Tuesday 20 October 2020

Covid 19 - why was the NHS so unready?

WHY WAS THE NHS SO POORLY PREPARED FOR COVID 19? Another lock down is about to start in Wales as many areas here display rising levels of Covid infection. Only Pembrokeshire and Ceredigion seen to have relatively low levels of new infections.
THE NHS WAS SET UP WHEN INFECTIOUS DISEASES WERE MAJOR KILLERS When Aneurin Bevan set up the NHS infectious diseases caused a great deal of death ans disability. Hospitals and sanatoriums were built to house and isolate the sick with infectious diseases. Tuberculosis, menigitis, septicaemia and polio were commonplace. Better living conditions, routine vaccinations and the development of antibiotics have led to a steep decline in infectious diseases but we know now, to our cost that we should have prepared better for the pandemic we have now. The risk has been ignored. When I was a medical sturdent there were still hospitals treating large numbers of patients in iron lung ventilators after polio had paralysed their breathing muscles. As a consultant I still saw a few patients cripled by polio as children. Nowadays polio is a rare infection and only a few dozen cases are repoted worldwide annually. some of the old diseases still occur, but a combination of healthier populations, vaccintions and prompt treatments and isolation have kept the numbers low in the West.
 Sars2/Covid 19 , is the virus that is causing so much trouble, Boris Johnson's "invisible mugger". A coronavirus originally from bats which was discovered in December 2019 in the customers of a wet market in Wuhan. Although some groups are more prone to serious complications and death, anyone can catch it. As plagues go, the death rate is modest – about 1% and falling as better treatments are found, but the groups most prone to serious complications and death , the elderly, obese, hypertensive, transplant recipients, cancer patients, etc can only avoid catching the disease by hiding from the invisible killer. As a large proportion of those infected by Covid 19 are asymptomatic, but infectious, some totally and others in the early days of the disease before they feel ill, every fellow human could be a possible source of the infection. You cannot tell who has it. Also. Test,track and isolate is much harder when many pass on the virus not even knowing they ever wwere infected.
HOW DO WE GET RID OF IT? In the absence of a "magic bullet treatment" at present we can only use the information we have about the virus to try to stop the tranmission. We know it is spread from person to person, mainly airborne, and so contact with others indoors, from outside our households is pretty dangerous. Social distancing and face coverings may well help but thre is no easy solution as yet. An effective vaccine would be great and as the doctors of the world learn more about the virus more drugs and therapies to save lives will emerge.
WHY WASN'T THE NHS READY FOR THIS? It was not ready for an entirely new, highly infectious virus despite the warnibg in 2002-3 of SARS 1, a very similar virus outbreak mainly in Asia and spread by air transport. THe UK only had 4 cases and no deaths. World wide it killed 700 people and had a 10% mortality.People were usually very ill with it, and it had a short interval between catching it and falling ill - 2 days rather than the 14 days or more of SARS.2. Test,track and trace worked well, and it was eradicated. It is now obvious that no governments or scientists yet have the instruments with which to permanently eradicate the SARS2-Covid19 virus. We are, for the time being, stuck with it, probably for at least a year or 2 and maybe longer. Lock downs, social distancing, masks, hand gel etc can slow it down, but that is all. New treatments and drugs are improving survival rates but not stopping all the deaths. Something like this has not been seen in recent times in the West and was something not expected by the NHS, . Pandemics are not unknown, far from it, but all of the UK have deliberately run down infectious disease services and isolation units, to save money, as governments of all colours have demanded NHS “efficiencies ” , otherwise known as cuts.
As these hospitals and units were closed, instead of being mothballed, they were generally sold off, often to developers, usually for building private housing to generate funds for whatever the NHS managers of the day desired. So both the extra space needed for isolation wards and the expertise in this new disease had to be built and learned fast by essentially unprepared health providers, whose previous policy was seemingly to ignore the threat .
Also, the growth of care homes and early discharge from hospital to other care in the community” has meant less medical supervision of the sick, This also allowed further asset stripping of the NHS, closing more geriatric wards and in general, reducing the choices for patients and increasing waiting lists for inpatient procedures. There was no slack in the system as any slack was pounced upon as an “efficiency saving” and eradicated. The effect of this general policy of the NHS has been, even pre-Covid, in many cases an increase the stress on the staff and a decease in the quality of care. Its a poor economy as leaving patients for long periods on waiting lists means that many deteriorate and need more treatment and some may even be told they are beyond cure. Only the private sector benefit from this, but unlike the USA, private medicine in the the UK rarely offers emergency treatments and has very little intensive care facility. Not much use in a pandemic.
LIONS LED BY LABRADOODLES [Labradoodles being dogs beloved by the wealthy middle classes and noted for enthusiastic devotion to their masters] After years of delivering healthcare on the cheap, but senior mangerial salaries keeping Aneurin Bevan spinning in his grave, the wake up call has come in the form of Covid. This virus does not fit with the plans of our healthcare managers. The NHS is unused to quck emergency responses to a real health crisis and here in Wales the response was building field hospitals which were mainly unused and so stayed empty. I supect general guidance was poor, and panic high, as local facilities were overwhelmed by severely ill patients with an unusual dispaly of symptoms and complications that no-one had been taught in medical school.
Our healthcare is managed overwhelmingly by a board of bureaucrats appointed by other bureaucrats who then appoint a token doctor and nurse to join them, with one or 2 trusted “members if the public” who are usually persons of note, and hardly representative of the public at large. Certainly no-one on a health board appears directly accountable to the public. Our front line staff are truly lions led by labradoodles, People who selflessly throw themselves into the battle against the virus are led by people selected for their talents of subservience to government and ability to look good while burying incompetence in platitudes and propaganda. We actually have had pandemic committees all over the UK, including Wales . They were planning for pandemic flu. When this virus is under control our planning for the next new infectious illness will hopefully be focussed more widely and our NHS more resilient. Its time for the NHS to become a more open and democratic system and accountable to those whose taxes pay for it IF OUR HEALTH BOARDS WERE ELECTED, NOT APPOINTED, WOULD THIS HAVE HAPPENED?
The answer is, that we would not have dodged the virus, but honesty about the clinical situation and wider and more open public discussion could have changed the atmosphere in which the public were asked to make the serious sacrifices necessary to stabilise the situation. Breaking bad news is never easy, but playing down a disaterous situation destroys trust. In our current position trust, and the confidence of the people, have to be won and kept.
If the Health Boards have a majority of elected members,{they may still need a senior doctor and nurse to consult) the board members will be people voted in whose conduct can be examined and judged.If they succeed they are rewarded, if they fail, they face replacement. In much of public service, deficiencies seem to be hidden rather than exposed and consequences for failure may be a quiet early retirement and a generous pension. A little more openness may actually inprove the relationship between the public and the public servants who we pay for. Without the trust and full cooperation of ordinary citizens everywhere, this crisis will last longer than it needs to, and none of us want that!
Dr. Siân Caiach Mob 07925 888053 Home 01554 785046 sian.caiach@gmail.com
Postscript : A reecent Guardian Article claims that Labradoodles are in fact, genetically mainly poodles, who could have guessed? https://www.theguardian.com/lifeandstyle/2020/sep/10/labradoodle-study-reveals-dogs-are-actually-mostly-poodle

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