Reflections on the Pandemic – a British Perspective

Dr Remy Perumal MBBS FRCP (Lond) FACP, Dip. In Journalism (LSJ)

Retired Consultant Physician & Freelance Journalist

Reflections on the Pandemic – a British Perspective by Dr Remy Perumal MBBS FRCP (Lond) FACP, Dip. In Journalism (LSJ) Retired Consultant Physician & Freelance Journalist

This Pandemic has claimed numerous lives!

Over half a million lives lost each in the United States of America & Brazil with the United Kingdom at just over 127,000. Of those lost in the UK were significant number of Doctors, Nurses and other healthcare workers. Many Consultants and senior clinicians, were amongst those, including the Registrar of the Royal College of Physicians of London, himself a prominent Nephrologist. In addition to the human cost, the borrowing binge, to keep the country afloat during the Pandemic means, there is a terrifying National debt which must eventually be repaid.

“Stay home, save the NHS, save lives” has been our recurring refrain. Yet, hospitals were inundated with ill Covid patients. The National Health Service which was created after the infinitely worse disaster of the 2nd World War, had never experienced a healthcare crisis, as this. It was overwhelmed, as admission rates soared.

“Winter Pressures” describes the increased admissions of medical problems leading to unrelenting demands on the available medical beds in the UK hospitals, during the winter months. This has been the experience every year, over the last two decades. It results in over flow of patients onto beds designated to other specialities. Acute medical units (AMU’s) were established in every hospital in the UK, to deal with such pressures. Those of us who have worked in Acute Medical Units in the NHS, are only too familiar with these issues that occur every winter. With the Pandemic, ill Covid patients, increased medical admissions to a different level. As a result, queues of ambulances outside the Accident & emergency departments (ED) were much longer. Ill patients on trolleys, lined in the hospital corridors were ever increasing. They were lined & waiting to be examined and cleared by doctors in the overstretched Accident & Emergency Departments. Pressures to move the patients from the ED to AMU, and where necessary, to the Intensive Care units, had been intense. Increased demand for Intensive care beds and the ensuing shortage of intensive care staff, necessitated retraining and redeployment of doctors and nurses from other specialities to meet these shortages. Such movements did reduce staff availability in other specialist departments, with a knock-on effect, resulting in longer waiting times for services provided by those Specialities.

Increase in patients with breathing problems and the demand for ventilators, meant patients who needed these machines, had to be prioritised. When Intensive care units are overwhelmed and the demand for ventilators out striped availability, doctors were called upon to make unpleasant life and death decisions.

In this high demand situation, one patient may need to be taken off a ventilator, for it to be offered to another more deserving person or one who has a better chance of survival. Such decisions together with the demands of dealing with the relentless stream of seriously ill patients admitted day after day, could be physically and emotionally exhausting, even for the highly experienced medical professionals. These front-line professionals who endured this immense workload, compounded by the unusually high death rates, would have indeed experienced significant psychological effects too.

In this scenario, of unrelenting admissions, medical professionals needed to prioritise care, outside the Intensive care units too. How do you reconcile the fact that, a bed given to a Covid patient may be, one denied to a stroke victim or that, by delaying a cancer scan that doctor, could be signing someone’s death warrant? It is simple, you can’t. Morally and spiritually, human life has equal value. Which is why, heartless though it may seem, age, quality of life and chances of recovery come into the equation. Also, doctors may be required to asses a patient’s eligibility for treatment, on a ‘capacity to benefit quickly’ basis. Of course, doctors agonise over these dilemmas even in normal times, but Covid has amplified the situation, taken them to a kind of twilight zone where they are forced to think the unthinkable.

In these circumstances, the British Medical Association’s (BMA) view is, it would be ethical and lawful to refuse someone potentially lifesaving treatment, where another patient is expected to benefit more, from the available treatment. In making these decisions doctors need to follow accepted local guidance, about how resources are allocated, laid out preferably, by the local Research Ethics Committee.

Also, with the hugely successful vaccination programme in the UK, ethical issues regarding the rollout of vaccines, have come to the fore. On the issue of quality of life and life expectancy, this Pandemic has brought into focus the validity of blanket rollout of the vaccine. Justification of starting the rollout with the very old and the residents of care homes, has come into question. The argument against is, why should the most vulnerable in society, with a limited life expectancy, be given priority? The proponents argue that, the younger adults of the working age groups need protection as, they are the ones who contribute to the economy. Applying this argument opens the debate of the value of life, as recently put forward by a retired judge, who argued that, in retirement, his own life is less valuable than those of his children and grandchildren. The Judge’s view, raises the question, if the value of life is related to age and productivity, is it purely an economic consideration? If so, where do we draw a line? Again, disabled people have a 6 times higher chance of dying of Covid. Disability groups are demanding, all disabled be included in the priority groups too. Also, how about those with stage 4 cancer but stable on treatment.

Are all these categories of persons classed as those with less valuable lives? Most plausible answer would be, we cannot put a value on human life. The opinion expressed by the retired Judge is that, ‘not only he is thinking the unthinkable, but also saying the unsayable’!

The World had ‘literally stopped turning’ in 2020. As we hoped for a better future, Covid 19 is still dominating events in 2021. Due to delay in ordering of the vaccines and their faltering vaccination programmes, EU countries are well behind. France, Germany and Poland have gone into lockdown.

This 3rd wave in the EU, with the potential for rapid spread due to very low immunisation levels, is likely to have an impact on the containment of the virus in the UK. It is also evident that, 130 countries worldwide, are still in the early stages of their vaccination programmes. Due to costs, delays in procurement and delivery of vaccinations, the poorer countries, could take much longer to achieve full vaccination, in their populations. In other words, many countries in the EU and elsewhere in the world, will ‘have to live with the virus for longer periods of time’. With such delays in vaccinations worldwide, the emergence of new variants is a real threat.

With UK’s highly efficient vaccination programme, more than half its adult population have received the first dose and the target of vaccinating all adults by 31st July 2021, is real. So, as flowers blossomed this Spring, optimism sprouts from the once barren ground of lockdown. As we begin defrosting our frozen economy and raise revenues to fund public services and begin repaying our gargantuan Covid shaped debt, the surges in Europe, India and Canada are a cause for concern – for, ‘no one is safe until everyone is safe.’

The battle with this invisible enemy is not over yet. Another lockdown by dropping our guard too soon, has to be avoided. Allowing the ‘cloak of human isolation’ to come back, to haunt us again, is not an option. Patience, vigilance and strict compliance with the scientific guidance is key to keeping ourselves safe, until we achieve the eventual satisfactory outcome, in containing the virus for good.

Many see this Pandemic as a catalyst for change. Societal norms are shifting, so as our world resets and we hopefully pass beyond Covid, we need to learn how to think differently and live more simply. There will be changes in the way we live, how we relate to each other and to our families. Covid has speeded the process immensely where changes may well have happened anyway. Home working is a classic example. Commuting had dominated so many lives for so long, we scarcely paid it a thought – Covid has accelerated this change.

Social distancing and wearing masks will be mandatory and will impact on socialising in general, on club life, pub culture, eating out, organised sporting events and the Theatre. No ‘hugs or kisses’ at family gatherings for some months yet. Although a contentious and controversial issue, vaccination passports will become necessary for foreign travel and possibly to enter pubs and access theatres, in the immediate future, at least. Most likely, we would continue to shop more on line & wisely. Eating healthily and buying essentials only, is likely to result in less waste. Concern for others, respect for authority and valuing our elders, could become a welcome change.

This Pandemic has brought into focus the value of life, on how fragile life is and the reality of death. Maybe, it would change attitudes too. Although not evident yet, it has the potential to alter the mind set of individuals – to make them realise the effects of irresponsible behaviour could have on others. With less commuting and air travel, we could experience better air quality, again a positive change.

These could be the ‘New Normal’. However, it is easier to predict what the future will not be, rather than what it will be!

A great deal changed after the disaster of WW 2. Within a few years, there were laws in place that extended secondary education to everyone and the birth of the NHS and welfare state. Also, America delivered the ’Marshall Plan’ that helped a ravaged Europe, rebuild itself. Likewise, the World today, devastated by this Pandemic, has to recue some ‘Blessing from this Curse’. First and foremost, we need a forensic investigation and analysis into, how this vicious virus originated and spread. The world owes it to those elderly residents whose final restful years were tragically cut short, the more youthful, including frontline workers whose fruitful lives were truncated by this invisible enemy and also their families who endured their loss. Only then, can we be assured of preventing another similar disaster happening. Secondly, the Nations of the Free world must unite and regroup to establish a strong manufacturing base and become self-reliant.

References:

Covid 19 – Ethical issues when demand for life saving treatment is at capacity – BMA Guidance.