Group A Streptococus (GAS) is a bacterium often found in the throat and on the skin and can cause both scarlet fever and strep throat. The bacteria can be spread between people through sneezing, kissing and skin contact. Most GAS infections are relatively mild illnesses. However, on rare occasions they may cause severe or life-threatening diseases, such as Invasive GAS (iGAS), which occurs when the bacteria get past the defences of the person who is infected.
Professor Alastair Hay, writing in the BMJ, said: “The UKHSA gave a clear description of scarlet fever and the late stages of strep A infection, advising parents to “trust their judgment” and contact NHS 111 or their GP if their child seemed “seriously unwell.” Parents of children who had breathing difficulties or blue skin, tongue, or lips or who were unresponsive were advised to call 999 or go to the emergency department. Since then, harrowing stories of children falling ill and dying from iGAS infection have appeared in the media.
“The result was a dramatic increase in demand as concerned parents contacted and attended NHS 111, primary care, paediatric assessment units, and emergency departments. Services were overwhelmed, with some reports of requests for care from parents of mildly unwell, and even entirely well, children.
“The paradox is that well intentioned messaging may have harmed public health by making the detection of unwell children harder.”
Professor Hay suggested three aspects of the messaging could be improved. First, it came without adequate preparation, for example, through ensuring the adequate supply of antibiotics to the NHS, despite the fact that the outbreak had been ongoing for two months prior. Second, the content, which did not make it sufficiently clear to parents when it might be necessary to contact their GP or NHS 111. And third, the apparent lack of consideration given to how clinicians could respond to a sudden rise in demand from worried parents, particularly in the absence of a specific diagnostic test.
Professor Hay, said: “The early symptoms of GAS infection, such as fever and sore throat are indistinguishable from other, more common, illnesses caused by viruses such flu, SARS-CoV-2, and respiratory syncytial virus (RSV). This means that, despite having some of the world’s best trained frontline clinicians, we cannot reliably respond to parents of children with undifferentiated symptoms who, prompted by the media, ask, “Does my child have strep?”.
He continued: “Research is needed to investigate the safety and effectiveness of public health messaging, to provide the public with evidence-based advice on whether (and when) to seek medical help, and to help people distinguish between “normal” illnesses and those that require intervention.”
Read the article: The group A strep crisis: can we do better? by Alastair Hay. BMJ.