(This interview took place on Saturday 28th March)
When we spoke to him earlier today, Dr Huzaifa Adamali, consultant respiratory specialist at Bristol’s Southmead Hospital in the UK, was waiting his turn in the car park of his local Asda supermarket. ‘Asda has a happy hour for NHS staff between 8 and 9am,’ but he was here on a day he wasn’t on call and was patiently waiting in line along with everyone else, diligently keeping social distance.
According to Dr Adamali, a large portion of the UK population has already been exposed to the novel Covid-19 virus, the unseen and as yet, incontestable disease that has turned the world upside down. Too many of those that have contracted the disease, have tragically passed away.
The respiratory physician went on to describe the way the virus binds to type 2 alveolar cells in the lungs via the angiotensin converting enzyme (ACE2), which injects its genetic material and takes over the cell protein machinery. It causes the human cells to produce more viruses.
‘It’s so clever,’ repeated Dr Adamali two or three times as he explained how the immune system then gets called over to combat the virus; this results in inflammation. Cytokines, small proteins, are released by the immune system to fight the infection. Sometimes the body’s response to fight infection can go into overdrive – there is a large Cytokine storm and this causes hyperinflammation causing serious harm or even proving fatal to the patient. Cytokine storms may explain why some people have a severe reaction to Covid-19 whilst others only experience mild symptoms.
‘We are on a military footing in these unprecedented times. Resources are centralised, the bed-base has completely changed, elective surgeries and outpatient treatment have been cancelled with telephone consultation becoming the new way to work,’ he told us. But despite knowing of the threat since January nothing could have prepared them for what was to come. Doctors have to assume an infection fatality ratio of 0.9% and hospital admission ratio of 4.4% with 30% requiring critical care.
At morning prayers, he told us, there can be intense anxiety over what is to come and by the time of the mid day prayer it is not uncommon for tears to fall upon the prayer mat. Physicians have to deviate from established standards for the management of most conditions and this raises significant anxieties. Some patients will be harmed, for example, by management of chronic lung disease or cancellation of planned surgery. Many doctors have to practise outside their defined areas of expertise.
In the evening, upon returning from work, you have to self-isolate from the family so that they are not exposed to unnecessary risk. Everything is separated, the bathroom, the utensils, the washing of clothes which go straight into the machine for a 60 degree wash. 10% of the staff at his hospital, some 800 people, have fallen ill. There is always anxiety to protect oneself and obsessive rituals of hand washing and showering have become the norm.
Psychologists traipse the wards looking out for the mental wellbeing of medics and allied professionals. It is, he told us, akin to entering a boxing ring with coaches urging you to think strong and stay positive before each round.
Prayer, he told us, was very important as well as the kindnesses of patients who phone back to ask after them. So too are the humanitarian efforts he takes special pleasure and pride in; especially work within the Bohra community such as distributing food at this particularly trying time. Today, he told us, food parcels went out to over 100 households in London. He is also one of a fifty strong group of Dawoodi Bohra frontline doctors in the UK who are part of the Saifee Burhani Medical Association.
As his conversation with us stretched to almost half an hour he was still in the line outside Asda awaiting his turn. At which point he told us of the positive and hugely uplifting work being done at the hospital to find a treatment for the virus with clinical trials, one of which is Randomised Evaluation of Covid-19 Therapy (RECOVERY) trial looking at different approaches to tackle the disease including conventional treatments, steroids, interferon-beta, anti-retroviral drugs (Lopinavir/Ritonavir) and anti-malarial (hydroxychloroquine) drugs.
There is clearly light at the end of the tunnel from the sound of his voice and his words. There have already been other advances, knowledge gained in ventilatory methods and goodwill abounds. Yet he also ended on a note of caution, this would likely be only the first of many waves of this disease. Hopefully, though, by then there will be a vaccine and ‘herd immunity’ will eventually kick in.
Dr Adamali praised the work of other inspiring Bohra medics around the country working in the frontline including intensive care, emergency departments and general practise and ended by telling us he didn’t want to focus on the negatives. He wanted to focus on the positives and today’s food to a hundred homes was as good a place to start as any to find the silver lining of this overwhelmingly grey cloud.