As the death toll passes 100,000, it is a good time to reflect on and remember those who have fallen trying to protect us
These past few weeks have not been particularly good for any of us.
January is rarely an easy month for doctors. The nights are long and we find ourselves wading through winter pressures which seem to come earlier and last longer every year.
This January, which is marked with some deeply upsetting moments for all of us, will undoubtedly stand out in my mind forever. In addition to seeing ourselves pass the sobering figure of 100,000 deaths, we have also, sadly, seen the number of colleagues falling sick and dying from this virus grow too.
It is a recognized matter of fact in the UK that healthcare workers are at higher risk of being infected and being hospitalized with COVID-19. The BMJ now keeps a memorial page for colleagues who have died – individual news articles which keep a tally are sadly too quickly out of date.
It has been touching to read tributes that reflect not just the grief of colleagues who knew these doctors, but which demonstrate one of the most important things we can do – to remember.
The act of remembrance is not just about recollection – it is also about reflection, whether this is on the deaths of our colleagues or if their deaths could have been prevented. I believe they could have been, and that preventing future deaths ought to be our lasting tribute to them.
Faced with the relentless streams of patients with COVID-19 we might start to feel that the personal risk of infection is inevitable. We know, however, that in ICU where higher grades of PPE (personal protective equipment) are used, rates of infection among staff are around half of those in other areas like acute medicine where (unless in proximity to a limited list of AGPs [aerosol generating procedures]) standards for PPE are lower.
The list of AGPs does not include chest compressions or being near coughing, spluttering and gasping patients. PPE has been identified by the British Occupational Hygiene Society as an important determinant of the risk of infection and they have called for standards of PPE to be upgraded, in line with the ‘precautionary principle’.
The precautionary principle suggests that where we find ourselves in uncertain circumstances where there is a potential risk, we should err on the side of caution without waiting for the evidence which confirms danger. Imagine if we had applied this principle to cigarette smoking, asbestos, and blood transfusion when questions were first raised.
Despite this, all four UK Governments and chief medical officers have so far refused to provide greater levels of protection. They have adopted the exact opposite approach where they say that they have not yet seen enough evidence to show current levels of PPE provision are inadequate.
This is unfortunately the approach we applied to cigarette smoking, asbestos, and to what became the tainted blood scandal. So far, it seems that the experiences of our colleagues who become infected and suffer a long-term illness, disability, and even death are not evidenced enough.
Some trusts in England, however, have heard enough and have taken steps to protect their staff – in line with a call by the BMA last month to enhance PPE. There is no doubt that this has been the result of leadership within these trusts and action from staff – as well as BMA representatives – who work there.
All employers must now do the same and take other necessary actions including ensuring adequate ventilation. It appears that up to 10% of those infected will develop long-COVID, with many experiencing illnesses which persist for months or longer. This can include respiratory dysfunction and myocarditis. We know that no vaccine is 100 percent effective so ensuring we protect staff from infection by other means remains just as important.
1 February marked the ancient pre-Christian Celtic tradition of Brigid’s day which traditionally signifies the coming of spring.
The lighting of flames would represent the growing power of the sun over darkness, as the days grew longer. So, as we remember colleagues who have passed let us light a flame that sends a clear message.
Our infection with this virus is not inevitable and is not acceptable. We have given everything, and protection is the least we should expect in return.