Worlds Apart: Tackling the pandemic in Scotland and New Zealand

With more than half of GPs in the UK tempted to quit the profession because of Covid, Holyrood talks to two doctors from other sides of the world – one in Scotland and the other in New Zealand - about their very different experiences of the pandemic

Deborah Morris is a British-born GP who emigrated to New Zealand 24 years ago. She was due to retire on the eve of the first lockdown in March 2020 but that was put on hold. 

Andrew Cowie has been a GP at Hawkhill Medical Centre in Dundee since 1998.

Andrew: Our time scale was possibly unusual for Scotland in that we were aware of it early. I mean, everybody was aware it existed in January, right? It was in the BMJ, there were reports about possible person-to-person spread and everyone was sort of vaguely looking at it and thinking, maybe it’s just going to be another SARS. Fingers crossed.

But the slight difference for us is that my practice has got around 150 students from Wuhan because they’ve got a link with the local art college. So, we were aware of it early on. One of the partners is also married to a respiratory physician. And in late January, early February, we were looking at this patient with an interesting upper respiratory tract infection. And while we didn’t immediately think, this could be Covid, it did make us focus on what we should be doing, and questioning were there any specific plans.

And so, because we had a primary care physician and a secondary care physician who were going to be looking after these things, and they were married, Emma talked to Tom and Tom talked to Emma, and as a result, we had plans in Tayside, some way, I suspect, before the rest of the country.

Deborah: So, did that patient turn up at the surgery? 

Andrew:  They phoned, and I think because it was vaguely in the background, one of the admin people in the surgery said, ‘hey, you know, we’ve got someone here from China, who’s just phoned about making an appointment’. So, we spoke to them, and they seemed fine and indeed they were. But at the same time, we were thinking, what if they had been sick, what should we have done? And that’s when we started trying to work out what was going on. 
 

Deborah: Well, you trump me left, right and centre in terms of when you became aware, although, I must admit to also sharing the same slight smugness because even though we were behind you, very much behind you, in that curve, we were early, I think, in the context of the rest of my country.

I’d gone off to celebrate my birthday with my family on the coast and in between jumping in the water and eating good food, we spent three days really absorbing what was happening in the States and what was happening in Italy. This was mid-March, and by this point we were still allowing everybody into the country other than from China, north Italy, and South Korea. So, we were kind of aware of what was going on, but no one was talking about practising any differently.

But by the time I’d had these three days away, I came back to work on that Monday, which would have been the 16th of March, so well behind your time frame, and I went to the local hardware shop and I bought emergency tape, emergency cones, found a two metre bamboo cane and covered it in ribbon, and I proceeded to do what I could to mark out physical distance and get the patients and staff separated.

Several of the staff later came to me and said, ‘you know, we thought you were completely bonkers’. But in fact, five days on, more or less the whole country was doing it. We were well into March before we did very much. But as a practice, we were still ahead of most others in terms of the physical distancing, and it was still another week before the country went into lockdown, at which point we had over 100 cases in the country confirmed. So well done on you being so early.

Andrew: Well, you say that, but in Tayside we have these regular GP catch-ups in the evening and we had a meeting on the 11th of March. I remember we were talking about it before and questioning whether it was okay to meet face to face, but everybody was trying to work out what the heck was going on and we didn’t want a Zoom meeting or whatever, so we decided to go ahead and just tell people to space.

Three days later, one of the local practices started testing and just stopped because every test was positive and they didn’t have enough tests to carry on. At the same time, I was feeling just incredibly knackered, had a minor upper respiratory tract infection, but carried on working although I’m delighted to say that by this time we were all separated, all in our rooms, doing telephone triage. But I think we can definitely agree that meeting on the 11th [of March] was a bad idea. We went slam down into full lockdown soon after that.

What was really scary for us was that you’re looking at Lombardy and thinking, oh, my goodness, this is what happens when the hospitals fall apart, when they cannot cope. How do you ration care? And horrifically - I mean really horrifically - we were going through all our patients to try and sort of upload as much information as we could to help the hospitals, but it really felt like you were saying, save this one, save this one, save this one…I know this one, I know he’s old but he’s lovely, save him. And it was horrible. It was really, really, horrible. 

Deborah: So, we didn’t have any of that horrific sharing of information with the hospital stuff, but I was particularly pessimistic because we had a similar experience to you in that the first thing that we didn’t have enough of was the testing. We were testing anyone that had come into the country initially just from the named countries, but quite quickly, by kind of early March, we were testing everybody that came into the country full stop.

But what we weren’t doing was surveillance testing in the community. So, although the announcements are coming through that no community cases had been discovered yet, those of us in the know knew that that was because no community testing was being done, because we didn’t have enough tests.

The good news for us was that very quickly we got the tests, and very quickly we started doing a lot of surveillance testing in the community. This is where our paths do separate, because having feared for the worst, which is everything that you describe, we then saw ourselves on a path where it looked like this wasn’t going to be quite as scary for us. And we thankfully have stayed on that path. 

Andrew: So, late February, March, April was terrifying because we just didn’t know what was going to happen. We genuinely thought it was going to be, you know, drawing crosses on doors and running away. And it was horrible.

One of the things we were doing associated with this triage thing was trying to phone everybody and just say, ‘hey, how are you doing and, apropos of nothing, do you know how to jumpstart a heart if it’s stopped?’  Can you imagine thousands of conversations like that, over the phone, to elderly people? Then the papers started running headlines like ‘your GP is putting you on a death list’, and we’re going oh, my goodness, we’re really trying not to do that, we were just being realistic about what might happen. Trying to plan.

Deborah: The big lesson in this is that you never do anything too early with this pandemic. If you think something needs doing, you’re right. And it needs doing right now. It probably needed doing yesterday. And it certainly doesn’t pay to wait till tomorrow. Exponential growth doesn’t allow you that luxury of reflection.

And on that, our government’s health messaging was frigging impressive. Jacinda [Ardern, the prime minister] just kept repeating simple core messages. The first one, ‘go early, go hard’, everyone knows that. ‘Staying at home, saves lives’, everyone knows that phrase and ‘vaccination minimises lockdown’, everyone knows that too. She even explained exponential growth in a simple way. 

She did a daily 1pm briefing with the director general of health, all the science was portrayed to us by the scientists and the doctors. She was always there. And it was always followed by an extensive media question time. So there was a real sense of the information being shared. Then every evening before she went to bed, heaven knows how she found the time to do this, she did a Facebook Live, which I think captured a large kind of group of probably the younger people. She was just sitting there in her home, talking, with her kid around her.

Andrew: Impressive. It’s fair to say that I have significant differences with Boris on a huge number of different areas, but I would recognise that it was difficult, because information was coming in all the time that was different. We were desperately trying to build a new bike while we were riding one with bits falling off all over the place. So I have some sympathy, but I still think he screwed up.

I still think we should have locked down before there were definite reasons why we weren’t. Everyone was worried about what happens if you shut down the country, no one had done it before. Everyone was making it up as they went along. But the biggest problem was the country was never united, ever. I mean, we had half the papers saying locking down is ridiculous. And half the papers saying, why didn’t you lock down already? And so, because there was no obvious clear thing to do, it became political, and the moment something becomes political you’re in trouble. It became political far too early in Britain.

Deborah: And we avoided that one way or another. Jacinda Arden’s actual degree was in communications, and I think that kind of showed. I think she has a good way of getting her, as she calls us, team of five million on board. Now, obviously, when you’ve got 55 million or however many you’ve got, it is a different picture. But there still must be a clear approach. 

Andrew: Plus, her approach was working, right? Ours was manifestly not working by any means. I mean, you can argue whether it could have been better, but in short, it was an absolute dumpster fire. 

Deborah: I’m an optimist mainly, but there is a little bit of me that feels pessimistic that this was just a dress rehearsal, and that this has been a relatively kind virus. I emphasise the relatively. It didn’t, for instance, kill all our kids, or all our babies, it has tended to pick off the older at least to start with. But is this a dress rehearsal for the next one, you know, and we need to prepare for that? 

Andrew: Gosh, I know a lot of people who have decided to get out of medicine because of this pandemic and that’s fine because none of this has been easy, but you know, you don’t do medicine for the easy. And I’m going nowhere.