With the UK now accounting for about 10% of global deaths from Covid-10, many of my friends from overseas keep asking me why the UK seems to have suffered so badly from the new coronavirus. As of 23rd April, we had the fourth highest number of deaths as a ratio of total population of any country in the world (at 28 per 100,000), behind Spain (at 47 per 100,000), Italy (at 42 per 100,000), and France (at 33 per 100,000). My previous posts on Data and the scandal of the UK’s Covid-19 survival rate (11th April) and Face masks and Covid-19: communal not individual relevance (29th March) go part of the way to explain why this is, but they do not fully take into account the increasing amount of evidence that the government has not sufficiently explained, and I thought it might be helpful (at least for me) to try to pull this together into a straightforward list of the key issues (in broadly chronological order):
- Why did the government not take action following Exercise Cygnus in 2016, and why has it not made the information about this publicly available? As I have commented before, this exercise “was undertaken to simulate the impact of a major flu pandemic in the UK. The full conclusions have never been published, but sufficient evidence is in the public domain to suggest that it showed that the NHS was woefully unprepreard, with there being significant predicted shortages of intensive care beds, necessary equipment, and mortuary space”. The government has also refused to respond to a freedom of information request about this as recently reported in The Guardian (26th April)
- Why did the government fail to act on warnings in 2019 that we were unprepared for a pandemic? The Guardian (24th April) has also reported that in a leaked document “Ministers were warned last year the UK must have a robust plan to deal with a pandemic virus and its potentially catastrophic social and economic consequences in a confidential Cabinet Office briefing leaked to the Guardian. The detailed document warned that even a mild pandemic could cost tens of thousands of lives, and set out the must-have ‘capability requirements’ to mitigate the risks to the country, as well as the potential damage of not doing so”. A recent investigation by the BBC’s Panorama also shows clearly that the government had not stockpiled sufficient protective equipment despite being warned that it needed to do so. Apparently “There were no gowns, visors, swabs or body bags in the government’s pandemic stockpile when Covid-19 reached the UK”.
- Why did the government not heed early warnings in January and February of the need for urgent action? I am neither an epidemiologist nor a medical doctor, but I was already writing in late January about the outbreak of a new coronavirus in China and its potential to have a severe global impact. If even I was aware, the government has absolutely no excuse for inaction.
- To what extent did the government’s focus on Brexit mean that they were distracted from the potential havoc of Covid-19? The Prime Minister’s overarching attention on Brexit and his determination that Britain’s departure from the EU on 31st January was appropriately celebrated, must have taken up a considerable amount of time, and it seems likely that the government simply did not have the systems in place to be able to consider the potential of a new coronavirus that had emerged in a distant land (see also links to racism below).
- Why did the UK take so long to implement lockdown measures? The BBC on 7th April provided graphic illustrations of the dates when different countries across the world began to introduce local and national recommendations and lockdowns, and it is very striking that the UK’s lockdown only announced on 23rd March was among the last in Europe.
- Why has the government’s rhetoric persistently focused more on protecting the NHS than it has on saving lives? My comments here may be controversial, but I have been very struck by the fact that one of the government’s dominant slogans over the last few weeks has been “Stay at home, protect the NHS, save lives“, often shortened to “protect the NHS and save lives”. The order is always the same, with protecting the NHS coming before saving lives. This was overwhelmingly emphasised once again in the Prime Minister’s briefing on 30th April where he reiterated that protecting the NHS had been at the centre of the government’s policies, and he paid scant attention to deaths. It seems to me that this priority largely reflects the government’s desperate wish to protect itself from criticisms of its previous failures to ensure that the NHS was in a fit place to deal with a pandemic. The slogan could easily have been “Save lives: stay at home and protect the NHS”. I just get this persistent feeling that many in government really don’t care much about preventing the most vulnerable from dying (see also next item below).
- Why does so much reliance appear to be being placed on a few (flawed) Prime Ministerial advisors? Again, this question is controversial, but it does seem that there was a dominant view at senior government levels in the UK at the end of February that protecting the economy was more important than saving the lives of some elderly people who were likely to die soon anyway. This has been traced back by the Sunday Times (22nd March) to a private engagement at the end of February, when Dominic Cummings (Senior Advisor to the Prime Minister) is claimed to have said words to the effect that “herd immunity, protect the economy and if that means some pensioners die, too bad”. No. 10 immediately issued a very strong rebuttal, claiming that the Sunday Times article was “highly defamatory”. Nevertheless, detailed examination of the government’s actions at that time, and before the change in policy on 16th March would indeed appear to suggest that in general the government was willing to sacrifice the lives of many elderly people, despite claiming that they were caring for the most vulnerable. The role of Cummings in attending meetings of SAGE (the Scientific Advisory Group for Emergencies) has also been controversial, with The Guardian (26th April) for example reporting that attendees at these meetings were worried about his participation. Furthermore, Cummings’ personal connections with one of the data-mining companies (Faculty) working with the UK government on Covid-19 (and mining patient data) has also caused concern and controversy (see for example Byline Times 22nd April, The Guardian 24th April and The Times 1st May). There is enough murkiness about Cummings’ role, for there to be a transparent enquiry into his influence in shaping the government’s flawed Covid-19 response.
- Why has the government persisted in saying that most UK citizens should not wear masks? The government has so far persisted in saying that people in the UK should not wear masks (of any kind), despite the very considerable evidence that these can indeed help prevent the spread of Covid-19. I have written at length about this before, but it seems fairly clear that the reason why the govenrment has done this is because it is afraid that the NHS will not have enough supplies if people try to buy medical face masks for themselves. Again, this comes back to the issue that Ministers do not want to be shown up for their failure to prepare for the pandemic sufficiently rigorously. While it seems likely that the government may well soon recommend the use of scarves or homemade cloth coverings as part of its package of actions following the lockdown (The Financial Times, 23rd April), this only further exacerbates their failure to have done so before!
- Why has the government been so slow to support vulnerable people being supported at home and in care homes? The lack of provision of Personal Protective Equipment (PPE) and other support for staff in care homes, and helping to support elderly people in their own homes has been shocking. This seems primarily to have been driven by two agendas: the focus on preserving the NHS at all costs for the government’s own political protection; and a willingness to let the vunerable elderly die. The net outcome has been that very many people have died, both directly and indirectly from Covid-29 in care homes. In the week ending 10th April there were more deaths (from all causes) in care homes (4,927) and at home (4,117) combined than there were in hospitals (8,578); 1,156 of these deaths in care homes and at home were Covid-19 related (The Health Foundation, 22 April). More recent figures on 27th April indicated that the number of Covid-19-related deaths in care homes in the previous week had doubled to more than 2000, meaning that around 3000 Covid-19-related deaths in total have occurred so far in care homes (BBC, 28th April). The government in its regular briefings, though, only reports deaths from Covid-19 in hospitals, which in the short-term significantly reduces the perceived overall level of deaths from this new coronavirus (for a wider discussion of Covid-19 data, see my Data and the scandal of the UK’s Covid-19 survival rate). Furthermore, recent evidence from the Chief Scientific Officer indicates clearly that “The risk of the coronavirus spreading in care homes was ‘flagged up very early on’ to the government” (The Times, 28th April).
- Why have vulnerable people not been directed to hospital sooner: NHS 111 and the need for oxygen? There is much anecdotal evidence that many hospital trusts, at least in the early days of Covid-19 were turning elderly vulnerable people away from hospital, and that NHS 111 (the online and phone service) only told people to go to hospital after being ill with symptoms for more than a week and if they were having severe difficulties breathing. At the same time, there is good evidence emerging that by the time most people have been taken into hospital in the UK it is probably too late for perhaps half of them to survive. The Independent (9th April) thus reported that over 67% of coronavirus patients put on ventilators go on to die. It now seems that other forms of treatment may be more effective. There is a growing body of evidence that patients are often seriously ill before they begin to have breathing difficulties, and that early oxygenation is key to their survival (New York Times, 20th April 2020). Hence, if NHS 111 and the government more widely had been willing for Covid-19 patients to go into hospital earlier to increase their oxygen levels before they started having breathing difficulties, many more of them would have been likely to have survived (it is interesting to note also that official NHS guidance on 9th April instructed medical staff to lower oxygen prescribing targets, seemingly to help manage the supplies of oxygen that they had available). It is shameful that so many beds in the rapidly constructed Nightingale hospitals still remain empty, when they could be used to give patients much needed oxygen. Indeed, the government announced on 4th May that the London Nightingale hospital would be placed on standby because it was no longer needed (BBC News; see also The Financial Times, reporting on 4th May that the NHS employed 60 KPMG consultants to build these temporary hospitals).
- Has the government really been acting on the scientific evidence? Another of the oft-quoted phrases to come out from the government’s media spinners is that they have always been acting on the scientific evidence. Prime Minister Johnson frequently uses the term, as in “that is why we’re following the scientific evidence in the way that we are” (Bloomberg, 9th March); “Matt Hancock likewise uses the term, as in “The scientific evidence is absolutely critical in underpinning our response” (Financial Times, 15th March). This is complete and utter nonsense. There has never been complete uniformity among scientists on anything – and there shouldn’t be; debate and discussion is the lifeblood of healthy science! Moreover, many academics (see for example Helen Ward in The Guardian, 15th April) have also made it clear that the government has not even acted on the advice given, perhaps in part because of the Cummings’ spin noted above. Neil Ferguson, leading the team of epidemiologists at Imperial College modelling Covid-19 has recently made two pertinent observations (quoted in The Sunday Times, 26th April): “What I worry about more is people who have a particular political agenda or point of view, distorting the science to support that point of view”; and “We have given insight into how different causes of action would lead to certain consequences but we have not made politicians decisions for them. Politicians have made the decisions”. This is absolutely right. It is up to governments to make the difficult political decisions, and they cannot hide behind claims that there is something called science which provides all of the definitive answers!
- Why has the government adopted such an arrogant and racist stance? In the early stages of the pandemic, far too many people in government, and indeed the British public more generally, conveyed the impression that the new coronavirus was a “Chinese” problem, and that the difficulties faced by the Italians were basically because they were less competent than people in the northern European countries who would easily be able to deal with it. To be sure this was less blatant than US President Trump’s very clear and explicit racism (The Washington Post, 20th March), but it seems to come from the same stable. In part this is linked to the ongoing global geopolitical “tensions” between China and “The West” (for my more detailed comments on this see Digital-political-economy in a post-Covid-19 world: implications for the most marginalised), but it also reflects unwarranted arrogance that the UK’s scientists and systems are better than those in China, other east Asian countries and our southern European neighbours (see, for example, The Sunday Times, 26th April, and The Sunday Times, 26th April). Perhaps too, this is linked to our government’s mistaken determination to leave the EU with its Mediterranean members, and be “Great” again alone (see The Great Britain Campaign).
- How and why were the companies selected to work on the data analytics and people tracing technologies associated with Covid-19? This issue was touched on above with respect to the involvement of Dominic Cummings in the development of digital technology solutions for tracing people with Covid-19 in the UK during and after the lockdown. I have already discussed the wider and long-term implications of this for the future of privacy and surveillance (see Digital-political-economy in a post-Covid-19 world: implications for the most marginalised), but there are also many questions to be asked about the process which led to companies with at best dubious track records in the field of big data analytics such as Palantir and Faculty (see The Guardian, 12th April, and Byline Times, 27th April) being involved in this development. The lack of transparency and openness around this by people at the heart of our government is deeply concerning.
These questions raise huge doubts about the judgement and performance of all of the leading figures in our goverment (many of whom have spoken at the daily briefings), as well (sadly) as those senior government advisors who have all too readily towed the goverment’s line in public on these issues, such as Sir Patrick Vallance (Chief Scientific Adviser), Prof. Chris Whitty (Chief Medical Officer) and their deputies. Whilst it would seem that these advisers have sometimes struggled with following the No. 10 mantra, I do wish that they had been more willing to stand up and be counted for the sake of truth and of UK citizens’ lives. We must indeed be united as we seek to overcome the challenges posed by Covid-19, but when there is a reckoning afterwards I very much hope that praise is given out where it is due, and failure is also dealt with appropriately.
[This post will be regularly updated as further evidence comes to light]
[Update 29th April: The Guardian today published quite a useful account entitled “Revealed: the inside story of the UK’s Covid-19 crisis” which covers some of the above issues in more detail]
[Updated 4th May: see The Financial Times report on how the large consultancy firms such as KPMG and Deloitte were contracted by the government without the usual competitive tendering processes to work on projects such as the Nightingale Hospitals]
[Latest update 16.26 4th May 2020]