Abstract
I am writing this podium on 19 March 2020 with the coronavirus knocking on the door of households throughout the UK. By the hour, people are becoming sick and will be dying over the following week or so in rapidly increasing numbers. While the UK epidemic is focused in London and the south east, it is steadily moving across the country with the Italian ski-going areas seemingly most affected, including presumably medics and their families. Yesterday, the total of deaths had reached 104 and was doubling every couple of days. By the time you read this, it will almost certainly be in the tens of thousands unless the about turn by government and its advisers can achieve the ‘suppression’ that is now its goal. Now is not the time for recriminations; there will be plenty of time for that, when we emerge from the other end, perhaps in 2021, chastened and, one hopes, wiser.
So despite the temptation to do so, this piece will not be a finger-pointing one, although it is important to capture the main elements that will be forensically examined later:
The impact of 10 years of austerity on the morale, staffing, capacity and resilience of Public Health and the NHS. The failure of the Prime Minister to convene and chair COBRA in a timely way with the fallout in terms of looking ahead, day by day, instead of driving looking in the rear-view mirror using only a flawed academic model. The consequent failure to appreciate the likely trajectory of the epidemic, to follow WHO advice to ‘Test, Test and Test’, to contact trace ruthlessly and contain the virus before it could take hold and penetrate every nook and cranny of vulnerable populations. The failure to look round corners, to follow emergent best practice from elsewhere, the failure to secure sufficient testing and ventilator equipment until it was too late. Perhaps most important of all, falling into the trap of taking a London and narrow ‘scientistic’-centric approach that ignored the lessons of the 2014 Ebola outbreak in West Africa that should have taught us that technology and medicine alone are insufficient without open communications and a fully engaged public as equal partners.
So where does that leave us, with so many dead and so much damage to the economic fabric of the country, political and professional reputations in tatters, and facing a long, hard road of recovery equivalent to that following Hitler’s war of 1939–1945?
At this stage of the pandemic, we have still to reach its peak; the NHS will have long ceased to cope with the sheer numbers of seriously ill and dying, so many will have had to be cared for and to have died at home in the absence of professional care.
Every part of our daily lives will by now have been challenged, but hopefully we will have risen to the task; around the country, neighbourhoods and communities have come together in a war against the common enemy of coronavirus and we will come out the other side, hopefully more united than in many years, with a new attitude, a new politics and a new everyday living. Nothing will be the same again. The next few years may come to resemble those post-war years when a cross-party political consensus laid the foundations of investment in personal and social economic growth and wellbeing; a real levelling up.
Historians of the future are likely to regard this global crisis as marking the end of an era and the beginning of a new one in which the new technologies will take centre stage. There will surely be a total transformation of our daily and working lives, of study and travel, and of the way we practise medicine and other crafts as we totally re-base our attitude to the meaning of life in the age of global threats to public health, of gross inequalities, of frivolous international travel, of the Internet and social media. As I write, we are still only entering this awful crisis, but let us keep our heads high, our minds clear and commit our craft to work for the common good.