Summer nights are supposed to be quiet on the children’s unit in A&E. Kids are normally healthy during the warmer months: the risk of colds and flu is low, and their bodies are invigorated by sunshine and exercise. They might suffer the odd scrape or broken bone from playing outside, but nothing that would land them in hospital in the middle of the night.
Not this summer. Something is different. I spent the first week of July working nights in the A&E of a major central London hospital, and it was full of children. Rushing between the emergency room and the ward, I barely had a moment to myself from 8pm when I started my shift to 10am when I handed over to the day team. It’s not normal. Children aren’t supposed to be this sick.
As far as I can tell, it’s largely down to a single problem. Pollution. Each night we filled more than half the beds on the paediatrics ward with children choking with asthma. This is not some mild, ordinary wheeze. Many of those we treated were in a life-threatening condition. I sat by their beds as they writhed, struggling for air, their small bodies wracked with coughs. It is a kind of torture, to fear for your next breath. You can see the sheer terror in the children’s eyes.
It’s a horrible feeling – to wonder whether a child will make it through the night. In many cases the toxic drugs and steroids we give them aren’t enough, and we have to breathe for them. Sometimes we have to put them into intensive care. Not all survive. And these are just the most obvious symptoms: studies show that air pollution is also detrimental to brain development in children, and can have adverse effects on unborn babies.
We’re in the middle of a public health crisis. Air pollution levels in London far outstrip legal limits, and it is worsening as the temperatures rise. Pollen also rises with the temperatures, and dangerous pollutants – such as nitrogen oxides (NOx) – congeal with pollens to create “super-pollens” that can be deadly. This noxious cocktail is claiming the lives of children across London, particularly those who live near busy roads or in low-lying areas; 24% of London’s primary schools are in areas that breach the legal limits on NOx.
Every year, air pollution kills 40,000 people across Britain. Roughly a quarter of these deaths happen in London. Our politicians treat this as an abstract figure – maybe they think it’s just a few years knocked off the end of life. They are wrong. The suffering is visceral. The deaths are real – we see them happening in front of our eyes. No one can fully appreciate how serious this is until they hold a wheezing infant in their arms.
My crowded children’s ward might seem like a medical problem, but it’s not. It’s a political problem. Our politicians are too reluctant to put up the right legislation or enforce the laws we do have.
As mayor of London, Boris Johnson ignored the crisis. We see the consequences of this inaction each night in A&E. Sadiq Khan’s plan for London is a step in the right direction. He put a £10 charge on the most toxic vehicles entering the city, promises to raise emissions standards for diesel vehicles by next year, and wants to start phasing out diesel buses. But, frankly, this is not good enough. Every day we have to wait is another day that my ward fills with children desperate for breath.
Paris plans to ban diesel cars by 2024 and petrol cars by 2030. There’s no reason that London shouldn’t beat them to it. The financial incentives are strong. Air pollution costs Britain more than £20bn each year. Even the most aggressive regulatory action will cost us only a fraction of that total.
It would take immense pressure off our NHS. And it would save tens of thousands of lives each year. If only those in charge of making decisions could spend one night in A&E with me to see what it’s like on the frontline of this crisis.
- Guddi Singh is a paediatric doctor in London and a fellow of the Royal Society of Medicine