Treatment without prejudice

We believe that all people are of equal value. Whether old or young, rich or poor, disabled or not disabled, we all share a common humanity. This was true before the coronavirus pandemic, and it remains true today.

Coronavirus is affecting different people in different ways. Many have a mild illness, but for some, it threatens their life. When severe disease strikes, there will be a choice about the types of treatment doctors offer. These decisions, though difficult, are made every day in hospitals and clinics across the country. Will a drug work? Will an intervention succeed? Or, will the side effects, the negative consequences, and the harms, outweigh the potential benefit to a person’s life?

Intensive care will not work for some patients. Ventilator support will sometimes not succeed. Doctors must judge who is most likely to improve with these measures, and who is not.

These decisions have previously always been made on a case-by-case basis, where the risks and benefits to an individual patient are carefully considered. The arbitrary condemnation of one group or another is inexcusable. Being old, living in a care home, or having a pre-existing disability should not lead to an automatic exclusion from possible treatment. Blanket categorisation of large groups of people in such a way is prejudice. There is no place for it in the NHS.

Rationing of care

There may come a time where our healthcare system is overwhelmed. But we have not yet reached that point. How we act now affects whether the country runs out of ventilators, oxygen, protective equipment, and medication. The single priority for all UK manufacturing must be the production of these goods. There is nothing more important. We must never reach the point where a person goes without a lifesaving treatment only because it is in too short supply. 

Secondary harms

The needs of those without coronavirus, but with other acute medical problems, remain despite the new pandemic. Their health must not be squandered while our attention is focussed elsewhere. 

Informal palliative care

Families must never be placed in the position to go without the support of either community-based, hospice, or hospital-based palliative care for a dying relative. Many already act as carers for their loved ones. They should not shoulder the further responsibility of administering palliative care that would otherwise only be conducted by a trained healthcare professional. Palliative care staff should not be routinely redeployed to other parts of the health service during the pandemic.

Telemedicine

The necessary shift to telephone and internet consultation presents a challenge in ascertaining objective measures of health. In normal times, a record of oxygen saturation would be a routine examination for a respiratory illness. It should be no different now. Pulse oximeters should be made widely available to all patients with coronavirus symptoms other than the most mild cases.

Unsafe working

It is immoral to request that a health or social care worker looks after patients without appropriate personal protective equipment. It jeopardises the health of the worker and their patients.

Volunteers and the newly unemployed

Volunteers are not a substitute for qualified staff. Their generosity is humbling, but they must only be offered jobs that maintain their safety and the safety of patients. 

The expertise of those now without work should not be squandered. Those with life support training and other transferrable experience may be utilised as key workers. Appropriate training, well-defined roles and written contracts must be always provided.

Immunity

The immune response to COVID-19 is not yet fully understood. Immunity may be relatively short lived. Any policy that relaxes social distancing and isolation measures must be based on robust understanding. Using ‘immunity passports’ without evidence will be futile. 

The improved civil liberties for those perceived to be immune would likely create social disharmony, and those still susceptible may seek out infection in order to resume their previous lives. This may well lead to many unintended harms.