Even before the coronavirus hit Britain, exhaustion, anxiety, and stress were already endemic in the country's overstretched National Health Service. Then came the government’s mishandling of the crisis, which has left health workers unprotected in battlefield conditions due to widespread shortages of personal protective gear and testing. Now, there’s festering anger among health professionals who fear for their safety and the safety of their patients. The virus has also changed their relationships with their patients, co-workers and families, and some are struggling under the psychological weight of the crisis. I conducted an interview with an NHS physician who requested anonymity to speak freely. The doctor’s remarks have been edited for clarity and brevity.
Can you give us some insight into how you and your colleagues are feeling right now?
Feelings of exhaustion, stress and anxiety are palpable among doctors and nurses in hospitals. It is not unusual for us to be working 7 consecutive 12-hour on-call shifts, although this varies across trusts. Many live with vulnerable adults themselves and therefore risk exposing their loved ones to the virus. Others have chosen to completely isolate themselves from their families for months to keep them safe. Meanwhile, on duty, we are constantly dealing with physically and mentally demanding situations, whether that’s breaking bad news to families who couldn’t visit sick relatives due to government guidance, or witnessing fit and well patients deteriorate rapidly after illness onset. Understandably, this puts all healthcare professionals under enormous mental and psychological strain. It is important to note that much of the workforce is classified as junior doctors, many of whom are between the ages of 24 and 35. Having these highly traumatic events unfolding in front of you every single day for months is enough to exacerbate and ruin anyone’s mental health.
Do healthcare workers have enough personal protective equipment (PPE)?
The availability of PPE can vary from trust to trust, but I am aware of many that have had to depend on the goodwill of volunteers to make the scrubs that we so desperately need to make up for shortages due to unprecedented demand. There is also a worrying discrepancy between the PPE provided for NHS workers and what is used in countries such as China where healthcare workers wear layers of protective equipment. Moreover, the continual shifting of guidance around PPE has left us feeling confused and vulnerable.
There were reports that NHS staff are being gagged from speaking out about widespread shortages of PPE. Have you or your colleagues received warnings from NHS bodies not to raise your concerns publicly?
Although I have not experienced this personally, and while I am aware of the media’s tendency to overuse hyperbole when there is a major news story, I was not surprised to read reports of doctors being warned not to make any comments about shortages on social media, as well as avoiding talking to journalists. I am sure many doctors and nurses who feel their safety, and by extension, that of their families, has been compromised through the lack of sufficient amounts of PPE of the right specification have tried to speak out.
A demonstrator wearing a face mask holding signs reading "PPE" (personal protective equipment) protests about the lack of PPE for NHS nursing staff, outside of St Thomas' Hospital in central London, while Britain's Prime Minister Boris Johnson was in intensive care on April 7, 2020. (Getty)
What do you think of the way the government has handled the crisis?
The government’s strategy has been a shambles since its inception, particularly when you contrast it to other countries such as South Korea and Singapore who reacted immediately and have excelled in containing the coronavirus through expansive testing, contact tracing and quarantining. Countries closer to home, such as Germany where the death toll is far lower, have also shone unforgiving light on the UK’s strategy. The government’s lockdown dithering, and its failure to procure enough Covid-19 tests and PPE, even when it became evident that the UK was just weeks away from experiencing a similar trajectory in death rates to coronavirus-battered Italy, undoubtedly led to the worst death toll in Europe. Moreover, flights have continued into the UK from the world's worst-hit coronavirus hotspots throughout the pandemic with no checks on incoming passengers. What is most concerning at this current stage of the pandemic is that UK’s strategy dangerously continues to leave too many questions unanswered even as we emerge from lockdown.
Has this made you think differently about local and national leadership?
I tend to avoid partisan politics but there is an overarching sense that the governing body is driven by selfish interests. This was crystallised when MPs received an above-inflation pay rise and were offered extra £10,000 to help with homeworking office costs, while NHS workers who have made profound sacrifices are rewarded with a possible two-year pay freeze and weekly clapping.
How do you feel about the public clapping for the NHS every Thursday at 8 pm?
While it is a nice gesture which my colleagues and I appreciate, when viewed through a political lens against the backdrop of a country that just a few months ago voted in a government that has critically overstretched and underfunded the NHS for over a decade in what seems like an attempt to speed up its plans to privatise the health service, all our clapping begins to look like deep hypocrisy. From a public health perspective, the irony is that the people congregating on streets and bridges while breaching social distancing rules are increasing the risk of putting more pressure on the NHS. It is important people observe social distancing at all times. Finally, clapping doesn’t put food on the table. You would be surprised to hear about the very low starting salaries for junior doctors and nurses that barely cover their bills and rent, despite working over 65 hours a week at times. This needs to be addressed as a matter of urgency.
Do you think we’ll have a second, deadlier wave?
History has shown that subsequent second waves of outbreaks of disease can be deadlier than the initial wave of disease. As governments around the world loosen restrictions, some countries such as China have already reported a resurgence in cases — prompting fears that a new wave of infections is imminent. Most viruses follow a seasonal pattern, and although not enough is known about SARS-CoV-2 to predict if it will have the same seasonality, I believe that is likely that we could see a second wave in the coming Autumn and Winter months.
Will the NHS cope with what is to come?
It’s very difficult at this point to assess how well the NHS has managed as we move past the first wave of the pandemic. The virus infection and death rates, and the numbers of patients admitted to Intensive Care Units and require mechanical ventilation are striking. Patients suffering from coronavirus and other illnesses who under normal circumstances would have required ICU admission and ventilation have been turned down purely based on age and comorbidities. It is chilling to think that someone in their early 60s who is still fit enough to work, is not fit enough to be ventilated. Therefore, I am not sure if it can be said that the NHS has coped, and if the second wave is even larger, it could be catastrophic.
Can you give some examples of tangible things the general public can do to help frontline workers?
The easing of lockdowns does not mean a return to pre-pandemic normality. As people are getting more freedom to engage in social and economic activities, they need to continue the public health measures that we have already been practising to keep infections low to avoid overwhelming the health system. We have already seen images of packed trains and tubes as the easing of the lockdown started in England. As we interact with others outside of our household, cases will likely rise again and effective mitigation relies on people’s individual decisions to comply with the guidance.
Fast-forward to Spring 2021, what do you think life will look like?
Around the world, hope for a return to normalcy is pinned on a vaccine, but some viruses, such as influenza, mutate so rapidly that vaccine developers have to release new formulations each year. So far, the Sars-CoV-2 coronavirus seems fairly stable, but it is acquiring mutations as it passes from person to person and there is a chance it could mutate in a way that could make a lasting, universal vaccine difficult to create. Until we have that crucial vaccine, we will have to get used to our new normal of social distancing which will continue to change how we work, how we travel and how we socialise with each other.
What has been one good thing that you’ve noticed during this outbreak?
The pandemic has sparked a spirit of unity and solidarity. Another major positive has been the technological response to the COVID-19 health care crisis. Telemedicine has quickly made its way to the forefront of healthcare delivery. Integrating digital solutions has facilitated remote telephone and video doctor-patient consultations which have obvious benefits during the pandemic and I hope they will be part of the future of medicine to increase efficiency and productivity.