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2 April 2020

Will Covid-19 change how people think about their health – and my work as an NHS doctor?

An intensive care doctor on how he learned to accept mortality, and whether coronavirus will shift public attitudes towards healthcare and how it's funded.

By Sam Goodhand

A sunny Saturday in north London: shoppers browse tables laden with organic vegetables and homemade chutneys, while the smell of venison burgers fills the air.

It could be any early spring weekend in the capital. But of course, it’s not a normal weekend, and I wasn’t there.

Many dozens of punters were though, wandering through West Hampstead’s weekly farmers’ market on 28 March – a week after the government’s shutdown – igniting a storm of fierce indignation across social media and news websites.

Twitter’s housebound devotees sent photos viral of the bustling stalls, letting loose at shoppers sacrificing social distancing – and the public’s health, no less – at the altar of premium muesli.

The very same day, the UK’s Covid-19 death toll accelerated by 260 people, six days into a strict policy of “social distancing”.

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As an NHS doctor, it’s clear to me that such devil-may-care behaviour is about more than just consumerism. It is at the core of much of the public’s attitude to funding our health service. We are infallible. Sure, bad stuff happens, particularly with a killer virus around, but only to other people.

Despite our vocal fondness and complete reliance on the NHS for immediate care, public feeling on personally funding it remains lukewarm. Putting party politics aside – a novel concept in the circumstances – the man or woman on the street is non-committal.

A 2017 YouGov poll indicated that only 42 per cent of people would support increasing income tax by just one percent in order to better fund the health service. By late 2019, this had edged up to 53 per cent. A large proportion have no opinion whatsoever.

When the dust of this utter catastrophe finally settles, and the much-publicised curve has completed its long descent from heaven-knows-where, we will see whether views have changed.

Even those falsely comforted by private health insurance, great for a knee op but irrelevant for life-threatening emergencies, may reconsider their own fragile position during the long days hidden from this indiscriminate menace.

As a doctor in an intensive care unit, I witness lives being changed in seconds by misjudgement and misadventure, but – most commonly – innocent misfortune. My own misfortune played out in a Rio de Janeiro hospital in 2010, almost ten years to this month, during a placement as a medical student.  Illnesses I’d studied for the past four years remained very much the preserve of someone else. Patients in their beds remained patients – never me.

But my appendicitis grumbled, and then worsened, and was operated on in routine fashion. Over a two-week period, I spiralled down the vortex of improbable complications, requiring further major surgery and a spell on intensive care with kidney failure, 9,000km from home.

The terrifying experience informed my approach as a doctor to my patients, but also reinforced my acceptance of sickness and mortality.

Now Covid-19 is here, I am fearful like I was in 2010. I’m worried for you, and for myself. I’m scared for people who continue to interact in close proximity to others, more so for those unwittingly infected by those who have chosen to dismiss clear advice. It is clear for all to see: bad stuff can happen to anybody. I’m seeing it already.

Belated or not, the lockdown aims to keep the peaks of our Covid-19 case curve below the dotted-line threshold of NHS capacity. If the curve inflects through this point, thousands of impossible decisions will need to be made. Who will be put on the one remaining ventilator? Who will instead have their hand held by an overworked, helmeted nurse while they slip away in an overflow corridor, their relatives prohibited from visiting?

This isn’t drama or hyperbole, it’s the reality of harrowing reports from Italy, which we are rumoured to be two weeks behind. And it’s not just happening to other people, it’s happening to people just like you.

A fatalistic Blitz spirit is the wrong approach right now. Had 1940s Londoners invited a hail of Nazi bombs upon their neighbourhood every time they went to the shop, they would’ve steadfastly stayed put indoors.

Feelings of infallibility, invulnerability and immortality are human and understandable. The spirit of West Hampstead market, while misguided, lies somewhere in most of us. Over the weeks ahead, all that presumption may be ripped away by Covid-19’s indiscriminate inferno.

From the ashes, we’ll see whether the collective attitude towards funding our health service has been moved. But that’s a discussion for another day. For now, stay home. Because, trust me, it can always be you.