Rachel Cunliffe talks to the oncologist Professor Karol Sikora, chief medical officer of Rutherford Health, dean of the University of Buckingham’s medical school, and former director of the WHO Cancer Programme.
Professor Sikora is a leading voice in the medical profession, and while not an epidemiologist, has been outspoken about the UK health service’s response to the Covid-19.
His comments, particularly on Twitter, have gained traction since this crisis began and at times gone against the grain of the mainstream medical community. He has, for example, been one of few public voices to focus attention not on Covid-19 cases, but on the hidden impact of this pandemic and subsequent lockdown measures to other patients.
And that isn’t the only view that sets him apart. A quick glance at Professor Sikora’s Twitter profile reveals words that we have heard little in the last month: “encouraging”, positive”, “great news”, “progress”.
In contrast to the daily press conferences which play down the deceleration in the spread of this virus, he strikes an optimistic tone. He has posited over the last few days that we have reached the plateau of cases and hospital admissions – with the plateau in fatalities not far behind. Just today he tweeted: “More encouraging figures today – both infections and fatalities down.The lag over the weekend makes it difficult to draw firm conclusions, but it does look like we could be on the plateau of mortalities now. The numbers will bounce around, but the trend is good.”
And there’s other good news too this week. Rutherford Health, the private cancer therapy provider where Professor Sikora is chief medical officer, has begun antibody testing for its staff and patients, using testing kits from South Korea. The company hopes that the results of its testing regime could help the government roll out antibody testing across the UK to determine how many people have already had the virus – one crucial route out of lockdown.
When I chatted to him, all that was still on the horizon, but he had a lot to say about other aspects of this crisis. His underlying message was that, while the NHS has made impressive strides in preparing for the peak in cases, it is crucial to get back to normal as quickly as we can after that – for both patients and for society.
How do you think the NHS has been coping with Covid-19 so far?
There’s been fantastic organisation. Britain is very good at this. The health service management and professionals – doctors, nurses, estates management, procurement, all the rest of it – is working as a single team, because it has a central purpose. Hospitals have been transformed over the last four weeks.
The NHS is well prepared, as well as it can be. The extra hospitals are there. People have worked day and night to get to where we are. And I think we’re better organised than some other countries.
Do you have any concerns?
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The reason I think we have to steady on a bit is that cancer patients and cardio patients are being thrown under the bus at the moment. In cancer treatment, a three-week delay is neither here nor there. But if you delay it more than a month or six weeks, you are going to affect the outcomes for those patients.
And the same applies to those people waiting for things like valve replacements. We need to get those patients through the system. And we need the testing, to make sure we can keep certain parts of the hospital completely Covid-free, and therefore get on with routine care.
We’ve just got to keep the whole system moving. We can put off people who need, for example, a hip replacement or a knee replacement – it’s a bit harsh on them, but they can wait until the autumn. But if you’ve got cancer, we can’t wait until the autumn.
This is going to come to an end, and if we’ve got a cohort of cancer patients who for the next six months don’t get proper treatment, that would be terribly sad.
Do you think the government understands that?
Sort of. I don’t think they did to start with. “Get everything out that’s not Covid, everything” – that was the impression one got.
That’s now been rectified. Priority lists have been drawn up, and patients are being treated.
We’ve got to get a balance. When this started off four weeks ago, it looked as though we were going to lose that sense of balance. Now, it’s there. And I think using the private sector to build up capacity is great – for cancer and for other things.
It is going to be a bumpy ride, but we’re going to get through it in the next few weeks.
What about balancing the impact on people’s mental health
I feel so sorry for people living in small flats with their teenaged kids or small children, for example – no garden, the weather’s getting warmer, and what are they going to do? There’s only so much daytime TV you can take. People will have serious mental health issues and take it out on each other. And people living on their own are particularly adversely affected.
The most important thing is getting everyone back to a semblance of normal. Not the medically vulnerable and the elderly, but gets everyone else back to normal as soon as we pass the bulge in NHS usage.
And what about an exit strategy?
Allowing small businesses and shops to open is the first thing. You could do it in two weeks’ time, three weeks’ time. And then see what happens. Measure the incidence, but still keep the older people and the people with illnesses semi-secluded. And then gradually open it up. Follow the rate of infection in the community.
Depending on what happens, you can reduce social distancing. You let the virus circulate and look at the incidence.
If it’s true that lots of people have actually already been infected, then we’ll get to herd immunity. When 60 per cent of the population has been infected, the virus has nowhere to go.
Testing the whole population for antibodies is just unrealistic. You might be able to do it in South Korea but you’re not going to be able to do it here, we’re not that disciplined. But you can certainly test 50,000 people. Look at it, work out how many have had symptoms, how many haven’t, and then you know the patter for what’s going happen.
This has brought society together. But the quicker we can get out of the, the better.