Last year around this time I was writing an article about my ‘predictions’ for the year ahead regarding public health. While I sit here now starting a new one, I sadly think that we, as a nation, haven’t seen much effort put towards the basic public health principles during 2023. Therefore, I am doubtful we are going to experience major improvements in 2024. My main concerns reside in the growing number of chronically ill individuals in the population and the increase in antibiotic resistance.
Sars-Cov-2 prevalence in the UK
Practically four years on since the pandemic struck, we are still facing thousands of infections with the start of yet another wave with the new sub-variant JN.1 that is reaching dominance. The WHO has classified it as a sub-variant of interest.
According to the Winter Covid-19 infection survey from December 2023, the prevalence of the Sars-Cov-2 was 4.2%. In other words, one in 25 people are infected. This percentage is higher than the one from November last year, which was around 1.7%, one in 65 people! It is not a progress, is it?
Taking into consideration these statistics and the fact that the Joint Committee on Vaccination and Immunisation (JCVI) has advised that only adults aged 65 years and over receive the vaccine, it is not difficult to predict that the number of individuals with Long Covid will increase substantially. It is more than time for the government and the JCVI to have a broader vision of the real impacts of their decisions and to recognise that their non-standard method of cost-effectiveness is unrealistic.
Number of individuals with Long Covid in the UK
The last data provided by the UK Office for National Statistics (ONS) is from March 2023. By that time, the approximate number of people presenting symptoms of Long Covid was 1.9 million (3% of the population). Not much difference from December 2022 when the number was approximately 2.2 million (3.4% of the population).
Although we know that the probability of developing Long Covid is lower than it was in 2020 after first infection with no vaccine, the repeated waves transform the small percentages of affected individuals into a large number. And this number of affected individuals has with no doubt not only an impact on the need of the NHS but also on the increase of individuals leaving the workforce.
What about a silent pandemic: antibiotic resistance?
Antibiotic resistance nowadays is positioned among the top ten global public health threats according to the WHO, which reported 5 million deaths in 2019. Among the plausible causes are misuse and overuse of antibiotics, health inequality and poverty – poor access to vaccination and medicines and lack of a resilient legislation.
England has not only seen a rise of 4% in antibiotic resistance from 2021 to 2022, but also a rise in the prescription of antibiotics that rose 8.4% from the year 2021. The bacteria that causes sepsis, Klebsiella pneumoniae, is becoming resistant to a range of antibiotics such as cephalosporins – from 13.5% in 2018 to 17% in 2022 and piperacillin – from 15% to 20%. In Scotland the use of antibiotics has decreased by 17% since 2017. Resistance to E. Coli has decreased and K. pneumoniae hasn’t changed. Important to note however is that the Scottish report was from 2021 and results might have been affected due to changes in healthcare delivery and treatment options due to the Covid-19 pandemic.
Therefore, a question that comes to my mind is; how can we deal with antibiotic resistance during a pandemic or with a health system that lacks resilience? The death rates due to antibiotic resistance is correlated to availability of oxygen, ventilators and obviously a good infection prevention and control protocol. Can our NHS isolate patients and have all the staff gowned? Are our governments sustaining the funds for research, mainly with regard to the use of AI that speeds up the process of finding antibiotics and/or metagenomics – genetic material study using environmental samples? What about the willingness to provide economic incentives to produce new antibiotics, since these don’t lead to profits?
Lessons for the future?
When I think about lessons for the future, I see myself repeating what I have already mentioned in my previous articles.
There is a need for a resilient health system due to absence of a strong primary and preventive care system. Focusing on building a strong surveillance system, mainly when we think about identifying new pathogens leading to asymptomatic or mild disease. Respect for mother nature – deforestation, climate change, refugee displacement, civil wars – all of these affect the pattern of infectious disease transmitted from animals to humans. Put an end to misinformation and make science more accessible to citizens in an attempt to decrease the appalling increase of vaccine deniers, which aggravated during the Covid-19 pandemic.
And if I am being repetitive, it means lessons haven’t been learned. Lessons that are simple and straightforward for any government that really wants to protect their population and therefore their economy. The Covid Inquiry has been showing us all the failures of government, which many of us are well aware of. If it will serve as a learning curve for preparedness for future pandemics, I strongly doubt it, as in my opinion, the failures are more due to our leaders’ characters than anything else.
Predictions for 2024
My predictions haven’t changed much from last year. I would add: The UK will become recognised as an impoverished nation with a failed system of governance, now outside of the EU and not matching up to its peers. I don’t think on any other criteria the UK would be so closely classed as ‘developing’. With a failed health system, high levels of poverty, spikes in infectious diseases due to climate change and a chronically ill population, this is becoming a reality to address and not deny.
Any hope for 2024? Yes! People learn a lesson that is still missing! Pay deep attention to our needs, our issues and how the politicians deal with them. Then vote consciously for our own sake!