Resolving the COVID-19 crisis in the UK

The UK has the ninth worst death rate (per head of population) from COVID-19 in the world at 120 per 100,000, and this is the third worst of the 20 most affected countries (Johns Hopkins, 9 January 2021; just behind Italy and Czechia); the total number of deaths (within 28 days of a positive test) now being more than 80,000 BBC, 9 January 2021). More worryingly the number of new cases remains around 60,000 despite the recent partial lockdown, and deaths per day are currently over 1000 (UK Government, 9 January 2021). Furthermore, the number of deaths is likely to rise rapidly perhaps to around 2000 a day in a fortnight as the effects of the recent surge in infections work their way through over-stretched hospitals.

None of this need have happened if:

  • the UK government had acted with leadership, foresight and wisdom over the last year; instead it has always acted too little and too late, often with calamitous mis-judgement (see critique of the government’s failures written in April 2020); and
  • more people had responded to the crisis responsibly and wisely, caring for others as much as they did for themselves, and not trying to push the boundaries of what limited restrictions the government had put in place.

What little we know, but what we should have acted on

It is remarkable how much we still don’t know about COVID-19, despite all of the valuable research that has been done such as the creation of new vaccines and the discovery of treatments that can reduce death rates of the most seriously ill. However, we do clearly know enough for the UK government to have acted very differently over the last year. Among the most important things we do know are that:

  • Countries that rapidly put in place comprehensive lockdown measures and keep them in place until the number of remaining cases is very low, have not only had lower overall mortality rates, but their economies are also recovering more quickly. The UK government has consistently gone into lockdown (or restrictions) too late, eased lockdown too early, and has never therefore got on top of the coronavirus. Particularly stupidly, the lockdown in November-December 2020 was nowhere near strict enough, and was foolishly eased in the anticipation that people could see their families over Christmas.
  • Many countries with a history of using masks (such as China, including Hong Kng and Macau) or that have made them mandatory (such as Malaysia and Vietnam; but also many African countries) have been able effectively to limit or reduce infection rates. Much of the debate around mask use has been because of unwarranted confusion about whether masks reduce the chance of the wearer catching COVID-19, or of this actually protecting others (see my post in March on Face Masks and COVID-19). Selfish, individualist societies, where people care much more about themselves than about others and therefore don’t wear masks have generally suffered badly from COVID-19.
  • The fetishisation of the R-number has caused unfortunate misunderstandings and led to many more deaths than would have otherwise been the case. The UK government has seemed to place inordinate emphasis on the reproduction number (R = the average number of secondary infections produced by a single infected person), rather than on the actual numbers of people dying. R is obviously important, but there is a huge difference in impact between a higher R number when total infections are low, and a lower R number when infections are high. Many more people in the short term are going to catch the infection (and die) when thousands are already infected even with a R-number well below 1, than will catch it if only a few people are infected and the R number is 2 or 3. This is crucial, because the government should have done much more to reduce new infections in the summer to virtually zero, and should have acted much more quickly in October when numbers started to rise again (lessons should have been learnt from the experiences of Australia and New Zealand).
  • Too much reliance was placed on digital technologies. It is remarkable how the much-lauded NHS app (in its various incarnations) is now never mentioned by the government. Moreover, it was very expensive: in September 2020, it was estimated to have cost more than £35 million. The entire UK test and trace service has been a catalogue of disasters, but the expenditure on an app that was meant to be a silver bullet was truly misplaced, and the only people to have benefitted were the companies involved in developing it! As many people warned, digital technologies are invariably a solution in search of a problem, and the failure of previous digital initiatives should have been a clear warning to the government.
  • Islands have a clear potential advantage in protecting their inhabitants from COVID-19. The UK has very clear borders that are relatively easy to “protect”, unlike so many other countries in Europe, and yet it has been very tardy in introducing restrictions for those croissing its borders (either way). Island states, especially New Zealand (only 25 deaths) and Iceland (only 29 deaths) with wise governmetns have been able to ensure that infections and deaths have been kept to a minimum by imposing very strict controls. Thus New Zealand specifies unequiovocally that “All people entering New Zealand must go immediately into managed isolation or quarantine facilities. They will remain there for at least 14 days and must test negative for COVID-19 before they can go into the community”.
  • People respond to clear and simple messages, when they are delivered by trusted leaders. Unfortunately, the UK’s blustering leadership has prevaricated and vastly over-complicated the messages to those living in the UK during the pandemic. Things were made far worse, and trust evaporated, when Dominic Cummings did not resign following his breach of COVID restrictions in May 2020, which made many people in the country think that there was one rule for those in power, and another for everyone else. With confused (and weak) messages, alongside a growing belief that it was alright to tweek the rules a bit, it was scarcely surprising that so many people failed to act responsibly in the latter part of 2020 when COVID-19 ran out of control.
  • It is not the new variants that have caused the recent dramatic rise in infections; it is people’s behaviour. Put simply, if everyone focused on protecting others from catching COVID-19, then regardless of the variant the number of infections would be minimised. Yet the government and news media persist in “blaming” the new variant for the recent dramatic increase in infections, which gives completely the wrong message to people. It is high time that we were open and honest about the fact that these recent very high infection rates have been caused primarily by people’s behaviour in December; if people were not giving the infection to others, then there would be no way that these others would catch COVID-19 – regardless of how infectious the variant is. We need to realise that perhaps one-third of infections are asymptomatic, and therefore that many people who feel perfectly well are probably giving COVID-19 to others.

What we should have done; but it’s never too late to take action

Based on the above, it seems fairly clear what the government should have done, but didn’t. This is not that dissimilar to what wise voices were saying back at the start of the pandemic (see my list in April of questions tbe government still needs to answer over its failures). Neil Ferguson and his team’s modelling back in March, although decried by some not only at the time but also subsequently, does indeed seem to have been quite an accurate prediction of what was going to happen, particularly as far as a second wave was concerned and especially given the lack of knowledge at the time about the precise dyamics of COVID-19. Anyone who read that March paper should have been left in no doubt that we were going to see at least 80,000 deaths from COVID-19. Those who argued vociferously and publicly otherwise should acknowledge their mistake and share some of the responsibility for the subsequent national vaccilation about the direction in which the pandemic was heading. We are already past this level, and many, many more are sadly going to die. Each one is a tragedy for their families and those cloe to them. There are absolutely no excuses for ayone saying that they were not aware of how serious the scale of the pandemic was going to be in November 2020-March 2021.

The creation of vaccines to counter the effects of COVID-19, as well as better treatment protocols identified over the past year, provide some hope for the future. However, drawing on the above evidence, the government still needs to take further steps immediately if the UK population and economy are going to be able to reduce the scale of suffering and damage that it has already caused. The following would seem to be wise actions (in approximate order of priority):

  1. Lead rather than react; be ahead of the pandemic. The Government must take control of the situation, and show real and decisive leadership in tackling it. All too often the Prime Minister and his cabinet have dithered, and as a result failed to protect the British people. If tighter restrictions had been in place in December, there wouldm have been many fewer than the 417,570 people tested positive in the last seven days. They should have known and planned for the scale of what has happened. They are culpable for their failure.
  2. Much tighter restrictions should be placed on personal mobility immediately, and they should be kept in place until the number of new infections is in hundreds rather than tens of thousands. This is likely to be a minimum of six weeks and possibly much longer, regardless of the hopefully positive effects of the vaccinations. The long term economic impact of COVID-19 would be far less severe with a shorter sharper lockdown than it will be if the government continues to try to pursue its on-off policy while maintaining relatively high levels of infection.
  3. Face masks should be made compulsory for all people both outdoors and indoors at all times (other than in a person’s own home). This should apply to those jogging, running or cycling, as well as to those just walking. Sanitation points should be made freely available in all workplaces, shops, bars/restaurants and entertainment areas.
  4. All people arriving in the UK should be required to show evidence of an appropriate negative COVID-19 test within 72 hours of arrival. As an island, the UK has the advantage of being able to manage its borders, and it needs to do so effectively so that additional infections are not brought into the country, especially of the inevitable new variants of COVID-19 that will emerge. It would also be a great gesture of our national care for others if we insisted on everyone leaving the UK also being tested.
  5. The vaccination programme must be delivered effectively and efficiently. In general, the priority system seems broadly appropriate, but insufficient priority has been paid to those aged over 90, staff working for companies that provide care at home for the elderly, as well as GPs and other medical staff (all of these should be in the highest priority category) and indeed teacher. With 46,000 healthcare staff off work, an already over-stretched NHS has become even less able to manage the impending crisis. This is unacceptable carelessness on behalf of the government. Moreover, the vaccination policy and practice needs to be very much more transparent than it currently is.
  6. A really efficient and effective test, trace and control system must be put in place once the number of new infections has reached less than 1000 a day. It is impossible for testing and tracing to work effectively with the level of infections that we now have. However, for longer term viability and success, once numbers have reduced to a manageable level (as they were for much of the summer of 2020) it is critically important that we have in place an appropriate and high quality epidemic montoring system that can prevent COVID-19 and its successor pademics from catching hold.
  7. We should put in place now mechanisms to ensure that effective control against COVID-19 is in place for the latter part of 2021. This must ensure that sufficient vaccines are in place (preferably of the Oxford-AstraZeneca vaccine) for GP surgeries to deliver them effectively as they have done for may years with the annual influenza vaccine over the next year, and indeed in future years as well.

Each of these seven action points could have easily been put in place by the government during the summer and early autumn of 2020. It failed to do so and is therefore culpable for the excessive numbers of deaths that we are now seeing. It seems that Johnson, his advisers and senior ministers all seemed to prioritise a focus on getting an easy deal done over post-Brexit trade and relations with countries in the European Union, and therefore took its collective eye off the COVD-19 ball.

It is, though, not just the goverment’s fault. Everyone who has given COVID-19 to someone else is also partly responsible. We should not have needed the government to order us what to do. Surely, knowing what we do about COVID-19, we should all have acted reponsibly and wisely by limiting our personal contacts as much as possible. It is self-evident that we have failed to do this. We can, though, all make a difference now. Wherever we can over the next two months as many as possible of us should choose to stay at home. It only needs one contact to start a new chain of infection. Sadly, trying to circumvent the regulations that have been put in place seems to have become a national pastime; perhaps this is Dominic Cummings’ lasting legacy. Any excuse for not adhering to them seems to be acceptable to the person making it. In part this is again the government’s fault. Why on earth, for example, was “local area” not defined when the government permitted outdoor exercise within it? For one person it is somewhere within a 30 minute drive; for another it might just be within walking distance of home. However painful it is, we all need to act even more responsibly than we did in March-April. I hope Chris Whitty (the UK’s Chief Medical Officer) is right when he said on BBC Radio 4 this morning that we are at the peak of the outbreak, but I fear he is not. Given the very large number of new infections that we are still having, death rates are bound to increase further for at least two more weeks. At least Matt Hancock said yesterday that “every time you try to flex the rules that could be fatal“; such a shame that this message has not been clearer from the government before. We, the people, need to act where the government has failed. We can make a difference, but we need to care for each other more than we do for ourselves – as the brilliant staff in our NHS strive to do every moment of every day.

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Filed under Brexit, Covid-19, digital technologies, Europe, UK

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