We’re publishing a new piece today by Dr. Alan Mordue, a retired Consultant in Public Health Medicine, who is alarmed and disappointed that longstanding and important principles of public health have been jettisoned in the pandemic. Alan worked as a Public Health Consultant in England and then in Scotland for 28 years, retiring in 2016. He has extensive experience of teaching and training in public health and was an Honorary Clinical Senior Lecturer at the University of Edinburgh for many years.
Here is the introduction, where Dr. Mordue highlights the difference between what the media often mean by a ‘public health expert’ and an actual trained and accredited Public Health Specialist.
During this Covid pandemic I have heard much in the media from ‘public health experts’ and ‘public health officials’, but rarely from colleagues in my own specialty – Public Health! This is very surprising since the specialty, which I practised for 28 years as a Consultant in England and Scotland before my retirement in 2016, usually leads the management of all outbreaks of infectious diseases in the U.K., and also has had the responsibility for leading the production of pandemic plans in the U.K.
But is there any difference between a Public Health (PH) official, expert and specialist? Certainly you wouldn’t think so listening to most broadcast media. Here are my definitions:
So these three groups are very different. Only one group has undertaken an in-depth specialist training and has theoretical and practical experience in outbreak control and management (as well as other areas of PH specialist practice).
When a PH ‘expert’ expresses views in the media about the management of the Covid pandemic it is therefore essential to know a little about their background training and experience. Even if they have an exalted title like ‘professor’, their chair may be in anthropology or their main experience in nutrition or dentistry. This is not to dismiss the contributions of diverse disciplines – given the inevitable complexity of a national response to a pandemic we certainly need to draw upon a wide range of expertise. However, over the last 18 months I have kept asking myself whether PH Specialist knowledge, skills and experience have had sufficient influence during the Covid pandemic. I will attempt to answer my question by referring to some of the key principles of Public Health and considering whether they have been followed or not during the pandemic response.
Among other things, Dr. Mordue criticises the redefinition of ‘case’ in the pandemic, where for the first time a positive PCR test alone in the absence of clinical symptoms has been counted as a case of the disease, causing big problems with false positives and over-diagnosis.
Either symptoms or a positive test alone is insufficient, both must be present to be counted as a confirmed case. It follows that there is no such thing as an asymptomatic case.
This standard definition was not adopted at the start of the pandemic. Because of this we don’t know how many real cases of COVID-19 we have had or have currently – the numbers recorded include real cases of people with relevant symptoms and a positive PCR test for viral RNA, but also include people with no symptoms of COVID-19 and only a positive PCR test. This has been further complicated by mass population testing in the community and hospitals of those without COVID-19 symptoms, the use of high cycle thresholds in the PCR test, and inevitably large numbers of false positive tests.
The piece is worth reading in full.