Traffic Light System – Clinical Sense?

Traffic Light System – Does this make Clinical Sense in this context?

We have written about this topic previously.

This photograph was taken at an airport of an ‘orange’ country at the time to indicate the flight patterns.

We have not liaised with one medical doctor who agrees that the traffic light system (green – orange – red system for travel) makes clinical sense in the context of this pandemic, most agree that this increases bio-psycho-social risk significantly.

Clinical initiatives have to make clinical sense; laboratory situations do not exist outside laboratories.

It is essential to liaise with medical doctors with experience in bio-psycho-social risk assessment and management when considering initiatives to safeguard children and the general public.

We will provide a recent example.

Earlier this year we returned from a red list country via a European country (orange list) to arrive in another European country (orange list). Please know that different countries see different countries as ‘red’, ‘orange’ and ‘green’ – for instance, one country may see Portugal as green, whilst another country sees Portugal as orange at the same time. Please also know that these colours change constantly (often whilst individuals are in a country on holiday or for work).

We arrived in the ‘orange country’ airport from the ‘red’ country. Thousands of individuals from various countries (red list, orange list and green list) eg India, South Africa, north Africa, Turkey, Maldives and the East gathered together in the large waiting areas to enter through immigration, and then in the shopping and dining areas at the airport of this European ‘orange’ country for at least 5 hours, but up to 15 hours for many.

During our wait at the airport, before boarding for our next flight, we observed one of the staff members at this airport wearing a mask, but removing her mask every few seconds to wipe her running nose and to cough over the food in front of her (she was sweating and looked physically unwell presenting clinically with what appeared to be a flu or cold). She did not wash her hands once between customers or at any time during our observation. She worked at the food counter and touched the food constantly as she handed it to passengers and staff who ordered food (with the same hand she wiped her nose with and coughed with). She also took food from passengers to heat up and then return to them.

Further to observing this consistent pattern we liaised with her and her manager, asking them to remove the food from circulation and to change staff members so that the staff member with the symptoms could go home to recover and be tested. They agreed.

Passengers and staff, further to these joint experiences within this airport for 5 hours or longer, leave on various flights to return home or for onward journeys.

Stop here and ask yourself whether a traffic light system makes sense here – even for one person? Ask yourself also whether we can tick the Education tick box yet? Simple initiatives, such as education, saves lives. It is our clinical / medical opinion, based on 15 years training and at least 20 years clinical experience (working with patients) that a traffic light system in this context, will not reduce bio-psycho-social risk, but that it would rather increase risk for the general public.

We left for another European country (also for work) and after a few weeks, upon our return from this orange list country to the UK (another orange list country at the time), the flight was filled with individuals from a red list country, who had arrived the same morning, however they were on the same flight as us.

Stop here and ask yourself whether a traffic light system makes sense here – even for one person?

Now know that 90% of these passengers, from this red list country (not South Africa), absolutely refused to wear face masks, which caused significant hostility on the flight.

Further to observing this increasing hostility, we asked the staff to ask the passengers to comply with guidelines and wear face masks, however, the staff said they could do nothing, that this was a regular occurrence (often weekly) on this particular flight to the UK (from this orange country). The staff was not able to speak with authority to the passengers, but said that they had raised these concerns before with their authorities without a response.

We landed together in London, all from an ‘orange’ list country, although 90% of our flight was from a ‘red’ list country that same morning, but this was not registered in the UK.

Stop here and ask yourself whether a traffic light system makes sense here – even for one person?

Many report that they would do “anything to avoid hotel quarantine, because we would not make it, but it falls on deaf ears, people care about control not people’s safety or health”. A family recently made a special request that their family member with dementia not be subjected to quarantine in a small space, however, this was denied. We were informed that no medical doctor in the UK had the authority to end travel related self-isolation or quarantine for any person for any reason including child abuse, domestic violence, suicide (or homicide) intent or plan, or fire or for serious health concerns such as chest pain (concerns relating to medical emergencies). We have liaised with legal colleagues regarding this matter. We have also raised these concerns with Public Health England and NHS England; many or most medical colleagues share these serious concerns. These concerns have also been shared with international health organisations and international organisations and courts safeguarding children.

We have flown in many airplanes without masks, as were the policies, especially during the first 5 months of pandemic (this did not appear to affect statistics and our personal preference, as stated before, is usually to avoid mandatory mask contexts), however, we observed that the staff and many passengers were uncomfortable with the significant hostility within the plane which often seems to exist between ‘mask wearers’ and ‘non mask wearers’, and this is why we asked staff to intervene.

Microbiology and virology colleagues comment that individuals who are at home with an infected person (close personal relationships such as partners, children and parents etc) probably have a 15% chance of becoming infected and sick themselves, which is less than most people in the general public would have guessed (this is in a context where no one wears masks at home). We have not confirmed this statistic, however, it is based on professionals’ experience and estimations.

Most medical colleagues agree that the traffic light system in this context makes no clinical sense, much like the generalised policy that everyone should wear face masks, and that this increases frustration, anger, anxiety, depression and general bio-psycho-social risk rather than reduce risk and harm.

Most medical doctors agree that regular exposure to agents and pathogens (as part of normal life, leaving home, social interaction in the community, travelling etc – not purposefully exposing a person or self to risk) stimulates, educates and strengthens the immune system to be able to defend against infections and risks. Many agree that remaining at home or in one country, closing borders, will not benefit the immune system at all, “it just postpones things for when you open the door”. Many comment on concerns that the general public is then also “often so afraid to leave home then, and the chronic anxiety makes their immune systems crumble so their defences to viruses and variants are like newborns, not developed”.

Initiatives have to be based on good clinical evidence to reduce bio-psycho-social risk and prevent harm, and a longterm and systemic view is not only required, but essential.

Nations have to work together, taking a global approach, rather than mark each other as ‘green’, ‘orange’ and ‘red’ if we are to move forward and safeguard the most vulnerable.

Let’s not waste time. Let’s focus on evidence-based protection.

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