Reflections on 2 years of COVID: What we got wrong

By Dr. Paul McCoubrie, columnist

May 17, 2022 -- There is a common myth of an old Chinese curse that runs, "May you live in interesting times." Although it isn't old or Chinese, it seems apt to describe the last couple of years. I can barely remember the simpler and more carefree times before 2020. All the things we took for granted, all the things we missed so much in various lockdowns, are slowly returning. Many of us had never seen viral pneumonitis back then. Many of us never want to see it again.

Paul McCoubrie
Dr. Paul McCoubrie from Southmead Hospital, Bristol, U.K.

The COVID-19 pandemic is by no means over, and it may never truly disappear, but there have been many curious changes in the last two years. In June 2020, I wrote about our early experiences. A lot of medical water has passed under the COVID bridge in the interim. Some of this has been revelatory, some of this has been -- frankly -- a pain in the butt.

The online life

Everything went online. Meetings, teaching, conferences, social life, everything. Initially, this was all rather novel as we discovered, for example, the hazards of leaving our camera or microphone on when we really shouldn't have. For me, the novelty evaporated within a week. I have come to absolutely loathe online meetings with a passion.

I can see the practical advantages of not having to schlep across the country or to another country -- specifically for introverts, the mobility-impaired, and those with childcare commitments. Having this as an option is a positive step, and I hope hybrid conferences are here to stay.

However, there isn't the engagement of a face-to-face meeting, there isn't the same emotion or nuanced communication, there isn't the gossiping over a coffee between sessions. I mean, you can sit in your underwear and still take part, but that is little solace to a gregarious soul like me.

Online teaching is very difficult to make effective. Most online courses or conferences are just a series of videos. Not all, but most. To me, that isn't a course or conference. Most people would be much happier browsing YouTube instead. I went to my first face-to-face conference a few months ago and it was a tonic for the soul -- so refreshing and reinvigorating.

Delivering online lectures is a personal bête noir. I was asked recently if I'd do an online lecture and replied, with a twinkle in my eye, that I'd rather do the splits on a barbed-wire trampoline.

Home working

If they had home reporting, many radiologists in the U.K. were barely seen in the department. Some didn’t have home reporting and rapidly deployed it for all staff. Some didn’t: I worked in the hospital every day, as per normal. Many worked a hybrid pattern of some days at home and some days in the hospital.

The upsides of home reporting are legion: no interruptions, no commuting, flexibility in the working day, decent coffee, and the ability to work in your underwear (again, not mandatory). The downsides are also manifold: isolation, fighting with dodgy IT and PACS, wearing out your preferred underwear, and increased pressure on your colleagues in the hospital.

This last point is crucial. Those left in the department were snowed under. Clinicians complained when radiologists weren't available for discussion. Our trainees felt abandoned. In many hospitals, face-to-face checking and supervision evaporated, adding to the misery of lockdown.

It isn't surprising. This is inevitable when a radiology department has only a ... erm ... skeleton staff.

Woeful mitigation

Masks became politicized, almost a partisan topic. Which is clearly a failure of political leadership, with stupid individualism trumping sensible collectivism. The U.K. Government has declared "COVID is over," so the general population has now almost abandoned them. Which is bizarre, given they are the cheapest and most effective method of reducing infection.

Speaking of which, the use of high efficiency particulate air (HEPA) filtration has been almost ignored. A proven method of almost eradicating viral bioaerosols, shouldn't every office, every reporting room, and every scanner have this portable device? Why aren't we retrofitting centralized air conditioning units with them? Everyone benefits from cleaner air. I can't understand this.

We used masks by the billions and, inevitably, the tonnage of plastic waste has been huge. The focus on handwashing was an unusual choice for a disease spread by aerosol, but not entirely without logic. However, the focus on single-use gloves and plastic pinafores was frankly ridiculous. Coming at a time when the climate crisis is in full swing, this has been difficult to swallow.

I don't want to be too political, but the U.K. Government policies on contact-tracing and private providers of personal protective equipment (PPE) have revealed corruption on an utterly unacceptable scale at the highest levels. billions of pounds have been frittered away. The hasty construction of the almost entirely unused regional series of "Nightingale" COVID hospitals was a scandalous failure of logistics. millions were wasted. No one has been sanctioned or even vaguely chastised. We have been very forgiving. Either that or we've been completely hoodwinked. Or both.

The red-tape bonfire

Desperate times allowed desperate measures. Normal rules and normal procedures were ripped up in the name of COVID and expeditious decision-making. This brought enlightenment and despair in equal measure.

Redeploying radiologists into the clinical arena was an obvious mistake. I wasn't affected, but many were. I know I would have been a positive hindrance, and many colleagues reported the same frustration. Fortunately, this was short-lived and hopefully will never be repeated.

In the U.K., the annual appraisal and revalidation scheme was suspended and the burnt-out mess that is the consultant workforce let out a collective sigh. What happened? The world did not come to an end, the seas neither boiled nor dried, and the land was neither ravaged nor pillaged. Some commentators asked serious questions about the validity of this widely loathed, paperwork-heavy system.

What next?

Although the quiet times of the initial lockdowns allowed a pause to catch up, reflect, and solve issues, I'm sad to report that U.K. coal-face radiology is now in no better position than it was in 2019. All the adulation for the National Health Service (NHS) in the early pandemic, all the "clapping for carers" was, sadly, an empty populist charade.

Our NHS scanners have never been busier, our workforce has never been more exhausted. With the U.K. economy as it is, there is no magic wand, no secret potion, no fairy godmother coming to our rescue. So, until the magic radiology tree starts bearing fruit, all we can do is grin, cope, and lobby for more staff and more resources.

Dr. Paul McCoubrie is a consultant radiologist at Southmead Hospital in Bristol, U.K. Competing interests: None declared.

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular vendor, analyst, industry consultant, or consulting group.

Copyright © 2022
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