratory cases without PPE. I have wonderful practice owners, and they quickly met and planned to build an isolation area in the clinic. Construction was completed in 5 days. Glass walls were built, air conditioning ducts were rerouted. We now have a dedicated “infection zone” where doctors can wear full PPE to see respiratory cases. The rest of the clinic is now the “safe” zone. Triaging improved. A Medicare rebate was made available for phone consults. I went to work feeling far more in control of my environment. I was still only allowed one mask per day but I was grateful to have something, just in case someone slipped through the cracks again.
Despite new social distancing measures, and mandatory quarantine for all international arrivals, the numbers of COVID-19 cases continue to grow exponentially. From my reading, it is clear to me that the countries who have managed to halt the spread and flatten this curve are those who either did early widespread testing or strict social distancing, early school closure and enforced strict quarantine. And we are not doing either here in Australia. Furthermore, 20% of these cases require hospital admission and 3-5% require an ICU bed (1). The 2200 ICU beds that we have in the entire country just are not going to cut it (2). We have a nation-wide shortage of PPE (3). We have a shortage of testing reagent. The conclusion is simple: Social distancing and lockdown is our ONLY hope.
Knowing this, I had cancelled my weekend plans. I decided to put my phone down and focus on my own physical and mental health by going for a run, solo of course. My joy at being outside alone without children on a warm sunny Saturday morning was short lived. I ran past running groups, large numbers of kids in the playground, a group of young men kicking a football, and a group fitness class. Panic and despair rose inside me and I asked myself if I was living in the same world as these people, who seemed oblivious to how quickly their lives were about to change. THIS IS NOT SOCIAL DISTANCING.
Now that my anger and frustration has dissipated, all I feel is deep despair and sorrow of what lays ahead. I can only liken it to standing on the beach watching a tsunami roll in while the rest of the community sunbakes and swims. Some are being vigilant, but many still think they are invincible and going to the park or to a party won’t matter. It’s the Australian way to think “she’ll be right mate”. I think this will be our downfall.
Meanwhile, medical social media groups explode. We are pleading, crying, not sleeping. The doctors who will be looking after everyone are alarmed. We are not as prepared as we could be. So we channel our fear to make plans. We set up Facebook groups to link university students with health care workers to babysit our children when the day cares close. We talk about supporting small businesses, like cafés, by asking them to deliver food to hospitals and clinics, as we mentally prepare to work 24-7. But the limbo we are in is torturous. We can’t afford daycare AND a nanny. We still have to go about life like normal. We want to move forward, take charge, but we are stuck. Waiting. Waiting, and watching the curve. Waiting with a fading glimmer of hope for us to go into lockdown.
We are a group of intelligent critical thinkers who are experienced at synthesising large volumes of information to make crucial decisions every day. We are only able to move forward from this state of limbo if all the facts are laid bare. We need information so we can then send a unified message to the general public. Front line workers are then able to make critical decisions on how to plan practice operations, hours and staffing over the coming weeks. We need to know so we can manage our family life and our childcare to ensure we are able to turn up to work. Prime Minister, I implore you to hear our concerns so we can move forward and work together to help solve this crisis.
After being a first-hand witness to events as they have unfolded over the past few weeks, it is clear to me that we are facing a type of world war that we have never seen before. We do not have a weapon to fight this virus, and we do not have enough armour to protect ourselves. It is normal to feel fear. But we can start to combat that fear by action. One person cannot change the world, but collectively our daily sacrifices and inconveniences will add up to not just save one life, but to save thousands.
We need to distribute accurate information amongst our colleagues. We need to learn how to correctly put on PPE. We need to listen to the advice coming from our colleagues in Italy and the UK. We need to start thinking about childcare arrangements and where we will live for the next 6 months to keep our family safe and not bring the virus to our own doorstep. We need to create a support structure within our profession. We need to take social responsibility and educate the general public. Explain what social distancing and self-isolation actually means. Make sure they understand that these simple measures WILL make a major impact. They don’t have to complete a medical degree to save lives – its simple: “stay safe, stay home”.
And for us on the frontline, we are going into battle whether we like it or not. We need to band together, put on our masks and fight.
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