Embargo: 2301H UK time Wednesday 10 June
**Please credit the journal Anaesthesia Reports when using this research**
A 26-year-old trainee doctor with no pre-existing medical conditions has told the traumatic story of how he himself became a COVID-19 patient, eventually requiring intensive care and mechanical ventilation before recovering. His story is in a new paper published in the journal Anaesthesia Reports (a journal of the Association of Anaesthetists).
Dr Shanath Ramachandran, based at Leighton Hospital, Crewe*, UK (part of Mid Cheshire Hospitals NHS Foundation Trust), contracted the SARS-CoV-2 virus after a busy week of clinical work during which cases were rapidly increasing across the UK, including in northwest England where he is based. Having started to feel unwell on April 5, 2020, he was hospitalised on April 20.
“I was aware of my personal risk of exposure to the virus,” he says. “I was however, reassured that as a fit and well 26-year-old with no underlying health conditions, it was unlikely that COVID-19 would be severe in my case. At the time I fell ill, I was unaware of the link between members of the BAME community and the risk of becoming seriously unwell with COVID-19. This directly affects me, as I am of South Asian descent with both my parents born in Sri Lanka.”
He explains that the infection prevention policy at his institution 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, surgical facemasks were to be used. He says: “Both national and local policy have since changed to incorporate wider use of respirator masks, possibly indicating that surgical facemasks were not providing adequate protection in the context of a high population prevalence of SARS-CoV-2 infection.”
Dr Ramachandran was on his second rest day following a busy week (April 5) when he began to experience fatigue, nausea and vomiting ̶ with fever, muscle pain and breathlessness developing over the subsequent week. Aware he was becoming seriously ill, he called an ambulance on April 12 and was transferred to Wythenshawe Hospital, Manchester. Blood tests and scans revealed suspected COVID-19, and he began treatment on intravenous antibiotics (ceftriaxone) and intravenous fluids, and was admitted to a medical ward. COVID-19 infection was subsequently confirmed.
However, within 12 hours he had significantly deteriorated despite oxygen therapy, and was transferred to intensive care and placed on a ventilator. “It had never previously occurred to me that I might deteriorate to this state; hence this news caused much anxiety to myself and my family,” he recalls. “The brief telephone conversation with my family, including a forced positive message, was my last clear memory prior to intubation.”
He remained on the ventilator for six days, before having his tubes removed after his condition improved. He spent two further days on the critical care unit whilst receiving physiotherapy, monitoring and oxygen via facemask, prior to stepping down to a medical ward. A nasal and urinary catheter were removed, he was able to commence soft food, and was discharged home after physiotherapy and speech therapy once his blood oxygen was stable when breathing only air.
Following discharge, Dr Ramachandran underwent six weeks of convalescence at his parental home. Whilst he had improved markedly whilst in hospital, he was still very weak on discharge. “My mobility was much less than before, and I had lost between 10-15kg whilst in hospital. My voice was incredibly hoarse and quiet, and I was occasionally struggling to swallow fluids,” he explains.
Over the next 6 weeks, he rested and slowly built himself up. His mobility and stamina is gradually improving; on discharge he would struggle to walk 100 metres without getting tired whereas now he is running 3-4 miles a day. His voice has returned to something resembling its normal tone with further input from the speech and language therapist at Wythenshawe Hospital and the ear, nose and throat team at Heartlands Hospital.
He has just begun a phased return to work on June 8, some two months after his last shift. “My recovery has been a slow, arduous and often frustrating process. I am much better now, however there is still some way to go; there are often days when I get tired very quickly with basic tasks. I am struggling with sleep and am yet to put on some of the muscle weight which I lost whilst in hospital. I’ve been advised that some of this can take up to a year to get back to normal.”
Reflecting on the experience, Dr Ramachandran says: “One of the issues I immediately noticed was a real and a perceived ‘lack of control’ which I found difficult to process…when caring for patients I am able to plot their progress and anticipate their clinical improvement or deterioration. This was not something I could do as was a patient; this led to uncertainty in my own mind and enhanced the fears that I already possessed regarding my clinical condition.”
He says that he was helped a lot by the clinical team communicating well with him, including discussing his test results with him in medical terms, because he himself is a doctor. Dr Ramachandran also thinks his anxiety as a patient was increased by the fact he had, just before becoming ill, treated a man even younger than himself who had sadly died with COVID-19 related pneumonia. And although he was frustrated from his own lack of function while ill, depending on the hospital doctors and nurses for all personal care, he says he was strangely slightly apathetic about recovering that function as he improved.
As well as the medical care team, Dr Ramachandran also pays tribute to the physiotherapists and speech therapists that helped him recover faster than anticipated to allow him to go home. He says: “Although it is tempting to focus on direct medical care, it is important to recognise the impact that the physiotherapists, speech and language therapists and occupational therapists had in enabling my recovery.”
He says: “Being admitted to critical care was an entirely new experience for me. As well as dealing with the challenges of being severely unwell, I had to deal with the added issue of being a doctor, who had treated numerous patients with the same illness prior to admission. There is a fine balance to be found in managing those who are both colleague and patient. Navigating this dichotomy is difficult but, as my case demonstrates, it can be managed with excellent, sensitive communication.”
He concludes: “When the country initially went into lockdown and the NHS was gearing up for the peak, I was aware that there was a high likelihood of catching COVID-19. As I stated earlier, however, I did not feel as though this would affect me severely as I was normally fit and well and have never smoked. As this case and others prove, however, this disease can affect anybody regardless of how healthy they previously were; further, the consequences of this infection can be stark. Catching COVID-19 has caused me to be off work for two months, has caused untold stress and anxiety to my family and myself, and it has caused a myriad of mental and physical health issues which I am working through – it only serves to stress how vital it is that the public continue to be wary of this potentially debilitating disease.”
Notes to editors:
*Dr Ramachandran is a current foundation year 2 doctor and is at the end of his foundation training. In September he is due to begin an 8-year training post in paediatrics starting with the North West Paediatric School, where his lead employer will be St Helens and Knowsley Teaching Hospitals NHS Trust. He will not be based at just one trust over the 8 years, as the northwest programme has lots of hospitals around Liverpool, Chester, Crewe and Macclesfield.
For full case report, see:
Selected media coverage
The Times, UK and international
BBC News, Northwest and national (TV)
ITV News, UK