Lockdown easing ‘terrifies me’ says Covid doctor

By Jez Hemming   |   Local democracy reporter   |
Wednesday 24th June 2020 1:25 pm
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Dr Chris Subbe is consultant in acute respiratory and intensive care at Ysbyty Gwynedd (Picture: BCUHB)

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A North Wales consultant leading trials looking for existing drugs to fight Covid-19 says seeing people rushing to shops as lockdown is relaxed “terrifies” him.

Dr Chris Subbe is consultant in acute respiratory and intensive care at Ysbyty Gwynedd, a senior clinical lecturer at Bangor University and has numerous research paper credits to his name.

He spoke to the Local Democracy Reporting Service about his team’s work trialling dexamethasone and his fears about what he called “the most deadly infection we have seen in Europe in my professional lifetime”.

He said he was concerned to see people rushing to reopened stores and gathering in groups.

He said: “It absolutely terrifies me. When people were queueing rather enthusiastically to get into shops, or shouting, those have been the events where there have been outbreaks in the past.

“We’ve all read in the papers those choir practice sessions where suddenly the whole choir have got Covid, and a significant number of members died.

“You kind of replicate this in those situations.

“It really is gambling. You just need one or two people who, unknowingly, have got it and they might be able to infect a significant amount of others.

“Then it spreads again and we’re back to square one.

“If you’re too close to somebody and they just happen to have it, you can just inhale it.

“In that sense it’s transmitted as easy as a cold.

“(Social distancing) is the only thing at the moment that is reliably protecting us.

“Everything else is gambling.”

Dr Subbe, who has worked for Doctors Without Borders said, although Ebola and SARS were concerning outbreaks, Europe had never see a such a dangerous disease in his “professional lifetime”.

He said Covid-19 had “at least two phases”, the first giving flu-like symptoms with “mild inflammation, so defence cells are being activated to boot the virus back out”.

Then patients would experience “a runny nose, sore throat, a bit of a dry cough, maybe some loose motions, some nausea and some headaches”.

Dr Subbe then revealed how after eight or 10 days Covid-19 randomly triggered the body’s immune system in some patients into what he called a “cytokine storm”, attacking it’s own organs.

He said: “We don’t understand this phase very well yet but it seems the immune system goes into overdrive. It explodes.

“In some patients, and we don’t know who they are when they present, this virus causes this fulminant, what we call a cytokine storm and it cannot be stopped with normal treatment.

“It literally is like a typhoon and there is nothing humans can do once it’s in full flight.

“You can’t predict who gets it and you can’t prevent it once you’ve got the virus.

“It seems the anti-inflammatory drug dexamethasone which we have been using for lots of conditions before, slows this inflammation down and gives the body a chance to recover.

“But it’s absolutely overwhelming. People from my own health board, colleagues, have died from contracting Covid.

“And I’ve had colleagues in intensive care that I know really well and it’s…there’s nothing we can do.

“At times we’ve felt exhausted from this knowledge that some of our colleagues will get infected and we won’t be able to help them as we would with other infections.

“It is very, very hard.”

Dr Subbe said the sickest patients were those who would probably benefit most from dexamethasone – those on invasive ventilators.

He said previously doctors could save one in eight people on ventilators and one in 25 on oxygen – but the new drug he and his colleagues helped trial seems to have increased those positive response rates.

One-in-three of patients on ventilators could survive with the help of dexamethasone, and one-in-five of those on oxygen, according to the initial study results.

“The drug probably helps you if you’re getting really ill,” he explained. “It’s much easier to treat a disease that’s not that bad.

“A disease that’s like a nuclear explosion, to get that back and manage it is exceptionally difficult.

“I’ve done many years of intensive care medicine before I did acute medicine and we’ve been trying these sorts of things on patients and we’ve tried virtually any drug you can think of, very unsuccessfully.

“So this is a real once in a lifetime event. It stops those inflammatory cells going into overdrive.

“So everything goes a bit slower and the body has the chance to ride out the storm.

“We have now got the first weapon in the fight against the bug that’s had an extremely difficult to penetrate armoury.

“That, clinically, is the most significant thing.”

He said other drugs were being tested in the same way as part of the ongoing trials, which were the most astonishing of any he’d seen in 20 years of research.

He said: “I have never, ever seen a study that has been started so fast, that has inspired staff and patients to the same degree as this study.

“The study was approved on March 19 – so what you normally do if you’ve got a study of this size, you start recruiting patients for a year or two, then you close the data and then you evaluate it, and after six months you get the first results.

“Within less than three months we already had results from two of the drugs.

“There were still hurdles we had to go through but I’ve certainly been wondering what can we learn from this study and use for other research.

“Some of it is context specific – it only works because of this enormous threat to life and civilisation as we know it, if you wish.

“We used drugs that were already known, so we were using them for other indications.

“That’s probably actually a good way to do research, so you already know a lot about the drugs and how safe it is for most patients.

“Basically everybody we asked to help us said yes. It’s been really inspiring.”

Dr Subbe said when the board’s first patient was recruited for the trial there were around 3,000 in the whole study but the numbers kept rocketing.

He said: “Every day you would go on the computer and have a look and it’s jumped up by a few hundred.

“That’s when I thought together we’ll make a difference.

“It’s not us, it’s not my colleagues here, it’s not our patients, it’s together we will make that difference.

“It’s important to say a big thank you everyone who participated in this trial.

“Obviously it was the team in Oxford who set this up with Government funding and I think they should be applauded for doing that.

“This was an historic trial the way everyone contributed and collaborated.

“We need to see how we can learn for other areas to get the same togetherness to get results for healthcare problems.”

He said the nation was “not out of the woods yet” and shared something he told medical students on Monday.

He said: “The main message I gave to them was this is the most deadly infection we have seen in Europe in my professional lifetime.

“There has never been anything remotely as deadly.

“I worked with Doctors without Borders and there are diseases in tropical countries where you know we’ve got very little we can offer.

“But in Europe for most patients we have got some hope we can battle infection.

“For this disease the margins are too slim.”

He added: “I think the vaccine trials are what I am hoping will change things, but we know results from those are probably still 12-18 months away.

“Viral infections are complicated, really complicated, and we know from previous outbreaks of SARS, or Ebola, they’re difficult to contain.

“So we need to be patient and disciplined with this.

“The biggest weapon we have is social distancing.”

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