TThe raw numbers around Covid-19 are simply incredible when you consider that it was a disease that hardly anyone had heard of in December 2019. At the time of writing, this year some 240,000 people are in the UK have been admitted to hospital. with Covid-19, and more than 70,000 people have included Covid-19 as a cause of death in their death certificate.
I started 2020 anxious about the reports emerging from Wuhan: They seemed to involve asymptomatic transmission of a respiratory pathogen that was severe enough to land patients in intensive care units. I am a clinical academic with specialized training in respiratory and intensive care medicine; I also run a research program that focuses on lung inflammation that causes respiratory infections; to me and others, what was reported seemed like a serious problem.
In response to the emergence of Sars-CoV-2, a clinical characterization from the World Health Organization study was activated on January 17, 2020, in time for the first wave of Covid-19 patients admitted to hospitals in England and Wales. This observational patient study was first established in 2013 to ensure that the necessary infrastructure was available to learn about the rapid spread of new respiratory infections when needed. The first confirmed Covid-19 patient in the UK was reported on January 31, 2020.
In early February, it was clear that there was a serious problem, and the ICU where I work began to prepare for whatever might arise. We held our first multidisciplinary meeting to discuss how we would handle the emerging threat, with colleagues from public health, virology, microbiology and others who joined us on February 12. In this point 10 cases of Sars-CoV-2 had been reported in the UK.
Things progressed rapidly and March was a hectic month for the UK’s response to the emerging pandemic. There were concerns that the situation could get so bad that the UK would be left without vital equipment such as mechanical fans, prompting the government to launch Fan challenge, to find, approve, and manufacture the apparatus from a wide variety of sources. Much has been written about this process, but I am sure it was necessary; I wouldn’t have agreed to help out if it wasn’t.
March also saw the launch of the Recovery test. It is a testament to 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 start recruiting patients. Since then, more than 20,000 people have participated to help us understand what therapies work for hospitalized patients with Covid-19, a phenomenal achievement.
In April we were at the peak of wave one of the pandemic, and ICUs in many areas were under significant stress. 12th April, there were 3,301 people with Covid-19 requiring mechanical ventilation in the UK. Fortunately, by August this number had dropped to less than 70. However, by the end of October, it had once again risen above 1,000, where it has remained, and currently shows little sign of abating. It is clear that Covid-19 is far from done with us yet.
In the fall, data emerged suggesting that what many thought would be nearly impossible had actually been achieved: Multiple effective vaccines against Sars-CoV-2 had been developed in less than 12 months. December 2020 has seen the start of what will be a massive vaccination program in the UK starting with 50 NHS hospitals.
Such a tumultuous and difficult period prompts him to reconsider the events and his role in them. Something in particular I have learned this year: Before 2020, I had never written a newspaper article, or appeared on television, or even talked to a journalist about my work. I am ashamed to admit that I had failed to appreciate the importance of communicating science to a wider audience. The torrent of noise and misinformation during the pandemic changed my point of view and convinced me to start trying to explain these issues more clearly. It is not always easy to understand, but we must make it clear why the availability of specialized health personnel (and not the bed) is important, and why we need both therapies and vaccines so that Covid-19 is available to everyone, among many others problems.
This year has also reinforced my view that building the resilience of healthcare globally, nationally and locally requires commitment and long-term planning. For the NHS, this means that we must ensure that we have the right specialized personnel, equipment and other infrastructure to deal with the storms we may face, with the coronavirus and beyond. No one can honestly say that the UK has navigated to 2020 without having to make difficult decisions and compromises that we would rather not have faced: the impact of the pandemic on the provision of healthcare for people with non-Covid conditions has been and is still, significant. On many occasions this year, doctors, patients, families, legislators and politicians have been faced with having to choose the least bad option in difficult circumstances. No one has been immune to the stress of this.
Most of the “wins” this year 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 has allowed us to quickly learn about Covid-19 by supporting recruitment for observational studies such as Isárico-4C (the WHO Covid-19 study described above), React (a Covid-19 home test study), and GenoMICC (a global initiative to understand critical illness) 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 conducting significant research.
As we move into 2021, I once again find myself looking forward to what the new year might bring. However, I am convinced that preparedness, 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 Professor of Intensive Care Medicine at the University of Cambridge.
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