One of the most memorable scenes in English literature takes place in the closing pages of The War of the Worlds, a science fiction novel written over 100 years ago by H G Wells.
In these pages, Wells describes a scene of utter devastation in which terrifyingly enormous machines that had been thought to be invincible lie motionlessly dispersed across the landscape, their frameworks split open to expose their dead occupants.
The invaders had hailed from Mars with the intention of conquering the Earth, arriving with a ferocious arsenal of weapons that overcame every line of defence we could muster. Defeat seemed inevitable until all the Martians unexpectedly died. The cause of death was the one factor that the invaders had not contemplated: microscopic organisms to which they had no immunity.
I could not help but remember this scene as I watched world leaders grapple with an enemy they also had never contemplated – an enemy that is invisible yet lethally effective and an adversary that travels across the globe without respect for borders or distances. It is invisible, yet as it advances, it leaves in its wake a stark path of illness and death. It is feeble, yet it has the ability to spread with a speed that far exceeds our abilities to contain it.
It is an adversary that can be killed with soap and water, yet vast military forces are impotent in front of it. It is a foe that efficiently and ruthlessly ravages through communities, nations and continents, dismantling local, regional, national and global economies and hurling the world into a deep recession.
Leaders from across the world, including those of Italy, France, Spain and the United States, appear dazed and confused. They are being forced to face an enemy they do not understand and whose methods cannot be neutralised.
US President Donald Trump, who commands the mightiest war machine history has ever seen, can only proclaim incremental and weak measures that are only marginally effective in stemming the inevitable march of the disease. Claims of gains and victory ring hollow in the face of the daily statistics of death and disease, compounded by the relentlessly negative reports emanating from world stock exchanges.
I have spoken of leaders, but I use this term loosely. Although these world leaders occupy the highest offices, they are not exhibiting leadership. A golden opportunity to demonstrate leadership has been squandered by the American president. It is disappointing that the warning signs that emanated from Wuhan in China were so arrogantly ignored by the US administration. Had the scientists’ warnings been heeded, containment measures could have been implemented at a much earlier stage, limiting the disease to only the Chinese epicentre. Such assertive leadership could have spared the human misery that has descended upon Europe and that is encroaching upon the US.
Alas, no such steps were taken, no leadership role was assumed, and now America is following, not leading, the rest of the world. The American people are confused. They are receiving messages from scientists and government officials that are contradictory and that generate uncertainty and heightened anxiety and even panic among some communities.
People are questioning how is it that the most prosperous nation in the world appears to be so drastically unprepared for what amounts to an infectious disease. How is it that the healthcare system in this, the most advanced of nations, has been so thinly stretched that it has become evident that its capacity to treat critically ill patients is questionable at best.
How is it that chronic federal underinvestment in research institutions and vaccines development has resulted in this national catastrophe? How is it that the prolonged inattentiveness to the effects of the privatisation of healthcare has resulted in the dramatic fragmentation of services, such that the potential for collaborative efforts on a national scale are essentially non-existent?
Hospitals have become war zones. As in all wars, there are stories of heroism and stories of heartbreak. Selfless nurses and physicians who willingly, and eagerly, expose themselves to this incurable disease are defending the front lines in this war. They are soldiers who are mounting every effort in spite of dwindling resources.
There have been reports of staff having to wash and reuse their masks and other protective equipment to reduce waste. Wearing protective equipment is a detailed and formalised process that produces body heat and sweat. Healthcare providers commonly wear this equipment for more than three or four hours, without a water break or a bathroom trip. They are often exhausted by the end of a shift and will occasionally prolong their working hours.
We have seen healthcare providers who have collapsed from fatigue and dehydration as they strive to support patients. It is at these times that we wonder how in the world have all the funds that were diverted away from healthcare and scientific research been used to advance the field of medicine and patient care.
Hospitals have also become cathedrals of humanity. This is where stories of success intermingle with tragic endings. While there have been patients who do recover and are discharged home to their families and loved ones, there have been many others who have succumbed to the disease. This is a particularly heartbreaking ending that takes place while the patient is lucid and recognises that the end is near. Sadly, that end arrives in the company of hospital staff and not with the comfort of the bedside presence of family members. This is the most difficult and most dreaded scenario that must be managed by a nurse or physician. But it is also probably the most important.
As a medical provider, and as a surgeon in particular, I may seem to possess a seemingly infinite supply of optimism. It is my custom to always search for the positives in any crisis situation. While there is no doubt that the human cost of this disease in terms of grief, misery and loss of life will be immeasurable, there will also be tangible benefits to be gained.
I am confident that as a result of this sobering experience, there will be widespread calls for a robust increase in support for the health sciences. There will be a resurgence of support for public healthcare services, and a resetting of attitudes in favour of population-based preventive actions. I am also certain that the long-cherished, long-respected and much-admired role of the healthcare provider will once more be revered.
The writer is MBBCh, FRCS, FACS former president, American Society of Metabolic and Bariatric Surgery president, Fellowship Council.
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