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Years ago when I left paediatrics to train in public health medicine, quite a few clinical colleagues thought it was a retrograde step. Public Health is seen by some as a backwater for failed doctors. Public Health was not sexy.
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Cardiology is sexy. Surgery is sexy. Patients can die from heart attacks & ruptured guts but modern specialist medicine treats & saves lives. Public health? Waste of time some say. Not surprising that Public Health struggles for influence over the specialties or resourcing.
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But, if anything COVID19 has shown, is that populations die from public health threats. If ICUs, hospitals, clinics are full it’s because public health measures have failed. Medicine treats the effects of disease, public health addresses the root causes.
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Public health failure is not due to lack of effort or skill or expertise of the PH workforce but reflects state of the specialty. PH has been grossly underfunded & under-resourced for years, & more cuts in public health funding are in the pipeline. This has consequences.
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We have a decent health protection system but it could have been stronger had we invested in it more. The HP teams kept Covid19 at bay for a month, delaying the epidemic. The economic costs of a month of lockdown FAR EXCEED the miniscule investments in health protection.
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Because of COVID19, public health is in the spotlight. When this is all over, PH may be quickly forgotten.
Just remember, deaths each year nationally:
77 800 smoking related
40 000 obesity related
7 551 due to alcohol
6 507 suicides
Public health threats kill populations
Primary Care is a key partner for Public Health. Real game changing power of primary care is thru what we do re:prevention, health promotion & local coordination of health & social care, & not the minor ailments that currently make up a lot of our workload.
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Andrew Lee
@andrewleedr
I’ve been asked to explain why I thought the high reported number of #COVID19 cases in Sheffield was misleading, so here it is:

Essentially, the COVID19 tracker is a type of crude disease surveillance that tots up cases. But, ALL surveillance systems have limitations.
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Firstly, surveillance does not measure all cases of disease, only what’s been reported or tested. I.e. it's a proxy measure for real incidence of disease. You only see the tip of the iceberg and you don’t always know the size of the iceberg you can’t see.
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If you test more, you will find more cases, i.e. you will see more of the iceberg. In the case of Sheffield, put simply they’ve been testing a whole lot more so it’s not a surprise they’ve uncovered more of the iceberg (ascertainment bias).
3/...
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Andrew Lee
@andrewleedr
DISASTER MANAGEMENT 101:
In my time I've been in a few disaster zones: Asian tsunami, Typhoon Haiyan, Zimbabwe cholera epidemic, Nepal earthquake, Afghanistan war zone. What characterises all disasters is that they exceed the capacity of the local system to cope.
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In disasters, chaos is not uncommon. People work frantically, but not always productively. Adrenaline (or anxiety) levels are high. People at the top try to exert top-down control in the hope it controls the situation (usually doesn't).
2/...
Common disaster myths: that the people affected are helpless, that outsiders/external help will save the day. Not true. The local response is almost always the main (and sadly sometimes the only) response. Local actors know what's needed on the ground.
3/...
Read 9 tweets
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Andrew Lee
@andrewleedr
@EmmaEversonHock @Smithkjj @felly500 This is a fascinating piece of work by the modellers at Imperial College. And it's grim. Without mitigation, we'll peak mortality in 3 months, 81% of population infected over the course of the epidemic, 510,000 deaths in GB.
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@EmmaEversonHock @Smithkjj @felly500 They looked at different mitigation strategies not to contain/stop it, but to reduce the health impact of the epidemic. Various measures work but healthcare demand (especially ICU) is breached many times over.
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@EmmaEversonHock @Smithkjj @felly500 They conclude mitigation is not viable option as healthcare systems will be overwhelmed. Suppression is alternative but requires really intensive controls (as implemented in other more authoritarian countries). My concern is can we do it in a liberal democracy like the UK.
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