Another week, and the NHS is in the midst of another crisis. As has been widely reported, Group A Streptococcus (Strep A) It’s circulating at higher levels than usual for the time of year. Streptococcus A is the bacterium that causes scarlet fever, certain throat infections and, more rarely, can cause severe invasive disease. Antibiotics are recommended to reduce the likelihood of serious illness, as well as to reduce the spread of infection.
The media have been regularly reporting on the number of child deaths this winter, and many parents are understandably concerned. However, invasive strep A rates are currently no higher than in March 2018 (the last major season for this infection), and it is unclear whether the total number of deaths for the entire season will be significantly different from 2017/18. .
However, the UK Health Insurance Agency has advised parents to seek urgent medical attention if their children have symptoms of scarlet fever, and schools have sent newsletters through official channels. But with symptoms as nonspecific as sore throat, rash, and fever likely to be present in many thousands, even millions, of mildly ill children this winter, guidance to seek early medical attention seems to be counterproductive. GPs report that the number of children presenting for their surgeries has skyrocketed, and pediatric emergency departments are experiencing unprecedented levels of demand.
Across the country, parents report difficulty accessing antibiotics and often need to visit multiple pharmacies to fill prescriptions. Surgeries have been getting phone calls from completely healthy patients requesting antibiotics to keep them on hold, in case they get sick and can’t access treatment. Perhaps all this panic is a response to several years of 24-hour reporting. on Covid rates and deaths. Or maybe it’s related to higher levels of isolation, as parents have had reduced support from peers and family members.
Whatever the cause: parental anxiety levels are worryingly high.
Surprisingly, no one seems to have predicted that some degree of panic could be induced by warning millions of parents that a sore throat or fever could herald a fatal illness. Coupled with a health service stretched to the limit in terms of capacity, such conditions can create a perfect storm. Paradoxically, if you convince enough people that they need urgent medical care, you can create a situation where care is not accessible to the small minority who are seriously ill. This is especially true of a health service, such as the NHS, which has been deliberately ‘reducedly run’ for many years. However, the occurrence of unintended harmful consequences of health policy interventions seems to be a depressingly common theme in the UK.
How it works with gasoline or toilet paper, this is a typical example of high demand meeting limited supply (perceived or real) and causing panic. If the situation is not calmly rationalized soon, we will see worsening access to medical care and antibiotic supplies, and preventable harm to patients as a direct result of irrational behavior. From my perspective as a GP, it would be much safer to encourage parents to behave as they normally would in response to common winter illnesses.
As health services fill up with mildly ill children, it will inevitably become more difficult to care for other patients. In the current context, it is hard to imagine how this can be secure. The NHS simply cannot afford to induce spikes in demand, without expecting serious repercussions. One wonders if healthcare leaders understand how difficult it already is for the public to access healthcare.
Of course, this slight rise in Strep A levels shouldn’t cause the NHS to collapse. But with GP practices and hospital departments already facing capacity and staffing crises, and no plans to fix our faltering health service: this is where we find ourselves.
Could these scenes of panicked parents struggling to access medical treatment for their children herald a new era in patient behavior? Could the many bottlenecks in our system drive the public to act in ever more desperate ways? This episode should serve as a reminder to healthcare leaders (if there was ever any doubt): the NHS ship is sinking and there aren’t enough lifeboats.