Covid-19 and the Golden Hour…

As countries emerge from their lockdowns and the death toll from Covid-19 recedes, it seems like an appropriate time to look back at the start of this pandemic and ask painful questions and face some hard truths. Indeed, at the recent World Health Assembly, the WHO committed itself to a review of the causes of this pandemic and how the organization responded to this outbreak.

It is likely that this review will limit itself to public health matters and skirt around matters concerning governance and culture that are too sensitive to explore. The United States’ withdrawal of support will make this exercise impotent in healing wounds and helping reconciliation.

When I trained as a surgeon, we were all required to obtained certification in Advanced Trauma and Life Support (ATLS). One key learning in trauma care is that there is a Golden Hour – an undefined period soon after trauma when prompt surgical intervention can prevent death. As a surgeon, when I reflect on the origins of this present pandemic, I cannot help but wonder if there was a golden hour that was missed.

If something went awry in that golden hour that led to the death or permanent incapacitation of the patient, a mortality and morbidity (M&M) review would ensue. These M&M reviews would not aim to assign blame but to identify any systemic failures that led to an incorrect act or an omission.

And so with the Covid-19 pandemic, the same principles and practices should apply! The first question is whether there was a missed opportunity in the golden hour sometime way back in December 2019 or January 2020 in Wuhan? Was it even possible to have intervened very early on and stop this unfolding global catastrophe?

The second more important question is whether there were systemic issues in Wuhan that prevented adequate measures being taken. Was there a problem in the way the city was governed that made it impossible for sensible doctors and health officials to act quickly and effectively.

Unfortunately the whole blame game has become very complicated. Those keen not to offend China point to her success in sharing the viral genome early, locking down Wuhan and keeping her own Covid cases and death rate low. Whilst governments who have been slow and ineffective in containing the pandemic seek to blame China for failing to contain Covid-19 within her borders.

Reading about Dr Li Wenliang who attempted to raise the alarm about this novel coronavirus is very insightful. Dr Li is remember as the whistleblower who was summoned and reprimanded for “spreading rumours” about this deadly virus . This state response is the “systemic failure” that led to officials in Wuhan messing up in that golden hour. It speaks about the nature of governance and culture that made it inevitable that the best efforts of doctors and healthcare workers would have failed.

One has to ask if an outbreak like this in a more open and less authoritarian country would have been snuffed out any earlier. The answer to that question is up for debate. Would a novel coronavirus emerging in a wet market in Taiwan, Korea or Singapore been identified early and stopped in its infancy?

As a surgeon, the death of any trauma patient who arrived alive in the resuscitation room carries with it important lessons for all. The same should be the case with Covid-19. This inferno started with a little spark that was fanned by authoritarianism, a lack of transparency and an obsession with the control of information. If these things do not change, we are doomed to have yet another pandemic in years to come.

A small disclaimer: Professor Harold Ellis who taught me anatomy once said “a surgeon knows nothing but does everything, a physician knows everything but does nothing. And a pathologist knows everything but is 24 hours too late!”. My comments which predate WHO’s review is clearly a reflection of my surgical DNA!

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