Previously on Covid-19

As we approach June, I thought it might be a useful exercise to recap on the last few months. After all, there’s quite a lot that has happened and it’s been a bit of a blur thus far! Who knows what the next few months will hold but these are the key events from a Coronavirus point of view since it all began.


31 Dec 2019 – The Wuhan Municipal Health Commission reports a cluster of pneumonia cases in the Wuhan province of China.

8 Jan 2020 – Chinese scientists announce that they have found a new strain of coronavirus.

12 Jan – The genetic sequence of the new coronavirus known to be causing these new cases is released publicly by China. The virus is known as SARS-CoV-2.

13 Jan – the first official case outside of China is identified in Thailand.

30 Jan – There are now 98 confirmed cases in 18 other countries and the WHO declares a Public Health Emergency of International concern.

31st Jan – The first 2 cases are confirmed in the UK.

11 Feb – The disease caused by the virus is named as Covid-19 by the WHO.

5 March – The first confirmed UK death related to Covid-19 is reported.

11 March – Due to being “deeply concerned by both the alarming levels of spread and severity and by the alarming levels of infection” the WHO announce a pandemic. The 2011 film ‘Contagion’ begins trending on various streaming platforms.

12 March – The UK moves from the “contain” approach to what is referred to as the “delay” phase. This means that people with symptoms are no longer tested unless requiring admission to hospital.

16 March – The WHO advises “test, test, test”.

20 March – Schools, nurseries, restaurants and pubs all ordered to close.

21 March – The government shielding scheme started. This has caused some confusion, both then and now. Letters were initially sent by NHS England to those with features suggesting they were ultra vulnerable should they contract Covid-19; even more so than the vulnerable groups normally granted free flu jabs annually. These included those with organ transplants, undergoing active chemotherapy or with any immunosuppressive condition. Some letters were sent to people who did not need to be on the list while others who did need to be on the list were not initially identified as the data used to draw up the lists was from a national database. Subsequently, lists have been revised at a more local level. The letters advised shielded patients not to leave their houses at all if possible and offered information about local support agencies.

23 March – The government announces lockdown measures with advice that people stay at home, only leaving for one form of exercise a day, for work if absolutely necessary, to shop for essential items and to fulfil any medical and care needs.

2 April – Suspected Covid-19 hospital admissions peak in the UK at more than 3,400 in a single day.

3 April – Worldwide cases of Covid-19 pass 1 million.

5 April – It is announced that Boris Johnson has been admitted to hospital with Covid-19.

6 April – The Primeminister is moved to ICU.

10 April – The UK daily hospital death rate reaches its peak at 980 for cases involving Covid-19.

12 April – Mr Johnson is discharged from hospital.

20 April – The government furlough scheme officially comes into effect.

23 April – Testing begins on the vaccine developed at Oxford University which uses an inactivated adenovirus with an additional “spike” protein found on SARS-CoV-2 in the hope that the body will develop an immune response to this protein, thereby potentially providing some immunity to SARS-CoV-2 itself. (Due to the more recent drop off in cases, there have been some reports that the trial may struggle to get results because a sufficient number of participants will need to be exposed to the virus for it to be reasonably certain that the vaccine works.)

29 April – Official figures show UK deaths pass 26,000 as care homes deaths related to Covid-19 are included for the first time.

5 May – Doctors in France report that, having retested a swab taken on 27th December 2019 on a patient at a hospital near Paris (who had no recent travel history), Covid-19 had been identified. This has raised questions over how long the virus has really been in circulation.

13 May – It is announced that lockdown measures are to be eased somewhat. Members of the public are still to observe previous measures but are now able to take unlimited exercise, restart open air sports and meet one person from another household in the open as long as social distancing measures are observed.

14 May – Data are published that show A&E attendances for April were 0.9 million, down 57% on April 2019. While clearly a very large number of A&E attendances are unnecessary, this raised concerns over how many serious medical conditions may have gone untreated or undiagnosed as a result of people’s reluctance to attend.

20 May – The official figures show that there have been 250,908 confirmed positive Covid-19 cases in the UK to date and 36,042 deaths. Bear in mind the drawbacks of such statistics without a robust and extensive testing system in place.

22 May – Testing is finally rolled out again for those with symptoms and, theoretically, anyone above the age of 5 and with symptoms (which now include loss of taste or smell) can access either home testing kits or testing at one of the regional sites via the NHS website. (Not via your GP).
These tests are swabs and detect the presence of viral RNA on the mucosa and in the saliva and can tell whether there is current infection or not.
In order to detect whether one has had the virus at some point in the past and therefore probably has a level of immunity (although this is not yet proven), an antibody test is needed. There has been much talk of these, first mentioned by the government in March as being imminent. However, as yet, no antibody tests are available. Two tests (developed by Abbott and Roche) were validated by Public Health England on the 14th May and will apparently be used from next week to test NHS and care workers. These tests are available privately from various centres but people should be cautious about the results. For a start, it could take up to 28 days after the infection before the test can properly confirm if a person has had the virus. Secondly, as mentioned above, there is currently no telling how much immunity one gets from having had Covid-19 so, until this is better understood, the benefit of antibody testing is largely for community statistical purposes.

So there you have it. The story so far. The next few weeks will no doubt contribute to our ever expanding knowledge about the virus. It might be useful to mention at this point an app developed by Kings in London called ‘COVID Symptom Study’ that I would encourage everyone to download and fill in if you haven’t already.

The more we know, the better we can understand how best to open things up and prevent a slide back into a second peak. Data, for all their faults, are key. Testing is integral to this.

Thoughts of the Week

It’s been however many weeks now in lockdown and, although easing a little, much of the entertainment (or at least unpleasant distraction) is watching our government muddle their way through things in farcical fashion.


Covid aside for a second, there was furore about the $26,000 (actually pounds but my keyboard doesn’t let me do a pounds symbol) or so salary limit on foreign workers, with critics accusing the government of not valuing the work of those on lower salaries. My gut reaction was to agree with the dissent until I heard another side to the argument – that workers below this salary cap can be more easily and more cheaply trained; not that the people and the jobs being done were at all not valued. I don’t like our government, don’t get me wrong, but it was a moment I had to check myself and remind myself that there is bias on both sides of the spectrum and there are always two sides to the story. This is something that we must all be wary of. Even when there is no attempt to deliberately mislead (and there are plenty of examples of that), the sheer strength of opinion almost took me to one side of an argument that, when one looks closer and puts aside bias, is not quite as simple as it seems.


I tried to remain measured when it came to Cummings. I really did. ‘If it was just a trip up to the house in Durham to isolate there’ I said, ‘then well I suppose I can understand that’. Of course, everyone now knows it wasn’t just that and to defend it is indefensible in itself. If you disagree you are hopelessly deluded or there’s something in it for you.
It is this sort of blatant disregard for accountability and flagrant shamelessness that we have come to know and love in politics in recent times, to the extent that even those who have practised it in the past have called Cummings and the PM out for it.


Our leaders are a bit like that naughty child at school. The one who constantly pushes his luck and plays up, each time emboldened when the consequences are far less severe than anticipated, the bluff of punishment having been well and truly called.


Not many succeed at this better than Donald Trump but, to me at least, it is obvious in our government too. Frankly I wouldn’t even trust Boris or anyone of his cronies to take a picture of me lest they run of with the camera. What surprises me is that some people are surprised. There are those who are now saying that this blatant refusal to be held to account in a position of power is a slippery slope. Of course this is true but what many don’t realise is that we’re half way down that slope already.


Enough of that. In other news, I’ve been reminiscing on my childhood Wednesday evening tv viewings (the slot just after the Neighbours/Simpsons power combo of my teenage years). Star Trek is not my favourite of the “Star” franchises. Despite the tangled and ill thought out mess of the recent Star Wars films, I favour the original trilogy above all else. Having said that, I did enjoy Patrick Stewart in the Next Generation, if not just for the outstanding potential for quotes. (“engage”, “make it so” etc). The new Picard series was something I was a bit sceptical of as reviews had, for some reason, been a bit cold. I have no idea why because quite honestly it’s brilliant. Clever, action packed, stylish, nostalgic and quite poignant so far, I am absolutely loving it. I genuinely don’t want it to end (although I will definitely finish the series, unlike my refusal to watch the last season of Lost, thereby somehow making it last forever in my head). Anyway, watch Picard, it’s awesome.


One final note, this week on cyclists. This lanky and lycra-clad species are a perpetual menace to me at the best of times. Let me be straight, I am never aggressive and am always safe when I drive but deep within me, I boil over with rage whenever I see one on the road. They are particularly irritating when strong in numbers, sitting lazily in packs across an entire lane and quite literally stealing 10 minutes of my life away from me. The rage is intensified all the more as they sail straight through a red light, presumably safe in the knowledge that they’ll just phase through any oncoming traffic without so much as a hair out of place (although is it just me, or are a lot of them not just tall and lanky but also quite prone to balding as well?). Either way, I don’t know if it’s the lockdown, the weather or both but there’s bloody loads of them out at the moment. They need to stop it. In the interests of balance, I will mention the one cyclist who waved me past him as the traffic light went green the other day. I was so shocked that he’d even obeyed the law enough to stop at the red light, let alone reveal some semblance of a conscience, so perhaps I didn’t thank him as much as I should have done. Regardless, he is in the minority. Get rid of them.


Ps. As a doctor, quite apart from the environmental benefits, I would say cycling is an excellent form of aerobic exercise, especially if you want to take the load off your knees and it should be unfalteringly encouraged.
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Thoughts of the Week

What a bizarre few weeks under lockdown this has been. While much of my life has been fairly similar in terms of structure (ie normal working days etc) the content of those days has been very different. I am one of the lucky ones in this respect. Fortunately, what my life has lacked in terms of pubs and cafes and shops, it has made up for in other ways.
The excellently amateur online pub quiz has been a particular highlight on a Thursday and Saturday night. It is genuinely something I look forward to and is something the whole family gets involved in. I have also been playing on the PlayStation a lot (Divinity: Original Sin 2 for those who are interested – an extremely nerdy but very involved dungeons and dragons type game which is not my normal choice but which I am finding awesome fun). Coupled with that – and I really have been getting my geek on – I have started playing a real life dungeons and dragons story with a group of friends via Zoom. I’ve never tried it before and I have to say, it’s cracking fun. Great change to catch up with friends from around the country (and the world) apart from anything else.


That has reminded me of a Harvard study I read about once in which levels of happiness were measured and quantified. The outcome I remember was quite poignant – those who were the happiest weren’t the richest or the most successful necessarily but were the ones who had maintained close friendship groups for long periods through their lives. Something that is particularly relevant at the moment I think. With so many people separated and levels of mental health issues rising, we should all be seeking to solidify friendships above all else.


In the same vein, a recent YouGov poll found that 8 out of 10 people would prefer the government to prioritise health and wellbeing over economic growth and GDP during the coronavirus. 6 in 10 wanted this to continue beyond. In some ways, slightly meaningless because one might argue economic growth is intertwined with wellbeing. Just as above though, this may not always be the case. I do wonder sometimes whether we are hurtling forwards inexorably in the interests of progress and expansion at the expense of so many things, not least the world around us. To halt this chain reaction is far from simple of course but there may be no better time than now to reassess things.


With the muddle the government have got themselves in this week over the new lockdown rules, I am not holding my breath. While I have actually been defending their overall plan (something that I never thought I would be doing) the evasive way it has been presented and the obvious and unsavoury motivation behind it (that of political damage control and self congratulation) has been pretty farcical. Looks like the lockdown is not as stringent as it was but it is not lifted. And we are to “stay alert”. To come up with that sort of nonsense slogan really is a symptom that comes from a lack of cohesion and leadership. Spin on care home deaths, overall cases and misuse of the R number (see my latest medical article) are just a few of their misdemeanours. There is no doubt that the government’s overall mismanagement of this crisis (and I repeat, I actually think their current measures are appropriate and require people to just use a bit of common sense and stop being so precious) has been nothing short of rubbish. That this is in any way surprising to people is the biggest surprise of all from my perspective!
Keir Starmer looks to me to be the future (and had done for a long time). Such a furore and a to do for so long before someone sensible like him comes along is the biggest tragedy. It’s just a shame we will have to wait a long time for him to get hold of the reigns.


Talking of length (apologies for the tenuous segue), my hair has not been cut for a couple of months now. Most obvious are the sides of my head which are expanding outwards at a fair rate. I look like Nicholas Cage. Beanie hats now make me look legitimately like a surfer dude (at least in my own head). My beard is another matter altogether. It is wild even despite my own feeble attempts at trimming it. I am one of those vain types that normally gets my hair cut every 3 weeks or so, so I have taken this as a sign and an opportunity to grow my hair out. I have tried it twice before in my life. Both times were pretty bad and I didn’t get past the mid length stage. (In fact my first attempt coincided with my “digestives and nutella” phase at uni and so, with the extra weight I was carrying at the time, I don’t think I have ever looked more physically repulsive. I am determined for things to be different this time – with the barbers closed, I really have no choice. So far I have resisted offers from several people who fancy themselves as stylists and so will have to just let things take their natural course. I think this is the right decision.

My Take on Music

“I see music as a catalyst for thought and emotion.”

 

“Music can change the world because it can change people” according to Bono. To be honest with you, I’m not really sure what he means by that. Indeed, I am not even sure whether the cheesy Irishman really knows what he means either. When it comes to music and what it represents, there are quotes galore from musicians and all sorts of other people on the subject of music and their interpretation of what it means to them. Lots of them refer to it being “life” and part of their “soul” and stuff like that.


Whatever anyone says, it is clear music is important. The recorded music industry was estimated to be worth $19.1 billion in 2018. That it is so popular is no coincidence. There is a difference between playing music and listening to it of course. Listening to it or playing it to yourself is enjoyable for reasons I will go on to explain. Performing it to an audience is altogether different, like opening up your mind and sharing an experience with other people. For those who are shy or lonely, this collectivism can be quite a release and encourage others to understand them a little. It is a way to gain recognition and to evoke a feeling of belonging to the performer. Very often, those listening will experience the same feeling and this may transcend the actual music itself. After all, most things are more enjoyable if experienced together.


It is the versatility of music – the ability to be both solitary and communal and to appeal to all types of human being – that is its main strength.


Despite all of this, I find myself listening to music less and less. A large part of it is related to how music is delivered in this day and age compared to when I was growing up. I used to love the excitement of getting a physical CD and listening to an album; fresh, organised and planned. I am of the cohort who insists on reading actual books rather than surrendering to kindles. Electronic versions whether it be music or books lose something in my opinion. Having the actual copy in your hands feels like the complete project rather than just a knock off version. There is also the draw of building a palpable collection that one can put on display and pick from at leisure rather than hiding away in a dusty hard drive somewhere.


Quite apart from the above, although streaming does still give one the option of listening to an album, it tends to be more a case of listening to individual songs these days. I have compiled some Spotify playlists to which I will add a song on occasion but find that playing these playlists over and over again gets a bit tired. New music is ever harder to come by and I find that relying on the algorithms Spotify uses is not quite the same as my discovery methods used in my youth. I can’t put my finger on why it doesn’t seem as good though.
Part of the problem, I suspect, is the sheer volume of music available now. On the face of it, one might see this as a good thing but when you factor in the quality on show, it becomes more clear.


Music as an entity is incredibly broad, so much so that it could be considered several different entities altogether rather than a single thing. I tend to think of it as similar to the concept of life – one form of music can be as different to another just as a single bacteria is to a blue whale. With a hugely varied spectrum of quality and an ever increasing ratio of good vs bad, the general pool of music available has been severely diluted.


Using the current ‘hear a good song and wack it onto a playlist when you hear it’ method of collecting music nowadays – by no means my favoured primary way to engage with music but all I am left with – the dilution of quality serves as a huge hindrance to this process.
We favour a song if it has the ability to enhance our current emotion, almost like a drug used to accompany everyday life. This could be joy, sadness, hopefulness, introspection, wonder, a feeling of courage and self-assuredness or any one of a multitude of other feelings. This is what composers are going for when they write (for the most part). Leo Tolstoy said that “music is the shorthand of emotion” and I would tend to agree. Imagine a scene from a film without music – far less intriguing or gripping for the most part. To that end, I see music as a catalyst for thought and emotion.


My thoughts on what makes a good song therefore starts with the above definition. Beyond this, things begin to get highly subjective and quite hard to put into words. For my part, a good song may fall into any genre and can be simple or complex. It will most likely have a unique and interesting and evocative melody alongside an intelligent rhythm. I also like a progression; a sense of building although, particularly for pop music, symmetry and appropriate resolution is a positive. Clever and well thought out use of time signature and pushed beats are features that draw me to a piece. I enjoy aggression and extravagance in my rock music and intricate and technically impressive instrumentation in jazz and pop. Orchestral music appeals to me if it is epic and bold rather than understated; think the Riders of Rohan theme from The Lord of the Rings as an example. Use of the right instrument is of interest to me as well but this will be dependent on the song; I don’t have a favourite instrument to listen to per se. Finally, nostalgia has a big part to play too – much like a smell, a song has the ability to activate memories in just the same way.


For me, lyrics are not that important. I do write music and I do take care to write lyrics of good quality that relate to a piece’s message but, ultimately, the music is far more important to me. I will rarely listen to the words of a song and I’m unsure of the lyrics to even some of my favourite songs.


Changing tack for a moment, there are certain things that will mark out poor quality music in my eyes. What does nothing for me is a song that lacks in detail. Much the same way as a childrens’ cartoon or a plastic toy will employ broad and simple colours and few points of real detail, so too will a generic song peddling the basics and nothing more. Unfortunately, there are a lot of these around, often relying upon a generic template; a cheap knock off of a once original idea – one known to sell. The fact that there are many of these around is likely due to several reasons. For a start, the market for children is a big one and so it follows that music appealing to teenagers and even younger exists and that it is fairly basic and uninspiring. Beyond that, there is a tendency now for the emphasis in music commercially to be more on style and image of the artist rather than the music itself. Many a song has been released by an artist well known for their influencing more than the quality of their music. It is likely that people will truly believe they like the music even if they wouldn’t think twice about it if released by a jobless drifter. There is a psychological premise behind this, the same one that leads people to rate the taste of whisky served in a crystal glass higher than the same one served in a plastic cup.


Unfortunately, for those interested in just the songs, this is not helpful and results in artists releasing material they would normally leave on the cutting room floor as they know it will sell anyway.


Thirdly, there is a category of people – and sometimes I feel this category is quite large – whose draw to music is so superficial, that they are drawn in by the trick of a catchy riff or a gimmicky chorus. They don’t have the ability to appreciate anything deeper. Before you say I am being a snob, let me explain. Some people really don’t have that ability. In the same way I can’t comprehend how someone can paint something from scratch, nor can others comprehend the sounds we hear and process them as such. Michael Jackson once said that “everything living has rhythm.” Clearly he never saw my Dad dance. Nor does everything have melody for that matter. My flat mate at university could not hold a note let alone a tune. Music is very much in the mind.


As such, there are a lot of people out there that are content with a broader collection of music, whether they like it or not , as they don’t necessarily comprehend how one can appreciate in any greater depth. Popularity drives industry and music is very much a capitalist endeavour. The onus is on selling music rather than producing something of quality and clearly it works.


Of note, there is another cohort at play here. The ‘music for quality’s sake not commercial potential’ crew, of which it would appear I am part of based on the above. That may be true but there is colossal potential amongst this group for pretension and can result in just as much dross; music to make a statement rather than actually being any good.
The sweet spot for a good song is, in my opinion, not commonly hit upon and is often not consistently hit upon by one person (hence the occasional but increasingly rare greats).


The upshot is, I find myself searching endlessly for good songs and this can be both time consuming and frustrating. When I do stumble across a decent one, it tends to be in isolation – there is no cohesion to the quality stuff, scattered as it is across genres and artists. What matters I suppose is that, as long as the mass of music out there (including the bargain bin dross) has an audience and evokes a strong emotion in people, it could be said to be valuable. My fear is that a lot of it is at least partially popular for the wrong reasons and moreover is detrimental to the production and showcasing of higher quality material.


For me, writing this has been quite cathartic and will no doubt redouble my efforts to find more music. There are phenomenal amounts out there. Just being out there in this day and age is not enough though. Finding a way to organise and collect my music to replicate the excitement and novelty experienced before the streaming age is the key. Whether that be vinyl or just being a bit more organised with my Spotify, I’m open to suggestions. If you have any tips or indeed any good new music, just drop me a message!

 

Thoughts on our Healthcare

“It is forecast that by 2030, the global consumption of antibiotics will rise by more than 30% (200% if it continues at current growth levels). By 2050, the annual death rate will have risen from 700,000 to 10 million with no action.”

 

It is a humbling situation when one realises how fragile we are in the face of nature and how little we really know in the battle to protect ourselves.

My generation have the unique honour of having grown up at a zenith of medical know-how. As a child, I often reassured myself that, if I or anyone I knew ever became unwell, everything would be fine. I always comforted myself that, should it be needed, there would be the medical expertise somewhere to cure anything. I was confident that the medical care and consensus behind every treatment was solid and complete; its efficiency spotless. Now I realise that this was simply a form of therapeutic self-delusion.

The truth is that, although our capabilities far exceed the wildest dreams of Hippocrates and Aristotle, we are far from perfect. What we don’t know far outweighs what we do. Treatments remain speculative, their quality reliant upon where we fall at any one time on the curves of demand and supply. Despite officious regulation, treatment remains highly subjective according to who treats you (bearing in mind this may be an exhausted doctor or nurse running on empty), and could still be based on faulty or unreliable evidence. We can’t guarantee a cure for your cancer and we can’t always tell for sure why you’re feeling so tired and achy, so sometimes we have to guess a bit.

Our exaggerated opinion of our own ability as a species extends beyond just medicine of course. While that can be catastrophic in other fields, it does at least provide some benefit in a healthcare setting. Confidence in physicians can be a therapy in itself. Despite what I have said, this trust is important and well placed. Though not perfect, we are better than nothing! And yet, when something like the Covid-19 pandemic hits – something so undeniably out of our control – it highlights those cracks that we’ve otherwise consciously chosen to ignore. 

What has struck me most about the Covid-19 pandemic is our reaction to it. While in some places it has highlighted tremendous courageous and community spirit, in others it has merely brought out human attributes that are the polar opposites of the aforementioned. For me, it has emphasised the prospect (and quite possibly the need) for fundamental change in how we utilise the medical expertise and the knowledge we have accumulated.

The meaning of ‘our NHS’ has become a bit warped in recent times. When someone has been treated with kindness and care, it is the NHS that gets the thanks. In reality, it is the people that work for the NHS who should be thanked as well as the organisation as a whole; a distinction that I feel too often gets overlooked. Obviously this is semantics and very often that is what people will mean when they praise the NHS. But in merging the two, a powerful message is being lost.

The people that work in healthcare, whether it be within or without an NHS, deserve all the praise they are getting. Likewise, the idea of a National Health Service that provides universal, comprehensive and free healthcare should also be praised. The problem is, at its inception in 1948, the idea of comprehensive healthcare is very different from what it is now.

In 1948, paracetamol was yet to become readily available, open heart surgery was 4 years old, statins had not yet been invented and antibiotics were in their infancy. Fast forward to the present day and we are seeing around 200 heart transplants a year in the UK, an entire pharmacy of medications available to us at our beck and call, lifesaving emergency services 24/7 and access to state of the art intensive monitoring equipment. Around half of the UK population takes at least one regular prescription medication. If your hips or knees go, you are entitled to have metal replacements inserted for no extra charge. If you have a rash, you can have it seen to or if you want your ingrowing toenail sorted, you can have it clipped or lopped off. If your ears are blocked, someone will clear that for you too.

With our population increasing and growing older, it is little wonder that the whole thing is beginning to creak. The outcome…? You have to wait a long time for your hip replacement, you might be denied the chance to have your bunions sorted out because it is a low funding priority. Your GP is running late by 20 minutes or even a bit longer. That may seem a bit insensitive or flippant (or both) but believe me, I’m not happy about it, certainly if it means people are waiting for treatments in agony. While some have a rational grip on such situations, others will not. Those are the ones that abuse the staff who are only trying their best in impossible circumstances.

Demand has far outstripped supply already. At current levels of funding, the promise of delivering a comprehensive service is no longer accurate. But that is only if we all agree on what counts as comprehensive.

We have been rather spoilt with the NHS, rather like a child who is given one sweet and then pleads for several more, never content with what they are given. The level at which our baselines have shifted (there is an actual concept know as shifting baselines syndrome that one could probably apply to much that is wrong with the world) is significant. Consider 100 years ago, antibiotics were non-existent, surgery was more dangerous than beneficial and not long before that there wasn’t even the luxury of an anaesthetic. Just read the 1810 diary account of Fanny Burney, the English novelist, who developed Breast cancer and underwent a mastectomy without anaesthetic to see what I mean.

Antibiotics and our use of them serve as a perfect microcosm to demonstrate my point. For all they have given us, they have also contributed to levels of antibiotic resistant infections that kill 700,000 people a year globally. Don’t get me wrong, antibiotics are great; a lifesaver in fact. Prior to their widespread utilisation, a cut or scratch could become infected to life threatening degrees and as such they have arguably become the single most important tool in our therapeutic arsenal (vaccination is arguably more important). And yet they have suffered a severe case of mission creep. They lend a hand in all sorts of unexpected ways. Caesarean-sections and routine hip replacements would be rather more hit and miss in terms of survival without them. Not content with saving lives, in fact they have become somewhat of a luxury, whether it be to shorten a cough or a bout of diarrhoea or to fatten up our animals so their meat is better.

In the UK, at least 20% of antibiotics prescribed in primary care are inappropriate (I would probably argue that figure is higher depending on your definition of inappropriate). At any one time, a third of patients in hospital are on an antibiotic. 

Resistant organisms transfer at will from one person to another, or to food and animals. As they do, we edge ever closer to a circumstance in which we are unable to treat them at all. There are already strains of TB and gonorrhoea that cannot be treated even by the antibiotics reserved as last resort.

The WHO cites antibiotic resistance as the biggest threat from global pandemic. Considering what is going on at the moment that should prick some ears.  Just as there are warnings about antibiotics, so there were for coronavirus. A pandemic such as the one we find ourselves in isn’t exactly a surprise and yet to a large extent, we have all been caught napping.  I liken it to sitting on a beach with a bag of popcorn, admiring the spectacle of a tsunami rolling in. Suffice to say, a tsunami of antibiotic resistance is far less palatable than the comparative swell of coronavirus we are seeing now.

It may therefore be time for some realism and some hard choices. This includes both those at the very highest levels but also, I’m afraid, for us all. Who knows in what shape we’ll emerge from the current saga.

In an ideal world, the government would pledge a suitable amount of money for the NHS to cater perfectly for everything from the largest and most severe of our medical needs down to the smallest and most trivial. Failing that, management of the entire system must get realistic and we must allow it to do so. No one wants to see a privatised NHS, (including the government if what they say is to be believed). Clarity of mission alongside acknowledgement of the problems– not spin – is what we need. Without this, whispers and rumours of privatisation will continue. If measures are to be painful, in my opinion telling people that is far better than trying to sneak it under their noses. Better still, a cross party approach in order to depoliticise proceedings is preferable so election success no longer rides on it. What we don’t want to see are more layers of management. Time and time again, we experience instructions from those at the top, far removed from the realities and often the progress we make is in spite of these targets instead of because of them. In any situation, the more layers you add, the more complex it becomes and the easier it is to trip over yourself. A bit like the game Tetris – a certain amount of blocks at the right speed will build something solid but as soon as the rate and number of bricks increases, it all runs away from you.

Just as importantly, perhaps even more so, is our individual role in all of this. As we clap our health workers every Thursday evening while in lockdown, perhaps take a moment to consider what we ask of them under normal circumstances. A large proportion of GP consultations are unnecessary and could be dealt with either by a pharmacist, or by the patient themselves. The NHS website has the information available if people were only to access it.

Between February and March, there has been a 22% fall in A&E attendances, many of would have been unnecessary anyway and would have taken up valuable resources and time.  General practice and outpatient secondary care has also seen a sharp drop in demand for routine enquiries. Many issues will have gone away on their own, or have been dealt with using online advice. Still more infections will have settled without antibiotics. We must harness this new way of using the health service.

This current situation may therefore serve as a not so gentle reminder of what are reasonable expectations in terms of our healthcare. That said, between early and late March, there has been a fall of 150 patients per day presenting with symptoms of heart attack. Now, it is unlikely that the Covid-19 pandemic has somehow cured heart disease altogether and though many people with chest pain turn out to be fine, there will be some within that cohort of 150 who have had real heart attacks; heart attacks that are currently going untreated.

Lack of presentation for this sort of thing, or indeed other worrying symptoms of things like cancer (loss of weight and appetite or a change in bowel habit to name just three), means the health impact of this pandemic will not be just related to Covid-19. For anyone with worrying symptoms like this, you absolutely must not ignore them just because of the outbreak.

We need to use the NHS sensibly. Not too much, but not too little. We have swung from one extreme to the other in the last few months. Once we emerge from this, we must all consider how best to use it going forwards, and focus on the bigger issues at hand, no doubt at a time of great change. Self-care is a big part of that, not just in how we deal with an acute medical situation but also in how we look after ourselves in general. Smoking alcohol, diet and exercise are the key areas that cost nothing to improve.

As a nation, our perspective in terms of the scope of our healthcare has run away from us. Some expect miracles – you don’t need to go to your GP if you have a cold. Nor do you need to go to A&E with a broken fingernail or a year old rash. Meanwhile, the threshold for others is far too high and there is a proportion of people that will hold off in coming to a doctor when they actually need to be seen.

As doctors we want to ensure that everyone who needs to be seen, and who we can help, presents to us appropriately. At the same time, we would request that others, who might reasonably be able to manage their own minor issues, do so. It is a fine balance and even writing this makes me uneasy that some may stay away for fear of overusing the service. The level of disparity in comprehension of how best to use the NHS is, in my experience, remarkable.

Nevertheless, I think we all could perhaps do with shifting our baselines back a hundred years or so. As doctors, we need to look at how we are using our resources and considering whether far more significant changes are necessary. Antibiotics use is just one example. Fundamental change at the top is needed to streamline the provision of healthcare and cut out the obfuscating bureaucracy. Difficult lines must be drawn. Leaders must consider taking more than half a glance at the deeper issues facing us – after-all from our current position, an antimicrobial resistant pandemic suddenly doesn’t sound as far-fetched as it did a few months ago. If that change is severe then so be it. Sometimes you have to go backwards to go forwards. In that case, we all have a responsibility to understand it and adapt, though politicians must realise that we cannot be expected to do that if left in the dark.

Urgent care must remain a priority for the service as a whole, but how we look after an ageing population effectively is just as vital. Prevention of health problems is key. One of the best ways to help therefore is to look after yourselves properly (we can only do so much in that respect) but also to seek help when appropriate in order to avert bigger health issues down the line. Staying away isn’t always the answer (particularly at the moment) although granted, there is a fine balance. That balance has always been upset one way or another and we all need to contribute in order to redress it. Now might be the time to set it straight.