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Covid update

Since this infectious disease was broadcast in the media from before it was acknowledged as arriving in UK., it has caused great distress. it has meant the people of my age from the beginning have had to stay within their own home. I am lucky in 2 ways. I have a lot of interests which occupy much of my time as well as as having a small garden c 30 ft square at front and back of the house, which I have developed in the 50 years ( November 1970) since we moved in. The year 2020 provided a lot of sunshine, hence lots of blooms.

I worked through the 1957 influenza outbreak in a general hospital as a second year student nurse. I did not get the disease, but some other staff did and were ill. `Apart from the usual precautions to make oneself safe -hygiene, good nutrition and isolation from other staff and patients with it , I do not remember anything alse being done.

I later did a Diploma in Nursing as part of joint study to enable me to become a Registered Nurse Tutor (1968-70). In particular, we had an excellent lecturer in Microbiology. This provided me with much valuable ideas about and insights into infection transmission especially in hospitals. Added to this was the structuring of care using the four principles of the Nursing Process. Assessment/ Planning / Action and Evaluation. Basically the process derived from engineering and is used in other contexts like teaching.

Regarding diseases, therefore it was important to discover their origin. Hence contact tracing and testing as well as dealing signs and symptoms of a disease, if known, are a basic requisite to identify and stop spread of the disease.

However testing is dependant on several factors. The specimen taken must not be contaminated by other agents. It is only accurate for the time/date it was taken and more generalised conclusions should not be made necessarily Once sent to the laboratory, the tests given must be as specific to the causative organism as possible (With Covid 19 as a new disease manifestation, it was important for testing to become as specific as possible )

Should a disease be infectious, it is important to contain it. Then the provision of appropriate treatment if available and the role of the nurse and many other paramedic staff in caring for the people affected should swing into action. For this to happen there should be local strategies for dealing with this, depending on the geography and population structure of the locality. As the care progressed, frequent evaluation of what was being done was instituted until recovery, impairment or death occurred. All this needed to be done in a social context , involving relatives, especially if carers, at all stages. My previous experience as a mental health nurse helped me to understand how to develop a widely based model as a teaching structure.

Wrong-headed model

Covid puzzled me from the start. It was portrayed as infectious. This should of course mean that sufferers once identified should be isolated. The model for the so-called ‘NIghtingale’ hospital wards was incredibly the open spaced Intensive Care Unit. My experience of dealing with the severely infected was to enclose them as much as possible in a glass unit with walls a single sealable door and ceiling. This meant that organism especially those resident in hospitals could have the most restricted possible access to and from the patient. Only appropriately PPE-d personnel are to enter this unit. The wards portrayed in the media were NOT this closed model, but the open one noted above . There were different types of curtains available Had senior staff responsible for fitting the covid unit never heard of ‘Fomites!!’.

Reservoirs of infection

What had been forgotten and still not realised by covid protectionists is that our institutions are deep reservoirs of multiple infections. this is a personal example. I had a melanoma between the shoulder blades about 10 years ago. The dermatologist removed it at outpatients. I was brought into hospital taken for resection of possible melanoma spread. This was fine. a week later, I suffered an abscess from the site due to cross infection- Hospital Resistant Staphyllococcus Aureus (HRSA). This made me very ill and toxic. Even after lancing the abscess, it took me 6 months to recover from it, while it healed slowly.

Besides HRSA, there are anaerobic especially the CLostrida group.

Restricted travel

Travel from country to country has hardly restricted from and to UK. From ancient times, “quarantine ( the Italian or Latin for 40 days) seclusion had been practised. Borders were thus closed and further entry to the country refused and a period of quarantine imposed immediately. This still has not happened unbelievably as a totality even after a year’ s anguish about covid at all levels of society from Downing Street to people of all ages and status being denied access to others. a

Local initiatives

Within the locality where sufferers were identified the local Community Physician should have decided a similar local regime in a dialogue about strategy with Clinical Commissioning Group , GP and their teams and Community Physicuans and calling in other sas necessary

General Practitioners (GPs) are usually regarded as the gate keepers and leaders of the Primary Health Care Team with practice and district nurses, health visitors as well as other allied professions and clerical staff within such a practice. These all should report likely symptoms and decisions made as to where the sufferer should be sited for further apprpriate care. In many other infectious diseases, this would be done at home. Only when symptoms are more life threatening would they be sent on to hospital for barrier nursing.

Symptoms of Covid- 19 seems to have been distilled out as raised tem perature, upper respiratory symptoms e.g coughing sneezing and a loss of smell, corresponding to other types of influenza in length of time it takes to manifest with symptoms, i.e. 7-10 days from catching the infection. Obviously some individuals are more susceptible to any kind of infection than others, e.g. those with diabetes mellitus, chest conditions, those living crowded family conditions, social care and other institutions. Others once they become ill show themselves susceptible to fatal sepsis – this can be more noticeable in the vulnerable with other serious conditions.

The effect of restrictions had been catastrophic for the nation as a whole. Many people, especially conscientious older people are quasi-prisoners where they are domiciled. Workers of all sorts are lucky, if they can work from home. Even then this has had effects on public transport system- losing revenue, wasting energy on empty trains, buses and trams and many other service providers, like cafes dependant on travellers.

Those confined to home, have had their social life truncated completely. This has effected all ages. Children are deprived of the extended family and vice versa.

The whole amateur/ voluntary scene so vital for individuals to provide all kinds of service to the communities around them in town and country are instead shut up into their houses (and gardens) if they have them. This means they are not able to gain their usual feelings of self-worth in achieving, care for others, producing various types of music, art, crafts and a whole of host of other skills. This also has an effect on local and national economies. Putting on an amateur show for instance means hall , costume, music hire, catering, printing programmes, posters, and the publicity by post, social media, etc – not to mention the pleasure of jsut doing it.

The result of this social deprivation has been a rise in suicides, in people becoming depressed because alone and isolated, whether in rural or more urban settings. hence more suicides or death through neglect both in a person’s own home, in university halls of residence and different forms of residential care.. Domestic violence has increased not only for children and women, but also for men.

This is a national disgrace and the inequalities that exist in our society have shown to be even worse in the desparate lack of leadership within the present Government circles, Her Majesty’s opposition and what seems an endless cohort of advisers, who vie with each other on the media to the confusion of the rest of us. Radio and TV here have shown how Goebbelesquely adept they have been in spreading confusion and fear for the present and future.

God help us all.

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