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THE first confirmed case of covid-19 in Brighton was around 1 February. I know this because I had been to a friend鈥檚 50th birthday party that night. Having left early, I didn鈥檛 know anything was wrong until I received a cryptic text from the host, something about us meeting up 鈥渨hen this is all over鈥�. I disregarded it.

I later discovered that somebody at the party had been in contact with this first confirmed case, so several guests had to self-isolate. Many were doctors.

It soon became clear that letting 鈥渉ot鈥� patients 鈥� those with a potential covid-19 infection 鈥� see their general practitioner (GP) might take many surgeries out of action, and money was made available for new solutions.

That is how my organisation was tasked with setting up a 鈥渉ot-hub鈥� for the area. The challenge was: how can you see patients who aren鈥檛 sick enough to go to an accident and emergency department but who might have covid-19, yet make it as safe as possible for healthcare workers?

What if someone has covid-19 symptoms, for instance, and is OK, but also has appendicitis? Our idea was to keep a patient in their car. You could recline them in the passenger seat and carry out a basic examination.

So we decided to set up the hot-hub in a car park, inside a huge drive-in marquee. We paid scrupulous attention to infection control and conversations took place on the phone before and after the physical assessment, to minimise face-to-face contact. All the practices in the area were signed up, covering about 350,000 people.

When we started, it felt as though every person we spoke to had covid-19. We didn鈥檛 have access to testing, but would advise patients on the basis of the phone call and physical examination. I became adept at recognising the 鈥渃ovid cough鈥� over the phone.

Some days were especially difficult. I remember one 60-year-old man in particular. He had driven himself in, with his wife, but when we measured his oxygen levels, they were surprisingly and dangerously low. I asked why he was driving, and he told me that he was fed up with his wife missing the turning so had taken over at the wheel. He was clearly unwell, so we called an ambulance, and 19 minutes later he was taken away.

I suddenly became very aware of his wife in the passenger seat. She wasn鈥檛 allowed to accompany him to the hospital, but had to drive home alone with the very real possibility that she wouldn鈥檛 see her husband again.

During my career, I have seen many patients very ill and dying, but this sudden aloneness without any ability to say goodbye or accompany the loved one affected me more than usual. After that, we made someone responsible for staying with the person accompanying the patient, to make sure we could respond to their needs as much as possible.

After a few weeks, the number of patients like this fell and we started to see people who had finished self-isolation but were still unwell. The common feature was a residual lethargy, with some people reporting a persistent dry cough or intermittent high temperature. Their managers expected them back at work and they simply felt unable to go, or they worked for a few days then were incapacitated afterwards. GPs had little to offer 鈥� encountering patients who continue to have physical symptoms where there is no clear course of treatment can make doctors feel uncomfortable and impotent 鈥� and were unable to see them in person anyway, so we would assess them at the hot-hub.

We would check their breathing rate, oxygen saturations, temperature and pulse. These were usually normal, but the patient was still effectively disabled by symptoms. We don鈥檛 have any medicine to offer, so all we can give is reassurance that this isn鈥檛 unusual, advice to rest and hope that it will pass as the weeks go by.

This is a new illness, so we lack the evidence that is available for other areas. This long-tail disease seems similar to chronic fatigue, but can also have a periodicity like a tropical disease 鈥� some people feel better for a while, and then it hits them again.

鈥淭hey used to go on 30-kilometre bike rides. Now they get breathless going up the stairs鈥�

It also seems as though those with prolonged disease are more likely to have initially had milder symptoms. In fact, the majority of people I have seen in this camp are fit, active people in their 20s and 30s. Some of them would go on 30-kilometre bike rides three times a week. Now they get breathless going up the stairs.

It isn鈥檛 clear whether this will become a chronic illness or get better over months rather than weeks. We are very far from understanding the long-term consequences of covid-19 and now need to support and advocate for people who are affected.