I love my job. For ten years I have worked at Public Health England (PHE) and its predecessor, the Health Protection Agency, responding to major public health emergencies including the ebola outbreak and the Novichok poisoning. There is nothing more fascinating than taking scientific advice, converting it into practical action, and encouraging the public to understand and support that action.
Last year I stepped down as the medical director of PHE after concluding that, with an incurable cancer diagnosed two years before, I could no longer do justice to the intensity of work needed during major national incidents such as coronavirus. Never the less I feel privileged to be involved still through an emeritus role and able to help wherever I can as the nation responds to the present crisis.
A week into March I managed to take a long-planned break with my wife in the Canaries. We arrived home, despite disrupted flights, just as Spain was going into lockdown and I was looking forward to rejoining the response effort. The very next day it was announced, based on PHE advice, that older and vulnerable people with diseases such as mine should largely stay at home for 12 weeks and limit any contact with those who do not live in the same household.
The strength of my reaction caught me by surprise – I was deeply upset. I have always considered myself fit and healthy. My way of responding to having an incurable cancer with a much-reduced life expectancy has largely been to keep calm and carry on, to live life as normally as possible including working, staying as physically active and mentally positive as I can, and spending time with those important to me, especially my family.
Suddenly this was no longer possible. I could work but only from home (back then everyone else was still travelling in to work), our children could no longer come to visit and the positive mental mindset took a quick, though mostly temporary, nosedive. None of this was because the cancer had progressed again. Rather it was to lower my risk of getting coronavirus, even though my preference was to continue more normally and accept the increased risk. More than anything I am a trained doctor and I really wanted to play my part in dealing with this pandemic. I wondered what had happened to shared decision making and patient autonomy.
After a few hours of festering, I began to think more rationally. I remembered the pandemic exercises showing that, without social distancing, many more people are infected, the NHS is unable to treat all those who need it and many more patients die as a result. I thought back, too, on a message I had tried to get across in media interviews: that we are all in this together. We all have a part to play and that includes being prepared to comply with advice on social distancing. Clearly this is a time to act collectively.
We do have a stark choice. If we can make social distancing work, we should see the peak of this pandemic in a small number of weeks. We will have supported the NHS, and many fewer lives will be lost. My part in that is to contribute what I can from home, not become another person needing NHS care, possibly with ventilation.
There are some up sides. My use of social media to stay in touch with my family has improved no end as has my ability to work from home. With the phone and internet, I can still use some of my skills as a trained doctor. At a personal level I finally decided to have a procedure that enables me to manage my cancer more at home and avoid some trips to hospital. This has helped to keep my lungs inflated – making me less likely to get complications if I do get Coronavirus – and my ability to exercise is improving again. Saving the time spent getting to work and travelling between meetings is liberating.
It is easier to find the upsides now that most people are working in the same way – I no longer feel singled out as one of the “vulnerable”. I am, of course, really looking forward to the pubs, restaurants and cinemas opening again, to travelling and to many other things getting back to normal. But in the meantime it really is possible to “keep calm and carry on". And, come what may, I will do my part.
Comment by LYNNE Tidball posted on
Very heartening, thank you.
We all need to look for any positives we can find.
That could be the present fine weather, where we might be lucky to live, any outside space we may be lucky to have, somebody to share our space, very tricky if you live alone as many do, time to do those jobs you never usually get around to and many more for different individuals.
Comment by Concepta Hite posted on
Very inspiring. Thank you.
Comment by Gill Nickson posted on
That was truly inspirational. As a mother of a doctor currently working at UCL on ICU I really appreciate the message going out
Comment by Lizzie Tempest posted on
What a great blog, thank you for sharing such a positive message.
Comment by Siobhain I’Donnell posted on
Thank you Paul. Despite the restrictions, which we should all share, the only way is to keep calm & carry on, though I appreciate this is challenging for some people.
As you have demonstrated we should concentrate on what we can do and enjoy and not on what has been put on hold for now. Much appreciation to all our colleagues and volunteers on the front line who keep us safe, our shops stocked, cared for, clean our wards etc. You are the true heros. Wish you good luck and thank you for what you are doing.
Comment by Mary E Black posted on
As ever, Paul Cosford, you enlighten us.
This made me stop and reflect on my busy day, about how important this is for my mental health, about the privilege of being able to influence with my actions. In the face of a threat our biological response is to act.
You have been constructively open about your life-limiting illness. My fathers favourite saying was ‘Mary, the graveyard is full of indispensable people.’ I always found this funny and profound. A reminder that none of us knows when our last day will be, and so we should treat each day as our last. A reminder that the world will continue without us
None of us will take our day jobs with us when we pop our clogs.
This makes it more important than ever to make sure we leave things at the end of each day in good order so that if hit by a big red bus or laid low by the Big C, others can step in.
Even more importantly, you have reminded me to take time to pause, share learning, encourage others, remind everyone that everything will end eventually - whether it is this immediate threat, or our own lives.
And also that action is not all that drives a pandemic response forwards. Wise words, a well placed joke, a gentle reflection, a pause - all are important.
Sometimes we can be too busy.
Sometimes we seek solace in busyness.
Everyone will have to face emptiness and not being important.
I find all of this comforting and I find you, Paul Cosford, to be a national treasure.
Comment by Val Messenger posted on
I really appreciate your honesty. It is really helpful to have insight into how many "vulnerable" people may be feeling. I certainly have felt some of these ups and downs myself, despite being able to continue working as normal (almost).
Comment by Sue Frossell posted on
I'm glad I took time to read this. Thanks for being so open and honest...and inspirational!
Comment by Ebere Okereke posted on
Thanks for sharing this Paul. As always an inspiration. It is and has always been a privilege to work with you and i look forward to our next meeting - by Skype of course.
Comment by Michael Warren posted on
Paul Cosford is an inspirational man. His bravery and such a measured, calm and selfless approach is admirable. I read the article in today’s newspaper and was quite moved by it.
Thank you Mr Cosford
Comment by James Walker posted on
Great attitude from a great public health doctor. Stay safe, keep calm, carry on and wash your hands often
Comment by Shiva Murugasampillay posted on
Paul many special thanks for sharing your personal and professional experience and continued commitment. This is highly motivating. I am reminded of the session you cochaired successfully with Jean-Claude Desenclos, IANPHI Secretary General - Influenza – 10 years after the H1N1 pandemic – are we prepared for the next Influenza pandemic. In this session George Fu Gao, Director General, Chinese Center for Disease Control Minwon Lee, Director General, Center for Public Health Emergency Prepardness and Response, Korea also made some excellent presentations that they appear to have turned into public health practice in response and control of COVID. Gao also gave me and us all special invitation to attend the-2020 World Influenza Conference and 3rd Flu day. Nov 1-3, 2020, Chengundu China. Very timely as public health, epidemiological and clinical principles of control of Acute Infectious Diseases such as seasonal influenza and now SARS-COVID 19 are almost the same although pathophysiology is more severe with higher R0 and morbidity and mortality. I also want to thank you and Neil for the offer to support the review and development of plan and proposal to strengthen Zimbabwe public health structure, capacity, systems and institutions towards a Zimbabwe National Public Health Institute. This may be also time for rethinking and resetting of national, regional and global-WHO-PH and CDC leadership, governance and accountability, structure and systems as we correctly respond vertically and rapidly to COVID at the same time also respond horizontally to boost surge capacity for sustainable expansion of National Health Services. Role and leadership of National Public Health Institutes and IANPHI may be strategic.Please keep safe, well and happy and will reach out to you to continue the above virtual and field work.
Comment by Mary Stanton posted on
Thank you for sharing your blog - truly inspirational and heart warming. You are an absolute credit to your profession, friends and family. May your life-limiting illness be long lasting for the best of possible reasons, and may we continue to have you in our midst to teach us gratitude and humbleness.
Keep safe and well and enjoy your exercise and other new found freedoms you have time to relish and appreciate.
Comment by Richard hopkins posted on
Comment by Eula Ellis posted on
Thank you for sharing.
Comment by Martin White posted on
Thanks for sharing Paul - wishing you all the very best over the coming months.
Comment by Christine posted on
Your words are so well expressed for us to all understand how to keep as safe as possibly we can, thus helping others.
My philosophy in life, as a person who has lived on her own, with little contact in general, for many many years, has been try and look after myself to the best I can, then others are not having to look after me, using their precious time, which could be needed for others who are in more need than I.
It is so gratifying to know others have learnt this way of life, even though it has been a sad way to discover this.
It is amazing how people thoughout our country, and also the world in general ,are coming together.
I hope you and your family continue to keep well.
Comment by Bobbie Jacobson posted on
Paul you are an extraordinary person. You have brought honesty & openness into a fraught debate about COVID19 policy. Your media interviews bring a sea of heartwarming calm into the frenzy for news- any news. Even though I don't agree with all of PHE's policies, we are lucky to have you in our profession.
I hope your treatment lasts for a very long time & that you find ways of sharing it well with your partner and family.
Comment by Prof. Paul Kingston posted on
Paul, what a read, inspirational, thank you.
As someone still working at 67 I share your initial frustration, (vulnerable me?) but with a structured day (even wearing a suit so I feel at work!), I have started to accommodate the absence of face to face natter and discussion.
Hope to be able to see you at the University again soon.
Please take care.
Comment by Rob Hicks posted on
Paul, you are, and always have been, an inspiration.
Comment by John posted on
Thank you for your measured, positive comments on Radio 4 this morning, 10th April. I was thrilled to hear your affirmation of the British public in their efforts ito comply with wise government guidelines. A superbly handled media interview in which you were not drawn into negativism. Thank you
Comment by Claire Pennell posted on
Thank you Paul, as always you are inspiring and motivating. Thank you for coming out and being so open and honest about your health issues it is a very brave thing to do. You look really well and I know we all worry about you and how much work you do. I feel proud when I see / hear you on telly and protective when you get a grilling!! I know they have to do that, you are representing PHE and we are accountable to the public!! You are doing a fab job as is Jenny H. All the best and keep safe.