Last week, Britain became only the second country in the world whose official death toll from coronavirus exceeded 40,000. The scale of the human tragedy is incomprehensible: at the pandemic’s peak, almost 1,000 people were losing their lives a day. They have left behind more than 40,000 families who are mourning at a time when they cannot come together to share their grief.
This is a pandemic that has tested the public health response of governments in every corner of the world. But the UK has performed poorly on any measure: the death toll is now more than double what the government’s scientific advisers said would be a “good outcome”, and, at this point, it has one of the worst excess deaths rates in the world.
Yet the prime minister has offered no apology for the serious mistakes the government has made so far: its haphazard procurement of protective equipment for frontline workers; the tragedy it did too little to prevent unfolding in Britain’s care homes; its unforgivably slow efforts to build up testing capacity. Last Wednesday, without a hint of contrition, he declared himself “very proud” of the government’s record on coronavirus, just the day before the chief operating officer of the NHS test-and-trace scheme told staff it would not be operating at full speed for another three or four months. All along, there have been worrying signs that this was a government prepared to put politics above pandemic management; in the past two weeks, that sense has only intensified as Johnson has rushed in multiple lockdown relaxations in what looks like an attempt to distract from the rule-breaking of his top adviser. We cannot wait for a post-hoc public inquiry into what the government has got wrong.
Inadequate capacity to react
Just 10 years ago, Britain was considered to be a world leader in public health and pandemic management. Its public health rapid-response teams have been deployed to assist in emergencies around the world. But over the past decade, cuts in public spending have left local public health teams depleted, funding on interventions to cut smoking and obesity has been reduced and the tightest funding settlement in its 70-year history has left the NHS stretched beyond capacity.
This hollowing-out of the state has left the UK far more vulnerable to the effects of a pandemic. In October 2016, the government ran a three-day simulation of an influenza pandemic. The conclusions were stark: Britain was not ready for a pandemic. Comprehensive recommendations were made, from increasing stocks of protective equipment for frontline staff to expanding the capacity of care homes to deal with patients in such an event. It is clear from what has happened since that these recommendations were not adequately implemented.
On top of that, the weeks of warning we had when the World Health Organization declared coronavirus a global health emergency in late January were wasted. By early March, several other countries had significantly invested in expanding their testing capacity; the UK had not. This forced the government to choose a different strategy from that which the WHO was imploring countries to take – to “test, test, test”. Instead, it announced it was abandoning efforts to control the spread of the virus through testing and tracing, with its scientific advisers going on the airwaves to suggest that by allowing some spread of the virus they expected the population to build up a natural level of herd immunity. Large sporting and cultural events that brought together many thousands of people from Britain and abroad, including from virus-stricken countries such as Spain, continued to go ahead in the first half of March, a decision that some scientists now believe will have certainly resulted in avoidable deaths. The official scientific advice that informed this decision betrays an over-reliance on simplistic assumptions about how people interact that could have been counteracted by having more frontline public health specialists at the table. And the UK left it until very late in the day by international standards to impose the level of lockdown needed to reduce the spread of the virus. Both the political decisions and the scientific advice that produced this late decision have rightly come under intense scrutiny.
These early strategic mistakes have since been compounded by a series of logistical failures. At first, it looked as though the government’s efforts to expand the capacity of the state to deal with coronavirus were going well - the rapid expansion of critical care capacity via the network of Nightingale hospitals was extraordinary - but other problems quickly emerged. In particular, a shambolic failure to ensure adequate supplies of protective equipment for health and care staff exposed serious weaknesses in the NHS’s decentralised procurement structures; it has taken far too long for the government to get a grip on this, allowing the infection to have spread more quickly throughout hospitals and care homes. The government has also been far too slow to increase testing capacity, focusing on meeting arbitrary targets through any means necessary; it has been criticised by the chair of the UK Statistics Authority for continuing to mislead the public on the number of tests being carried out. And the intense focus on increasing the NHS capacity was not extended to care homes, where there have been twice as many deaths as usual for this time of year.
Perhaps unsurprisingly, given the government’s failure to acknowledge, let alone address, these errors, a similar set of mistakes seems likely with respect to its test-and-trace scheme. The effective operation of this scheme, which would allow local government to track and limit the impact of local outbreaks, will be critical in minimising a second wave of deaths from the virus as lockdown restrictions are relaxed. It is the most complex delivery project of the pandemic yet. But the government was for weeks too reticent to involve local councils, which already have contact tracing and public health expertise, instead choosing to outsource huge parts of the scheme to large contractors, such as Serco, which have a poor track record of delivering government contracts. The emphasis has been on recruiting large numbers of poorly paid, inadequately trained call centre staff. It is extremely concerning that the scheme will not be fully operational until the autumn, given the lockdown relaxations that are already under way.
If the government has failed to learn from its logistical failures, the same can be said of its failures to incorporate a sufficiently wide range of scientific thinking and evidence into its decisions. The number of scientific experts who say that the government left it too late to impose a lockdown has only grown. One might reasonably have expected the government to broaden the range of expertise it relies upon in response.
Instead, it appears to be ignoring any politically inconvenient science. Last week, it began to relax several areas of the lockdown simultaneously, with more to follow in a week’s time. Many scientists, including several prominent scientists who sit on the government’s scientific advisory committee, have warned that a more cautious approach is needed while there are still thousands of new infections a day, the estimated reproduction rate of the virus remains dangerously close to one and before a test-and-trace system is fully operational. The government’s scientific advisory committee has estimated that a limited reopening of schools alone – just one of the measures introduced last Monday – could increase the reproductive rate of the virus by 0.2. Yet the government has pushed ahead, without setting out its calculation as to why these risks are warranted, in what appears to be an attempt to distract from the political row over the revelation that Johnson’s senior adviser, Dominic Cummings, broke lockdown rules at the height of the pandemic. Meanwhile, Johnson’s failure to hold Cummings to account over his action sends a damaging message to the public that complying with the lockdown restrictions is optional.
The events of the past week give further credence to the view that the government is putting populism before public health: the proposed introduction of a 14-day quarantine for travellers coming into the UK appears to go against scientific advice and to have been motivated by the fact that Cummings believes it is regarded positively by the public. Similarly, the ridiculous scene of MPs queuing for more than a kilometre to physically cast their vote in parliament after the government ended virtual voting, even for those who are in the vulnerable category, suggests a government that is willing to ignore scientific advice when it goes against its own political interests.
Calls for public inquiry
All this points towards a depressing verdict. As the pandemic goes on, the government appears to be moving further away from, not closer to, the balance of scientific opinion; ministers are increasingly struggling with the huge logistical challenge of managing this pandemic, rather than learning from their mistakes; Johnson is approaching pandemic management more, not less, through the lens of the populist politics of the Vote Leave campaign that he and Cummings together led.
We agree with the scientific and medical experts who wrote to the Guardian on Friday calling for a rapid public inquiry. Such an inquiry should be focused on producing practical recommendations for the autumn and could be conducted by a cross-party committee of senior parliamentary backbenchers. The government has so far proved too willing to take reckless risks with people’s lives. It must be called to account for that sooner rather than later.