I love my job. For ten years I have worked at Public Health England (PHE) and its predecessor, the Health Protection Agency, responding to major public health emergencies including the ebola outbreak and the Novichok poisoning. There is nothing more fascinating than taking scientific advice, converting it into practical action, and encouraging the public to understand and support that action.
Last year I stepped down as the medical director of PHE after concluding that, with an incurable cancer diagnosed two years before, I could no longer do justice to the intensity of work needed during major national incidents such as coronavirus. Never the less I feel privileged to be involved still through an emeritus role and able to help wherever I can as the nation responds to the present crisis.
A week into March I managed to take a long-planned break with my wife in the Canaries. We arrived home, despite disrupted flights, just as Spain was going into lockdown and I was looking forward to rejoining the response effort. The very next day it was announced, based on PHE advice, that older and vulnerable people with diseases such as mine should largely stay at home for 12 weeks and limit any contact with those who do not live in the same household.
The strength of my reaction caught me by surprise – I was deeply upset. I have always considered myself fit and healthy. My way of responding to having an incurable cancer with a much-reduced life expectancy has largely been to keep calm and carry on, to live life as normally as possible including working, staying as physically active and mentally positive as I can, and spending time with those important to me, especially my family.
Suddenly this was no longer possible. I could work but only from home (back then everyone else was still travelling in to work), our children could no longer come to visit and the positive mental mindset took a quick, though mostly temporary, nosedive. None of this was because the cancer had progressed again. Rather it was to lower my risk of getting coronavirus, even though my preference was to continue more normally and accept the increased risk. More than anything I am a trained doctor and I really wanted to play my part in dealing with this pandemic. I wondered what had happened to shared decision making and patient autonomy.
After a few hours of festering, I began to think more rationally. I remembered the pandemic exercises showing that, without social distancing, many more people are infected, the NHS is unable to treat all those who need it and many more patients die as a result. I thought back, too, on a message I had tried to get across in media interviews: that we are all in this together. We all have a part to play and that includes being prepared to comply with advice on social distancing. Clearly this is a time to act collectively.
We do have a stark choice. If we can make social distancing work, we should see the peak of this pandemic in a small number of weeks. We will have supported the NHS, and many fewer lives will be lost. My part in that is to contribute what I can from home, not become another person needing NHS care, possibly with ventilation.
There are some up sides. My use of social media to stay in touch with my family has improved no end as has my ability to work from home. With the phone and internet, I can still use some of my skills as a trained doctor. At a personal level I finally decided to have a procedure that enables me to manage my cancer more at home and avoid some trips to hospital. This has helped to keep my lungs inflated – making me less likely to get complications if I do get Coronavirus – and my ability to exercise is improving again. Saving the time spent getting to work and travelling between meetings is liberating.
It is easier to find the upsides now that most people are working in the same way – I no longer feel singled out as one of the “vulnerable”. I am, of course, really looking forward to the pubs, restaurants and cinemas opening again, to travelling and to many other things getting back to normal. But in the meantime it really is possible to “keep calm and carry on”. And, come what may, I will do my part.
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Contributor: Paul Cosford