Coronavirus doctor’s diary: Take care when you clap for carers

The Thursday evening celebration of NHS workers causes a spike in arrivals at A&E, Dr John Wright of Bradford Royal Infirmary writes in his regular diary. And below he tells the story of one of those workers, a nurse who suffered badly from the virus but has been discharged just in time for her son's first birthday.

2 May 2020

The Thursday evening clap for carers gets louder and more joyous every week. It is a deeply moving tribute that captures the very essence of our communal spirit in these times of adversity. It is also the only time communities now come together and generates a rare feeling of release and togetherness, a faint memory of a previous era.

But when people have gone out to clap we've seen interesting little peaks in accident rates that we weren't expecting.

People might need to be a bit more cautious, especially if they've been sitting down all day and then get up to clap. It might be one of the only times older people come outside and so there is a risk of falling and I'd just remind people to take care.

"The clap for carers has made us a little busier," says Richard Pilling, consultant orthopaedic surgeon at Harrogate District Hospital.

"It's very nice that everyone is very enthusiastic about showing support but it's escalated, so people are coming out banging pans and seeing who can clap the loudest, and therein accidents lie.

"It's nice to walk on to your doorstep and show appreciation, it's a chance to see your neighbours, and it's lovely to see people sticking together during the lockdown. Just do it less vigorously – you don't have to be the loudest on the street."

Clapping injury

Ella Simkin, 23, went out with her parents to clap on Thursday at their house in south London, and decided to jump up on to a raised concrete flower bed to get a better view of all the neighbours.

She missed her footing, and suddenly "there was this sharp pain," she says.

"It sliced into my knee – I was wearing jeans and at first I didn't realise but it was bleeding a lot and we went to Accident and Emergency.

"I was very embarrassed when we got there. When I went for the X-ray I was telling them I was out clapping when it happened. Everyone found it very funny and lots of people said my heart was in the right place."

Richard points out that some people have been exercising more than usual during the lockdown, but others have stopped exercising, and problems can occur when they suddenly get up and clap. They may fall and break a bone, for example.

Some people arrive at hospital immediately after the clap, others later in the evening, after trying and failing to get over their injury at home.

"When you're trying to keep pressure off the NHS, it's adding to the workload at a time when we really want to avoid that happening," Richard says. "I think people need to be careful and just slow down a bit if they're going out into the street."

Despite the precautions taken in our hospitals, health workers do sometimes catch Covid-19 – and even fit young people without previous health problems may find themselves needing hospital treatment. Palliative care nurse Kelly Ward, aged 35, had been looking after elderly Covid patients at a neighbouring Bradford hospital, when she began to feel out of breath at the end of a shift one day.

By the time she got home she was feverish, and the following day she was brought into hospital by ambulance, hardly able to breathe.

Front line diary

Prof John Wright, a medical doctor and epidemiologist, is head of the Bradford Institute for Health Research, and a veteran of cholera, HIV and Ebola epidemics in sub-Saharan Africa. He is writing this diary for BBC News and recording from the hospital wards for BBC Radio 4's The NHS Front Line

• Listen to the next episode at 11:00 on Tuesday 5 May, catch up with the previous episodes online, or download the podcast
• You can also read the previous online diary entry: 'We aren't diagnosing many cancers now'

She was put on a continuous positive airway pressure (CPAP) machine, which has been our secret weapon in the treatment of Covid-19. It blows air into the lungs, keeping them inflated, but the feeling is unpleasant – and the mask needed for machine to work can make people feel claustrophobic. Some of our patients just cannot tolerate it.

"At first I panicked, I'm not going to lie," Kelly told me when I visited her on the ward 10 days ago.

"I've never had anything like that before and I tolerated it for maybe about an hour or two, and I was fine. And then I told the doctors overnight that I wasn't having it on any more, it was so claustrophobic. It felt like I had no control over what was going into my lungs, even though I know it was helping me. I felt like I couldn't breathe.

"And one of the doctors gave me strict talking to and said, 'You know, if you don't have it on you are going to go downhill.' So I had it on again."

She got on fine with it for the rest of that day, but the following morning – the day we met – she started panicking again and rejected it.

Fortunately, by this stage, Dr Paul Whitaker, a consultant in respiratory medicine, felt she had turned a corner, and could already start to be weaned off oxygen. Kelly agreed. She confessed that there had been a moment during her first 48 hours in hospital when she'd thought she might die, but that moment had passed.

However, I witnessed Dr Whitaker talking to another patient, a woman in her early 70s who had tried CPAP and couldn't face it again.

He asked her whether she would use it if it was a case of life or death. "No," was the answer.

"It's not what my family would want but it isn't their decision," she said.

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