The Covid-19 pandemic in the UK seems to generate a never-ending stream of pivotal moments. Yet another one of these has arrived with the very strong indication that the virus is starting to spread rapidly in a substantial number of communities. With children back at school, the reopening of colleges and universities imminent, and the government trying to force reluctant employees back into offices, a substantial rise in community transmission of the virus looks likely.
This may be particularly serious in some of the most deprived communities in England where, according to information from Public Health England, the virus has continued to spread in an uncontrolled fashion. The revelation that in boroughs in the north west of England, such as Bolton, Manchester, Oldham and Rochdale, the virus was never brought under control during lockdown, and that it is now regarded as endemic, is all the proof that is needed that the government’s shambolic approach is not just costly and ineffective but dangerous.
We will probably not see the numbers infected grow with the extraordinary speed with which Covid-19 multiplied in February and March, and we are, hopefully, unlikely to see anything like the same levels of hospital admissions and deaths. A major reason for this is that a very substantial proportion of older people and those living with chronic illness are disregarding the government’s loosening of social distancing and keeping themselves safe. If the number of infections is allowed to grow, we may well see a highly age-segregated society emerge, where older people are rarely seen in public.
At present the age profile of people testing positive is relatively young, and thus hospital admissions and deaths have so far, thankfully, been few. But if the number of new infections continues to grow, it is inevitable that the virus will spill over into places such as care homes, nursing homes and hospitals. This is starting to happen. In the past week four patients on the haematology ward of a hospital in Northern Ireland have died from Covid-19 following a serious outbreak among staff in a number of different departments. It is, however, not just older people and those with chronic health problems who should be concerned. There is growing evidence that the long-term effects of infection can be serious and life-changing, and that these can affect younger people.
To avoid a very difficult and dangerous autumn and winter, the government urgently needs to abandon its highly centralised approach and shift resources and control to the local level. The hugely expensive, private sector-based, national approach to dealing with the virus must be replaced with a comprehensive Find, Test, Trace, Isolate and Support system based around local authorities, their directors of Public Health, and the mobilisation of local resources including health visitors and environmental health officers. Community leaders – and leaders of ethnic minority communities in particular – must be given a role in developing local systems that can support the complete elimination of Covid-19.
Above all, there is a need for a strategy. It is astounding that the government has no strategic plan and no publicly stated goal for controlling and eliminating the virus. That strategy should be comprehensive and include devolution of resources and control; establishment of regional co-ordinating mechanisms; implementation of a functioning system of public health controls on our borders to stop reinfection from abroad; and a willingness to examine what has been successful in other countries and how it can be replicated. Continuing along a path of proven failure should be entirely unacceptable to anyone who cares about health, social and economic well-being.
Gabriel Scally is president of the epidemiology and public health section of the Royal Society of Medicine