Covid-19 is the most serious respiratory disease to affect the world for a hundred years – but it isn’t the first. There was SARS (severe acute respiratory syndrome) in 2002 and 2004; and MERS (Middle East respiratory syndrome) from 2012, with the most recent case in the UK reported in 2018. What public health lessons can we learn from these outbreaks, to reduce future risks to our health?

Those most at risk

Those most at risk are often older, have underlying health conditions (like diabetes or heart disease) or compromised immune systems (including cancer patients receiving chemotherapy or radiotherapy). They are more likely to experience serious symptoms and to require longer periods of specialist hospital treatment.

This can place enormous pressure on even well-resourced health systems, meaning there is soon a shortage of protective equipment, ventilators and intensive care beds – increasing the risk of both mortality for patients and infection for health workers, which then compounds the problem. So, how can these risks be reduced?

Be prepared

We’re told the NHS had pandemic plans in place. And the world had already experienced SARS and MERS, meaning it can hardly have been a surprise that another serious respiratory disease might follow and that contingency plans were needed. So:

  • Why has so little testing been available?
  • Why has there been a shortage of protective equipment for health and social care workers?
  • Why has the government taken so long to ramp up the supply of ventilators?

Take testing, as an example. South Korea had arranged 316,000 tests by 20th March, compared with just 64,000 in the UK – which may help explain why South Korea has a lower mortality rate.

The UK clearly needs to be better prepared in these three key areas next time, to help it identify, track and contain the spread of any new high-risk virus.

We can also learn from other countries. For instance, China found that intermediate care units were helpful. For patients who could potentially manage without invasive ventilation support that requires an endotracheal or tracheostomy tube, special helmets are now available, providing non-invasive ventilation support – thereby reducing demand for traditional ventilators.  

Take public health seriously

Following a healthy lifestyle doesn’t guarantee a long and healthy life – but it can help you age more slowly and significantly increase your chances of living longer in good health.

This matters when there’s a pandemic like Covid-19, where those most at risk are the elderly and those with underlying health conditions. In the UK, for years we’ve concentrated resources on the NHS and on treating people once they fall ill – not on preventing people falling ill in the first place. As a result, people are spending more years in poor health. This means they are more vulnerable in a pandemic and also more likely to require intensive hospital treatment. In turn, this places significant pressure on the NHS, which may find difficulty coping with the level of demand.

If the government were to take public health seriously, as we recommend, recognizing that prevention is better than cure, then the number of people with underlying health conditions would be fewer, demand for intensive care beds and social care would be reduced and pandemics would be more manageable.

The following actions by the government would all make a positive contribution here:

Do more to tackle smoking and air pollution

Smoking and air pollution weaken our respiratory systems. This makes us potentially more vulnerable to Covid-19 and other respiratory diseases – and more likely to require lengthy specialist hospital treatment. 

So, when the Covid-19 crisis is over, we urge the government to redouble its efforts to tackle smoking and air pollution - including implementing its plan that all smokers who are admitted to hospital be offered support to stop smoking (based on the success of this approach when pioneered in Canada). 

Make prevention part of the NHS’s role 

As long as health professionals see their role as being to diagnose and treat illness not prevent it, the NHS will continue to miss opportunities to improve the nation’s health. That’s why we recommend: 

  • Prevention needs to feature more strongly as a clinical skill in the medical school curriculum and in the continuing professional development of health professionals.
  • Clinical Commissioning Groups (CCGs) be required to commission health improvement, not just the treatment of accident and illness.

Invest in public health

Public health is the front line when it comes to the nation’s health, providing the potential to hold back mental and physical illness. Yet it remains a Cinderella service. That’s why the government needs to:

  • Make the same investment in prevention as it does in cure, with investment in public health that matches that in the NHS. If it doesn’t do this it can keep building hospitals but will keep running out of beds (and doctors and nurses) as demand continues to rise.

Take new opportunities to improve the nation’s health

We spend many of our waking hours at work (and commuting to work). Think of the potential for health improvement if more employers can be encouraged to develop Health at Work initiatives. We know good work is good for health.

GPs are beginning to recognise that medication isn’t always the answer and that lifestyle changes can have a big impact on their patients’ health. So, the government should continue to expand social prescribing, to encourage physical activity and social interaction in particular.

Joined up thinking

Improvements to people’s health requires action across central government, in partnership with local government, charities and community groups not just action by individuals themselves and by the Department of Health. The Covid-19 crisis has shown the need for joined up thinking. We hope this will inspire more joined up thinking in the years ahead.

And

Given the billions of pounds we spend each year on the NHS, to help it treat illness once it has been diagnosed, it is interesting that the three main health messages from the government so far, when it comes to Covid-19, have all been essentially standard public health advice i.e.

  • Wash your hands thoroughly for 20 seconds, to kill viruses
  • Cough/sneeze into a tissue or your elbow, to reduce the spread of infection
  • Social isolation and social distance, to avoid spreading infection.

 

Michael Baber   March 2020