Safe distance

I’ve gone back to work after almost three weeks at home. Things changed quickly during that period. The streets are deserted. In the psychiatric unit where I work, there are very few patients and activities, and safety measures are in effect. There’s free food in the canteen for the staff at the NHS hospital next door. Long lines to get your hot lunch, and I was heartened to see so many people together. The macaroni and cheese was decent.

The underground is still running. The trains come every 20 minutes. At the station entrance, signs and messages repeat that transport is for essential workers only, and the rest of the population must remain at home. The station is deserted at 5:00 PM. I can see just two other individuals, waiting far from me on the platform. The passenger car is mostly empty, a sign that people are respecting the guidelines.

Right now it is easier to find people in green areas or parks. The British government authorizes the practice of some kind of outdoor exercise per day, as long as social distancing of 2 meters is maintained. This is an excellent idea. It’s good for physical and mental health, especially with the return of the sun after a long winter. Benches and playgrounds have been cordoned off to prevent contagion. I see a very odd woman in a jogging suit and mask, using a bench to exercise with baby wipes in her hands. In general, people respect the recommended distance — some even shout a warning if you are distracted and approach within 1.95 meters.

A poet who lives in Madrid tells me that he spends the day locked up in his kitchenette in the center of the city, usually asleep, because he hates live online events and activities. He tells me about the repressive of policemen with machine guns who control trips to the market and inspect “essential purchases”. He’s disgusted that people still applaud the police every day at 6:00 in the evening. An hour later they applaud the good behavior of kids during the quarantine. Then they applaud the garbage collectors.

Today they announced that the quarantine here will extend for another three weeks, as we expected. The UK peaked at almost a thousand deaths per day last week, but hospital admissions apparently began to stabilize. The NHS controls people’s access to hospitals by phone. It’s community-centered medicine, not patient-centered. You don’t do a lot of testing here, like you do in Brazil, and you don’t use hydroxychloroquine, but case management is certainly easier and more consistent, because everyone uses the NHS.

When I say that I’m fine, lay people and pessimists send me recently published scientific articles or comment on the risk of my “not developing” immunity. Recent articles and studies (with methodological criticisms) on the subject are leaked to the press. Results are distorted, and anxious people are frightened. Yes, immunity is not linear, there is a variable window of time for the development of antibodies, the tests are not 100% effective, and so on. If there is a very rare reinfection, I think it will be mild. I repeat my litany. Some people are relieved. What will it be like when so many health professionals are infected, recover and go back to work all over the world? Only time will teach us about late immunity to COVID-19. I can’t live in a plastic bubble like that 70s movie with John Travolta. Life goes on.

I come home and spend time with my eight-year-old daughter. On Sunday she was upset and complained to me: “nobody told me it was Easter”. Preoccupied with the pandemic and matters of life and death, I forgot the date. What are holidays now? On the way home, I stopped at the supermarket and bought a chocolate egg (at a 50% discount) to redeem myself. The shelf was still full. I suspect that sales of chocolate Easter eggs have not been very promising this year.

After eating her chocolate, I asked my daughter what she thought about the quarantine. She said there were positive things. It’s good not to go to school, to spend more time with her mom and dad, to watch more TV and use the computer and apps. She’s well-informed. She checks coronavirus news on the BBC site for kids. Suddenly, she said: “the world used to be one thing, and now it’s another. Now it’s a world of headaches”. I asked what she’s been missing during the quarantine. Playing outdoors with her friends. Hugs. She loves to hug. Really, hugging is wonderful. It releases endorphins. What will become of physical proximity in the near future, when this isolation ends?

Virna Teixeira

Translated by Chris Daniels

Between losses and miracles

I didn’t write for a few days because although I got better, I had to deal with difficult circumstances linked to Covid-19, including the loss of a person dear to me who had a severe form of the disease. I followed the whole process closely, from the onset of symptoms to his admission to the hospital, and the two weeks he spent in the ICU. His hypoxia-confused messages on WhatsApp before intubation. His request that ‘Virna the medic’ take care of communication with the medical team. The family’s anguish every day, his wife who was isolated at home, recovering.

Contact with the hospital is by telephone only. The ICU number is always busy or no one answers. Information is usually provided through the nursing staff. So you wait twenty-four hours to hear a “stable on the respirator” or something. Or an excess of medical details that make the family uneasy. I have never felt so helpless as a doctor from afar, and I know that the feeling of helplessness is universal right now among healthcare professionals. However, a few times I had to make myself heard, and demanded more precise information directly from a colleague. Even in communication there are echoes of isolation. I feel sorry for the people who are currently hospitalized, and for those who are dealing with hard losses caused by this horrendous virus. There is the dark side of respirators too, and the aftermath of recovery. It is not just about miraculously surviving an ICU.

I listen skeptically to hydroxychloroquine enthusiasts, especially my Brazilian colleagues. Some of them, by the way, are enthusiastic theoreticians in specialties far from the front. Some of them are isolated in their apartments, scared to death of contracting the virus. The British do not use hydroxychloroquine. They are right. There is no evidence. The CDC, embarrassed, removed Trump’s hard-hitting drug from the recommendations on its website. An interesting article in The Guardian newspaper commented that Nero also came up with a miracle drug during an epidemic in Rome. An excellent metaphor.

It is not that I am against attempts, but I do not see much scientific method in this “miracle”. What I see is a tiny amount of research undertaken with debatable methodology, and anecdotal reports shared in hospital corridors and last-minute training classes. We have take it easy, and we know that in Brazil and elsewhere there are mainly political interests behind this move. The number of infections and deaths continues to rise at an alarming rate worldwide. There are other research medications against viral replication that look more promising. I think that suddenly one could try to use Ayahuasca for Covid-19 in Brazil. I don’t know why, but I have more faith in Ayahuasca than hydroxychloroquine. It must be my Brazilian spiritualist side.

Maybe I became cynical after watching Zoom’s first online funeral, which was absolutely surreal. It is a kind of support, but until recently is was something unimaginable. Anyway, I no longer have patience for boring people who come to you with their lying pseudo-compassion, to talk about themselves, their little histrionic dramas. I also have zero tolerance for cowardly covidiots locked up in their homes with imaginary, narcissistic symptoms, sharing articles as stupid as they are, these ridiculous articles they read in the media, and thinking themselves to be authorities on the subject. A little alcohol gel in the cerebral cortex would do them a world of good. And I cheer for those who have made more productive and creative decisions in their lives at this time, despite the crisis.

About the close person who died. He was an extraordinary and generous man. He had a beautiful life. He was 75 years old, and an athlete. He fought bravely on the respirator, but his time came. Death is also part of life. It’s been over fifteen days since I got the virus and I’m almost healed. My senses of taste and smell returned. I’m alive. My mood has lifted. I cooked a beautiful meal, drank half a bottle of wine, and listened to old songs, my way of dealing with the loss of a wonderful man who knew how to live and enjoyed the good things in life. I thought of the famous excerpt from Shakespeare’s Julius Caesar, ‘a coward dies a thousand times before his death, but the valiant taste of death but once’.

Virna Teixeira

Translated by Chris Daniels

Dyspnea

The fever broke, and I was able to sleep for more than five hours. A soft, gray sky this morning. I woke up with mild dyspnea, and did some exercises to control my breathing. Dyspnea, a word from the Latin dyspnoea, from the Greek dúspnoia, from dys, ‘bad, inadequate’, and pnein, ‘breathing’. Difficulty breathing.

It is hard to use the stethoscope on yourself, but my auscultation seems clean. My respiratory rate is normal. Yesterday I also had a bit of dyspnea, and a slight pain when breathing — uncomfortable sensations. My husband and daughter went down to the garden, and I went to the balcony in a bathrobe for some sun and fresh air. It helped. I was thinking about tuberculosis, a disease that kills many people (as an infectologist friend reminds me), in the sanatoriums. I put another Brazilian film on my list to watch. Floradas na Serra, with Cacilda Becker.

Having access to information is good and bad at the same time, because it increases anxiety, but this is the time to be patient, to stay away, which for doctors is not easy. There are many changes taking place in the medical profession, and other occupations have become secondary. Some psychiatric hospitals in London are temporarily becoming coronavirus units, for example.’

COVID-19 has a special tropism toward the lungs, even in people without respiratory symptoms. I follow a Chinese radiologist based in Madrid who became infected with the virus. Every day he does an ultrasound of his lungs. Despite having mild symptoms, he noticed a thickening of the pleura and other findings since the beginning of the infection. His record is original and very useful. We can learn from his symptoms and observations, which will be useful for our work.

My appetite has returned a little, but the food is tasteless. My senses of smell and taste have decreased. I tried smelling acetone. Almost nothing. This is an early symptom of COVID-19 infection; Spanish neurologists have alerted us to this.

What bothers me at the moment is a little nausea, an accelerated intestinal transit. There are people who have only digestive symptoms, even abdominal pain, and others who will have respiratory symptoms later. This has only been known very recently. You have to be alert. Not everything is the dyspnea / dry cough / high fever triad.

Meanwhile, my immune system is still fighting. In general, I feel better and more willing today. Women are healthier, have fewer comorbidities, and for this reason they seem to recover faster from COVID-19 infection. Mortality is markedly higher in men. This is a gender advantage.

Virna Teixeira

Translated by Chris Daniels