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Caution, vaccines, testing: the only way forward

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1781 (Published 15 July 2021) Cite this as: BMJ 2021;374:n1781

Read our latest coverage of the coronavirus pandemic

  1. Fiona Godlee, editor in chief
  1. The BMJ
  1. fgodlee{at}bmj.com
    Follow Fiona on Twitter @fgodlee

The world was already deeply divided before the pandemic, but covid has cruelly deepened the divisions (doi:10.1136/bmj.n1783).1 From the start it was clear that people in deprived or ethnic minority communities were at greater risk of contracting and dying from covid, because of their work, housing, or poorer underlying health. They have also been harder hit by the economic impact of lockdowns. Research published this week shows that people with learning difficulties are at greater risk of covid related hospital admission and death (doi:10.1136/bmj.n1592; doi:10.1136/bmj.n1701).23 And the “digital gold rush” to provide health information and care online has left many poorer, older, and disabled people behind (doi:10.1136/bmj.n1732).4

The UK government’s decision to drop almost all covid restrictions next week will only worsen these inequities. The decision is at odds with medical advice and mathematical realities (doi:10.1136/bmj.n1751; https://blogs.bmj.com/bmj/2021/07/13/kit-yates-the-dangers-of-allowing-exponential-growth).56 Cases are rising exponentially despite the current measures and will inevitably rise more steeply when these are lifted, with resultant increases in hospital admissions, long covid, and deaths. A weary NHS, grateful no doubt for the George Cross (doi:10.1136/bmj.n1775) but actually needing a pay rise (doi:10.1136/bmj.n1754), will bear the brunt, as will the growing lists of patients unable to get the routine care they need (doi:10.1136/bmj.n1762).789

What then should we do? First, we must hope that most of us won’t follow our political leaders’ dereliction of duty in throwing caution to the wind (doi:10.1136/bmj.n1768), but their confused messaging is already undermining efforts to contain the virus (https://blogs.bmj.com/bmj/2021/07/13/how-government-messaging-is-undermining-the-covid-19-response).1011

Second, the drive to vaccinate all adults must be stepped up (https://blogs.bmj.com/bmj/2021/07/09/where-are-we-with-covid-19-vaccination-in-the-united-kingdom).12 Some countries are resorting to incentives (doi:10.1136/bmj.n1737),13 and many have also extended vaccination to children, but not yet the UK. Arguments against vaccinating children are that the benefits to children themselves don’t outweigh the risks, that worldwide there are populations in much greater need (doi:10.1136/bmj.n1687),14 and that sharing vaccines across the world is the only way to suppress new variants (doi:10.1136/bmj.n1544).15 But the arguments in favour begin to sound more convincing: that side effects in children are extremely rare while the harms from covid are less so, and that the global need for vaccines should be met by demands for vaccine patents to be waived (doi:10.1136/bmj.n1687).14

Our third crucial bulwark against a devastating third wave is testing. The UK has been so dogged in pursuing its flawed approach that a change in policy now seems unlikely. But hints that the NHS will stop providing free lateral flow tests (doi:10.1136/bmj.n1760)16 raise the possibility that the government is seeking to quietly move away from this costly and ill conceived programme—how much better if the money had been invested in rebuilding our public health infrastructure. Apart from the rapid tests being used in contravention of both the manufacturer’s instruction and the guidance of the Medicines and Healthcare Products Regulatory Agency (https://blogs.bmj.com/bmj/2021/07/11/why-all-the-secrecy-around-innova-lateral-flow-tests),17 testing is only as good as what people do with the results. Data from Liverpool confirm that people in deprived communities were less likely to come forward for testing for fear of having to self isolate and losing their jobs. They were also more likely to test positive (doi:10.1136/bmj.n1637; doi:10.1136/bmj.n1741).1819

We need targeted testing, contact tracing, and proper support for self-isolation. Without these seemingly obvious traditional public health steps, the pandemic will continue to worsen our longstanding social divides.

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References

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