Gary McFarlane is Director for Northern Ireland at the Chartered Institute of Environmental Health.
What was striking about the recent article in ConservativeHome by Dr Liam Fox MP is the number of things he said we didn’t know about the virus.
He’s correct; we don’t know everyone who has it, who’s had it or who they’ve been in contact with.
In fact, for such a society-changing epidemic, we don’t even have its basic epidemiology. Modelling produces a reasonable ‘best guess’, but this has limitations based on the data fed into the model. Dr Fox was also quite correct to say we lack the basic information to make an informed decision on how and when to relax the lockdown.
The answer to this is contact tracing. The importance of contact tracing cannot be overstated. The father of epidemiology, Dr John Snow, was the first to use this in a methodical and meaningful way back in 1854 at the height of London’s Cholera epidemic.
His contact tracing identified a specific water pump on Broad Street, London as the source of an outbreak from which contaminated water was drawn. He ordered the pump handle to be removed and cases fell. Soon after, the epidemic came to an end. Ironically, victims of the 19th century ‘Broad Street Outbreak’ were nursed under the supervision of Florence Nightingale, whose name is given to the Excel Hospital for this 21st Century outbreak.
This tried and trusted method of outbreak control – identifying cases and engaging with all known contacts – has been largely overlooked and the reason is palpable. It is resource intensive, requires skills to gather, collate and make best use of the information and this is a resource central Government simply doesn’t have in sufficient numbers.
But those expert skills are available, ready and willing in a single profession, namely Environmental Health. They are largely perceived as just local government officials, but this is only a part of their presence in the UK. Local government professionals used in this emergency have thus far been confined to checking that businesses that should be closed are closed as well as providing advice and support to businesses still operating on social distancing.
But there is more, so much more, that they could do. It’s important to note that this skilled resource does not only work in local government, far from it. Richard Short, for example, a former parliamentary candidate for the Conservative party, is a chartered environmental health practitioner (EHP) for an international hotel chain.
He has been working day and night using his considerable skills getting hotels ready and safe to use as hospitals, homeless shelters and accommodating our NHS workers, including the newly formed Nightingale Hospital at Excel, and he is at the top table of decision making where his expertise is in high demand.
He’s not alone. Dr Lisa Ackerley, also a chartered EHP and a regular media figure has been giving advice to the public and healthcare professionals, as has Sterling Crewe, a well respected and highly experienced professional.
Other EHP colleagues are providing support to community and voluntary sector in community-led food distribution schemes, helping them to do so safely, safeguarding against food-borne illness and a plethora of other infectious diseases which, I am sure we all agree, is the last thing we need on top of a coronavirus outbreak (given it would inevitably lead to greater loss of life).
Some are providing direct support to businesses severely impacted by the crisis and trying to diversify. And other colleagues are even answering the call for help beyond our shores and providing international support to developing countries. But it’s equally fair to say that there are so many EHPs out there champing at the bit to get their, as yet unused, skills utilised in this outbreak.
We at the Chartered Institute of Environmental Health have established and facilitated a National Environmental Health Volunteer Register. We have invited any professionals, who currently find themselves out of work, with spare capacity or just wanting to do more, to offer their skills.
Hundreds of professionals, including Richard Short and Dr Lisa Ackerley, have volunteered their services and we now have a very full register of the exact skills the Government needs to assist and bring a controlled end to this national emergency.
Our offer to the Government is genuine and clear. It takes up to six years to train an environmental health practitioner in the range of skills they need to practice. These people are experts at outbreak control, the very heart of which is contact tracing.
Environmental health practitioners have the skills the Government agencies, in particular the Public Health agencies and local health protection teams, need to assist in contact tracing. But equally our members also have the skills to assist the Government in making that informed decision on when and how to relax the lockdown and finally environmental health practitioners have the skills to help manage the relaxation in the community.
We have written to all three Public Health agencies in England, Wales and Northern Ireland making this offer. We have already received a very positive response from the Chief Medical Officer in Northern Ireland. We are looking forward to receiving an equally positive and direct response from Professor Chris Witty in England and his Welsh counterparts.
If Government wishes to consider how this resource could be more meaningfully engaged in the national effort they only need ask.