T.The raw numbers around Covid-19 are simply unbelievable when you consider that it was a disease that hardly anyone had heard of in December 2019. At the time of writing, around 240,000 people in the UK have been hospitalized this year. hospital with Covid-19 and more than 70,000 people had Covid-19 listed as a cause of death on the death certificate.
I started 2020 anxious about the reports that emerged from Wuhan: they seemed to imply an asymptomatic transmission of a respiratory pathogen severe enough to put patients in intensive care units. I am a clinical academic with specialist training in respiratory medicine and intensive care; I also conduct a research program that focuses on lung inflammation caused by respiratory infections: to me and others, what was being reported seemed like a serious problem.
In response to the emergence of SARS-CoV-2, a clinical characterization study by the World Health Organization was activated on 17 January 2020, in time for admission of the first wave of patients with Covid-19 to hospitals in England and Wales. This observational patient study was first initiated in 2013 to ensure that the necessary infrastructure was available to learn about the rapid spread of new respiratory infections when needed. The first confirmed patient with Covid-19 in the UK was reported on January 31, 2020.
In early February it was clear that there was a serious problem and the ICU I work in began preparing for what might happen. We held our first multidisciplinary meeting to discuss how we would manage the emerging threat, with colleagues from public health, virology, microbiology and others who joined us on February 12. At this point, 10 cases of SARS-CoV-2 had been reported in the UK.
Things progressed rapidly and March was a hectic month for the UK’s response to the emerging pandemic. It was feared that the situation could become so bad that the UK would run out of vital equipment such as mechanical fans, resulting in the government launching the Ventilator Challenge, to research, approve and manufacture the apparatus from a wide variety of sources. Much has been written about this process, but I am sure it was necessary – I would not have agreed to help the company if I had not.
March also saw the launch of the Recovery process. As evidence of the responsiveness of the British research system in the face of the pandemic, on 17 March the study had been conceived, received ethical and regulatory approval and was ready to start recruiting patients. Since then, more than 20,000 people have participated to help us understand which therapies work for hospitalized patients with Covid-19 – a phenomenal result.
In April we were at the height of the first wave of the pandemic, and intensive care units in many areas were under severe strain. On 12 April, there were 3,301 people with Covid-19 in the UK who needed mechanical ventilation. Thankfully, this number had shrunk to less than 70 by August. However, by the end of October, it had again risen above 1,000, where it remained, and currently shows little sign of abating. It is clear that Covid-19 is not done with us yet.
In the fall, data emerged suggesting that what many thought would be nearly impossible had actually been achieved: more effective Sars-CoV-2 vaccines had been developed in less than 12 months. December 2020 saw the start of what will be a massive vaccination program in the UK starting at 50 NHS hospitals.
Such a tumultuous and difficult time prompts you to reconsider events and your role in them. Something in particular I learned this year: before 2020, I had never written a newspaper article, had never appeared on TV or even talked to a reporter about my work. I’m embarrassed to admit, I didn’t appreciate the importance of communicating science to a wider audience. The torrent of noise and misinformation during the pandemic changed my view and convinced me to start trying to explain these issues more clearly. It is not always easy to understand, but we must clearly state why the availability of skilled health personnel (and not the bed) is important and why we need both therapies and vaccines for Covid-19 to be available to all, among many other issues. .
This year also reinforced my view that building global, national and local health resilience requires commitment and long-term planning. For the NHS, this means we need to make sure we have the appropriate specialized personnel, equipment and other infrastructure to cope with the storms we may face, with the coronavirus and beyond. No one can honestly say that the UK went through 2020 without having to make tough choices and compromises that we would rather not have to face: the impact of the pandemic on the provision of health care for people with non-Covid conditions has been and continues to be, significant. On many occasions this year, doctors, patients, families, policy makers and politicians have all had to choose the least negative option in difficult circumstances. No one has been immune to the tension of this.
Most of the “victories” this year came from preparation and collaboration. An example of this is the extraordinary contribution of the National Institute for Health Research (NIHR) to the UK pandemic response. It allowed us to quickly learn about Covid-19 by supporting recruitment for observational studies such as Isaric-4C (the WHO Covid-19 study described above), React (a Covid-19 home test study) and GenoMICC (a global study initiative to understand critical illnesses) and has offered many thousands of people the opportunity to participate in clinical trials of therapies and vaccines. This work has helped change clinical practice around the world by providing important research.
As we approach 2021, I find myself once again anxious about what the new year might hold. However, I am convinced that preparedness, flexibility and commitment to collaboration are what is needed to weather the storms we may face in the coming months and years.
• Dr Charlotte Summers is a professor of intensive care medicine at the University of Cambridge