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Tue 14 July 2020
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Dr John Ashton, a former director of public health, argues that the Prime Minister’s handling of the Dominic Cummings scandal is a tipping point in the politics of the COVID-19 pandemic.

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Since COVID-19 made its appearance in January the language of epidemiology and public health has dominated the mass and social media alike. Arguments over numbers, the meaning of Ro and Re, trend lines and histograms have competed for headlines on a daily basis with speculation over the vicissitudes and moral failings of the Prime Minister, Dominic Cummings and other government advisors.

Evidence-based politics has become a thinly veiled disguise for politically manipulated science.

We have been invited to accept that the arcane machinations of statistical modellers from Imperial College, Oxford University and the London School of Hygiene and Tropical Medicine represent ‘ Science’ of the highest order; perhaps to be seen as on a par with Albert Einstein’s Special Theory of Relativity, where the equivalent to E=MC2 might well have been brought down from the mountain by Moses himself.

For the past three months opinion has been dressed up as solid facts the provenance of which is too complicated for the comprehension of other  scientists, never mind the media or — God forbid — the public at large.

Here are some of the ‘facts’ that didn’t stand up.

  •  On TESTING AND CONTACT TRACING. In a country with such a robust and resilient public health system, it was said that the WHO Director General’s instruction to ‘test, test, test’ was an irrelevance, applicable only to underdeveloped countries. The truth was that we no longer had the capacity to test and trace because Andrew Lansley’s disastrous NHS reforms of 2013 and the centralisation of Public Health England had stripped bare the capacity of local and regional public health teams to fulfil their historic mission.
  • On PERSONAL PROTECTIVE EQUIPMENT. Unique to this country it was decided to downgrade the risk of the virus from a ‘High Consequence Infectious Disease’ requiring full personal protection for those in clinically exposed roles to ‘ Haz Group 3’. This enabled the government to pass off the failure to maintain supplies of personal protective equipment for major incidents as irrelevant in the face of a less serious viral threat.
  • On the DISCHARGE of thousands of INFECTED HOSPITAL PATIENTS to CARE HOMES, starting a second epidemic that would kill thousands. This was dismissed as a misunderstanding and a misrepresentation — that no clinician would have knowingly done that — just one of many such examples of outsourcing the blame for decisions by sleight of hand.
  • On allowing MASS GATHERINGS to take place in Bristol, Cheltenham and at Anfield in the week of 9 March, on the grounds that people at such gatherings are only in close contact for a short time, insufficient to spread the virus.
  • On the DELAY in instituting a LOCKDOWN in March on the grounds that the public will tire of it and it will be difficult to make it stick. Despite treating the public like children from the beginning of the emergency the level of compliance was extremely high but sadly too late to prevent thousands of deaths. These could have been avoided if it had been implemented earlier, according to former Chief scientist, Sir David King.

The Gloves are Off

From early in February, when it first became apparent that the Government was failing to get a grip on the emerging public health disaster and that its advisors were failing to provide the informed challenge that was their responsibility, those of us who tried to raise the alarm were first written off and disparaged as ‘ranting’ and somehow deranged. Later, as the emperor’s clothes came into clearer sight, became the object of a politically orchestrated campaign as being political, left-wing loonies, unrepentant ‘remoaners’ and worse.

However, the public has become increasingly suspicious that, in setting up the Chief Medical Officer and Chief Scientist together with a confusing array of deputies as a Praetorian guard, we have been led down a rose garden path in which evidence-based politics has become a thinly veiled disguise for politically manipulated science.

If the week beginning 9 March 2020 was the one in which the UK epidemic spiralled out of control, the last week of May, the week of the Dominic Cummings’ rank hypocrisy is another; political intimidation of the BBC to control an independent-minded Emilie Maitlis; desperate attempts to divert attention from the meltdown of government support by a reckless abandonment of lockdown; the humiliating put-down of the Chief Medical and Chief Scientist by the Prime Minister at a press conference.

Last week will surely stand out as a tipping point, not only in the political management of the COVID-19 emergency but also in a reappraisal of the place of public health, its representatives and its institutions in national life.


Two Centuries of Policy Undermined

The roots of public health run deep in the UK. The origins of the study of epidemiology ( literally ‘the study of that which is upon the people’) lie in the urban slums of the industrial revolution and the poverty studies begun by Rowntree and continued until today by Marmot. The tradition goes back 150 years to the epidemics of cholera that led to Liverpool appointing William Henry Duncan as the world’s first Medical  Officer of Health in 1847; John Snow famously confronting the select vestry in Soho to remove the handle from the Broad Street pump in 1854.

The scope of this calling was first describe by Charles Winslow, in 1920, and and subsequently revived by our former Chief Medical Officer Sir Donald Acheson in the 1980s:

“The science and art of preventing disease, prolonging life and promoting physical health and efficiency through organised community efforts for the sanitation of the environment, the education of the individual in principles of personal hygiene, the organisation of medical service for the early diagnosis and treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.”

Now is the time to remind ourselves of our proud history of public health over that almost two hundred year period, and to be aware of the cul-de-sac of treating it as a purely technical rather than a political endeavour.

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