Remember Bergamo

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My abiding memory of Bergamo is of a wonderful short holiday spent there 10 years ago. I still wonder how such an historic, hilltop, small medieval city; gateway to the mountains and lakes of northern Italy, became the epicentre, in Europe, of the COVID-19 pandemic, writes Denis Doherty.

Denis Doherty
Denis Doherty

To their eternal credit, the hospitals in Bergamo coped admirably with what must have seemed like an existential threat to their region. The health services there must have come close to being overwhelmed but didn’t. The cemeteries in Bergamo, though, were overwhelmed. Will we ever forget the images of convoys of army trucks transporting bodies to be buried elsewhere? The dignity and respect with which that task was undertaken was striking.

At the outset of the pandemic, it would have seemed reasonable to ask – ‘What will the EU do to support Bergamo to cope and what role will it play in attempting to contain the spread of the virus? It would have seemed reasonable to assume that lessons would have been learned by the EU from the experiences of AIDS, Swine flu and Ebola, for example. The answer would have seemed incredulous to many: the EU does not have, what are known as competencies, in relation to health services. That is because the Member States have not provided the EU with the necessary authority to enable it to play a role in the improvement of health care across the Union.

The weaknesses in not having a health services entity at EU level soon became apparent. PPE, in the quantities required, could not be sourced within the EU and, worse still, vast amounts of the goods sourced from outside the EU turned out to be unsuitable, unusable and in many instances orders placed and paid for were not delivered. Pathetically, special flights to China to collect what passed for PPE featured prominently on television main news programmes.

It is surely not an option any longer to configure and staff hospitals at levels suited to meeting predictable demands and expect staff to perform heroically when surges in service needs are experienced.

Then, when the first vaccines became available, the ham-fisted attempt by the EU to prevent the export of vaccines to the UK because they had been manufactured in the EU, nearly resulted in the Brexit Agreement, Northern Ireland protocol being triggered by the UK. The early negative impact that had on EU/UK relationships, in the early post Brexit era, has still not dissipated.

Though the EU lacks competencies in relation to health care, it has competencies in relation to public health. We experienced that in relation to EU approval of COVID-19 vaccines, for example. The EU appears to have played only a passive role in relation to public health matters throughout the period of the pandemic.

It is already apparent that the configuration of hospitals, using shared wards, inadequate intensive care bed numbers, inadequate designated step-down beds and staffing levels based on historic levels of service needs, is obsolete. During COVID-19, staff were expected to perform heroically, even when their numbers were depleted, when the virus they were treating infected many of them. They did perform heroically, but at a cost to themselves and the services they provide. The claim that public health policies were based on the science of COVID19 sounded hollow when accompanied by, it seemed, another overriding concern; the need to avoid the hospitals becoming overwhelmed. It is surely not an option any longer to configure and staff hospitals at levels suited to meeting predictable demands and expect staff to perform heroically when surges in service needs are experienced.

EU Member States are now focusing on the lessons or blame attributable to how the pandemic was managed, all of it, it seems, focused on how individual Member States dealt with it. Just as 27 variants of the science were used to manage COVID-19, 27 variants of look back, review or inquiry are being considered or deployed to assemble the learning that can be derived from the experience. The scientific and medical communities will doubtless deploy their considerable resources to learn the lessons to be derived from the COVID-19 experience and WHO will be important in distilling the learning that will be derived from all of that activity. At Member State level, the focus is likely to be predominantly on the political decisions and the economic consequences being experienced. The potential to learn from the experiences of the Member States collectively does not appear to be part of the dialogue, at least not yet. How likely is it that the learning to be derived, in relation to healthcare experience across Europe, will be pursued? That’s unlikely, in my view, based on what appears to be acceptance at EU level of its current limited role in the health area and continuing unwillingness of Member States to afford the EU a role in healthcare at Union level?

If the much used motto that ’no one is safe until everyone is safe’ is meant to be more than a slogan, consideration will have to be given to the future roles of Member States and the EU within and beyond the boundaries of Member States and the EU.

Past experience would suggest that the EU tends to retreat rather than pursue the learning from major seismic events that impact all of the Member States. The ‘economic community’ origins of the Union tend to become the default position at times like this. In the years leading up to the global financial crisis, much lip service, as it turned out, was paid to developing social solidarity across the EU. When tested, economic considerations displaced all others. Disgracefully, bank debt was reclassified as sovereign debt regardless of the social and economic consequences that approach would have on the weaker member states. Most notably, the contribution of Greece to the development of much of what we hold dear in Europe went unrecognised. Greece was particularly badly served at home and in Europe during that time.

When I listen to expressions of hope for a return to what passed for normality I am tempted to proclaim; please God, don’t revisit that on us!  It seems to me that Ministers for Health, their governments and all of us need to be open to the possibility of a verdict being reached that during the past two years, in the language of Yeats    

“All changed, changed utterly:

A terrible beauty is born”.