You may have seen on the news that the first 4 doctors to die on the NHS frontline are all male, African and 3 out of 4 of Arabic (Sudanese) origin. We, in the medical family, have understandably been analysing this news with super-critical microscopic gazes. I will take you through the most prevalent theories and one of my own at the end.
- Genes: maybe something in the African DNA makes the coronavirus more dangerous to us. In the early days of Covid-19, there were a lot of false theories about the virus not liking the heat and that this was why it didn’t strike in Africa for so long and is still relatively contained. Possible I guess but as it is an RNA virus and viruses like to attack DNA, it is more likely that it’s more to do with DNA than environmental factors such as temperature and weather. Perhaps we have particular DNA sequences unique to Africans of that region (Sudan and northern Nigeria) that means the virus is more likely to successfully infiltrate our cells to replicate and overwhelm our defences. Maybe Africans are not getting infected as often as non-Africans but those that do, get a more severe disease?
Advice: don’t be foolhardy fellow Africans. As we can’t alter our DNA (yet), we need to follow the shielding/self-isolating/hand washing rules very strictly. No visiting family guys. This is serious now.
- Vitamin D deficiency: it is a known fact that in the UK, a large proportion of non-white people have either insufficient or deficient vitamin D levels. Many of us don’t know this unless we go to our doctor with generalised symptoms such as tiredness or non-specific widespread aches and pains and we have a blood test. Or if you’re a woman when you see someone for pregnancy or menopause related appointments. When I was in medical school, the importance of vitamin D was just starting to emerge outside of bone health. I remember an Ophthalmology consultant telling me to look up vitamin D in cancer and that if I was to learn anything from him, it was that I should take vitamin D supplements every winter for the rest of my life. Anyway, it turns out that vitamin D is central to many of our metabolic processes – in other words all those things your body is doing at cell level to keep you alive and functioning. It has something to do with Cancer, all autoimmune diseases, brain function, eye disease, mental health. You name it, vitamin D probably has a role. Therefore, it is a solid theory that these 4 doctors could have had that in common.
Advice: probably worth being on vitamin D if you live anywhere like the UK where the sun don’t shine most of the days. Or relocate back to the Homeland (lol)
- ACE inhibitors: there has been a link proposed that people being on these anti-hypertensive (BP) drugs having worse outcomes from Covid-19. In simple terms, those on these drugs (common ones Elanapril, Ramipril, Captopril) are more likely to die if they get sick from coronavirus. African have the highest incidence of hypertension in the UK so it makes sense that these 4 men might all be on an ACE inhibitor.
Advice: do not stop your anti-hypertensives without seeking advice from your GP. Even if this theory proves right, if you practice shielding/self-isolation and good regular handwashing, your relative risks will remain very low. You are at risk of complications of high BP too (heart attacks and strokes) and it is a balancing act.
- Inadequate PPE: this is likely to be a huge contributing factor. I think this is most likely the issue. Despite Bojo and his Government officials making grand announcements about PPE availability for NHS staff, it is not so in reality. Doctors across England are reporting a lack of PPE and feeling forced to see patients regardless. As a group, medics are prone to putting themselves second to the needs of patients and whilst that is admirable, it is also unwise. Up to 25% of healthcare workers will be infected with Covid-19 according to statisticians. This number should be much less. Of those 25% it is estimated looking at global data (particularly China, Italy and Spain) that between 5 and 10% will die. Maybe more as data is incomplete. If you look at the number of NHS staff, those numbers are huge! We medics are not indispensable. We are a limited resource and no, despite Jeremy Hunt’s claims of yesteryears, no one can magic up 1000s of doctors in the next few months. Not even if you paid them double of what you’re paying them (remember the junior doctor contract bullshit everyone?). No amount of money is worth dying for. Especially if you’re a locum and your family don’t even get a death in service pay out to compensate them in a little way for your loss.
Advice: if you are a healthcare worker, do not go within 2m of a probable Covid patient without an FFP3 mask and full gown as per WHO guidance. Help them from a distance if you must. If you are put under pressure to go closer, walk out. What are they going to do? Fire us all? A sick or dead doctor won’t do the patients any good. Trust me.
- African Bravery: I really don’t mean this to sound like I am victim blaming or being flippant, but this is my take on it. These 4 men probably had risk factors that meant they should not be frontline. Be it due to age or comorbidities (existing illnesses as per Government guidelines like Asthma/COPD, chronic heart disease, autoimmune disease, on cancer treatment). But they decided to be brave and put the need of their patients first. If they are like the African men I know (I come from Northern Nigeria like Dr Alfa Saadu), they would have prayed (all Muslim too) for protection and gone to serve with inadequate, despite knowing the risks. Whilst I admire that bravery, I really do think it needs to be discouraged at times like these. We cannot afford to lose medics who are essential in combating this pandemic. We need the Government to step up to the plate and provide correct PPE for all frontline staff. All of them. The Government/NHS says full PPE only for those performing aerosol generating procedures. I put it to you all that one of the commonest symptoms of Covid-19 is a cough. That is an aerosol generating procedure. As you cannot predict when a patient will cough, you should always be in full PPE. Simples. Only patients who are ventilated are not at risk of coughing on you if you go in close.
Advice: don’t be a martyr. You are more useful to the NHS alive and well. Demand full PPE or work from a safe distance from all possible cases of COvid-19. Walk away if you must. Go and work at another hospital that will provide you with the right PPE.I quit the NHS and clinical medicine 2 years ago in March 2018. I had many reasons but basically, although I loved my paediatric patients and a lot of my peers and the paediatric nurses, I felt that the NHS was a poor employer and didn’t care about the individual. I couldn’t see me working for 30 years as a consultant in the NHS. Couple that with Jeremy Cunt and the junior doctor contract debacle which forced me to see that the public we serve generally has no appreciation for the sacrifices we make as doctors in the NHS and think that it has to do with pay. My health and wellbeing was beginning to suffer and I had a baby to put first. So, I quit and moved onto a non-clinical medical role. I took a pay cut to do it (it really isn’t about the money folks) and lost the security of my NHS pension and sick pay. Despite all that, in my new job, I am treated with respect and feel appreciated. My mental health is much better. I am in a better place career-wiseThen bam! Covid-19. I am one of those doctors whose licences have been restored by the GMC. I have agreed to return to serve the NHS through this time. In February, I was very ill. With hindsight, I think I have had and recovered from Covid-19 (which would be great as that’ll mean I am immune going back into the viral soup that is the NHS). But my recent illness and exacerbation of asthma puts me in the higher risk group. I am also an African Muslim which is beginning to look like a risk factor. I am on vitamin D supplements and not on ACEi.Whilst I am happy to sacrifice and serve, I will not be going to the frontline without adequate PPE. I intend to stay safe and alive. My daughter will have her mother for many years to come if it is in my power to insure that. That is my promise to myself and my worried friends and family. I aint going nowhere without a fight!Stay safe folks. Peace and love