Like many of you my life is now fully consumed by single-stranded RNA ne’er-do-well viruses. I am writing this the night before returning to what I expect to be pandemonium in my place of work—an intensive care unit in Canada. I have an unusual sense of anxiety, but not about my personal health, or the dedication of so many of my incredible colleagues. Instead, I fear that it is not just coronavirus that is spreading. We also seem to have a growing pandemic of dysfunction, or what has been coined an “infodemic.” It’s time we also flattened that curve.
After a brief pity party, I have decided that I am simply choosing to get through this; after all, there is no reasonable alternative. Excuse me if I come across like Poly-Anna in a facemask, but we can choose to grow or we can choose to fail. If we can’t change the situation then we can at least change ourselves. If we believe those shmaltzy tea-towel quotes and bumper sticker exhortations about “growth-through-challenge” then here’s our chance. While others are in-line bulk-buying toilet roll, we should take a deep breath (albeit not literally) and work out how to keep calm and carry on. For a generation that has grown up with peace, this may be one of the first times that many have truly been tested.
I was recently reminded that William Shakespeare wrote King Lear during one of London’s plague quarantines. Hyperbole and eye-rolling not-withstanding, this is a similar opportunity for healthcare professionals (and all previously unheralded people) to leave our mark. Sure, these are genuinely scary times, but we can remind others that health and service matters most. Moreover, we have a chance to ponder whether society (a too-often vacuous buzzword) is as resilient (another too-often vacuous buzzword) as we would like to believe.
A pandemic, or any disaster, highlights that healthcare is more than just a machine that helps ill people get better. Big-H healthcare (and big-C community) is an instrument of social cohesion, distributive justice, and even economic viability. This is forgotten during times of relative peace, as well as during contract negotiations. These existential threats are also an opportunity to remind ourselves that we are professionals who step up, and that this job is meaningful. It is a chance to remember that the team matters, not just our personal success. Moreover, “society” should be defined by how it treats (literally and figuratively) the vulnerable, not just the privileged.
This pandemic is also offering up free lessons in psychology, sociology, and economics. Given that many universities have closed we might have more bandwidth to listen. I fear that this virus could kill as many through our response (or lack thereof) as through organ failure. Moreover, I fear many more will die from financial bankruptcy as through tissue hypoxemia, and that social isolation is more deadly than we realize. For most of us with bank balances and secure jobs, it’s going to be disruptive and grounding (quite literally, given all of the flight cancellations) but not deadly. Plenty of people may even be looking forward to a few weeks of Netflix, and fewer questions asked. However, when it comes to pandemics, safety nets are like immune systems: you better have one or you’re in trouble.
So, what about those without healthcare insurance, without savings, without secure jobs, or those with zero-hours contracts? I do have sympathy for famous folks on home quarantine, and for my family, colleagues and neighbours if they develop symptoms; however, I wish I understood more about those living from pay cheque to pay cheque and out of view. Once again, with covid-19, it will be the financially frail as well as the medically vulnerable who feel the brunt. One hundred and fifty 50 years after Darwin wrote his seminal work, we are still living with survival of the richest and luckiest.
So, what of our current response? Well let’s get to the heart of the matter, or at least to its backside. When it comes to bulk buying toilet paper, it seems bonkers (if you are charitable), selfish (if you are not), or reprehensible (if you hear of people reselling rolls at inflated prices). Perhaps, the toilet-paper phenomenon is best understood by people wanting to feel control, and this is one, albeit misdirected, way to do so. Regardless, it has made me think about how irrational, judgemental, and frankly prehistoric all of us hominids are: me, most definitely included. After all, my first thought was to laugh at others’ stupidity, followed quickly by patronizing remarks. A few days later, I decided I better stock up on a few rolls: you know, just in case.
While discussing irrationality, I fear that too many people assume that viral concerns will be done and dusted in a few months, never to be heard of again. Instead, we need to remain vigilant and agile. The threat of covid-19 will presumably ease, but these viruses are becoming like buses: Not only because of their regularity, but because of the damage they do when we don’t see them coming. It would be better to assume that members of this dysfunctional family, Coronaviridae, will be an ongoing source of anxiogenesis and disruption: A potential ongoing “new normal,” whether we like it or not.
For healthcare professionals, we will be increasingly challenged at work and those holidays that we call conferences may be increasingly cancelled; but we will manage. In contrast, for the older, poorer, frailer, and already isolated these viruses are a genuine and ongoing threat. Writing this has helped me calm my anxiety, but also understand its myriad causes. I’m worried about my profession’s present and future, and I worry about the economy but if I’m honest—and life is too precious not to be—I’m ashamed of my initial response. I wasted too much time focusing on what it meant to me, compared to others. No amount of toilet paper can make up for that, but I am happy to share
Peter Brindley, Professor of Critical Care Medicine, Medical Ethics, Anesthesiology at University of Alberta, Canada.
Competing interests: None declared.