This is an interesting personal insight from May 18 on the situation in the United Kingdom, one of the current epicentres of the COVID-19 pandemic. Our UK correspondent reports:
I returned to Britain in mid-February. Leaving the plane at Heathrow was delayed to await the arrival of leaflets about identification of Covid-19 symptoms and voluntary self-isolation, but there were no temperature checks.
A dental appointment in early March was cancelled after my dentist caught Covid-19, possibly when passing though Milan airport after skiing in Switzerland; isolation of certain Northern Italian towns did not register much in the UK. The government initially assessed the threat as low while scientists were slow to pick up on the extreme danger of the virus, initially putting it in the same category as a flu-type epidemic. The Prime Minster did not attend 5 emergency Cabinet Office Briefing Room meetings in the run up to the crisis. By that stage, testing and tracing of suspected positive cases had been abandoned. Airlines had severely reduced flights but there was still no testing of new arrivals; not even temperature checks. The government was slow in moving to lockdown on the 24th of March after epidemiologists produced terrifying estimates for casualties if no action was taken.
Years of underinvestment in the National Health Service (NHS) had led to the UK having almost the lowest per capita number of intensive care beds in the whole of Europe1. Pressure from the annual winter flu epidemic had already led to postponement or cancellation of some elective surgery before the Covid-19 epidemic struck. Once it had arrived, the rapid construction of the first large-scale ‘Nightingale’ Hospital (temporary critical care hospital) by British Army engineers, postponement or cancellation of most elective surgery, and some other treatments including those for cancer patients, created and freed up Intensive Care beds, while the public cut visits to Accident and Emergency Units by half, either out of a wish to reduce pressure on NHS facilities or out of a fear of catching Covid-19 in hospital.
The government’s communication of the lockdown message was effective and reinforced by the appearance of an obviously ill Prime Minister, Boris Johnson, in a photo call on the steps of No.10 Downing Street in early April, his subsequent removal to St Thomas’ Hospital, followed by a life-threatening spell in Intensive Care2. His convalescence took more than a week and may not yet be complete. Secretary of State for Foreign and Commonwealth Affairs, Dominic Raab, was a generally effective stand-in for Johnson but problems over the provision of Personal Protective Equipment (PPE) and the need to provide guidance on what was to follow lockdown were ducked. Raab’s wish to avoid irritating jealous colleagues by exerting too much authority and usurping the PM’s role, underlined the leadership vacuum. ‘Collegiate’ Cabinet government still requires a ‘big-beast’ to knock heads together and provide leadership. The Secretary of State for Health and Social Care, Matt Hancock, was caught out overpromising and bluffing3. The absence of Parliament meant, in effect, that for a time, the BBC’s Chief Political Correspondent, Vicki Young, was the main person calling the Government to account.
The Government achieved the objective of avoiding the swamping of the NHS hospital system, albeit at the cost of destroying a large part of the economy, ending almost all normal social life and forcing Covid-19 patients to die without the comforting presence of relatives. It took some time even to arrange limited mobile phone contact on the eve of death. The emphasis on ‘saving the NHS’ came at the cost of neglecting the care sector, particularly old people’s homes. Staff died from insufficient protective equipment. National death statistics were misleading for a long period, ignoring deaths in care homes and those who died quietly in their own home4. For a certain period, it appears some hospitals were refusing to accept referrals from the care sector or dumping elderly patients out of hospitals back into care homes without even providing the means of testing for the renewed presence of the virus5.
Testing for the presence of the disease, and more recently for antibodies is, as of 16 May, still muddled. The 100,000 target for the number of tests carried out daily by the end of April was met once, then discredited for counting not tests, but test kits sent out, then undermined further by the news that 50,000 completed tests had been sent to the US for examination with concomitant delays. Some drive-in sites for medical staff were inconveniently located, and the booking system was swamped. Army personnel were used to staff some units and to provide mobile units to care homes. Entitlement to testing seems to have been driven by the latest headline.
The PM’s speech on 10 May was preceded by Cabinet infighting on the degree of relaxation and the related messaging. The initial response was largely positive after weeks of prohibitions but many tricky questions remain. Continued social distancing is incompatible with commuting to work in large urban centres by public transport, full reopening of the leisure sector and air travel. Testing and tracing on a centralised basis is yet to get off the ground. Notifications based on mobile phone networks depend on about 80% of the population signing up to the app. Longer term solutions such as vaccines and more effective treatments for Covid-19 patients are some way off. Even supplies of essential drugs and protective equipment for health workers cannot be guaranteed.
As expected, detailed discussion of the gradual lockdown steps has intensified criticism of the government. Teachers unions have been critical of the 1st of June date for restarting two years of primary school classes, claiming the action is rushed and gives no consideration to the difficulty of getting young children to maintain social distancing in class. Factory managers have reordered work patterns and increased protection measures. Until schools resume fully and grandparents are released from captivity, some parents will be unable to return to work and some children will even not get enough to eat.
Data on the spread and intensity of the disease is still patchy and hampers sensible policy decisions. “R” (the Reproduction number6) may be between 0.5 and almost 1 but is a lagging indicator. No one really knows the likely effect of easing lockdown, only that it might be necessary suddenly to slam on the brakes again.
The country is grasping at national myths and ritual: national solidarity during World War II and the eventual triumph on VE Day; the skilfully implied comparisons in two speeches by the Queen with the dark days of 1940, the present events ending on notes of optimism and solidarity, and the ritual clapping on house doorsteps in appreciation of health workers at 8.00pm every Thursday.
The new leader of the Labour Party is the antidote to the Corbynism virus. He has an open goal in making ‘helpful’ criticisms of government measures and listing its inadequacies. In the longer term the Covid-19 post mortem will make it hard for the Conservatives to be re-elected as chronic underfunding of the NHS and the slowness of the response to the epidemic will wipe out the credit for efficient handling of the crisis, assuming that starts any time soon. Resumption of ‘yah-boo’ Party politics and a degree of points-scoring by ‘national’ administrations in Scotland, Wales and Northern Ireland risk creating confusion.
The Way Forward
There is a gradual realisation that the effects of Covid-19 will be here for a time, failing the provision of an effective vaccine. A comprehensive debate about risk is needed including on the economy, the danger of prolonging the absence of the compensation effect of education on children who are victims of poverty and poor parenting, a fundamental change in the pattern of physical movement to attend places of work in large urban centres, and the trade-off between social distancing and normal gregarious human behaviour. Assessment of the willingness to take risks will need to move in part from the government to the individual.
Any post-mortem on the crisis should examine whether over-centralisation of the NHS was a problem, especially over the approach to the provision of testing and the procurement of protective equipment. The balance between effective local initiatives and national direction should be examined carefully. Private sector offers of help appear to have been ignored, maybe for good reasons, such as difficulties with quality control and the efficiencies of contracting in bulk. Any Treasury role in encouraging the running down of stockpiles and insisting on awarding contracts to low-quoting companies with poor track records should also be included.
Whether the government should foster greater national security of supply of medicines and PPE will also arise. In the context of Brexit, an objective analysis of how the EU27 functioned during the crisis might help avoid wasting time on discussion of reversing the UK’s decision to leave. Ad infinitum….