LONDON — Ten days ago, I was asked to see a patient. I’m a respiratory specialist in an intensive-care unit at a hospital in London, so it wasn’t surprising that the patient needed a ventilator. It seemed fairly typical. But the patient turned out to have the coronavirus — our hospital’s first case and one of nearly 2,000 people who have so far tested positive in Britain. I hadn’t worn a mask. Soon I developed a cough.
Though I experienced neither fever nor breathlessness, I was told to self-isolate for 14 days. That’s where I am now, in self-isolation. And I’m not the only one from my hospital. After just one patient with Covid-19, a quarter of our junior staff are off with coughs and sniffles we would normally work through. A single case of the coronavirus has wreaked havoc in our hospital.
It’s a microcosm of what may come. Britain has fewer intensive-care beds than most other European countries. Occupancy rates are high, and there’s a daily struggle to discharge enough people to make space for new patients. Even when a bed is available, we do not have the nurses to staff it. A decade of cuts and underfunding has left us dangerously exposed. This is the perpetual winter of the N.H.S.
For the past week I have been watching from the sidelines. Watching while my colleagues gear up for the long road ahead, resting when they can, shoring up procedures for managing infected patients, training one another, and making plans for illness and ways to isolate themselves from their families. Watching while plans are made to cancel nonemergency care and move staff members to the front line.
It’s all hands on deck. Rotations to new departments and hospitals have been canceled: I will stay on in intensive care, and doctors in other departments will come join me on the front line. My plans to work part-time have gone out of the window. But this is my vocation — we are never not doctors. When we are called upon to step up, there is only one answer.
As people with the coronavirus flood our corridors, hospitals will be pushed to the breaking point. Britain is a rich country and may fare better than others. But the N.H.S. is creaking at the seams after years of underfunding. A decade of cuts by successive Conservative governments has stripped the service of resources. Staff morale is low and retention is poor. We are already working at capacity.
When our hospitals are overwhelmed and we have to decide how to allocate scarce resources, how do we choose whom to ventilate and whom not to? Italy is nearly at that point, and its health service has many more intensive-care beds per person than Britain’s. Will I have to tell someone we can’t treat a loved one because we’re out of ventilators, oxygen, tubes, masks, hospitals, staff? Will we then impose an age limit, as some hospitals in Italy are considering, or will some notion of “deservingness” come into play?
The government’s strategy centers on flattening the peak of the epidemic while ensuring the public doesn’t give up on self-isolation at just the wrong moment and head outside into the eye of the storm. So unlike some other countries, we are not yet in full shutdown. After a week of cabin fever, I can understand not wanting to enforce isolation sooner than necessary.
But I worry about how we know where we are on the epidemic curve. Have we tested enough people? What if lockdown comes too late? Will we be overwhelmed too soon? Across the N.H.S. this winter there have been patients in corridors and canceled surgeries. How many people will die because we’ve been working on the brink of collapse for too long?
I am not an epidemiologist. I do not pretend to know the right strategy. But if Britain experiences anything like what we’ve seen elsewhere, we’re on our way to tragedy.
What’s certain is that with 100,000 job vacancies already, the N.H.S. will not survive this crisis without protecting and respecting its staff. In 2018, two-thirds of doctors in their second year of training chose not to pursue specialty jobs. We are being asked to do more with little compensation while colleagues are hung out to dry because the system failed them. To add insult to injury, we have been provided with out-of-date masks with which to protect ourselves.
We already know that our counterparts in Italy, China and elsewhere have given their lives to the vocation they chose. For years, health care workers have been raising the alarm that the N.H.S. is in crisis — calling on the government for better funding for our hospitals and better working conditions for ourselves.
As the coronavirus crisis intensifies, we must be given the means to protect ourselves and our patients, particularly those most vulnerable. We deserve transparency. We demand honesty. Without that, I don’t know how many people will stick around after this is all over.
And right now, it feels like we’re heading into the abyss.
Jessica Potter (@DrJessPotter) is a respiratory specialist doctor working in London and a member of EveryDoctor, an organization that campaigns for the working rights of doctors.
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