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Public health

We need long-term changes to tackle COVID-19 and future pandemics

Open access article

The Royal Pharmaceutical Society has made this article free to access in order to help healthcare professionals stay informed about an issue of national importance.

To learn more about coronavirus, please visit:

In 2006, Michael Leavitt, the then secretary of the US Department of Health and Human Services, said: “Anything we say in advance of a pandemic is alarmist; anything we say afterwards is inadequate.[1]

Then, in early 2020, the Chinese government instituted rational measures to contain the spread of COVID-19 from its origin in Wuhan. Not only did it construct new hospitals (within around ten days), but it also cancelled public events and enforced strict quarantine procedures.

Across the pond, on 23 March 2020, president Donald Trump tweeted: “We cannot let the cure be worse than the problem itself.”

And when Anthony Fauci, head of the US National Institute of Allergy and Infectious Diseases, told him that it could take up to 18 months for a COVID-19 vaccine to be made available, Trump said: “I like the sound of a couple of months better, if I must be honest.[2]

At the time of writing, the United States has the highest number of cases of COVID-19. Trump wants his country to be back to normal “by Easter”, on 12 April 2020, but how this could happen is beyond any professional, thankfully including senior public health officials in the United States[3].

It is worth listening to Fauci, who has said: “You can’t make an arbitrary decision until you see what you’re dealing with … you’re talking about three to four months in a couple of cases, a year in other cases.

“A vaccine that you make and start testing in a year is not a vaccine that’s deployable,” he added.

Data show that those at the highest risk of death from COVID-19 are older people and those with pre-existing conditions. Each government is taking what it deems the relevant steps for its situation. There appear to be three basic commonalities for now: early social distancing seems to be the best weapon to combat the virus; this situation should not be treated as ‘business as usual’; and we should be prepared for significant changes in how society functions going forward, until either a mass immunisation programme is in place or the pandemic has passed.

Even in the absence of a respiratory infection like COVID-19, thousands of hospital admissions each year result from poor air quality, smoking and poor living conditions[4],[5],[6].

One wonders whether our government, or any government that wants to seriously limit deaths during a pandemic, will take the necessary long-term steps to address these factors, including basic housing needs. I would refer anyone who requires evidence that stark inequalities result in shorter lives to the excellent research undertaken by University College London — ‘Lives on the Line’ — which plots life expectancy and child poverty by London underground stations[7]. For example, those born near the swanky Oxford Circus could expect to live to more than 96 years of age; while those born just a short ride east to Star Lane can expect 20 years fewer.

Dave Sharma, company director, Consilia Medica Ltd

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20207872

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