Covid-19: The impact of red on green
Trainee oncologist and FMLM Douglas Fellow
‘Unprecedented times’ has become a familiar phrase since the emergence of the COVID-19 crisis and news of the daily coronavirus ‘battle’ fought by frontline staff has spread widely. However, the coronavirus presents a battle on multiple lines.
The whole of the healthcare system has stepped forward, and every specialty within it, to help reduce the pressure on our acute services, as well as protect our patients and prepare for recovery.
As an oncologist, my experience of these unprecedented times is different. Working in a so-called ‘green zone,’ as opposed to the COVID-19-focused ‘red zone’, our ward has empty beds, our patients are staying away from hospital and as a result we are seeing patients present with increasingly complicated problems, later, and more unwell than in ‘normal’ times.
This has become a different kind of crisis, one mixed with a real sense of guilt as colleagues yearn to help the frontline COVID-19 response.
The desire to help our colleagues on the frontline is conflicted with the need to care for our cancer patients who are part of the cohort of ‘vulnerable’ individuals. I have seen efforts across the country to redeploy ‘green zone’ specialists to the frontline COVID-19 response.
Although the response from green specialties, such as cancer services, has seen comprehensive planning to reduce the risk to patients, implementation of new pathways of care and preparations for recovery that are not always apparent when we discuss the ‘battle’ with coronavirus and will become increasingly important as we transition into a recovery phase.
Any treatment decision, in its basic form, is an evaluation of risk versus benefit individualised to the patient. Challenging discussions with patients evaluating risk of treatments and long-term benefit are commonplace in cancer consultations, although now, there are new and uncertain risks involved in these virtual consultations. In most cases, when faced with an uncertain risk, there is no single solution. Patients struggle with decision-making in scenarios with added complexity and it provokes anxiety among clinicians working in an ‘evidence-light’ area.
It is exactly these experiences and skills that make clinicians well placed to lead the complex problems we face across healthcare during the COVID-19 response.
For some colleagues, as the peak in COVID-19 cases reduces activity will begin to settle, while for others it is only the start of a challenging recovery where the baton is passed from acute to elective activity.
The lessons learnt from managing uncertainty, embracing change and exploiting opportunity that these unprecedented times has thus far afforded us will equip us with some of the skills required to lead the recovery in the coming months and deliver the best care we can to our patients.