Dithering, Incompetence, Lies and Austerity: How the UK Government Failed to Tackle COVID-19: Part 3
The Johnson Government, or Rabbits in the Headlights
In the UK we have had nine weeks to listen, learn and prepare. We have had nine weeks to run outbreak simulations, set up supply chains to ensure sufficient personal protective equipment (PPE) and ventilators, and bring about the availability of rapid, cheap tests. We have had nine weeks to establish algorithms to support contact tracing, and start mass awareness campaigns not only about hand-washing, but about the risks that the virus would pose to social and economic activity if not taken seriously by all. Countries such as Senegal were doing this in January.
Britain had a head start on Covid-19, but our leaders squandered it by Devi Sridhar
In its key early stages the Johnson Government dealt with the emergence of a novel coronavirus and the revelations of its potential severity in much the same way it has dealt with everything else: near-total opacity, tough talk with little action and guided by a small, select cadre of advisors.
Details of decision-making and modelling in the weeks leading up to mid-March remain scant. Sources supplying information about government preparations are frequently anonymous and in places contradict each other, presumably the result of genuine confusion and of individuals supplying statements with a view of what a future inquiry may find in regards to culpability. But what is beginning to emerge is just how profoundly these methods of governance have failed the UK in managing the outbreak throughout its crucial early months, culminating in the revelation that it was following a plan of action that was almost exactly wrong.
Through late January to early March several other nations failed to appreciate the threat of the pandemic and downplayed or ignored it. Amongst the most notable was Germany, which saw its first cases around the same time as the UK. Like the UK, Germany is a large, urbanised and wealthy European nation. Through January and early March its politicians engaged in a similar public relations strategy to the British Government: damningly, German ministers accused scientists of scaremongering, even suggesting COVID-19 would be less deadly than SARS or the flu.
But while the public attitudes were similar the policies put in place as the crises unfolded could not have been more different. While German ministers downplayed the potential of an epidemic, this was because the state was engaged in an intensive programme of contact tracing, testing, quarantining and strategic, limited lockdowns that they were confident would prevent the need for stricter measures. This confidence proved to be dangerously misplaced. But these early measures were vital in slowing the infection, hospitalisation and death rate so that Germany’s health service could quarantine and treat the afflicted, and were critical in informing the German Government of how its protocols were coping with the infectiousness and deadliness of the disease. As the extent of the epidemic became clear Germany was able to change policy quickly.
He held up Germany as an example of a country with a lower death rate that had “very early on introduced testing on a scale that was remarkable and continued to do that and isolate individuals and look after those who got very sick”.
“By isolating those that were positive it meant they weren’t able to infect other people,” he said. There were undoubtedly lessons to learn from that, he added.
Source
The UK was remarkable in its complacency, and ministers, the Prime Minister particularly, continued in cheerful, jokey, dismissive and self-aggrandising press conferences while doing remarkably little else into March, before tone, if not deeds, became far more serious.
In these months the UK never engaged in large-scale procurement of vital equipment such as ventilators, beds or PPE before the pandemic would cause global shortages. Stocks of basic supplies were already at chronically low levels due to austerity. Examples abound: the Department of Health, for instance, rejected a 2017 recommendation for sufficiently stockpiling PPE for this exact eventuality on the grounds of cost. The latest test of the UK’s preparedness was Operation Cygnus in 2016. The results of the test detailed the necessity of all of these resources, the vast chasm between what was stockpiled and what would be necessary, and how tremendously insufficient our pandemic planning and organisation was. But little has been done in the years since to rectify these shortages and inadequacies, even when a pandemic was obviously imminent.
The UK saw its first confirmed case of a person infected with COVID-19 on the 31st of January, and its first confirmed case of local transmission — transmission of the virus within the country — on the 29th of February. The plan followed so successfully by many other nations, of contact tracing, testing, and quarantining, was never achieved at scale in the UK; still, even now. It was even briefly explicitly abandoned as a goal. It remains unclear that it ever was one.
In fact, the U.K. government even took a strategic decision on March 12 to stop testing those who have mild symptoms, those coming into hospitals but not admitted, or even the country’s health workforce. This was a dangerous and shortsighted decision, as Prime Minister Boris Johnson’s U-turn less than a week later, when he committed to a goal of 25,000 tests per day, reveals.
Without Mass Testing, the Coronavirus Pandemic Will Keep Spreading
We do not know why the UK Government did not attempt comprehensive contact tracing in these pivotal months. The myriad models and proposals drawn up over the years simply seem to have not been used as blueprints for the response when the time came. In particular, local environmental health staff trained to engage in contact tracing in the event of a pandemic were left sitting around waiting for calls that never came, apparently due to a combination of intentional Government policy and a baffling lack of co-ordination:
Environmental health workers in local government have wide experience in contact tracing, a process used to prevent infections spreading and routinely carried out in outbreaks such as of norovirus, salmonella or legionnaires’ disease. But a spokesperson for Public Health England (PHE), which leads on significant outbreaks, said the organisation did not call upon environmental health workers to carry out contact tracing for coronavirus, instead using its own local health protection teams.
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The UK government approach is understood to be that once virus infection numbers have tipped, manual contact tracing is unworkable, while social distancing and self-isolation measures reproduce much of its effect.
But Anthony Costello, professor of global health and sustainable development at University College London, said giving up on it was a mistake. “You still need to do it,” he said, highlighting regions where infection numbers were relatively small. “In low-intensity areas you could ramp up your testing … use all your people to jump on it.”
UK missed coronavirus contact tracing opportunity, experts say
There is little in the way of Government explanation for this sweeping pattern of inaction. Questions about such issues have dwindled in the daily, televised press conferences, and when they were asked were normally ignored or dismissed. Michael Gove did suggest that the chemicals to create COVID-19 tests were in short supply. Every expert to comment on the matter has suggested this was untrue then and remains untrue now. The source for the claim is as unknown as the reason he made it.
There are allegations that many of these failings were allowed to happen because of a lack of co-ordination and transparency amongst the various state and healthcare organisations involved and with the Government:
Others say that the problem lies not with the supply of chemicals, which are commonplace, but with the initial decision to centralise work in a dozen laboratories run by Public Health England (PHE), a government agency. Greg Clark, chair of the House of Commons science and technology committee, has criticised this approach, arguing that more work could be done in hospitals and universities.
Downing Street has since taken control of the operation, on the grounds that PHE and the medical regulator, the normal channel for approval, are too slow, and a number of new labs are being set up to ramp up testing swiftly; but a lack of communication between Number 10 and PHE means a lot of confusion. “There are parallel structures,” says Deenan Pillay, professor of virology at University College London. “They don’t talk to each other.”
In tandem, there has been the suggestion of a lack of overarching plan of operations or structure in the state’s response to the pandemic. That ministers simply did not do their jobs, and each organisation — such as Public Health England — was left to its own devices, at which point their own unguided bureaucracies were simply too inflexible, too uninformed, too lacking in funding and resources, too isolated from each other, and too small to engage in the kind of response Germany, for instance, was capable of. An inquiry appears necessary.
At every stage the UK has been on the back foot in containing, eliminating or treating the outbreak and it remains unclear why this was allowed to happen. Leading up to March, NHS and social care workers appear to not merely have been the front line but our entire line of defence, largely abandoned by the wider state. The failure at every stage leading up to the epidemic has been multifaceted and catastrophic.
The UK Government’s Contain–Delay–Mitigate–Research strategy failed. It failed, in part, because ministers didn’t follow WHO’s advice to “test, test, test” every suspected case. They didn’t isolate and quarantine. They didn’t contact trace. These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque. The UK now has a new plan — Suppress–Shield–Treat–Palliate. But this plan, agreed far too late in the course of the outbreak, has left the NHS wholly unprepared for the surge of severely and critically ill patients that will soon come.
The UK Government looks to have bungled its response more than any other country in Europe. While most other governments acted, the leaders of Britain answered the challenge of COVID-19 mostly with passivity and smirks. And then, by mid-March, it started to proudly explain its strategy.
This is part 3 of a series.
Part 1, Why the Government’s Actions Matter is here.
Part 2, The Outbreak in China, Onwards is here.
Part 4, Government Timidity and Opacity Kills is here.
