Guest Blog: Urgent Care Perspective – Looking Ahead From Lockdown

I am writing this, on Sunday 10th May, with a slight feeling of anticipation in the back of my mind, knowing that later today the government will be announcing their plan for the country over the next few weeks.

Essentially I’m waiting to be told how my life is going to look in the immediate future. I think one of difficulties about the pandemic lockdown is the feeling of it being so totally outside of our control. Not only are many of the decisions we are usually free to make taken away from us by the rules of lockdown, but also we face a threat about which there is growing, but still limited, understanding.

Having control over our lives means making decisions about our actions, and how can you make a decision about something without reliable information on which to base it? When I say reliable information I am in no way deriding the scientific research that has sprung up, at a speed never before seen in the scientific literature. We know a vast amount more about SARS-CoV-2, the virus that causes the illness Covid 19, than we did 4 months ago. However, coming back to a point I’ve made before in this blog, medical science is only ever as good as where it is at, right at that moment.

In the future, the approach being used at a given moment in time may come to be understood as having been incorrect. Each study builds on what was found by previous ones, and each new finding corroborates, adjusts, or occasionally contradicts, the existing understanding. So it takes time to come to what can be accepted as ‘the truth’. Add in the fake news, abounding on social media, and we find ourselves in a situation which feels out of our control, and where we often cannot be sure of the right course of action for us when making the decisions that we are still free to make. It has become clear that this is not going away in a matter of weeks, although current research in to how many in the population are already immune, then future work on how long the immunity lasts, will give a better idea of how long stringent restrictions will be needed. We are going to have to cope, for a sustained period, with the pandemic world around us.

There some ways in which we can take back control, and some facts which we can trust. There is excellent scientific evidence, for example, that finding a way to quiet our minds regularly helps combat stress and promote wellbeing. This has been known throughout human history, with different religions building it in to their practices. Other time-honoured, as well as scientifically proven, facts relevant to this post include that outcomes are almost always better when something is dealt with before crisis point, and burdens feel more manageable when they are shared. So with those in mind let’s take stock, and take back a bit of control as we make decisions on how we as individuals will move forward into the coming weeks.

From what I’m hearing from patients, colleagues and friends it seems that experiences of lockdown can be categorised into 3 groups. The positives: increased opportunities for physical activity, more time to spend with immediate family (even if home-schooling wouldn’t be everyone’s preferred activity), a strengthened feeling of community, a requirement to appreciate what we have in the  moment when the future is so unclear, and a slower pace of life with more time to stop, reflect, and appreciate the details of our environment. The serious negatives: those suffering abuse, domestic violence, loneliness, bereavement, physical and mental ill health, abrupt suspension of NHS treatment for pre-existing illnesses, and those thrown into poverty. And thirdly, the universal stresses: anxiety about the virus, separation from family and friends, and adapting to altered routines.

Each person’s experience of lockdown will be a mix of positives and negatives in various balances, but the universal stresses every one of us will have experienced. I think now is the moment, as we creep towards an easing of lockdown, to consider how we want to make our post-lockdown future look. To think about the positives, and about the ways in which we’ve coped with the universal stresses. To plan how we are going to take that learning forward with us when life starts to speed back up again. I have been fortunate to have been made aware of many new resources for the prevention and management of stress related problems. So far I have tried mindfulness and meditation, but moved on to yoga, as it turns out that for me my mind is more still when my body is moving. A 15 mins of yoga per day App is something I really want to carry with me as we move forward out of lockdown. If you haven’t yet found your thing(s), or not sufficiently to counterbalance the lockdown stress, then my advice is to keep trying things out until you do. Although do be careful not to write something off because it doesn’t immediately fix everything 100%. All new skills/activities take practice to master, and a 20% improvement could still be enough to make the difference between feeling you can cope and feeling you cannot. One starting point with links to more information about wellbeing and mental health can be found at https://www.nhs.uk/conditions/stress-anxiety-depression/.

What we don’t want to carry with us is the damage of the serious negative experiences. And that is a really tall order when we are talking about things like bereavement when people were unable to be by their loved-one’s side, or have the funeral they would have wanted; or like being trapped with an abuser, with no prospect of even temporary escape. But there is also an unprecedented (sorry, I know it’s been rather overused that word) amount of help available. New self-help websites, support phone lines, free Apps, and NHS and charity services have come into being, prompted by the pandemic. Pre-existing sources of support continue to be delivered. Mental health support in particular has been boosted beyond what I could have imagined 6 months ago. So now is the right moment to access help, at this point, as we look ahead, trying to create as stable a platform as possible from which to build our future lives.

The array of options could actually be a little overwhelming. But please, if you are, or know, someone who is struggling, just start somewhere. If it isn’t the right service, they will be able to direct you to one that is. The most important thing is to make contact. You will not be burdening the system. Services are swinging into action, a degree of normal business is resuming, and these services are there to be used when they are needed. The NHS 111 online assessment tool (https://111.nhs.uk/) or NHS mood self-assessment (https://www.nhs.uk/conditions/stress-anxiety-depression/mood-self-assessment/) could be good starting points if you need reassurance that you are not burdening anyone unnecessarily. I have included a very limited selection of other links/phone numbers at the bottom of this post, in case anyone reading this is ready to act, and just needs somewhere to start.

I am aware that I intended to write about physical activity a little more as a follow-up from my last post, but then a pandemic got in the way. This time I’ll make no plans for the next post, let’s roll with the uncertainty ahead, and see what is relevant at the time. At some point I hope I will get the opportunity to share some amazing statistics about the benefits of physical activity for most health conditions. I don’t think research has been done about direct impact of physical activity on covid 19, but physical activity is beneficial against diabetes and helps maintain weight loss, while diabetes and obesity are risk factors for more severe illness in Covid-19.

The sentiment of the Serenity Prayer seems to fit as the final sentence of this post. I hope for us all to find ‘the serenity to accept the things we cannot change, the courage to change the things we can, and the wisdom to know the difference.’

Sources of support

This government website has loads of information, links to validated information, and helpline details. It also covers particular groups (those with dementia, autism, learning disability, and mental health problems https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-on-mental-health-and-wellbeing/guidance-for-the-public-on-the-mental-health-and-wellbeing-aspects-of-coronavirus-covid-19?mc_cid=fde42a2877&mc_eid=9960cdbfed

By Dr Kate Roberts-Lewis

The opinions expressed in this blog are those of the authors and not not necessarily those of DHU.