Before Covid-19, says Dr Farzana Hussain, it was rare for her 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 dramatically.
“By the time a patient comes to me for advice, everyone in the family has it, including all the children,” she says. “The itching is maddening. People are demanding immediate treatment.”
Transmitted by tiny mites that burrow and lay eggs under the skin, scabies is a disease associated with misery and overcrowding. The disease is spread by close personal contact and is so contagious that during the Victorian period workhouses had separate ‘itch’ wards so that those infected with the mites could be separated and treated before being allowed into the workhouse proper.
According to the Royal College of General Practitioners (RCGP), the rate of scabies now stands at three per 100,000 residents in England, double the five-year seasonal average. That translates to about 2,000 cases of scabies per year. However, in the north, the worst affected region of England, GPs are seeing rates as high as six per 100,000.
Scabies isn’t the only disease that appears to be making a comeback in Rishi Sunak’s Britain. In 2022, 423 patients were admitted to English hospitals with rickets, a disease caused by lack of sunlight and insufficient vitamin D. In the same year, 188 people were treated for scurvy, a condition caused by not eating enough fresh vegetables and fruit. causing a vitamin C deficiency.
Both scurvy and rickets are often seen as indications of malnutrition; In England, hospital admissions are around 10,000 per year, four times as many as twelve years ago. No wonder Dr Clare Gerada, the former president of the RCGP, has warned that Britain is in danger of going “back to the Victorian era”.
Sir Michael Marmot, director of the Institute of Health Equity at University College London, agrees. “The idea that we are starting to suffer from the same diseases that people suffered on long ocean voyages in Victorian times because of the shortage of citrus fruits is simply appalling,” he said recently.
For Marmot, the rise in infectious diseases reflects the cost of living crisis and decades of cuts to social services and public health, leaving Britain with 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 – lived in poverty in 2021-2022 and 6 million people – or four in ten of those living in poverty – lived in “very deep” poverty. , with an income far below the poverty line.
Poverty and disease are closely linked: according to the Royal College of Paediatrics and Child Health, children living in deprived areas are twice as likely to die from infections as children living in the least deprived areas. These health inequalities are reflected in adult mortality rates, with almost 11,000 more deaths in the most deprived areas of Britain than in the least deprived 20% in 2020, according to Marmot’s latest overview of the country’s health.
But are poverty and deteriorating social and economic conditions the only factors? According to the UK Health Security Agency (UKHSA), cases of measles – a disease for which there was no vaccine in Victorian times – are also increasing, with 1,603 suspected cases last year, more than four times the number in 2021.
Britain is also seeing an alarming increase in sexually transmitted diseases, such as syphilis and gonorrhea. The latter has increased by 50%, from 54,961 cases in 2021 to 82,592 in 2022. That is the highest number since registration began in 1918. And syphilis has 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 use home tests as half of the UK’s sexual health clinics were closed. However, the magnitude of the increase also indicates more infections in the community, leading to greater demand for sexual health services.
According to the Local Government Association, STD clinics carried out 4.5 million consultations in 2022, a third more than in 2013. But due to cuts to frontline services and a shortage of sexual health counselors, getting an appointment at a clinic can take weeks, and Patients who manage to get one can wait up to four hours before being seen.
“If people can’t get in when they want to, there’s a risk they won’t come at all,” said Prof Matt Phillips, chairman of the British Association for Sexual Health and HIV.
But this is certainly not the whole story: the increase in STDs may also be a result of fewer people taking precautions than in the 1980s and early 1990s, when fear of AIDS prompted people to engage in less risky sexual behavior . In contrast, the availability of pre- and post-exposure prophylaxis for HIV today means that gay and bisexual men have less incentive to use condoms.
And when it comes to measles and other preventable diseases, the increases are likely due to a similar set of factors, including fear of vaccines, fatigue with childhood vaccination schedules and the difficulty of accessing vaccinations for households where both parents have full-time jobs. to have. .
The visits where mothers were allowed to ask questions about their baby’s health no longer take place in the same way as in the past
Helen Bedford, professor of child health
The result is that in Birmingham, where doctors treated more than 50 cases of measles last month, prompting the UKHSA to declare a “national incident”, only 80% of children received two doses of the mumps-measles-rubella (MMR) vaccine. had received. their fourth birthday (the national target is 95%). And in Hackney, East London, this is just 56.3%.
No wonder some experts believe Britain faces a serious challenge from past infections. One thing that could make a difference is attracting more healthcare visitors. But due to local government cuts, this workforce has fallen by 40% since 2015.
“We don’t have enough health visitors to meet the rising need,” said Georgina Mayes, policy and quality lead at the Institute of Health Visitors. “As a result, too many families are missing out on vital assessments from health visitors.”
Helen Bedford, professor of child health at University College London, believes the shortage is one of the factors causing low uptake of the MMR jab and other vaccines.
“It means that visits where mothers were allowed to ask questions about their baby’s health will no longer take place in the same way as in the past,” she says. As a result, parents are less likely to take medical advice to vaccinate their children.
Bedford says this hesitancy was exacerbated by the pandemic, when people were encouraged not to visit GP surgeries unless necessary, even though most operating theaters never suspended their vaccination services.
“The message should have been: stay home, but you can still get your child vaccinated,” said Bedford.
Hussain says fatigue is another factor: “During the pandemic, people have bought into the message of getting the Covid vaccine, but now don’t feel it is necessary – or that they have the time – to get the measles jab for their to have children. If you’re on a zero-hours contract and struggling to make ends meet, you’re less likely to take the time to leave the office to get a vaccine.”
Bedford agrees, which is why she would like to see more mobile vaccination centers.
Another factor driving the increase in measles infections is misinformation and conspiracy theories about vaccines. In 2018, 93% of people thought vaccines were important for children. Today, only 72% 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 vaccines containing gelatin are prohibited for Muslims, even though alternative vaccines that do not contain gelatin are also available.
For others, it reflects the continuing influence of disgraced gastroenterologist Dr Andrew Wakefield, who suggested there was a link between the MMR jab and autism. Although Wakefield’s theory has been completely debunked, it continues to appear on numerous anti-vax sites, as well as on the WhatsApp chats where many parents get their medical information.
The danger now, Hussain argues, is that the ‘Wakefield cohort’ – people who missed their MMR jab because of Wakefield in the 1990s – will have babies of their own, raising the risk of further outbreaks in both unimmunized adults and children increases. Such outbreaks are serious. Measles is extremely contagious: in a susceptible population, one measles carrier can infect between 12 and 18 people, and for every 1,000 children who contract measles, one to three will die.
But is there a danger that in comparing the current situation with the Victorian period we are seeing things blown out of proportion? For example, one of the main reasons why cases of scabies are increasing is a shortage of treatments such as permethrin and malathion, according to the British Association of Dermatologists. And not every case of scurvy is due to parents not being able to afford fresh fruits and vegetables. Sometimes a vitamin C deficiency can be due to children being picky eaters.
Similarly, the rate of rickets is far below the rate in the 19th century, when London was blanketed by smog, blocking UV rays. It is estimated that the condition affected 60% of children in the capital.
However, that doesn’t mean we should be complacent. Dr. Benjamin Jacobs, an expert on rickets at the Royal National Orthopedic Hospital in Stanmore, Middlesex, says that while it was unusual to see a case of rickets in the 1980s, today the condition is unfortunately no longer a rarity . “Every year I see at least three children with rickets; each case is a heartbreak,” he says.
“The NHS has been providing free vitamin supplements to some children for almost two decades, but the vitamins often do not reach the children who need them most. It is shameful that the NHS has not made more progress in preventing these serious diseases.”