Saturday April 4, 2020

Our messaging on Covid-19 must be balanced

Our response to the coronavirus may well define our modern society. Nihilistic comments and ill-informed tweets cause damage and distress

22nd March, 2020
“Covid-19 is the first pandemic of our generation – and our response to it may well define our modern society and medicine.“

Ring-a-ring o’ roses, a pocket full of posies . . .

Many people will know the supposed origin of this childhood nursery rhyme – plague-riddled London, where notions, potions and self-quarantining were a normal part of society throughout the centuries.

All of us know the next line, but on this occasion, no – we will not all fall down. Most of our parents lived through epidemics of TB, polio, rheumatic fever, measles and diphtheria, all serious illnesses with serious consequences.

Many of us got these diseases as children and lived to tell the tale. I remember the protective panic of my mother during the last polio outbreak in Cork and, as a young child, standing in the long queue snaking around the dispensary in Kinsale to be vaccinated by a lump of sugar.

Covid-19 is the first pandemic of our generation – and our response to it may well define our modern society and medicine. I don’t believe in statements like “we cannot stop this virus”, even if they are aimed at improving public compliance with very necessary measures to reduce the rate of spread.

I prefer the positive “call to arms” approach taken recently by our Taoiseach. It is guaranteed that medicine will stop this virus soon, given that there are a number of antivirals in live clinical trial and at least two vaccines in human-phase testing,

Granted, it will not be soon enough for there to be no deaths or economic disruption. But we will prevail and most people will be minimally affected health-wise, directly at least.

The narrative of Covid-19 in the media is important. Our journalists are probably as naïve of pandemics as I am, but we must carefully measure the effect of content. Nihilism, catastrophising and out-of-context ill-informed tweets are damaging to our children, our older citizens and our health service.

Yes, the number of cases is increasing as we test more and follow the South Korean model of ‘identify and isolate’ to get best results. Yes, we will have deaths – including unexpected ones in younger people – as happens every winter in flu season, and perhaps more so with this virus.

But we will get through this, and our messaging needs to be balanced. Scaring people away from hospital attendance when our normal urgent healthcare needs continue with or without Covid-19 is already causing harm.

Already we have had stroke patients not attending on time for treatment because they were understandably frightened. We have surgeons rationing urgently needed and life-determining surgery.

Our urgent business must always be business as usual. There’s not much point in concentrating every effort on avoiding the illness you don’t have on the grounds it might harm you if you got it, when the illness you do have right now is more dangerous.

It is important to remember that the vast majority of people who get Covid-19 will not get seriously ill, and that the majority of those who fall seriously ill will recover. To our older citizens, I say: take heart. Over 80 per cent of the octogenarians who contract this illness will survive.

More importantly, by following the guidance of the HSE and delaying the spread of this virus, you are giving hospitals the best chance to manage the caseload and give everyone necessary care. Equally important is the fact that you are buying medical science time.

Almost every week we “buy” in this crisis means that we understand more about this virus. Never has so much been learned so quickly by the scientific data analytics of this pandemic.

The national effort we are all undertaking is absolutely crucial and worth it, as every week of delay and flattening of the curve is optimising care and treatment for everyone.

Morale among both public sector and healthcare staff is a significant determining factor in the difficult months ahead. Many a person has dined out on their reputation, but we are fortunate in Ireland to have a still-thriving ethos of vocation and committed healthcare staff who will be there to treat, cure and support patients and their families in a very difficult time.

I am conscious every day at work to ensure we keep the message balanced and supportive to our junior staff and patients. None of us will have seen what is to come, but I am heartened by the fearless professionalism shown to date by our young healthcare staff of all codes as the first suspected cases arrived.

All of us need your support and the support of our employers, because we too are apprehensive about being able to manage and treat everyone to the best of our ability. We are also naturally apprehensive of the risk to ourselves and our families through repeated exposure to this virus.

Proper personal protective equipment, laundered clinical scrubs and showering facilities to change in and out of work clothes are not too much to ask for, surely, before we return to our partners, children or parents?

Much innovation is already being born out this crisis, and one of the legacies of this pandemic will be changed work practices in hospitals as elsewhere, with less hospital footfall and travelling, more remote conferencing and more tele-health.

Another legacy will be the traumatic effect on people through the grief not processed through the loss of our normal and supportive community rituals around the dead. And then there will be the job losses and economic difficulties, which will bring their own health challenges.

The health effects of the last economic crash are all too fresh in my mind. They must not be allowed happen a second time. Every Irish citizen at home and abroad will be needed to do their bit to commemorate, restore and rebuild after this pandemic. That will be the changed Ireland we will need.

Professor Ronan Collins is consultant physician in geriatric and stroke medicine at Tallaght University Hospital in Dublin

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