What does the experience of Covid-19 have to teach us?

Being ready for the next pandemic goes beyond science and requires looking at societal issues

One year on from the beginning of the Covid-19 pandemic, what have we learned? It would be easy to focus on the gloomy answer to this question. But before I do, let’s acknowledge some of the positive aspects of the last year.
As a long-time sceptic of the scope of practice possible using telemedicine, I’ve been amazed at how readily doctors and patients have taken to this form of consultation.

Not being able to lay a hand on a patient remains a problem for me. However, it has to be said that I’m in a minority. Patients in particular have adapted readily to the undoubted convenience of audiovisual interaction with their doctors. It has been so successful that the value of telemedicine must be one of the biggest learning points in healthcare from the pandemic. I cannot see its utility being abandoned in the new “normal” world.

Other positives include a reduction in road traffic accidents as fewer people are on the roads during lockdown. And the environmental benefits in terms of pollution levels dropping across the world are striking. On the debit side of the equation, some of our knee jerk reactions to the new coronavirus were laughable: Where did the insatiable desire to hoard toilet paper come from? For what seemed at the time to be primarily a respiratory virus, with no obvious gastrointestinal involvement, what were we thinking?

Apparently it can be explained by a concept called “social proof”. We are influenced by each other. Show us images of selfish lockdown behaviour and we are more likely to be selfish; show us noble altruists and we aspire to be like them. But strict rules around social distancing tend to be blunt instruments, when a lighter touch may well have caused less collateral damage. Tim Harford, The Financial Times ‘Undercover Economist’, said we may have done better with altruism, social pressure and clear guidance.

“Japan’s advice – to avoid the ‘three Cs’ of closed spaces, crowded places and close contact – is far more memorable to me than whatever strange combination of households, settings and exemptions the authorities… are currently allowing,” he wrote.

Some public reactions to Covid-19 surprised experts. Rather than vaccine development being a major hurdle, after watching the reaction to Covid-19, experts say the biggest future challenge will be convincing people to take the steps that are necessary to protect humankind from a threat. Dr Iruka Okeke, a Professor of Pharmaceutical Microbiology at the University of Ibadan in Nigeria, said it has been impossible to make people stay home or wear mask to avoid transmission in most countries.

“When given the choice between skipping a holiday and posing mortal risk to another’s life, sufficient
numbers of people have chosen the latter and we have to presume that they will do it again,” she told Nature Medicine. Clearly, being ready for the next pandemic goes beyond science and requires looking at societal issues also. An effective pandemic response requires a clear, consistent voice and an actionable message. This message needs to be individualised and must evolve over time. Risk communication experts have started looking at the best ways people can manage the flood of information during a pandemic. There’s been an ‘infodemic’ of Covid-19 fake news, and so we need new strategies for sharing reliable information.

Of course, we are nowhere near the end of the pandemic. More lessons will be learned before then. According to Andrew Pollard, the Chief Investigator for the Oxford/Astra Zeneca vaccine, “the end of this pandemic is not the end of this virus, it’s the end of an unsustainable impact on health systems. If we can convert it into something more innocuous, then we will have the end of the pandemic in sight.”

History suggests that pandemics rarely finish in a neat way. Diseases are seldom eradicated and outbreaks of Covid-19 will continue to emerge. It is our collective attitude to the disease that is likely to decide when the pandemic is over.
Harford lays out what he thinks we have learned in the past year: “I’ll remember to trust the competence of the government a little less, to trust mathematical models a bit more and to have some respect for the common sense of ordinary people.”

Rural medicine is an important part of general practice here. Readers may be interested in a virtual “Rural and Remote Medicine” conference run by the Society of Rural Physicians of Canada. It takes place from 22 to 24 April. Northern Ireland GP Declan Fox is involved and for those who would like more information his email is declanfox@hotmail.com