It’s been a logistical nightmare to deliver medical services in this ‘Covid-world’. As (hopefully) levels of Covid-19 recede, and the vaccine programme begins to significantly influence mortality rates, we’ll find ourselves at a turning point when it comes to managing the pandemic. As the rest of the country does, the NHS will need an exit strategy.
If we genuinely believe that Covid vaccines are 76-90% effective at preventing serious disease after three weeks – once we’ve managed to vaccinate the first four priority groups which account for 88% of Covid deaths – the narrative around the dangers this virus poses must surely change. And yet, I fear they won’t, for quite some time.
The past year has seen a media frenzy over the casualties from Covid. The public, having been reminded daily of the danger, will now find it difficult to accept the fact that for younger adults and children, Covid may actually be no more dangerous than the common cold or flu.
And much as we may like to believe we’re impartial scientists, it will also prove challenging for clinicians to take necessary steps in relaxing safety measures. Once you’ve seen that horrendous film clip of a young woman visiting her grandfather and infecting him over a cup of tea, it’s hard to forget.
Many of my patients have been scared witless. The problem with using fear as a behavioural tool is that it appears to be most effective on those who need it least. So the already anxious and cautious 80-year-old will commit to never again hugging her grandchildren, but the 30-something-year-old builder watches the same footage and dismisses it out of hand as fearmongering. That builder may then go on to dismiss other warnings, as he feels the dangers have been overstated by a Government bent on controlling the population for nefarious gains.
The decisions taken by the Government around lockdown measures (on the advice of scientists), have inevitably affected the wellbeing of the population. From mental health issues, financial stresses and mounting debt (and therefore limited future public spending), to child poverty, increased alcoholism, increased child abuse, poorer educational attainment, and reduced levels of physical exercise – the harms are myriad, and expected to be long-lasting.
I remain unsure how history will judge our nation’s response to Covid. Part of me wonders whether the next five years will see such a significant fall in deaths, that the death rate or life expectancy over this period (including 2020) will be relatively unchanged from the average. Yet I worry that the economic and wider societal harms and mental health issues may stay with us for several decades.
Will we look back on all the drastic things that were done, and wonder if some of it were disproportionate? What if a virus emerges next year which is ten times more deadly? What if we experience a severe environmental disaster, or economic collapse from deteriorating international relations? None of us knows what the future holds. Right now, I believe it’s crucial that we don’t take too long to reduce restrictions, out of a sense of misplaced fear or caution.
As GPs, we’re in the business of delivering pragmatic healthcare. We vaccinate en masse, and get through large swathes of the population annually. We perform blood tests at breakneck speed; we swiftly sign off repeat prescriptions; we manage mental health disorders within ten minute consultations. What we do is certainly not perfect (I’ve often felt uneasy about our prescription systems), but general practice is uniquely efficient and provides a great quality service, considering our restricted budget and limited workforce. GPs have never allowed perfection to be ‘the enemy of the good’.
At some point, before too long, we’ll need to declare that Covid has lost its sting. Will we dispense with wiping down every chair in our waiting areas; no longer insist on donning and doffing PPE; no longer attempt to manage everything remotely? Will we reopen our doors (and the wider NHS) to patients again, as efficiently as we previously did? It might feel uncomfortable – some may say it’s dangerous, and many will try to impede these changes.
Yet I find myself more alarmed by the surgical waiting times; delays for outpatient reviews; and all those those cancers that remain undiagnosed partly as a result of our reduction in face-to-face consulting.
Perfection (and a lack of pragmatism) can indeed be the enemy of the good. The NHS has never been perfect. When it works well, however, it can be bloody impressive.
Dr Katie Musgrave is a newly-qualified GP in Plymouth and quality improvement fellow for the South West