Sir, – Kathy Sheridan is to be congratulated on her excellent and incisive article “The appeal of hindsight on Covid-19 is that it is risk free” (Opinion & Analysis, March 8th).
Application of the retrospectoscope can lead to unfair recrimination of people placed in situations where decision making took place under the pressure of an event unprecedented in living memory, with little scientific evidence available to them during rapid transmission of a viral pathogen to pandemic proportions.
One of the interesting facets of the recent pandemic is the relative lack of pandemic literature published to date and a tendency to relegate the trauma to the back of the collective consciousness, now that we have returned to normal living. Few in the medical and other healthcare professions will forget the real fear generated by scenes from Italy, a health service with greater capacity than our own. The ominous black cloud of worry, the restless nights, the discussions about makeshift hospitals, ventilator shortages, depleted oxygen supplies, recruitment of those with little experience into areas outside of their competence, as well as a real fear for our own health and possibly life. Those working in emergency medicine, intensive care and anaesthesia were particularly exposed, teams of doctors in training, often reallocated. Many had personal worries about bringing the virus home to infect vulnerable loved ones. Consultant decision makers had to develop an agreed multidisciplinary team approach and protocols to admit a patient needing semi-urgent care or surgery. The risks of the condition progressing had to be balanced against the risks of contracting Covid-19 to that individual, as well as to the entire team, with particular concerns for our team of nurses and care assistants, many of whom are from ethnic groups with a higher risk profile from the Covid-19.
People made their own decisions, not just the Government or public health advisers. Many medical staff spent time speaking to patients over the phone and encouraging them to attend where delays in care could lead to real progression of irreversible conditions. Over many months, even after each lockdown, presentations to emergency departments of patients who had wrongly, if understandably, waited out symptoms at home led to untold grief and loss due to delays, in circumstances where they certainly could have been seen and treated had they decided to come in earlier.
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We are, even yet, seeing the effects of late presentations, some voluntary and not due to Covid-related delays in care. This cannot be laid at the doorstep of those who stepped up and, to the best of their ability but with the paucity of scientific data available to them, made decisions in real time and in the context of our overstretched health system. Decisions that others who watched or criticised from the sideline were unhappy with. We do not see what was prevented because it did not happen. But has anyone forgotten the images of coffin stacked upon coffin in New York’s Hart Island, the overfilled graves in Brazil, or the bodies floating in the river Ganges?
Most certainly we have now learned that there have been effects that were not predicted or taken into account, and the purpose of a useful inquiry would be to examine, without fault or blame, the decisions that were made and how they affected groups such as older people, children, young people and their educational needs, nursing home patients, etc. The involvement of representatives of marginalised groups and those in need of particular care, and advisers on respecting equality and human rights should be included. A more flexible adaptation of the public and private hospital closures to elective work allowing the broader healthcare system to react more quickly to surges in need for bed capacity, while maintaining elective care when capacity exists, would be desirable, as happened in later waves of Covid.
Is it too much to hope that we could set aside the blame culture and examine the handling of the Covid-19 pandemic in this country in a spirit of generosity, learning and open-mindedness so that we can take that learning on into the future for whatever the next threat may be? – Yours, etc,
AOIFE DOYLE,
Consultant
Ophthalmic Surgeon,
Dublin 13.