Reflections – In the Eye of the Hurricane
by Ahmed El-Mansouri
Today I sat with a colleague at lunch. Inevitably, the topic of Covid-19 reared its head.
He fell into the camp of people who had flourished in the eye of the storm. ‘Every day I cook a new type of cuisine! I ask my son what he wants then I look up the recipe online, and off I go!’
This was followed by pictures of the DIY bar he was constructing in his garden. A task that he pointed out he would not have time to perform without the imposed lockdown. Without it, his week would have consisted of working his normal shift patterns, visiting several family members, work socials, seeing various friends’ groups, birthdays, engagement parties – the list goes on.
It was at this moment that the realisation hit. Those are all things that I hadn’t had to do either. As a result, I have been more on top of my exercise; my house is cleaner and tidier. I’m up to date with my work and personal projects. I have not felt rushed, like there is not enough time to just . . . live. I certainly wouldn’t have had the time to sit and write my thoughts down.
Isolation hasn’t just expanded my mental space. When I do venture outside the space looks bigger too. No litter, no sad, tired-looking people sat in cars 2cm apart in metal queues.
It is not all good news. I miss my friends and family; seeing them over a webcam is not the same. I appreciate that there is a whole other camp of people who haven’t found themselves more productive or calmer but rather trapped in their own home and very much alone. At the time of writing this over 250,000 people around the world have lost their lives, including many of my colleagues in healthcare, taken too early from their loved ones.
I am a junior doctor. Within medicine, reflective practice is a core value and I have come to realise that although difficult and often tedious, it is essential to growth. From every disaster, there comes learning. Science gave us the warning that this was coming, but without knowing when it would arrive and in the face of so many other global challenges, governments failed to prepare. National health security is fundamentally weak globally according to the 2019 Global Health Security Index, a report written by experts from Johns Hopkins and the Economist Intelligence Unit. This is despite experts having clearly documented in the literature that the biggest risk to Public Health is not nuclear missiles, it’s a global pandemic. Following an evidence basis is key to ensuring that the decisions being made are the most valid and reliable they can be. Governments are not immune to this practice. If anything, they have a greater responsibility than many.
Here in the UK, the Science and Technology Committee have published a few concerns. For example, only 28 of the 120 papers used to inform the Government’s actions against Covid19 have been made public. Public Health England has been far from transparent about the UK’s ‘inadequate testing capacity’ throughout the pandemic. Not only have we failed nationally to prepare, but there has been a failure, to be honest and transparent with the public with what is being done. In many ways, we were lucky with this pandemic, and it could have been a lot deadlier. Would our Government be ready to do better if the next one was? (1)
Not only were we not prepared as a country, but we were not prepared as individuals to act responsibly. Police in England and Wales have issued more than 14,000 fines for alleged breaches of lockdown laws. If we cannot do what is necessary as individuals, how can we deem the Government responsible for our fate? (2)
We, as individuals, have some reflecting to do. What parts of self-isolation life do we like? What have we learnt about ourselves that we would have never discovered without this very particular set of circumstances? It has become more important than ever to have a healthy relationship with ourselves. As my colleague realised, finding time to do things that we need or want, was low on the priority list before lockdown.
The final issue I want to address is the deafening silence from the world’s media on the elephant in the room. Did you know that 75% of all emerging infectious diseases are zoonotic? That is, they come from animals. One of the most common modes of transmission is through the consumption of animal products, which is how we think the COVID-19 pandemic began. Factory farming and wet markets are prime breeding grounds for these infections. In a 2004 joint consultation of the World Health Organisation (WHO) and the World Organisation for Animal Health found that intensification of farming to meet the increasing demand for animal products is one of the major drivers of zoonotic disease emergence. Without the consumption of animal products, intensified farming and wet markets need not exist.
The pandemic on the horizon is antibiotic resistant bacteria. Worldwide an estimated 73% of all antimicrobial use is in farm animals. Clinicians are desperately avoiding any possibly unnecessary use of these medicines in patients to prevent resistance. In a literature review of published research 72% of 139 studies found a link between antibiotic consumption in animals and resistance in humans. How is it reasonable for us to undermine our efforts in keeping antibiotics usable by pumping animals full of them in order to avoid mass disease breakout within farming environments? (3)
Human ingenuity has afforded us a luxurious lifestyle in the developed world. However, in the face of adversity, we have a responsibility to take a breath. Look back. Learn something. Or risk losing the future.
1.Coronavirus: Ten key lessons the government must learn set out in new report. Sky News. 2020 [cited 9 June 2020] Available from: https://news.sky.com/story/coronavirus-ten-key-lessons-the-government-must-learn-set-out-in-new-report-11990584
2.Police issue 14,000 fines for lockdown breaches [Internet]. BBC News. 2020 [cited 9 June 2020]. Available from: https://www.bbc.com/news/uk-52674192
3.Antibiotic use in farm animals ‘threatens human health’ [Internet]. NHS. 2015 [cited 8 June 2020]. Available from: https://www.nhs.uk/news/medication/antibiotic-use-in-farm-animals-threatens-human-health/
Ahmad El-Mansouri is a foundation year two doctor at University Hospital Southampton. He undertakes research in medical education and is the co-founder of the Wessex Finals Revision Weekend. He is currently working in general medicine as part of the Covid-19 response.