The first time I heard the Clap For Our Carers applause on a Thursday night at the end of March, I shed a tear. It seemed a fitting tribute to my tireless colleagues, borne of a renewed appreciation for the NHS, and a heartening coming together of my neighbours to support one another during this difficult time. But in the four weeks since, over 100 NHS staff have died from coronavirus, and the UK probably has Europe’s highest death rate. Now, the claps ring hollow; we need more decisive action.
Much has been said in the press about the lack of preparedness, the mistakes and the missed opportunities in the early stages of the pandemic. It is right that in the fullness of time, the governments’ approach should be scrutinised in detail. But right now, we must prioritise protecting lives, using the methods we have seen work elsewhere.
These strategies seem relatively simple: PPE of sufficient quality and quantity; scaling up of test and trace; public health policies that encourage access to health care and minimise the risk of viral spread, and suitable protections for health and social care staff. Yet, faced with an opaque government that elevates small wins whilst ignoring the reality of the crisis that has unfurled around us, there are still significant strides required to meet these strategies in any meaningful way.
First and foremost, we must ensure the safety of frontline staff. NHS trusts have admitted that PPE is in short supply and that they are having to make contingency plans to conserve stock. Meanwhile, reports have come to light that offers from British textile companies to produce PPE have been ignored by the government, and that ministers have refused to work with the EU to secure PPE.
Second, we must review our public health strategy. Dr Tedros Ghebreyesus, director-general of the World Health Organisation, likened treating a pandemic without testing to fighting a fire with a blindfold. Countries such as South Korea and Germany have enthusiastically adopted the WHO strategy “test, test, test”, and experienced a significantly lower number of adverse outcomes when compared with the UK.
However testing alone is not enough: we need a comprehensive contact tracing system and focused isolation to limit transmission as we come out of full lockdown. In addition, doctors this week called for clarity on the discrepancy of the UK’s approach to the rest of the world, particularly with regards to our self-isolation policy for those with symptoms of Covid-19. In many areas, the UK’s approach to coronavirus seems anomalous; clarity on the evidence base of our guidance would alleviate the concerns of the medical community.
In order to implement a successful test and trace strategy, we must also ensure that everybody is able to access the health service without fear of doing so. This requires an immediate end to legislation enforcing eligibility checks and charging in the NHS, including those related to residency status or national origin.
Many of my colleagues who are rightly applauded every week as heroes face the daily worries of paying rent and bills. From nursing colleagues who use food banks to the many NHS cleaning, portering and catering, services are outsourced to companies that hire workers on zero-hours contracts without proper sick pay, job security or pensions. It is heartbreaking to think that death in service payments are not yet embedded in the NHS, especially during this time.
As a doctor, I have been trained within an ethical framework that requires me to reflect on my practice and acknowledge my mistakes. My colleagues up and down the country are having to apologise to the family members we have failed. But this isn’t a clinical failing, it’s an epidemiological one. We have not seen this same candour from our politicians: while we accept that the national response will never be perfect given the scale of this crisis, politicians, clinicians and the public would all benefit from politicians’ honesty, self reflection, and an approach that is open to new ideas and willing to adapt.
From starting mutual aid groups to abiding by difficult social distancing policies to the gratitude we offer to our frontline staff on Thursday nights, coronavirus has united the country in a way rarely seen before. But now we are asking for more than your applause; we need your help. Tonight, don’t just clap for us, chant for our PPE, and demand that the government protect the workers leading our national effort against coronavirus.:
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