The COVID-19 pandemic, due to the novel SARS-CoV-2 beta coronavirus, arose in Wuhan, China in December 2019. By July 2021, the virus had affected one hundred and eighty-five million people in two hundred and nineteen countries, causing four million deaths .
COVID-19 has upturned healthcare delivery and its public perception more than any other event since the inception of the NHS in 1948. We have witnessed, first-hand, how COVID variants in distant countries have rapidly reached the UK, and have seen stark limitations in healthcare systems under pandemic pressures. Reduced healthcare access has necessitated a shift to increased self-care with individuals accepting increased responsibility for pandemic suppression through personal hygiene, sanitizing, handwashing, lockdown adherence, and mask-wearing . Digitalization and remote healthcare delivery have been accepted to reduce COVID infection risk .
The COVID-19 pandemic has resulted in a resurgence of respect for the diligence, dedication, and professionalism of National Health Service health workers. . Increased volunteering and social cohesion have resulted . Finally, the COVID-19 pandemic has shone a spotlight on the environmental effects of human behavior and the necessity for global collaboration to eradicate the pandemic virus .
Figure 1: The SARS-CoV-2 virus
SARS-CoV-2 beta-coronavirus, with a 5% case fatality rate, binds with high affinity to the ACE2 receptor on human cells, and its spike protein, cleaved by TMPRSS2 exposes a fusion peptide which facilitates entry and release of viral RNA into infected cells, producing 100-1000 new virions per day. The infection fatality rate is 1% with a mean duration from symptom onset to death of 18 days. 
The COVID pandemic is the first pandemic that our generation has witnessed and increased knowledge of pandemic structures, virus pathology, replication, and dissemination processes has ensued. Populations have become aware of the vulnerability of humanity to infectious disease and the lack of a successful cure for COVID-19 has introduced widespread unease in our sophisticated, developed world. No individual has been immune from COVID-19, and our lack of autonomy over this pandemic has disturbed individuals and communities . COVID-19 has had a major impact on population mental health, with doubling in rates of self-reported depression, anxiety, and emergency psychiatric referrals.
Global tracking of COVID-19 statistics has enabled populations to witness the epidemiology and rapid spread of the virus together with its associated morbidity and mortality to a much greater extent , while televised images from around the globe have demonstrated visually the shocking adverse impacts of the pandemic. Consequently, the population responsible for the suppression of the pandemic has been realized leading to greater adherence of individuals to restrictive measures, lockdowns, and PPE use . With this greater personal sense of responsibility and involvement, greater cynicism and mistrust of government health policy have occurred . Individuals have challenged health policy to a much greater extent placing more emphasis on authoritative international voices such as the World Health Organization , direct scientific data, and views of medical professionals. Greater individual knowledge of COVID-19, epidemiology, R factors, vaccination, and health implications has resulted . Effects of globalization on health have become obvious with greater awareness of the environmental and medical risks of worldwide human behavior. Similarly, the necessity for all nations to eliminate COVID-19 to protect everyone has become clear .
Within the UK, the COVID-19 pandemic has brought a resurgence of respect and admiration for the National Health Service and the dedication, professionalism, and diligence of health care workers . The great charitable efforts of individuals such as Captain Tom and social measures such as clapping for the NHS on Thursdays have introduced greater cohesion in the battle against the disease. Communities have come together to support their vulnerable, weaker, and self-isolating members, ensuring food, safety, and medicine delivery. Individuals have been more willing to volunteer in healthcare and volunteers have contributed substantially to the production of personal protective equipment, healthcare provision, and vaccine clinic delivery. Engineering and manufacturing companies have produced PPE and ventilators for the NHS [15-16]; political red tape has been abolished to give accommodation to the homeless; unnecessary work, political tasks, and appraisals have been removed from medical staff to enable them to concentrate on clinical care; medical students have offered childcare to enable health workers to attend work; supermarkets have provided priority shopping for vulnerable individuals and health staff. Communities have stood together to support their local populations, their NHS, and their nation. The multidisciplinary collaboration of many different health professionals, researchers, nurses, pharmaceutical specialists, and key workers has been witnessed and appreciated for the first time.
Equally, limitations in health service capacity and a necessity for healthcare rationing have become more obvious to the public . Access to routine hospital care has been restricted, diagnosis of chronic disease and cancer delayed, ITU and specialist equipment insufficient, leading to complex ethical issues in clinical practice. Individuals have been grateful for their medical care from non-specialist medical or surgical staff deployed to ITU or COVID wards and have accepted care in mega-hospitals further from their homes, such as the Nightingale Hospitals. This appears to have led to an increased sense of gratitude and efforts to bolster the service and help in any way possible. Individuals have demonstrated a greater willingness to adopt self-care strategies for health and illness, using online exercise programs, pharmacy services, and community facilities to a much greater extent than before the pandemic . Inappropriate use of accident and emergency, and general practice services has declined, and populations have embraced telephone triage and telemedicine digital technology to consult remotely with their healthcare professionals for the first time . Indeed, almost 70% of UK adults were more likely to consider self-care because of the pandemic, 31% were more likely to visit a pharmacy and 51% were less likely to see a GP appointment for illness . According to a 2016 survey, “86% agreed that A&E and GP appointments should be used only when essential” . These altered attitudes to healthcare attendance and digitalized models of remote consulting provide insight and possible solutions to increase the availability of health services around the globe and reduce the unnecessary burden upon current healthcare systems. Fear of hospitalization or COVID-19 has led to under-reporting of significant symptoms in many individuals, resulting in delayed cancer diagnosis and adverse health consequences . Equally, a reduced feeling of support for health disorders has led to increased mental health issues for many individuals . Work is now needed to determine the correct balance between remote and in-person consultations, advance remote digitalization consultation solutions, support empowerment and self-care with positive mental health, and provide optimal patient care outcomes.
Finally, COVID-19 has shone a spotlight on the environmental risks of human behavior and the vital necessity to alter our habits to prevent future disease and pandemic occurrences. Relationships between global travel, urbanization, climate change, and increased human-animal contact on disease pathogenesis and pandemic occurrence are now alarmingly clear . Ironically, COVID-19, through lockdowns and the absence of non-essential manufacturing and travel, has also demonstrated the immense positive environmental change that occurs with altered human attitudes and behavior.
In summary, COVID-19 while dramatically reducing healthcare access, diagnosis of cancer, and chronic disease, has had immensely positive effects on personal responsibility for health, trust in medical professionals, self-care, and social cohesion. Empowerment of individuals to manage their health and illness, utilize health services appropriately and work together for optimal collective health outcomes have been positive outcomes of the pandemic. Equally, huge advances in remote digital healthcare technology have been made, which could in the future help secure access to high-quality healthcare globally, even in remote regions of the world. These changes in attitudes, behaviors, engagement, and personal responsibility due to COVID-19, are exactly those needed to deliver optimal global healthcare and preserve our planet and humanity.
Catherine James, Youth Medical Journal, 2022
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