Better Health For All

So as I and many others predicted some weeks ago, new cases are rising rapidly in the UK and these cases are predominantly amongst the young and the disadvantaged.

The impact on hospitalisation rates and deaths has so far been modest, which is to be expected because of the epidemiology of the disease in the under 40s, but we only have a small window of opportunity before infection rates start significantly rising in persons at much greater risk of experiencing significant morbidity and mortality.

The ‘rule of six’ is a good start but much more needs to be done if we are to achieve the prime aim of preventing significant further morbidity and mortality in the population and the secondary aim of allowing the economy to function at a reasonable level.

This is obviously not easy but i repeat again that the epidemiology of this disease is very helpful in achieving these aims and we need to follow the epidemiology.

Why is the epidemiology so helpful? Because the most at risk group, say people aged over 60 years who represent over 95% of deaths in the UK are usually retired!

So the policy that needs to be followed is simple to describe

1. Protect the most at risk, especially the elderly and those with underlying conditions, by positively discriminating in their favour by making the safe choice the easier choice for them.
2. Encourage other people to work in a Covid secure setting. For many this can mean continuing to work from home. So what needs to change?
3. Visiting to care homes and hospices should be stopped. It is reckless not to learn the lessons of the first wave. We must minimise the risk of introducing the virus into high risk settings by regularly testing staff, preventing visits and adherence to strict control of infection procedures.
4. Pubs should be closed at 10 pm. Allowing pubs to stay open for long hours encourages drunkenness and disinhibition and therefore non-adherence to viral control of transmission measures.
5. Change the regulations so that the elderly and others at high risk can maintain a 2 metre rule. So for example in a restaurant, some tables would be obliged to allow 2 metre distancing whilst others could continue to follow the one metre plus guidance. This is an example of positive discrimination.
6. A public health messaging campaign to encourage those at high risk not to engage in risky behaviour and to encourage the general public to take particular care when they are meeting persons at high risk.
7. An effective test and trace system.
   5.1 This requires a significant increase in public health staff and others in the test and trace system – as the number of new cases rise the amount of contact tracing work increases.
   5.2 An increase in testing capacity with prioritisation of the testing to those with classic Covid19 symptoms. The test needs to be accessible and provide fast, reliable results.
   5.3 End the reliance on phone contact by ensuring non-responders are visited.
   5.4 Have a more agile local system, with more control over resources and decision making.
   5.5 Integration of the app into the system.
8. Maintain messages on the fundamental need for hand washing, social distancing and mask washing to prevent transmission.
9. As lab capacity increases, a prioritised use of this capacity to detect asymptomatic infectious persons.
10. An effective quarantine system at ports of entry.

It would have been useful to have introduced measures to try to eliminate the virus a policy which has worked so effectively in countries like New Zealand but that opportunity has probably been lost.

We can expect that improvements in hospital management will mean that the mortality rate in hospital will be lower than in the first wave.

Public health messaging will need to be both sensitive and authoritative. We will be disrupting people’s normal lifestyles in important ways.

Ellis Friedman
13/09/20