Dr Child's Casebook: Navigating a New Normal

With ‘encouragement’ from the government we are returning to life ‘almost as we know it’. The comforting mantra ‘Stay at Home’ has morphed into the cautious refrain ‘Return to Work’.  Many are eager to resume their roles on site and in the workplace, especially those in ‘people professions’. But with people professions comes proximity and attendant hazards. A mental health nurse, with lung complications, is enthusiastic to return to his position in Elderly Care and contacted Dr Child for advice.

Q: I have Marfan Syndrome, diagnosed in 2002. I have had surgeries on my chest for right-sided pectus carinatum the last surgery in 2003. I have never smoked. I have been shielding and working from home as a Discharge Liaison Nurse for the past 3.5 months with the aim of returning to work on the 2nd August. I work as a Mental Health Nurse and work on the frontline, on an elderly ward. I am unsure whether I should continue to shield and work from home if a 2nd wave hits, or  whether I am at a significant risk from Covid-19 or not. Please could you advise.

I have previously had pneumonia requiring several courses of antibiotics to treat, I have poor, delayed healing. I have an echocardiogram around every two years, and the cardiologist is happy that my aorta has remained stable at 3.3cms. I have however been advised that I have mild aortic valve regurgitation. Each time I catch a flu type virus I get a severe chest infection that usually takes around 4-6 weeks to recover from and I usually require a course of antibiotics. I have also previously suffered from pleural effusion.

Ultimately, I am eager to return to work to have patient contact. But i need to ensure that it is safe for me to continue within that role. 

A: Your pneumonia episodes put you in the high risk category, simply because this virus attacks the lungs , and if you have reduced resistance, you will have great trouble throwing off this infection. For this reason, we would advise you to have your ordinary winter flu vaccine with your GP, to lessen the chance of catching winter flu which will decrease your resistance further.

You were right to shield, and should do so again if the need arises and government guidelines are altered.

However, at present the guidance is that you should venture out when necessary, before or after the crowds, wearing a mask and socially distancing at least 1 meter. And hand washing frequently. You could also change out of work clothes when you come home after work, wash your face and hands, and only put on your work clothes next morning to go back to work.

Could you do shifts which mean you are not travelling at peak times? Or work part-time? You need to use common sense when weighing up the pros and cons. Try to work, as the Prime Minister has encouraged us to. Can you stay 1 meter from your patients as you speak with them? If not, perhaps you could volunteer to work in a less exposed role temporarily, until the risk for everyone has reduced.

Do check our guidelines which we update as the situation changes.


Dr Child's Casebook: Navigating a New Normal
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