Monday, August 8

The winter Covid plan will be marked by delay, confusion and ignorance. Sounds familiar? | Gabriel Scally


TOAll signs are that Boris Johnson will reveal a winter plan for Covid this week. Deaths from coronavirus are already around 1,000 per week, and the number of hospital admissions is growing slowly but steadily. The staff is exhausted and the outlook for the fall and winter cannot be considered anything but unstable, uncertain and potentially very dangerous.

The government and its senior officials say that Covid should be viewed as similar to influenza and that we have to “learn to live with it.” This worryingly persistent and flawed approach ignores the dangerous and evolutionary nature of the virus. Perhaps the worst manifestation is the UK’s three-month delay in using vaccines approved to protect children aged 12-15. Last week, Dr. Anthony Fauci, President Biden’s chief medical adviser, gave a lecture to a public health society in the UK. He strongly supported the US policy of fully vaccinating young people for three reasons. First, children transmit the virus; second, we see cases of severe Covid illness in young people; and third, we do not know the long-term effects of infection in children. With European regulatory approval for a vaccine for children ages five to 11 expected next month, the government will soon face another challenge in decision-making.

The delay in vaccinating young people is all the more surprising given that the government and its advisers have put all their eggs in the vaccination basket. The total lack of attention to preventive measures is shocking. We know that the virus is airborne, but ventilation is unfortunately neglected, despite the excellent scientific advice provided to the government by SAGE experts. The government was explicitly advised that the quality of ventilation in buildings across the UK is unknown and that there is evidence that a wide range of premises are not adequately ventilated, particularly in winter. However, children and adults are being sent back to closed schools, universities and workplaces without those spaces being properly assessed.

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The law is unequivocal. Every enclosed workplace should be ventilated with a sufficient amount 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 program to improve workplaces before winter hits. Trade unions and professional bodies of all kinds should make it clear that it is essential to prevent people from becoming infected through polluted air. Some groups are already compiling non-mitigation cases for future legal action.

Similarly, our knowledge of airborne transmission should drive a change in the way we use face masks. In the early days of the pandemic, because there was a shortage of masks and we thought cough and sneeze droplets were a crucial means of transmission, roughly constructed three-layer face coverings were the norm. We now know that airborne transmission is the main problem, but the public has not been told that we should switch to wearing properly manufactured masks.

We must also stop much of the effort made to decontaminate surfaces and objects. Surfaces are not a significant transmission medium. Cleaning may recognize the virus, but it is misplaced and has been called “hygiene theater.”

Also surprising is the inadequacy of public communications on Covid-19. Too often, messaging has aimed to transfer responsibility to people. Pointing the finger at people who are obese, reluctant to get vaccinated, or who are unlucky enough to have serious underlying illnesses and telling them to be cautious does not replace what has been lacking all along: an effective strategy to control the virus.

Developed countries that I have controlled the virus, thus saving lives, they have also safeguarded their economies. The UK government seems determined to continue its clumsy and hesitant approach while engaging in a significant restructuring of the NHS and what remains of the public health system.

The lack of communication of clear and consistent messages with appropriate public health content reflects the weakness of expert public health leadership at the center of government and the tendency of the conservative leadership to view anything to do with public health as reflexive. of the “nanny state.” The negative effect of the diminishing influence of public health physicians within the government should not be underestimated.

The position of medical director as the government’s chief adviser on health was created in the mid-1800s. A public health physician, a physician trained and experienced in population health, has always held the position until recently. In the last decade, the public health orientation of the position has been undermined by the appointment of physicians with specialized training in clinical medicine but not in public health medicine. This change helps explain why preventive measures to stop Covid-19 have been inadequate and why the government response has often been geared towards protecting the NHS rather than the population.

Furthermore, it is clear that the government’s plan will focus on the national level. Covid’s introspective approach has been shocking and the refusal to learn from the experience of other countries is remarkable in a nation that boasts of opening up to the world.

Moving to universal booster doses of the vaccine or adopting a three-dose vaccination regimen will put increased pressure on supplies. The promises of the developed world to share vaccines with developing countries will be significantly affected by the requirement of 50% more vaccines than initially planned. The UK and the EU have shamefully opposed international demands for a patent exemption to allow more vaccine production globally. Covid-19 vaccines will become the most profitable pharmaceutical product of all time.

It is a harsh indictment from many developed countries who are side by side with the pharmaceutical industry in restricting the supply of vaccines, ignoring the simple fact that we are not safe from Covid-19 until we are all safe.

Gabriel Scally is Visiting Professor of Public Health at the University of Bristol and former Regional Director of Public Health


www.theguardian.com

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