Covid-19: The unofficial UK inquiry—why did so many have to die?

From the early mess on test, track and trace to dangerous immunity theories, there’s plenty of blame to go round. But a lot of drift and delay seeped down from the top

Governing is always difficult, and this is doubly true in the face of a grave and unfamiliar threat. The challenge of a novel, deadly and contagious coronavirus is one that has confronted governments around the planet. But a year into the crisis it is plain that nations have not risen to it with equal efficacy.


Going by the figures collated on Statista.com in mid-January, a randomly chosen Briton is now 35 times more likely to have died of Covid-19 than a random Australian, 39 times more likely than the average citizen of Japan and 55 times more likely than a typical South Korean. The lethal danger in Britain is 249-fold that in New Zealand, and 369 times that in China, where the virus emerged. The UK government can point to the differences in demographics, population density or culture in some cases, and question the reliability of statistics in others. But such excuses have to do a vast amount of work to substantially narrow these statistical gulfs.


If we look only at Europe, we find rare cases (Belgium) where the death rate from Covid has been higher, but the British toll is heavier than nearly everywhere else—the chance of a Briton having died is roughly a quarter higher than for a French citizen, and a third higher than for people in Sweden, which has barely locked down. The differential with the Germans is more than double, and with the Norwegians 13-fold. The death rate is even somewhat higher than in the US—where Donald Trump’s incoherent response left the world aghast.


“The final total could turn out to match Britain’s 125,000 losses in the Battle of the Somme”

The pandemic is a sprawling and multifaceted problem, and in due course every aspect of the response—from macro-economic management and the shadow of “long Covid” to House of Commons remote voting arrangements—will have to be evaluated by an inquiry. So, too, will important differences between England and the other three UK nations, which have sometimes played things very differently, but which—with less than 20 per cent of the UK population between them—are relatively marginal in the overall statistical picture. There will also come a time to take stock of the happier story of the vaccine that will—eventually—offer a way out. This is a story that British institutions have helped to write, and a solution that the UK has started implementing more rapidly than most.


But as the official death toll closes in on 100,000 (more comprehensive counts are already in six figures), it is starting to look like the final total could match Britain’s 125,000 losses in the Battle of the Somme. So there is one urgent question that cannot await the appointment of commissioners who, in Harold Wilson’s phrase, will “take minutes and waste years.” We must take a broad look over the last year, and ask: why did so many Britons have to die?


Preparedness

On paper, Britain entered this crisis ahead of the game. Successive Chief Medical Officers (CMOs) had warned of, and planned for, the threat of a pandemic. Britain war-gamed an outbreak of a novel flu strain in 2016, and by 2019 the threat topped the Cabinet Office’s risk register.


Free universal healthcare meant infected citizens needn’t fear calling a doctor, and as an island nation Britain potentially had strong control over the movement of infected people through its borders (although unlike New Zealand, it has barely exercised it). Only the US beat Britain in a global pandemic preparedness index produced in October 2019 by, among others, the John Hopkins Center for Health Security.


But like the US, Britain had hidden weaknesses too. Its hospitals “run hot” by comparison to countries like Germany, with fewer spare beds to absorb sudden surges in demand. Public health budgets had suffered years of cutbacks, while social care relied on casual workers whose movements between different homes created transmission opportunities. Poverty and cramped housing would exacerbate transmission in parts of society, including minority communities. Britain had stockpiled personal protective equipment (PPE) for medics but not enough, and didn’t have the factories ready to produce it at short notice. Crucially, its planning focused on flu, not a coronavirus.


Flu symptoms emerge fast and so invisible (ie pre-symptomatic) infectious cases are relatively rare, rendering testing of little relevance. But Covid-19 sufferers can be unknowingly infectious for days before symptoms emerge. That makes testing to find cases of the virus, then tracing and isolating contacts, essential for containing the spread. Britain had no system for doing this en masse, unlike some Asian countries harder hit by previous outbreaks of the earlier coronaviruses Sars and Mers.


Testing and tracing

From the start, the World Health Organisation urged exactly such a “test, trace and isolate” (TTI) strategy. South Korea and Japan followed the advice and fared well. In the UK, by contrast, there were no factories ready to manufacture tests at scale, nor did Public Health England have the lab capacity required to analyse a lot of results. Worse, it was slow to accept and co-ordinate help from academia and industry. Consequently, testing resources were soon in short supply. In order to prioritise tests in healthcare settings, community testing was halted on 12th March.


A peculiar gloss was put on this damaging if understandable decision. CMO Chris Whitty suggested that, with the virus spreading, it was “no longer necessary for us to identify every case.” But as the first wave crashed through society, the upshot was that the UK could not monitor the spread—and had no chance of managing it.


As for tracing, early efforts were also soon overwhelmed and effectively given up on. Again, rather than being candidly regretted, this failure was rationalised: at the No 10 press conference on 26th March, Deputy CMO Jenny Harries suggested WHO advice was for developing nations and may not apply to Britain. “There comes a point in a pandemic,” she said, where contact tracing was “not an appropriate intervention.” When eventually established, the centralised tracing system failed to capitalise on local authority and public health know-how, and the contact-tracing app was dogged with problems despite immense expenditure.

In some respects, things did get much better. Britain steadily ramped up testing to exceed the capacity of many European countries. New “Lighthouse Labs” soon processed results at speed. But problems persisted—results were sometimes slow to arrive, or even lost wholesale. In early autumn, amid a predictable surge in demand as schools and universities returned, some people seeking tests found that they had to go on a 100-mile round trip; others found they couldn’t book a test at all.

Some involved in the TTI system blame the inexperience and errors of private contractors like Deloitte and Serco. The tendering process was necessarily accelerated but the close connection of some contractors to government invites questions. Meanwhile, grandstanding distorted things. The Commons Science and Technology Select Committee recently concluded that the eventual expansion of testing was driven by what health secretary Matt Hancock called his “personal initiative,” rather than “a scientifically-based plan.” And the putative “moonshot” scheme for 10m daily tests is a punt on unproven technologies, without—experts involved in testing say—a clear rationale.


“The science”

The UK has a strong research record on infectious diseases, and entered the crisis with a distinguished epidemiologist—Whitty—as CMO. British scientists enjoyed a direct line to ministers through Whitty, his colleague Patrick Vallance, the Government Chief Scientific Adviser (GCSA), the Scientific Advisory Group for Emergencies (Sage) and the Cabinet Office Briefing Rooms (Cobra) meetings. Ministers initially vowed to “follow the science,” as if it were always something clear and unambiguous that could remove any need for political judgment.


Yet despite the integration of science into Whitehall, there were many errors, which the fast-evolving understanding of a new virus only partly excused. On 12th March, one Deputy CMO, Harries, suggested masks could be harmful: a “trap” for the virus; on 3rd April, another Deputy CMO, Jonathan Van-Tam, insisted they wouldn’t slow infection. This was early and the WHO was still ambivalent, but their confident dismissal of masks was ill-judged. A low-cost measure that was worth trying (and eventually proved useful) was instead discouraged.

More damaging was the early idea of accepting that the virus would and perhaps even should spread to those at low risk. Misappropriated from vaccine programmes, the term “herd immunity” was inapplicable to the management of a virus with a significant mortality rate. Likewise, “sheltering the vulnerable” was impractical when “the vulnerable” live on the same streets as everyone else—it wasn’t even clear who all of them were. The origins of such dangerous ideas remain murky, and their precise relationship to policy is complex. And yet their influence would soon be felt.


The official early strategy was couched in terms of “contain,” “delay” and “mitigate”—to “squash that sombrero” of infections, in the Prime Minister’s words of 12th March. But concern to control the timing of when cases arose was initially coupled to complacent fatalism about the eventual volume. In a 13th March TV interview, Vallance revealed the underlying thinking: one aim should be “to allow enough of us, who are going to get mild illness, to become immune to this, to help with the whole-population response, which will protect everybody.” Around 60 per cent exposure might, he suggested, achieve such herd immunity. This logic was indulged by some on Sage, even though other members now claim they do not remember it being discussed. It was regarded with horror outside the UK, and abandoned in mid-March. But the days lost brought a heavy toll: in the summer, epidemiologist and Sage adviser Neil Ferguson told MPs that first-wave deaths could have been halved by locking down a week earlier—that is 20,000 lives.

More fog surrounds “behavioural fatigue,” the idea that public stamina for restrictions would be time-limited, mentioned by Whitty in early March as a reason not to lock down too soon. The behavioural scientists who advise Sage claim not to recognise the term so—again—the genesis is unclear.

Greater transparency might have seen bad ideas flushed out and challenged—which is not a new insight. Back in 2000, the Phillips report (after the BSE epidemic) specifically insisted that official scientific advice should be made public. But in early 2020, Whitehall initially kept Sage’s minutes under wraps, publishing them only in late May. By this time, trust in Sage had already been compromised by concerns about the participation of political advisers (notably Dominic Cummings). A former GCSA, David King, has been moved to convene a parallel and fully open “Independent Sage.”


“For all the problems with the scientific advice, the graver difficulties came with the decisions based on it”

As late as January 2021, the Science and Technology Select Committee bemoaned that “there is still insufficient visibility” with all manner of technical input, from economics to epidemiology, “as to what advice was given to the government.” Beyond opacity, Sage was too narrow—it lacked sufficient public health specialists, who would have warned of the dangerous interface between care homes and the community, something epidemiological modellers disastrously overlooked.

Yet for all the problems, the Select Committee judged “up-to-date” scientific advice was “readily available,” but aired “concerns” that “policy decisions” based on it “were taken more slowly than was needed.” Unlike scientists, though, governments need to weigh up broad social consequences—not least regarding unemployment, which can also have lifelong implications for health. Those in power are fated to wrestle with such dilemmas, and the country is destined to live with the consequences. Ultimately, advisers advise, but ministers decide—and are accountable for it.


Decision-making

On 24th January, around three weeks after China alerted the WHO to its outbreak, Cobra met to discuss coronavirus. The health secretary Matt Hancock emerged declaring the risk to Britain “low”; Boris Johnson, due to sign his EU withdrawal agreement that day, did not attend. Ten days later Johnson gave a major speech positioning post-Brexit Britain as “Clark Kent”: poised to “leap into the phone box and emerge with… cloak flowing,” to sign new trade deals, while standing firm against any coronavirus “panic.”

February’s catastrophic outbreak in Italy changed the mood. On 9th March, Italy’s prime minister Giuseppe Conte instigated lockdown, begging other countries to take the virus seriously. Days later, Ireland closed schools. Yet with Sage (wrongly) estimating Britain was still four to five weeks behind Italy’s curve, Johnson merely asked Britons to flatten the peak by isolating if they showed symptoms. As late as 13th March, a packed Cheltenham Gold Cup was allowed to go ahead.


But days later came new modelling from Sage adviser Ferguson, showing the British outbreak growing faster than assumed and predicting 250,000-500,000 deaths, depending where policy fell between existing mitigation measures and total inaction; only a “suppression” strategy could avoid this awful toll. On 16th March, Sage recommended extra social distancing “as soon as possible,” but requested more time to assess whether schools should close; two days later, it concluded they should. Yet the stay-at-home order came only on 23rd March.


Within another 10 days, Covid-19 had ripped Downing Street apart. Hancock, Johnson, Cummings and head of the civil service Mark Sedwill had all caught the virus. By 7th April, Johnson was in intensive care, and Dominic Raab was running the country. Critical decisions loomed on accelerating testing, protecting care homes, procuring PPE and planning to exit lockdown safely. Yet Raab and the Cabinet, navigating uncharted constitutional waters, were wary of overstepping their authority. When a convalescing Johnson resumed control on 24th April, he faced a backlog of decisions needing answers in a hurry.


Desperate to restart the economy, he began easing restrictions from 10th May, ignoring warnings from the Greater Manchester mayor Andy Burnham that it was too soon for the northwest (where the R number remained relatively high). Johnson insisted a “Whac-A-Mole” approach of controlling new outbreaks via local restrictions, while relaxing elsewhere, could suppress any resurgence.


Although pubs were allowed to reopen before many children returned to school, the experience of closing schools in March (except to key workers’ children and vulnerable pupils) had gradually convinced ministers to keep schools open in future at all costs. Educational inequalities have deepened, as private secondaries offered interactive online teaching at four times the rate of state schools; GCSEs and A levels were ditched for moderated teacher-assessed grades, which were deemed unfair to poorer high achievers and caused chaos. With summer research suggesting children did not catch or transmit the virus as easily as adults, education secretary Gavin Williamson committed to a full reopening in September. What he couldn’t have known was in that very month a more contagious new Covid-19 mutation would emerge and change the calculation.

Universities, which had faced financial pressures in the spring from students demanding refunds on their unused accommodation, reopened despite evidence of Covid-19 spikes when students returned in Scotland (where term starts earlier). Predictably, English student outbreaks followed, fuelling already high infection rates in Manchester and Liverpool. But having boxed himself in by dubbing a second lockdown an “economic disaster,” Johnson was slow to react to this northern second wave, rejecting Sage proposals for a brief “circuit breaker” lockdown over October half term.

In retrospect, even that might not have sufficed: Wales instigated a “circuit breaker” but saw cases climb swiftly afterwards, a pattern repeated when England locked down (keeping schools open) in November. Alarm bells should have rung. Instead, Johnson promised families five days of social mixing at Christmas, insisting even after the existence of the new variant was confirmed on 14th December that a rethink would be “inhuman.” Five days later, he was forced, in his own earlier phrase, to “cancel Christmas” in the southeast, while scaling back (but still not calling off) festivities elsewhere.

When, amid rocketing cases in the southeast, Greenwich and a few other London councils sought to close schools early for Christmas, Williamson threatened court action. Teaching unions’ pleas to move schools online in January were rejected; heads who could have spent the holidays preparing for online learning were instead ordered to create a mass testing regime for pupils. By New Year’s Eve, hospitals had so many Covid-19 patients some were running low on oxygen.

Sage advised on 22nd December that a November-style lockdown, keeping schools open, wouldn’t be enough to contain this new wave. It wasn’t even sure a stricter March-style lockdown could. Yet on 3rd January, the eve of a new term, Boris Johnson told the BBC that “schools are safe” to reopen. The next evening—after thousands of primary pupils had duly returned and mingled for precisely one day—he suddenly declared they must close, having been warned again that the NHS was close to being overwhelmed. Britain re-entered lockdown, too late to stop the deaths bound to follow the already-apparent surge of infections. Nine months on, Johnson was repeating the mistakes of March. Why?


Leadership

As so often before, Brexit was distracting Downing Street in December, this time with the culmination of trade-deal brinkmanship. No 10 had also become increasingly dysfunctional, riven by factional and personal conflicts that prompted Cummings’s resignation in early December.

But crises test a leader’s instincts, not just their organisational capabilities, and Johnson’s are more risk-taking than precautionary. Torn between the clear demand for restrictions and his libertarian impulses, he sought to delay unpalatable decisions, or soften bad news. Conflicted himself, he sent conflicting messages to the public, admitting to shaking hands with coronavirus patients or planning to see his mother on Mother’s Day when experts were frantically discouraging social contact. He muddied the stay-at-home message by failing to sack Cummings when the latter was caught fleeing London with his Covid-infected wife during lockdown. And he personally transgressed by addressing an overly-packed roomful of Tory MPs in September, vowing that Britons as a whole would also soon be “cheek by jowl.”

Polls have consistently showed the country is overwhelmingly pro-lockdown. (A YouGov survey published just before the latest restrictions registered 79 per cent support). But Johnson played to his base (and former employers at the Daily Telegraph) by fretting publicly about removing “the inalienable right of free-born people… to go to the pub.” Despite his commanding majority, after the first lockdown Johnson had conceded that restrictions were subject to a parliamentary vote, and thereafter avoided confronting the “Covid Research Group” of lockdown-sceptic Tory backbenchers (including many supporters of Johnson’s leadership bid) who demanded “economic recovery” at all costs.


Economy

The Johnson government has often acted as if it faced a painful trade-off between curbing Covid-19 infections (and so saving lives) and “saving” the economy. In reality, there is no such trade-off—even over a period of a few months. The Financial Times’s Martin Wolf compared countries that had gone for straight suppression of the virus against those “trading off deaths against the economy” by applying lighter restrictions and concluded: “By and large, the former group has done better in both respects,” with lower mortality rates and a smaller hit to national income. A lax early approach was often unsustainable, and almost always prolonged the economic disruption.

Some economists had predicted this all along, and the government’s stubborn failure to grasp it amounts to its single biggest failure of strategy, fuelling costly hesitancy in locking down and impatience in unlocking. Tactics doubled down on the error: Chancellor Rishi Sunak’s “Eat Out to Help Out” filled restaurants (and spread the virus) when it would have been far better for health and ultimately the economy to pay them to stay shut.


“Despite his own serous brush with the virus, Boris Johnson never approached it with the appropriate humility”

But initially, the government got one big thing right. Financial anxiety impedes compliance with lockdown and the “isolation” part of TTI. The more potentially-infected workers fear the consequences of staying home, the less they will comply. So the task is to keep unemployment down, and incomes up. In the spring, the Chancellor moved with impressive speed to establish the furlough scheme without being unduly detained by the huge cost. A (supposedly) temporary £20 across-the-board increase in the means-tested safety net further calmed the fear factor. (See Speed Data, p13.) There were problems—some self-employed people were not compensated at all, others were paid more than they had lost—but this may have been inevitable given the speed with which decisions had to be taken and implemented.

The real flaw was the complacent assumption about how fast normality could return. All the energy went on emergency expediencies while permanent features of the system were neglected: two million of the lowest-paid still didn’t qualify for statutory sick pay, and those who did got a meagre £95.85 a week, making isolation unaffordable for millions more. Stopping work will soon become a trapdoor to poverty for many others if that £20-a-week safety net increase is withdrawn in April—which is why the government is being forced to rethink.

In retrospect, it would have been better to offer a slightly less generous furlough for longer, rather than presume it could be abruptly withdrawn. For months, the government stubbornly insisted it must end on 31st October. Just a fortnight before, it got into a bitter stand-off with Mayor Burnham, insisting it was now unaffordable to compensate those who couldn’t work in locked-down Manchester at the same rate offered to workers nationwide last spring. But Johnson finally conceded that a fully restored national furlough would be needed on his Halloween deadline—six hours before the scheme was due to expire. Redundancies had already been issued on the basis it would stop.

In the autumn, a means-tested £500 was made available through councils, specifically to support the low-paid who were isolating. But limited awareness will impede take-up, and amid rocketing unemployment forecasts, some will already be calculating that they cannot afford to comply with the duty to stay home.


Conclusions

With a solid administrative state, strong health services, and well-established channels to feed expertise into government, Britain should have weathered this storm. And yet it endured one of the world’s heaviest Covid-19 tolls.

Some frailties would have dogged any government—a relatively cold climate and indoor lifestyle; a relatively elderly population; relatively serious pockets of poverty in communities now doomed to live in the shadow of this disease for the longest. But note the “relatively” in every case: Japan is older, Norway colder, and penury bites harder elsewhere. The way Britain has run the crisis mattered.


While new, this virus was not a beyond-the-imagination “black swan event,” but rather a “known unknown.” Indeed, a novel pandemic topped the official risk register, and exponential spread was well understood. We knew, in other words, that we were up against a set of dangerous and fast-moving uncertainties. Which means we should have understood the wisdom of respecting a precautionary principle, and erred on the side of over-reaction.

And yet what comes through our findings time and again is a tendency for drift and delay. As the evidence firmed up from January, Whitehall first pronounced the situation “low risk,” and then lurched only falteringly towards what needed to be done. The summer unlocking and subsidising of the hospitality sector was reckless. Further procrastination in the face of the new variant then led to the dangerous absurdity of children being sent back to school for one day.


Each bad decision locked in higher baseline infection, making every subsequent call more painful. Despite impressive early protection for jobs and wages, the government was unable to grasp the fundamental truth that there was no trade-off between health and wealth: the epidemiological and economic crises could only be fixed together.


For all its muscle, a clunking and centralised British state sometimes struggled to implement even those things it had settled on—witness its lack of grip over track and trace. It was not just the political leadership that was found wanting: several individual bad decisions can be explained by deficient expert advice. The idea of gradually letting the virus pass through much of the population was not as rapidly discounted as it should have been. Advisers occasionally showed cavalier—even exceptionalist—disdain for advice from beyond Britain’s shores.


More recently, the scientific top brass have sounded a reflective note: this January, Vallance said the big lesson was to take “broader,” “harder” and “earlier” action than might feel comfortable. He is right, but hindsight should not have been needed to see it. Could it be that even the scientists were initially caught up with a complacent mood that emanated from the top?


Despite his own serious brush with the virus, Boris Johnson never approached it with the appropriate humility. He never mustered that consistency of purpose that was, among other things, a precondition for clear public messaging. He never sought to bring in from the cold rivals, such as former health secretary Jeremy Hunt, who publicly engaged with the detailed dilemmas in a way he did not. Nor did he fully transcend his instinctive individualism, and summon a spirit of truly shared endeavour in the face of a shared threat. He continued to take a truculent stance to the likes of the teaching unions, who governments find difficult in ordinary times, but whom a creative leader could have turned into partners in this rare moment of national crisis. The requisite command and resolve was not there—and Britain is counting the cost in lives.


Source: Prospect Magazine https://www.prospectmagazine.co.uk/magazine/covid-19-the-unofficial-uk-inquiry-coronavirus-nhs

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