Why did it take a pandemic to clap?

I broke my leg a few months ago. It was the last desperate action of a football match we were losing. Soon after the final whistle one of the opposition players drove me straight to the University Medical Center in Amsterdam. As I hobbled in I could feel the broken bones in my lower leg grating against one another.

A nurse showed me to a ward and I sat on a bed with my busted tibia throbbing with each surge of adrenaline. One of my mates came with me, more for language support (although my Dutch is getting better). We chatted for about half an hour about hospitals and health. In the next door cubicle was the only other patient I could see. He was with his girlfriend. Otherwise the hospital seemed empty and overstaffed. And over the next three hours Dutch student doctors would approach me to assess my fracture, ask a few questions and then depart into the night. One arrived as another disappeared. As if there was this endless supply of youthful healthcare workers.

I returned to the hospital for several weeks after that, each time to get an X-ray, see a doctor and then leave all within 45 minutes. The other day, I think about those student doctors as we clapped for health workers toiling against this rising Covid-19 tide. I wonder where they are now? After that quiet evening in October, they went to graduate into the worst health crisis in living memory. In the Netherlands we held a three-minute standing ovation on March 17. In the UK, they clap every week outside their homes at 8pm on Thursday. In New York, it’s every night at 7pm.

But why didn’t we clap before?

Partly, because we expect so much from healthcare; our expectations are set ludicrously high. We demand miracles every day. In single payer systems (as we have in the UK, Netherlands and much of Europe) we want fast pain relief, first-time right diagnosis and no waiting or delays. All at minimal expense. We don’t avoid hospitals because a visit might bankrupt us, as people do in the US. We quietly savor a good healthcare experience as a job well done, but a bad one will spread like a virus. This is where expectations are: all surgeries must be successful, all lives saved, all diseases cured. Awesomeness, all the time, forever.

Which, of course, isn’t realistic. It’s too much pressure on too few. And health care workers are in decline almost everywhere in the world. We will need an extra 18 million health workers, roughly a fifth of its current capacity, to adequately deliver care by 2030, according to the World Health Organization. By 2030 the world will be short of 7.6m nurses, which is a third of their number today. The NHS workforce gap could reach almost 250,000 within 10 years with one in eight nursing posts left vacant. In Europe, even with an increase in the last decade, the projected number of doctors and nurses won’t meet the region’s future healthcare needs.

Those forecasts were made before the coronavirus pandemic. But workforces were quietly on their knees long before that, battered by long work days, increasing pressure and the emotional intensity of their work. Burnouts among doctors range between 17.2% (Japan) and 32% (Canada), according to the WHO. Exhaustion, depression, anxiety are all very common. Around 40% of US physicians screen positive for burnout, and 7% report suicidal thinking — almost double the rate of the general working population. Medical errors are now the third-leading cause of death after heart disease and cancer in the US. And yet this crumbling of the health workforce goes largely unseen.

“I’ve heard more examples of people crying into a mirror as they don their uniform before leaving for work—sobbing to their reflection, trying to convince themselves that they must push through another shift of utter shit,” one health care worker told The Guardian.

Coronavirus is adding a new layer of pain and hardship. A study of 1257 health workers in China who attended to Covid-19 patients found symptoms of depression (50%), anxiety (45%), insomnia (34%), and distress (72%). Most countries have had to call up retired nurses and doctors to replenish their depleted workforces: the NHS sent out 65,000 letters to retirees asking them to return and help battle the outbreak. A few months ago that might have sounded like a neat synopsis for a movie: A nurse from Nottingham is called out of retirement after the arrival of a deadly pandemic. Maybe the nurse could be played by Charlotte Rampling or Francis McDormand?

The instinct to care tends to lead directly to danger. My gran was a nurse during the war. In 1937, she followed the same healthcare calling and it took her from the tiny island of Lewis in Scotland, aged just 17. She trained as a nurse at Glasgow Royal Infirmary, before signing up with Queen Alexandra’s Royal Army Nursing Corps after the war broke out in 1939. For thousands of young nurses the war was a calling. She was deployed to Accra in Ghana where she managed a military hospital with 27 local staff, responsible for wards full of sick and wounded soldiers. I have no idea what impact it had on her, as the times called for stoicism; if the war damaged you in any way, you packed it into the recesses of your mind. Stress probably wasn’t even a word that health care workers used back then.

This pandemic has had the opposite effect: despair, pain and frustration is shared. It spills out in bursts onto social media platforms. Nurses can vent their spleen at systematic failures, lack of protective equipment and public indifference. The Facebook photo of Italian nurse, Elena Pagliarini, collapsed asleep on her laptop with her mask still on her face after a 10-hour shift in the northern town of Cremona; the critical care nurse who posted a video from a supermarket car park berating stockpilers; the pleas of Shirley Watts, an ICU nurse from Basildon in England (below).

“I’m working the hardest I can, delaying toilet breaks, for a patient who I have never seen open their eyes, let alone breathe for themselves,” a junior ICU assistant writes. Simone Hannah-Clark, a New York ICU nurse writes in the New York Times:

“We are not handmaidens or angels. We are professionals in our own right. We turn treatment plans into action. We question when things don’t make sense or aren’t going to work. We find solutions that work for our patients. Nurses assess and observe, question and console. We stand between the patient and the enemy. We are the front line.”

When this pandemic started I didn’t like the use of war terminology. This isn’t a war. It’s a healthcare crisis. But how else to describe the scale of this health crisis. And the unbending sense of duty and selflessness? Gran’s journey to the Second World War was a ferry that sailed from the south coast of England to North Africa. At her destination was a war, an enemy and a duty of care. Off to the frontline. I thought about that trip the other day. I also thought about the Dutch student doctors who took the time one October evening to attend to a broken leg. Where are they now? A new deployment, a different war. That is the healthcare calling. Think about that. Because it took a pandemic to stand on the streets and clap for healthcare workers. When we probably should be clapping for them every day.

• Rob O’Brien is a writer and producer for Balance of Zero. He is a former journalist whose work has appeared in the Independent, Nikkei Asia Review, New York Times, Dazed Digital, BBC World Service and Penthouse magazine.
• Marieken van Huijstee is creative director at Shitart Amsterdam, which specialises in art direction, mural works and everything in between. For more: https://www.instagram.com/shitart.amsterdam/?hl=en