The recent letter from several GPs to the health secretary raised concerns about restrictions and lockdown to assist control of the Covid-19 pandemic. While I thank them for raising the voice of GPs in this debate, I don’t feel the letter represented the full breadth of GPs’ views.
The letter focuses on the non-Covid harms of the pandemic – cardiovascular deaths, mental health of children and those shielding, and excess deaths in private homes that have not been documented as resulting from Covid-19 infection. These are extremely valid concerns.
But minimising non-Covid harm remains intricately linked to minimising the consequences of uncontrolled Covid infections across all society, and the letter fails to highlight this issue. If you ask yourself the question of why non-Covid harms became worse during the pandemic – the answers are linked to Covid-19.
If hospitals become overrun with a wave of acutely unwell Covid-19 admissions, theatres are converted back to critical care beds again, and staff are working beyond capacity, then it becomes near impossible for routine non-Covid care to continue.
I speak to and see patients every day who are scared. Some have worsening chronic conditions, and some have new problems which may be indicative of a worrying underlying diagnosis, and many of these patients are now afraid. They are afraid that if they go to hospital for investigations and treatment, they will be alone, and might catch Covid-19. I have had patients literally beg me to do things in general practice which are entirely beyond the scope of any GP, because they are fearful of going to hospital.
Resisting lockdowns recommended by public health experts at this point in time seems a high-risk strategy. The letter states the position now is ‘transformationally different (than the first lockdown)’. I acknowledge a lot has been learnt and we have some treatments for severe disease, but I disagree that we are in a sufficiently different stage yet. There are still many gaps in our care and unknowns, such as treatments for early Covid-19 to prevent deterioration, predicting which healthy individuals are most at risk of severe disease or Long Covid, or whether having had Covid-19 protects you from re-infection a second time around.
Providing confidence to the public that Covid-19 is under better control alone would be an enormous step forward in improving the care of non-Covid conditions.
Foremost GPs need to be involved in building public trust in an efficient testing and tracing system. A recent comparative analysis of Covid-19 testing in six countries found that the UK was the only one to exclude primary care input in testing and suggested that this has led to the ‘faltering’ system. Testing is a fundamental aspect of pandemic control. The letter missed the opportunity to highlight this issue and the critical role that GPs could be playing in improving this cornerstone of the national Covid-19 response.
While the letter rightly calls for the importance of GPs views to be heard more widely, this should be served to support public health efforts to control Covid-19 through more accessible and effective testing and tracing. Achieve that and our care of non-Covid will improve too.
Dr Liz Pollara is a salaried GP in Kentish Town