A real change is on the horizon. In October 2021, Facebook announced that it would rebrand itself as ‘Meta’, and this generated high levels of public interest in the metaverse for the first time. Definitions for the metaverse vary and there is still much uncertainty in its eventual future manifestation. It is perhaps best defined as a fully immersive parallel digital reality where users will be able to interact at a scale previously unimagined.1 The advent of the metaverse could have transformational impact on every aspect of human life, from our social interactions to what we ascribe real value to. Just as the Internet has completely transformed health, the metaverse will redefine virtual and physical possibilities in health.2 This will have major implications for our health and for healthcare delivery. The coming of age of the metaverse is in due largely to the maturation of technological advances in artificial intelligence and devices that enable the delivery of mixed, augmented and virtual reality, along with cryptography, the catalyst behind web3, and increased computing power.
There has been an increase Group A Streptococcal (GAS) infections in recent months, which has led to at least 8 deaths in children. Although GAS rates are higher than expected for this time of year, they have been higher at periods over the last decade. GAS causes a range of infections including Scarlet Fever and also more severe invasive disease.
For more information on management, see: Scarlet fever: a guide for general practitioners. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319/
The Centor score can be used to assess the probability of an illness being GAS pharyngitis: Tonsillar exudates, tender anterior cervical adenopathy, absence of cough, history of fever (>38 °C). Penicillin V (or Amoxicillin) is the preferred treatment unless contra-indicated in which case an alternative such as a cephalosporin or clarithromycin can be given.
Scarlet Fever and invasive GAS disease are notifiable and should be reported to the local health protection unit. Contacts (although at higher risk of GAS infection) do not generally need antibiotics unless symptomatic. See contact tracing flowchart for details. Health protection teams are responsible for contact tracing.
Antibiotics should only be administered:
1. To mother and baby if either develops invasive group A streptococcal disease in the neonatal period (first 28 days of life);
2. To close contacts if they have symptoms suggestive of localised Group A streptococcal infection, i.e. sore throat, fever, skin infection;
3. To the entire household if there are two or more cases of invasive group A streptococcal disease within a 30 day time period.
Oral Penicillin V is the drug of first choice where chemoprophylaxis is indicated. Azithromycin is a suitable alternative for those allergic to penicillin. Some areas of England are now reporting shortages of liquid antibiotics.
There is currently considerable media coverage and some public anxiety in the UK about Group A streptococcal (GAS) infections. Journalists who write about cases of infectious diseases need to understand the principles of the Poisson distribution. Events such as infections can sometimes cluster in time or space due to chance, and not because there is an underlying cause behind the cluster of cases.
Some journalists and doctors are stating that the cases of Group A streptococcal infections we are currently seeing in the UK are from lower levels of immunity because of Covid-19 control measures over the last 2.5 years. This is not necessarily the case and needs further investigation. The UK has experienced large outbreaks of Group A streptococcal infections in the past. For example, the UK had a large outbreak of Group A streptococcal infections between September 2015 and April 2016 (the largest since 1969), resulting in PHE issuing an alert.
The current cluster of Group A streptococcal infections won’t be the last we will see in the UK. Outbreaks of this and other infections will continue to occur. What is important is that our public health agencies and the NHS have the capacity to investigate and manage any outbreaks.
Witing in the Journal of the Royal Society of Medicine, myself, Austen El-Osta and Chris Rowe set out a vision for building sustainable, self-driven healthcare spanning primary care, secondary care and the wider health and social care system has been set out by medical innovators. Self-driven healthcare (SDH) is an umbrella term introduced by Innovate UK, the UK’s national innovation agency, to conceptualise aspects of healthcare delivery that can support people in becoming more engaged in managing their own health and wellbeing, rather than being passive receivers of healthcare.
In our paper, we describe an SDH ecosystem that supports individuals to take more ownership of their health and wellbeing and in recording their own data (e.g. weight, blood pressure) using a phone app, tablet, computer or Bluetooth device. This self-generated data would then be uploaded onto a secure online SDH portal which holds all their health records, including those generated in the wider healthcare system.
Individuals would also enter other data such as what medication they had taken that day, the food they had eaten or the exercise they had done. They may even have a range of other devices that automatically record and upload useful information, such as environmental data about local air quality that day. A personalised dashboard would automatically present the user with their ‘digital twin’ and the portal may also be enabled to routinely offered insights and actionable advice, including microlearning and behaviour change interventions and a holistic picture of the person’s overall health and wellbeing status.
The SDH approach must create better access to all sections of the community rather than just wealthier and more technically literate individuals. It is also crucial that the SDH movement does not exacerbate inequalities due to the digital divide. How SDH is adopted in the future is very important, especially when it is applied to help enhance the consumer health system by trying to link it effectively with state-funded NHS health and social care systems. It will be important to determine if these online environments will be provided by expanding the NHS App, for example, or by commercial companies.