BBefore Covid-19, says Dr Farzana Hussain, it was rare that she saw a case of fire blight at her GP surgery in Newham, East London, but since the pandemic the number of patients with the parasitic skin infection has increased dramatically.
“By the time a patient comes to me for advice, everyone in the family has it, including all the children,” she says. “The itching is crazy. People are demanding immediate treatment.”
Transmitted by tiny mites that burrow and lay eggs under the skin, scabies is a disease associated with misery and overcrowding. Spread by close personal contact, it is so contagious that workhouses during the Victorian era maintained separate “itch” wards so that those infected with the mites could be separated and treated before being allowed into the workhouse itself.
According to the Royal College of General Practitioners (RCGP), scabies cases are run now at three per 100,000 of the population in England, double the five-year seasonal average. This amounts to approximately 2,000 cases of anthrax per year. In the north, the worst-affected region of England, GPs are seeing rates as high as six per 100,000.
Scabies isn’t the only disease that seems to be making a comeback in Rishi Sunak’s Britain. In 2022, 423 patients were admitted to English hospitals with ricketsa disease caused by a lack of sunlight and insufficient levels of vitamin D. That same year, 188 people were treated for scurvya condition caused by not eating enough fresh fruit and vegetables, resulting in a vitamin C deficiency.
Both scurvy and rickets are often seen as proxies for malnutrition, for which hospital admissions are at around 10,000 a year in England, four times the level of 12 years ago. No wonder Dr Clare Gerada, the former president of the RCGP, warned the UK is in danger of “going back to the Victorian era”.
Sir Michael Marmot, director of the Institute of Health Equity at University College London, agrees. “The idea that we’re starting to suffer the same diseases that people suffered on long sea voyages in Victorian times because of the shortage of citrus fruit is simply appalling,” he said recently.
For Marmot, the rise in infectious diseases reflects the cost of living crisis and decades 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 s 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 of those in poverty – were in “very deep ” poverty, with an income below the poverty line.
Poverty and disease are closely correlated: 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 neighborhoods. These health inequalities are reflected in adult mortality rates, with almost 11,000 more deaths occurring in the most deprived areas of the UK in 2020 than in the least deprived 20%, according to Marmot’s most recent review of the state of the nation’s health.
But are poverty and deteriorating social and economic conditions the only factors? According to the UK Health Security Agency (UKHSA), cases of measles – a disease for which there was no vaccine in Victorian times – are also 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 gonorrhea. The latter is up 50% from 54,961 cases in 2021 to 82,592 in 2022. This is the highest number since records began in 1918. And syphilis is up 15% to 8,692 in 2022, the highest number since 1948.
Some of this increase in STDs can be explained by more diagnostic tests – during the pandemic the government encouraged people to use home tests as half of UK sexual health clinics were closed. However, the magnitude of the increase also indicates more infections in the community, leading to more demand for sexual health services.
According to the Local Government Associationin 2022 STD clinics carried out 4.5 million consultations, a third more than in 2013. But due to cuts to frontline services and a shortage of sexual health counsellors, it can take weeks to get an appointment at a clinic , and patients who manage to get one can wait up to four hours before being seen.
“If people can’t come in when they want, the risk is that they might not come at all,” says Prof Matt Phillips, president of the British Association for Sexual Health and HIV.
But that’s by no means the whole story: the increase in STDs may also reflect that fewer people are taking precautions than in the 1980s and early ’90s, when the fear of AIDS persuaded people to adopt less risky sexual behavior. By contrast, today the availability of pre- and post-exposure prophylaxis for HIV means that gay and bisexual men have less incentive to use condoms.
And when it comes to measles and other preventable diseases, the increases are likely due to a similar variety of factors, including fears about vaccines, fatigue with childhood vaccine schedules and the difficulty of accessing incentives for households where both parents are in full-time work.
The result is that in Birmingham, where doctors treated more than 50 measles cases last month, prompting the UKHSA to declare a “national incident”, only 80% of children had two doses of measles, mumps and rubella (MMR) ) vaccine received. their fourth birthday (the national target is 95%). And in Hackney, East London, the figure is just 56.3%.
No wonder some experts believe Britain faces a serious 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 increasing needs,” says Georgina Mayes, policy and quality lead at the Institute for Health Visitors. “As a result, too many families are missing vital health visitor reviews.”
Helen Bedford, professor of child health at University College London, believes the shortage is one of the factors driving the low uptake of the MMR jab and other vaccines.
“This means that those visits where mothers had to ask questions about their baby’s health do not take place or happen in the same way as in the past,” she says. As a result, parents are less likely to take medical advice on board to vaccinate their children.
Bedford argues that this reluctance was exacerbated by the pandemic, when people were encouraged not to visit GP surgeries unless necessary, even though most surgeries never suspended their vaccination services.
“The message should have been, stay home, but you can still get your child vaccinated,” says Bedford.
Hussain says another factor is fatigue: “During the pandemic, people took the message on board to get the Covid vaccine, but now don’t feel it’s necessary – or that they have the time – to give the measles seeds to their children don’t get If you’re on a zero-hours contract and you’re struggling to make ends meet, you’re less likely to take time away from the office to get a vaccine.”
Bedford agrees, which is why she would like to see more mobile vaccination centers.
Another factor driving the increase 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 – that vaccines containing gelatin is prohibited for Muslims, although alternative vaccines that do not contain gelatin are also available.
For others, it reflects the continuing influence of the disgraced gastroenterologist Dr. Andrew Wakefield, who suggested that there is a link between the MMR shot and autism. Although Wakefield’s theory has been widely debunked, it continues to appear on numerous anti-vax websites, as well as on the WhatsApp chats where many parents get their medical information.
The danger now, Hussain argues, is that the “Wakefield cohort” – people who missed their MMR boosters in the 1990s because of Wakefield – are having babies themselves, increasing the chance of further outbreaks in both unimmunized adults and children. Such outbreaks are serious. Measles is extremely contagious – in a susceptible population, one measles carrier can infect between 12 and 18 people, and for every 1,000 children who get measles, one to three will die
But is there a danger that when we compare today’s situation with the Victorian period we may be blowing things out of proportion? For example, one of the main reasons why scabies cases are increasing, according to the British Association of Dermatologists, is short of treatments such as permethrin and malathion. And not every case of scurvy is due to parents not being able to afford fresh fruit and vegetables – sometimes a vitamin C deficiency can be due to children being picky eaters.
Similarly, the incidence of rickets is well below the rate seen in the 1800s, when London was blanketed in smog, which blocks UV radiation, and the condition is estimated to have affected 60% of children living in the capital .
However, this is not to say that we should be complacent. Dr Benjamin Jacobs, an expert in rickets at the Royal National Orthopedic Hospital in Stanmore, Middlesex, says that while in the 1980s it was unusual to see a case of rickets, the condition is unfortunately no longer a rarity today. “Every year I see at least three children with rickets; every case is a sadness,” he says.
“The NHS has been providing free vitamin supplements for some children for almost 20 years, but the vitamins often do not reach the children who need them most. It is a shame that the NHS has not made more progress to prevent this serious illnesses.”
