MIKEY was only 18 months old when he died. This was about 30 years ago and, other than his close family, I doubt if anyone else will remember him. But I do, and I am still filled with sadness when I recall his case. This is the story of his death.
A normally fit and happy little boy, he was admitted to hospital acutely ill and semi-conscious. A chest X-ray demonstrated a severe pneumonia but with a particular pattern suggesting that he had tuberculosis (TB), which was later confirmed. A subsequent brain scan revealed that the linings of his brain were also infected (TB meningitis); even with prompt treatment his condition was not survivable.
The death of an infant from TB is fortunately almost unheard of in this country although much more common in the Third World. It is a notifiable disease which meant that the hospital was legally required to report cases to the public health authorities who would then initiate appropriate investigations to trace the source of the infection.
This is a standard public health procedure in place for many years, the details of which were outlined and updated in a publication in 2014 by Public Health England (as it was then known): ‘Communicable Disease Outbreak Management: Operational Guidance’. This outlines the practical steps to be taken where there is an outbreak of an infectious disease, focusing on the source of the infection and those at risk of being infected.
In Mikey’s case it did not need a Poirot to investigate. His next-door neighbour, a man in his thirties, was being treated for TB. Such treatment requires a high degree of compliance by the patient, who must avoid alcohol since it reduces the efficacy of the medication. Although infectious and capable of infecting others in the early stages, after a few weeks of consistent therapy the patient may mix freely with others.
Sadly for Mikey, his neighbour was a feckless alcoholic and concerns had already been raised over his compliance with treatment. It was discovered that, in addition to being the source of Mikey’s infection, he had infected several others including one of his own children, fortunately with less serious consequences.
Public health (PH) have legal powers to intervene if individuals pose a significant health risk to others. Consequently the authorities paid a visit to the neighbour, only to discover that he was on a coach trip with his family to Blackpool to see the illuminations. The police were informed, the coach was stopped at a service station, and the man was taken to a secure health facility. This is permitted under the regulations if voluntary measures to control the spread of infection are insufficient. This eventuality requires a formal order by a magistrate and must be balanced and proportionate to the risk. However the regulations specifically state that ‘a person may be required to undergo medical examination but NOT treatment or vaccination’ (their emphasis).
Fortunately this scenario is vanishingly rare, as the PH policy document acknowledges: ‘Generally there is no need to compel people to take action to protect other people’s health.’ In other words, most of the public may be trusted to make sensible decisions about their own and others’ health and take appropriate action.
This should have been the end of the story, but several days later a story appeared in a national tabloid with a heading on the lines of ‘Man arrested on holiday for simply being ill’. It gave lurid details of police cars with flashing lights, officers bursting into the coach and bundling the man out to be taken who knows where, leaving frightened children and an upset partner. ‘How could this happen in a free democratic society?’ the tabloid asked. Surely such things were symptomatic of only the worst totalitarian regime? The journalistic outrage continued for several paragraphs.
Several of us at the hospital were so incensed by this that we wrote to the editor pointing out that there was more to this story than was given, and perhaps a coach trip, including a man with a highly infectious serious disease, was a significant reason for urgency. To the editor’s credit, a more balanced account was published a few days later.
Fast forward three decades to March 2020 and Covid, an infection much less serious than TB for most people. But at the infamous press conferences, rather than following standard PH guidance and advising sick people to quarantine for a few days and the vulnerable to take precautions with suitable support, the Government instructed the whole population, sick or well, young or old, to imprison themselves. Rather than trusting us to make our own decisions we were all treated as if we were irresponsible like Mikey’s neighbour.
What was the response of the tabloid mentioned, and other media, to this ‘totalitarian’ act? You might have expected a degree of outrage with headlines demanding the rescinding of these draconian measures, or at least some questioning of the underlying evidence. Sadly all we got was virtually total compliance and support of the government’s actions. We all had to ‘follow the science’. Indeed the media went further, with the vilification of anyone who dared to question what was happening.
Now we come to the latest infectious disease scare. Health officials have revealed that in week 46 there were 851 cases of scarlet fever in children compared with an average of 186 in previous years. Cases generally are significantly higher than in previous years. It is caused by a bacterium streptococcus group A, and it is highly infectious in younger children, though generally benign and easily treated. But tragically to date nine children have died. Experts in infectious diseases have stated that the lack of social mixing due to lockdown resulted in young children not being exposed to the multiple infectious diseases which usually circulate, rendering their immune systems poorly developed and unable to cope with common infections.
So Mikey died because of his feckless neighbour. These children are dying because a feckless government failed to follow established and tested public health policy or even to perform a proper risk assessment of their actions. And the tabloids were silent.