“….died with pre-existing conditions.”

What I want to do this week is to explore three of the issues that we need to learn very quickly from our experience of the infection emergency. Next week I will explore how we might embed the politics of change after the pandemic rather than allowing the possibility that it all gets blown away by the politics of ‘thank god that’s over, lets get back to normal’.

Today I want to explore a phrase that we hear on almost every news bulletin. Whenever daily death toll is announced there is usually a comment that a high percentage of those that died had done so with pre-existing conditions.

The reality is that a large proportion of the people who die from the virus have been suffering for some time from one or more of the long-term conditions that make such an impact on the lives of our population.

But it isn’t universal. One of the people I know who has had the virus – in his late 40s – had recently had very severe bronchitis and has asthma as well. The virus caused him to suffer badly from prolonged fatigue and some high temperatures – but it did not touch his lungs.

Looking at the bigger picture, I have been struck by a word the Mayor of Bergamo has been using about the virus. His community may be one of the most ravaged in the world and he says the virus is deceitful. Whilst it’s important not to anthropomorphise a virus, the word does seem very apposite since it does seem to hit some people much harder than others. We think we understand how it operates. But, when we see a recovered 106-year-old wheeled out to joyous applause and simultaneously hear about the horror of a 13-year-old dying on his own, we can only agree. The virus is indeed very deceitful.

However, the fact is that a high proportion of those that die of the virus do have existing long-term conditions, and it is this that firmly places them at the centre of our experience and anxiety about the emergency.

Regular readers of this blog will know that I have regularly discussed the failure of -not just our NHS – but the whole of society to fully engage with both prevention and much better management of long-term conditions. We all know that – before the coronavirus emergency – the vast bulk of NHS resources were spent on patients suffering with them. We also know that most of those resources are spent during the emergency, exacerbation and end of the experience of the condition.

The infection epidemic has taught us that these conditions are not just big health problems for people in their own right, but are proving to be life-threatening when  overlaid with a pandemic virus. If people had not had these pre-existing conditions it is probable that some of them would have survived.

Therefore in preparing a plan for health care that is ready for the next pandemic, we must try and reduce the impact of long-term conditions on people’s lives.

  • We need an plan to stop people from getting them.
  • We need a plan to, wherever possible, reverse the condition if people have just acquired it.
  • We need an emergency plan for much better management of conditions to reduce the debilitating impact of exacerbation.

We have always needed to deliver significant improvement on these issues. But now we know that failing to improve the incidence of ill-health has had a deadly impact on some people. We cannot plan for a future pandemic without urgently tackling this issue.

During my fallow year on the blog an excellent piece of work was published that supplements our knowledge of long-term conditions. Produced by the new All-party Parliamentary Group on Longevity it was called, The Health of the Nation. A Strategy for Healthier Longer Lives.

This report outlined issues about healthy life expectancy – the number of years that you live without a long-term condition. Published in February its main conclusion – that these conditions are not experienced evenly across different parts of our society – was important. In April, in the middle of the coronavirus emergency, it has become more than important. It really is a life-and-death matter.

The inequalities are horrible.

  • Our lowest income group has 24% fewer people in good health than the richest. In Greece, France and New Zealand the gap is 5-10%. (Report p.10)
  • Females in deprived areas are expected to spend a third of their shorter lives in poorer health. (p.29)
  • One in three patients in the poorest postcodes have 3 or more long term conditions compared to only 7% in the least deprived. (p. 30)

I’m of an age when many of my friends have long-term conditions. Stop for a minute and think about your own health and know what these stats mean for poorer people’s lives. The pain and distress for themselves and their families.

And we know what to do about it.

In the report the CMO is quoted as follows,

There are a bunch of things that we know work that are simply not happening but if they happened to most people at risk, things would improve really quite fast” (Oral evidence by Professor Chris Whitty, Chief Medical Officer, to House of Lords Science and Technology Select Committee. October 2019).

International comparisons further elaborate the point about ‘the bunch of things’ Canada treats 50% of women and 69% of men with high blood pressure. England treats 37% of men and women. (p.14)

So others seem to be committed to doing something about it.

The Secretary of State for Health and Social Care, Matt Hancock, is also quoted in the report saying,

It can’t be right that a man born in Buckinghamshire can expect 68 years of good health whilst a man born in Blackpool can only expect 53”. (Secretary of State for Health and Social Care speech at Policy Exchange. 18 December 2019)

So in terms of years of healthy life it is clear that we are not all in this together.

Now, in April 2020, everyone is quite rightly focusing on the impact of the pandemic on people’s lives. But the moment we are out of this emergency, if we want to save lives in the next pandemic, we will need to focus on these awful inequalities in the experience of long-term conditions.