Coronavirus crisis: WA respiratory physician Dr Fiona Lake on how COVID-19 is like nothing she’s seen before

As Western Australia stays at home to avoid coronavirus, Fiona Lake leaves hers every day to confront the virus head-on. As a doctor at Perth’s Sir Charles Gairdner Hospital, Dr Lake is on the COVID-19 frontline treating virus-stricken patients and helping to prepare the hospital for what’s to come. She and her colleagues are currently treating eight coronavirus patients, three of whom are in the intensive care unit, and a further six who are waiting for test results. Dr Lake was among those caring for WA’s first coronavirus patients James and Theresa Kwan. Mr Kwan died on March 1. A respiratory physician for 30 years in Perth and overseas, she has seen a lot when it comes to diseases of the lungs, but says coronavirus is different. “It’s a new disease. Although we’re very comfortable looking after patients with influenza, this is different in terms of its manifestations,” she said. “Often people are unwell for 20 days — that’s a much longer course — and can often become much more unwell at day six to 10. “That’s challenging, keeping an eye on people and looking for that possible deterioration and trying to make sure they’re getting the right care.” Dr Lake said it was “horrifying” to see the virus strike down people who she did not consider old or to have significant co-morbidity or lung problems. “We’re all in it together with joint decision-making but you do feel a bit helpless sometimes,” she said. With coronavirus known to attack the lungs, Dr Lake’s specialism is invaluable and she acts as the hospital’s “COVID consultant” when she is on duty. She had worked for seven days straight when she spoke to The West Australian, typically doing 18 hours a day. On top of that, Dr Lake takes calls through the night, including one this week from a colleague in a country hospital asking for advice on how to deal with a suspected COVID-19 case. “We have occasionally slept in our offices,” she admitted. Dr Lake said coronavirus patients must be treated differently because of the highly infectious nature of the virus. Patients are often kept in single rooms, or in groups of four. Often only a nurse and doctor will go in there, the doctor only once a day if they are stable. “Before you go in and see someone, you check if anything else needs to be done, like taking the food tray in or out,” Dr Lake said. “We all try to reduce the exposure to us and to save on the personal protective gear. The world will run out if we indiscriminately use it.” Dr Lake said she changes out of her own clothes and into scrubs and shoes when she’s going to visit an infected patient. Then there is a strict process and order of putting on and removing personal protective equipment, which includes a long-sleeved gown, gloves, a surgical or N95 respirator mask, and possibly goggles or a visor depending on the patient and what needs to be done. In between each step, hands must be washed. Despite the precautions, the risk to healthcare workers like Dr Lake is obvious. It has been borne out by the fact that some have already been infected, and died, after contracting the virus through their work. “People feel vulnerable as individuals, though I have to say a lot of people are sensible and they feel comfortable,” she said. “The evidence would suggest if you use your personal protective equipment properly and have the right gear, the chances of getting infected are minimal. “There’s been a lot of focus on training people up, making sure we’re using the right gear in the right place.” The appearance of coronavirus symptoms in patients outside of the quarantined COVID-19 areas had sometimes caused a “panicked reaction” among hospital staff, she said. “I think we’ve gone through the fear and panic phase and now we know what we’re doing. Let’s get on with it. We’ve got the system that’s working,” she said. But while it was easier for her because her children had grown up, she said, colleagues with a young family had more to fear. “I think they do have that angst, absolute fear about taking the virus home. Certainly you don’t take anything you've worn here home,” she said. Dr Lake recalled looking after Mr and Mrs Kwan who had been on a cruise ship off Japan, as the pandemic unfolded overseas. “Every time the television came on, it was just this deadly disease and this is how many more people have died in the world and China,” she said. She said it was also scary for coronavirus patients because doctors were unable to tell them with much certainty what will happen to them because the virus’ course is little known and varied. “I think they’re also very scared that there are limited resources. You only have to look at what’s happening in Italy,” she said. “Social distancing isn’t about making sure individuals don’t catch the virus. It’s about making sure our health system doesn’t fall apart. People are concerned we might withhold care.” That concern will hopefully not be realised in WA, at least. Much of Dr Lake’s work so far has focused on preparing the hospital for a deluge of coronavirus infections and, crucially, preventing it from spreading within the hospital. This has included splitting the workforce into “clean and dirty” teams (that is those who do not deal directly with coronavirus patents and those who do), re-deploying staff, designating wards for coronavirus patients as numbers grow and organising medical supplies and protective gear. “The sheer numbers are of concern. When you calculate how many live in WA, how many could get sick, how many could need hospital and how many could need ICU, you’re just blown away by it,” she said. “You think ‘my god, this is ridiculous. I haven’t calculated it properly’.” But Dr Lake said WA had benefited from having some time to get ready and she felt they were now “pretty prepared” to deal with whatever may come. “I think we’re in a good position. I think we need to make sure we can sustain it. It’s going to be for quite a long time,” she said. Dr Lake said people were now scared of coming to the hospital and were not presenting with other health problems. She said she expected that to change as time goes on and said hospitals needed to make sure they had the capacity to deal with regular and coronavirus patients. During this strange and stressful time, Dr Lake and her colleagues cope with their difficult jobs as they always have. She said they look out for each other, de-brief and talk about the difficulties and have a sense of humour. Though she said stress, and junior doctors’ workloads, were a big issue. “My husband says my life is going to fall apart. He’s quite right. You just get up and you go,” she said. “I do see that we’re going to move into a different phase soon. We’ve done a lot of the planning. “When you're on the wards, that’s all you do.” Although WA’s case numbers remain relatively low, Dr Lake said it feels like they are waiting for the crisis to hit. “The description everybody is using is it’s like when the wave goes out before the Tsunami,” she said. “Who knows, maybe it’ll just be a nice rideable wave.”