Greg Fell: Living safe with Covid – the next steps

Public health teams must maintain crucial skills and capacity to respond quickly to the pandemic if needed in the months and years to come, writes the vice president of the Association of Public Health Directors.

Boris Johnson announced this week that he would soon publish the government’s long-term strategy for living safely with Covid.

Greg Fell, vice president of the Association of Public Health Directors

The plan will need to combine flexibility, proportionality and strong, reliable communication, and must find a reasonable path between the extremes of lockdowns and letting the virus spread. The wobble hurts businesses and disrupts public services more than a course of action to keep Covid numbers more stable.

As early as February 2021, directors of public health advocated – and implemented – such a strategy, and the Association of Directors of Public Health issued guidelines outlining our thinking and approach. here. We recognized that this would need to be reconsidered, and the current abandonment of Plan B is a good time to reflect.

Decide on risk thresholds

Local public health teams and NHS and social care colleagues are still under considerable pressure from Covid-19 and as long as the virus is circulating this work must be funded and supported, but our thinking must also involve moving more attention and resources towards improving public health and addressing the inequalities revealed and exacerbated by the pandemic.

Virus finally decides ‘when it’s over’

Most likely, the virus will become endemic, although we are not there yet. It is in this context that we must decide what we are prepared to tolerate both in terms of harm and interventions to mitigate harm. The appropriate risk threshold should reflect the weekly peak of deaths, hospitalizations, and community prevalence of viral respiratory illnesses in high-severity years.

Public health directors and their teams have worked with laudable tenacity and ambition to ensure an effective response to the pandemic at the local level and to support better policymaking at the national level. From managing contact tracing to promoting vaccination and supporting the most vulnerable in their communities, the local public health system has performed remarkably well.

Choose to be prepared

We have strengthened our teams over the past two years and, while we are rightly reducing our capacities as the omicron wave passes and national funding decreases, we must retain the crucial skills and capacity of our teams to respond quickly if necessary. The virus ultimately decides ‘when it’s over’. We can’t choose his next move, but we can choose to be prepared.

We plan to respond to the virus in the medium to long term and as such, sustainable funding must be made available to support the core of our local response. The continued lack of clarity about the future of the Containment Epidemic Management Fund risks undermining our attempts to live safely with the virus. Some surge capacity at local, regional and national levels will be essential to respond to outbreaks, waves and variants for the foreseeable future.

The government‘s upgrading program is expected to build on existing work undertaken by local authorities across the country

For now, our teams are working at pace to reach every corner of our society with the offer of a vaccination, providing tailored communications and leadership to promote the benefits of widespread vaccination to protect us and those that surround us.

But the bigger question about the next steps in the pandemic response concerns the stark inequalities that the past two years have exposed. The government’s leveling up program is expected to build on existing work undertaken by local authorities across the country. There is no shortage of energy and knowledge available, especially in local public health teams.

However, there is a funding shortfall – the government has cut year-on-year public health spending by almost a quarter since 2015, and recently announced grant allocations for 2022-23 are effectively a reduction given from rising inflation, ongoing pandemic pressures, the backlog of public health services, and ambitious political plans on the race to the top and health inequalities.

Take coordinated action

Partnerships will be essential. Strengthening collaboration among local organizations through integrated systems of care can help us create communities where we not only treat disease, but also create health. The pandemic has shown that if we fail to protect public health, the economy suffers. If we are bold enough to make improvements in public health, it will have a positive impact on the economic success of our places and regions.

A central challenge for government policy and action is to take coordinated action. New investments in weight and obesity management services, for example, are welcome, but must be backed by policies and funding to tackle the causes of poor health, from poverty to housing. poor sanitation, limited access to green spaces, inadequate education, skills and employment. Opportunities.

After spending two years focusing on the pandemic, public health directors are ambitious about opportunities to create healthier places and people in the years to come.

Greg Fell, Vice President, Association of Chief Public Health Officers; Director of Public Health, Sheffield City Council

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