Keeping Calm and Carrying on with COVID-19: challenges 1 year later

Two weeks ago, two of my elderly patients died of natural causes not related to COVID. Each of them died peacefully at home. Another patient died unexpectedly in hospital after admission for a non COVID illness. Due to the current stop on burial orders in Jamaica, the families of these patients cannot bury or cremate their loved ones and observe the rituals that allow us to cope with the grief of losing a loved one.

In this past week, one of my elderly diabetic patients developed leg ulcers and her blood sugar has sky-rocketed. This is something that ideally should be managed in hospital. Knowing of the bed shortage in the hospitals, we are trying to manage this at home. This means her daughter who lives in St Catherine and works in Kingston has to stop by her mother mornings and evenings before and after work to dress the ulcers and check blood sugars. Yet another elderly patient with end stage heart failure has clearly stated that she wants to draw her last breath at home. She may need oxygen therapy at home to make her last days comfortable. Given the current oxygen shortage, we may not be able to provide this for her when she needs it.

I have another elderly patient who is as we say in Jamaica “travelling”. Her sons who live abroad are hoping that they can see and touch her one last time before she takes her final breath. Travel restrictions related to COVID may rob them of that opportunity. Yet another patient in a nursing home may be on a similar journey and because of COVID protocols her loved ones cannot say their goodbyes in a way that makes this loss easier to bear.

None of these patients have COVID, yet they and their families are being deeply impacted by the havoc that the pandemic has wrought on our health care situation. We all listened with horror to the account of the teenager who died as a result of untreated asthma, even though she was taken to the hospital. We should all realise that given the current situation, any one of us could find ourselves with a non COVID medical emergency for which we cannot get treatment because our health care system’s capacity to cope has been exceeded. At this point there is no need to differentiate between public and private health facilities because all the hospitals are overwhelmed.

I am mentally, physically and emotionally drained. Since the Prime Minister’s last major press briefing on February 28, 2021, providing health care has become a nightmare for me, and I am only a general practitioner in private practice, looking after mostly non-COVID patients. Imagine the exhaustion of my colleagues who work in the hospitals and health centres that have now burst at the seams. How much longer can the health care workers hold strain?

At the time of the Prime Minister’s press briefing, our COVID positivity rate was about 30%. That means roughly 1 in 3 people tested had COVID. Three weeks later the rate is now closer to 40%. This means about 2 out of every 5 people tested have COVID. The stop on the burial orders and the increase in curfew hours which the Prime Minister announced do not seem to have reduced the numbers. In spite of appeals to maintain social distancing and mask, we hear daily of social gatherings being held after curfew hours. Vaccinations began on March 10, 2021, but that first dose takes 2 weeks before it offers protection, so none of us who got vaccinated since March 10, 2021 are protected yet. A field hospital with about 40 beds is to be opened shortly in St Catherine, but our Chief Medical Officer reports that admissions are on the order of 50 per day…and there are a staggering number of nurses and doctors who are out of service due to quarantine or isolation. What more is it going to take for us to do something different to decrease the rate at which this virus is spreading in our country?

We seem to be currently on a path of expecting the government and the health care workers to continue to provide care for COVID and non COVID illnesses even as many members of the general population continue to ignore the pleas to observe the infection control measures. Countries with far greater resources than ours could not prevent a collapse of their health services by simply providing more beds, ventilators and oxygen. The government and the health care workers alone cannot solve this problem. All of us have to do our part to flatten the curve, or ultimately all of us will pay the price.

It is up to each and every one of us to behave responsibly and to look after each other. Our government has not mandated a lock-down seemingly because of the need to balance livelihood and lives. But with hospitals running out of beds and oxygen, and the dwindling capacity to provide care even for non COVID patients, it seems the time has come to consider whether we are sacrificing lives for livelihoods. Halting the issuing of burial orders does not stop people from dying. Mandating curfew does not seem to stop the social gatherings that must surely be contributing to increasing number of COVID-19 cases.

Hopefully the government will appreciate these truths eventually. In the meantime, there is nothing to stop us as private citizens, organisations, companies and businesses from voluntarily engaging in a lock-down to save lives which are a prerequisite for livelihoods. For the next 4 weeks, if all of us stayed home as much as possible , consistently wore masks, and practised both hand hygiene and physical distancing, we could create a little breathing space for the overcrowded hospitals and the exhausted health care workers. We could help to redirect our current path into one that will actually help to flatten the curve. Even if we are reluctant to sacrifice individual freedom for the good of the community, perhaps we might consider participating in a voluntary lock-down as an act of enlightened self interest to preserve our own individual access to a working health care system when we need it.

One thought on “Keeping Calm and Carrying on with COVID-19: challenges 1 year later

  1. It’s with great pleasure that I’ve come across your blog, and I’ve read a few entries. I myself am a medical doctor but only recently graduated (class of 2019.. so I’m completing my senior house officer year and will become a medical officer in July). Like you I also attended the great Campion College & I love the values they instilled in me too. To always strive to be greater like the Magi, never settling for mediocrity and to live a life of service. My blog is mostly related to local travel because quenching my thirst for adventure has saved me in more ways than one. I seldom post about medicine. Anyway, best wishes on your journey and with your practice of medicine. I look forward to future posts.

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