Notes on a crisis: Why we must not allow death on this scale to be neutralised or normalised

As the death toll has risen inexorably, I have become increasingly disturbed by the caveats – age, and “underlying health conditions” – that are routinely applied.

By Phil Whitaker

I have lost count of the number of people I have seen die over the past 30 years. While I would like to pretend that I remember every one, the truth is, I cannot. I still vividly recall two patients whose deaths I witnessed early in my first year as a junior doctor. Quite quickly, though, a professional detachment develops. It has to. It is not a lack of care, but all doctors need to find ways of insulating themselves from the rawness of dying and grief.

Death ceases to scorch its imprint on to memory. It becomes instead a medical condition to try to manage well – with control of symptoms, and support to patient and family. Care of the dying is just one, albeit highly important, part of the job. Some patients still cut through. I’ve had two children die of cancer during my years as a GP; both cases had me in tears at times. And there have been several adults in the prime of life whose premature deaths, and the shattered families left behind, have rocked me. But when death comes at the end of a long, fulfilled life, it is easier to accept as a doctor – particularly when one has been able to make a positive difference to those affected.

As the death toll from the pandemic has risen inexorably over the past year, I have become increasingly disturbed by the caveats – age, and the presence of “underlying health conditions” – that are routinely applied. Most notorious, but far from unusual, was the erstwhile Brexit Party MEP, Claire Fox, who tweeted in December 2020: “Only 377 people under 60 without pre-existing conditions have died of Covid in England.” The objective appears clear: make Covid mortality into something acceptable, natural. Or the unavoidable complication for bodies that are already sick and ailing and beyond repair.

Barry, the first patient I lost to Covid, was in his mid-fifties. His chronic lung condition did not prevent him working, nor being a father to his two children, nor enjoying an entirely normal life. Then there was Helen’s mother. I am still troubled by Helen’s anguish: prevented from entering the nursing home to say goodbye, while we healthcare professionals were allowed in to assess and palliate her mother’s terminal Covid. And the pictures scrolling through my social media feed: nurses, doctors, carers, struck down by a virus their vocation exposed them to. As the UK marks the milestone of 100,000 coronavirus deaths, we must not allow this national tragedy to be neutralised or normalised – nor in any sense be presented as inevitable.

In the first Downing Street briefings, held in the early weeks of March 2020, the three lecterns at which the Prime Minister and his senior advisers stood were emblazoned with the royal coat of arms. Union Jacks were ranged on the wood-panelled walls behind. The tone was of sober national confidence. The pandemic would likely prove challenging, we were told, but the UK was one of the best-prepared nations on Earth.

Johnson cited our “world-leading” science, an adjective that struck a chord with me. Flanking him were Chris Whitty, the chief medical officer for England, and Patrick Vallance, the government’s chief scientific adviser. Both are highly regarded physicians and research scientists. Johnson’s conduct had been erratic and shambolic, but Whitty and Vallance were emblematic of something deeply reassuring: Britain as a bastion of scientific rationality in healthcare.

It is a hallmark of the scientific method that all theories are provisional, subject to challenge and revision as new data emerges. The UK was blindsided by the first wave: our pandemic plan, geared wholly towards an influenza virus, proved fatally flawed, with an early abandonment of containment, and a shift instead merely to try to keep infection rates within health service capacity. But during the summer lull between the first and second waves we should have undertaken a scientific reappraisal; data from around the globe was by then demonstrating a “zero Covid” strategy as the optimum approach, in terms of both human and economic health. At its core, this was a scientific failure. To the best of my knowledge, Sage, the forum for channelling expert advice to the heart of government, has never yet questioned the validity of our extant pandemic plan, first published on 3 March 2020, nor presented an alternative “zero Covid” option for ministerial consideration.

Yes, it was a UK clinical trial that identified the most important lifesaving Covid treatment to date, the steroid dexamethasone. Oxford University developed one of the world’s first vaccines. But our governmental science has proved intrinsically unscientific. From the outset of the pandemic, there have been many UK-based scientists – notably the shadow advisory group Independent Sage, which urged the government to adopt its “zero Covid” strategy in July 2020; as well as voices such as professors Devi Sridhar and John Ashton – whose alternative analyses have consistently been vindicated by events. At the centre, Sage has appeared mired in groupthink, and impervious to external critique. Alongside the deaths of so many compatriots – among them numerous healthcare workers – I am also mourning something less tangible but still profound: the sense of our national scientific competence.

This article is from our “Notes on a crisis” series