A Doctor Calls: Intensive Care

Intensive Care: A GP, a Community & COVID-19 by Gavin Francis

Profile Books

Pp. 198

Gavin Francis’ memoir about the outbreak of the coronavirus pandemic provides a fascinating first-hand account of how the medical profession dealt with the infection in the face of changing priorities and conflicting information. As a GP in Edinburgh, he also writes proudly of the city’s history, particularly in terms of medical science, and how that relates to current procedures. Published in 2021, this takes a contemporary view of the situation, and certain cautionary tales have proved true in upsetting ways, such as the prioritising of physical health to the detriment of mental health, and the long-term effects of this approach.

We have become inured to the word ‘unprecedented’ – indeed a popular internet meme reads ‘I could really go for some precedented times’ – but the pace of the spread of the virus was extraordinary. Francis writes, “In the space of days, what had seemed like a surreal joke became reality.” Originally doctors were ‘assured’ there was no evidence of human to human transmission, but within weeks the guidelines changed. Doctors dealt with uncertainty, lack of clear messaging and trying to allay fears as well as treat illness.

Of course things are more obvious with hindsight (although this book is written only halfway through the pandemic), and Francis is cautious with his criticism of the politics involved, but he is clearly frustrated about the lack of guidance. He believes that social distancing measures should have been introduced as soon as it became clear that the virus could spread through contact, but understands the hesitancy. While health is his priority – he is a doctor after all – he understands that not everyone will react in the same way. While noting enforced quarantines overseas, he is aware this would be problematic at home. He further appreciates the dichotomy between the suffering of the global economy compared with the recovery of the environment.

There are one or two positives to be drawn from the response to the pandemic, as Francis clutches at straws of hope, such as the speed of the response to the homeless crisis, and the recalibration of which jobs are important, “as if all the old hierarchies were being pushed aside and new possibilities were emerging.”

Some people found that after years of agoraphobia and anxiety, they now felt better as they were not pressured into going out and doing things: introverts were more accepted and acceptable. On the other hand, however, strides taken in the advance of understanding of mental health were now being pushed back. As a GP, his job is to attend to all aspects of his patients’ health, and he finds the crisis causing phenomenal mental health consequences. “Some days every call I took was about loneliness, self-harm, anxiety, panic attacks.” The lockdown may have slowed the pace of transmission, but it provoked “a silent epidemic of despair: panic and anxiety are the virus’s dark refrains, a second pandemic leaching into everyone’s lives.”

Francis writes of the history of epidemics and how public health awareness is the greatest weapon against disease. “More lives have been saved though better housing, sanitation and vaccination than were ever saved by a surgeon’s knife or a physician’s drugs.” He also writes of the development of vaccines and the public attitude to them, both contemporary and historic: it turns out the anti-vax movement is nothing new.

Francis offers some glimpses of hope and humanity, with examples of what we can achieve when we care for each other. But he also presents us with a world that has changed and will never again be the same. How we handle this crisis or challenge depends on our viewpoint and whether we believe in the overwhelming good or bad of society – and yes, there is such a thing.