So that's where the customers went

Last weekend was a humdinger in A&E. It was definitely the busiest we have seen for weeks. It was also notable because there were far more patients with symptoms that had nothing to do with COVID-19.

The department was still split into a COVID side and a non-COVID side. We are still seeing suspected COVID-19 patients with plastic aprons, gloves and bare arms… plus ça change, plus c'est la même chose (“the more it changes, the more it's the same thing”).

The other side of the department was a grand assortment of injuries. The public are voting with their feet when it comes to lockdown, increasingly deciding to enjoy the sun shine. As doubt about the lockdown and its length are building, the British are quietly practising civil disobedience in the understated way that only the British can. Although the British have no constitution (apologies for the controversial view), they simply assert their rights and dare the government to disagree.

The gradual breakdown in the lockdown is also noticeable as I travel to work with a lot more traffic. We are seeing a lot more of the usual A&E fodder – injuries to ankles and wrists… especially from mountain biking.

We are also seeing some serious medical conditions that have clearly been brewing. As an example, I saw a middle-aged patient presenting with shortness of breath that turned out to be caused by a massive collection of fluid in the chest. Although any diagnosis of cancer will require biopsies, the imaging was pretty suspicious. This patient had clearly twigged that something was wrong some time ago but had chosen to sit on the symptoms with the hope that they would go away. In this sad case, the delay in presentation caused by COVID is unlikely to change the outcome but has begun to highlight the real problems of effectively closing hospitals to non-COVID patients.

For some patients, closure of screening programmes will clearly change outcomes from potential cures to palliation.