The COVID-19 pandemic presents many of us in public health with our greatest challenge. Swine flu presented something of a global false alarm – a relatively mild illness causing fatalities similar to seasonal flu, with a false promise of an antiviral treatment and world health care systems mobilised disproportionately. There have been pandemics we have not alarmed ourselves unduly with in the past – Hong Kong flu and other ten-yearly flu A waves stretched us less, because there were no treatments and no vaccines. Spanish flu was a disaster of extraordinary proportions, which we seem to look to most in this current pandemic. Ebola, SARS and MERS were deadly but burned themselves out rapidly…

Now we are confronted with a coronavirus that spreads easily and rapidly and carries significant mortality. We discover its new rules too slowly to prevent spread… some questions still unanswered. Are children silent spreaders? Levels of asymptomatic cases? Length of time of virus excretion?

ASPHER commends and celebrates our colleagues working tirelessly in all countries. It also laments the cuts to public health systems and services in many countries over many years and for the disdain of politicians towards expertise in population health (see box below on decision of the Trump Administration to defund WHO). There will be a time for a reckoning on the failures of global response. Ted Tulchinsky’s COVID blog reminds us of the erosion of public health capability and the need to reinstate this for the future.

Box 1: Comment on Trump Admistration decision to defund WHO

ASPHER deplores the decision of the Trump administration to withdraw funding for the World Health Organisation (WHO) in the middle of this pandemic. The US calls for an investigation into the conduct of the WHO creates uncertainty and added disruption at a time when all governments and international organisations should be collectively focused on tackling the coronavirus. ASPHER Honours Committee Chair, Jose Martin-Moreno eloquently describes the role of WHO and the need for this international health organisation in a soon to be published piece in BMJ Opinion; keep a lookout for when it becomes available. Our international agencies are our major resources with oversight of how this virus is crossing borders, killing people and destroying lives, and what we must all do to stop it. There will be a time for reflection, audit, critical, legal and public inquiry, bringing our leaders to account, leaving no stone unturned. Right now our task is to work together, fearlessly and tirelessly to defeat this killer virus.

For now, our efforts must be focussed entirely on ending this pandemic. Jeffrey Levett reminds us of the perils of not learning from pandemics of the past. Recent stunning evidence from Wuhan, and from our dear colleagues in Italy and France show the effectiveness of lockdowns in the current pandemic. The Wuhan report also shows the effectiveness of centralised quarantine of sick patients. The Italian study suggests that lockdowns in lesser affected areas can be highly protective and beneficial to those areas. And the French analysis shows that in absence of any control measures, the COVID-19 epidemic would have had a critical morbidity and mortality burden in France, overwhelming in a matter of weeks French hospital capacities.

ASPHER has set up a task force on COVID-19 with members from more than 10 countries. Our early work produced the ASPHER statement which is still open to signatories. A major review of use of masks supports a hierarchy of use, with supplies for health and care workers to be protected, but we support the idea of public use as part of the ‘precautionary principle’. We are reviewing evidence on testing. We have also joined with Physicians for Human Rights Israel, in calling for collaborative efforts between Israel and Palestine to secure an effective response to COVID-19 in the West Bank and Gaza. We are looking as well to assembling the evidence of widening inequalities between rich and poor in coping with the lockdown and at the adverse effects on minorities and vulnerable groups – please forward any reports to the secretariat for this neglected area of action during the pandemic.

We congratulate Anna Odone and colleagues on their production of an engaging video on coronavirus for children, available now in both Italian and English; part of our TIPH #THISISPUBLICHEALTH European campaign. There is mounting concern over the mental health of children during lockdown, and clearly wide-ranging negative impacts on health and inequalities through all ages.

The ASPHER Task Force is also putting together an inventory of issues to be addressed in de-escalation from lockdown and formulating recommendations. The COVID-19 Health System Response Monitor from the European Observatory, could be a powerful resource for us all. Check it out, and help us and our partners, to keep international comparisons up to date and accurate.

With the vast actions of our members responding to the outbreak, it is vital that there is also some thinking space for strategic planning ­– for de-escalation from the peak and for the management and prevention of a second wave. We must also be thinking about the end of the outbreak. We will be building the log of public health services cut, resources lost, education and training devalued, science and expertise ignored or rejected. We are also planning for a strengthened public health function – colleagues have been working through this time of frantic activity putting together a proposal for enhanced competencies for communicable disease control for consideration by the European Centre for Disease Prevention and Control.

In addition to working for a better public health system, we will continue to advocate for better public health. How can gains made in terms of reduced air pollution and energy use be maintained? How can streets turned over to walking and cycling be kept in place? How can homes made for homeless and vulnerable people be made sustainable beyond lockdown? How can we rebuild our economies without returning to wanton destruction of our environment and over-reliance on fossil fuels, how can we create social welfare and economic systems which acknowledge the true ‘key workers’ and are more equal and fairer? Can we reward citizenship more equally as with Spain’s leadership on the universal basic income? The Secretary General of the UN has called for global ceasefire during the pandemic – and who knows? Perhaps beyond? We must plan for a world built on values which are central to better public health – for a world free from violence; for more equal societies; for more sustainable economies and environments; for fairer social welfare systems; and for health services which are built on prevention of ill health, protection of health and primary care.

Dear Colleagues - keep up the great work serving and protecting the people we serve and keep yourselves and your loved ones safe.

John Middleton,
President ASPHER

Download the full ASPHER Spring Newsletter here.