I spent the first part of the evening doing triage calls, but then a nurse phoned from St Michael’s, one of the community hospitals I cover out-of-hours. Derrick, in his eighties and recently discharged from the district general to continue his gradual recovery from Covid-19, had taken a sudden downward turn – high fever, vomiting, rapid pulse. His NEWS score – a tool for helping assess how acutely ill someone is – had risen to six. He needed a prompt review. I told her I would be over right away.
I work with a fantastic driver, Shirley, who swiftly gathered the laptop and the controlled drugs, stowing the latter in the safe bolted into the boot of the visiting car. She shut the door and checked her watch. “We’re going to hit the clap,” she said.
I always work Thursday evenings. The out-of-hours base is in a triple-glazed, purpose-built health centre. For the first six weeks of Clap for Carers I didn’t hear a thing. I saw clips on social media later, which were moving, but it felt like it was happening elsewhere, to other people.
In week seven, the weather had warmed considerably and I had the windows open in my consulting room. I shall never forget the din that erupted at eight o’clock: cheering, pans banging, horns and whistles, drums pounding. I couldn’t see a soul – my room looks out on the car park – yet from every direction was coming this sustained, ebullient appreciation from the community living around us.
Shirley and I put on our gloves and masks – social distancing is impossible inside a vehicle – and got in the car. We must have reached the first residential street just as the hour turned. Dozens of people were at their front gates, clapping and banging saucepans; wearing smiles and summer clothing. The visiting car is done out in unmistakable emergency service livery. Every group we approached started to wave and cheer.
I waved back, especially to the kids holding up NHS rainbow pictures. But even though I was on my way to attend a Covid-19 positive patient, I felt embarrassed and a fraud. The people who deserve this outpouring of gratitude are the intensive care nurses, doctors and allied hospital staff who have borne the brunt of the first wave, and been stretched beyond all reasonable endurance, as so powerfully described by Edward Docx in this magazine last week. And the care home staff, defenceless in DIY PPE as coronavirus felled resident after resident in their neglected facilities. And the paramedics, overrun in their first-response role. Their exhaustion and sense of disconnection from the rest of society – where the majority have no direct experience of severe Covid-19, and where lockdown hardships are usually measured on a different, mundane scale – have exacted an enormous toll.
The “moral injuries” – the emotional trauma – sustained by those on the true front line have yet to be reckoned. And for some, there will be no recovery. Again and again throughout the first wave, faces of nurses, carers and doctors killed by Covid-19 have appeared on my social media, so many of them from minority ethnic groups. On many occasions, I have wept for them – strangers to me, but people whose values and vocation I know and understand intimately.
Shirley drove us on towards St Michael’s, passing more and more groups of applauding people. Everyone looked happy. The weather was great, lockdown was being eased, we were well and truly past the peak.
This was the tenth and final Clap for Carers; more corroboration for wider society that the job must have been done. It is right that the Clap has ended: it had become a weekly obligation. It has also provided a cloak that the politicians who were supposed to lead us through this crisis could drape over themselves: solidarity-shouldering sherpas, rather than incompetents whose serial mismanagement has caused the avoidable deaths of tens of thousands.
As we drove past numerous well-wishers, I wondered what they truly know and understand. The government appears content to keep the NHS from being overwhelmed – not to prevent people dying.
The Office for National Statistics estimates that there are still as many as 54,000 new Covid-19 cases in England each week, and easing of lockdown means efforts to suppress the virus further have been judged economically unaffordable. The infection-fatality rate for Covid-19 lies between 0.5 and 1 per cent, which suggests the government considers 270-540 deaths a week a price worth paying to reopen society.
That we have such high infection rates after ten weeks of lockdown is attributable to ministers’ poor decision-making in February and March, which allowed the first wave to climb so high. Few other countries – the US is an obvious exception – have eased lockdown with such rates of new infection.
And we risk even worse. Our testing regime is erratic and disjoined. Track and trace hasn’t even taxied to the runway, let alone taken off. The bonhomie of ministerial announcements – horse racing is coming back! The shielded can now venture out! – conveys the same message: we’re over it.
No fewer than four Sage advisers have broken ranks publicly to voice their disquiet over risks of a second wave, particularly in regions where the R number is hovering around one. Their misgivings have been echoed in statements from the Association of Directors of Public Health and the Royal College of Nursing.
Derrick had done well to survive Covid-19 given his age. He was even sicker by the time I got to him. Urgent bloods confirmed secondary bacterial pneumonia. He went back to the district general, where IV antibiotics have now rescued him from the brink a second time. We may have clapped our last for the carers, but coronavirus has a very long way to run.
This article appears in the 03 Jun 2020 issue of the New Statesman, We can't breathe