May 25, 2020
Fear. Frustration. Futility. These are just some of the emotions I have experienced in my work as a GP over these past months. 
I’m A GP, And I Don’t Know When Things Will Be ‘Okay’ Again
When Coronavirus began to emerge from China, I was initially filled with an inflated sense of security that if the virus did arrive, we here would have the power, intellect and sophistication to control it rapidly.  
But perhaps I was too influenced, subconsciously, by all those apocalyptic films from my childhood where mankind always came together to beat any obstacle. As this creeping death edged closer, it became apparent that the threat was not being taken seriously enough.
While restaurants and bars were ordered to close in Italy, cases of chest infections in fit and healthy patients began to appear here, some unable to explain the severity of their symptoms other than an influenza-like illness. More and more patients reported feeling unwell – but our lagging clinical systems put us behind the spread of the virus. Quickly, it became clear that the spread of the virus in the community was not being monitored adequately.  
The first few admissions from our local hospital began to trickle in, closely followed by the first few deaths – initially the very frail with multiple comorbidities, but within a few days whole households began to fall ill. Our laissez faire lockdown eventually arrived as surgery consultations filled with patients calling in with flu-like symptoms, and confusion was rife. Is it fever and a cough, a fever or a cough? What is a ‘continuous’ cough?Most of us were stoic in the face of peril – but I’d be lying if I said I wasn’t petrified deep down.Desperate patients requested medical notes to allow them to shield despite not falling into any category, while elderly Covid-positive patients judged well enough were being discharged back to their nursing homes, likely going on to infect others. 
And as the number of deaths of patients at home continued to rise, colleagues caring for them began to fall ill too. Friends and colleagues recovered, but I heard of colleagues of colleagues who did not fare so well:a health care assistant who worked in my old trust, a nurse who trained my friend, the GP partner of a doctor I work with in one of my clinics. Suddenly, we were vulnerable and exposed and expected to make the ultimate sacrifice. Most of us were stoic in the face of such peril – but I’d be lying if I said I wasn’t petrified deep down. 
Amid the chaos, though, both doctors and patients adapted. Photos of rashes are emailed in, texts can be sent, clinical signs are assessed via video. There are plenty of iPhone-savvy eighty-year olds, but the small number without access to email or a smartphone have found it difficult.
Surgeries like mine have remained open throughout this time, but we’re seeing patients opt to stay away from the health service due to fear of contracting the virus. Patients need to be encouraged to seek help but with the pandemic expected to stay with us for some time I cannot see how services can resume to a pre-Covid state – leaving the health of the country in a precarious position. 
We will adapt to the ‘new normal’ but everything comes back to testing.  Without adequate surveillance, by the time a second rise in cases could be documented, the virus will have already spread once more. While this impasse remains, patients will continue to hesitate about attending for blood pressure checks or cervical smears – and who can blame them? I certainly feel a fleeting sense of dread when I physically see each patient, worrying whether they might pass on Covid-19 to me, or indeed vice versa. Some people thank me for what I do, some people may even clap for us on Thursday evenings but that doesn’t lessen my apprehension about my Job.Simply, lockdown cannot be lifted without a test, track and trace system in place. Watching images of tubes and buses filled with commuters leaves me extremely anxious about the next few weeks. I expecting we will see a rise in patients presenting with Covid symptoms, being unable to test them and whole families falling ill. Less of an apocalyptic movie, and more reminiscent of Groundhog Day. 
Like many key workers, I have had to reduce physical contact with my children. My youngest child, being vulnerable, is no longer allowed to climb into my bed at night. I fight this inner battle between my heart and head every day.  My son’s a sensitive soul who takes comfort in being held – to cut him off so suddenly has been immensely hard, and I worry daily what impact this will have on him, especially when he’s anxious about me going to work and I can’t even hold him to console him.
Some people thank me for what I do, some people may even clap for us on Thursday evenings but that doesn’t lessen my apprehension about my job. At the moment, I cannot see when things will improve. We as a country still hold this inflated sense of security that everything will just be okay as long we keep saying the right words and repeating the same slogans. Ultimately, it’s the virus which will have the last say.
Dr Sara Ahmed is a general practioner based in London
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