Everything has been different since the beginning of the COVID-19 pandemic. First, there was the optimism that SARS-CoV-2 would not affect the UK as had been the case with SARS-CoV and MERS-CoV, but then came the realisation that it was a serious risk even to the UK population. Daily, more is learnt about SARS-CoV-2, namely, its transmissibility; incubation period; the proportions of those with mild illness, those requiring hospitalisation and those requiring intensive care; mortality among those aged less than 65 years; and the comparison of SARS-CoV-2 with previous pandemic influenzas (Petersen et al, 2020). The evidence suggests that the virus is mainly transmitted through the air in close-contact environments rather than through fomites (World Health Organization (WHO), 2020a). Consequently, the focus is on breaking the chains of transmission by limiting close contact between infected individuals and others and the use of fabric face masks to counter inadvertent transmission by asymptomatic individuals in the community (WHO, 2020a).
Although the NHS has demonstrated resilience in response to COVID-19 in the UK, other key services were downgraded. In particular, cancer screening was suspended, with routine cancer diagnostic work deferred except for those with clear symptoms (Maringe et al, 2020), and some cancer treatments, suspended. Recently, the NHS in England has announced £160 million funding of COVID-friendly treatments, which has been widely welcomed (NHS England, 2020). Maringe et al's (2020) statistical modelling of the impact of the COVID-19 lockdown on four cancers estimated that there would be 3291–3621 avoidable deaths and an additional 59 204–63 229 years of life lost (YLL) due to delays in cancer diagnosis. Equally concerning has been the decline in childhood vaccination uptake, not only globally (WHO, 2020b), but also in the UK. The ‘stay at home’ message appears to have deterred parents from taking their children for routine vaccinations (Saxena et al, 2020), despite Public Health England (2020) clinical guidance recommending the continuation of the routine immunisation programme. The testing of new therapies for non-COVID-19 conditions has also been disrupted, with many clinical trials suspended or stopped, which will likely impact on the approval of new treatments, with long-term effects on medical science and patient outcomes (van Dorn, 2020).
Whether the COVID-19 epidemic can remain contained in the UK until there is an effective vaccine depends on the populations' behavioural adherence, both at work and at home. In the meantime, it is likely that some of the changes to healthcare delivery will remain. Hopefully, the UK will avoid a second peak of COVID-19 infections in the winter.
‘The ‘stay at home’ message appears to have deterred parents from taking their children for routine vaccinations’