By Dr Sarah Hudson (@sarahhudsonUK)

On January 9th 2020, the World Health Organisation (WHO) released a statement regarding a cluster of pneumonia cases in Wuhan, China caused by a novel coronavirus (1). Under 9 weeks later there were more than 118,000 cases of COVID-19, the disease caused by this novel coronavirus, in 114 countries (2). WHO formally characterised it as a pandemic, and as cases climb in the United Kingdom (UK) it is clear there are challenging times ahead for everyone working in healthcare, including cardiologists.

It is obviously important to consider the impact COVID-19 will have on our patients and plan how essential cardiological services can be maintained. However, in this period of ‘calm before the storm’ is also vitally important to take a moment to stop and consider how we are going to look after ourselves and each other in the coming weeks.

Advice on how we should do this was requested from frontline UK cardiologists. The responses are collated below, grouped into 8 themes. Given that often several people contributed similar suggestions they are not attributed to individual cardiologists, but a complete list of those who offered thoughts is at the end of this post.

Theme 1: Protect yourself from infection

1. Wash your hands.

2. Stock up on moisturiser – with the increased washing and alcohol gel they will quickly get sore

3. Take responsibility for getting yourself fit tested, and make sure you know where to find PPE (personal protective equipment) in your trust

4. Change into scrubs when you get to work and back into normal clothes at the end of the day. If that is not possible, make sure you change as soon as you get home

5. Consider having a separate set of shoes for hospital

6. Wipe down computer keyboards/phones/dictation devices regularly with appropriate cleaning agents

7. Clean your stethoscope well between each patient

8. Clean your phone

9. Try and decrease unnecessary patient interaction – see if outpatient appointments can be done by phone

10. If outpatient appointments are continuing, move chairs further apart

11. If you have a health condition that puts you at higher risk, let your colleagues know!

Theme 2: Protect others from you

12. If you have symptoms of COVID-19, do not come to work

Theme 3: Family are important – make plans so you aren’t worrying about them while at work

13. Have conversations early in your departments about which colleagues have children and will be unable to come to work if schools close or they are unwell

14. Think about other caring commitments, such as getting food to elderly relatives, and make plans on how this could be achieved

Theme 4: Don’t forget the basics

15. Even if it feels like you are working more like a machine than a human, remember even machines need fuel and recharging.

16. Try and eat healthily and have an adequate fluid intake.

17. Sleep is important, not just to relieve fatigue but also for the correct functioning of the immune system – don’t neglect it.

18. Remember “you can’t pour from an empty cup”

Theme 5: Keep up to date

19. Read the emails being sent by your trust so you remain informed of local plans and protocols

20. Soak yourself in knowledge so you are in the best position to manage your patients well and keep yourself safe

21. Make a plan on when you are going to read emails/news/Twitter in a day to avoid looking too frequently and becoming overwhelmed

22. Think about how communication lines for important information can work in your local area – a dedicated email list? A WhatsApp group? A bulletin board?

Theme 6: Remember to look after your mental health too, and that of your colleagues

23. Doctors can be nervous about admitting they are uncomfortable, but talking about how you are feeling in an unprecedented situation is crucial – do talk to your colleagues.

24. There is no shame in admitting you feel worried.

25. Optimise communication networks for emotional support, both within work teams and also neighbourhoods/friends. WhatsApp or Slack can help people stay connected when not together

26. Debrief with colleagues frequently

27. Remember colleagues from abroad/from other parts of the UK may not have local support and may be worried about family elsewhere. Ask if they are OK.

28. Forget about other deadlines, papers etc for now and focus on relaxing and those who are important to you when you’re not at work

29. Don’t forget that non-medical colleagues – cleaners, admin, other support staff – will also be worried. Check they are OK and offer support.

30. Write a diary.

Theme 7: Help each other

31. Flexibility will be key – be prepared for everything to change in an hour if necessary

32. Anaesthetics/intensive care colleagues are likely to be under the most pressure – think now about how we can help them

Theme 8: Nurture the right mindset and remain positive

33. Accept the uncertainty. Things will change daily; don’t get cross about it

34. Enjoy non-work time as much as possible

35. Think about what nice things you will do in the future

36. Remember we do a very good job in difficult circumstances on a day to day basis anyway, so believe in yourself!

37. You make life and death decisions and get involved in potentially hazardous situations as a doctor usually – this is a highly concentrated version of what you know how to do, and know you can do.

38. Remember this is going to be a marathon, not a sprint, so pace yourself, think about what is actually important and remember heroics only works in the short term.

39. Laugh. Group dance sessions may not be part of our culture, but black humour in times of crisis is. Jokes can break the tension and fear can be defused if you are able to laugh at something you can’t change.

40. Take time to make a small gesture of kindness – a kind word and smile cannot be underestimated in value.

Many thanks to all the cardiologists who responded to the request for advice and tips to share in these unprecedented times:

Dr Dan Augustine, Bath; Dr Ami Banerjee, London; Dr Richard Bogle, London; Dr Navin Chandra, London; Dr Derek Connolly, Birmingham; Dr Colin Cunnington, Manchester; Dr Marc Dweck, Edinburgh; Dr Rohin Francis, London; Dr Shouvik Haldar, London; Dr Cara Hendry, Manchester; Dr Shazia Hussain, Leicester; Dr Wajid Hussain, London; Dr Tom Johnson, Bristol; Dr Vijay Kunadian, Newcastle; Dr Guy Lloyd, London; Dr Chris McAloon, Gloucester; Dr Lynn Miller, Fife; Dr Holly Morgan, Newport; Dr Rajay Narain, London; Dr Peter O’Kane, Bournemouth; Dr Dominic Pimenta, London; Dr Andrew Sharp, Cardiff; Dr Hannah Sinclair, London; Dr Chris Steadman, Poole; Dr Andy Thornley, Newcastle; Dr Richard Till, Norfolk and Norwich; Dr David Tomlinson, Plymouth; Dr James Wilkinson, Southampton.

References:

1 https://www.who.int/china/news/detail/09-01-2020-who-statement-regarding-cluster-of-pneumonia-cases-in-wuhan-china

2 https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020

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