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The GP with a different take on Covid
TEDDY JAMIESON TALKS TO GP GAVIN FRANCIS ABOUT COPING WITH THE ONSLAUGHT OF CORONAVIRUS
FOR most of the 20 years Gavin Francis has been a GP, his working life had a pattern and a rhythm that didn’t change. In fact, it’s a pattern and a rhythm that probably hadn’t altered for decades, he reckons. To be a GP at the start of the 21st century was not so very different from being a GP in the 1960s or 1970s. “There was a kind of timeless feeling about the nature of the work,” he tells me.
And then everything began to change. Sunday morning. January 3. It is the day before the latest lockdown is announced and Francis is thinking about our lives under the shadow of the coronavirus; about how his life and work has changed in the last 12 months and how everyone else’s has too.
Francis who is both a GP and an author has written Intensive Care, a book about what it was like to be a doctor in the first few months of a pandemic.
In the past he has written about his love of islands (Island Dreams), his time in Antarctica (Empire Antarctica) and on medicine and human change in the awardwinning Shapeshifters. “I make sense of the world through writing about it,” he says.
In Intensive Care he charts his experiences in 2020, in both an inner-city GP’s practice in Edinburgh and his short time spent as a doctor up on Orkney.
The result, as he writes in the introduction, is an attempt at “an eyewitness account of the most intense months I have known in my 20-year career”.
Define intense, Gavin? “I was trying to keep my clinic going because I’m a GP partner with key colleagues in an inner-city practice. I was trying to manage the home-schooling of my children. I was managing a huge amount of uncertainty and stress among my patients, among my staff and my colleagues.
“And then, when I actually was seeing Covid patients, the kind of measures we had to take were extraordinarily difficult to get used to; the layers, the barriers, the length of time it took to get all the PPE on and get if all off again safely.
“It just put huge pressure on the simple business of medicine, which is to see
people in distress and attempt to ease their suffering. It was phenomenally complicated by the measures that we had to take. I suppose that’s what I mean by intense, because everything was just laden with this stress and with this drama brought by the virus.”
Clearly, things are not getting better. We are entering this new year with coronavirus cases surging. Francis, like he has been for the past 12 months, is on the front line.
“It’s very, very difficult. Where I’m working in Edinburgh the hospitals aren’t full yet, like the scenes we are seeing in the south-east of England, but they are filling up.
“There’s a winter beds crisis every year, but this year is so much worse because we’ve got this terrible new respiratory virus to deal with on top of everything else.”
There are a few small upsides, he says. There has been a lot less flu around this winter than normal as a result of all our social distancing. Still, last week he got an email from NHS Lothian asking him and his colleague to do everything within their power to try to prevent admitting patients to hospital.
That’s an annual request, he says. However, he adds: “We’re having to contemplate shutting down routine care yet again. We’re becoming a national Covid service at the moment.”
To think back to last January and February now is to recall another world. We lived in a pre-pandemic world and it took us all a while to realise how much was changing. As a GP, Francis and his colleagues had to completely rethink how to deliver care, how to organise their daily practice of medicine. It was a tricky transition.
“We were forced into trying to manage things on the phone because we had no option. Ordinarily my training would tell me you should always see people face to face.”
Francis had a front-seat view of the spread of the virus. In the book he points out that last February and March he was very quickly aware of how rapidly the virus was spreading, more rapidly than the government, health boards and the chief medical officer seemed to be acknowledging at the time.
“I would hear stories that made me conscious of just how widespread the virus was in the city,” Francis recalls.
“I was working up in Orkney in February before it had really hit and then, by the time we were into March, it was definitely spreading quite quickly when I was back in my usual practice.
“The government knew that, but I think this was such an unprecedented, explosive situation in terms of controlling the infection that at every stage it feels like the government couldn’t quite believe that they were going to have to go to these extremes.
“They couldn’t quite believe that they were going to have to close down all the hotels, that they were going to have to shut down flights in and out of the city.
“At every stage, when it proved we had to do these things, there was an understandable and justifiable reluctance to go that extra step, which subsequently proved necessary.
“And that’s why I think every single Western country has struggled with this virus. The ones that have done pretty well with it in the Far East have got populations that are willing to tolerate a far greater level of state intrusion into their lives.
“Countries like the UK are not used to accepting that the state can just lock us up in our own houses for 14 days.
“We’re not used to having to hand over our personal details every time we visit a pub or a restaurant. We’re just not used to that level of state intrusion.”
INTENSIVE Care is a cool, thoughtful book, and not one, it should be said, particularly interested in blame. “No, not at all. It’s very easy to look back retrospectively. At every stage I was quite incredulous too. ‘Are they are really going to have to close all the schools? Are they really going to have to ban flights?’ ”
What he hopes is, if this happens again, we will be quicker to close borders and quicker to ramp up mass testing.
“Going forward from this pandemic I think government will be a lot better at keeping pandemic stocks of PPE up to date. Ours had all started to go out of date because they had been stockpiled for the swine flu of 2009.
“We did have access to masks, aprons and so on. We didn’t have gowns and the WHO was advising people to wear full gowns.”
One of the most striking revelations in Intensive Care is how quickly Francis and his colleagues were dealing with a surge in mental health problems as lockdown began. “One day, March 25, almost everything I dealt with related to mental health,” he writes.
That’s just two days after Boris Johnson announced a lockdown, I say.
“It was happening so fast, partly because I am in the city centre of Edinburgh and so much of the economy of that part of Scotland is devoted to tourism. There’s a lot of guest houses there, a lot of people who depend on tourists. And suddenly that was all blown away.
“So, I was seeing the effects of people not just coming to terms with a very dangerous, life-threatening pandemic infection, but also the collapse of their businesses, especially at that time when it wasn’t clear what the economic support measures would be. There was a real sense of terror among people who were furloughed or even under threat of redundancy. The uncertainty of that, combined with being ordered to stay home on the pain of essentially risking your life.”
The impact on our mental health led Francis to join a number of doctors and nurses in writing a letter to Education Secretary John Swinney to try to get children back into schools.
“You could see the government was doing everything it could to avoid a measurable harm, which was Covid deaths among
adults because that is a statistic that would be on the front of every newspaper. A terrifying statistic. But there were innumerable, less measurable harms still being perpetrated.
“I don’t envy the politicians making these choices but, essentially, because the deaths were measurable, everything was done to mitigate that. But there were enormous harms being done by keeping the kids off school, by enforcing everybody to stay home, by the shutdown of massive sectors of the economy.
“That’s before we get on to the enormous harm done to the elderly people told to shield and to be away from anybody, to not see their grandchildren for month after month after month. And I’m seeing real outcomes of that now, after almost a year of this. People in their late eighties and nineties are saying, ‘You know, I might not have many years left and to avoid seeing the people who make my life most worthwhile for so long has been truly terrible, truly difficult’.”
The impact on our mental health can also be seen in the rise this past 12 months of cases of self-harm, panic attacks and psychosis – all, Francis says, on the rise in his own practice.
It’s a reminder, I suggest, that being human is about contact and without it we are damaged. “Absolutely and one of the cruellest aspects of this virus is it spreads through touch and through voice. Singing was one of the worst ways of spreading the virus. We’re told to mask up, to not touch each other. It’s kind of like an attack on the most basic elements of our humanity.”
We’re being urged to resume clapping for our “heroes” again. Francis quite enjoyed the clapping that accompanied the early weeks of the lockdown. Not all of his colleagues felt the same, though.
“Some of them hated it. I didn’t so much like the clapping, but I really liked the opportunity to chat with my neighbours.
If I happened to be home on a Thursday evening and all the neighbours were out on the street, it was quite nice to see each other, four metres apart.
“And it’s interesting how much that amazing upwelling of good feeling towards key workers at that time has kind of dissolved now.”
Well, indeed. He talks about the scenes of Covid-deniers gathering outside hospitals in England with utter incomprehension.
“What can we do to assure people it is absolutely not a hoax? People are dying of this and the ones that aren’t dying of it are very ill, sometimes for a long time. I’m not sure how else you can convince people. It’s quite extraordinary to me that people can even deny it exists.”
Does that make you angry? “Not so much angry. I’m absolutely mystified.”
What the pandemic has reminded us, Francis suggests, is that we are vulnerable. But, also, of human ingenuity. “The ability to create several functional vaccines within a few months of this emerging is tremendous,” he says.
What can we do to assure people it is absolutely not a hoax? People are dying of this and the ones that aren’t dying of it are very ill
“On the other hand, it’s quite startling to think we haven’t progressed in terms of how we best manage and control this kind of viral outbreak. I found that depressing in many ways. In some ways we haven’t moved on, for all our sophistication.”
AND, so, here we are in January 2021, somewhere between hope and fear. Francis leans towards the former. “Yeah, I’m really hopeful. I’m optimistic because we have two vaccines approved for use. I’ve already had my first vaccination. I’m getting my booster later this week. We’re vaccinating care homes just now. We’re going to vaccinate the over-80s very shortly.
“That is the only way we’re going to get out of this. We’re going to get herd immunity through vaccination rather than herd immunity through people having caught and recovered from it.
“Of course, it could have been better. Of course, I could point to things that have gone wrong over the last year. Now what we’ve got to do is stick with the measures and vaccinate, vaccinate, to get out of it.”
Gavin Francis is a GP. His job has changed in the last year. He hopes, soon, it will return to the rhythm of the past.
Intensive Care by Gavin Francis is published by Profile Books in association with Wellcome Collection, priced £16.99