After weeks of restricted healthcare, there will be a backlog, and surgeons in particular will be desperately playing catch up. We hope patients recovering from operations do not contract Covid-19 in hospital. Some will. The faster tests of the future will help segregate patients at the front door, but until they are available, hospital-spread will be a risk to endure.
But we can. I imagine a future without corridor medicine and packed waiting rooms – in one fell swoop, some scrap of protein, on the edge of life, has solved a dilemma that politicians and NHS managers have struggled with for years. There will be more side rooms, perhaps even pods or infection-control tents. The whole ‘front door’ of the NHS – presently A&E – could be unhinged and patients guided first through a ‘digital front door’. This will reduce demands on A&E, a necessary step, aided by self-managing health through education, delivered digitally too. None of this will come without trade-offs. Fewer patients in, more pathology missed, a tragedy redoubled if hospitals are seen as intimidating edifices, too thick with infection to risk. Recent analysis estimates cancer mortality increasing by 20 per cent over the next year because of treatment delays and reduced screening.
Surviving intensive care does not mean an easy leap back into jobs and family life. For most, it is a brutal experience that takes months or years to truly heal from. Initially, patients lose between two and three per cent of their muscle mass per day in ICU: we will need physios. Eighty per cent suffer psychological trauma, and PTSD is commonplace: we will need psychologists too. How lungs will be damaged in the long term remains to be seen, but rehab for fibrosis of the lungs may be required. Twenty to 40 per cent of patients in ICU with Covid-19 require renal replacement therapy to treat damaged kidneys, on which many will be dependent after they leave. It is not the ventilators we will be short of, but the complex, costly dialysis machines.
Technophobes working in the NHS, I am sorry to tell you this, but you will be hit hard by the virus; many patients, though, could prosper. Health apps are proliferating, telephone and video triage ramping up, online prescriptions have not yet peaked. I only hope the hyperbole of the venture capitalists touting artificial intelligence doesn’t divert attention from getting the basics right. Adoption of what’s already out there will allow us the most salutary break from the past – we may choose to resolve sketchy digital data-sharing and patchy coordination of care.