Tom Bourner is an ex university colleague and a very good friend of mine. In a manner similar to many academics he felt the strong desire to speak out about what is happening with regards to the government handling of Covid-19. What follows is Tom’s guest post on the government response to Covid-19.
British government’s top ten cock-ups in responding to covid-19
By any objective test Britain has had a very bad covid-19. Using the most objective test of all, the number of deaths from covid-19, Britain’s record is disastrous. Only four of the 195[1] countries in the world have had more deaths than Britain; they are the USA, Brazil, India and Mexico, which are all much bigger countries. The USA has a population of 328 million, Brazil has a population of 209 million, India has 1.353 billion and Mexico has 126 million (compared to Britain’s population of 67 million). Britain has, of course, had many more deaths from covid than any other country in Europe.
How did Britain’s government mismanage its response to covid-19 so badly? Here is a list of what I see as the ten main ways:
- Too late introducing lock-down The impact of covid has been least in countries that acted most swiftly to suppress it. Such is the power of exponential growth that it has been estimated that if the government had made its lock-down decision two weeks earlier (i.e. 9 March instead of 23 March) then about 50,000 of the so-called ‘excess deaths’ to the end of May could have been saved, including 30,000 of the officially reported death due to covid (Powers, 2020). According to Martin McKee, at the London School of Hygiene and Tropical Medicine “The countries that moved fast have curtailed the epidemic. The countries that delayed have not. It’s as simple as that.” (quoted in Shields, 2020).
- Discharging patients from hospitals into care homes without requiring testing for covid This was government policy until the 15 April (which was three weeks after lock-down). It allowed the disease to run riot in the very places where the most vulnerable people were and where it would be most deadly.
- Too slow closing UK borders to travellers from countries with high and rising rates of covid. Good public health practice would have included closing the borders between Britain and covid hotspots at an early stage in the pandemic. According to David Hunter, professor of epidemiology and medicine at the University of Oxford:
“The reasons why the UK did not do so are unclear. Australia, albeit at a different stage of the epidemic, has been highly successful in closing its border, as has New Zealand, and that has almost certainly played a role in the much lower number of cases.” (reported in Shields, 2020)
Border closures in the islands New Zealand and Australia were in complete contrast to the island of Britain, which only briefly introduced restraints on people arriving from Wuhan. Australia barred flights from China in February. It is not clear why the UK government did not place restrictions on travellers from covid hotspots.
Between the 1st of January and 23 March almost 18.1 million people arrived in Britain from other countries. In March, 3.1 million people landed at Heathrow alone: nearly half a million came from the Asia-Pacific, 711,000 came from North America and 875,000 came from the European Union (Shields, 2020). Moreover ships were allowed into Britain that had been denied entry to other countries and private planes from covid hotspots were allowed to land in Britain. According to Jamie Grierson: “At least 1,800 private aircraft landed in the UK during lockdown, official figures have shown, with no requirement for arriving passengers to provide contact details for purposes of tracking the spread of coronavirus.” (Grierson, 2020)
- Quarantining overseas visitors has been too little and too late. In the absence of closed borders to travellers from covid hotspots, the government could have introduced a system of testing and quarantining those arriving from overseas. It was noted in mid-March that 80 percent of Australian covid cases were related to travellers returning to Australia (Sridhar, 2020) :
“When the UK went into lockdown on 23 March, people living within the country were instructed to stay home and not travel farther than a few miles from their homes and only for essential journeys. At the same time, passengers from countries such as Italy, Spain, the US, Brazil and Russia could arrive at Heathrow and take the tube straight into London with no checks, screening or monitoring.” (Sridhar, 2020).
During the whole of March and April Britain had no testing or quarantine measures in place for those arriving in the UK. Then Priti Patel, the Home Secretary, revealed proposals for a blanket 14-day quarantine for travellers to Britain from anywhere in the world to come into effect in June. This blunt instrument approach was later (July) amended with an exemption list of 73 countries. After that, considerable chaos ensued, particularly for those returning to Britain as countries were added or removed at short notice from the list. At least one British government minister, Grant Shapps (Secretary of State for Transport) fell foul of these changes when he was holidaying in Spain.
- Abandoning local track and trace too soon On 12 March the British government stopped its track and trace policy and instead of trying to contain covid it aimed to ‘delay’ the spread of it. In an article evaluating the Britain’s response to the coronavirus Bevan Shields wrote:
“By March 12 a full-scale outbreak had taken hold in Italy and the illness was spreading across Europe. More than 1,000 Italians had already died and thousands more were gravely ill in packed hospitals in the country’s hard-hit north. The deadly potential of an invisible killer was becoming more obvious by the hour.
That day, Johnson announced Britain would move from the “contain” phase of the emergency to the “delay” phase. This decision would prove a pivotal moment. The shift meant contact tracing would be abandoned, and testing would be restricted to those only in hospital with symptoms. The move was at odds with the WHO, which urged countries to “test, test, test”, as well as Germany’s much-lauded program of mass testing.” (Shields, 2020)
- Failure to use the 750,000 people who volunteered in March to help In March the government appealed for volunteers to help with the fight against Covid. When three quarters of a million people had volunteered it said that no more volunteers would be needed. It then became clear that the government had no real idea about how to use so many volunteers. Stories abounded about the volunteers sitting around doing nothing. For example, an article in the Guardian reported that student Sarah Rimmer tweeted on 22 April: “Signed up for the #NHSvolunteer scheme not too long ago. Been ‘Active’ on the app for approx. 2 weeks now. Nothing has happened. I’ve given up.” (Butler, 2020). The abundance of these volunteers meant that the government had access to unprecedented resources to pursue, for example, track-and-trace if it had decided to do so.
- The government asked our scientists the wrong question i.e. ‘What can we do to prevent the NHS from being overwhelmed?’ rather than ‘What can we do to minimise the number of covid infections/deaths’? The government claims it was following the advice of its scientists. This raises the question, why were these scientists giving it different advice from the scientists in all the other major countries of Europe? The answers that scientists give depends on the questions they are asked. “If you ask, ‘How can we ensure that the NHS will not be overwhelmed?’ you will get a different answer from what you will get if you ask, ‘How can we minimise the number of deaths?’ Britain’s scientists were not, however, reluctant to answer what they thought were the right questions. For example, on 14 March 229 scientists, who were independent of government, sent an open letter to the UK government saying that its slowness in taking COVID-19 seriously was “risking many more lives than necessary.” But the government was only willing to listen to answers to its own question. This suggests that the government’s priority was to avoid the sort of media pictures of an overstretched health-care system that were coming out of North Italy rather than minimise the number of deaths. Such pictures would have raised questions about the government’s competence in managing the covid crisis and under-resourcing the NHS over the previous ten years.
- Failure to protect our front-line workers in the fight against covid There was widespread appreciation of the risks being taken by the frontline workers and on Thursday evenings people took to the streets to show that appreciation. At the same time there was a failure to protect these front-line workers by adequate testing for covid and insufficient provision of personal and protective equipment (PPE).
- Failure to learn from the experience of other countries By early March the European country most affected by covid was Italy. It soon became clear that Italy was not an outlier but a front-runner. At that time, the other countries of Europe were about three weeks behind Italy, which gave them time to prepare for the deluge. Rather than learning from the responses of most other European countries, the British government adopted a mindset of British exceptionalism, declining to follow the lead of ‘johnny foreigner’. According to Sir Richard Mottram, Visiting Professor at the LSE:
“No ministerial statement or comment by a government spokesperson seems complete without a reference to the ‘world-leading’ or ‘world-beating’ nature of the UK’s handling of the topic at hand. The handling thus far of the COVID-19 crisis should be an important corrective to this mindset. In reality, we have much to learn from other countries. A useful discipline would be to ban such phrases from public discourse while the lessons to be learned from recent events are exposed and acted upon.” (Mottram, 2020)
- Scrapping Public Health England (PHE) In August 2020 the Secretary of State for Health, Matt Hancock, announced the scrapping of PHE, to be replaced by a National Institute of Health Protection. The government justified this in terms of centralising activity for health, security and pandemic preparedness. There is concern that PHE is being lined up as the scapegoat for the British government’s failures in managing the covid epidemic, despite the fact that a recent (2017) a government review of PHE concluded that as a national institution of public health, PHE “rivals any in the world” and “exceeds the standards outlined in the UK Government Cabinet Office Model of Capability for delivery, leadership and strategy.” The PHE is the repository of huge amounts of experience, knowledge and expertise, not least from carrying out government policy in responding to covid. The abolition of PHE and the creation of the new body, which hopefully will involve considerable consultation, will take months to put in place at a time when speed of response to new covid developments are likely to be critical. Moreover, the new body is bound to experience at least some teething problems. This delay and disruption is the last thing that is needed for the efficient and effective management of the next stage of Britain’s response to covid.
References
Butler, P. (2020) ‘NHS coronavirus crisis volunteers frustrated at lack of tasks’ Guardian, 3, May 2020.
Grierson, J. (2020) ‘More than 1,800 private planes landed in UK during Covid-19 lockdown’ Guardian, 18 May 2020.
Mottram, R. (2020) ‘Eight Provisional Lessons from Britain’s Handling of Covid-19’ LSE Blogs.
Powers, J. (2020) ‘The Deadly Consequences of Not Understanding Exponential Growth: 30,000 – 50,000 Avoidable Deaths’. (Unpublished), 19 May 2020.
Shields, B. (2020) ‘Biggest failure in a generation’: Where did Britain go wrong?, Sydney Morning Herald, 3 May 2020.
Sridhar, D. (2020) ‘Britain’s quarantine plan for travellers is too little too late’ Guardian, 4 June 2020.
Tom Bourner, 15 Sept, 2020
[1] Counted as the 193 member countries of the United Nations and two non-member countries, the Holy See and the State of Palestine.
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