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Instead of vilifying young people who breach physical distancing guidelines, we should focus on the social inequalities that are driving the spread of Covid-19
We read the recently published HSE Winter Plan in the knowledge that last year was the worst winter on record. Healthcare workers are looking to the Government more in hope than expectation that this plan will finally deliver the capacity to meet need. It has never been clear how twinned the economy is to hospital capacity; it was clear in the first Covid-19 surge that we had to titrate lockdowns to match our bed capacity.
By investing in acute hospital beds, ICU capacity and community step-down beds, we can cope with larger surges and keep our society and our economy more open. We can only hope that the Winter Plan, which was short on granular details, delivers the practical solutions necessary. There is no time to waste.
It is abundantly clear that modular beds must be delivered rapidly and staffed with enough consultants; nurses; health and social care professionals; medical scientists; and public health specialists so that we can provide care for all patients who need it in a timely fashion this winter as we work and live alongside Covid-19. The impact of the first surge on the already unacceptable waiting lists is that, as of September 2020, there were over 610,000 people waiting for an outpatient consultant appointment and just shy of a quarter of a million waiting over a year. There is a huge impact on people’s lived experience of delays of access to care. Some people get worse and need to present acutely.
Unlike the first wave, where essentially all routine scheduled care was postponed and staff were diverted to Covid-19 activity – be it acute inpatient care, swabbing or contact tracing – this second surge must be managed differently. We must now try to ensure that all non-Covid scheduled and unscheduled care continues in parallel with Covid-19 care.
At the time of writing there is huge focus on individual breaches of the guidelines by small numbers of young people, first in the Oliver Bond flat complex in Dublin and more most recently at the Spanish Arch in Galway. Instead of vilifying young people when a small number of them mess up, we should acknowledge and celebrate how many of them are getting it right so much of the time. We should be reflecting on our own privilege. I am married with small kids and in my late 30s. Lockdown meant my life contracted to work and home.
But let’s be honest, I’m at a life stage where that was pretty much it for me most of the time anyways. Not so my 21-year-old self or other young adults now. The cost of Covid-19 is not borne equally. As the articulate founder of WiMiNMedIreland Dr Sarah Fitzgibbon said on twitter: “We are all in the same storm, but we aren’t in the same boat.”
The reason that Covid-19 incidence is highest in Blanchardstown, Tallaght, Southwest inner city, Balbriggan and Finglas and lowest in Dún Laoghaire, Stillorgan, and Blackrock is not because of house parties. It is because of social inequality and its impact on the social determinants of health.
Many of the essential workers that kept meat in our fridges, bread in our cupboards and keep hospitals and businesses clean and open are working minimum wage jobs, living in cramped “co-living” shared accommodation and dependent on public transport to get them to work.
Their working and living conditions make it harder for them to keep the public health rules and maintain social distancing and make it more likely for them to get infected with Covid-19. Was anything more of an indictment of our society than hearing about the practice of ‘hot-bedding’ where meat plant workers working different shifts were sharing the same beds?
The next time we hear of someone young or poor slipping up and making a mistake, instead of condemning them and virtue signalling about all the sacrifices we ourselves are making, let’s pause and reflect. It is much easier for those of us who live in houses, who can drive to work and who have back gardens where we can meet with friends and social distance with ease. Instead of feeling smug, let’s reflect on how privileged we are and most essentially, we must all do our bit to call on politicians to actively address social inequality and the disproportionate impact of the pandemic on those living in poverty so that all have a living wage and safe working and living conditions.
We need to get back to basics: Social distancing, handwashing, wearing a mask, and reducing our close contacts as low as possible. By making these individual sacrifices cumulatively we will get community transmission down again, which is critical to keeping schools open and hospital capacity able to tolerate the surges. If we attend events that breach guidelines, the downstream effect could be the lack of a bed for our relative or friend who needs breast cancer surgery, inpatient Covid-19 care or a coronary artery bypass.
We all want this to be over, but we must keep working together in the interim and hospital capacity must be addressed so that all patients have timely access to care.