THERE’S nothing more lonesome, morbid or drear,
Than to stand in the bar of a pub with no beer . . .
Actually, I thought this Australian lament had got it wrong as I walked past my local pub*, a welcoming place but, thanks to the government’s ‘lockdown’, as far out of bounds as if it were on Alpha Centauri. It was only by gracious permission of the government that I was allowed to take my walk past it – once per day and no more!
My wife and I are not great pub-goers but we did enjoy having this one nearby, providing excellent meals, as this notice in the window reminded me, and at the sort of prices which encouraged quite frequent visits.
The notice also set off another train of thought, concerning the question of public health generally. It was the Environmental Health Officers of South Derbyshire District Council who had inspected the pub and given it their highest rating. Now that all the pubs, hotels and restaurants were closed, they must have had quite a lot of time on their hands and a great deal of unused expertise in epidemiology which ought to have contributed to ending the Covid-19 pandemic. Across the country as a whole, here was a large corps of experienced public health experts who could be deployed quickly and be expanded with recruits from recently retired colleagues – people needed just as urgently as additional nursing staff in hospitals. More so, in fact, because to stop an epidemic it is necessary to trace, track and isolate those infected very quickly before they spread the disease to the wider community.
This was exactly the sort of thing for which local government was established from around 1854 when it had been discovered that the dreadful disease of cholera was transmitted through the water supply and ‘The Great Stink’ of 1858 brought it home – even to the delicate noses of MPs and high-born peers – that the Thames had become one great sewer. Throughout the country ‘sanitary districts’ were established to clean things up and to combat infectious diseases with the best available knowledge, under local control. Whilst the problems were nationwide, they could be dealt with only locally. Every district had its own Medical Officer of Health in charge of a team, originally called Public Health Inspectors but now known as Environmental Health Officers.
With infectious diseases, it was quickly established that infected people should be isolated from the healthy population as quickly as possible. Indeed I can remember the seriousness with which this was taken in 1948 when my big sister Sue got scarlet fever. She disappeared. An old curtain soaked in disinfectant was hung across her bedroom door. Any clothes or bedclothes which came out had previously been soaked in a bath of disinfectant before they emerged. The doctor had to be satisfied before my sister could be allowed to reappear. Something must have worked because I didn’t catch scarlet fever!
In 1974 the local authority Medical Officers of Health were abolished and replaced by community physicians. Relentless centralisation followed – way beyond any local control. In Blairite reforms, the Health Protection Agency was established in 2003 and public health laboratories were transferred to NHS hospitals. Responsibility for public health was carved out of the NHS in 2012 by the Conservative Health and Social Care Act which created the quango Public Health England (PHE), supposed to protect the public from infectious disease. It is reported that PHE staff clocked up 5.1million air miles in the last three years, so its staff have been very busy at something – perhaps academic junkets to exotic places – but it is obviously semi-detached from the well-established, basic procedures of local responsibility necessary for control of infectious diseases and known for over a century.
Many things went wrong in the Seventies which built towards the present situation. On top of out-sourcing many supreme legislative powers of Parliament to the European Economic Community (a super-quango above all quangos and parliaments), the Heath government reorganised the NHS. I cannot forget my aunt, a senior nurse, sitting amidst piles of glossy folders and manuals. ‘I have read everything,’ she said, ‘and I can’t find a mention of the patients anywhere.’ The same sort of thing continued under governments of all colours in many areas of life from then onwards.
If they had been alert, the air-miles addicts of Public Health England could have learned in advance from those countries which have been far more successful at containing the infection than ourselves, places such as Singapore, South Korea, Japan, Hong Kong, New Zealand and Australia. All moved very quickly to quarantine incoming travellers and to identify and isolate people with the infection or in contact with infected people. Far fewer people died and their economies were in a position to recover more quickly.
Yet from March 12 Public Health England had stopped effective tracing. The regular presentations by government have obscured rather than clarified this dereliction of normal epidemiological practice. They are exercises in public relations and propaganda rather than anything else. On March 11, following the infection of Nadine Dorries MP, Health Secretary Matt Hancock informed the House: ‘Public Health England has world-class expertise in contact tracing which it initiated as soon as her case was confirmed.’ He did not tell MPs that they were discontinuing the programme on the following day.
Only now is the government establishing a smartphone app-based system of tracking. This is imposed from the top down. The locally available expertise was spurned in favour of an ‘eye-catching initiative’, staffed by minimum wage operators, given scripts and a day or two’s training at the most, and only now is the government considering placing incoming airport arrivals in quarantine. Meanwhile the Manchester Evening News informs us that the local authorities there still do not know how many of the people tested in their area are infected because they cannot get the information from the government!
It is only fair to mention that English local authorities are short of resources and that the prosperous Eastern countries which I have mentioned have well-established administrations and health services. But money is not the only requisite. The Indian state of Kerala has a population about half of the UK’s and its gross domestic product (GDP) per head is only £2,200, compared with ours which is £33,100. Yet Kerala has done amazingly well under its vigorous Minister of Health, a woman called KK Shailaja.
On January 20 she read about this dangerous new virus in China. She immediately began preparations and set up a control room on January 24. By the time the first case arrived on January 27 on a flight from Wuhan, Kerala had already introduced the policy of test, trace, isolate and support. Three passengers found to be feverish were isolated in hospital and the remaining passengers placed in quarantine.
At the height of the crisis170,000 people were quarantined at the state government’s expense but the rest of the 35million population could – with care – go about their business. Other precautions were taken, such as restricting public meetings and temple services.
By May 19, Kerala had reported 690 cases of Covid-19 and four deaths. Even allowing for some optimistic reporting, it is far below our total, now pushing towards 40,000 deaths in the UK. Here is a personal account from a doctor.
However we got here, we are where we are and must now hope that the lethal arrogance, incompetence and slovenliness, which the government has displayed so far, will soon be at an end. Then perhaps my local will be able to open again.
*The Hawk & Buckle, Etwall, Derbyshire hawkandbuckle.co.uk
