Like so many of my colleagues, my mind is preoccupied with the current crisis. For the past few weeks, I have been driving along near-empty roads and making my way to work across a campus that has fallen silent. Now I am self-isolating and working from home. Watching the news and talking with friends on the telephone; sharing stories of shop and school closures, it seems surreal; like a disaster movie about some future apocalyptic event.
However, unlike many of my colleagues, I have not been reflecting on National Institute for Health and Care Excellence (NICE) guidance or other clinical protocols—necessary and praiseworthy as these may be. Instead, my reflections have been looking beyond the novel coronavirus, and its impact on mortality and morbidity, to the future and the opportunities that may present themselves. Some commentators are saying that our world will never be the same again. I hope they are right. There are important lessons to be learnt and principles to be espoused that form a collective hangover from the socioeconomic and political debates of the previous century.
Lessons in infection control
Some fundamental public health lessons have been lost on generations born in the second half of the 20th century and in the early part of this one. These include neglecting to wash hands, washing them ineffectively or bizarrely, washing hands and failing to dry them following toilet use, or before and during food preparation.
These are all behaviours born of the complacent ‘pill for every ill’ mentality characterising the post-antibiotic era. Studies among children in Italy (Milandri, 2004) and Greece (Bozoni et al, 2006) have shown that this culture—which equates public health with hospitals, doctors and nurses—may be deeply embedded in our thinking from an early age. In an affluent society, it is easy to forget that simple proactive infection control measures have had a larger share in delivering public health than biomedical treatment (Naidoo and Wills, 2016).
If COVID-19 has successfully reinforced the need for everyday hand hygiene on current life cohorts, then its impact will not have been in vain.
Lessons for the food industry
There is still speculation about the original source of the coronavirus outbreak in Wuhan in China. However, the source is thought to have been infected animals such as fish, birds, snakes and pangolins sold dead and alive in a street market. In Chinese wet markets, livestock are stored tightly packed and butchered at the point of sale, permitting infection to spread from one species to another (European Centre for Disease Prevention and Control, 2020).
In our diverse multicultural world, achieving consensus on what foods are acceptable and how they should be safely and hygienically prepared and sold is a huge task. The adoption of the code on the hygienic practice for street-vended food in Asia (Food and Agriculture Organization of the United Nations and World Health Organization, 2017) is a progressive step and the Chinese government has banned the farming and sale of wild animals since the start of the COVID-19 outbreak. However, enforcement of this legislation will be difficult, given that wild animal trading in China is the business of small-holding farmers marginalised by industrial-scale agribusinesses attracting huge international investment.
‘There is a certain irony in the praise and honour currently being heaped on nurses … the same nursing workforce who only a matter of months ago were having their wages capped’
Similarly, factory farm practices that increase the virulence of viruses exist throughout the developed world. So COVID-19 cannot be labelled a ‘Chinese problem’ (Spinney, 2020). A global initiative that calls a globalised food industry to account will be needed to stem the roots of viruses such as COVID-19 in the future.
The value of social cohesion
COVID-19 has made its entrance on the international scene at a time when Britain and the British people are ill prepared to cope. Notwithstanding the lamentable state of our health and social care services, health inequality is at a historic peak and life expectancy has fallen. Large sections of the population have been made vulnerable to disease by their social status. For example 83 000 families that include 125 000 children are homeless (Marmot et al, 2020).
The current government health advice to stop the spread of coronavirus can be of little help to them. The notion that such conditions, as part of an austerity plan, are a necessary price for balancing fiscal books has been laid bare for the myth that it is by the extensive economic measures the government has been forced to take in response to the impact of coronavirus.
If there is a price worth paying, it is surely long-term government investment in public health strategies, inclusive of high-quality social housing, green space, transport infrastructure, education and skills, together with comprehensive health and social care provision. Such investment builds resilience, security and optimism, along with economic prosperity for the many. When families do not have to live their lives weathering one crisis after another and relying on zero-hour contracts and food banks they are better placed to cope with major life events (Graham and Power, 2004).
A new perspective on nursing
It is in all our interests that retired nurses who are safe to practise respond to the government's call to reinforce the ranks of frontline practitioners. However, there is a certain irony in the praise and honour currently being heaped on nurses for their hard work, heroism and fortitude. After all, this is the same nursing workforce who only a matter of months ago were having their wages capped, the same nursing profession whose recruitment has been undermined by the termination of the bursary and the introduction of tuition fees.
In the midst of all this, the largest group of health professionals in the country has had to cope with a highly costly health service reorganisation, which has proved a distraction from real health need (Ham et al, 2015). Political expediency is possessed of a deficient and highly selective memory that governments hope is shared by a naive public.
The dedication and fortitude currently observed in nurses caring for patients with COVID-19 calls into question the idea that professional resilience is and has been somehow lacking in their ranks. Certainly, personal and professional resilience are not sustainable in an environment where essential resources are sparse and respite is rare (Borneo et al, 2017), where organisations are dysfunctional, and the value placed on nurses varies with the socioeconomic climate (Traynor, 2017).
These very factors have formed much of the impetus behind an intention to leave on the part of 30-40% of the profession across the span of a decade (Li et al, 2011; Buchan et al, 2019). As we enter the third decade of the 21st century, more nurses are leaving than entering the register in the UK (Buchan et al, 2019).
It is time for a political consensus for consistent investment in a nursing workforce practising against a backdrop of kaleidoscopic change. Investment that provides a safe and effective staff–patient ratio, supported by adequate resources and services under a facilitative management umbrella, would prove cost-effective in the medium to long term. Cost-effectiveness would surely be manifest in an end to the mindless waste of universities producing repeated cohorts of graduate nurses, while the experts who taught them in practice are lost to early retirement, ill health or alternative employment.
The overriding principle
From the army of volunteers responding to government calls for help to the needless panic buying and aggressive behaviour in supermarkets, coronavirus has brought out both the best and the worst in humankind. In coming together to find a vaccine, the international scientific community has set an example for the rest of us.
For many years, the dominant sociopolitical discourse has been that autonomy is the pinnacle of life course development. But the overriding message from the greatest challenge of this century has surely been that humans are at their best when they recognise their interdependency (Benner and Wrubel, 1989). Moving forward, it makes sense, therefore, that we remember this principle in times of prosperity and peace, as well as in times of strife and crisis. A world unity discourse on resolving global problems is called for—one that does not seek isolation from neighbours or scapegoat minority groups, foreign residents and those among our citizenry with a mixed cultural ancestry.
Conclusion
As with many events in human history, the advent of COVID-19 has taken its toll on society, but it also provides motivation and opportunity for change. Some forgotten public health principles have been called back to mind and need to be re-embedded in our daily lives. World leaders can ensure their place in history by calling corporate forces to heel for the common good.
The next time the nursing profession calls on politicians to act we need to remind them of how much they needed us during this perilous time and will again. And human rights are best upheld when we all remember our responsibilities to each other.