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  • michaeltinmouth

The challenges of moving from lockdown to “new norm”

We’ve had several weeks of listening to the Government, and for those outside England, listening to our devolved leaders, tell us to stay at home to protect ourselves and the NHS.

The lockdown is starting to ease, at different rates in different parts of the country, but before long it’s likely that most of us will be trying to live in a world where we are allowed to go out and do many more things but we will be trying to do them without coming into close contact with those from beyond our households.

I doubt I’m the only one bemused by the attitude of a significant proportion of the public to the idea of social distancing. On my daily walk there are people who cross the road to avoid my wife and me, and then there are those who plough determinedly ahead in family groups taking up the whole pavement. This morning I drove past a row of 16 construction workers sitting on a wall eating their morning bacon butties, and they were literally shoulder to shoulder.

For the elderly, and other groups vulnerable to Covid-19, the sad truth is that the population as a whole is either not going to remember, or isn’t going to bother, to limit the spread of the virus by staying apart. Sooner rather than later young people, and those who think it unmanly (yes it’s nearly always men) to be concerned about a virus, are going to be gathering in large groups, crowding up behind you as queue to get into a shop, and squeezing past you when you’re between them and somewhere they want to be. Few of these people will suffer any ill effects from their casual disregard for the guidelines but along the way some will acquire and spread Coronavirus and people will undoubtedly die as a result. It’s not a problem we can fix, and we probably shouldn’t even try too hard because of the backlash that would result. The best the vulnerable can do is to accept that this is primarily their problem, and to modify their own behaviour until a vaccine is available.

What does that mean? It’s very unlikely that towns and cities can be split into “strict” and “sloppy” social distancing zones where the vulnerable can choose to queue and shop only in places that follow the guidelines. The only thing they can do is to minimise the time they spend in enclosed spaces with other people. And where’s the worst place you could spend time? In all probability it’s your local hospital or your doctor’s surgery.

There is good news though – over the last couple of years GPs had already started to increase the number of consultations provided by phone. For England and Wales, in the year ending March 2019, there were 3 million telephone consultations (out of 26 million appointments), but by March 2020 that had more than doubled to 7 million (out of 35 million). The main concern that GPs have about phone consultations is whether they are missing something, so a migration to video calling addresses a large part of that concern. It’s also a much better way to establish a rapport with an unfamiliar patient. While there is no substitute for a detailed hands-on physical examination in many cases, there is a lot that can be covered well through a high-quality video call including assessing gait, movement, wounds, mental acuity etc. It’s difficult for a patient to position a phone or a tablet in such a way that they can allow the doctor the view that they need, and for most elderly people using a smartphone or tablet is simply not viable – which is where TV-based devices like Kraydel have a lot to offer.

In the last two months Kraydel has worked flat-out to accelerate the delivery of paired clinical devices – initially a clinical thermometer and a pulse-oximeter, so that we can enable self-isolating people to track key indicators and symptoms of Covid-19 and share that data with their doctors. It is now understood that one challenging aspect of Covid-19 is that it can dramatically reduce blood oxygen levels without causing the patient to feel the respiratory distress normally associated with that condition. As a result, many patients are not reaching hospital early enough for passive oxygen treatment alone to get them through the disease. Now that we know this hopefully, we’ll be monitoring the right things to reduce the need for traumatic mechanical ventilation.

Covid-19 isn’t going away soon. The best we can hope for are pulses of infection moderated by changing levels of lockdown, and almost inevitably an autumn spike as the weather becomes favourable to greater spread. But we’ll get through it, and getting through it safely means continuing to isolate as much as possible if you are elderly or otherwise vulnerable to the virus, and if you’re not vulnerable, then continuing to be a kind and thoughtful friend and neighbour to those that are isolating.

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