INTERVENTIONS, TOUGH DECISIONS, AND JUSTIFICATIONS
The recent reports from the People’s Republic of China show that, despite the draconian restrictions imposed by the authorities as part of their Zero Covid, the number of cases continues to climb at an alarming rate. This led me to ponder the approach taken to the pandemic around the world.
We all remember that, at the start of the pandemic, Sweden adopted a much lower key strategy than most European countries with a very laissez faire approach. Restaurants stayed open, people mingled freely and initially all was well it seemed. However, rapidly rising cases soon forced a change of heart by the Swedish government who then mandated a greater restriction on the population. Throughout Europe this approach was echoed and for many seemed to, if not prevent infection, at least reduce the numbers affected. Of course, we’ll never know what would have happened if the Swedish approach had been allowed to continue and that is one of the major issues in deciding what interventions are justified in treating or preventing illness.
As health care professionals we are all programmed to intervene in the face of disease. But let’s consider what will happen if we don’t. A classic debate was that of the screening for cervical cancer where millions of women had cervical smears and for a significant proportion this led to surgical intervention. We never were able to allow the positive smear test to be observed over time, to see if minor degrees of dysplasia would ultimately develop into cancer. In a recent discussion with my dentist (rendered somewhat one sided by my having his fingers in my mouth) he pondered whether all the small cavities he had filled over the years would, with good hygiene and fluoride toothpaste, have remineralised and avoided the drill.
Lest you think I’m and incurable luddite I should stress that, on the whole I incline towards intervention rather than wait and see. The main issue to me is whether the intervention is potentially worse than the untreated outcome and that was the problem faced by authorities around the world in their response to the Covid pandemic. We’re already seeing reports of the rising rates of cancer due to delays in referrals during the UK lockdown, and the economic consequences are still being felt.
Despite this I do feel that our response, although imperfect, was helpful in attenuating the effects of the virus. However, to me the most striking feature of the pandemic was the way that the pharmaceutical industry, the academic researchers and the regulatory authorities worked together to develop and distribute effective vaccines under huge pressure. Today, despite Covid still being with us (and likely to remain so for the foreseeable future, we’re now able to go about our business with minimal restriction. Let’s hope that our winter flu vaccination is as effective!