14. Florence Nightingale and the Coronavirus Pandemic: Prevention, Parallels and Principles

by Lynn McDonald than 30 years after it opened. Nightingale joked to her MP brother-in-law, Sir Harry Verney: “Really, it is Florence Nightingale (1820-1910) was an early and not our fault if the number of sick has fallen so much persistent advocate of the best means to prevent the that they can’t fill their hospitals.” spread of infectious diseases—frequent handwashing —calling for it in her 1860 Notes on Nursing, and 1. Collecting the necessary data. After the Crimean adding details on the use of disinfectants in later writ- War, and learning its lessons, Nightingale began to ing. She was a pioneer of evidence-based health care, call for systematic improvements in data collection, from the lessons learned from the high mortality rates both for the military and general population. Epi- of the Crimean War (1854-56). demics have to be identified and tracked, without delay. Good weekly data on disease and death had The National Health Service, in giving the name to be produced, to become daily data as an epidemic “Nightingale Hospital” to five temporary hospitals for appeared. Nightingale called for data on health sta- COVID-19 patients is recognizing her relevance to com- tus and housing (as a major determinant of disease) batting infectious diseases. Note the parallels: to be collected routinely as part of the Census. 1. Nightingale’s own Crimean War Barrack Hospital had 2. One last parallel from then to now: the first NHS 4000 beds in 1854 and was then the largest in the Nightingale Hospital (in London’s Docklands) was world. It had high death rates, which were brought officially opened by Prince Charles, from his down dramatically by the introduction of strict sani- residence at Birk Hall, on the Balmoral estate in tary measures. She herself documented the decline Scotland. Nightingale herself stayed at Birk Hall in in deaths in a comprehensive analysis after the war. 1856, when it was the home of Queen Victoria’s 2. There are great similarities between the infectious physician, Sir James Clark, a Nightingale ally. The diseases (fevers and bowel diseases) of Nightingale’s Queen, Prince Albert and Nightingale together, at day and the coronavirus of ours: no vaccine or effec- Balmoral, pressed Lord Panmure, the secretary of tive treatment for any of them. Health care workers state for war, for a study to be done of what went help the patient through the crisis, now with respira- wrong in the high death-rate Crimean War hospitals. tors, and there is now (when available) better pro- This became Nightingale’s 853-page Notes on tective equipment for them. Given the advances in Matters Affecting the Health, Efficiency and Hospital medical sciences since Nightingale’s day, however, Administration of the British Army¸ 1858. the prospects of a vaccine and/or effective treat- Will the lessons of this coronavirus pandemic be ment for COVID-19 are great. learned? It happens that different countries/states 3. Nightingale and her team of experts learned the have adopted different measures of prevention, from lessons of the Crimean War and went on to press, thorough lockdown to mere voluntary social successfully, for higher standards in ventilation, distancing. The amount of testing done has also varied cleanliness and clean water (through improved sew- enormously from substantial numbers to only the ers and drains) in hospitals, barracks, towns and ru- worst cases. Thus, like it or not, the elements of an ral areas. The new standards worked--death rates experiment are in place. What gets the best results-- declined. the lowest number of deaths per population? 4. Evidence of this success can be seen in the declines This pandemic is likely to carry on for some time, and/ in the number of hospital beds the British Army or return in later waves. We need medical experts to needed. The vast army hospital that was built after find an effective vaccine and methods of treatment. As the war, at Netley on the south coast of England, was well, especially while waiting for such developments, over-built, its number of beds based on the usual we need Nightingale-type research, to assess the pre-Crimea percentage. That hospital was not filled success (or not) of the various measures used to limit to capacity until the Boer War of 1899-1902, more that spread.

For further on Nightingale see http://nightingalesociety.com/backgrounders/