Comment // Health

Debi Evans Blog: 6 December 2022

This week, I was going to concentrate on language by showing some alternative suggestions regarding the narrative that His Majesty’s Government is setting out. However, that may have to wait until another week. News this week has been dominated by reports that Strep A infections are responsible for the deaths of ten school-age children in the UK. Our sincere condolences go out to all those families who have been affected. No parent should have to bury their child. Fear appears to be high on the agenda again.

Looking back in time when I was a young mum in the 1980s, it was ‘Sudden Infant Death Syndrome’ (SIDS) that made me lose sleep at night. I was pregnant with my daughter, and the press was full of terrifying stories of babies dying in their sleep for ‘no reason’. The ‘trusted messengers’ of the day were Anne Diamond and Colin Baker, who tragically lost their babies to SIDS. Both became ambassadors to the cause, and as a result, the Back to Sleep campaign was launched. Every newspaper covered it; you couldn’t avoid it. At that time, my levels of anxiety went through the roof. We bought safety mattresses, along with alarms and monitors galore. I absorbed every bit of information I was being given: anything to protect my darling, precious and adored new daughter.

Breastfeeding gave babies more of a chance and offered them protection from SIDS. Even though I had already made a personal choice to breastfeed my babies, the pressure was really on. Peer pressure was as immense back then, as it is now. Good mothers breastfed, and those that didn’t were looked down on. Breast definitely was best, no matter the circumstances, according to Sheila Kitzinger, who was the guru of her time. SIDS and breastfeeding advice became a lucrative business. If someone had recommended something to me, no matter the cost, if I thought it would give my baby the best chance, then I probably would have done it or bought it. Looking back now as a granny, knowing what I know, would I have done things differently? I suspect I would have.


Strep A

The headlines and the mainstream media are full of tragic stories of children becoming very sick and dying of Strep A. It is reported that 16 children have so far died of the infection. Lockdown appears to be the main driver, reported as the causal factor after Sir Christopher Whitty, Chief Medical Officer, released his latest report indicating that excess deaths are as a result of lockdown. Let’s explore this latest bit of fear-inducing news a bit more. Is it what it seems at first glance, or is there more to it? Of course, the grieving parents affected will be screaming warnings from the rooftops to other parents in order to alert them to symptoms so that it never happens to their child. But how common is this? How scared do we really need to be?

What is Strep A? Streptococcal infection is caused by strains of the Streptococcus pyogenes bacterium (Group A streptococcus, abbreviated to GAS) that is most commonly associated with mild, self-resolving infections of the skin and oropharynx, tonsillitis being an example. In rare cases, it can cause shock or sepsis. You will note further down this article that I refer to iGAS, which is the invasive form of GAS.

These bacteria can live on the hands or in the throat for long enough to allow easy contact between individuals through sneezing, kissing and skin-to-skin contact. Many of you reading may have heard of the terms strep throat, tonsillitis or impetigo. Usually, these are mild illnesses, and most people make a good recovery with little or no treatment. The bacteria rarely infects healthy people, but if it does get into the body it can cause serious and even life threatening conditions.

The latest United Kingdom Health Security Agency (UKHSA) press release and update on Strep A can be found here. Six children in England and Wales have died from the infection in recent months, and in the week ending 20 November, there were 851 cases reported, according to the UKHSA. Those figures are compared to an average of 186 in preceding years—an increase of 357½%. This data is also included in the latest release from the UK Government, where notifications of scarlet fever are higher than normal for this time in the ‘season’. This appears to be attributed to a rise of respiratory infections, or perhaps Covid–19 (I am being ironic). Physicians and GPs, teachers and parents have now been put on ‘alert’ to look for symptoms in their children.

Thankfully, because the incidence is so rare, many doctors have never seen any cases in their careers. Luckily for us, Professor Hugh Pennington, a bacteriologist from University of Aberdeen, has—and he has told GB News that the bacterium is still sensitive to penicillin, but only if you get it in quick enough. He has told GB News:

Now, every year there are fatalities, very, very few, I want to emphasise that. Most cases of infection with this are very mild.

Some children have the classical symptoms of scarlet fever, where you get a skin rash and feel pretty sick and perhaps have vomiting or diarrhoea, you know, headaches and all that kind of thing.

Most of those get better, and would get better even if they weren't treated. But the good news is that treatment is straightforward with penicillin.

This is not a bug that's developed antibiotic resistance, like so many other bacteria, it's still sensitive to penicillin, the whole issue really is can we get the penicillin in there quickly enough. And if you can, the disease is coped with extremely well.

Symptoms that parents are being told to look out for include a sore throat, headache, fever, and a body rash that has been described as a fine pinkish colour with a ‘sandpaper texture’. So what happens when things get really serious? When should you start to be concerned?

iGAS is the term for an invasive Strep A infection where the bacteria can get into the bloodstream, causing a serious illness. However, it should be noted that this very rare. Parents are being told to call emergency services if their children’s condition deteriorates suddenly. Speed is of the essence. iGAS is uncommon; however, parents are being told to watch for symptoms and see a doctor as quickly as possible. 

How do parents manage that? Will anyone answer 999—or will anyone come? Should they queue up to listen to a lengthy answerphone message from their GPs telling them that there are no face-to-face appointments available, but if you are worried, call 999 or seek help from eConsult, the online doctor referral system? Perhaps they should phone 111 and get told to go to 111 Online? What does a parent have to do to see a doctor in December 2022, let alone a paediatrician? With nurses threatening to walk out of paediatric wards on days of the strike, where do parents go? If a child gets really sick when every second counts, what then? 

All of that said, what can we expect to see shortly? Throat swabs will be taken from children suspected of presenting with symptoms, and they may be excluded from school until at least 24 hours of antibiotic treatment has been received. According to the latest press reports, it appears the threshold will be lowered for prescribing antibiotics and their use will be recommended at the earliest opportunity, which would appear to fly in the face of the Government’s Antimicrobial Resistance Plan. Many of our regular audience will be familiar with the Scottish Government's favourite Dr Devi Sridhar, who has again weighed in on the debate here.

She warns:

Diagnosis is a challenge in the NHS, given that swabs need to be sent to laboratories and can take days to get back – this creates delays in diagnosis and treatment. The US uses rapid strep A tests, which are throat swabs taken by a medical practitioner and the results are obtained within 15 minutes. If the test is positive, antibiotics can be immediately started. If it’s negative, but strep A is still suspected, then the swab is sent to the laboratory for more extensive investigation.

Introducing these rapid strep A tests into primary care would help an overburdened system by allowing nurses and support staff to test children who are unwell, and move quickly to the most appropriate clinical management. It makes sense to introduce these during a surge of cases and pressure on the NHS, and also to help keep children out of hospital.

The first treatment for Strep A are generally the broad-spectrum (belt-and-braces) antibiotics that we have all become familiar with. However, an academic paper from 2015 makes the following observations—note the term ‘surveillance’ and the need for a vaccine even back then:

Despite the continuing susceptibility of GAS to β-lactam antibiotics a resurgence of serious streptococcal disease has been observed over the past 30 years. While the cause of this resurgence is incompletely understood it has been tentatively attributed to the reappearance and/or increased circulation of a highly invasive clone of serotype M1T1 GAS. This shift in the epidemiology of GAS infection highlights the need for increased surveillance of GAS in the community, faster, more reliable diagnostic tests for GAS infection in a clinical setting, and more targeted treatments of invasive GAS disease. Above all, the development of a safe, effective GAS vaccine would prove invaluable. [Emphasis added]

Professor Adam Finn announced on Sky News on 2 December that the need to develop a vaccine was urgently required, but up until now has been ignored. You can see where this is going, can’t you? This brings me neatly on to my final point. 

I have decided to throw it out to all of you so you can make up your own mind. With regard to whether the ‘lockup’ is the (or a) driver for this increase, I wouldn’t rule it out as a contributing cause. Children who have been separated from society for a long time will no doubt have had their immune systems compromised. We all know the best place for small children is outside, playing with their friends, climbing trees and getting muddy. That is just common sense; however, to lay the blame wholly and solely at the lockup door is perhaps a step too far. Could we be seeing a sudden drive to get children vaccinated against Covid–19?

Will parents be scared into believing that vaccinating their children with a Covid–19 injection will make them less at risk of other diseases such as Strep A? Perhaps schools will insist that children are vaccinated ‘to protect other children’ and staff from those other illnesses. Will the next Strep A be ‘resistant’ to penicillin? Mercifully, so far it appears it is still effective, but will we have enough?

Perhaps I am joining too many dots? However, given that the MHRA admitted to me in a Freedom of Information reply that they had received an application from Moderna to extend the use of their mRNA Covid–19 injection to babies from six months old, it is very likely that they will authorise it for use, in line with the European Medicines Agency and the Food and Drugs Administration in the USA. The next step is for the Joint Committee of Vaccination and Immunisation to approve the recommendation for use in babies. The chances of my baby succumbing to SIDS were, in reality, extremely low, yet I was made to believe that the trend was on the increase and my baby could be at risk. Is the same happening again, only in the guise of Strep A, RSV and other illnesses? Will parents buy into this through fear and offer their children up for an experimental gene technology?

My personal advice to all parents is to use your own discretion when assessing your child. Your child’s temperature will normally be anything from 36.4°C to 37°C, depending on what activity they are doing. No one knows your child better than you. My children would be constantly on the go and demand my attention pretty much every waking second. If one of my children were, when they were young, flopped out on the sofa for any more than a couple of hours during the day, very sleepy, hot with a temperature or unusually quiet, I would know that something was wrong. If they deteriorated, I called the doctor. It was that simple. As a parent, you know instinctively when something is wrong.

In my day, a child with high fever, no matter what the cause, would initially be ‘tepid sponged’ (gently cooled down using lukewarm water flannels). An electric fan would be used to bring down the room temperature, and a recommended dose and frequency of Calpol would be advised (please remember that Calpol is paracetamol, so dosage and frequency should be as per the patient information leaflet inside). If a high fever does not come down, or is increasing, and you are seeing a sudden deterioration and you are becoming concerned, it’s time to call a doctor. 

Many will be asking, when does the fever cross the line and become an emergency? Which thermometer should I use and how often? Depending on the age of your child, there are different recommendations. The NICE Guidelines can be found here. The NHS says anything over 38°C is a high fever. However, others say the threshold for concern is 39°C. Discernment should be used. Observe your child and keep them hydrated. It is far more important for them to drink water or juice than it is to eat. Regular sips are sometimes better tolerated than gulps for sore throats. Ice pops can be soothing, and a great home remedy recommended to me by Fran Adamson is a spoonful of mānuka honey with a clove of garlic and a similar quantity of ginger—a great natural healer if your child can cope with the taste. An additional treat afterwards is definitely a good incentive. In any event, please do your own research and seek medical advice if you are worried or your child’s condition suddenly deteriorates. 


Antimicrobial resistance

Antimicrobial resistance is the next emergency brewing on the horizon. For many months, UK Column News has warned of an antimicrobial crisis. Antimicrobial Resistance (AMR) is simply a posh term for saying that antibiotics are becoming ineffective and won’t be around for too much longer. The term ‘antimicrobial’ includes antibiotic, antiprotozoal, antiviral and antifungal medicines.

Already, at world level, we are seeing shortages of many ‘medicines’, with antibiotics being at the top of the list. Most recently, an amoxycillin shortage has been noted in the USA and UK. Specifically, the antibiotics that appear in short supply are exactly the ones we need to treat Strep A throats. According to the American Society of Health System Pharmacists’ website, manufacturers are not providing any reason for these shortages—and, with no quick fix in the pipeline, we can expect more of the same. One reason that has been suggested is the increase in respiratory illness such as Respiratory Syncytial Virus (RSV) requiring an overwhelming demand for amoxycillin. Combine that with the reluctance by doctors to prescribe antibiotics when they don’t feel that they are indicated, or who overprescribe them even when not indicated, and there you have the perfect storm!

Dame Sally Davies is the UK Special Envoy for Antimicrobial Resistance. As the architect of Generation Genome 2016, she lays out the plans to achieve the ‘genomic dream’ for the United Kingdom. She is also a member of the United Nations’ Interagency Coordination Group on AMR. Davies, a haematologist (special interest: sickle cell anaemia), was Chief Medical Officer for England until 2019 and Chief Scientific Officer with the Department of Health from 2014 to 2016. She was one of the founder members of the National Institute for Health and Care Research (NIHR). There is no end to her talents: Drugs Don’t Work: A global threat is the title of her 2013 book. Dame Sally’s third and present husband is the Dutch haematologist, Willem H. Ouwehand, the leader of the UK’s National Blood and Transplant Transfusion research group. It may be worth noting that Dr Ouwehand is an ‘experimental haematologist’, a profession which involves stem cell research. Who knew experimental haematologists even existed?

One of her ‘pleasures’ was writing an annual report and being given the freedom to write about whatever she wanted. She recalls meeting David Cameron, the then Prime Minister, in the café at the Wellcome Collection at King’s Cross, London, to discuss it. She chose infection because clearly it was, in her opinion, a very important subject. The New Statesman wrote this about her:

Davies, aged 72, is a convincing and colourful character. When we meet, the multicoloured stripes on her black skirt are set off by a pair of red and white trainers, a navy flower-shaped ring and dark blue glasses. To illustrate the sheer scale of AMR she reeled off terrifying scenarios. “Without antibiotics we can’t have modern medicine, which underpins standard care,” she said with an air of unconvincing nonchalance. “One in four patients with cancer gets a nasty infection that can kill without effective antibiotics. 

The Review on Antimicrobial Resistance (AMR) was commissioned in July 2014 by the UK Prime Minister, who asked economist Jim O’Neill to analyse the global problem of rising drug resistance and propose concrete actions to tackle it internationally. The Review on AMR was jointly supported by the UK Government and Wellcome Trust, although operated with full independence from both. The O’Neill Report, written in collaboration with the Wellcome Trust, has a chapter entitled Increasing coverage of vaccines can reduce antibiotic use, which suggests that universal coverage by a pneumococcal conjugate vaccine could potentially avert 11.4 million days of antibiotic use per year in children younger than five years old.

The UK and Chinese governments announced in October 2015 a Global Innovation Fund to improve funding for AMR-related research. Together, these countries have committed £100 million so far (US$145 million), a sum which is expected to increase as new partners join the initiative. The Bill and Melinda Gates Foundation has also committed its support.

AMR is a big business, and anyone who is anyone is involved: the World Health Organisation, the World Bank, the World Economic Forum, the United Nations, Wellcome, the UK Government, the NHS—and that is just the tip of a very big iceberg.

In October 2022, Dame Sally Davies said AMR could kill us before the climate crisis does. The angst wasn’t calmed by a huge error of judgement by Thérèse Coffey, our last Health Secretary, who was caught out this year of giving a box of leftover antibiotics to a friend without permission or advice from a doctor. Despite her maintaining that it was an anecdotal story, she was accused of monumental stupidity, and her plan as Health Secretary to make antibiotics available over the counter was ‘moronic’.

We have reached a critical point and must act now on a global scale to slow down antimicrobial resistance.

Professor Dame Sally Davies, former Chief Medical Officer for England

Clearly, AMR is the next big ‘fear’ agenda looming on the horizon. We must thank the architects, Dame Sally Davies and Sir Jeremy Farrar of the Wellcome Trust, who fear the UK has reached a ‘tipping point’ and AMR will ‘creep up on us’. Are we on the precipice and about to ‘tip’ over because it was planned all along? Or is this just another remarkable coincidence? Personally, I don’t believe in coincidences.


Ambulance strikes

With the news full of patients unable to get to hospital due to long waits for ambulances and hospitals overwhelmed with medically fit patients ready to be discharged, we now have another strike on our hands. There are eleven ambulance trusts covering England and Wales. Their main union, the GMB, has announced industrial action before Christmas, in line with the nurses' strikes. Paramedics, emergency care assistants and call handlers at nine different trusts will be participating—this on top of the announcement by another union, Unison, that its members working at five ambulance trusts would also walk out.

How this affects us individually depends on our circumstances. Whilst we are all familiar with the all-singing, all-dancing blue light 999 emergency vehicles, the ones without blue lights, sirens and black windows mainly go unseen. Non-emergency ambulances ferry people to and from outpatient appointments and day centres, and for discharges from hospitals back home. The Government has told us that the Army and a reserve fleet will be replacing paramedic staff for emergency services, which will only cause a huge bottleneck in our hospitals. Effectively, this means that whilst the front door of Accident & Emergency will remain open when some will require admission, the back door, where patients get discharged, will be not only closed but locked. Patients who are medically fit for discharge, but who rely on non-emergency ambulance transport to get them home or to their care home, will be trapped. 

As hospital corridors become makeshift wards on wheels where paramedics have become temporary nurses, we should question why paramedics are protesting. Is it pay, or is it conditions? Are they being asked or told to perform a function that they are neither trained nor contracted for? As with nurses, experienced paramedics are telling me that patient safety is being compromised and the demands being made on them are totally unsustainable. Many cannot sleep at night knowing that they are working in a broken and unsafe service. 

This, in my opinion, is not the fault of the paramedics. The ambulance service has deliberately been destroyed in order to ‘build back better’. 

Finally, I realise I have not covered as many of the hundreds of new health stories whizzing around as I may normally do, but I make no apologies for highlighting Strep A, AMR and perhaps an upcoming drive to fear parents into getting their youngsters injected with a Covid–19 injection. These stories are worth keeping our eyes on.

What will next week’s headlines bring? Which emergency will be announced? What’s the next drama to befall us all, or will our news be dominated by the Duke and Duchess of Sussex's 2022 Netflix rerun of Dynasty? Anything is possible. As ever, don’t take my word for anything, question everything, join your own dots, do your own research and find your own truth. 

Until next week, hold the line, keep the faith and keep smiling.