Chronic Emergency

Halfway down the Shambles in York is a shop that closed just before Christmas 2019. Perhaps a victim of an increasingly difficult retail environment, Zatchels ceased trading before the pandemic. However, COVID-19 is almost certainly the reason that this shop has remained sealed and unchanged since its demise. Closing when it did, the window brings a hint of Narnia with its winter decorations and a Christmas that never came. Complete with snowflakes and tinsel it has seen out two summers. In a street which millions normally visit every year the longevity of this winter scene is a small sign of the crisis through which we are living.

The most helpful thing I watched before the start of the COVID-19 pandemic was Chernobyl. The Netflix mini-series is pitch-perfect in its portrayal of an unfolding crisis. Events progress from initial denial, to hastily constructed counter-measures and finally to a realistic assessment and response to the catastrophe. Tragically, like the nuclear accident, it is certain that the consequences of COVID-19 will be with us for years to come. Looking back I’m sure there are many lessons that will be learned and a host of things that would have been done differently with hindsight. In the case of Chernobyl, collateral health consequences and psychological harm were (and are) a significant legacy of the original event – and arguably more damaging than the effects of radiation itself. There has even been the suggestion that relocating residents away from the disaster area to cities such as Kiev caused more deaths and ill health due to pollution compared with the probable outcomes had residents remained in place. It may well transpire that elements of our COVID response likewise caused unintended consequences that outweigh the initial dangers.

There is a human fascination with the consequences of an overwhelming event. Perhaps Pompeii and surrounding cities may be one of the oldest examples of this tendency. These are times of accelerated human analysis and response, when unprecedented actions are taken. It is claimed that the eruption of Vesuvius led to the first attempt at the mass evacuation of a civilian population by a military force for the purpose of rescue from natural disaster. Critical moments can generate unusual thinking and actions, leading in turn to developments which might otherwise have taken decades. I’ve no doubt that the strides made in creating vaccines in 2020 will have speeded up the capacity to design effective pharmaceuticals in the future.

Pompeii – the focus for the launch of a military attempt to evacuate citizens out of the path of disaster

There is little disagreement that a world-changing event such as the pandemic moves through phases. For some time now colleagues in the NHS have characterised this as a ‘chronic emergency’. The immediate response has been made, and now we are living with a high level of daily cases and a steady population of patients in hospitals. The crisis hasn’t ended but we know far more about what we are dealing with and have both vaccines and new forms of authorised treatments. Yet there is little indication that COVID is going away. Despite the high level of vaccination in the UK population we have not entirely halted serious illness, deaths and disruptions to daily life.

The concept of chronic emergency may help explain the high rate of job vacancies in the UK. One report notes that 22% of workers over-50 are planning to bring forward their retirement plans. The unending crisis caused by COVID is sustaining pressures within organisations such as the NHS. Just how long this can continue without staffing issues becoming critical is uncertain. As we drift into the final days of August, with daily cases approaching 40,000, the prospect of schools re-opening; university students re-connecting; and an inevitable turn in the weather, must raise concerns that there is yet another mountain to climb. Just how many summits must be reached before the chronic emergency degrades to a manageable pressure is unknown. Even this uncertainty is a stress on staff who see and experience the impact of the pandemic, not as a set of figures, but as lives ended or changed forever.

“our previously world-beating health service is at risk of moving to the middle of the pack”

Siva Anandaciva, the chief analyst at the King’s Fund, The Guardian, 4 /8/2021

At some point there will be an evaluation of how different response to COVID-19 led to different outcomes. It was sad to see in the most recent evaluation of health systems by the Commonwealth Fund that the NHS has slipped from first to fourth. While this is not entirely attributable to the pandemic there can be no doubt that absorbing the care of thousands of patients with COVID-19 has come at a cost to the NHS. Few other countries have placed so much strain on their health resources during the past two years. If the plan is to ‘learn to live’ with the virus we need to provide the health service with the means to carry out its usual care as well as support people with COVID and its consequences.

In many ways the UK is returning to normality at a pace that will surprise many people. Walking round York and visiting a supermarket, it appears that mask wearing is on the wane. The emergency is slipping from public view and becoming focused in hospitals and GP services. This may be fine for the moderately wealthy, fit and well, but the pressures that continue in health and social care will not remain isolated from wider society. Keeping the standards of the NHS at a high level requires funding that will increase the staffing levels needed to cope with normality plus COVID. That’s no small challenge, but without it the medium and long-term consequences may outweigh the original crisis. We forget the lessons of history at our peril.

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