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Schoolkids in lockdown put home-made signs in their bedroom windows thanking brave doctors and nurses. Families stepped outside their front doors for a national round of applause. Public buildings lit up blue. Stores have offered discounts to hospital staff, and designated hours.

They are hailed as heroes in Italy and Spain as the countries bear the brunt of the coronavirus pandemic, but nowhere does the medical system stir more passion than in Britain. When the government asked for 250,000 volunteers to help, three times that number signed up.

The cult of the National Health Service has been key to so many political fortunes over the decades, but no leader has weaponized it more than Boris Johnson after years of austerity measures implemented by his Conservative Party. While peers across Europe come under strain fighting the pandemic, few have more to gain or lose from the ability of the health system to cope than the British prime minister.

During the 2016 Brexit campaign, Johnson’s message was that leaving the European Union would save £350 million ($433 million) a week to pump into the NHS, a sum later discredited. His emphatic election victory in December used the slogan “Get Brexit Done” so that the government could focus on areas like “our fantastic NHS.” The mantra for the Covid-19 pandemic is stay at home to “Protect Our NHS.”

“The cynic in me says it is easy to clap,” said Martin Lodge, a political scientist at the London School of Economics. “Emotionally the NHS is a uniting symbol. All parties know electorally the NHS is a key thing.”

The U.K. is now bracing for the disease to spread rapidly. The number of fatalities is already increasing at more than 500 a day, the level of Spain, the most deadly epicenter in Europe along with Italy, less than two weeks ago.

Signs in support of British National Health Service staff who are fighting the coronavirus outbreak are displayed at DLD College near St. Thomas' Hospital in London on Tuesday. | AP
Signs in support of British National Health Service staff who are fighting the coronavirus outbreak are displayed at DLD College near St. Thomas’ Hospital in London on Tuesday. | AP

Meanwhile, the government is relying on that regard for the NHS to keep the country united and, crucially, deflect from criticism that the heath system has been starved of the money it needs.

The last decade has seen the NHS under more pressure than at any time since it was founded in 1948, the vaunted postwar ideal of free medical care for all. Deeper-than-average cuts to hospital beds, seen previously as a sign of efficiency, are drawing scrutiny. The system has about 40,000 unfilled nursing positions and fewer doctors as a percentage of the population than countries such as France, Germany and Italy.

“What’s really noticeable in the U.K. is not so much that our funding is out of line, but that our physical capacity is much lower,” said Anita Charlesworth, director of research at the Health Foundation. “We run our system really hot.”

Health care spending has grown just 1.3 percent a year in real terms since 2009-10. That compares with annual growth of 6 percent in the preceding 13 years. When it comes to beds, many countries have scaled back as medical care advances, but Britain has cut more than most. That meant more than 9 of 10 beds were occupied before the coronavirus, according to Charlesworth. The number of doctors, nurses and MRI scanners also is below the average of a group of European countries.

“The inescapable reality is that insufficient investment in the nursing workforce over the last decade is already making it hard for nursing staff to fight the pandemic,” said Donna Kinnair, chief executive of the Royal College of Nursing, the labor union for nurses. “The government must recognize the added pressure these developments are putting on an already overstretched nursing workforce.”

Johnson and Health Secretary Matt Hancock have emphasized that any health system in the world would be unprepared to cope with an uncontained outbreak of the coronavirus, which had so far killed 2,921 people across the U.K. as of Wednesday.

Both have been infected with the disease amid mounting criticism of the government’s response, from failing to protect health care workers by testing them for the virus to giving them enough protective equipment to treat patients.

Medical staff have had to isolate with members of their family because they can’t get checked. Only 5,000 out of 1.3 million NHS employees have been tested so far. By the end of April, the government aims to process 100,000 tests a day.

Members of the public take part in an event to show thanks for Britain's National Health Service workers and frontline medical staff around the country as they battle the novel coronavirus pandemic, in London on Thursday.  | AFP-JIJI
Members of the public take part in an event to show thanks for Britain’s National Health Service workers and frontline medical staff around the country as they battle the novel coronavirus pandemic, in London on Thursday. | AFP-JIJI

The signs from elsewhere in Europe make alarming reading. Italy was forced to call in emergency help from Medecins Sans Frontieres, the group more known for working in Middle East war zones or dealing with Ebola in Africa. Spain has come under fire as hospitals became so overwhelmed that staff were forced to choose who to let die.

But in Britain, the impact could have far greater potential political ramifications that go beyond the pandemic. Indeed, one former Conservative chancellor of the exchequer famously quipped that the NHS was the closest thing the English have to a religion.

In London, the hardest hit population in the U.K. by coronavirus, medics are already reporting that some emergency departments are struggling.

The question is not just whether the NHS can cope, but whether it’s just able to cope enough. In short, whether the coronavirus infects Britain’s most-cherished institution to the point where its future viability is undermined.

The tsunami of illness means that there’s no health system, however rich, that would be prepared to deal with it, according to Rosalind Raine, a professor at the UCL Institute of Epidemiology and Health Care in London.

“As a direct result of COVID-19, people with other conditions are really going to suffer,” said Raine. She cited the example of one hospital in East London, where at least three people with the virus have died and which could delay chemotherapy appointments due to a surge in patients.

For sure, the NHS has fared better than other departments during the spending cuts in the wake of the global financial crisis. The government is also promising to plow tens of billions extra into the service by the middle of the decade. A spokesperson for the Department of Health and Social Care said the chancellor of the exchequer has made it clear the NHS will get “whatever funding it needs” to respond to the pandemic.

“There has been a massive cash injection in some much needed equipment to deal with COVID-19 and that is here to stay but do I think that will be sustained once this is over?” said Rosie Kalsi, a consultant intensivist. “No. I think there will be a correction and we will go back to the experience of continued underfunding in hospital buildings, technology and in people.”

In the meantime, there’s a national mobilization in preparation for the jump in coronavirus cases. The army helped build a new makeshift hospital with a capacity of as many as 4,000 beds in London with other facilities planned in events centers in Glasgow and other cities.

The government called on recently retired doctors to rejoin the medical workforce. Letters were sent to more than 15,000 of them in England and Wales with reportedly more than 500 doctors signing up to return to the NHS in a variety roles in the first 48 hours. Medical students in the final year are also being enabled to practice.

Companies have got involved after Johnson called on them to help produce the ventilators needed to treat the worst cases of the disease. Dyson, famous for its high-suction vacuum cleaners, said it plans to contribute, while the Mercedes Formula One motor racing team is working with academics in London to produce hundreds of breathing aids.

Grounded staff from airlines EasyJet PLC and Virgin Atlantic have volunteered as part of the effort to bring more personnel into the NHS, while some soccer clubs have made medical staff and facilities available to support the effort.

As the virus gets more entrenched in Britain, Annie Evans, a 24-year-old medical student at the University of Sheffield, is getting ready to be deployed in a hospital on the front line.

“It very much feels like the calm before the storm,” she said. “It’s a bit scary because nobody knows what’s going to happen.”

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