Respiratory doctor challenges COVID-19 deniers

Interviewer: Hello, could you introduce yourself please?
Doctor Monaghan: I’m Dr Catherine Monaghan, I am a consultant at North Tees and Hartlepool hospital and I specialise in acute and respiratory medicine.
I qualified in 1997 in Leeds and I’ve been practising respiratory medicine since 2004 and I’ve been a consultant here since 2013.
Interviewer: Cath, what actually is COVID-19? How does it attack the lungs?
Doctor Monaghan: So essentially it’s a virus. There’s a bit of a joke, maybe it’s just in my family, that when people don’t know what something’s the matter with you, a doctor says it’s a virus.
But actually viruses are extremely damaging and COVID-19 is what we call a novel Coronavirus.
So there’s a broad group of other viruses within that family but Coronavirus is one of the newer ones and it’s a very interesting virus.
In all my years of practising medicine, I’ve never seen a virus that behaves quite so differently in different people and that’s part of the problem.
Some people will literally just lose their sense of taste and smell, where other people who have got no health problems and are otherwise young and fit well will end up on intensive care and will die.
The pattern that we see in the lungs can be quite wide-ranging. From nothing in people who haven’t got the typical cough and breathlessness symptoms.
But we can see situations where the whole of the lungs, when we look at them on X-rays, on CT scans, become completely white. They should be black. Black is air in the lungs and when we look on them in very badly affected lungs, they are white and that is a massive problem because instead of air spaces where our oxygen can get in, it can’t at all.
Interviewer: So to those who say, it’s a conspiracy’, ‘it isn’t real’, as a front-facing doctor at the Trust what would you say?
Dr Monaghan: I can’t imagine why anybody would have the time or the energy or the motivation to make something up that’s not real.
It is very, very real. It’s a very real threat and it’s very, very dangerous.
I cannot emphasise that enough.
In the NHS, we have not got time to make things up. We’ve got enough to do with managing the day-to-day work.
Covid is a massive problem and it’s very, very real.
Interviewer: So how is it spread and who is most at risk?
Doctor Monaghan: So in terms of how it’s spread, it’s spread by droplet.
So if you coughed and you had Covid, whether or not you knew it, the virus would be in little particles in the secretions that you cough out.
You get them on your hands, you put your hands on your face, you put your hands on somebody else’s face, you put your hands on the table and somebody else comes along and touches the table – that’s how it’s spread, by droplet.
This is why we think wearing masks is effective.
You say ‘why we think that they’re effective’ because we haven’t been able to do a trial yet that proves it but from our extrapolation from other viruses and transmissions, we think that masks are effective because they stop that droplet spread.
Interviewer: So who is most at risk? Doesn’t it only affect older people?
Doctor Monaghan: No, absolutely not. So age is absolutely definitely a risk factor for becoming seriously unwell with it. There’s absolutely no doubt about that. The older you are, the more at risk you are from a severe illness from Covid.
But it can significantly affect other people.
So we know the black, Asian and ethnic minority populations do much worse.
Men do much worse. Particularly older men. Our experience, clinically, has been that that group that tends to do much less well.
And when I say old, at the risk of offending people, certainly men once they’re over 50.
If you’re overweight, you’re significantly more at risk. And then various other conditions that we call comorbidities so high blood pressure, diabetes – they would put you more at risk of having a severe illness.
Younger people generally seem to do much better and we don’t fully understand that.
But essentially a very, very key message I would like to give everybody is if you think as an individual that you’re going to get it and going to be fine, you’re playing Russian roulette.
Interviewer: So, Cath, to those who anecdotally say there’s a 99 per cent survival rate or ‘I don’t know anybody who’s had COVID-19’, what would be that message again?
Doctor Monaghan: Absolutely clear.
I know plenty of people who’ve had it, I’ve had it myself. It’s deeply unpleasant.
If you are young and otherwise fit, you will probably be all right.
Is that good enough? No. As a consultant if I said to you that spot on your X-ray’s probably not cancer and it’s probably all right, would you be happy when you left the room?
The answer is no. So don’t take risks that you do not need to take.
I cannot guarantee that anybody would be okay.
I can tell you who is more likely, from the experience we have, to do badly.
But, as I’ve said earlier, you are potentially playing Russian roulette. And people who we would not ultimately have expected to do badly have done very badly and unfortunately some of them have paid the ultimate price and have not survived in spite of our best efforts.
Don’t gamble.
Interviewer: So with the lockdown now in place, what will this achieve? What will another lockdown achieve for us?
Doctor Monaghan: We are hoping that it is going to reduce the rate of transmission that we are currently seeing.
I say ‘hoping’ because we can’t guarantee. We are relying on the public to do the right thing and the right thing is to follow the rules of lockdown.
I don’t want this. I don’t want this, personally. We’re people too and we don’t want to have to follow the rules of lockdown but I cannot emphasise enough the importance to the NHS of doing what you need to do.
We are starting to feel immense pressure and we do not normally feel winter pressure at this time of year.
We are having to balance things in a way that we have never had to balance before.
So we are already under pressure for beds. We have to balance patients who we know have got Covid, who we don’t think have got Covid and who definitely haven’t got Covid with vulnerable patients.
And we simply have not got enough capacity, either clinically, physically, for beds or for staff.
You cannot forget the NHS is its staff. We are not a building. That is not what we are. We are the people and if we haven’t got enough staff, we can’t look after you properly and so you have to protect us. You have to.
Interviewer: How different is it from flu?
Doctor Monaghan: So it is different in that it does tend to affect a broader spectrum of people and it can affect younger people much more severely.
So flu generally can be very, very serious, especially if you get what we call a secondary pneumonia and people can die of that. But generally that does tend to be old people who have other problems going on.
Covid is not the same as that and it is, in some people, much, much worse.
Interviewer: We’re hearing that most people’s symptoms are mild but what treatments are you administering for serious cases?
Doctor Monaghan: So the trials from the first wave of Covid have been very successful. As a Trust, we were one of the leading recruiters.
So we know that steroids work. If people need oxygen, if their oxygen levels are so low that we need to give them oxygen to keep them satisfactory, then a drug called dexamethasone which is a steroid – that works.
And there’s another drug in the trials called remdesivir which improves the length of stays – so the amount of time you need to be in hospital and the time to recovery.
We would give oxygen if people came in.
Another treatment which is quite deeply unpleasant actually is called CPAP. So it’s a way of delivering oxygen under pressure without putting you to sleep and putting a tube down to take your breathing over for you.
It’s a tight mask that sits over your face and it pushes air in and it helps clear out, on a very simple level,
the white spaces that I talked about earlier. So it gets air into those spaces.
The best analogy as to how it would feel like is imagine you’re driving along the motorway at 70 miles an hour and you stick your head out of a window into the air. I’m not suggesting that you do that. But that’s what it feels like.
And then imagine that you’re already feeling breathless and that happens, it’s unpleasant.
Don’t get yourself in that position.
Interviewer: So Cath, if somebody’s got mild symptoms of Covid and they are staying home rather than coming to the NHS, what do they need to do to ensure that their health and welfare is looked after?
Doctor Monaghan: So the first thing I would say is you need to make sure that you follow the government guidelines about isolating. That’s absolutely vital.
The second thing is the usual recommendations we would give to make sure you’re drinking plenty of fluids.
If your appetite isn’t great, don’t worry too much – eat small amounts of whatever you fancy.
One key message that we would like to give is that this can turn significantly bad and your symptoms can worsen, usually at about day seven to ten after symptoms.
So if your symptoms start and about day seven to ten you start feeling much worse, you must seek medical attention and you need to tell them that you’ve been diagnosed with Covid.
We have experience in the first wave of people leaving it very, very late and coming into hospital in really quite catastrophic situations where the intervention, if it had come earlier, the outcome might have been different.
The local primary care are running a virtual coverage ward so what that means is if you go and see them and you’re diagnosed with Covid, depending on your individual situation, they may give you an oxygen monitoring probe. And they provide you with that support so that they can identify, much more early, patients who are deteriorating.
Use common sense but if you are still not feeling well, then please seek further medical attention. It’s really important.
Interviewer: So, Cath, we’re hearing about the impact here and now but we’re also hearing about long Covid. Can you tell us a little bit more about what that means?
Doctor Monaghan: A lot of that is just starting to filter through now. But as a respiratory department, we are now seeing referrals from patients who didn’t come into hospital who are still considerably symptomatic months down the line.
So very, very breathless on minimal exercise. Very, very fatigued.
We’re seeing people who were in hospital and were unwell have got quite dramatic X-ray changes months down the line.
We don’t know what this is going to mean but even if you do get what we would potentially perceive as being a mild illness that doesn’t require hospital admission, there are people months and months down the line who are still feeling really, really unwell.
And as of yet, there there’s no solution for that. We haven’t got any treatment for that.
We think it’s probably going to be what we call pulmonary rehabilitation so an exercise program.
But as things stand, there is no pill, there is no tablet, there is no injection that’s going to make you feel back to your normal self months down the line.
It goes back to my original point – don’t play Russian roulette.
You don’t know which camp you’re going to be in and you don’t want to find out that you’re one of the unlucky ones who doesn’t make it. Or that you’re, months down the line, still not being able to do what you used to be able to do because there is no solution for that at the moment I’m afraid.
Research is going on.
Interviewer: So, in your own personal experiences, can you tell us about some of the difficulties you and the team have faced since March this year?
Doctor Monaghan: It’s been extremely challenging, as I’m sure you can imagine. Much more so for the respiratory team that look after the patients back of the ward. I tend to look after them at the front of house.
It’s extremely difficult. You’re having to make very difficult challenging decisions about what may or may not help somebody.
That takes its emotional toll. We are not robots that can just pop along and say ‘well I’m going to give you a chance and I’m not going to give you a chance’.
It’s very, very emotionally demanding. It’s really hard, it’s physically hard.
People are complaining about having to wear masks.
I know it’s a bit of a cliché now but try wearing a respirator, a visor, a gown and two pairs of gloves on a Covid ward for 12 hours. It’s deeply physically unpleasant.
You’ve got emotional anxiety for yourself, you’ve got the anxiety for your family and your friends.
We’re fed up of lockdown as well. We would like to go out and do normal things and we can’t and that is taking its toll.
And the harder thing now I think is that, as much as possible, we are trying to keep our normal business going so we’re trying not to cancel outpatient appointments.
We understand that people want their normal health dealing with. That’s really important. But it’s becoming physically impossible because we are needing to be in two places at once. We have to be here to look after the critically ill who will die if we’re not here and we have to balance that with the ongoing health needs of the population.
And it’s not a position I ever wanted to be in.
I’ve never been more worried about the future of the NHS and I’ve been here since 1997.
Interviewer: So physical social distancing – why is it important?
Doctor Monaghan: Because of the issue about droplet spread.
So if I cough now and you’re over there, if I was rude and didn’t cover my mouth if I had Covid – which I do not –but if I did, the droplets would reach you.
If we’re standing next to each other and we’re physically in contact or we cough or the virus is just there, then it will be transmitted much more easily.
Interviewer: Okay. So if it’s spread through breathing and droplets, why do we need to wash our hands?
Doctor Monaghan: The natural response for most people if they cough they cover with their hand.
You have then transferred the virus in the droplets onto your hands. If you don’t wash them, then you’re going to touch surfaces, you’re potentially going to touch other people then they’ll come along they’ll touch the surface and you’ve transmitted it.
So it’s why hand hygiene is vital. Good hand hygiene is absolutely vital.
And one thing we have noticed through this is that we’ve seen a significant downturn in other illnesses. So diarrhoea and vomiting we’re seeing a lot less of. We’re seeing a lot less of a very nasty diarrhoea that people can sometimes get.
And we think that it’s probably related to people washing their hands much better so long may it continue.
Interviewer: Hands face space really is true?
Doctor Monaghan: It’s a bit of a gimmicky phrase and I do understand it. It’s short and snappy. But wash your hands, cover your face and keep apart from people.
Yeah. It’s the right thing to do.
Interviewer: So Cath, finally how important is it once again that people come together to help reduce infection and protect the NHS?
Doctor Monaghan: It is absolutely vital in my opinion. More so now than the last time.
This hospital is not a TARDIS and we are not automatons. We cannot replicate ourselves.
We’ve got to ensure that we’ve got enough capacity to keep critically ill and unwell patients safe and in a position where we can get you into a bed if that’s where you need to be.
If the trajectories continue the way that they are, then we are going to be in a very, very, very serious position in a couple of weeks’ time.
Even if you, as an individual, still don’t believe everything I’ve said and you’re not concerned about your own individual risk of getting Covid, then just consider where you might be as an individual in three weeks’ time. If you have a nasty accident in your car and the ambulance is taking hours to come because there’s no capacity in the system.
Or you come to A&E and you have to wait hours and hours and hours because there is no capacity in the system.
You have to take this seriously, even if you don’t believe in Covid.
It’s not like Santa Claus or the tooth fairy. It’s not a matter of opinion, it’s real.
And even if you don’t believe me and you just want to think about yourself, think about where you might be as an individual if you need us in four weeks’ time.
We’ve never ever not been there before.
Interviewer: Dr Catherine Monaghan, thank you very much for your time.
Doctor Monaghan: It’s a pleasure, thank you.