A view from UK public health registrars on the challenges of COVID-19
Authors: Matilda Allen, Isobel Braithwaite, Shelui Collinson, Youssof Oskrochi, Anamika Basu
Journal: The Lancet (2020)

The quotes from frontline workers in Richard Horton's Comment1Horton R Offline: COVID-19 and the NHS—"a national scandal".Lancet. 2020; 3951022Summary Full Text Full Text PDF PubMed Scopus (123) Google Scholar about COVID-19 and the National Health Service (NHS) make for distressing reading, and the risks currently facing our clinical colleagues weigh heavily on our minds. As public health registrars, we understand that root causes of the current challenges regarding COVID-19 include historical policy decisions that have affected the UK's health workforce and systems,2Buchan J Charlesworth A Gershlick B Seccombe I A critical moment: NHS staffing trends, retention and attrition.https://www.health.org.uk/sites/default/files/upload/publications/2019/A%20Critical%20Moment_1.pdfDate: February, 2019Date accessed: May 18, 2020Google Scholar including laboratory capacity. Nevertheless, a pandemic caused by a novel highly pathogenic virus would prove profoundly difficult in any context. Sourcing personal protective equipment, scaling up testing, and increasing hospital capacity are problematic worldwide, and are exacerbated by global shortages.3Ranney ML Griffeth V Jha AK Critical supply shortages - the need for ventilators and personal protective equipment during the Covid-19 pandemic.N Engl J Med. 2020; 382: e41Crossref PubMed Scopus (1377) Google Scholar The statement by Richard Horton that "They [UK Government] didn't isolate and quarantine. They didn't contact trace" is inaccurate. Many of the signatories of this Correspondence were involved in Public Health England's extensive early contact tracing, testing, and isolation efforts, done by health protection staff working tirelessly across the country. The transmission dynamics of severe acute respiratory syndrome coronavirus 2 make it challenging to control through these measures alone4Hellewell J Abbott S Gimma A et al.Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts.Lancet Glob Health. 2020; 8: e613-e614Summary Full Text Full Text PDF PubMed Scopus (1685) Google Scholar and, despite these efforts, a proportion of cases went under the radar. By mid-March, 2020, widespread community transmission was evident, precipitating a shift towards advising the public to self-isolate and supporting higher-risk settings such as care homes, prisons, and homeless shelters. We agree that improved testing capacity, combined with innovative ways to contact trace at scale, are vital.5Ferretti L Wymant C Kendall M et al.Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing.Science. 2020; 368eabb6936Crossref PubMed Scopus (1668) Google Scholar However, implementing these strategies presents several practical and ethical challenges5Ferretti L Wymant C Kendall M et al.Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing.Science. 2020; 368eabb6936Crossref PubMed Scopus (1668) Google Scholar and they might not offer a panacea.3Ranney ML Griffeth V Jha AK Critical supply shortages - the need for ventilators and personal protective equipment during the Covid-19 pandemic.N Engl J Med. 2020; 382: e41Crossref PubMed Scopus (1377) Google Scholar This pandemic calls for collaboration rather than division, and we have seen concerted efforts across society to rise to this unprecedented challenge. We must learn from both failings and successes, and seek out solutions, not scapegoats. This online publication has been corrected. The corrected version first appeared at thelancet.com on June 11, 2020 This online publication has been corrected. The corrected version first appeared at thelancet.com on June 11, 2020 We hold honorary contracts with Public Health England (PHE); as such, we are required to follow PHE's code of conduct, and we have worked directly on PHE's response to COVID-19. We are not paid directly by PHE and are employed by Imperial College Healthcare NHS Trust, which is reimbursed by PHE for any overtime carried out for PHE. Signatories and contributors of this Correspondence are listed in the appendix. Download .pdf (.11 MB) Help with pdf files Supplementary appendix Department of ErrorAllen M, Braithwaite I, Collinson S, Oskrochi Y, Basu A. A view from UK public health registrars on the challenges of COVID-19. Lancet 2020; 395: 1830—In this Correspondence, the declaration of interests has been corrected to reflect that the authors hold honorary contracts with Public Health England (PHE), are required to follow PHE's code of conduct, and have worked directly on PHE's COVID-19 response. The authors are not paid directly by PHE and are employed by Imperial College Healthcare National Health Service Trust, who are reimbursed by PHE for any overtime carried out for PHE. Full-Text PDF