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Avoiding another lockdown could harm all our patients



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

READERS' COMMENTS [2]

Patrufini Duffy 21 October, 2020 2:46 pm

Pre-covid winters were a worldly joke. ‘Granny dumping’ one would say in A&E. Covid has had positives. But, hospitals have been wiped debt free, shut their doors, pathways and phones. GPs fault as per usual. What this has taught GPs is how to be smarter. Re: 2ww many get fast tracked quicker via telephone. Just get out of that PCN DES I would say.

David Church 22 October, 2020 1:03 pm

I strongly agree with Liz, despite the adverse effects of lockdowns on both my income and my ability to partake in trips and social activities I enjoy. The reason we cannot do our job properly and the reason hospitals are not doing their routine job properly, and patients all over are suffering, is because Covid is spreading wildly through the communities. We should not have relaxed the initial lockdown as early as we did, as the situation was not right for this, and was too rapid to see the damage each relaxation did, which was revealed a couple of weeks later – hence the exponential rise in transmission, and late disocvery of unsafe wlorking practices and locations. Further strict lockdown, univerally and cooperatively applied fairly throughout Britain in solidarity with the communities most affected, is the only way to get our health services back to normal working again to protect patients from non-Covid harms too! And, as an aside, also to enable a sooner return to SAFE participation in all the other things we want to do, but Covid (not lockdowns!) have prevented us from being able to do safely! Just, please, have government ministers and advisers support it this time by showing solidarity with the vulnerable, not that they are immune to the law.