Dithering, Incompetence, Lies and Austerity: How the UK Government Failed to Tackle COVID-19: Part 4
Government Timidity and Opacity Kills
The UK Government — Matt Hancock and Boris Johnson — claim they are following the science. But that is not true. The evidence is clear. We need urgent implementation of social distancing and closure policies. The Government is playing roulette with the public. This is a major error.
Richard Horton (10th March 2020)
What we’ve seen is a Prime Minister who was absent on his watch. He should have convened COBRA early on […] we’ve lost five, six weeks now. I think it’s interesting that the amount of testing is very, very little, and they’re reducing that. They haven’t built up the capacity for testing…
John Ashton (13th March 2020)
Now is the time for the UK Government to ban large gatherings, ask people to stop non-essential travel, recommend employers shift to home working and ramp up the response. The curve can be shifted (like South Korea and Singapore) but only with government action.
Devi Sridhar (13th March 2020)
The Johnson Government has faced two major issues with great success for itself, if not the country, already: a general election and Brexit. To succeed in both, messaging was prioritised. Its marketing has required the careful distribution of speculative proposals, allegations and claims along specific channels, controlled as much as it was able. Selling effectively has been key to its triumphs.
But viruses are not won over by numbers printed on a bus or cozy interviews with old chums. Dodging media and Parliamentary scrutiny to prevent judicial intervention, stymie political opponents and to win votes does not stop disease from killing people. When faced with a public health crisis the Government’s insularity meant that the wider medical community, which has been right all along, was not involved in guidance and had little idea just how dramatically wrong the Government — and perhaps also its scientific advisors — would get its response until it became too late to prevent an outbreak on a scale to rival Italy and Spain.
In the days leading up to COVID-19 being recognised as a pandemic by the WHO on the 12th of March, as European countries enacted strict lockdowns on businesses and movement in an effort to slow the transmission of the virus, pressure mounted on the UK Government to follow suit by imposing social distancing rules, banning mass gatherings and by intensifying its pitiful testing and containment procedures.
Later that day Boris Johnson gave a speech explaining that he would do none of this for the foreseeable future. The speech is astonishing for the extent to which Johnson laid bare the Government’s complete lack of preparedness for what was coming while claiming to appreciate its severity. Horribly, there’s some evidence that he did.
We are considering the question of banning major public events such as sporting fixtures. The scientific advice as we’ve said over the last couple of weeks is that banning such events will have little effect on the spread.
[…]
But I want to stress something that is very important in the wake of what we’re saying this afternoon — I urge people, who think in view of what we’re saying about their potential symptoms that they should stay at home, not to call 111 but to use the internet for information if they can.
The press conference was alarming, as the Prime Minister focused on what advice from international public health organisations he would not be following:
- The hitherto feeble attempt at testing for the disease was to end and be scaled back only to those seriously ill in hospital. Tests would be denied even to healthcare workers. This was contrary to advice from the WHO, foreign medical bodies, British experts and foreign heads of state. The failure to test frontline healthcare workers meant that many were forced to stay home with potential symptoms, though of course many later turned out to be uninfected. This greatly exacerbated the already chronic state of staffing shortages and ended any attempt at tracing and controlling the pandemic. The decision was not reversed until the 27th of March.
- Schools were not to close, as this would ‘do more harm than good’. This was explained in subsequent briefings and interviews: closing schools would deplete socialcare and healthcare of too many members of staff as they would be forced to return home to look after their children. The reason the UK was regarded as uniquely incapable of adopting such a measure went unstated: a decade of austerity has already led to a staffing shortage in the healthcare industries of hundreds of thousands. Schools were not closed until the 20th of March.
- Large sporting events should continue. Anonymous briefings by Government insiders ridiculed football associations for ‘alarmism’ in ignoring the Government by closing stadiums and cancelling matches anyway; Ministers publicly argued against such a measure. The very next day the Government reversed its position, but actual closures were not until the 21st of March.
Otherwise, the Prime Minister stressed self isolation for those infected, banned school trips, advised people with a cough to stay home and reminded people of personal hygiene measures. While people with symptoms of COVID-19 were advised to remain home for seven days, members of the same household were told they did not have to; the source of this perverse idea is unknown. Johnson did however emphasise the reason for the Government’s protracted delay in taking action: a strategy that stressed, and came to be known by, ‘herd immunity’. The fundamental nature and intent of this notion was incredible. Its details were clarified further via interviews that were fantastical in their tone and explanation.
Our aim is to try and reduce the peak, broaden the peak, not suppress it completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission, at the same time we protect those who are most vulnerable to it. Those are the key things we need to do.
Patrick Vallance, Chief Scientific Advisor to the Government
Stringent social distancing measures would only be applied to more vulnerable people, and then, such measures might only be necessary in the coming weeks rather than days — Johnson going so far as to explain that quarantining would not begin until the peak of infection. It is unknown where this idea comes from, as waiting to quarantine the vulnerable so late into an outbreak would have been futile. Even the basic precaution of preventing external visits to elderly care homes — presumably a central component of targeted quarantines — was not yet on the horizon.
Over a series of interviews and conferences Ministers, the PM and Government advisors downplayed the urgency for more stringent interventions. Over this same week the death toll in Italy exceeded a thousand and every other big European country adopted strict lockdowns. A large minority of individuals within the UK had already begun to self-isolate despite the lack of Government support. Public approval of more concrete steps in enforcing social distancing, of giving people enough support to allow them to say home, was increasing dramatically, but rather than anticipating this trend or engaging in leadership the Government hesitated.
The various people explaining the Government strategy placed much emphasis on flattening or broadening the curve of the outbreak — that is, slowing the rate of infection so that the number of seriously ill people during the worst period would be low enough for our healthcare system to be able to accommodate them without being overwhelmed.
But the measures being adopted in mid-March do precious little to explain how they expected this to be achieved. We know the Government’s advisors had studied the impact of social distancing and had once again acknowledged their necessity on the 9th of March. They knew they were most effective if put in place as soon as possible, and yet the Government argued against using any of them for the time being.
The combined effects of various social distancing measures (including closing schools, cancelling large public events, closing places of entertainment, and home isolation) if started very early on in a locality affected by influenza may have a significant impact on reducing transmission.
SPI-M Modelling Summary (November 2018)
Part of the Government’s strategy was to “flatten the curve” of new cases to reduce the strain on the NHS, and relied on an assumption that just 5% of symptomatic cases will require hospitalisation. Given the numbers above and the initial lack of aggressive social distancing measures to achieve such a “flattening,” it was unclear how that figure could be possible.
In the meantime, the idea was that mass infection (incredibly, to the tune of 60–80% of the population) would eventually render survivors amongst the wider community immune to the virus, thereby preventing them from becoming vectors for the disease and providing those at most risk some measure of protection from being infected in the first place. The idea was that this would limit the deadliness of subsequent waves of infection.
External experts were galvanised. ‘Herd immunity’ seemed horrifyingly irresponsible, and based on evidence that looked very much like it did not exist. Almost every one of the assumptions behind the strategy has been challenged, and some (allegedly all) of its advocates have subsequently accepted it would have collapsed the NHS:
Now subject to intense public scrutiny, the modelling teams at universities across Britain continue to work on different scenarios for how the world can escape the virus’s clutches. According to Medley, the chairman of the SPI-M pandemic modelling committee, no one now doubts, for all the initial reservations, that a lockdown was essential in Britain.
Medley added: “At the moment we don’t know what’s going to happen in six months. All we know is that unless we stop transmission now, the health service will collapse. Yep, that’s the only thing we know for sure.”
At the time an open letter from hundreds of scientists from numerous related disciplines called for more stringent social distancing measures similar to those adopted by other nations:
By putting in place social distancing measures now, the growth can be slowed down dramatically, and thousands of lives can be spared. We consider the social distancing measures taken as of today as insufficient, and we believe that additional and more restrictive measures should be taken immediately, as it is already happening in other countries across the world.
Public request to take stronger measures of social distancing across the UK with immediate effect
A separate open letter from over 500 behavioural scientists criticised the notion that stronger social distancing measures would have to be delayed in order to offset ‘behavioural fatigue’, the idea that people would begin to flout rules as the stresses of social distancing became too great to bear. It remains unclear why the Government chose to delay quarantine, given the high cost they knew delays would have, rather than trying to mitigate its effects and encourage people to abide its difficulties by providing financial and other support.
In fact, it seems likely that even those essential behaviour changes that are presently required (e.g., handwashing) will receive far greater uptake the more urgent the situation is perceived to be. “Carrying on as normal” for as long as possible undercuts that urgency.
More broadly, it appears that concerns about behavioural fatigue lead the government to believe that halting the spread of the disease is impossible, and the only solution is to slow the progress of the disease across most of the population, until herd immunity is achieved. But radical behaviour change may be able to do much better than this, and would, if successful, save very large numbers of lives. Experience in China and South Korea is sufficiently encouraging to suggest that this possibility should at least be attempted.
A group of Harvard researchers modelled a better-than-best case scenario for the plan, determining that at its peak, the NHS would have less than half the required number of ICU beds. It was an academic exercise in how obviously the intent of the policy would fail. As one of the authors explained: ‘I’m an epidemiologist. When I heard about Britain’s “herd immunity” coronavirus plan, I thought it was satire.’
We talk about vaccines generating herd immunity, so why is this different? Because this is not a vaccine. This is an actual pandemic that will make a very large number of people sick, and some of them will die. Even though the mortality rate is likely quite low, a small fraction of a very large number is still a large number. And the mortality rate will climb when the NHS is overwhelmed. This would be expected to happen, even if we make the generous assumption that the government were entirely successful in restricting the virus to the low-risk population, at the peak of the outbreak the numbers requiring critical care would be greater than the number of beds available. This is made worse by the fact that people who are badly ill tend to remain so for a long time, which increases the burden.
Source. The entire article is worth a read.
Labour, SNP and Liberal Democrat politicians who had previously avoided appearing confrontational with the Government — engaging in the show of political unity pundits claim is desirable in a crisis — began to seriously pressure the Government to release the data on which its decisions were based, asking the not terribly unreasonable question of why it so directly contradicted the advice and experience of other health organisations and governments.
By March 16th the pressure from the public, politicians and scientists was enormous. But the majority party in Parliament has few constraints on its power. Rather than take any tangible action they recommended social distancing, working from home and avoiding gatherings and travelling, but there were no teeth to these suggestions. There would be no enforcement and no state assistance. By refusing to force closures many businesses were left with a dreadful choice: they could pay rent, staff, bills and maintenance while earning no income and risk mass lay offs, closures and financial ruin, or they could remain open and risk worsening the crisis and the health of their staff. Some closed, but the vast majority stayed open. Sporting events and concerts were being cancelled en masse.
It was not until the 20th of March that the Government formally closed pubs, clubs, cafes, gyms and restaurants in a tentative step towards lockdown — the ephemeral recommendations of the 16th then appeared to be dithering from a flailing Government. That same day President Macron of France was threatening to close its border with the UK due to its laxity; the UK was becoming a danger to its neighbours. The Government was seriously lagging behind businesses and members of the public in establishing the lockdown that would have been vital in saving lives. It would, it seems, have to be dragged every inch of the way into adopting more substantial policies, to try to save lives.
Why did the Government never purchase any of the equipment they knew would be needed? Why did they never try to implement contact tracing, quarantining, or close the UK’s borders? Why did they talk so much of ‘flattening the curve’ of infection without implementing any of the policies they knew would flatten the curve? Why, once the deadliness of the disease was well known and on Britain’s doorstep, did they engage in half-hearted measures, suggestions and advice rather than enforcing social distancing?
There is an obvious interpretation of the Government’s inaction, and it has nothing to do with science, or any of the models or plans which existed. The people elected to lead the UK did not know what to do. Confronted with difficult choices the Prime Minister and his cabinet delayed and blustered. Tough talk with little action continued until the voices demanding more comprehensive measures became too great and numerous to ignore. At a crucial time there was no ambition or will to make hard decisions or to persuade the British public that they were, by far, the least evil options available to us. The Government cast about uselessly until their choices were made for them.
By the 23rd of March the UK Government finally accepted what so much of the rest of the world knew. It would have to lock much of the country down. They justified the extraordinary change in strategy by pointing to a new study published by Imperial College, London. The Government claimed, and a few less-than-critical journalists repeated, that the science had changed. It had not.
After weeks of inaction, the government announced a sudden U-turn on Monday, declaring that new modelling by scientists at Imperial College had convinced them to change their initial plans. Many journalists, led by the BBC, reported that “the science had changed” and so the government had responded accordingly. But this interpretation of events is wrong. The science has been the same since January.
The false suggestion that the science had changed is, like the untrue claims that no one saw the pandemic coming and no one prepared, an admission of the Government’s outrageous failures and lack of willingness to accept responsibility for them. The notion that the science changed is contradicted by an earlier study published by the government’s own pandemic modelling committee, SPI-M, on the 2nd of March. Notably, both studies predict a worst case scenario of over 500,000 deaths and both predict overwhelming numbers of people requiring prolonged hospitalisation and the use of ICU facilities. Both predict that social distancing measures, including school closures and banning mass gatherings, would be beneficial in delaying and flattening the peak of infection.
To re-emphaise: even before the Imperial College study, the basis of the Government’s initial strategy predicted and accepted that hundreds of thousands of people — perhaps over half a million people — may die of COVID-19. When Boris Johnson suggested that people should prepare to ‘lose loved ones before their time’ he was not messing around. But a large amount of the culpability for so many people losing loved ones lies on Johnson’s shoulders.
Due to effective Government messaging and a swathe of obsequious media outlets, the ‘science had changed’ narrative has taken root in spite of several journalists catching government advisors alluding to the figure before the Imperial College study was published:
Chris Whitty, England’s chief medical officer, said the “reasonable worst-case scenario” was that 80 per cent of Britain’s 66m population would be infected, with an expected mortality rate of 1 per cent or less. On that calculation a worst case death toll could be in the region of 500,000.
The Government has since, with some success, pretended that all of this did not happen, or was merely a shift in phases for a plan that has never changed. But despite the fact that the Government has had near-total control in its messaging, its explanation for its initial strategy was repulsive, and the public were repulsed by it at the time. It remains baffling that the Government (and perhaps even its advisors) found death and suffering on such a scale a more politically palatable outcome than the financial and other costs of a lockdown that intense political, public and expert pressure forced it to adopt anyway.
Why the presumptions the Government laid out to the public so drastically diverged from the understanding of the vast majority of other scientists remains currently unknown. They intend to keep them secret at least until the pandemic is over. But public statements from advisors and the few studies released so far strongly suggest to other researchers that they were too closely based on flu epidemics and slow to adapt to the data of the actual outbreak (the advisors who have thus far spoken on the matter explicitly reject that this was the source of major error).
There is also some suggestion that the Government abdicated its policy-making responsibility to an advisory panel called SAGE. The allegation goes that SAGE lacked consensus — was indeed bitterly divided — and, with an absent Government, the future of the country hinged on the organisational procedures of a small group of scientists whose membership is not fixed and whose identities and disciplines remain largely private.
Chief among them is the view — expressed by several ministers and Tory MPs to BuzzFeed News over the last few days — that Johnson and his chief aide Dominic Cummings have effectively “outsourced” the government’s decision-making process to Vallance, the chief medical officer Chris Whitty, and a small team of scientific advisers.
While Downing Street’s deference to the experts won plaudits early on, this approach has turned out to be lacking, the ministers and MPs said, because the scientists themselves disagreed on what to do. One minister said that it was then the political responsibility of Johnson and Number 10 to decide which scientists to back, but described a “vacuum of leadership” among aides.
Whatever the extent that any of this is true, we do know the secrecy with which the Government made its decisions, and we know that science flourishes in the open. It is a collaborative enterprise. Scrutiny is as vital to good science as it is antithetical to Conservative politicians. Beliefs must be challenged to be refined, to be made accurate. Even if we are to accept the narrative that Government advisors were fundamentally wrong in their advice, this does not then shift the blame for failure of leadership to those advisors. Policy should not have been solely in their hands anyway.
Had the ideas underpinning decision-making in the months leading to this critical juncture been publicly discussed amongst the wider community of infectious disease experts, good practice could have been established in a timely manner. Rather than hiding from inquiry, politicians could have acted on the vast breadth of expertise that exists within the UK while persuading the public of the necessity of extremely strong and proactive intervention. It is not an exaggeration to suggest that thousands of lives may have been saved had the UK not orchestrated its response behind closed doors. Transparency is key to competent government, especially during a crisis of public health. Instead, we saw increasingly alarmed independent experts trying desperately to sound the alarm to a Government which was not listening and which had perhaps even given up already.
Pointing this out is not to impugn the competence of advisors to the Government or to agree with the grotesque attempts of ministers to scapegoat them. Nor is it to suggest that Matt Hancock or Boris Johnson of all people should have personally been epidemiological or behavioural experts. But by excluding external voices, by not being frank and open, the Government had isolated itself from the quantity and quality of expertise that exists within Britain. In doing so it squandered a critical time period that many countries did not have the luxury of and which multiple countries used much more effectively. It could, and should, have acted. It had a responsibility to do so. People are dying now who did not have to. People will continue to die who did not have to. The delay in effective countermeasures caused by secrecy has adversely affected every other policy and choice made since.
Our lot haven’t been working openly and transparently. They’ve been doing it in a (non) smoke-filled room and just dribbling out stuff. The chief medical officer only appeared in public after about two weeks. Then they have had a succession of people bobbing up and disappearing. Public Health England’s been almost invisible.
Boris Johnson should have convened Cobra himself over a month ago and had regular meetings with the chief medical officer with the evidence. The thing should have been fronted up nationally by one person who could be regarded as the trusted voice and who could have been interrogated regularly. That’s not happened.
John Ashton (12th March 2020)
This is part 4 of a series.
Part 1, Why the Government’s Actions Matter is here.
Part 2, The Outbreak in China, Onwards is here.
Part 3, The Johnson Government, or Rabbits in the Headlights is here.
