Here we go! Spain and Italy are lifting their lockdowns, at least in part, and there’s an immediate clamour in the British media to do the same. But (1) we are a few weeks behind them on the curve – though ours does seem to be flattening and we have only used 19 beds in the giant Nightingale Hospital in London – and (2) has it occurred to the clamourers that it might be worth waiting to see what happens rather than rush in prematurely and get a horrible rebound?
It seems that the highly imaginative reconfiguration of our existing hospitals, albeit at the expense of closing some services, has kept the lid on ICU capacity. If indeed that is so, how long, I wonder, will it be before the mediafolk start screaming about the ridiculous overprovision, what a waste, all those unused and therefore useless ventilators, why didn’t you start making these wonderful CPAP machines sooner, they are much cheaper, money could have been spent better elsewhere etc? Not long, I suspect.
Come on, mediafolk. At least try to understand that hindsight makes everything clear when it isn’t at the time. What we medics call the retrospectoscope is a highly dangerous instrument.
Perhaps there is one mistake that was made. Perhaps testing in care homes should have begun earlier. The point was made by one of the medical advisors that the management of serious infections such as MRSA has improved dramatically, but even they seem to believe that most of it was hospital acquired. I don’t. Most of that was hospital identified, not acquired. It actually came in from the community (the bacteriologist in my hospital did a study proving this). Likewise in care homes the original introduction must have been from somewhere else in the community. It cannot just have appeared by magic. The numbers of Covid-19 deaths are sad, but pneumonia has always been the old person’s friend; flu epidemics carry off the elderly and infirm; while each case must be taken on its individual merits I believe it may be morally unjustifiable to subject an elderly and infirm person to ICU management when the overall outcome is likely to be an inevitable death anyway. But that applies to all old people who get very sick. As I have written in my book “Mad Medicine” when my 94 year old mother was admitted to hospital with a broken arm following a fall, the surgeons wanted to fix that and also replace her arthritic hip. Part blind, mostly deaf, suffering from a chronic and untreatable urinary infection, doubly incontinent, wishing to die (and having signed an advance directive) one’s only response could be “You cannot be serious”. Not least because she was a retired doctor and knew all the ins and outs.
What has been awful if that old and unsaveable folk have died without their relatives being there. That has now been relaxed; one might say that is the first easing of lockdown, and very humane it is. It would be nice if funeral services could resume, but only as long as those attending understand that there remains a risk. But as I have said repeatedly, just because we can treat something does not inevitably mean that we should.