The joint report issued today is a stark and largely damning appraisal of the UK’s Covid response. The report asks why, despite being ranked alongside the US as best prepared for a future pandemic, the UK was among those countries worst affected by Covid during 2020. While it avoids directly apportioning blame, this document will doubtless inform the long-awaited public inquiry.
Dr Michael Ryan from the World Health Organisation wisely said at the very start of the pandemic: “Be fast, have no regrets […] the greatest error is not to move.” This evokes the “precautionary principle” – ie assume the worst case scenario and hope to be proven wrong.
Indeed, where the UK has succeeded, this principle is in evidence. Funding for vaccine research in 2016 led directly to the rapid development of the Oxford/Astrazeneca vaccine, while the Vaccines Task Force successfully secured the national supply, which was ably distributed by the army and public volunteers.
However, it seems that the benefits of foresight and planning were also sometimes squandered, with recommendations from simulation exercises Cygnus and Winter Willow not implemented. Modelling for a Mers coronavirus outbreak was also seemingly suppressed.
The threat of pandemic influenza influenced much of the initial pandemic response, despite reports from China of asymptomatic spread, and researchers from the London School of Hygiene & Tropical Medicine advocating early and robust restrictions to curtail virus spread. While this approach mirrored Asian countries that had successfully controlled Sars and Mers previously, the UK instead took a “fatalistic” decision that it would not be possible to suppress the virus. In retrospect, the attempt to control spread by “flattening the curve” was naive, bordering on arrogant, and whether intentional or not implied that UK strategy hinged upon pursuing the futile prospect of infection-driven herd immunity. A more aggressive approach would likely have saved countless lives.
However, Sage was acting upon limited information, not helped by the cancellation of community testing despite the UK being one of the first to develop virological tests. This blinded us to the scale of imported cases from Europe, and mass gatherings such as the Cheltenham Festival continued. Public Health England, after years of cuts, was never capable of conducting mass testing, and a centralised out-sourced model was ultimately preferred, ignoring early offers of assistance from university labs. While UK testing and genetics capacity in 2021 is world class, failures of privatised contact tracing raise serious questions around the scale of investment. Contrast this with the lack of financial support made available to the least well-off, who needed to self-isolate.
Revelations showing a three day doubling of UK infections led Sage to recommend immediate lockdown on 16 March, yet this was not enacted until 23 March, another delay now well-recognised to have cost lives. However, the paucity of available data was symptomatic of troubling disconnects within the framework of central government, highlighted by the report. For example, exclusion of electronic devices from meetings in the Cabinet Office Briefing Room, COBR, made discussion unwieldy at best. Criticism that the “organisation of preparedness for future emergencies was too thin at the top of government and constantly prone to being sacrificed to the short-term demands that predominate in government” is another recurring theme.
Further delays to implementing mitigations and restrictions followed after summer 2020, caused by overly optimistic, and naive assumptions that the epidemic had passed. Testing capacity was found lacking, and the government rejection of the Sage-proposed September “circuit breaker” was both an obscure and dubious process. The ineffectual “tier” system that followed typified the UK response, noted by report witnesses, with restrictions implemented only after high prevalence occurred, not before. The scene was therefore already set fair for the emergent Alpha variant to compound the rapid escalation of cases during December and early 2021.
The pandemic shone a harsh, revealing spotlight upon national infrastructure and the “just-in-time” model of preparedness common in the UK. The NHS “running hot”, staff shortages and creaking infrastructure caused unnecessary burden, while the gross failure in the duty of care that saw care home residents returned without testing is a genuine human tragedy. Building resilience into national infrastructure must become a driver of “levelling up”.
Sadly missing from the report are the clinically vulnerable and those now affected by long Covid morbidity. Liberation was not forthcoming for them on “freedom day”, and the current drive back to “normal” risks return to a self-comforting ignorance where such groups are made to feel ultimately expendable. The current mass prevalence policy is the converse of the precautionary principle, and is impossible to reconcile with best practice, or any semblance of conscience.
Stephen Griffin is a virologist at the University of Leeds
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