On 27 March 2020 we locked down Ireland in an effort to minimize the effects of a virus we knew little or nothing about. We are now emerging from that lockdown changed, wiser and with a lot more to learn.
Our individual experiences over the past few months have left each of us with a myriad of views, thoughts and opinions. As healthcare professionals, the experience has been transformative, challenging, harrowing, and educational.
While each of us has had a unique experience of COVID-19, it is also a shared one. It will be some time before we process what we have just been through. There will forever be a shared bond between the teams that worked together over the first 16 weeks of our battle with the first wave of the COVID-19 Pandemic.
Over the coming months it will be important for us to reflect and talk to each other, and effectively debrief. We should do this for many reasons. Primarily we should do it because out of such conversations will emerge learnings and lessons that will improve how we manage future pandemics, and indeed how we manage other medical conditions. These conversations will also help each of us process what we went through and for those that are traumatized by it, will begin the process of healing and adjusting to the changed medical world we will now work and practice in.
It is hard to know where to start with what I have learnt from the whole experience myself, or indeed what I will take away from it.
I am very proud of everyone I worked with over the last few months. I am proud of how the teams in our hospitals and communities rallied together. The leadership at all levels and the pace at which change happened, how flexible and adaptable people were throughout this was at the same time humbling and inspiring. I learnt more about what ‘selfless sacrifice’ in the workplace is.
When the virus arrived here earlier this year, we had no real idea of what to expect. The uncertainty, fear of the unknown, unsettled calm and expectation in the workplace was palpable. But we all got on with the work at hand. Difficult decisions had to be, and were, quickly made. They were made with the best, albeit limited, evidence available at the time. The evidence changed quickly, the decisions had to change with this evidence, so the relentless pace of change and learning continued. I learned that, hindsight doesn’t help, and how true the statement about how easy it is to be ‘the hurler on the ditch’ is.
Among the learnings to come out of this for me is how my views on ‘cocooning’ have evolved.
From the first time I heard the word used in this context, by our Taoiseach Dr Leo Varadkar in his historic speech that started with ‘This is a St Patrick’s Day like no other...' I was uncomfortable and uncertain about the term. The concept of shielding at risk groups of people, whatever their ages, sat well with me. We were being attacked by a virus and those at risk groups were most likely to suffer the worst of outcomes. Those that were older, if they did get it, were more at risk of increased morbidity and mortality. At the time, I thought I understood the why, the how and the absolute need. 16 weeks later, with the benefit of ‘hindsight’ I see a different side to the story.
In battening down the hatches, in trying to protect those most at risk, and reducing the likelihood of overwhelming our health service, so those that did get sickest would have access to the health care they needed, we saw the emergence of what we coldly call ‘unintended consequences’.
Lockdown continuing for too long runs the risk of flattening the curve while at the same time resulting in poor outcomes in many other areas including isolation, loneliness and confinement, to mention but a few. This, and a report by the Irish Longitudinal Study, appeared in a recent blog on the Irish Gerontological Society website, Isolation, Loneliness and the Value of Exercise in COVID-19 Times.
In those that do self isolate, we are seeing the consequences of isolation, loneliness and deconditioning. We hear of people who were not visited by family, friends or neighbours. We saw the longer term effects of closing respite services, withdrawing home help and redistributing staff and teams from community services to acute hospital services. We also heard of people who died and families who could not grieve normally. Families and friends who could not celebrate the passing of a life of well lived because of the rules and regulations around funerals.
So what is the right balance? Now that we are all better informed than we were 16 weeks ago, do we leave these decisions up to the individual? Is the risk our collective risk or an individual one? Is it a public health decision, for the ‘greater good’ and are individual rights less important in settings of extraordinary times, such as a pandemic?
In life, balance is everything. This pandemic has shone a light on many things for us all. It will change the way we think and act for years to come. If the legacy of this pandemic is to be a positive one, we must be careful not to fall into the trap of being that ‘hurler on the ditch’.
While we must be brave, we must also be pragmatic as we answer the questions dropped on our plate by the COVID-19 pandemic. We must find the way to get the balance of the decision making right. I hope the decisions we all make individually help reduce the likelihood of another COVID surge.
I want to thank all our doctors for the contribution you made to how we worked our way through the first phase of this pandemic - those of you in Ireland and around the world who were on the frontline, risking your own health to save the lives of others, those of you who are training to be specialists and have experienced enormous disruption to normal postgraduate training, those of you who came out of retirement or returned to home countries to help ease the burden on colleagues, those of you with young children who had to juggle childcare and long hours on the frontline, and those of you who kept going in spite of your understandable fear and anxiety.
Thank you for your dedication to your work and your patients. We here at the College we are very proud of the contribution you continue to make.
Dr Diarmuid O’Shea is the Registrar of the Royal College of Physicians of Ireland. On taking up this role in 2014, he stepped down as Vice-President of Education and Professional Development, a role he held for 8 years. He acted as the Masterclass Series Convenor in the RCPI since its inception in 2007. He was National Specialty Director in Geriatric Medicine from 2000 – 2004. He is currently a Consultant Physician in Geriatric and General Medicine in St Vincent’s University Hospital, Dublin and is the current President of The Irish Gerontological Society of Ireland. A UCD medical graduate, he served as Chair of the Irish Committee on Higher Medical Training from 2017 to 2019. He stepped down from his role as Clinical Lead for the National Clinical Programme for Older People in May 2019.