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TThe raw numbers around Covid-19 are simply incredible considering that it was a disease that hardly anyone had heard of in December 2019. At the time of writing, this year , around 240,000 people in the UK have been admitted to hospital with Covid-19, and more than 70,000 people have had Covid-19 listed as a cause of death on their death certificate.
I started 2020 worried about reports emerging from Wuhan: they appeared to implicate asymptomatic transmission of a respiratory pathogen serious enough to place patients in intensive care units. I am a clinical scholar with specialized training in respiratory medicine and critical care; I also run a research program that focuses on lung inflammation caused by respiratory infections – for me and others what were reported looked like serious problems.
In response to the emergence of Sars-CoV-2, a World Health Organization clinical characterization study was activated on January 17, 2020, in time for the first wave of Covid-19 patients admitted to hospitals. hospitals in England and Wales. This observational study of patients was first established in 2013 to ensure that the necessary infrastructure would be available to learn more about new respiratory infections that spread rapidly when needed. The first confirmed patient with Covid-19 in the UK was reported on January 31, 2020.
By the beginning of February, it was clear that there was a serious problem, and the ICU where I work began to prepare for what might happen. We held our first multidisciplinary meeting to discuss how we would manage the emerging threat, with colleagues from public health, virology, microbiology and others who joined us on February 12. At this point, 10 cases of Sars-CoV-2 had been reported in the UK.
Things moved quickly and March was a hectic month for the UK’s response to the emerging pandemic. There were concerns that the situation would become so dire that the UK would run out of vital equipment such as mechanical ventilators, prompting the government to launch the Ventilator Challenge, to research, approve and manufacture the device from a wide variety of sources. Much has been written about this process, but I’m sure it was necessary – I wouldn’t have agreed to help the effort if I hadn’t.
The month of March also saw the launch of the recovery trial. It was proof of the responsiveness of the UK research system to the pandemic that by March 17 the trial had been designed, received ethical and regulatory approval and was ready to begin recruiting patients. Since then, more than 20,000 people have participated to help us understand which therapies work for hospital patients with Covid-19 – a phenomenal achievement.
In April, we were at the peak of the first wave of the pandemic and intensive care units in many areas were under considerable pressure. As of April 12, there were 3,301 people with Covid-19 requiring mechanical ventilation in the UK. Fortunately, by August, that number had fallen to below 70. However, by the end of October it had again risen above 1000, where it had remained, and currently shows little sign of falling. slow-down. It is clear that Covid-19 is still far from being done with us.
In the fall, data emerged suggesting that what many thought was nearly impossible had been achieved – multiple effective Sars-CoV-2 vaccines had been developed in less than 12 months. December 2020 saw the start of what will be a massive vaccination program in the UK starting with 50 NHS hospitals.
Such a tumultuous and difficult time prompts you to reconsider events and your role in them. One thing in particular I learned this year: Prior to 2020, I had never written a newspaper article, appeared on TV, or even talked to a reporter about my work. I am embarrassed to admit that I did not understand the importance of communicating science to a wider audience. The torrent of noise and misinformation during the pandemic changed my perspective and persuaded me to start trying to explain the issues more clearly. It’s not always easy to understand, but we need to be clear about why the availability of specialist healthcare staff (not beds) is important, and why we need both therapies and vaccines for Covid-19 is accessible to all, among many other problems.
This year has also reinforced my vision that building resilience in healthcare globally, nationally and locally requires long-term commitment and planning. For the NHS, this means we need to make sure we have the right specialist staff, equipment and other infrastructure to deal with any storms we may face – with the coronavirus and beyond. No one can honestly say that the UK sailed into 2020 without having to make some tough choices and compromises that we would have preferred not to face – the impact of the pandemic on the provision of healthcare to people with non-Covid diseases has been, and continues to be, important. On many occasions this year, clinicians, patients, families, policymakers and politicians have all had to choose the less bad option under difficult circumstances. No one has been immune to this tension.
Most of this year’s “wins” come from preparation and collaboration. An example of this is the astonishing contribution of the National Institute for Health Research (NIHR) to the UK pandemic response. It allowed us to quickly discover Covid-19 by supporting recruitment in observational studies such as Isaric-4C (the WHO Covid-19 study described above), React (a home screening study of Covid-19) and GenoMICC (a global study initiative to understand critical disease) and has offered thousands of people the opportunity to participate in clinical trials of therapies and vaccines. This work has helped change clinical practice around the world by carrying out important research.
As we head into 2021, I again feel worried about what the New Year might hold for us. However, I am convinced that preparation, flexibility and a commitment to collaboration are what is needed to weather the storms we may face in the months and years to come.
• Dr Charlotte Summers is Senior Lecturer in Critical Care Medicine at the University of Cambridge
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