Junior Doctor Recounts Traumatic Effects of COVID-19

Peter Russell

June 11, 2020

A junior doctor has given a harrowing account of how he became a COVID-19 patient at the height of the pandemic.

Dr Shanath Ramachandran went from a busy week of clinical work at Leighton Hospital, Crewe, to eventually requiring intensive care and mechanical ventilation before recovering. 

He recounts that he was aware of the risks of exposure to the virus but felt reassured that as a fit 26-year-old with no comorbidities, it was unlikely that COVID-19 would be severe in his case.

At the time he fell ill, Dr Ramachandran, whose parents were born in Sri Lanka, was unaware of any link between members of the black, Asian, and minority ethnic (BAME) community and the increased risk of serious complications from the disease.

Dr Shanath Ramachandran

In the case report, published in the journal, Anaesthesia Reports , he explains that the infection prevention policy at his hospital at the time, which was aligned with national guidelines, permitted the use of respirator (FFP3) masks only when managing a patient with confirmed SARS-CoV-2. When managing all other patients however, including those awaiting SARS-CoV-2 swab results, staff were advised to wear surgical facemasks.

On the 5th April, Dr Ramachandran was on his second rest day after a run of night shifts when he began to experience fatigue, nausea, and vomiting.

He called an ambulance on 12th April when he realised he was seriously ill, and was   transferred to Wythenshawe Hospital, Manchester.

Blood tests and scans revealed suspected COVID-19, and he began treatment with ceftriaxone and intravenous fluids, and was admitted to a medical ward. COVID-19 infection was subsequently confirmed. 

Within 12 hours he had deteriorated significantly despite oxygen therapy, and was transferred to intensive care and placed on a ventilator for 6 days.

Medscape News UK asked Dr Ramachandran for details of his treatment, recovery, and thoughts on contracting the disease as a health professional.

Q&A

I was aware fairly soon that I probably had COVID.

I'd been working nights, finishing on the Friday. At the weekend, I started with a temperature and I started feeling a bit sick.

At the time, you know, whenever you had a temperature, you assumed you had COVID. Considering the fact that I'd spent most of those nights working on COVID wards, admitting COVID patients, I thought there was a very high chance I had it.

And then I spent the next 6 to 7 days in my flat, isolating. And to be fair, for the first 4 days I had nausea, and a bit of vomiting initially, coughing – a lot of coughing – and was a bit short of breath, but it wasn't too bad. But during that time I was definitely aware of it.

It only really worsened, and quite significantly, from Thursday or Friday, on to the day I was admitted.

How did you feel when you knew you had developed COVID-19?

It helped that it happened so quickly because I didn't have a huge amount of time to process it.  So, the time from calling an ambulance to being intubated was sort of less than 24 hours. But yeah, in short, it was terrifying.

I'm a doctor – a junior doctor – I'm not used to the 'other side', I prefer 'our side'.

I've never been to hospital and stayed in. The only times I've been is for the odd broken bone. I'm fit and well, I've never had any problems. So, you naturally assume that you will be absolutely fine.

So, yes, that made it more significantly scary.

When you were on shift, did you have adequate PPE?

The hospital was sort of aligned with national policy. That policy at the time was you use a respirator mask – FFP2 or FFP3 – with any COVID patient who had a positive swab, or if there was an aerosolised procedure. Anyone else involved using a surgical face mask. So, they were following the rules.

The fact that the rules have changed to now state they're using respiratory masks for anyone with symptoms, and the fact that policy has changed, probably speaks for itself really. I wouldn't go as far as to say that we were unprotected but, yeah, it probably wasn't ideal, all things considered.

I just happened to be one of the unlucky ones really – it's a bit of a perfect storm.

On the other hand, it's really easy to talk in hindsight, so I don't want to say too much but in essence, it wasn't ideal.

Were you aware at the time you became ill that being of South Asian descent could increase your risk of worse symptoms?

It wasn't known at that stage at all. It wasn't something I was even aware of when I was ill. That's actually only something I have become aware of since I woke up and started my recovery. So, before then I honestly had no idea. That information wasn't really out there.

Tell us about your recovery

I was discharged from hospital around the 22nd April. It's taken about 6 to 7 weeks to get back on my feet. The first 3 or 4 weeks were just about getting my mobility back, trying to be able to speak properly.

I dropped a lot of weight – I dropped about 15 kilos I think, roughly – and most of that was muscle, so it meant that mobility was poor, my strength was awful, I was getting tired very easily with basic things like showering, brushing my teeth, all of which was immensely frustrating. I'm used to being fit and independent.

So, the first few weeks was about getting that back, and the last 3 about building myself up.

I'm not fully there yet. I still get pretty tired, and my voice is still not perfect, so it's going to be an ongoing process. I've been told about a year to be fully normal.

What would you say to other health professionals about this virus and the risk of getting COVID-19?

In particular, to healthcare professionals, be so careful, and look after yourselves.

It's really, really easy to get into a spiral where you don't. You spend most of your time thinking about other people and you tend to neglect yourself. Sometimes you don't always lead the healthiest lifestyle with eating habits and exercise, etc. I'm not saying it played a part but you just have to look after yourself and be really self-aware about it.

If it gets you, and it gets you bad, it's awful. I mean it's one of the single worst experiences of my life.

And it's not just what happened to me, but it's the impact it had on my family. I was intubated for 6 or 7 days – they were tortured, you know, not knowing, not being able to visit. So, it's not just what it does to you, it's what it does to everyone else.

And for that reason, you just got to be so careful.

Adhere to social distancing.

If you're ill, self-isolate.

Healthcare people, just be aware of your own bodies. If you've got symptoms, be careful, seek medical attention as soon as you can, as soon as you think something's wrong. Don't be too proud to go to A&E.

Have you been able to return to the wards?

So, I've started very gently at work. My first day back was a half-day yesterday [Monday this week].

It was great to be back. I'm doing a phased return. So, this week I'm just doing 3 half days, seeing where I'm at.

A junior doctor’s experience of critical illness: from treating patients to becoming a patient with COVID‐19 Anaesthesia Reports , published 10th June 2020.  https://doi.org/10.1002/anr3.12052

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