Emerging from the Pandemic, a personal perspective - Dr Ishak Nadeem
Has the existential challenge of COVID-19 about which I wrote in my last article been met and have we emerged from the crisis? What has been the cost of our emergence? Have we learnt any lessons?
Despite our herculean efforts to research, develop and roll out a vaccine programme the world had not seen till the COVID-19 crisis; the lockdowns, some draconian and some less so, and the largest exercise in social engineering- distancing, information/propaganda, masks etc, we paid an inestimably heavy price. We know not what we need to count and what to ignore. Is it only the mortality, morbidity, the hospital admissions, the number of tests carried out, the number of vaccines administered, the cost of developing and administering new treatments? How do we measure the psychological impact on the survivors of the death of their dear ones? What about the psychological impact of the fear, isolation and anxiety caused by the lockdowns? And what about the economic and social impact?
Perhaps it is now time to ponder the wider implications of our rush to respond to the existential challenge of COVID-19.
No doubt the experts will debate for decades, and we will be fed the digested gist of various opinions. Lacking expertise in any of the fields, I can only offer a personal perspective
In March 2020, my elder brother and I were not only separated by distance, he in India and me in UK, but also in our experiences of the pandemic, the rush for vaccinations and the lockdowns.
Two continents, two experiences, two narratives but so different! Similar upbringing, separate lives. One remaining home and the other flying to seek other nests. Faced with a threat we responded with the classical response; freeze or flight because fight was out of the question. We could not fight as we did not know what the enemy was. Fear on the one hand and flight from reality on the other- flight or burying the head in the sand to see if the storm would blow over? Anyway, we stumbled along as did the others guided by the “experts” and the so-called experts on social media. Masked faces keeping a safe distance, rushing to get a rapidly developed vaccine in the hope that we would not catch the crown (Corona). I did catch it. An illness unlike I had in my fairly long life. I slept the sleep of the dead for a week, secluded to a room, shunned by family. I was the fortunate one. I did recover, but! The ensuing months of long fatigue, unable to even walk a slight uphill. Deconditioned by all the rest, my muscles and lungs refused any exertion. Mind over matter, I exhorted myself and chivvied up by my better half, I slowly started going for walks. Questions racing through my mind, even though my steps were tardy. What was the point of the vaccines? I had two doses, yet I got the bug. Maybe, the illness was milder as I had been vaccinated. Later, my wife and two sons also got, all either asymptomatic or slightly ill. Or was it milder because of the change in the strain of virus. We will perhaps never know the answer to this question. On the other side of the world, everyone of my three sibling’s families had COVID-19, except my brother. The psychological responses of each member were unique as one would expect.
Our experiences are no different to the millions of experiences across the world. Fortunately, we did not have to go through the more difficult experiences, and I can only imagine the anguish and suffering of those who were hospitalised and those who are no longer with us. I cannot also feel the pain of the survivors whose near and dear ones lost the fight against the virus.
Our reactions to the stress of COVID-19 are a reflection of our psyche which is moulded by our life experiences. We all brought our prior psychic condition, beliefs and attitudes to the experience of the pandemic and our response will be unique.
Writing in the report on The Kings Fund report “COVID-19 recovery and resilience: what can health and care learn from other disasters?” the authors identified that after past disasters psychological issues present as a pyramid of conditions with around 75% exhibiting transient stress, worry, feeling upset and no disorder, 15-20% presenting with mild anxiety and persistent insomnia, but 3-4 % showing signs of Post-Traumatic Stress Disorder and severe depression. Can we extrapolate these figures to the COVID-19 crisis? My contention is that the proportion in the tip and middle would be significantly more as the figures are derived from acute severe events like earthquakes and other natural disasters, which are both spatially and temporally confined. Humanity has not had an experience of a disaster which was worldwide since the Spanish Flu of 1918 which has lasted over the last two years. Add to that the effect of prolonged lockdowns, the social isolation especially of the elderly and the unsettling effect of a rapidly developed vaccine with no track record to rely on.
In the final analysis, we have been hit by a tsunami of deaths, physical pain, and psychological distress, and scarred by our experiences we are struggling to emerge from the pandemic. The decision to drop the masks, end social distancing and return to normal human interaction taken by some countries is based on the best available evidence, pragmatism of returning to business as usual and realign the wheels of economy which had also been shackled in the lockdowns. The social animal can only be tethered for a finite time and two years is enough time. It is restive to return to its known ways.
The blurb on McKinsey and Company’s website’s featured insights reads “Making the shift to sustainable and inclusive growth and explores insights on the new era of growth- one that doesn’t treat growth and positive impact as opposing forces.”
The Kings Fund report mentioned earlier, presents a picture of a heroic response following an impact of a disaster followed by a honeymoon phase where community cohesion is maximum followed in turn with disillusionment, working through grief and coming to terms and a new beginning, a reconstruction.
What shape does this reconstruction need to take?
The report highlights the following,
“Putting mental health and wellbeing at the forefront of recovery efforts”
“For recovery to be successful …identifying and assessing the level of community needs is essential”.
“Ensuring communities are not left behind”
“Community resilience is key to the process of recovery, but a community won’t be resilient if parts of it are left behind”
So how do we focus on the two lofty goals of sustainable and inclusive growth, and an equitable growth which makes all parts of the community resilient as the big thinkers suggest?
Discussing the Kings Fund report with my brother I asked the question why the honeymoon fades and what can be done to capture and continue some of the heroic efforts and the community cohesion?
Human beings he said, “we come together to fight an enemy, be it nature (think Covid-19), another nation, another group or community, but slide back to behaviours of self-preservation once a threat has receded.” I can see the truth of his assertion.
He counselled to focus on changing myself, which is the only thing possible and was sceptical about the “big thinkers” formulae for recovery. The solutions to a large extent proposed by the west and well to do nations. Haven’t we seen the varied response of nations to the calls for economic sanctions against Russia in the ongoing Ukraine war. Has the west lost its credibility or is it a reflection of national self-interests coming to the fore? It is a combination of the two.
Should we become victims of scepticism, focusing only on self-interest and build boundaries?
We cannot afford the luxury of the above options, as the Covid-19 challenge is by no means the last. We still have “emerging viruses” a term coined in the 1990’s which with the changing climate are predicted to become more of a threat.
Perhaps, each person changing his or her self, will gather sufficient mass, which could become a critical mass setting up a chain reaction. In other words, as the Buddha says “drop by drop is the water pot filled. Likewise, the wise man, gathering it little by little, fills himself with good”
Dr Ishak Nadeem was a GP Partner at Grovelands Medical Centre for 16 years. His career comprises of several chapters, after qualification and post graduate training in India he worked for about 6 years in Saudi Arabia, moving to UK in 1994 he trained to become a General Practitioner. Moving on to senior management he was on the Governing Body of South Reading CCG from 2012 till 2016, the last two years as Chair during which he gained experience of the challenges of commissioning and the demands on NHS. He has since moved on to a full time role as Occupational Physician with TPhealth providing occupational health services to the Atomic Weapons Establishment.
His other passions are photography, poetry and writing. He self published a book of pictures and poems - Rhythm Of Life, in aid of Dingleys Promise, and raised £1000.00.
Further he is the founder chairman of OneNature-CommonWealth CIO which aims to raise funds for projects which help build sustainable communities, protect environment and promote biodiversity throughout the Commonwealth. Visit their website at www.onenaturecommonwealth.org
In the battle against COVID, the biggest threat is transmission from inhaling airborne droplets, not from touching contaminated surfaces. Despite a campaign by the world’s leading aerosol scientists, atmospheric physicists and indoor-air researchers, the WHO was slow to react to that knowledge and lost vital ground. In war, any delay in acting upon intelligence costs lives. Looking beyond COVID, that message needs to land. Indoor air quality must now become a central pillar of global public health policy and air purification a weapon in the arsenal of those who apply that policy.
