How do you remember the major milestones of your life? Do you divide them into significant life events such the start of secondary school or use specific decades related to your age? Perhaps you may base it on geography – where your ‘home’ was at any given time?
There is a significant chance that the COVID19 pandemic may create a new form of reference point, that of everything pre- and then post-pandemic.
It’s actually quite difficult to go back to January 2020 and imagine what you thought 2020 might be like. So much has happened in the last 12 months that expectations have perhaps been irrevocably altered; leaving the retrospectoscope even more biased than it always has been.
I can objectively demonstrate that at the beginning of the year I had some funded research I would like to publish, that I was looking forward to a number of international conferences and was already wondering how winter 2020 would pan out (feeling that we’d got lucky in 2019 which hadn’t been quite as bad as 2018). I can’t quite remember what I was expecting in relation to new interventions and developments in paediatric emergency medicine but I think, even with hindsight bias, it’s reasonable to assume that I suspected many things were likely to remain in status quo.
At the beginning of 2020 there was no reliable biomarker for identifying serious bacterial illness in sepsis (and still isn’t) and by the end of 2020 management of asthma and wheeze still remains essentially unchanged (although we know magnesium sulphate nebulisers probably don’t add much). A systemic review of the management of asthma essentially said (with all respect to the authors who are just interpreting available evidence), “more research is needed”. There have been no major practice-changing studies in the management of gastroenteritis, seizures or bronchiolitis. In fact, in many countries of the world, the less is more approach to bronchiolitis was easy to implement as the public health response to #COVID19 appeared to completely remove it as a disease entity.
What about personal plans. Did you think about what you wanted to achieve at the beginning of this year?
Do you ever?
And if not why not? Should we not have a semblance of some goals, however small and sparse of detail? Or do you argue a random calendar month, which happens to be the one Julius Caesar determined a new year should start, is a poor method with which to do this?
Pushing philosophical questions aside it’s likely that COVID19 revised, or ripped up, many individuals, departments and organisations strategies. The consequences of this aren’t clear and it may never be possible to determine overall positive or negative impact. There is a delicate balance between what has been gained that wouldn’t have normally occurred versus those critical investments and interventions which haven’t. As the DFTB review has clearly highlighted the pathophysiological consequence of COVID19 on children is limited but the wider impact is potentially extreme. Regardless of which way the overall outcomes swing appropriately responding to many enforced changes is vital. The cancellation of DFTB20 was a great sadness but at the close of DFTB: Live + Connected it was clear it is possible to generate an atmosphere of collaboration and solidarity even when participants are distanced by thousands of miles. Future DFTB conferences, whether digital OR in-person, will utilise this learning for the benefit of either medium.
Without wishing to overlook the immense emotional trauma and financial hardship #COVID19 has had on society it is important that we all use 2020 to examine its impact on us as individuals. This will be through both our personal and professional lives. For the former, lockdown may have brought your immediate family and friends together, or it may have pushed them apart. In the latter, the utter transformation of healthcare services, both adult and children, will have altered your role in your department. This may have placed you in positions of leadership or responsibility that you have thrived in, or perhaps opened your eyes to a stale status quo, which had been implicitly tolerating without really enjoying. Every year brings the chance to reflect and grow but this year has given everyone a different lens with which to view their lives.
#COVID19 will have changed the world around you but I’d argue it is possible you may have changed more. 2020 may well be the milestone with which many new life journeys begin.
Let us hope that 2020 is a major milestone in the way governments view the NHS, that they appreciate that they are there to facilitate and not obstruct clinical activity and that they must plan ahead beyond the end of their nose and the next election. The present government has done its best but the scandalous running-down of the NHS between 2012 and 2019 created an impossible situation for them. No one responsible for that era has apologised or admitted fault yet.