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The public health bird is on the wing

We are at a stage in dealing with the C-19 pandemic where we look even more to numbers to guide our response than at any previous point.

That doesn't mean we have lost sight of the human impact of a disease for which there is nothing in the pharmacological toolbox with which to fight it. There is a range of interventions that are being used to manage the effects of the virus in patients. The use of ventilators is one. So our main objective, as it has been from the start, is to stop the spread from person to person.

One of the very interesting things to emerge from Professor Harry Burn's evidence to the COVID-19 Committee yesterday was in relation to face masks. Now he is someone to whose advice I have always listened carefully. We were fortunate to have him and Professor Linda Bauld, a public health specialist, before our Committee.

Harry told us that masks worn by those who are infected reduces the number to whom they pass on the virus, to one-tenth of what it would otherwise have been. And of course, not everyone who is infected, knows they are. So the advice to wear masks in public looks sound. All those we meet can benefit.

Both exhibited the skill that the best QCs have when addressing the jury. They broke down complex issues into bite-size chunks and deployed numbers to explain their conclusions. They were like the best teachers. Able to speak intelligibly to an audience considerably less knowledgable or experienced than themselves and lift us to a new and better understanding.

However, they also spoke to the shortcomings and gaps in the currently available data. Why the "test, trace and isolate" phase now becomes the priority. Not because it will provide better numbers, although it will, but because it is the next tool to slow, even stop, further transmission of the disease.

In Committee, colleague Ross Greer pursued whether we should be aiming to eliminate the virus. And I believe he heard that that could be an outcome of the approach just announced. But for my part, we are likely to need a program like the ten-year World Health Organisation (WHO) program to eradicate smallpox. If it remains anywhere in the world, it can travel to a country, like our own, which has eliminated it and thus re-infect us. The Washington Post today suggests that a single carrier of the virus in New York State caused 60,000 people to catch the disease.

That's why we need the USA in particular, who are presently reluctant to collaborate internationally, to re-connect with the WHO. They are the only credible body who can lead a world-wide eradication program. They did it once and are our best hope of doing it again.

Adam Tomkins is also part of the Committee. He questioned why when only about 15% of Intensive Care Unit (ICU) beds in Scotland are currently occupied, a key priority of the messaging had been about the need to protect the NHS from being overwhelmed. The number made it a fair question.

Is that 15% number a measure of the success of the strategy adopted, basically in all four UK countries, or an indication of an excessive caution in public policy? I don't yet have all the evidence to support my instinctive belief that it's a success and caution is good. Yesterday's answers won't have settled this question and I imagine Adam will return to the issue later. Quite properly.

The bottom line is that if we have people of the calibre of yesterday's witnesses engaged in understanding and responding to this pandemic we are in good hands.

Harry is, of course, no stranger to public policy decision-making. He was appointed Chief Medical Officer by the Labour-Lib Dem administration in 2005 and was in post when I became a Minister in 2007. He asked to speak to whole team of Cabinet Secretaries and Ministers very early in the life of our Government. And substantially influenced our policy actions across a range of portfolios.

He illustrated that a "public health" approach needed to cross boundaries. His appointment was a good decision by Jack McConnell and his team. We were fortunate to have him in post when we arrived in Government.

Public Health has perhaps been a neglected area in both medical training and policy-making. I invited Linda to agree with me on that point and, not too strangely given her specialist interests, she did.

I recalled that my father's medical training, he enrolled at Edinburgh University in April 1924, included a course in public health. He recounted that the lectures took place on Saturday mornings and that you had to sign-in to gain the necessary certificate attesting that one had "duly performed" (DP) the work of the class. However, in practice, only a few students attended, but many more were "signed-in" by those who did.

My father failed to make adequate arrangements for his (apparent) signature to appear with sufficient regularity in the attendance register. He, therefore, was not issued with his DP certificate. And found when planning to graduate, that he could not do so without his public health course DP. He did not fail any exam; there was no public health exam to be passed. How he solved this problem was never fully explained to me. But he did graduate.

Public health was an orphan subject then. And it seems it may still to be.

It's not as if we shouldn't know. When physician John Snow discovered in 1854 that the Broad Street water pump in London was the source of a cholera outbreak which killed hundreds, he more or less invented a modern public health discipline. And accumulating data was a key part of his understanding of the role of the water supply in the transmission of the disease. Public health issues remain crucial today.

As mathematicians, my wife and I count things. Today's diary will bring the total of words by me in the 51 days of writing since my social isolation started to 57,858 words.

More excitingly for me, numbers-wise and in lots of other ways, I expect to make my 821st Parliamentary speech on Tuesday next. But this time it will be part of our first use of "hybrid" technology for debates. From our benches, Christine Grahame and I expect to join colleagues, present in our debating Chamber, from our homes courtesy of video-conferencing. 657,524 words in my speeches and 4,965 minutes of speaking time so far; and rising.

The exercise program continues, 274.61 miles since 17th March. A plan for another eight or so this afternoon. Should get over the 300 miles before that next Parliamentary speech.

The Bird of Time has but a little way
To flutter--and the Bird is on the Wing.
(The Rubaiyat of Omar Khayyam, verse 7)


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