We Must Create Breathing Space

Letter to the Guardian (unpublished) dated 15th March 2020

I grimly acknowledge our vulnerability to Covid-19 as described by a fellow NHS consultant to Denis Campbell in today’s Observer. [NHS frontline: One doctor’s story, 15th March 2020]. Incessant defunding and the crippling of community health services mean that nurses and doctors have been functioning in crisis mode day and night for over a decade. Sadly (and in an undeserving reprieve for some), efforts to mitigate this imminent catastrophe must take precedence over answers and accountability.

It is imperative that each clinical specialty mobilises their available resources towards the most serious complications of Coronavirus infection. Care for patients in mine (vascular surgery) is broadly categorised into three groups: (1) ‘elective’ - cannot walk far due to chronic arterial disease, (2) ‘urgent’ - severe arterial narrowings that cause constant pain, and (3) ‘emergent’ - abrupt and total disruption of blood flow. I recommend that we defer the first indefinitely, prioritise the second at consultant discretion on an individual patient basis, and maintain the third as best we can.

Cases of lethal pneumonia from this pandemic will decimate the reserves of NHS respiratory care. Every other department must sharply redefine job roles and redeploy to the need of the hour. We must reallocate operating theatre ventilatory equipment, provide crash-training so that other specialty colleagues can assist the intensive care teams, and reorganise work rotas sensibly to minimise staff morbidity and mortality. Organisational leadership must empower us to do so. There is no more time to lose.