COVID-19: The Global Environmental Health Experience

Chris Day

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780367743314
• eBook ISBN: 9781000433548
• Edition: 1
• Topic: Medicine
• Subtopic: Environmental Science

This book is devoted to the efforts of Environmental Health Practitioners (EHPs), their employers and supportive professional bodies world-wide in responding to the COVID-19 pandemic.

Drawing upon the first-hand experiences and reflections of EHPs working across the professional discipline in countries around the world, the book highlights how they responded to the initial wave of SARS-CoV-2 infection as it spread globally. It explores how this impacted on their environmental health work as their wider public health skills and expertise were increasingly called upon/ The book recognises the significant contributions that EHPs have made to protect lives and livelihoods since the seriousness of COVID-19 became apparent. It also identifies shortcomings in the response and deployment of personnel and makes a series of recommendations to inform future practice.

This book:

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• Captures a moment in history through the experiences of Environmental Health Practitioners in meeting the complex challenges presented by the COVID-19 pandemic.

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• Features the observations of front line practitioners on the practical challenges and opportunities encountered globally, suggesting the lessons learnt for current practice in infectious disease prevention and control.

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• Expands upon the reflections of some of the professional bodies around the world as to how the response of EHPs to the COVID-19 pandemic should result in a renewed commitment to public health through Environmental Health.

EHPs in current practice and in training, other public health professionals and those looking to build better health protection services, now, and in the future, will find this book a valuable resource to inform the case for the key role of Environmental Health in the current pandemic, in response to future challenges and crises, and in managing risks to health encountered in more usual times.

1 Countdown to the pandemic
An Environmental Health point of view

DOI: 10.1201/9781003157229-1

1.1 Introduction

Just over a year has passed since SARS-CoV-2 emerged and spread around the world as COVID-19 and is now doing so again through a second wave associated with new strains. In just 12 months it has brought many nations to their knees socially, economically and emotionally, taking away lives and livelihoods. In its wake, SARS-CoV-2 has put public health systems to the test like no other infectious agent since the influenza pandemic of 1918/1919. Some have buckled under the strain, while others have excelled, though there is no doubting the fact that none of this should have come as a surprise.

While our interest is in the professional response to COVID-19, in a sense it is the people’s disease, as our media inter-connectedness caused the population at large to confront it. Whereas one might have been hard-pressed to discover many members of the public with more than a hazy idea of what ‘Public Health’ was, still less an awareness of who practised it and who spoke on its behalf, this is no longer the case. If the term ‘epidemiology’ might have evoked something mysterious and beyond the need for comprehension, today, its language punctuates everyday conversation, with the ‘R-Value’ much-quoted and the personalities attending press conferences identified by name, title and mannerisms.

However, in the time it has taken us to orbit the sun, COVID-19 has moved from being a condition of little real consequence to one whose devastating effects have been felt by billions. Together, as a world audience, we have watched while clinical science and biotechnology have played catch-up with a novel coronavirus in real time. Yet, all the while science has been hard at work devising effective treatment regimens and the ‘magic bullet’ of a vaccine, we have been reliant on the most basic of Public Health measures to keep us safe.

Among those responding to COVID-19 were a small but dedicated band of lesser-known health professionals that have been involved in promoting and performing many of these fundamental measures so as to bring this disease under control. Their discipline is known as ‘Environmental Health’ (referred to throughout as ‘EH’) and they are called ‘Environmental Health Practitioners’ (‘EHPs’)

For EHPs, like so many others with a remit to protect health, and even more so those rescuing their fellows when they succumb to illness, this has been a testing time. Yet they have risen to the occasion, and despite finding themselves performing unfamiliar tasks, demonstrated their special blend of skills to critical acclaim. How EHPs were confronted by COVID-19 and emerged from the first wave as a force for good among the wider Public Health workforce is the subject of this book.

1.2 SARS-CoV-2 and the COVID-19 pandemic

The story of where this strain of coronavirus may have originated, and how the infection took hold and spread, prompting the stark realisation that the world was not immune, literally or metaphorically, to the direct and indirect effects of infectious disease, is a story already much told. We outline it here because it serves as a warning that, ‘midst the excitement of discovering drug therapies that help to keep patients out of ICU and off ventilators, and vaccines that may prevent people getting sick in the first place, Environmental Health, and hygiene measures based on the principles of sanitary science, will remain the third and vital element of the solution for the foreseeable future.

While we are eternally grateful to medicine, and those that practice it, for keeping us going individually, medical science does not have all the answers when it comes to keeping populations safe and well. COVID-19 is not going to be the last infection associated with a zoonotic pathogen that threatens to break out from its point of origin and transmit serious disease worldwide, so we must better learn lessons from this one.

If we did not know it already, novel agents responsible for infectious agents such as SARS-CoV-2 require, by their nature, time to be identified and understood, and then more time still to develop the biomedical means to treat and ultimately prevent them. As we write, across the world, vaccines are being approved by national regulators, mass production is underway and supplies are being distributed and, in the vernacular of the moment, ‘getting into peoples’ arms’. Also, sadly, we are now seeing the outbreak of the World Vaccine War, as countries vie for their doses, with richer countries inevitably prevailing.

Clearly, its efficacy will only be properly known when a critical mass of the world’s population has the protective antibodies, whether acquired naturally or through vaccination. Even then there will still be many unknowns, not least how long immunity will last and whether it is truly effective against onward transmission of mutant variants, though the signs are hopeful.

Given the sheer enormity of the problem and the response to it, we can only really touch on the key points, still less subject them to critical examination – the time for this will come. What we can do is set the scene for subsequent consideration as to how the Public Health service, and EH in particular, were called on to respond.

However, before we do so, some preliminaries are in order so that we can properly appreciate what EHPs seek to achieve under normal circumstances. Only then can one understand how practitioners of EH have gone about meeting the challenge of COVID-19. We apologise to those who know this already; however, recognising the distinction between different disciplines and areas of practice is vital to an appreciation of the response overall.

1.3 Public Health

In subsequent chapters we will be exploring how the COVID-19 epidemic has served to draw attention to different Public Health and Environmental Health interventions and brought practitioners of both disciplines, if they weren’t already, closer together. To EHPs in countries where the two have always been practised as a single, integrated service, this may seem odd. However, for others, Environmental Health and Public Health were set on separate paths some years ago, though as we shall see, the pandemic has served as a reminder – if one were needed – that they come from the same stable.

Poignantly, 9 January 2020, the day a novel coronavirus was identified as the cause of a cluster of cases of pneumonia in China marked the centenary to the day of Charles-Edward A. Winslow’s (1920) neat definition of Public Health as ‘… the science and art of preventing disease, prolonging life and promoting health through the organised efforts of Society’ appeared in Science. However, to do justice to Winslow’s vision for Public Health, we should consider that he went on to describe it as including ‘… the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organisation of medical and nursing service for the early diagnosis and preventive treatment of disease …’, thus capturing the characteristics of a discipline that has found itself coming to the fore as the COVID-19 pandemic gained traction.

Of course, the focus of disease management and control in the intervening 100 years has shifted markedly from the communicable to the non-communicable, and the effort that practitioners of Public Health invest in protecting health and well-being from diseases to do with genetic vulnerability, environmental exposure and the so-called diseases of lifestyle must not be overlooked in this present climate. In this respect they seek to bring about health improvement by promoting the value of good health through diet, exercise and so on, while drawing attention to inequalities and inequities, and advocating for the disadvantaged.

For now, our interest is in the control of respiratory disease, and so Winslow’s observations remain as relevant now as they did when the world emerged from the 1918/1919 Influenza pandemic. Consequently, the simple rules of public health and hygiene he espoused, and which were put into action once the aetiology of the COVID-19 became known – ‘test and trace’, outbreak investigation, quarantine/isolation, raising hygiene awareness and so on – will need to continue indefinitely.

While the ‘science’ of Public Health is simple and straightforward to apply in theory, the ‘art’ is to know how to see these measures effectively and efficiently implemented. Anyone who has had experience of trying to impart information to someone who might have been convinced by a contrary argument, or to persuade them to exercise restraint or adopt a particular behaviour – especially if this means restricting their personal freedom, causing them financial loss and possibly additional hardship – will know it to be a skilled art.

1.4 Environmental Health

In seeking to represent the discipline we know as ‘Environmental Health’, and especially the activities of those that practise it, the ‘new’ definition arrived at by Ian McArthur and the late Xavier Bonnefoy in 1998 (based on the outcome of a WHO Consultation in 1994) is a good place to start. They saw it embracing, ‘… those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social and psycho-social factors in the environment’, which for practitioners of EH means applying ‘… the theory and practice of assessing, correcting and preventing those factors in the environment that can potentially affect adversely the health of present and future generations’ (MacArthur & Bonnefoy, 1998).

We see from this the nature and extent of the challenge faced by practitioners of Environmental Health even without the complication of pandemic disease. This is especially the case for those working in wickedly poor and deprived areas of the world, where unequal access to the most fundamental elements of health – clean water and sanitation – compromises something as basic as handwashing as a means of interrupting viral transmission (Local Burden of Disease WaSH Collaborators, 2020).

For the purposes of this book, it is helpful to regard EH as a specialism of Public Health, where its ‘science and art’ lies in understanding those factors in the environment that can cause harm – sometimes referred to as the ‘social determinants of health’ – and then understanding the underlying reasons why this should be the case – sometimes described as recognising and seeking to resolve the ‘causes of the causes of ill-health’. By doing so, and subsequently directing attention to those situations where the greatest need exists and greatest good can be affected, practitioners of the discipline also hope to go some way towards addressing inequities in health and redressing inequalities in health.

The COVID-19 pandemic has demonstrated the heightened risk of infection, serious illness and death are experienced by those already most vulnerable to suffering ill-health and premature mortality for other reasons and through other causes. Therefore, as the pandemic slowly wanes, it is beholden on practitioners of both Public Health and Environmental Health to bring their efforts to bear most decidedly on those likely to suffer from living in unsatisfactory housing, employed in cramped and poorly paid workplaces, on an income (if they have one) that deprives them and their families of a proper diet.

Nothing should ever be taken away from the curers and carers whose contribution to restoring our health must never be forgotten. However, the much used adage that ‘prevention is better than cure’ is as true now as it has ever been. Put simply, the question should not be whether we have enough ambulances at the foot of a cliff to take away those who keep falling off it, but to see why they are doing so in the first place, and then finding ways of preventing others from following suit.

1.5 The practice of Environmental Health

Traditionally based in local government and not a healthcare setting, Environmental Health practice draws on a strong association with the local community, and, where necessary to maximise impact, the development of effective community partnerships. As we shall see later, these close and long-standing practitioner-community links have proved vital in taking public health messages and instructions out to those who need to hear them most. As one practitioner from South Africa (SM35) put it to us in researching this book, having cause to deal with people in their homes, shops, churches and burial society meetings, no other health professional ‘… is able to reach so far and these were the main target areas …’. Yet in some parts of the world – here, thinking about England – it was quite clear from early on in the pandemic that EHPs with expertise in Public Health and ‘… getting messages out to the public’ were not being deployed effectively’ (Battersby, 2020).

‘Environmental Health 2012: a key partner in delivering the public health agenda’ (Burke et al., 2002), prepared on behalf of the Health Development Agency (HDA), explored as a positive ‘Vision’ the scope of Environmental Health services in the settings of the home, workplace and the living environments, where food, air, water and the land are challenged by the biological, chemical, physical, social and psycho-social stressors, with EHPs playing a central role in meeting these challenges.

While this book considers the roles performed by EHPs in coping with an acute respiratory infection, it should be remembered that their wider professional skills and expertise interests extend to the effects of exposure to multiple stressors, especially where issues of equality and social justice have been recognised as key aspects of public health for some time (Marmot, 2010), Their efforts should be considered alongside the role played by local auth...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• Series preface
• Acknowledgements
• List of contributors
• 1 Countdown to the pandemic: an Environmental Health point of view
• 2 Discovering an Environmental Health perspective on COVID-19
• 3 Early impact of COVID-19 on Environmental Health practice
• 4 How environmental health practitioners responded to COVID-19
• 5 How Environmental Health practitioners met the challenges (and discovered opportunities) arising from the COVID-19 pandemic
• 6 Support for the practitioners
• 7 Reflections on the global Environmental Health response … so far
• 8 Learning lessons from the global Environmental Health response to COVID-19 so far – conclusions and recommendations
• Index