How can we bridge the divide between the public and public health? Raj Bhopal argues for a strong but supportive pandemic response.
There is widespread scientific and social support for taking the coronavirus pandemic seriously. But has civil society had proper democratic input on the restrictions introduced by nation states worldwide to curb coronavirus transmission? What explains the ongoing antagonism between the public and public health?
Raj Bhopal, CBE DSc, BSc MD, MPH, MBChB, FRCP, FFPHM, is professor emeritus of public health at the University of Edinburgh, Scotland. He held the chair of Public Health in the university until his retirement in 2018. Bhopal is also the author of Concepts of Epidemiology: Integrating the Ideas, Theories, Principles, and Methods of Epidemiology.
Bhopal’s recent article, COVID-19 zugzwang: Potential public health moves towards population immunity, was published in Public Health in Practice. It is written to be thought-provoking for both the general public and infectious disease specialists.
The article argues that scientific appraisal of the various SARS-CoV-2 interventions introduced in the initial wave of COVID-19 has been stifled by fear based responses to the complex competing ethical priorities societies face, alongside politicization of scientific concepts. In addition, Bhopal uses his background in public health to point toward ways supportive measures could accomplish more than punitive or overly-regulatory ones.
Part 1 of the interview is recapped in this segment, and can also be found here.
"COVID-19 is pandemic, and likely to become endemic, possibly returning with greater virulence. Outlining potential public health actions, including hygiene measures, social distancing and face masks, and realistic future advances, this paper focuses on the consequences of taking no public health action; the role of natural changes such as weather; the adverse public health consequences of lockdowns; testing for surveillance and research purposes; testing to identify cases and contacts, including the role of antibody tests; the public health value of treatments; mobilising people who have recovered; population (a synonym for herd) immunity through vaccination and through natural infection; involving the entire population; and the need for public debate. Until there is a vaccine, population immunity is going to occur only from infection.
Allowing infection in those at very low risk while making it safer for them and wider society needs consideration but is currently taboo. About 40—50% population immunity is sufficient to suppress an infection with a reproduction number of about 1 or slightly more. Importantly, in children and young people COVID-19 is currently rarely fatal, roughly comparable with influenza. The balance between the damage caused by COVID-19 and that caused by lockdowns needs quantifying. Public debate, including on population immunity, informed by epidemiological data, is now urgent."
- Abstract, COVID-19 Zugzwang: Potential public health moves towards population immunity