HealthEd

A View on the COVID-19 Pandemic in the UK

Osmosis Team
Published on May 2, 2020. Updated on Sep 15, 2020.

With the entire globe facing the COVID-19 crisis, everyone is scrambling to find solutions. In today's COVID-19 Stories from Around the World, Dr. Daniel Afloarei provides his insight into the UK government’s slow-moving and sometimes-questionable response to the pandemic. 

I am reporting from the frontline as a Psychiatry trainee in London. In essence, this is a story of thousands of main characters and of a single under-funded health system set in a country haunted by political uncertainty. However, despite the pungent smell of urgency lingering in the air, there are some silver linings. 

Tom Bodett once said that you need “three things to be truly happy: someone to love, something to do, and something to hope for.” And the British seem to have listened. Their love for the NHS (National Health Service) is abundant, they stocked up on plenty of episodes of Love Island to watch while self-isolating, and—more importantly—they are keeping the dull flame of hope alive even when critical patients flood the shores of the ICU.


COVID-19 by-the-numbers in the UK

By April 4 (my time of writing this), there were over 150,000 tests performed in the UK, 38,150 positive cases, and almost 4000 deaths. London is currently the hardest hit area, and public figures who tested positive include Prime Minister Boris Johnson (age 55) and Prince Charles (71). There were also deaths reported among the hospital staff that treated COVID-19 patients, which is too close to home for comfort.

More updates on the COVID-19 Pandemic from Rishi Desai, MD, MPH, can be found in the Osmosis Coronavirus Pandemic Daily Report.

The response

Since the first domestic case was confirmed on January 31, The British Government has been trying to find the right solution to contain the pandemic. Despite this, the government has been proven to be rather slow to react, and there’s still a lingering feeling that it doesn’t take the threat the kingdom faces seriously enough. This is because, instead of opting for a more aggressive approach like most European countries did, the UK was reluctant to close the borders, ban mass events, or set the country into lockdown because they feared an economic meltdown.

Instead, the Government decided to cap the pandemic via a four-pronged strategy: contain, delay, research, and mitigate


Contain

This initial phase consisted of regulations that provided new powers for doctors and the police to allow them to detain and put into quarantine individuals at risk or suspected of having the virus. It also included public advice on topics such as hand washing, self-isolation, and testing. In reality, the contain phase was mostly talk and little action—and as expected, not very successful. The infection, from a few isolated cases that could be traced back to known overseas sources, spread out like invisible wildfire throughout the country. Subsequently, the Government moved to the second phase: delay.

Here is how to properly wash your hands:

Delay

We entered the "delay" phase on March 12. After authorities had accepted that a major outbreak was inevitable and containing the spread of the virus was no longer sustainable, they decided to try and slow the rate of infections to reduce the strain on the NHS. This could be seen as a U-turn, and it included further public guidance on proper hygiene and social distancing and urging people with characteristic symptoms or risk factors to self isolate for the full duration of their illness. 

Now, keep in mind that this abundance of guidelines were still mere suggestions. Subsequently, the streets and shops remained full, the schools open, and lockdown was considered something of a fairytale or—more appropriately—something out of a cheap Hollywood dystopia. It wasn't until the middle of March that most public spaces were ordered to close without imposing lockdown or closing the country's borders and airports.

Here’s some advice from our colleague, Hilary Acer, on how to take care of your mind and body during self-isolation:


International doctors’ registration with the General Medical Council (GMC) was also facilitated to cover the rather chronic staffing bleeding the NHS is suffering from. And, despite Italy warning us of high mortality rates within this group after adopting a similar measure, the GMC decided to recall retired doctors to help the NHS cope with the pandemic. This decision was—surprise, surprise—highly controversial, given the risk this population is associated with. Unfortunately, Italy’s warnings did come true: Some of our brave doctors did catch the virus and subsequently died.



Another change that affected me personally was Health Education England’s (HEE) decision to stop all medical rotations and to pull junior doctors from non-acute wards and transfer them to acute and COVID-19 wards to cope with the staff shortage. Of course, that’s perfectly understandable, and I made peace with that as a junior doctor. The one thing that actually scares me is the severe lack of personal protective equipment we are facing which, unfortunately, seems to be a universal issue. HEE also decided that final-year medical students have to graduate earlier and be sent to the battlefield before their time.

Research

This phase is not subsequent but rather parallel to the others as research related to coronavirus is underway both in the UK and internationally Teams are currently looking for a vaccine, a targeted treatment, and more knowledge into how the virus unsheathes its deadly weapons.

More on the current COVID-19 infection treatment here:


Mitigate

The United Kingdom will enter the mitigate phase if the transmission of the disease becomes established in the general population. Although it sounds like giving up, it actually means that attempts to trace asymptomatic cases will be scaled down. Instead of testing everyone and their (elderly) mom, testing will be reserved for those with severe symptoms and for those which require hospital admission. The government's focus will also move to more proactive tactics such as economic stimulus packages and other practical means to support the NHS, the economy, and local authorities in dealing with the pandemic and its effects.

To herd or not to herd

Throughout this process, Boris Johnson also caused a riot with his policy of "herd immunity.” Now, herd immunity is usually used when most of the population has been vaccinated against a disease, and they have developed a robust immune reaction that reduces the chances of infection or spreading the virus. However, there seems to have been some ministerial confusion as there's no definitive research on the immune response COVID-19 triggers to back up the policy. Also, to build resistance in the population, a lot of people would need to get the disease—and in the case of COVID-19, the death rate would be insurmountable. To me, this sounds like the government was telling us, “Okay, let some people die as that will help the general population and will save us some money.” And I am not alone in feeling this way as the policy was highly criticised by the public, media, and medical professionals, causing Boris to backtrack. 

Even under current circumstances, the number of predicted deaths is not something that can be overlooked. According to a study by Kings University, CODIV-19 could infect up to 60% of the UK's population, leading to roughly 250,000 deaths. Given the way the infection and mortality rates are increasing, that is likely to be the case. And the matter will only get worse due to Brexit complications and a lack of ventilators. 

Empathy is a bottomless well

To conclude this rant, I feel like the Government’s policy to combat COVID-19 is part scientific and part political, given that Boris Johnson decided to go at it alone and against the (well-established) global trend. But despite this, we—the NHS—are still fighting with all the power we have. The pan-European spirit of solidarity is still alive despite Boris being allergic to all things European, and optimism is still fueling both the frontline and the general population—making me think that there might be a nugget of gold at the end of the tunnel after all.

You can find more information on how you can help us #flattenthecurve and beat the pandemic here:

About Daniel 

Dr. Daniel Afloarei is a Romanian doctor specializing in Psychiatry in the UK and has been part of the Osmosis script writing team for the last 15 months. When he is not on a Psychiatric ward, Daniel is most likely reading books or articles on Psychiatry topics as he is totally and irrevocably in love with this field. Daniel also has a writer's assistant—his cat, Sky, who never leaves his side.



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