Covid#12 - What would Florence Nightingale make of coronavirus?

The new Nightingale Hospital at ExCeL, London opened yesterday, having been constructed in just a couple of weeks and with eventual capacity for up to four thousand Covid19 patients.  It’s impressive but another grim symbol of the magnitude of this emergency.

Over one million people in 181 countries have now contracted the virus and 53,000 have died.  The USA recorded over a thousand deaths in a day for the first time and looks to be on the brink of a catastrophe.  The PM is still in isolation with a fever and looks dreadful.  684 more people died in the UK yesterday – as my mum keeps commenting, that’s 684 more families.  They include two nurses: Aimee O’Rourke and Areema Nasreen. 

Florence Nightingale was a medic ahead of her time.  While she never saw a pandemic on the scale of Covid19, she certainly witnessed epidemics of cholera, typhus and typhoid in the Crimea, so I wonder what she would make of our twenty-first century response to Coronavirus.

On one hand, she would probably be in awe of the hospital that now bears her name, of the doctors that will save lives there and especially of the nurses.  She would commend the cleanliness, the hygiene, the disinfection.  She would approve of the training, the professionalism and the compassion.  She would be impressed by the attention we pay to washing our hands.  She’d recognise herself in the nurses and her admiration for them would be boundless.

She would also share the widespread concerns about the lack of personal protective equipment for health and care workers.  When Nightingale herself arrived in the Crimea, she was so appalled by the lack of supplies, that one of her first purchases was of towels and she later provided enormous supplies of (amongst other things) clean shirts and soap.  Today it’s masks, visors, gowns and ventilators that are lacking. 

This week, the daughter of a healthcare assistant from London who died from Covid19 blamed his death on the Government’s failure to provide vital protective equipment.  The BMA has called the death of frontline medical staff in Italy ‘an urgent warning’.  With hospital trusts giving up on the Government and striking deals directly with private manufacturers and companies openly asking why the Government has ordered nothing from them despite asking two weeks ago what protective equipment they could make, demand has grown for answers from the Government, together with sufficient PPE.

Nightingale would be fascinated by our advances in Science and especially our capabilities to test for illnesses.  I doubt it would take her long to question why more people are not being tested for Coronavirus.  This week, the Health Secretary, Matt Hancock – fresh out of isolation himself – promised to increase testing to 100,000 a day by the end of April.  There’s a sense of panicked catch-up in his response to some bad headlines: ‘550,000 NHS staff, only 2,000 tested’ screamed Thursday’s Daily Mail.

Criticism mounted as daily coronavirus testing passed 10,000 tests per day in the UK on Thursday – two days later than promised – while Germany tested 50,000 per day.  There’s suspicion that this is a legacy of the Government’s dismissal of the need for widespread testing when the pandemic first took hold here, despite the World Health Organisation’s insistence that it was critical to slowing the spread.  There’s also scepticism about Hancock’s promise to increase testing ten-fold in a few weeks.  There are issues about lab capacity to process tests, although the Government now says it will use private companies in addition to NHS labs.  Like many of us, Florence would roll her eyes and ask why they didn’t do so sooner.  Worldwide demand for the specific reagents needed for the tests far outstrips demand.  South Korea and Germany apparently started out with greater capacity for testing – South Korea has huge virology labs following the SARS epidemic of 2003 and Germany has long been a global testing base – but both acted faster than the UK Government, which has only just called on GlaxoSmithKline and AstraZeneca to make the required reagents.  Even now, a Health Department spokesperson has clarified that the promise is to have 100,000 tests available by the end of the month, not necessarily to carry them out.  I can imagine Florence’s exasperation.

More than one person has suggested that Johnson and Hancock might do better to promise less and deliver more, but Boris does like his numbers, which more often than not need some clarifying - £350 million per week for the NHS; 50,000 new nurses; 20,000 new police officers.  Some skilled political bluster and a good slogan might deal with questions about those figures; that won’t work when the numbers of infected and dead doctors and nurses rise.

Describing Scutari Hospital in January 1855, Assistant Surgeon Henry Bellew wrote, ‘There has been somewhat unaccountable neglect in the arrangements for this hospital.’  Today’s Government tells us, ‘Stay at home.  Protect the NHS.  Save lives.’  Fears are rising, however, that the Government itself might not have done all it should to protect our doctors and nurses.  Florence Nightingale would mourn the tragic passing of Aimee O’Rourke and Areema Nasreen.  With the advances in science and medicine that have been made since the nineteenth century and the resources available now that she herself could never have drawn upon, she would also be scandalised by modern-day unaccountable neglect.