Let’s be honest about what riding out this wave really means: more pressures on health workers, and lower standards of care
“We tell ourselves stories in order to live,” wrote the late, great Joan Didion. But what if the narratives we compulsively weave end up being the death of us? Another 335 deaths within 28 days of a diagnosis of Covid were recorded on Thursday, even as the pandemic is being dismissed as essentially over by many in the government and media. “Endemicity” is the new virological watchword of 2022, meaning – at least when touted by those opposed to Covid restrictions – the mutation of Sars-CoV-2 into something so mild and weedy it is no more threatening than a common cold.
Yet 335 deaths are an entire jumbo jet’s worth of people, crashing from the sky above. Has it really taken less than two years to become inured to such dizzying daily casualties? Perhaps, if we are honest with ourselves, what herd immunity really means is our newfound capacity to render ourselves emotionally untouched by – immune to – mass loss of life. The departed as no more than a hum of background noise.
Medics do not have that luxury. We witness death close up and viscerally. The rattle of saliva in a larynx, the sheen of sweat on a cheekbone, the pulse so weak it scarcely flickers. Set against our current experience, the most pernicious story of all this January is the emerging narrative – aggressively promoted since Christmas – that the NHS has “coped” with Omicron.
First, Boris Johnson insisted in a televised press conference that no new restrictions were necessary. Although hospitals were “sending out signals saying that they are feeling the pressure hugely”, he claimed, we could nevertheless “ride out” the Omicron wave with nothing more than “a difficult period for our wonderful NHS for the next few weeks”. Next, cabinet ministers waded in to insist that the prime minister had got it spot on. Michael Gove, for example, told BBC Radio 4 last week: “His judgment has been vindicated. He argued publicly that we would be able to get through this with the booster campaign.”
But have we, really, got through it? More than 30 hospitals have declared critical incidents. The army has been drafted in to provide basic bedside care. Pressures on some ambulance services have been so severe that heart attack patients have been told to make their own way to hospital. Critically ill patients have died in their homes, died on the way to hospital, or died while stuck in an ambulance on a hospital forecourt, waiting 10 or 12 hours for a bed inside.
Enduring conditions so manifestly unsafe for patients, multiple frontline staff have risked their jobs to go public. One emergency medicine consultant, Helen Goldrick, spoke for us all when she tweeted: “Never have I seen patients receive such suboptimal care and be at such risk. They are coming to serious harm as are [emergency department] staff who feel overwhelmed, broken, abandoned. This was predictable and preventable.”
The politically convenient story of a plucky NHS being pushed to the brink, yet bravely soldiering on, is built on a false and dangerous binary. Healthcare cannot be neatly categorised into success or failure, coping or not coping. We are overwhelmed by stealth, by degree. The greater the pressures, the lower the standards of care we can provide. We need to be honest about what “riding it out” actually means. Bluntly, not everyone has. This winter, some have died from Covid who needn’t have. Some have died from NHS overcrowding, mistakes and delays who needn’t have. These are avoidable deaths, ones we could have prevented with different choices. What the prime minister announced, in effect, in his press conference was the decision to turn a blind eye to preventable dying – to knowingly sweep it under the carpet.
Is it any wonder that record numbers of staff are quitting the NHS frontline? More than 27,000 people voluntarily resigned from the NHS from July to September last year, the highest number on record. Too often on the wards I see nurses or doctors breaking down in tears. I know colleagues who have seriously contemplated suicide. Burnout, depression and post-Covid PTSD are rife. We are dismissed as crying wolf, blamed for bleating incessantly about exaggerated winter crises. But only someone privileged enough not to know, or have been, an NHS patient this January could possibly pretend the NHS is coping.
In his new book Dirty Work, the American author Eyal Press investigates the phenomenon of “dirty” work – labour that society considers essential, yet ethically compromised. He argues that the essential workers we prefer not to think about – guards in violent offender units, abattoir staff, drone operators inflicting aerial strikes from afar – engage in activities that sustain modern society yet are deliberately concealed from our gaze. It sounds ludicrous to suggest that these activities may have anything in common with those of highly trusted and valued professionals like doctors and nurses. But the connection is stigma, shame and moral injury.
In an overwhelmed NHS, staff are conscripted, whether they like it or not, in the soul-destroying business of delivering substandard care. It feels rotten, corrosive, morally reprehensible. You are forced to see, hear, touch and smell the patients you are certain you are failing. There is no hiding behind weasel words like “coping”. Every shift is an act of survival – or not – for staff and patients alike.
We can keep arguing about how much of the current NHS crisis is due to Omicron, versus the most prolonged funding squeeze in NHS history, but to do so misses the fundamental point. For years now – and long before Covid – the NHS has been quietly imploding, failing more and more patients as the months go by. It may suit the government to gloss over reality, but each of us actively chooses what stories to believe. You may have never witnessed the patients dying on trolleys, in lifts, on the floor, in their own excrement, but please – please – don’t pretend they’re not there.
Rachel Clarke is a palliative care doctor and the author of Breathtaking: Inside the NHS in a Time of Pandemic