Dr Farzana Hussain says before Covid-19 it was rare to see a case of scabies at her GP practice in Newham, east London, but since the pandemic the number of patients with the parasitic skin infection has increased significantly.
“When a patient comes to me for advice, everyone in the family has that information, including all the children,” he says. “The itching is maddening. People are demanding urgent treatment.”
Transmitted by tiny mites that burrow under the skin and lay eggs, scabies is a disease associated with squalor and overcrowding. The disease, spread through close personal contact, is so contagious that in Victorian times workhouses maintained separate “itch” wards so that those infested with mites could be separated and treated before properly entering the workhouse.
According to the Royal College of General Practitioners (RCGP), cases of scabies currently occur at a rate of three per 100,000 of the population in England; This is twice the five-year seasonal average. This means approximately 2000 scabies cases per year. But in the north, the worst-hit part of England, GPs are seeing rates as high as six per 100,000.
Scabies isn’t the only disease making a comeback in Rishi Sunak’s Britain. In 2022, 423 people were admitted to UK hospitals with rickets, a disease caused by lack of sunlight and vitamin D. That same year, 188 people were treated for scurvy, which was caused by not eating enough fresh fruits and vegetables. It causes vitamin C deficiency.
Both scurvy and rickets are often seen as indicators of malnutrition; The number of hospital admissions in England is around 10,000 a year, four times the level of 12 years ago. Former president of the RCGP, Dr. It’s little surprise that Clare Gerada warns England is in danger of “regressing back to the Victorian era”.
Sir Michael Marmot, director of the Institute for Health Equity at University College London, agrees. “The idea that we are starting to suffer from the same diseases that people suffered during long ocean voyages in the Victorian era due to citrus shortages is truly terrifying,” he said recently.
The rise in infectious diseases reflects a cost-of-living crisis and a decade of cuts to social services and public health, according to Marmot; This makes Britain one of the poorest and most vulnerable populations in Europe.
According to a recent report from 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 people in poverty – were in “very deep” poverty. He has an income well below the poverty line.
Poverty and disease are closely linked: children living in deprived neighborhoods are twice as likely to die from infections as those living in the least deprived neighbourhoods, according to the Royal College of Paediatrics and Child Health. These health disparities are also reflected in adult mortality rates; There were nearly 11,000 more deaths in the UK’s most deprived areas in 2020 than in the least deprived 20%, according to Marmot’s latest review of the nation’s health.
So are poverty and deteriorating social and economic conditions the only factors? According to the United Kingdom Health Safety 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.
There are also worrying increases in sexually transmitted diseases such as syphilis and gonorrhea in Britain. The latter increased by 50% from 54,961 cases in 2021 to 82,592 in 2022. This is the highest figure since records began in 1918. Syphilis, on the other hand, increased by 15% to 8,692 in 2022; The highest number since 1948.
Some of this increase in STDs can be explained by more diagnostic testing; During the pandemic, the government encouraged people to test at home as half of sexual health clinics in the UK were closed. However, the size of the increase also indicates that there are more infections in the community, which increases the demand for sexual health services.
According to the Local Government Association, STD clinics carried out 4.5 million examinations in 2022; This figure is one third more than in 2013. But due to cuts to frontline services and a shortage of sexual health counselors, it can take weeks to get an appointment at the clinic, and patients who manage to get one can face waits of up to four hours before being seen.
“If people can’t come in when they want, there’s a risk they won’t come in at all,” says Prof Matt Phillips, president of the British Association for Sexual Health and HIV.
But that’s not the whole story: The rise in STDs may also reflect that fewer people are taking precautions than in the 1980s and early ’90s, when fears of AIDS persuaded people to adopt less risky sexual behaviors. In contrast, the availability of pre- and post-exposure prophylaxis against HIV today means that gay and bisexual men have less incentive to use condoms.
When it comes to measles and other preventable diseases, the increases are likely driven by similar factors, including fears about vaccines, fatigue from childhood vaccination schedules, and difficulty accessing vaccines in households where both parents work full-time. .
Visits where mothers ask questions about their babies’ health are no longer happening as they used to.
Helen Bedford, professor of child health
As a result, in Birmingham, where doctors last month treated more than 50 cases of measles, leading the UKHSA to declare it a “national incident”, only 80% of children will receive two doses of the measles, mumps and rubella (MMR) vaccine by 2013 It turned out to be. their fourth birthday (national target 95%). And in Hackney, east London, the figure is just 56.3%.
No wonder some experts believe Britain faces a serious problem due to legacy infections. One thing that could make a difference is employing more health visitors. However, due to local authority cuts, this workforce has decreased by 40% since 2015.
“We don’t have enough health visitors to meet increasing levels of need,” says Georgina Mayes, policy and quality lead at the Health Visitor Institute. “As a result, too many families are missing out on essential reviews from health visitors.”
Helen Bedford, professor of child health at University College London, believes this deficiency is one factor contributing to the low uptake of the MMR vaccine and other vaccines.
“This means that visits where mothers have to ask about their baby’s health are not occurring or occurring as they have in the past,” she says. As a result, parents are less likely to seek medical advice to vaccinate their children.
Bedford argues that this hesitancy has been exacerbated by the pandemic, with people encouraged not to attend GP surgeries unless necessary, although most practices never suspended vaccination services.
“The message should have been: stay home, but you can still vaccinate your child,” says Bedford.
Another factor, Hussain says, is fatigue: “During the pandemic, people heeded the message of getting the Covid vaccine, but they no longer feel it is necessary or they have the time to vaccinate their children against measles. “If you’re on a zero-hours contract and struggling to make ends meet, you’re less likely to take time out of the office to get your vaccine.”
Bedford agrees, which is why he’d like to see more mobile vaccination centres.
Another factor causing an increase in measles cases is misinformation and conspiracy theories about vaccines. In 2018, 93% of people thought vaccines were important for children. Today, only 72 percent 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 gelatin-containing vaccines are prohibited for Muslims, although alternative gelatin-free vaccines are available.
For others, it’s Dr. Disgraced gastroenterologist, who suggested a link between the MMR vaccine and autism. It reflects the continuing influence of Andrew Wakefield. Although Wakefield’s theory has been extensively debunked, it continues to appear on numerous anti-vaccine sites and in WhatsApp chats where many parents receive their medical information.
The danger now, Hussain argues, is that the “Wakefield cohort” who missed out on MMR vaccines in the 1990s because of Wakefield will have babies themselves, increasing the likelihood of further outbreaks in both unvaccinated adults and children. Such outbreaks are serious. Measles is highly contagious; In a susceptible population, a measles carrier can infect 12 to 18 people, and 1 to 3 in every 1,000 children who get measles will die.
So is there a danger of blowing things out of proportion when comparing the situation today with the Victorian era? For example, according to the British Association of Dermatologists, one of the main reasons for the increase in scabies cases is the lack of treatments such as permethrin and malathion. And not every case of scurvy is due to parents not being able to afford fresh fruits and vegetables; Sometimes vitamin C deficiency may be due to children being picky eaters.
Similarly, the incidence of rickets is well below that seen in the 1800s, when London was shrouded in smog and blocked out UV radiation, and the condition is estimated to affect 60% of children living in the capital.
But this does not mean that we should remain complacent. Dr D, a rickets specialist at the Royal National Orthopedic Hospital in Stanmore, Middlesex. While cases of rickets were uncommon in the 1980s, unfortunately the condition is no longer uncommon today, says Benjamin Jacobs. “Every year I see at least three children with rickets; “Every case is a heartbreak,” he says.
“The NHS has been providing free vitamin supplements to some children for almost 20 years, but vitamins often do not reach the children who need them most. “It’s a shame that the NHS hasn’t made more progress in preventing these serious diseases.”