A polite and kind plea from a medical student to everyone – please take the government advice seriously

 

How do I feel? I feel a bit sad. An apology in advance about the content of this article (what on Earth did we talk about before this?) but you guessed it, I’m referring to Covid. While the virus itself is no doubt sad and frightening, what I am finding even sadder and more alarming, is not the actual virus, but the response of some people to what is happening.

There have been some beautifully inspiring reactions to Covid all across the globe, and to this I feel comforted. But what I want to discuss here, is how the inaction of others has caused me to feel the opposite. I’m referring to the students I overhear in Sainsburys planning their big final house party before they head home, the students who continued to (until they could) go to the pub. To the people packed on the crowded bus, and the people who seem to find it impossible to resist the urge for a big social meet up in the park. To the people who, despite the serious and weighty warnings from experts, governments, other countries, and our own healthcare system, maintain the mindset that going about their daily life as normal is ok. Seeing people deliberately ignore the advice from our government about what is acceptable to do socially – this makes me feel sad.

My experience

Maybe the reason I feel so sad is that I’ve been lucky enough to witness and appreciate some of the colossal changes being made within hospitals in preparation for Covid. On the final day of my clinical placement (Monday 16th), I experienced NHS staff discuss very seriously the changes that need to occur in preparation for what’s to come. Whole wards were being reorganised, patients were being discharged to make space, and discussions about coordinating the necessary extra shifts were taking place. This was on Monday – a whole 6 days ago (at the time of writing this article). Due to placement being cancelled, I haven’t actually been back into hospital since. But what I can’t help but think is, if that was taking place 6 days ago, what is going on in hospitals now? There’s been an immense shift in attitude from the government and public in the past 6 days, so I can’t begin to imagine the extent of escalation in hospitals.

A junior doctor working in London – an area which is currently accounting for a third of the UK’s coronavirus deaths – reported in the Guardian on Saturday that all elective surgeries have been cancelled, and anyone with experience of ICU or intubation is being redeployed to meet in the pressures of Covid. Another Guardian article, written the day before, reported that operating theatres were being turned into makeshift intensive care units – “I had to turn my operating theatre into a four-bed ICU, and we are intubating two or three patients every eight hours or so”. Another doctor stated that “all of our high dependency units are being used for intensive care. We have patients spilling over into the recovery areas”, with other doctors warning that “it was only a matter of time before hospitals in London ran out of intensive care beds and had to start making difficult decisions about which patients could go on a ventilator”. On Thursday evening Northwick Park hospital in north-west London declared a critical incident after it ran out of critical care beds, with a senior manager at another London trust telling the Health Service Journal “given we’re in the low foothills of this virus, this is fucking petrifying”. NHS England have already announced measures to slash the normal GP workload in order to free up capacity to prepare and manage the outbreak, and have also blocked almost all of the private hospital sector’s services for the foreseeable future in preparation. 

It’s these enormous changes taking place within the NHS in response to Covid, which, to me, makes the changes we are being asked to make socially seem really quite minor. I appreciate it’s so challenging to completely reverse the way we are used to living our lives, especially in our very individualistic society, but when we consider the sacrifices the NHS and its staff are making in order to best effectively care for those who are going to get ill, it’s really sad that our population are unable to find the motivation to return the favour.

I have enough faith in humanity to believe that advice about social distancing and isolation is being ignored not because people are selfish or don’t care, but because it’s actually so hard to fully comprehend the extent of what the NHS are facing and why these government measures are necessary.

What are the facts?

I won’t quote statistics, because the reality is, if I do, by the time this article is published, the figures will have changed, and what I say becomes insignificant. What I will say is that medics in the capital are warning that numbers of Covid-19 patients are doubling every three to four days, predicting that they will be treating “thousands” within a fortnight. At the time of writing this article, the current number of deaths in the UK is at 233, which was the same number of deaths in Italy 14 days ago. The current number of deaths in Italy stands at 4,825, and it would not be surprising or unexpected if the UK death toll in 2 weeks’ time is something similar. 

The nitty-gritty of statistics and the figures are not actually what’s imperative in my message. What’s essential is to understand that the number of cases and deaths in the UK is inevitably going to increase, and it’s going to increase at an exponential rate. We have no control over the number of cases increasing. What we do have control over however, is the rate of this growth. As we’ve heard Boris repeat over and over, the aim is to “flatten the curve”. Minimising the rate of growth is crucial to the effects and outcomes of this disease outbreak. This is because the faster this rate of growth, the greater the impact and pressures on the NHS. If we can minimise pressures on the NHS, this will save lives, as minimal pressure means there will hopefully be enough resources, staff, and beds to effectively care for everyone who is ill.

How do we minimise the pressures on the NHS? By slowing the rate of transmission. How do we slow the rate of transmission? With effective social distancing and strict social isolation where necessary. The action of each individual, and how seriously they adhere to these measures, will ultimately collectively determine the rate of Covid transmission, cases, and deaths. If we seriously abide by the advice to socially isolate when we have symptoms and take seriously the practise of social distancing despite symptoms, then the rate of transmission across the UK will (hopefully) be an expansion the NHS can cope with. However, if individuals are inflexible in the changes they are willing to make, and are unable to transiently make comparatively small sacrifices to the normality of their daily routine, then the truth is that growth will be so exponential that the NHS will become overwhelmed. An overwhelmed NHS risks losing the ability to match the pressures of Covid and risks becoming deprived of the ability to care for everyone.

Pressure on the NHS

I think the other really important aspect, which is so often overlooked in discussions about Covid, is the indirect deaths the repercussions of an overwhelmed healthcare system will cause. When the NHS is unable to deliver adequate care to Covid patients, when there aren’t enough beds, resources, or staff, then deaths unrelated to Covid are inevitably going to take place. The stress on the system will trickle down to not only Covid patients, but patients needing urgent care for completely unrelated health issues.

The robust alterations the NHS are making to tackle this outbreak alongside all its amazing staff who are devoted to delivering the best care possible was so evident on my last day of placement. Putting into words how proud and appreciative I felt is hard. It emphasised to me that the least we can do in return is take seriously the advice and alterations we are being asked to. 

Hopefully an understanding about why these individual changes are so fundamental to relieve the pressures on our healthcare system will make people think twice before ignoring guidance. During what is no doubt a disorientating, anxious, and uncertain time for everyone, I plead that people reading this take the time to seriously consider the direct and indirect consequences of their choices and actions. There are people who may lack the ability and luxury to adhere to the advice – the homeless, families in refugee camps, people being forced to go into work. If you have the capability and luxury to adhere to advice, please do so seriously. To the people I see on their way to the gym, to the students gathered in the park, to those who were sat outside the pub – please consider the consequences. 

The measures of social distancing and social isolation are without a doubt extremely disorientating and boring. But when you find yourself thinking this is impossible, I can’t do it, and why does this matter, I beg that you please alter your perspective. This isn’t about just you. 

Consider, if you can, a moment of reflection about the even more strenuous sacrifices and hard work taking place right now in the NHS. Take a moment to weigh up how little changes we can each make individually can collectively make a massive difference in the care the NHS are able to deliver to the most ill and vulnerable. 

What can we all do?

I’m not telling anyone what to do, nor am I encouraging fear and panic. I wholeheartedly believe that calmness and positivity are the two things which are going to see us through this. I’m also not criticising or judging anyone for their decisions. The situation is an exponentially everchanging one, meaning people’s attitudes won’t necessarily adjust at the same pace. I appreciate that what we’re being asked to do is create a complete new set of rules and foundations about what is moral and socially acceptable, and this will not come overnight or easily. 

However, in the politest and kindest way I can, I ask everyone to please listen to and trust the experts by taking government advice seriously – social isolation in light of symptoms, and the practise of effective social distancing otherwise. If only a fraction of us are doing this, the results will be minimal. For the biggest difference to be seen, and to best help the NHS cope with this outbreak, unity is needed – everyone making changes, all together. 

Information and advice regarding Covid can feel quite overwhelming and confusing, so here is a link I’ve found really useful to answer any health related questions: https://stopthespread.info 

Tasha Ratti,

4th Year Medical Student, University of Leeds

 

 

 

 

 

All illustrations in this article are by Mona Chalabi. Instagram: @monachalabi Website: https://monachalabi.com/projects/data-visualisation/#covid-19