John Snow was a doctor in London in the 1800s. He believed there was more to people dying from diseases, such as the bubonic plague, than simply pollution or poverty.
In the summer of 1854, the city’s Soho district, which was filthy and had not yet been reached by the sewer system, was hit by anoutbreak of cholera. Dr Snow discovered the source of the outbreak was a public water pump.
He persuaded the local council to disable the well pump by removing its handle, an action that is credited with ending the outbreak.
Snow is considered the founding father of public health, a pioneer of research in epidemiology, the science of studying disease pattern. Another trailblazer is Florence Nightingale, who was hugely influential in hospital hygiene policy. Known during the Crimean War as “the Lady with the Lamp”, sheimproved sanitary conditions at a British base hospital, hugely reducing the number of soldiers who died. Her writings transformed healthcare all over the world. Granted, her reforms were within hospital settings, but her proposals helped entire populations, which is what public health medicine is all about.
As one public health doctor described it this week: “What we do is a helicopter view of what is happening at a public-health level, rather than an individual one. A GP or a consultant is looking at an individual and waiting for the next one to come in, but the public-health doctor takes the wider view.”
Public health was long-viewed as the Cinderella speciality of medicine, but is now firmly established. Suddenly, it seems as if our world is being led by public-health doctors. This happens once in a while, with outbreaks such as swine flu in 2009, foot-and-mouth in 2001, and now coronavirus, or covid-19.
The chief medical officer of the Department of Health, Dr Tony Holohan, is a public-health doctor who trained initially in general practice. As chief medical officer, a significant part of his job is to use his medical expertise to advise the Minister for Health on medical matters.
It is not always an easy marriage between medicine and politics. John Snow discovered this early on. Despite his success with the cholera epidemic, officials were slow to accept his theory on how the contamination came about.Indeed, during the annual Pumphandle Lecture in England, members of the John Snow Society remove and replace a pump handle to symbolise the continuing challenges they face.
There is a fine balance between protecting your population and safeguarding the economy upon which that population depends. And containing the current outbreak has the added challenge of the keyboard warriors just waiting to pounce on what might not even be a mistake, but what might be perceived as one.
Nations and their health officials and medical personnel are working around the clock to protect everyone, but too many people see conspiracy.
The fear that we are all experiencing is understandable and can make us cranky. But why would we pile further pressure on the very people who are trying to keep us safe?
This is not to argue that their every single utterance should be accepted without being questioned, but we should be supportive, not suspicious.
The National Public Health Emergency Team — the frontline source of advice on this outbreak — has 18 members, who have a range of specialties, from public health, to virology, to primary care, to immunisation.
The team assists all health agencies in the State to respond to a public health emergency in an integrated and co-ordinated manner. Ireland, we were told in a statement a few weeks ago, has comprehensive emergency plans for responding to public-health issues and these plans are up-to-date and rehearsed.
That’s all very reassuring, except we have an inbuilt, understandable distrust of our health authorities, following on years of broken promises, waiting lists, and hospital overcrowding. Added to that is global distrust of authorities and ‘experts’ and oftentimes deliberate and sustained efforts to subvert the truth.
Official withholding of any information is seen by the public as highly suspect. Of course the health authorities knew that the name of the Dublin school where there was a case of coronavirus would leak almost immediately after a letter was sent out to parents. They had probably taken bets amongst themselves about just how long, or short, that would take.
But how anyone could have thought that the Department should be the ones to release that information and still expect people with symptoms to come forward is a head-spinning mystery.
Our view of what action the authorities should take on coronavirus depends on our individual health, our ability to calculate risk, what sector we work in, how much money we have, our age, and whether anyone close to us is elderly or has a compromised immune system.
For instance, going ahead with the St Patrick’s Day ceremonies would look very different to someone who has a compromised immune system than it would to someone who owns a restaurant that might do extra business because of the parades. But my public health doctor contact said that, at this moment, we remain in a containment phase and that the evidence means the parades should go ahead.
‘DOING something like shutting down the St Patrick’s Day events, or stopping people coming in from certain places, whether we like it or not, has significant consequences for businesses and taxes and how we can pay for things in the future. If that is how you are going to run your society, where do you stop? Right now, we have a small number of cases,” said the public health doctor.
“It drove me nuts how people responded to the foot-and-mouth outbreak, people dipping their feet into disinfectant going into mass, and all of that. But it was how it was spun to them and the belief that we had to have a national response to it. Foot-and-mouth was stopped at the ports and the rest was bullshit. Then, you look at people saying we should stop flights from Italy: half the people on those flights are Irish. Yes, half the problem of what we do, as public-health doctors, is that you are wise after the event, and doing things on imperfect information, because things change.
“That’s what makes it really tough for the people making the decisions: they’d need a serious amount of hard data to justify cancelling St Patrick’s Day, otherwise it is a guess. Ultimately, what is the acceptable degree of risk will be a political decision.”
It’s not easy to know.