Effectiveness of national responses to COVID-19

By Peter Warrington

On the 3^{rd of} March 2020 the Government described itself as being “well-prepared” to respond to Coronavirus¹ – was this the case?

Becoming aware of the pandemic

The Chief Medical Officer for England first held discussions about the outbreak of the Coronavirus on the 2^nd of January, where they agreed it was “serious” and “something to watch”.²

The Scientific Advisory Group for Emergencies held it’s first “precautionary” meeting on the 22^nd January, where the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) advised against measures such as screening, opting only for limited public messaging. This is because it concluded rapid, reliable testing was not available at that point.³

On the 3^rd March Public Health England stated that widespread transmission of COVID was now “highly likely”⁴

Patrick Vallance said that “it became clear in January that the infection was spreading faster” and by the 11^th March (when the WHO announced a ‘pandemic situation’) that the Government was already “planning it would go across the world”.⁵

Critisism of the national government response

Before the first lockdown – were we too late?

There has been widespread criticism of how much preparation was put in place before the pandemic became widespread in the UK. Dr Richard Horton, the editor of medical journal The Lancet said in March 2020 that "we knew in the last week of January that this was coming. The message from China was absolutely clear that a new virus with pandemic potential was hitting cities. ... We knew that 11 weeks ago and then we wasted February when we could have acted.", while others made similar points such as former WHO director Anthony Costello. Labour’s shadow health secretary Jonathan Ashworth said similar saying “Heading into the first wave, we were too slow. The first cases reached the UK on 31 January.”⁶

On May 15^th 2020 the British Medical Journal published an editorial in which it’s executive editor and others describes the UK as “forewarned but not forearmed”, calling for a locally led testing and tracing strategy. Gabriel Scally of Bristol Uni adds in the editorial that “By the time the UK formally announced a lockdown… almost two months of potential preparation and prevention time were squandered”.⁷

In April, Leader of the opposition Kier Starmer said in Parliament that “Something is going wrong, and there is a pattern emerging here. We were slow into lockdown, slow on testing, slow on protective equipment and now slow to take up those offers from British firms.”⁸ And in November claimed that “At every stage, the Prime Minister has been too slow, behind the curve.”⁹

In June, Professor Neil Ferguson, a Government adviser during the first stage of the pandemic, said in June that by locking down a week earlier, deaths could have been reduced by a half.¹⁰

That being said, researchers from Imperial College London in a study published in Nature estimate that Lockdown still managed to avert 470,000 deaths in the first wave.¹¹

Systemic problem? See also: Was the UK already in a bad place to respond to COVID

The House of Lords public services committee report into the Government response to the pandemic concludes that their response was “hampered by overcentralised, poorly coordinated, and poorly communicated policies”, that there was “Insufficient support for prevention and early intervention” and that “The COVID-19 pandemic has accentuated the systemic frailties in the care sector”. Notably it emphasises “Inequality of access to high-quality public services” and a failure to support vulnerable children.¹²

Thought: Can it be argued that cuts to public funding and a lack of investment left the UK in a significantly worse place to respond to COVID-19?

Economic support

The institute for employment studies estimates “around one hundred thousand workers” missed out on Government furlough payments when “starting a new job in March, paid monthly, and [were] laid off due to Covid-19.”¹³ While UKHospitality suggests “350,000 and 500,000 workers in its sector would be ineligible”¹⁴.

Comparisons

Comparisons have often made between the UK response to Coronavirus and that of South Korea that denied travellers from the Hubei Province on the 4^th February¹⁵ (while the UK only expected travellers from affected areas to self isolate¹⁶) and where cities banned mass gatherings in late February¹⁷, while the UK only banned these gatherings at the start of the first lockdown in mid March¹⁸.

PPE

A survey by the British Medical Association in May revealed that 65% of doctors “said they felt either partly or not at all protected”, while 69% of GPs have bought their own PPE.

Questions have also been raised over the use of Government contracts to buy PPE amid claims of cronyism and that the Government have been giving contracts for this equipment to doners of their party. An example people often bring up is the Government purchase of 50 million unusable face masks as part of a £253 million contract to Ayanda capital¹⁹, an investment firm. The Government contract for this PPE was brokered by an adviser working for the company and was also an adviser to the Government’s board of trade.²⁰

Slow into November lockdown?

On the 21^st September 2020, SAGE were concerned about the rise in COVID cases across all age groups across the countries and said that a “package of interventions would need to be adopted to reverse this exponential rise in cases” including a short period of lockdown known as a “circuit breaker”. On the 13^th October 2020 Starmer then called on the Government to put in place this type of lockdown²¹, something that he only did later on the 31^st22. This is despite these early calls, 68% of residents supporting a temporary lockdown as of the 14^th October²³ and research suggesting it could reduce deaths by 29 to 49%.²⁴

Free school meals

The Government also were faced with widespread criticism over it’s (now rejected) policy of not providing free school meals during Summer²⁵, leading to a nation wide campaign by footballer and campaigner Markus Rashford which led to the Government reintroducing free school meals over the summer.²⁶ Boris then rejected calls again during October for during the half-term²⁷.

Concerns were raised again in January 2021 where photos were posted on social media showing the food parcels given to some families that were supposed to last a week by contracted firms, but were widely considered inadequate, Gavin Williamson Education secretary describing them as disgusting, leading to their replacement with vouchers.^{28 29}

Herd immunity – A stratergy the Government took at any point?

One criticism often levelled at the Government is that they took or strongly considered to take a herd immunity strategy, where you infect most of the population to build immunity and therefore hope to decrease transmission, something that has been widely branded as dangerous by medical experts, politicians, and the media. I thought this would be interesting to look at as it is commonly used by critics of the Government response as an example of what they see as its incompetent response, where how well the government responded is a crucial question of this dissertation.

The concerns first arose when Patrick Vallance, the Chief Scientific Advisor to the Government, told BBC Radio 4 on the 13^th March that they needed to “broaden the peak, not to suppress it [the virus] completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission”³⁰.

This received widespread criticism by others, for example an editorial by an epidemiologist in the guardian 2 days later expresses concern, explaining that such a response is different to creating herd immunity through a vaccine as “This is an actual pandemic that will make a very large number of people sick, and some of them will die”. He concludes that “The UK should not be trying to create herd immunity, that will take care of itself. Policy should be directed at slowing the outbreak to a (more) manageable rate.”³¹

This led to political criticism as well, for example by Labour shadow minister Yvette Cooper on the 17^th March 2020 who said that “the number of lives that would be lost by pursuing a mitigation or herd immunity strategy would be far too great.”³²

Relatedly, on the 12^th March Patrick Vallance at a government press briefing said that "It's not possible to stop everybody getting it and it's also actually not desirable, because you want some immunity in the population. We need immunity to protect ourselves from this in the future."³³

Matt Hancock however on the 15^th March 2020 wrote in the Sunday Telegraph that "Herd immunity is not a part of it [the Government’s planned response to COVID-19]. That is a scientific concept, not a goal or a strategy.”³⁴ He repeated this in the commons next day saying “We are very clear that herd immunity is not part of our plan”³⁵.

On the 12^th April 2020 however, the Guardian published an article with the headline “Documents contradict UK government stance on Covid-19 'herd immunity'”, claiming a contractor for the government included it in a list of possible interventions for analysis. Despite this, the scenario appears to have never been simulated, was the result of “entirely internal, preliminary discussion” and appears to have been the responsibility of an external contractor, although was also listed on an NHSX document.³⁶

In addition, Jeremy Corbyn claimed in an interview with democratic socialist magazine Tribune’s “A world to win” podcast that he attended a meeting with the cabinet office in his capability as leader of the opposition at the time where he “got a lecture about herd immunity” where he claims that “allowing people to die” was their “absurd” policy at the time. The Government responded by saying that “This is an unprecedented global pandemic - our strategy was clearly set out and guided at every stage by the advice of scientific experts” and that “Our response ensured the NHS was not overwhelmed even at the virus' peak, so that everyone was always able to get the best possible care.”³⁷

Overall, this would all suggest that it was a response that was likely considered by government who may have taken actions using this strategy prominently in the early stages of the pandemic to widespread criticism, although there are doubts over the extent to this this actually reflected policy and actions if it did at all. Nonetheless, it is an interesting example of concerns over how the Government have handled the crisis which I can reference as part of my dissertation.