Coronavirus and social care: what does ‘learning to live’ and the ‘endemic’ stage really mean?

It has been another significant week in the Covid pandemic. I will leave it to others to comment on the shameful goings on at Number 10 Downing Street, but alongside these events and the commentary attached to it, one of the announcements that I took note off with a degree of regret was the news that the English Deputy Chief Medical Officer, Prof Jonathan van Tam will soon depart to return to his substantive post at Nottingham University.

I cannot have been the only one that liked van Tam’s metaphorical turn of phrase, not least his footballing analogies, as he attempted to convey the meaning behind complex information, science and data. One of his best moments, for me, was when he said:

“It is a bit like being 3-0 up in a game and thinking we can’t possibly lose this now. But how many times have you seen the other side take it 4-3? Do not wreck this now. It is too early to relax.”

Having been ‘that fan’ at too many Scottish lower division games I know precisely what he meant! It has, therefore, intrigued – and I will be honest irritated me a bit – that this last week so much of the discussion has been about ‘learning to live’ with the virus and moving from a pandemic to an endemic stage. I accept the hopeful prospect of both, but these are phrases which it is self-evident mean so many different things to many people, and I cannot but feel at times that we are in danger of scoring a few own goals. Indeed, the irritation I mention is that for tens of thousands of social care staff right now work and life is about surviving exhaustion and fatigue as they spend themselves in supporting those who use services in the greatest crisis anyone can remember, and not just since the start of Covid19.

It is also important to acknowledge that yesterday we passed the horrendous toll of 10,000 of our fellow Scots who have died because of this Covid virus. Talk of ‘moving on’, of ‘learning to live’ and the ‘end stage’ has to be wholly sensitive to the grief and pain, hurt and abandonment so many feel today. For so many the rawness of reality does not make us feel that life now is any easier than it has been, quite the reverse.

In this blog, therefore,  I want to reflect a little bit about these concepts of ‘living with the virus’ and the endemic phase and specifically what they may potentially mean for social care services and those who use social care support.

Language, as van Tam powerfully illustrated, is always important and there has been a sense in the past week that in the rush back to ‘normality’ that the  careful use of language and appreciation of its subtlety has gone out the window.

Take for instance the commentary that we should stop talking about the Covid pandemic and start talking about a Covid endemic stage. As Wikipedia puts it:

‘In epidemiology, an infection is said to be endemic in a population when that infection is constantly maintained at a baseline level in a geographic area without external inputs. For example, chickenpox is endemic in the United Kingdom, but malaria is not.’

There are lots of viruses and infections which are endemic, but it is not true to say that those infections are harmless or not dangerous. Smallpox is endemic but it can and will kill. So being in an endemic stage does not mean there are no risks, does not mean there is no need for measures to protect or precautions which are required for safety to ensue.

Across Europe there has in the last seven days been much chatter about us moving into the endemic phase of coronavirus. This started off last Sunday with the English Education Secretary Nadhim Zahawi, who talked about the transition from a pandemic to Covid being treated as “endemic”. After his remarks news outlets began to reflect on what living with the virus and being in the endemic stage actually means.

Alongside this the Spanish Prime Minister declared a shift in policy away from counting cases and quarantining, towards a model of managing outbreaks of diseases like influenza that seeks to protect the most vulnerable. Others countries such as France and Switzerland have followed that lead in seeking to ‘manage and diminish restrictions’ because they believe the disease is entering an endemic phase.  However, in a word of caution the World Health Organisation stated on Tuesday that it was too early to believe we were entering an endemic stage as it warned that more than half of people in Europe would catch the disease over the next two months.

Covid is undoubtedly here to stay and we will over time have to learn to balance the risk from the virus with the requirement to live our lives. It will become less threatening and hopefully more like the ‘common cold’ as the vaccine discoverer Dame Sarah Gilbert, recently told a seminar.

But of course, life is not as simple as any politician going on air and declaring their belief that we are moving into the endemic phase, as Prof Christina Pagel, from University College London and member of Independent Sage, indicated on Sky News, the endemic stage will mean that Covid is :

“present, but you don’t get exponential rises in the absence of other measures”… We’ve literally just had a month of exponential rises of Omicron in our population – so we’re not at endemic stage… You can’t just say we’re moving from pandemic to endemic. That’s the virus’ timescale. It’s not ours.”

Of course, she and others are also right in asserting that it is a naïve presumption to assume that the progress of any virus, never mind one like Covid19, is inevitably along a trajectory of ever-decreasing threat. Our ability to reduce mortality during Delta as compared with the original Wuhan strain was because of the brilliance of vaccines not the fact that Delta was less severe. Virus threat fluctuates and just like that oft heard warning– they can go up as much as can come down. In Van Tam’s metaphor – the time you are most likely to lose a goal; is when you take your eye of defence.

So what does all this mean for social care?

This last week has been a really worrying one for many who use services and supports, especially those in their own homes. Last weekend’s Sunday Times carried a story suggesting that there would be an end to freely available Lateral Flow Tests (though of course they are not free as we pay for them in our taxes.) Although subsequently denied by Westminster ministers it has left many who are clinically vulnerable in our communities concerned that one of the key protections and mitigations may be removed from the Covid defence armoury especially as nothing was said in the ‘leak’ or ‘briefing’ about social care staff and service users in the community.

Then we had the announcement of a reduction of social isolation in England to five days with two clear LFTs. Whilst this may be acceptable it is argued for the majority population on ‘economic grounds’  (though personally the reality that over a third still remain positive and potentially infective after that time questions the morality of that assessment), the lack of robust safeguards for those who receive care and support in the community, or who have anyone from electrician to friend, come across their front-door, risks imprisoning a whole sector of the population into a perpetual isolation.

The balancing of the harms caused by lockdown and other restrictions cannot be at the cost of those who for whatever reason live with vulnerabilities and who need protection from harm. They deserve equality of citizenship and attention to their basic rights as anyone else.

Why is it that we believe that returning to ‘normal’ is inevitable? What is it in the presumption that ‘progress’ is always a continuum into the future? Perhaps progress is an acceptance that things can never be as they were, that difference is part of our tomorrow, and that maturity is living with that new reality? This time last year we were speaking about a ‘new normal’ of a way of living and being in community with one another that accepted that there may be some elements of behaviour and mitigation which will need to become part and parcel of our being with one another in society. Whether that is mask wearing or testing in defined circumstances and  environments I do not know but I strongly suspect that it will mean a continued period of awareness and support for those in our care homes and those who receive social care supports in their own homes. We will need to re-think social care support.

Living with the virus needs to become a state of being responsible in relation to others not an abandonment of the knowledge we have gained in the last twenty-one months. If the science is to continue to give insight, we cannot pick and chose the bits we like and ignore the evidence of challenge.

Living with the virus will for those working in social care undoubtedly mean an awareness that we have a workforce which is exhausted and drained, many of whom today as they fight the threats of Omicron are desperate for a rest, and many of whom might well be considering can they possibly go through this again.

Living with the virus will mean a necessary requirement to adequately resource the social care sector not solely as the appendage of the acute NHS sector, or even as the enabler of independent living and individual citizenship, but as a sector and workforce that equips the whole community to continue to remain healthy and which fosters the wellbeing of those who are at particular risk. The likely demand of continuing testing, IPC measures and other mitigations and precautions requires focussed planning and strategic attention now.

Living with the virus will mean that we have to acknowledge the massive extent of unmet social care need, the drained and diminished ability of family and non-paid carers to give any more, and their desperate need for real support and practical assistance.

Living with the virus should mean that we have especial regard for those who are at most risk, a characteristic of behaviour and priority because of the priority of those individuals regardless of age, disability or circumstance who are as vital a part of our place as we are, whose creativity and contribution need to be fostered and enabled as much as yours, whose rights and dignity require to be enhanced as anyone else’s in any day.

Living with the virus requires a re-orientation of all our lives, not just the lives of the few. It is one which can only be made together, in partnership and collaboration, in engagement and consent, and cannot be achieved by a rush to the exit door of caution and precaution. We are 3-0 up let us not lose the game.

 

Donald Macaskill