How the birthplace of Epidemiology is an epidemiological failure in the COVID-19 Pandemic
It is an irony that the birthplace of epidemiology failed to adopt the principles of epidemiology!
Epidemiology is the branch of medicine which deals with how a disease spreads through a population and the ways to mitigate it. In the current SARS-Cov-2 pandemic, also known as COVID-19, it is the principles of Epidemiology which is guiding the fight against this pandemic.
Unfortunately, today UK recorded the highest death toll in a single day and probably going to have the highest death toll in Europe. Sadly, most of the people have forgotten that it is this country which has given the world the science of epidemiology.
The legacy of John Snow (not the one from GoT)
It was the year 1854 and London was having one of its worst outbreak of Cholera, a disease which spreads via contaminated water and food. However, people at that time believed that cholera was caused by pollution or a noxious form of “bad air.” John Snow, an accomplished surgeon and anesthesiologist, did something which no one had done before. He talked to the residents and used mapping to identify the source of the outbreak as the water pump on Broad Street (cross in the image). However, he could not convince the local authority as the germ theory was unknown at that time. So he did something unthinkable! He removed the handle of the water pump, rendering it unusable, and thus ending the outbreak in the locality.
He broke the chain of transmission — the key in controlling any epidemic.
The 3 t’s which were not crossed
Test, Trace and Treat — the three T s which are well known epidemiological principles that are used to achieve the fourth T — breaking the chain of transmission.
Test: This is the basic starting point of any epidemic control strategy.
“What we really need to focus on is finding those who are sick, those who have the virus, and isolate them, find their contacts and isolate them,” Dr Mike Ryan
But the UK was slow from the start and still has one of the lowest test rates among the developed countries. Germany, the country which has achieved good control so far, has tested more than 1.3 million people, approximately 15000/million population. In comparison, the UK has done only 280,000 tests so far, approximately 4000/million population. Most of these tests, till recently, were only done in patients who were admitted in the hospitals. Which meant that the majority of people who were infected with coronavirus went undiagnosed and continued spreading the virus in the community.
Trace: Contact tracing is another key principle which was never properly used in the UK. If a person tests positive for COVID19, contact tracing is used to find people who may have been exposed to that person. There are two types of ‘contacts’ — close contacts and casual contacts. Most of the countries test and isolate the close contacts for the incubation period. This minimizes the community spread. All the countries which had early and aggressive contact tracing has achieved great success so far — Vietnam, Singapore (despite a recent rise), S Korea and New Zealand.
By not adopting the aggressive Test and Trace strategy the UK could not use a key advantage — it is an island — a geographic location easy to defend against foreign enemies and epidemics.
Treat: Unfortunately, there is yet to be an effective treatment for COVID19. So the key remains to quarantine the patients and their close contacts. In UK, there was no dedicated COVID19 hospital. So the patients were treated along with other patients and showed a significant spread to ther patients and healthcare workers.
There might be many reasons why the UK did not act on the basic principles of epidemiology. But one thing is clear, South Korea, Vietnam, Japan, and Taiwan have a combined population about four times the UK’s, had less warning, and have recorded 24 times fewer deaths between them.
