All the signs are that Boris Johnson will this week unveil a winter plan for Covid. Already, coronavirus deaths are running at around 1,000 a week, and the numbers of hospital admissions are growing slowly but steadily. Staff are exhausted and the outlook for the autumn and winter cannot be regarded as anything other than unsettled, uncertain and potentially very dangerous.
The government and its senior officials claim Covid should be regarded as similar to influenza and that we have to “learn to live with it”. This worryingly persistent and flawed approach ignores the hazardous and evolving nature of the virus. Perhaps the worst manifestation is the UK’s three-month delay in using the approved vaccines to protect children aged 12 to 15. Last week, Dr Anthony Fauci, the chief medical adviser to President Biden, gave a lecture to a UK public health society. He strongly backed the US policy of fully vaccinating young people for three reasons. First, children spread the virus; second, we see cases of severe Covid disease in the young; and third, we don’t know the long-term effects of infection in children. With European regulatory approval for a vaccine for children aged five to 11 expected next month, the government will soon face another decision-making challenge.
The delay in vaccinating young people is all the more surprising given that the government and their advisers have put all of their eggs into the vaccination basket. The complete lack of attention to preventive measures is shocking. We know that the virus is airborne, yet ventilation is woefully neglected – despite the excellent scientific advice provided to the government by SAGE experts. The government has been warned explicitly that the quality of ventilation in buildings across the UK is unknown and that there’s evidence that a wide range of premises are not adequately ventilated, particularly in winter. Yet children and adults are being sent back to schools, colleges and enclosed workplaces without those spaces being adequately assessed.
The law is unambiguous. Every enclosed workplace must be ventilated by a sufficient quantity of fresh or purified air. The Sars-CoV-2 virus has de facto changed the definition of fresh or purified air. As other countries are doing, the government should respond to that altered reality and fund an urgent programme of improving workplaces before winter arrives. Trade unions and professional bodies of every kind should be making it clear that preventing people from being infected through contaminated air is essential. Some groups are already collecting instances of non-mitigation with a view to future legal action.
Similarly, our knowledge of airborne transmission should be driving a change in how we use face masks. In the early days of the pandemic, because there was a shortage of masks and we thought droplets spread through coughing and sneezing were a crucial means of transmission, crudely constructed three-layer face coverings were the norm. We now know that airborne transmission is the major problem, but the public has not been told that we need to shift to the use of properly manufactured masks.
We also need to halt much of the effort put into decontaminating surfaces and objects. Surfaces are not a significant means of transmission. The cleaning might acknowledge the virus but it is misplaced and has been dubbed “hygiene theatre”.
Startling, too, is the inadequacy of public communications on Covid-19. All too often, messaging has been aimed at transferring responsibility to individuals. Pointing the finger at people who are obese, reluctant to be vaccinated or unlucky enough to have severe underlying conditions and telling them to be cautious is no substitute for what has been missing all along – an effective strategy for getting the virus under control.
The developed countries that have controlled the virus, thus saving lives, have also safeguarded their economies. The UK government seems set on continuing its bumbling and hesitant approach while engaging in a significant restructuring of the NHS and what remains of the public health system.
The failings to communicate clear and consistent messages with appropriate public health content reflects the weakness of expert public health leadership at the centre of government and the tendency of the Conservative leadership to regard anything to do with public health as being a reflection of the “nanny state”. The negative effect of the decline in the influence of public health doctors within government should not be underestimated.
The post of chief medical officer as lead adviser to government on health was created in the mid-1800s. A public health physician – a medical doctor, trained and experienced in population health – has always, until recently, occupied the post. In the past decade, the public health orientation of the post has been diminished by the appointment of doctors with specialist training in clinical medicine but not in public health medicine. This change helps to explain why preventive measures to halt Covid-19 have been inadequate and why the government response has frequently been orientated towards protecting the NHS rather than the population.
Further, it is clear that the government’s plan will be focused on the domestic. The inward-looking approach to Covid has been shocking and the refusal to learn from the experience of other countries is remarkable in a nation that has been boasting of opening itself up to the world.
The move towards universal booster doses of vaccine or adopting a three-dose vaccination regime will put greater pressure on supplies. The promises of the developed world to share vaccines with developing countries will be dented significantly by the requirement for 50% more vaccine than planned initially. The UK and the EU have shamefully opposed international demands for a patent waiver to enable stepped-up vaccine production globally. Covid-19 vaccines will become the most profitable pharmaceutical product of all time.
It’s a stark indictment of many developed countries that they stand alongside the pharmaceutical industry in restricting vaccine supplies, ignoring the simple fact that we are not safe from Covid-19 until we are all safe.