A nurse's perspective on the impact of coronavirus on health and the economy

There have been many infectious diseases that have spread to become pandemics throughout history, from the Black Death of the 1300s, through the cholera epidemics of the 1800s to the Spanish flu pandemic of 1918-1919 (Centers for Disease Control and Prevention (CDC), 2019; Piret and Boivin, 2021).

This article is my reflection on the COVID-19 pandemic. This was a formidable phenomenon, brought on by a virus unaffected by socio-economic status. No one is safe from it. It was evident from the outset that the behaviour of the coronavirus could not be predicted by the scientific community (although it was well known that viruses mutate—that is how they survive). In the UK, this lack of understanding and a degree of complacency hampered both the Government's and the NHS's response. According to the Independent Panel for Pandemic Preparedness and Response (2021) (which reported to the World Health Assembly and UN), in some countries, a lack of political leadership to acknowledge the seriousness of COVID-19 has cost millions of lives. If the UK had pursued a more proactive approach to the management of the virus initially, as taken by some island nations (such as New Zealand, Australia and Taiwan), this may have resulted in reduced mortality and morbidity.

The Medical Dictionary provides a definition of health as: ‘a relative state in which one is able to function well, physically, mentally, socially, and spiritually’ (https://tinyurl.com/y8wrb7n6). Integral to this concept are education, employment and income (Marshall et al, 2018). Health has a significant influence on overall wellbeing. It is a concept that should be viewed as an asset, and one that is worth investing in for society to prosper (Marshall et al, 2018). From a nurse's perspective, this is something I strongly believe—good health is a person's most valuable asset (Anderson, 2010).

The economy is defined as the state of a country or region in terms of the production and consumption of goods and services and the supply of money, at the heart of which is business, the main economic engine for the country. A person's health affects their social and economic outcome. From an economic standpoint, the health of the population has a significant influence on a country's productivity and output (Marshall et al, 2018).

Management of COVID-19

The pandemic has underlined the importance of working together to accomplish the overriding goals of controlling the virus, restoring health services and restoring economic stability. However, as we have witnessed, accomplishing these goals has been challenging—a challenge that was made more difficult by a lack of knowledge, insight, understanding, and experience of the virus's behaviour. Consequently, management decisions were often based on trial and error, reassessments and subsequent re-adjustments.

As illustrated in Table 1, in its attempt to minimise the risks of COVID-19 to the general public and reduce the overall impact on the NHS, the Government introduced measures, integral to which is the expectation of the public's compliance with government guidance. However, life has taught us that humans are complex and, as such, are susceptible to unpredictable behaviour, and may choose not to follow rules.

However, as explained by Cribb and Entwhistle (2011), the co-operation of individuals, communities and groups with public health policy is not achieved by moral judgement and edict, but by evidence-based persuasion that takes account of a person's beliefs and values. Hence, no matter how irrational or unpredictable people's reasoning, they are unlikely to respond favourably to a lecture. In the case of COVID-19 in the UK, although the majority of people were compliant with the enforced measures, a vocal minority have been non-compliant. Some of the reasons given for this non-compliance included: belief that the virus is not real and that it is a government ploy to control people or to deny their free will; others thought the virus, if it did exist, was not as dangerous as it actually could be.

However, I strongly believe that some non-compliance can be partly attributed to the Government's communication of key virus information, and its proposed management. Since communication was often ambiguous, the messages were open to misinterpretation, leading to confusion. An example is the Government message stating that people should stay at home and work from home but if they could not work from home, they should go to work.

Confusion and frustration was particularly evident with regard to the lockdowns and travel. Lockdowns significantly restricted people's freedom of movement. I am sure most people would agree that travel, both inside and outside the UK, is an activity people are passionate about and one that is important to a healthy work-life balance. As such, the inability to take the much-needed weekend excursion, the spontaneous drive to places of interest, and generally getting out and about to meet up with family and friends was extremely frustrating.

Impact and consequences of COVID-19

I think most people would agree that the impacts and consequences of COVID-19 have been comprehensive, for both health and the economy, and human interaction.

Impact on the NHS

It is evident that the rise in COVID-19 infections have had a notable impact on the NHS's efforts to deliver high-quality, compassionate care to the public. This delivery was complicated by a number of variables, including a lack of workable spaces; a shortage of beds; inadequate supplies of resources, such as ventilators and personal protective equipment (PPE); and a skills deficit among staff redeployed to critical care areas.

Although it was intended that the lack of workspace and shortages of beds would be partially alleviated by the opening of the ‘Nightingale’ hospitals; in hindsight, it could be argued that this programme was a white elephant, as the hospitals could not provide care necessary for COVID-19 patients, especially those in need of dialysis. The Nightingale initiative also had a knock-on effect, by taking resources away from local hospitals. Many nurses deployed to the Nightingale hospitals were not specifically intensive-care trained, and the deficit of these skills in this environment was a huge oversight. I believe this shows that decisions were made with little thought being given to their effectiveness in delivering optimal care to very sick patients.

COVID-19 has also had a devastating impact on planned surgeries, introducing significant delays to patient waiting times. Since resources were concentrated on providing emergency and critical care, many trusts were unable to honour their commitment to patients requiring elective surgeries, who experienced delays and cancellations.

The emergence of new coronavirus (SARS-CoV-2) variants, and the resultant spikes in infection rates, has raised the pressure on the NHS and its staff. In terms of delivering care, practitioners acknowledged that, due to increases in the numbers of very sick people needing their help, they had to make difficult choices about who would receive treatment. Added to this were high rates of staff sickness, due to staff becoming infected with the virus and a difficult working environment, exacerbated by inadequate PPE. For nurses, the physical and emotional toll has been so great, that some have left, or are thinking of leaving, the nursing profession (Royal College of Nursing (RCN), 2020).

Impact on the economy

We have observed the knock-on effects of measures that were designed to stem the virus's reach, such as lockdowns and the resulting closure of both essential and non-essential trading (shops, hospitality venues, sports centres and gyms) has been particularly harsh on business and industry, in terms of increased job losses and the ensuing impact on people's livelihoods, and their ability to provide for themselves and their families. For those working in the NHS, it could be argued that because the management of COVID-19 demanded an ‘all hands on deck’ approach, staff were unlikely to lose their jobs. Nevertheless, reductions in staff availability due to sickness and increasing workloads has led to spikes in stress levels. The ensuing emotional burnout has resulted in nurses having to take sick leave—actions that further increased the pressure on those remaining.

A thriving economy is highly reliant on businesses, and tourism is a fundamental part of the UK economy. As well as in the travel industry, tourism creates jobs within the service sector. However, as we have observed, the impact of COVID-19 on this industry has been significant, in particular the closure of some smaller airlines, cancelled holidays and subsequent job losses (Office for National Statistics (ONS), 2021a). Although this outcome of the pandemic was predictable, and in parts understandable, for many, myself included, the cancellation of holidays was extremely difficult to bear. Admittedly, the Government provided financial support for businesses and their employees through the furlough scheme. However, although the scheme has proved to be extremely beneficial, it places another significant burden on the economy—one that will certainly have long-term ramifications.

The emotional impact

Mental health refers to a person's psychological and emotional wellbeing—a condition that can be hugely affected by stressful occurrences. The impact of COVID-19 on people's mental health became evident during the lockdowns. For many people, the isolation and the realisation that they would not be able to interact with loved ones and friends on the same level has been extremely stressful. This is a situation in which a healthy diet and regular exercise has proved to be beneficial to countering high levels of stress. However, gyms and sports centres were deemed ‘non-essential’ facilities, and as such, were among the first businesses to be closed in the first lockdown. Increased pressure from the public, however, saw this decision reversed in the second lockdown, provided the appropriate health and safety measures were put in place. This was a welcome decision. Unfortunately, the emergence of new virus variants, escalations in new cases and spikes in death rates, resulted in a third lockdown and a further closure of these facilities.

As a recently retired nurse, I am not surprised by the emotional impact that COVID-19 has had on NHS employees, especially nurses and doctors. After all, they are human, and as such are likely to experience the same feelings of anxiety, fear and distress as anyone else. In this instance, although their overriding responsibility is to their patients, there is also a responsibility to their own and their family's needs.

Thinking back to the beginning of last year, with the daily news updates, the fear of becoming infected with COVID-19, of losing patients and colleagues to the virus, as the true magnitude of events unfolded, is deeply sobering. As health professionals working in the NHS, we know that deaths occur. However, death on this unprecedented scale was not only alarming and emotionally draining, it has also been soul destroying for health professionals to watch their patients die, despite all their efforts.

Because of the restrictions on hospital visiting, many families were unable to be with loved ones at the time of their death and were denied the opportunity to touch and comfort their relatives, and to say a final goodbye. It is understandable why this situation, combined with the imposed restrictions on funerals, has had such an effect on their ability to grieve and led to feelings of resentment and distress.

COVID-19's impact and consequences has also extended to births. Despite some predictions that more babies would be conceived during the first lockdown, official figures show that December 2020 and January 2021 saw relatively steep decreases in monthly fertility rates, when compared with the same months in the previous year (ONS, 2021b). Tragically, some pregnant women contracted the virus, gave birth and subsequently died. Hospital restrictions on visitors also meant that partners were not able to provide vital support at births.

In terms of marriages, for many, COVID-19 restrictions on the number of people who could attend the ceremony, combined with the enforced closure of wedding venues and subsequent cancellations, resulted in the knock-on effect of lost revenue for businesses and understandable emotional upset for those affected.

Impact on human interactions

I think we would all agree that in terms of lockdown measures, COVID-19 has significantly impacted the way we interact generally, both with family and friends and the way we work. Humans are sociable beings and, as such, touching and hugging are integral and essential parts of our daily interactions. The inability to do so has impacted negatively on individuals' mental health.

An example of where COVID-19 impacted negatively on human interactions, relates to Christmas 2020 (the promised five-day ‘meet-up’ between 23 and 27 December that would have allowed three households to meet up over the Christmas break). Sadly, the rise of new variants and spikes in infection and death rates, resulted in a further tightening of the rules, including changes in the tier status from 3 to 4 for most of the country, and the cancellation of the Christmas ‘meet-ups’ at the eleventh hour. For the majority of people, this cancellation of the opportunity to reconnect with loved who they may not have seen for some time, and the loss of long-awaited hugs, was a bitter pill to swallow, especially for elderly people who had been isolating.

Impact on education

The impact of lockdown has been widely felt by all educational institutions—from primary-school pupils and teachers to university students and lecturers. The closure of these institutions placed the emphasis on home-schooling and the burden of support fell on parents, teachers and lecturers and much learning was undertaken online. Although there were some problems with home-schooling, the feedback on distance/e-learning protocols is that they have been largely beneficial. However, the loss of interaction with friends and colleagues, and the absence of face-to-face support from teachers and lecturers was hard for students of all ages.

Impact of conspiracy theories

Despite mounting evidence on COVID-19, some people allowed conspiracy theories and negative reporting about the authenticity of the coronavirus to cloud their judgement. Such theories and reports were fuelled by the circulation of information via social media platforms purporting to show that the virus was either not real, or not as serious as reported. This misinformation could be harmful. One previous supporter of such theories I know only realised the impact of this misinformation after they unfortunately personally experienced the death of a loved one from COVID-19.

Guidance on maintaining social distancing and wearing a mask in enclosed spaces, especially when entering shops or other establishments, has been very clear. However, I have personally experienced anti-social behaviour in this area, and it is evident that some people will ignore the guidance.

Impact on working lives

There is no doubt that COVID-19 has changed the way many people work. For many, the daily commute to the office has changed to working from home—a change that was made possible by using online video conferencing platforms such as Zoom and Teams. A consequence of more people working from home was the inevitable reduction in the number of people travelling into city-based offices, significantly impacting the businesses reliant on this type of customer (coffee and sandwich shops, pubs and restaurants), not only to keep them afloat, but also to keep people employed.

Impact on charities

The coronavirus has particularly impacted charities, especially the smaller organisations, whose survival is hugely reliant on the income generated from fundraising. For the larger charities, such as Cancer Research UK (CRUK), Prostate Cancer UK (PCUK) and Macmillan Cancer Support, reductions in funding have significantly impacted research.

‘COVID-19 has highlighted people's previously unrecognised mental health vulnerabilities. Paradoxically, it has made people more able to be open about their mental health issues’

Impact on cancer services

The virus has impacted the cancer referral pathway. For example, according to PCUK, delays in two-week rule referrals and, consequently, delays in the early diagnosis and treatment of prostate cancer, has potentially led to less favourable outcomes. This has caused heightened fears of recurrence and disease progression for individuals. These delays are further compounded by reductions in monitoring, such as the prostate-specific antigen test, the performance of trans-rectal ultrasound biopsies and diagnostic imaging, all of which are crucial to establishing an early diagnosis. Likewise, reductions in screening uptakes have resulted in a significant rise in late diagnoses (PCUK, 2020).

Vaccines: a welcome ray of hope

Considering we knew very little about the coronavirus at the beginning of 2020, and were uncertain whether a viable vaccine could be created before mid-2021, the successful development of the Pfizer/BioNTech vaccine and its subsequent roll out in the UK in December 2020 (BBC News, 2020) was a huge achievement that provided a glimmer of light at the end of a very long tunnel. The subsequent addition of the Oxford/AstraZeneca vaccine made it possible to initiate a mass immunisation programme that targeted individuals in accordance with age group and level of vulnerability. This programme was only possible due to the NHS's great experience in delivering mass vaccination roll-outs. The subsequent reductions in rates of infection and deaths were reassuring; however, there were some worrying issues to address.

First, the emergence of the new variants has been a challenge for scientists and a booster programme has been necessary.

Second, with regard to the AstraZeneca vaccine, not only did reports of potential blood clots generate understandable doubts about its safety and a significant degree of reluctance from individuals to take it, these doubts were also responsible for the noticeable delay in rolling-out the vaccination programme across countries in the EU. There were reports of a lack of confidence in the vaccine's efficacy, which were attributed to scepticism around the vaccine's development in so short a timescale, and a lack of available trial evidence to support efficacy, or refute any actual or potential implications for individuals' health.

However, with the development of the Moderna vaccine, and the likelihood of more vaccines in the pipeline, there is clearly hope for the future. But, with the virus's future behaviour still uncertain and the development of variants, the future is still unclear. In terms of management of the virus at this stage, it seems that the role of vaccines is to help prevent the spread of the virus and reduce the severity of the illness should an individual catch it. Therefore, I believe it is important to point out that, like the flu vaccine, booster vaccination programmes may be necessary for some time to come.

Summary and conclusions

The year 2020 will go down in history as extraordinary. The coronavirus phenomenon has had an impact on all aspects of our lives, including health, education and the economy. For many, reflection on the year has been sobering as they were forced to re-evaluate their lives and think about what is important.

Some see the changes to working life, with more people working from home, as an opportunity to have a better work/life balance, and do not wish to return to the ‘traditional’ way of working. Many employers have discovered that having employees work from home has had little or no impact on their business's performance. Some larger companies have seen this as an opportunity to reduce their office space and thereby their overheads.

We may need to accept that we will have to revise how we interact with loved ones and friends, that life as we knew it may never return. In fact, we may simply need to adjust to a ‘new normal’. COVID-19 has highlighted people's previously unrecognised mental health vulnerabilities. Paradoxically, it has made people more able to be open about their mental health issues. It is imperative to ensure the correct measures are in place to help those in need of support.

In 2021, despite falling infection and death rates, the new variants have shown that the coronavirus is still unpredictable, and thus complacency is unwise. Hence, while we are all eager to venture outdoors, to meet up with loved ones, and to socialise on a broader scale, the Government's message is that we should do so cautiously. The final lockdown easing was due on 21 June 2021; however, because of the uncertainties posed by the Delta variant, and in light of the rise in new cases, the decision was made to delay this easing until 19 July 2021 (Shearing and Lee, 2021). Since then, spikes in the number of COVID-19 cases have continued and there is an ongoing need to remain vigilant as the pandemic shows no signs of abating in the short term. Nevertheless, the Government's proposed way forward is a tentative return towards restoring normality, in which the economy is of key importance.

This article has not discussed many aspects of the pandemic, including PPE shortages and the test and trace system. What it has done is present views on particular aspects of consequence to me and my colleagues.

Clearly, no one can predict what the future holds, but thanks to the vaccines, it is a future that appears more promising and a whole lot brighter.

During my years as a nurse, the connection between health and the economy was always clear, in that the delivery of health care was, and still is, driven by money. In conclusion, therefore, my perspective is that health and the economy are both equally valuable assets. However, if we were to abide by the long-standing principle of putting safety first, then health should always have a greater priority over the economy, despite the cost implications.