What can we do? The moral dilemma of Covid 19.

An old university friend used to say, “for every action, there is a reaction.” Physicists know this. Philosophers know this. The laws of the natural world and the laws of logic would appear to have more in common than we might initially think. But how far were they used when faced with the huge dilemma of a pandemic  earlier this year?  How far were we able to see that whatever action we took would result in multiple reactions? 

We can turn our criticism on the government and on the scientific advisers and on anyone we choose, and certainly mistakes have been made, but what this pandemic has illustrated is that sometimes in life, there is no right answer, no correct way. Unless we have far greater resources in the NHS, whatever way we choose will privilege some and penalise others. We could allege that in lockdown the government chose to protect its elderly voting base, and to disguise the decimation of the NHS over the last decade. We could also complain that the latest U-turn in opening up society again has privileged those who were sidelined by lockdown – the young, the mentally ill and those who cannot work from home. 

Part of the problem in making decisions around how to use an insufficient pot of money is that  sections of society are seen as the chosen ones and those who do not fall into those categories are seen as being less important.  The Covid 19 pandemic has dramatised the age old debate around rationed care on a much larger scale. Nobody would have wanted patients with coronavirus to go untreated, but in choosing who to protect, who to ask to wait, the subliminal messages around whose life is worth living, and whose is not, seeped into the public consciousness, even if they were not aware of it. Now we see some of those who were not able to access care or support are now suffering, screaming in pain. 

 How far were the choices made back in March about who to protect reflective of the innate but hidden biases that have existed  in the NHS for years? These biases are deeply rooted, and imperceptible to those who enact them; they are part of the cultural warp and weft of the fabric of our healthcare. Individual clinicians are incredibly adept at conducting their work with an equality of regard, using clinical prioritisation over social, economic or age related factors. But when a government orders the very thing that they strive to transcend: the prioritisation of one group over another, it can only send their judgement into disarray. 

We could claim that stopping all other work to be ready for Covid 19 patients was acting on clinical need, but given the high mortality rates of those hospitalised and especially those admitted to ICUs, the salvageability argument complicates the view that Covid was the only illness worth treating.

Healthcare professionals have had a tough time, of that there is no doubt. The fear of being overwhelmed, the scare mongering about mass burial sites in the preparation stages, followed by the grim realities of caring for Covid patients, not to mention the death toll among colleagues and the daily fear of passing the virus onto ones loved ones, mean that they are all functioning now in a hinterland of credulity, physically and emotionally decimated.  As political decisions try to second guess the future, as well as respond to population behaviour, patient demand changes with no warning. If you squeeze the toothpaste tube in the middle, you aren’t sure whether the paste will come out of the top or the broken bottom. Healthcare professionals are not forecasters. They are brilliant at dealing with crises when they happen, but very little if any of their training or work to date involves looking at what might happen if we do this, or that at a population level.  So not only have they been on an intensive rollercoaster for five months, but the rollercoaster has now taken off from its rails and is careering free through the countryside, with apparently nobody at the controls. 

It is so hard when you are in the eye of a storm to see which way it is heading, to ride above it and look down on it, to see the storm free parts of the world. When we are in a storm our human reactions tell us to save ourselves. Our healthcare professionals are also conditioned to save as many others as they can. For that we are so grateful. But if their survival is all that they can focus on because the storm is so aggressive, their escape route blocked and the threats so close and all encompassing, then they cannot see beyond the immediate. 

Covid has brought a storm for all of us. For some of us it has only had a moderate impact; made us work differently, lost us our summer holidays, kept us from the fun things in life, while for others it has been a tornado, a tsunami, destroying everything we hold dear – people, jobs, sanity. 

Only now are we seeing the non obvious impact of this year. We can count the cases, and count the dead, and we do. But who is counting the other tolls? How many people have turned to addictive substances to try to cope? The professional middle classes joke that they will emerge from this as “fat alcoholics,” but what about the people for whom life was already only just manageable some of the time before this hit us? To lose your job, your income, all the ways in which you tried to relieve the mundanity of your life, and to be told that you really don’t matter, and at least you’re  not dead and pull yourself together – the subliminal messages from the media, how would that make you feel? Imagine working 12 hours a day for 8 hours pay, all under threat of redundancy, then seeing the business who employed you fold, wondering how long it will take to get financial help from the state – the average is about 7 weeks you have heard, but you don’t have 7 weeks worth of money for rent and food and bills. You are desperate. You are going mad with worry. Nobody understands or is willing to help. 

What kind of society do we live in? Those who do work are really struggling to cope with the ever shifting demands and the lack of security, whether you’re a doctor wondering  if the GMC are about to descend on you for a decision you made during a manic shift when you were as ever, understaffed, unsupported and twice threatened with a weapon, or whether you are the person in the previous paragraph, trying to play by the rules of society and wondering what society has ever done for you. 

Whichever end of the societal spectrum we inhabit, we are all affected by the collective decisions made on our behalf, yet left to our own devices to cope when things get tough. We may all be in it together but it doesn’t feel like that at times. We are all up against it might be a better caption for the Coronavirus times. 

Whilst we can, to a degree, control our individual exposure to the virus through our own actions – avoiding public transport, wearing masks, limiting our social contact, hand washing etc, we cannot, sadly influence the collective impact of the pandemic, governmental decisions or mob mentality. This year has highlighted more than ever in our lifetime, the need for people to understand the relationship between individual and collective, the idea that we all have  responsibility for ourselves and for each other. Any solution that manages to consider and care for every group in society, not just the old, or the ill or those who work in one sector only, that would be a solution worth having, and worth working together to achieve. Until then we will continue to defend our own, protect ourselves and be increasingly wary of others. What a sad indictment on a so-called civilised society.