by Before Covid-19, says Dr Farzana Hussain, she rarely saw a case of scabies at her GP in Newham, east London, but since the pandemic, the number of patients with the infection has increased dramatically parasitic skin on them.
“By the time a patient comes to me for advice, everyone in the family has it, including all the children,” she says. “There is oppression. People need immediate treatment.”
Transmitted by tiny mites that land and lay eggs under the skin, scabies is a disease associated with squalor and overcrowding. Spread by personal contact, it is so contagious that during the Victorian period almshouses kept separate “itch” wards so that those infected with the mites could be separated and treated before being admitted to the workhouse proper .
According to the Royal College of General Practitioners (RCGP), cases of scabies are now running at three per 100,000 of the population in England, double the five-year seasonal average. That equates to around 2,000 cases of scabies per year. However, in the north, the worst affected region in England, GPs are seeing rates as high as six per 100,000.
Scabies is not the only disease that seems to be coming back in Britain Rishi Sunak. In 2022, 423 patients were admitted to English hospitals with rickets, a disease caused by lack of sunlight and insufficient levels of vitamin D. In the same year, 188 people were treated for scurvy, a condition caused by not eating enough enough fresh fruit and vegetables, which leads to vitamin C deficiency.
Scurvy and rickets are often seen as proxies for malnutrition, with hospital admissions of around 10,000 a year in England, four times higher than 12 years ago. It is little wonder that Dr Clare Gerada, former president of the RCGP, has warned the UK that there is a risk of “going back to the Victorian era”.
Sir Michael Marmot, director of the Institute for Health Equity at University College London, agrees. “The thought that we are starting to suffer the same diseases that people suffered on long ocean voyages in the Victorian era because of a shortage of citrus fruit is terrifying,” he said recently.
For Marmot, the rise in infectious diseases reflects the cost of living crisis and a decade of cuts to social services and public health, which have left Britain with one of the poorest and most vulnerable populations in Europe.
According to a recent report by the Joseph Rowntree Foundation, 14.4 million Britons – or one in five people – were living in poverty in 2021-22 and 6 million people – or four in 10 people in poverty – were in “extreme” poverty. deep”. , with income below the poverty line.
Poverty and disease are closely linked: according to the Royal College of Paediatrics and Child Health, children living in deprived neighborhoods are twice as likely to die from infections as those living in the least deprived neighbourhoods. These health inequalities are reflected in adult mortality rates, with almost 11,000 more deaths occurring in the UK’s most deprived areas in 2020 than in the least deprived 20%, according to Marmot’s latest review of the state of the nation’s health.
But is poverty and worsening social and economic conditions the only factors? According to the UK Health Security Agency (UKHSA), the number of cases of measles – a disease for which there was no vaccine in the Victorian era – is on the rise with 1,603 suspected cases last year, more than four times the number in 2021.
Britain is also seeing alarming increases in sexually transmitted diseases, such as syphilis and gonorrhoea. The latter is up 50% from 54,961 cases in 2021 to 82,592 in 2022. That’s the highest number since records began in 1918. And syphilis is up 15% to 8,692 in 2022, the highest number since 1948.
Part of this increase in STDs can be explained by more diagnostic testing – during the pandemic, the government encouraged people to use home tests, as half of the UK’s sexual health clinics were closed. However, the scale of the increase also suggests that there are more infections in the community, resulting in greater demand for sexual health services.
According to the Local Government Association, in 2022 STD clinics will carry out 4.5m consultations, a third more than in 2013. But due to cuts to frontline services and a shortage of sexual health advisers, it can take weeks to get an appointment at a clinic , and for patients. if they manage to find someone they can wait up to four hours before being seen.
“If people can’t come in when they want to, they risk not coming in at all,” says Professor Matt Phillips, president of the British Association for Sexual Health and HIV.
But this is by no means the whole story: the rise in STDs may reflect fewer people taking precautions than in the 1980s and early ’90s, when fear of AIDS gripped people to adopt less risky sexual behaviour. In contrast, today, the availability of pre-exposure and post-exposure prophylaxis for HIV means that gay and bisexual men have less incentive to use condoms.
And for measles and other preventable diseases, these increases are likely the result of a range of similar factors, including fear of vaccines, fatigue with childhood vaccine schedules and the difficulty of accessing jobs for families in both parents are working full time. .
Those visits where mothers can ask questions about their child’s health are not happening in the same way as before
Helen Bedford, professor of child health
The result was that in Birmingham, when doctors treated more than 50 cases of measles last month, prompting the UKHSA to declare a “national incident”, only 80% of children received two doses of the measles, mumps and rubella (MMR) vaccine by their fourth birthday (national target is 95%). And in Hackney, east London, it’s only 56.3%.
No wonder some experts believe Britain faces a major challenge from past infections. One thing that could make a difference is to employ more health visitors. But due to local authority cuts, this workforce has fallen by 40% since 2015.
“We don’t have enough health visitors to meet the rising levels of need,” says Georgina Mayes, head of policy and quality at the Institute of Health Visitors. “As a result, too many families are missing out on essential health visitor reviews.”
Helen Bedford, professor of child health at University College London, believes the shortage is one of the factors causing low uptake of the MMR and other vaccines.
“It means that those visits where mothers can ask questions about their child’s health don’t happen or happen in the same way as they used to,” she says. As a result, parents are less likely to accept medical advice to vaccinate their children.
Bedford argues that the pandemic has contributed to this reluctance, encouraging people not to visit LG surgeries unless necessary, although most surgeries have not suspended their vaccination services.
“The message should be, stay home, but you can still vaccinate your child,” says Bedford.
Hussain says fatigue is another factor: “During the pandemic, people accepted the message to get the Covid vaccine, but now they don’t feel it’s necessary – or they have the time – to get measles jabs if children. If you’re on a zero-hours contract and you’re struggling to make ends meet, you’re less likely to take time off from the office to get a vaccine.”
Bedford agrees, which is why she would like to see more mobile vaccination centers.
Another factor contributing to the rise in measles infections is misinformation and conspiracy theories about vaccines. In 2018, 93% of people thought vaccines were important for children. Today, only 72% think so, according to the London School of Hygiene and Tropical Medicine’s vaccine confidence project.
For some groups, these views may reflect religious and cultural taboos – gelatin-containing vaccines are prohibited for Muslims, although other non-gelatin-containing vaccines are also available.
For others it shows the continuing influence of disgraced gastroenterologist Dr Andrew Wakefield, who suggested a link between the MMR job and autism. Although Wakefield’s theory has been comprehensively debunked, it still appears on scores of anti-vax sites, as well as on the WhatsApp chats where many parents get their medical information.
The danger now, according to Hussain, is that the “Wakefield cohort” – people who lost their MMR jobs in the 1990s because of Wakefield – are having babies themselves, increasing the chance of further outbreaks in adults and children without immunization. Such outbreaks are serious. Measles is highly contagious – in a susceptible population one measles carrier can infect 12 to 18 people, and for every 1,000 children who get measles, one to three will die.
But is there a risk that we are becoming out of step with today’s situation and our Victorian era? For example, one of the main reasons why cases of scabies are increasing, according to the British Association of Dermatologists, is a shortage of treatments such as permethrin and malathion. And not all cases of scurvy are caused by parents not being able to afford fresh fruit and vegetables – sometimes, vitamin C deficiency may be due to children being picky eaters.
Likewise, the incidence of rickets is much lower than the rate seen in the 1800s, when London was blanketed in smog, blocking UV radiation, and the condition is estimated to have affected 60% of children living in the capital city.
That’s not to say we should be complacent, though. Dr Benjamin Jacobs, a rickets expert at the Royal National Orthopedic Hospital in Stanmore, Middlesex, says that although it was unusual to see a case of rickets in the 1980s, today, sadly, the condition is no longer rare. “I see at least three children with rickets every year; every situation is heartbreaking,” he says.
“The NHS has provided some children with free vitamin supplements for nearly 20 years, but the children who need them most often do not get the vitamins they need. It is disgraceful that the NHS has not made more progress in preventing these serious diseases.”
