It was a thought provoking discussion with Harper's Bazaar on the fatigue causing us to "tweak" (if not break) the covid regulations. With the papers bemoaning the "lack of a plan" for releasing restrictions against the concerns of the number of cases and the extreme pressure on the NHS - I thought I would reflect on what could constitute an "effective plan" using a slightly different analogy - my dad's kidney function!
If you've read my previous blogs, you will be aware that my dad went into hospital in mid-December with heart failure/oedema - which also revealed renal failure. Unfortunately while waiting to be transferred to the renal team, he caught covid on the ward which he thankfully (especially at 79 with diabetes) overcame. He was finally discharged a month later with a "treatment plan" in place. I set the background to explain how we are proceeding with his wonderful NHS medical team, and perhaps how this may inform how "planning" in the face of uncertainly could be approached.
To return to lifting lockdown - I would certainly make it clear that the papers will only ever be able to report "the highlights" of what is really going on. From what I can glean those "headlines" are:
- There is no clear plan for a "lifting lockdown" date
- There is "sort of" a plan for returning to the tiered system as lockdown lifts
- The R level is a key measure but while it appears to be falling in some places, the number of cases is still a huge cause for concern in terms of health
- The Vaccine is helpful in being able to lift restrictions - but the full effect/whether one can still "catch and transmit" after vaccination is unclear
I had a conversation with my dad at his pre-dialysis clinic last week and he said his "plan" would be to delay dialysis as long as possible if he could. It turns out this is also the "plan" from his consultant and dialysis nurse. But to ask "how long" is not the correct question. For my dad it is not possible to say to him - we'll keep you off dialysis until May...August...December - perhaps even for years because if his health takes a turn for the worse - dialysis will need to start. Therefore answering "when will lockdown be lifted" with a date - although it would help people to plan...and I do feel desperately sad for those in the leisure, travel and hospitality industries - would either result in a false sense of security where the rug may be ripped from under them at any minute or it might result in them making different plans and then being told - oh, it's ok - we're starting to "return to normal" now.
So what makes a "plan"!?
The measures my dad's team are using are his health stats:
- GFR (kidney filtration rate)
- Phosphate/Potassium/Blood Sugar etc
- Blood pressure/Weight (awareness of water retention)
(I will not bore you with the rest)...but these are regularly taken at the clinic, as well as the ones we can do being measured at home every day...as well as an overall view of his sense of personal health.
For each of these measures there is a target beyond which (or due to a combination of changes) - dialysis will need to start.
Transparency of targets will help!
This is perhaps the focus needed when it comes to lifting lockdown - the R number is clearly not the only measure - what other targets do we need eg:
- R number
- Number of people in intensive care
- Number of cases being admitted
- Number of deaths
- Number of vaccinations/second doses
- ...I am not a virologist - I don't know what else to ask - BUT I would guess that if "decisions are being made on science" - those scientific targets are the key numbers either on their own or in combination, that need to be met before lockdown can be lifted. Perhaps if THOSE numbers - or rather "The details upon which one makes the decisions" are made clear - ministers - and we, the public, know what we have to do.
To return to my father - we know that in some cases, no matter what, kidneys may just pack up - BUT in other cases, a careful monitoring of diet and exercise can preserve kidney function as long as possible. Healthy hydration and blood sugar management means less pressure on the residual function; a healthy weight means a healthy blood pressure, and makes it easier to exercise - also helping overall strength and wellbeing to keep fighting renal disease progression; daily monitoring also enables the ability to catch things before they go too far eg: a sudden weight gain may indicate water retention which in turn requires medical help. (So, like the "organiser" that I am, I have a spreadsheet where we list my dad's stats every day.)
...which brings me back to the Covid19 "science".
- if I knew what the targets were that decisions would be based on, and what measures would be helping them - I would know what to do right now.
- if I then SAW results - so perhaps if, like the R-rate, there is an accessible updated measure of the targets so we can see whether lockdown is working, or whether schools being open or shut is causing an issue in spread, or whether constant testing is actually working to contain the spread - I would be more inclined to keep doing it.
- if I then FOLLOWED THE TREND (and what I was being told by the "experts" also followed the trend - using the same data I was seeing, because transparency is key) - I might be able to make better plans for myself (regardless of the eventual decisions that are made on the larger scale)
With my dad:
- We know what's being measured and what might affect them
- We will follow the daily measurements and check the changes with the medical team weekly for any medical stats changes
- We know what is working and what is not - and are able to prepare ourselves
"Planning" is not always about making sweeping decisions - especially when a plan can only be executed based on data.
"Planning" needs to show some idea of where we are heading - lockdown into tiers/lockdown into no lockdown (or dialysis v no dialysis!)...
AND "planning" needs transparency over the data being used before said "plans" are executed.
Transparency of what we are aiming for helps us collectively:
- Know what we need to do
- Know what is working and what is not
- Have an idea of the trend - which we can then use to make our own decisions
- Have an idea of what might be going awry so we can correct it
- Work together - especially because clarity means we TOO can "trust" in the science/decision making process...or at least in our own actions before or after the broader decision, with an idea of the consequences....based on the science. If you are following the science - let us follow it too!!
Dr Audrey Tang is a chartered psychologist and author. Listen to her podcast Retrain Your Brain here; and catch her practical masterclasses Psych Back to Basics on DisruptiveTV & Energy Top Up for resilience.
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