Valentine’s Friday, 2020. A quarter century practising medicine. Half in hospitals, half in general practice. I’d been treating unseasonal, politely-coughing, relatively-well patients for the previous two and a half weeks.
Extraordinarily, on Saturday at 4am I was abruptly awoken by uncontrollable, whole body, flailing movements. They continued without relent for 5 hours. I’d hypothesised I was having a grand mal seizure, but as I lay violently shaking and goose-pimpled I coldly concluded I was conscious, so these were rigors. I’d witnessed two in my career one as a naïve house officer on a medical ward, and now the second in the comfort of my own bed. It wasn’t my last hurrah.
Two Paracetamol, two duvets, two days of bad diarrhoea and I returned to work Monday, a few pounds lighter and clinically puzzled. This was no ordinary fever. As it happens, two other GPs in my vicinity later described similar contemporaneous symptoms, and we all tested negative for Roche’s Covid-19 antibody assay 4 months later. That, however, is not so meaningful since most people are thought to clear the virus without the need for specific SARS-CoV-2 antibodies. On top of this, in PHE’s own studies, Roche’s test demonstrated only 83.9 per cent – 86.7 per cent sensitivity, so it was missing 13-17 per cent of true positives.
How many are still dying of perfectly treatable illness?
There are two arms of the cellular immune response. The immediate, innate system (no specific antibodies required), and the delayed, adaptive immune system (B and T-cells, and specific antibodies required which may or may not persist after the infection). So, no antibodies does not necessarily equate to future risk. 10 per cent of us may raise antibodies in response to the acute infection. We could die in the attempt. 90 per cent of us might deal with the infection innately, yet have nothing but our healthy, vigorous lives to show for it. A vaccine may not work, it may not be safe to some, it may raise antibodies but still not work. It may raise antibodies and make matters worse by ‘pathogenic priming’ and enhancing any future infection. These are all normally valid medical points, but I do not feel our governmentlikes doctors and scientists making these anymore. The normal medical and scientific truths of our time feel radically heretical to modern day Dr. Galileos.
Something very odd was going around. I don’t usually get ill on the job, and I have never had the influenza vaccine. As many doctors might agree, to our families’ inconvenience we become ill as soon as we switch off, relax, and take a holiday.
What was even odder to witness was the surreal lock-stepped, global lockdown that began around March 2020. Same language, same procedure, same time, no independent engagement of resource nor intelligence, no bespoke solutions. All but Sweden appeared to fall into a blind panic. The theatrics of lockdown on 26th of March did affect me, I was ejected from my accommodation and struggled to find anyone willing to take on a walking NHS repository of certain viral death. I returned to work in a single-handed practice with a deep dread of the cataclysm that would befall me and my community. No such thing happened.
I recall the fear of the clerical staff. They furtively asked why I wasn’t wearing a mask – remember this was the early days of PPE shortage, with no government mandate of general mask-wearing. My attitude was flimsy clinical masks were of no real effect, and besides risk of infection is part of the job description. However, I quickly succumbed to their unease to avoid the inevitable escalating inquisition and workplace disciplinary. I learned quickly, knowledge and experience were now nullities.
Frankly, if it had not been for mainstream media and the government, I would not have even noticed there were a pandemic. I experienced no excessive dying, and no excessive becoming seriously ill. Since January, I have worked in three different general practices across England, in two regions. Accumulatively, they contained over 16,000 patients. Up to my last time of asking in September 2020 there had been many well Covid-19 “swab positives”, and only 5 deaths “with” a Covid-19 “swab positive”. Those 5 deaths were all white, over 60 years, with other co-morbidities.
In the BAME-dominated practice of nearly 6000 where I work with the most deprived, the poor, the homeless, addicts, and migrants, no one was known to have died in association “with” a Covid-19 swab-positive test.
In the practice of 1800 where I worked through the inception and peak of the pandemic, only two people died of anything between January and July. These two were expected deaths of metastatic terminal cancer.
Enough has been said on statistics and science to convince the current government response is disproportionate. Yet most governments dismiss it all with incredible contempt. Clinical experience is as equally relevant as the statistical manipulation and science. My experience is no one but the government and mainstream media are sharing apocalyptic Covid-19 death experiences with me. I don’t see it in my clinical practice as a simple GP.
My attitude to the government pandemic advice hardened significantly when I received the CCG (Clinical Commissioning Group) advice on pyrexical over-70-year olds in the community: do not admit them. If they get very ill, call the Macmillan nurse and palliative care team. This was my first sniff of the new-normal clinical lunacy. It was redolent of the swine flu panic where in 2009 we were negligently told to prescribe novel anti-viral medication to anyone on the basis of the slightest raised temperature, regardless of better alternative diagnoses. A reasonable body of doctors would never do this under sane conditions.
I did research. Given my older patients were to be left at home to sink or swim, I concluded that the very safe hydroxychloroquine, zinc and azithromycin combination was worth trying in the best interests of those marooned patients. I was blessed to have my own NHS dispensary and quickly ordered the medications. That was when the second whiff of madness was caught: the gas-lighting mainstream media was repeatedly telling me it was very dangerous, they were lambasting my brave and learned international medical colleagues for daring to say anything but a vaccine was effective in mitigating Covid-19. Our CCG pharmacist emailed all GPs to ask us to not prescribe hydroxychloroquine in suspected Covid-19 cases as this would diminish stock for the usual rheumatoid and lupus users.
My older patients were to be left at home to sink or swim
As it happens, such was the lack of community cases of clinically unwell Covid-19, I never had to use the triple therapy. The closest I got was when a very feverish lady in her 80s was being left to probably die of a severe sepsis. She was refused hospital admission. At that time, I was not allowed to see her, as we had a dedicated coronavirus “red hub” to remotely triage queried coronavirus cases to. Its guidelines had concluded temperature equated to coronavirus, which in turn equated to no hospital access allowed for over-70s. This was my third experience of what was now a reeking stench. Fortunately, her home-help called me to notify me of the ensuing danger. I assessed the situation remotely and concluded that the clinical logic of the red hub was wrong. The most likely cause was line sepsis (she had an in-dwelling feeding line in a major blood vessel). I spoke to the red hub and the hospital to explain that the guidelines were fatally negligent. They took her in, and line sepsis it was. This simply required a new line and intravenous antibiotics. She survived to re-join her husband, but how many are still dying of perfectly treatable, potentially fatal illness?
The fourth time, I was called by a Macmillan nurse. She had been delegated the responsibility of persuading me to prescribe a cancer drug without due normal clinical process by the Consultant breast surgeon, who presumably was instructed to avoid doing his job at all costs. The nurse explained to me the lady who had a very large breast lump diagnosed in hospital just before lockdown was somehow neglected to be assessed for 5 weeks, presumably because of lockdown. Here’s where it got more distressing. She said the consultant would not be able to see her for at least 3 months. Would I see her and confirm there really was a lump and prescribe a speculative breast cancer treatment? Normal protocol would be a two-week maximum wait for a cancer specialist and biopsy. Then a treatment plan, usually some combination of a biopsy-determined hormonal medication, radiotherapy, surgery and chemotherapy.
In her case, they wanted me to provide speculative hormonal medication without any real prospect of review, confirmatory biopsy nor other intervention for at least 3 months.
Moreover, I was told by the nurse that the poor dear did not even sound all there over the phone. Inference: doesn’t really matter what she thinks, she’s old and it’s a hopeless case.