It’s a life-saving procedure I’ve witnessed – and carried out myself – dozens of times in the almost two decades I’ve worked as a doctor: a patient’s heart being shocked by a defibrillator.
I watch as the body of the man in front of me, surrounded by highly skilled A&E staff, jerks and almost leaps off the hospital bed as a burst of electricity surges from the pads taped to his chest. He swears, his face contorted.
We all turn our eyes to a monitor that shows his heart has stopped beating – then, after what feels like an endless, agonising wait but is actually just a few seconds, it slowly restarts, reaching a normal rhythm.
As an oxygen mask is put on his face by a nurse, he seems calm as he comes to, eventually mustering the energy to ask: ‘Did I say anything embarrassing?’ Suddenly, tears are streaming down my masked, visor-covered face. Because this is not just any patient.
He is my brother, Alexander – or Xand, as he’s known to everyone. We’re identical twins – both of us doctors, and often co-presenters of various TV documentary series. I’m closer to him than I am to anyone else. He is half of me. It’s a bond that, perhaps, only other identical twins will ever understand.
Crisis: Xand van Tulleken as his heart is shocked during his Covid-19 ordeal. Before we started filming in late March, Xand fell ill: it was classic coronavirus, writes his twin brother Chris
And at that moment, my professional demeanour, something every medic strives to maintain in even the toughest situations, gave way.
Fear, anticipation, anxiety and finally, relief. The raw emotion was too much, and I found myself crying. Most astonishingly of all, it was caught on camera.
We were both due to appear in a documentary about life on the NHS front line at the height of the Covid-19 pandemic – which will be broadcast next week. After a decade or so of working mainly in research laboratories, or on projects abroad, I decided I wanted to return and join my NHS colleagues in the battle against this new threat. My brother, who trained in public health, felt the same.
But before we started filming in late March, Xand fell ill: it was classic coronavirus, a fever, a hacking cough and a temporary loss of smell.
He isolated at home for two weeks, while I worked alongside a team on a Covid-19 ward at University College Hospital, London. We began filming, and yet privately, Xand was suffering strange symptoms – breathlessness and heart palpitations, albeit mild. I was concerned, of course. But I assumed as a fit, healthy man, aged 41, he would eventually recover.
Not so. Three weeks later, things became serious. The palpitations worsened, leaving him feeling sick, exhausted and scared.
In the early hours of April 21, our mother called, clearly frightened. My brother’s condition, she explained, had worsened dramatically overnight. She’d told him to travel to see me – I happened to be working at the hospital closest to his home – immediately.
He’d been vomiting and had a heart rate of 170 beats per minute – nearly three times the normal resting heart rate for a man of his age. My colleagues decided that the only way to return the heart to its normal rhythm was by shocking it with a powerful electric current – a procedure called DC cardioversion, which is similar to the defibrillator used to restart the heart after a cardiac arrest. It is thought to work by ‘rebooting’ the heart, so it stops, then starts beating again, hopefully with a healthy rhythm.
It’s a relatively routine and normally successful procedure. But it does carry the small risk that the heart will not restart properly, or at all. You cannot be entirely certain it will spring back to life unaided.
I knew all this and at that moment, it hit me hard. To be brutally honest, back at the beginning of the outbreak, I thought the virus was probably nothing more than a cold that seriously affected only old and vulnerable people. Now, I realise just how naïve I was.
Thankfully the shock treatment worked and Xand was discharged later that day. After a few days at home, he was able to continue filming – cameras followed him as he helped out in an old people’s home. But there seems to have been lasting damage.
Since the cameras stopped rolling in early May, Xand has had another episode of extreme heart palpitations, landing him in hospital. The doctors performed the same shock treatment to resolve the problem, and he was discharged that same day.
The twins filming for a a documentary, which will be broadcast next week, about life on the NHS front line at the height of the Covid-19 pandemic after Xand, at the back, recovered
But, again, it didn’t solve the problem entirely. Subsequent tests have led to a worrying diagnosis – the common heart condition atrial fibrillation, which usually affects people over 60. He’s currently taking medication to stablilise the heartbeat, but at some point in the future, he may need heart surgery to destroy the damaged tissue.
Covid-19 is completely different from any other illness we have ever seen. It attacks not only the heart and lungs, but the gut, kidneys, brain and other organs.
During the documentary, I asked one of my colleagues, Dr Phil Gothard, how he thought the virus could have affected Xand the way it did.
Phil speculated that perhaps there were mini-blood clots deep inside his lung tissue. And maybe these were preventing oxygen from being transferred into the bloodstream, upsetting his heart rhythms in the process. But then, with searing honesty, he admitted: ‘Actually, I just don’t know. We are in uncharted territory.’
Phil is one of the most experienced infectious disease experts in the country and during my early years working at University College Hospital, he was one of my mentors. To hear him say he just didn’t know why the virus has the effects it has was unnerving.
But that’s the thing: during this pandemic, even the most experienced and skilled among us have had to go back to the medical books for clues on how to treat and manage Covid-19 patients. And much about the virus still remains a mystery. Indeed, until recently I had never seen senior colleagues – leaders in their field who rank among the finest doctors the NHS has to offer – admit to feeling completely and utterly helpless in the face of a new clinical challenge.
Yet, in the early stages of the Covid-19 pandemic at least, that’s just what happened. With no effective drugs, no vaccines and inadequate intensive care facilities, this has been the greatest single challenge our health service has faced in its 70-year history.
Medics on the front line say every time they think they have an understanding of how the virus works, and what it can do, there is a new twist or turn. It’s as if we are constantly playing catch-up. Aside from the horrendous death toll, I’m left wondering how many survivors of severe infection have been left struggling with debilitating after effects such as irregular heartbeats – as Xand has been – or severe breathlessness. I’m worried we are seeing only the tip of the iceberg.
On the front line: Chris on the Covid unit at University College Hospital, London. Covid-19 is completely different from any other illness we have ever seen, writes the medic
One patient featured in the documentary is Florentino, a Portuguese restaurateur from London. He is critically ill with coronavirus. A CT scan of his lungs looks like nothing I’d ever seen before in all my years of medicine – as if his left lung has been completely destroyed. With his desperately worried family unable to visit him, Florentino’s condition declines further, to the point where senior doctors hold a case conference to discuss whether prolonging the trauma of intensive care treatment is justified.
But, desperate to do everything they can for him, they decide to press on against all the odds.
Incredibly, nearly three months after admission, Florentino is discharged from hospital to continue his recovery at nearby St Pancras rehabilitation centre in North London. It’s nothing short of a miracle.
But as intensive care consultant Dr Mike Patterson tells me: ‘It’s really hard to understand why Florentino got better, but the guy in the bed next to him, who seemed the same and got the same treatment, didn’t. And a great many more patients are not as lucky.’
What scares me most about Covid-19 is its unpredictable nature and ability to cause severe illness in otherwise young, healthy people.
Recently, I heard of the case of a young competitive marathon runner, who came through a nasty infection only to be left so breathless that, weeks later, he was still gasping for air after climbing a single flight of stairs. Then there is the disturbing evidence that the virus can cause strokes in otherwise relatively healthy people – such as Chuck, whom we meet in the film.
The 48-year-old mental-health support worker suffered a massive stroke just ten days after contracting Covid-19. Fit and well, he was left unable to walk or talk properly and is shown having to relearn the simplest movements, such as picking up one object and placing it on top of another. It’s a heartrending scene – but then comes the sucker punch.
Even before we’d ever heard of Covid-19, we had an underfunded health service that was barely able to cope with normal winter pressures, says Dr Chris van Tulleken (file photo)
As the camera zooms in on a family photograph by his bedside, it turns out that Chuck lost his wife to breast cancer weeks earlier, just as the virus was starting to wreak havoc. They have two young children. His eyes filling with tears, he says: ‘They are desperate for me to come home. I cannot imagine what they are going through – they lost their mother and cannot see their dad. I just want to hold them as much as possible.’
As Xand says at one point in the documentary, seeing people whose entire bodies have been destroyed by the virus, and who will take months, maybe years, to rebuild, is something none of us expected.
My colleagues at University College Hospital London are anticipating such an increase in workload from these patients that they are in the process of setting up a dedicated clinic just to deal with the numbers of post-Covid patients. Such a centre would be one of the first of its kind and, I suspect, many more may be needed across the NHS over the next few months and years.
And there’s yet another cloud on the horizon. Deaths may be falling but the virus is still in circulation – leading to about 2,000 new cases a day across England. And the evidence suggests that the decline in these new cases is slowing: numbers may even be plateauing.
If we head into the winter months with that level of virus circulation, it could be catastrophic for the NHS. Not only does the virus appear to survive more easily in colder, drier winter conditions, but as we tend to spend more time sheltering indoors, it may have more opportunities to spread.
Even before we’d ever heard of Covid-19, we had an underfunded health service that was barely able to cope with normal winter pressures. The UK has much higher occupancy of beds and thinner resources than most countries, as rich as we are.
The NHS has done fantastically well with the resources it has but it’s in no position to go through that again so soon. Staff are emotionally and physically exhausted. This outbreak has pushed the NHS to its absolute limits, and the fact that it survived is largely thanks to the incredible ingenuity, dedication and disregard for their own safety shown by frontline staff.
Not only does the virus appear to survive more easily in colder, drier conditions, but as we tend to spend more time sheltering indoors, it may have more opportunities to spread (file photo)
Yet I genuinely fear the NHS’s chances of surviving a second onslaught of this lethal virus are tiny. During filming, Dr Patterson said the greatest mistake we can now make is to think we have beaten Covid-19. ‘Nothing could be further from the truth,’ he said. ‘How do I feel about a second wave? I feel scared.’
After a gruelling couple of months in the thick of it, I’m now at home on paternity leave (my wife gave birth to our second child in June) and feeling pretty well rested. But many NHS and nursing home staff have been working round the clock since the pandemic struck.
It’s not just the gruelling hours – the nature of the work has been fantastically unpredictable and dangerous. Some have paid dearly, particularly those mainly from the black and Asian communities, who appear to have suffered disproportionate loss of life. And, of course, Covid-19 has had some unexpected benefits.
It has broken down the professional barriers in medicine like nothing before it. There has been no hierarchy, and everybody pulled together to work as a single team with a single aim – to save as many patients as possible.
It truly was an honour and a privilege to be part of it and I would do it again in a heartbeat. I just hope I never have to.
Surviving the Virus: My Brother & Me is on BBC One at 9pm on Wednesday August 5
Q&A: Is flu jab related to Covid, and what are rules on masks now?
Q: I am healthy, and in my 50s but have read that I’m eligible for a free flu jab this year, due to the coronavirus pandemic. I thought Covid-19 had nothing to do with the flu?
A: Covid-19 and the flu are two separate illnesses. However, there are fears the NHS could be overwhelmed this winter if it faces a double-whammy of a bad flu season at the same time as a surge in coronavirus cases.
People who contract Covid-19 and flu at the same time could also have a far more severe illness. The Government has decided to make the flu vaccine available to more people this year, to try to reduce the pressure on the health service.
Normally, the flu jab is offered on the NHS to people over the age of 65, pregnant women, and people with certain health conditions, who are at risk of being badly affected.
Children aged two to ten are offered the vaccine in a nasal spray, to stop them spreading the disease to other people.
But the Government last week announced over-50s and 11-year-olds would also be eligible for a free jab this year. Free vaccines will also be offered to those on the shielded patient list and their households. People most at risk – such as over-65s, pregnant women, anyone with pre-existing conditions and healthcare workers – will be first in the queue when the phased roll out of flu jabs begins in September. The Government then plans to have all over-50s – who are also at an increased risk of being hospitalised with flu – inoculated by Christmas.
The NHS says it will contact everyone who is eligible for the flu vaccination programme.
Q: Could we have a vaccine by Christmas?
A: Last week, University of Oxford scientists said that the Covid-19 vaccine they have developed appears safe and triggers the immune response scientists have hoped for.
Trials in more than 1,000 people showed the injection caused them to make antibodies and virus-fighting cells called T-cells.
Antibodies stop viral cells from attacking healthy cells, while T-cells can help the body spot the virus and destroy it.
Most effective vaccines cause a response in both of these.
Crucially, the study also found the vaccine is safe – with the most common side effects a mild fever and headache.
But scientists have stressed it is too early to say whether the immune response it triggers is enough to protect someone against coronavirus.
Further trials are needed, testing people exposed to Covid-19 in the community, to prove this to be true.
More than 10,000 people in the UK will now take part in the next stage of the research.
Because levels of coronavirus are now low in the UK, the trial has also been expanded to other countries. If all goes well, it is possible the vaccine could be proven effective before the end of the year.
But even if this happens, it is very unlikely it will be widely available to the public by Christmas.
Q: What’s the latest on masks – where are they mandatory, who’s exempt, and do I really have to wear one if I’m grabbing a sandwich for lunch from Pret?
A: New mask regulations came into force on Friday in England. Along with public transport, they must be worn in shops and supermarkets, indoor shopping centres, banks, building societies and post offices – as well as airports, bus stations and other travel hubs.
You should wear a face covering upon entering any of these places. Those who flout the rules could be fined up to £100. Shop workers, children under 11 and people with certain health conditions are exempt.
There had been confusion over whether masks would be required in takeaways and sandwich shops but people must wear masks in shops where they are buying food and drink to take away. But if you are sitting down to eat in a shop then you can remove your mask in the seating area.
In Scotland, face coverings have been a requirement in shops since mid-July, while Wales and Northern Ireland are both reviewing their policy.
Q: If I want a snack or drink on public transport, can I take my mask off?
A: Government guidance says you can remove your mask to eat or drink ‘if reasonably necessary’ – which sounds vague. This means if you need to have some food or drink water, if you’re feeling faint or unwell for example, then you should do so.
But grazing on a pack of sweets is unlikely to be seen as necessary. And you should put your mask back on as soon as you have finished.