Categorized | Health, UK

Where did the UK go wrong on coronavirus?

Leading figures from science, medicine and politics deliver their verdict on the government’s response to the Covid-19 pandemic.BY NEW STATESMAN

John Ashton: Austerity and the government’s lost month led to catastrophe

The failure of the UK government to respond effectively to the threat posed by Covid-19 has had far-reaching economic and social consequences, and led to thousands of avoidable deaths. Many factors have contributed to the absence of what should have been a robust response.

The UK is not alone in prioritising hospital medicine and pharmacology over public health. But efforts were made to build a new international public health movement from the 1980s onwards. During the 1997-2010 Labour government, this was demonstrated by the appointment of the first minister for public health, significant investment in local public health teams, and reducing health inequalities through initiatives such as Health Action Zones, Healthy Living Centres and the Sure Start programme. But this approach was thwarted by the 2008 financial crisis and ten years of austerity.

The situation was compounded by the chaotic and disruptive reorganisation of the NHS and the public health service in 2013. This created a centralising new body, Public Health England (PHE), and led to local public health moving from the NHS into local government, with a loss of influence and a weakening of the ties to clinical care.

A consequence of this was the failure to maintain robust planning for large-scale health emergencies. For example, no action was taken to address the weaknesses in pandemic influenza planning identified by Exercise Cygnus in 2016. The scene was set for the catastrophe that was to follow.

We now know that Boris Johnson failed to attend the first five meetings held on Covid-19 by the government’s emergency committee Cobra (his first was on 2 March). That lost month led to the desperate catch-up efforts ever since. The government struggled to secure adequate capacity for testing and tracing, as well as the necessary supplies of personal protective equipment (PPE). It also failed to provide timely intelligence to local public health teams to enable effective outbreak control.

These errors were aggravated by the failure to adopt the World Health Organisation (WHO) recommendation to “test, test, test”, as well as the disastrous, ideologically driven use of private sector organisations to oversee a national programme of testing and tracing, rather than rebuilding local public health capacity. Further missteps included the sloganising news-management approach, rather than one of transparency and public engagement based on a broad range of professional advice; data hoarding by the controlling PHE; and the decision to discharge hospital patients, untested for the virus, to care homes, where they ignited a parallel Covid-19 epidemic.

At this stage in the worst threat to public health for 100 years, in the middle of a premature easing of lockdown, and with the UK recording one of the highest excess death rates, we have little idea what the next weeks will bring. The ramifications for public health and democracy will be profound. We must rebuild our public health system from the bottom up, and strive to restore trust in our political system and professional and scientific advice as a matter of urgency.

John Ashton is a former regional director of Public Health England

[see also: How the UK failed on Covid-19: the international view]

Sadiq Khan: The shameful treatment of care home residents was the biggest failure

The number of people recorded as having died in the UK with Covid-19 is the highest in Europe, and per capita our death toll is among the highest in the world.

There will inevitably be a public inquiry into the government’s handling of this crisis, from which key lessons will emerge. But we don’t need an inquiry to tell us that serious mistakes have been made, with devastating consequences for thousands of families.

The government was late to initiate the lockdown, with ministers dithering during those crucial early days because they were reticent to use the degree of state intervention that was required. Scientists now believe this delay cost many thousands of lives.

The government was also slow to deliver PPE to front-line staff, slow to make face coverings mandatory on public transport, slow to warn of the disproportionate impact Covid-19 is having on people from black, Asian and minority ethnic communities, and slow to put in place a testing and tracing system – which is still not fit for purpose.

But when the report from the inquiry is released in the years to come, what will be remembered as the biggest national failure of the pandemic is the shameful way vulnerable care home residents were treated.

What we can’t afford to have now is the same level of incompetence, ineffectiveness and inertia from the government in the case of the economic recovery. We are beginning to see the true scale of the challenge ahead, with unemployment expected to reach levels not seen since the 1980s. We can’t underestimate the profound impact this could have – not only on the economy, but the longer-term mental, social and financial health of those affected and their families.

The government now has a historic responsibility to embark on a programme of unprecedented investment in our economy, in skills and in job creation. I know that it’s possible for us to mitigate the worst economic impacts of Covid-19, avoid more years of austerity and prevent mass unemployment. But it’s going to be up to the government to make this choice and to get this vital part of the national response right.

Sadiq Khan is the Mayor of London

Richard Horton: It is not too early to learn the lessons of a mismanaged response

The spectre of a second wave hangs over us. Some infectious disease specialists believe that Covid-19 might be losing its virulence. Most are less sanguine. Dr Tedros Adhanom Ghebreyesus, the WHO’s director-general, said that “the pandemic is accelerating” – across the Americas, south Asia, and the Middle East. “The world is in a new and dangerous phase…” he said. “The virus is still spreading fast, it is still deadly, and most people are still susceptible.”

Prolonged lockdowns are certainly not the answer to future waves of Covid-19. School closures are not sustainable. The economy cannot be refrigerated every time the virus spikes. The risks of worsening non-Covid-19-related health are real. Work at the Institute for Health Metrics and Evaluation in Seattle suggests that Covid-19 displays strong seasonality. In the Northern Hemisphere, some predict that a second wave of the pandemic may arrive in September. The public is likely to have less tolerance for future government mandates to shut down their societies. What if local outbreaks do take off? Modelling suggests that brief lockdowns, followed by relaxations for between two and six weeks, might be enough to cut lines of virus transmission. But one casualty of Covid-19 has been trust in models attempting to forecast the course of the pandemic.

One solution to managing a second wave is early diagnosis, contact tracing, isolation and continual efforts to keep public awareness high. In the UK, the test, trace and isolate system is not fully functional, and won’t be for some months. There have been angry debates about whether physical distancing should be 1m or 2m. The lesson from the HIV pandemic is that no single preventive measure is adequate to control transmission. What matters is combination prevention – in the case of coronavirus, a mix of measures that include hand washing, respiratory hygiene, mask wearing, physical distancing (as much as is possible), and the avoidance of mass gatherings. Politicians and public health officials have not advocated the idea of combination prevention – they should.

Another lesson from HIV is the importance of protecting key populations. Covid-19 is not socially neutral. Coronavirus exploits and accentuates inequalities. The pandemic is plunging as many as 60 million, according to the World Bank, into poverty. Billions of people have had their lives disrupted. Covid-19 has fused with the killing of George Floyd to fuel our collective sense of racial injustice. Our Prime Minister, inexplicably supported by his medical and scientific advisers, says that it is too early to learn the lessons of their mismanaged response.

It’s time to write a new script for humanity. This crisis is not about health. It is about life itself. We have an obligation to remember the consequences of this humanitarian emergency. The needless lives that have been lost. The harms that our government has caused. The failure of our system of science to heed the warnings from Wuhan. There can be no return to what went before. Covid-19 has held up a mirror to society and we have seen the injustices we have for too long left untouched. We can’t turn our gaze away from these appalling realities. We must now ask and answer the question: what do we owe to one another?

Richard Horton is editor-in-chief of the Lancet

Dr Sarah Wollaston: The Prime Minister squandered the trust placed in him

The Prime Minister has said he is “proud” of the government’s record on handling coronavirus. Proud of the 65,000 excess deaths? Proud of his failure to protect care home residents and those who look after them? Proud of the inequality exposed by the death toll across BAME communities, and the hollowing out of the report by Public Health England on this scourge?

The list of failures and missed opportunities is long. We were late into lockdown, inadequately prepared, and we abandoned testing and tracing too early as a result. To that we can add the expensive fiasco of an unworkable contact-tracing app and the sidelining of local public health systems.

A government that will not accept that anything could have been handled differently is doomed to make further mistakes.

The chair of the UK Statistics Authority, David Norgrove, issued a rebuke to the government over its misleading spin. Testing statistics were being rendered incomprehensible and meaningless, he warned, because “the aim seems to be to show the largest possible number of tests, even at the expense of understanding”. The same was true of PPE, with weeks of inflated numbers as social care and NHS staff reported they were working unprotected.

It is time for the public health officials who flank ministers to insist on the clarity and independence that their offices should command. Some did so but were axed from future appearances at the daily briefings. These were supposed to replace the unattributed briefings to the media by “No 10 sources” with much-needed openness. But by the end they had become little more than a vehicle for delivering government spin.

The PM has squandered the trust that so many people placed in him. That has serious consequences for public health because trust is essential if people are to listen and adhere to rules that have a major impact on their lives. What are contact tracers to say to those who, like Dominic Cummings, want to pop back to their workplace after being in contact with someone who is feeling ill, or travel hundreds of miles with them, potentially seeding the virus elsewhere?

An effective strategy requires transparency and a willingness to learn from mistakes. We urgently need an inquiry or commission in real time, to ensure this can happen in advance of any second Covid-19 wave.

There are many models. The Commission on Banking Standards, which was set up to provide a rapid response in the wake of the 2008 financial crisis, is one. A similar commission of both houses of parliament could adopt a broader approach than is possible for a single select committee. This would benefit from cross-bench expertise in the Lords, and could instruct counsel and hear evidence in public, with a number of specialist panels sitting simultaneously to take a rapid, forward-looking approach.

An inquiry is inevitable, but it is surely better that it be held now – when it could help to save lives in the current crisis – rather than merely gathering dust in the future.

Sarah Wollaston was the chair of the health select committee from 2014-19. She is a former MP for Totnes and GP, now returned to a supporting clinical role in the NHS



No man’s land: Covent Garden on 28 May. Credit: David Cliff/Nurphoto/PA

Mark Woolhouse: History may judge lockdown a monumental mistake

As much of the world grapples with the problem of ending Covid-19 restrictions, it is worth asking how we got into lockdown in the first place. One answer is that it was a panic measure for want of any better response to this emergency (and I supported its introduction in the UK on 23 March for that reason). But there is more to it than that. Lockdown was conceived as part of the WHO’s attempt to eradicate Covid-19. It took months for the WHO to accept that eradication was a hopeless cause – the number of Covid-19 cases worldwide continues to rise – but the damage was done.

One country after another followed the WHO’s lead. Some, such as New Zealand, controlled their first waves quickly; others, including the UK, were slower to respond and have suffered badly. None knows what to do next. As one of my colleagues put it, we have made it to the lifeboat but we have no idea how we’re going to reach the shore.

Covid-19 is not going away any time soon, if at all, so we need to devise alternative solutions. It’s concerning that lockdown is still the WHO’s recommended public health response six months into the pandemic. No Plan B is being offered to countries such as Brazil or India that can’t or won’t inflict such a damaging policy on their peoples.

The vital step is to recognise that this unpleasant virus is not equally unpleasant for everyone. Age is by far the most important risk factor. In the UK, the chances of dying from Covid-19 are at least 10,000 times greater for the over-75s than the under-15s. Yet we worry as much about schools as we do about care homes.

Our priority should be to protect the old and others at greatest risk. Shielding through self-isolation cannot be a sustainable solution; we need to shift emphasis from reducing social contacts to making those contacts safe. Testing has a significant role to play but we need to be more ambitious about scale and speed, concentrating first on those in close contact with those most at risk. If we had focused on this from the outset we might have saved thousands of lives and avoided locking down our children and damaging their futures in so many ways.

The longer we remain in the limbo of lockdown the more we are harming the world’s economies, healthcare provision, our mental health and our children’s education. When the reckoning comes we may well find that the cure turned out to be far worse than the disease, devastating though the disease undoubtedly is. I fear that history will judge lockdown as a monumental mistake on a truly global scale.

Mark Woolhouse is a member of the Scottish Government Covid-19 Advisory Group and professor of infectious disease epidemiology at the University of Edinburgh

Jonathan Powell: Johnson and Cummings have shown spectacular incompetence

Boris Johnson repeatedly told us the UK’s response to Covid-19 would be “world-beating”. Well it has been, but perhaps not in the sense he intended. Britain has achieved one of the highest death tolls relative to population size in Europe, and is forecast to suffer the largest fall in national income in the developed world, according to the Organisation for Economic Cooperation and Development. Achieving either would have been remarkable, but achieving both is spectacular. Sweden risked more deaths but at least saved its economy.

We don’t need to wait for the inquiry to tell us how this happened: we closed down too late, we mismanaged PPE, we failed on test and trace, and on and on.

Who is responsible? Once an inquiry is held, the government will try to blame PHE, the NHS, the civil service, scientists and even the hapless Health Secretary, Matt Hancock. But the blame lies with No 10.

There are three fundamental flaws in the Johnson-Cummings prime ministership that have proved fatal. First, you cannot run a government in the same way you run a campaign. I know, because Labour tried to do so in 1997 and had to change rapidly. Different skills are required to run complex government machinery. By importing the Vote Leave campaign – both personnel and manner of working – into No 10, Johnson and Cummings have left a gap of management. The painstaking work involved in tackling the pandemic is not the same as devising three-word slogans to put on podiums. It is paradoxical that a No 10 that for the first time has daily polling and focus groups has lost public support faster than any previous government.

Second, over-centralisation can be catastrophic in these circumstances. Trying to run the whole government machine through a network of special advisers reporting to one person slows everything down. You need a system that can respond at the local level to different circumstances and do so swiftly, as in Germany. And by staffing the whole machine with true believers you end up with pensée unique and a lack of challenge to daft ideas or plain mistakes. Add to this the bunker mentality, into which No 10 has slipped remarkably early, in which everyone else is regarded as both useless and an enemy, and you have a recipe for trouble.

Most important is the character of the Prime Minister. It is not that Johnson is a clown, an inveterate liar and so lazy he is trying to do the job part time – although those failings contribute. The real problem is that he is indecisive. Famously, he had to write one article in favour of Brexit and one against before he could decide which position to take. And so with Covid-19 he took the decision on lockdown too late because he couldn’t decide which way to go.

Prime ministers such as Margaret Thatcher and Tony Blair were decisive because they were conviction politicians and had a sense of direction. Johnson wanted to be king of the world but has no convictions. He doesn’t much care whether we go this way or that and so can’t decide until it is too late.

The one thing the public expect of a leader is the ability to manage a crisis. The incompetence that Johnson and Cummings have demonstrated in handling one will not be easily forgiven or forgotten.

Jonathan Powell was No 10 chief of staff from 1997 to 2007



Credit: Andre Carrilho

Robert West: The government put political priorities ahead of public health

To date, the UK has been one of the worst-affected countries in the world by the Covid-19 pandemic. The average age of the population, and the prevalence of health conditions such as high blood pressure and diabetes, may have contributed to a relatively high infection-mortality ratio. However, it has become evident that many thousands of deaths could have been avoided had the government acted differently in readiness and responsiveness.

In terms of readiness, the UK’s health and social care system had been hollowed out by underfunding and by outsourcing to for-profit contractors. The NHS was already in crisis, and critical care capacity was among the lowest in Europe. Social care was largely privatised, run on a shoe-string and staffed by a dedicated but underpaid workforce. Public health infrastructure had been destroyed, and despite dire warnings arising from Exercise Cygnus in 2016, epidemic preparedness had been downgraded.

In terms of responsiveness, the government failed to enact epidemic control procedures until it was too late. Instead it focused on putting out reassuring messages based on a kind of jingoistic exceptionalism; on keeping the economy going rather than following the example of other countries and WHO advice to act quickly to suppress the pandemic. This has meant that we have consistently been behind the curve – an exponential growth curve, amounting to thousands of unnecessary deaths and many people suffering from horrific disease.

We were late in stemming the influx of infection from abroad, late in sourcing PPE, late in protecting care homes, late in implementing social distancing measures, and late in setting up test, trace and isolate systems.

These failures have arisen because the government has put political priorities ahead of public health. The crisis has been seen as an exercise in reputation management and expediency. Each failure has been met with denial, obfuscation and reassurance. As the pressure has mounted, the government has retreated into a command-and-control bunker. This approach shows no signs of changing but it will have to if we are to avoid a death toll running into six figures.

Robert West is a participant in the Scientific Pandemic Influenza Group on Behaviours, which advises Sage, and professor of public health psychology at University College London

Allyson Pollock: Spending cuts and privatisation have left us without a functioning social care system

Covid-19 has forced us to confront three realities. First, that we are all vulnerable; second, that we all have an absolute need for a functioning health and social care system; and third, that decades of underinvestment, privatisation and fragmentation have damaged our public services.

Hospital closures and cuts to primary care, public health and communicable disease services, coupled with privatisation and fragmentation, left our health services unprepared. The NHS became a Covid-19-only service as most routine care stopped, including reductions in cancer care, cardiac care and rehabilitation. There are now thousands of excess deaths from non-Covid conditions.

The UK also lacks a functioning social care system. Deaths from Covid-19 mainly occur among older people, particularly those over 80. By 23 June, the majority of the 65,000-plus excess deaths in the UK had occurred among those aged 75 and over, and many in care homes. The government failed to protect the 1.5 million disabled, elderly and chronically ill people who have essentially been in solitary confinement for 15 weeks.

The government failed to protect citizens because it failed to take control of social services. According to a 2017 report, there are around 410,000 residents in UK care homes, with around 5,500 different providers operating 11,300 homes for older people. For-profit providers own 84 per cent of care home beds, with a further 13 per cent provided by the voluntary sector. Social services are also underfunded: between 2010-11 and 2017-18 government funding for local authorities fell by 49 per cent in real terms. Spending on adult social care fell from £16.1bn in 2009-10 to £14.8bn in 2018-19.

Underfunding, coupled with diversion of resources to shareholders, means understaffing, and understaffing leads to poor quality care. Adult care services in England employ roughly 1.6 million care staff (1.1 million full-time equivalent), of which 78 per cent are employed by the independent sector. Pay is low; 24 per cent of the adult social care workforce are on zero-hour contracts, and in March 2019 around a quarter were being paid the then national minimum wage of £7.83 per hour.

The sector is 120,000 workers short, which results in inadequate care, while the use of agency staff moving between homes increases the risk of disease transmission. Staff on zero-hour contracts do not receive sick pay, and often go to work when sick.

Social care has been a low priority despite the high mortality associated with Covid-19 among older adults and the increased risk for social care staff. With residents in care homes denied visits from relatives and with minimal interactions with staff, care homes have become closed institutions, increasing the risk of neglect, even abuse.

The government must take control of staffing and social care. It should have doubled the staffing levels, redeploying medical students, nursing students, and clinical staff from the quiet parts of the NHS into this sector. The disinvestment in health and social care has had shameful consequences. To prevent future catastrophes, the government must pass legislation for a publicly funded, publicly operated and fully integrated National Health and Care Service.

Allyson Pollock is director of the Newcastle University Centre for Excellence in Regulatory Science and a public health physician

Ian Boyd: All countries fell short but the UK should be especially concerned

The possibility of a pandemic such as Covid-19 has been high on the UK National Risk Register for many years. We practised regularly for pandemics and yet, in the end, we were not well prepared. Why? There are at least five core reasons.

First, these risks were not communicated appropriately to the public. People understand the risk from terrorism but they are mostly unaware of the risk from natural events such as pandemics. They are even less aware of systemic risks such as food supply failure. Consequently, in the absence of the necessary public support, the government’s risk analyses had almost no policy impact.

Second, the national risk assessment process is itself flawed. The probability of each individual national risk may be small but the total risk from all of them is higher and most likely increasing. Yet little is done to understand and manage this aggregate risk. Its drivers include population growth, accompanied by rising consumption and resource depletion, increasing global connectedness and high leverage of assets including lean supply chains. All had important parts to play in creating the current pandemic.

Third, when risks manifest we need to act decisively. Many countries, including the UK, were too slow and indecisive. A combination of bad luck and poor prescience, and in some cases poor organisation, dragged some countries deeper into the Covid-19 crisis. Many developed countries – where we would have expected better organisation – were slow to respond and struggled, both politically and practically, to absorb the magnitude of what they were facing.

Fourth, science (including medical science) created an unjustified sense of protection. While science has powered the response, countries that invest heavily in science were not necessarily quicker or more effective at responding. Coronaviruses were a known quantity, suggesting that more needs to be done to direct scientific effort towards serving the national interest based on the known level of risk.

Finally, there are inadequacies in public health systems. This is more than an issue of coping with the acute effects of epidemics because Covid-19 has exposed vulnerabilities among sections of society related to ethnicity and wealth. Much of the impact of Covid-19 has not yet surfaced in developing countries. These are deep-seated problems that will not be fixed by simply spending more money on clinical healthcare.

All advanced economies have failed to cope with the Covid-19 challenge. The UK should be especially concerned. Covid-19 has created a systemic failure, suggesting that the way we live, what we value and the way we are governed needs to change.

Ian Boyd is a contributor to Sage and a professor of biology at the University of St Andrews

Michael Heseltine: A no-deal Brexit threatens further economic devastation

Informed criticism requires a factual knowledge of a practical alternative. In this context I refrain from criticism of the government’s handling of the coronavirus pandemic. This is not to deny the existence of criticism; it is rather to recognise that every ministerial decision has required a judgement between unpalatable options. Saving lives in the face of Covid-19, for instance, risks endangering life elsewhere.

The government has rightly presented its scientific advisers to public scrutiny, but the decisions are ultimately political. The incidence of Covid-19 has fallen significantly. Allowing for the differing social, ethnic and distributional factors between comparable states, the government is entitled to claim it has coped reasonably well. With no specialist knowledge or relevant experience, and locked down in rural England, I cannot know what I would have done differently.

I take a different view of the government’s planning for our economic recovery. Brexit may have disappeared from the headlines, but the stark choices of its reality remain. In six months, the UK will either crash out of the EU without a deal or cobble together a set of compromises. In both cases, the adjustments will add to the economic devastation evident in every new set of statistics.

We are now expected to wait while the Prime Minister plans a major speech and the Chancellor a mini-Budget. More revealing of the government’s thinking was the recent announcement by Grant Shapps, the Transport Secretary, of specific policies backed by borrowed money, all targeted within his departmental responsibilities. This was a typical set of standard counter-cyclical policies dreamed up in Whitehall by officials only remotely linked to the priorities of economic recovery, as they are seen in England’s towns and cities, the engine rooms of our recovery.

The proposals for bus lanes, cycle tracks, bypasses and other transport initiatives, followed by one departmental announcement after another (money for housing, cash for training, help for schools, finance for research), may be important. But they fail to recognise the benefits of determining priorities locally and fitted to local need, generating the most productive response and attracting the largest additional investment.

In Scotland, Wales and Northern Ireland, local decisions drive policy. In our major cities in England it is the conurbation mayors who should be playing the lead role, planning recovery based on the opportunities within their reach, harnessing the strengths they possess and attacking the weaknesses as they know them to be.

The mayors have been instructed to lead their communities in devising strategies to coordinate public and private endeavour. The hunger is there. But faced with the most acute economic challenge of modern times, the government appears to cling to the old mantra – Whitehall knows best.

Michael Heseltine is a non-affiliated peer and the former deputy prime minister

Dr Rosena Allin-Khan: Ministers are failing to tackle the mental health crisis

Ahead of the 72nd birthday of the NHS, it is vital that the workforce, who have sacrificed so much, are recognised, respected and remembered. Front-line staff, who have given so much to protect us during this pandemic, have received so little in return. The government was too slow to distribute PPE and roll out testing for staff and their families. It is now too slow to tackle the looming mental health crisis among staff and the wider population.

Throughout this pandemic, front-line NHS and care staff have been in an unenviable position: they have been redeployed to other departments, have been scared of going to work, and have lost patients – and colleagues. Coronavirus has stripped the humanity from grieving. Delivering the news that someone’s loved one has died over the phone, with the inability to put an arm around someone while they grieve, is something that medics have simply not trained for. It feels robotic. Sterile. Inhumane.

It has been heartbreaking to witness the toll this virus has been having on the mental health of NHS and care staff. As the UK moves beyond the acute stage of the crisis, they will not be able to rest. With elective procedures, cancer treatments and mental health services all anticipating a surge in demand, the government needs to stop ignoring the needs of front-line workers.

In the month after being activated, the mental health hotline launched by the government for NHS staff was utilised by just 0.1 per cent of them. With five million days lost due to mental health reasons in the NHS in 2019 alone, the current offer is at best inadequate, and at worst neglectful.

The government must ensure that mental health support is available now, for all NHS workers and care staff, for as long as they need it – this must include post-traumatic stress disorder services. All staff, from porters to doctors, cleaners to carers, have experienced the burden of coronavirus together. No one should be left to carry this alone.

It is time for the government to give back to those who have sacrificed so much to protect our loved ones. Unless our staff are protected, they cannot continue their vital work of keeping us all safe.

Rosena Allin-Khan is shadow minister for mental health, MP for Tooting and a doctor

Lawrence Freedman: The government was too slow – but should cope better with the next stage

This is not, to use Churchill’s words, the beginning of the end but the end of the beginning. The first desperate stage of the battle against Covid-19 is coming to a close and a more relaxed period beckons. But already countries that seemed to have done a far better job than the UK in suppressing the virus are seeing it creep back. As people return to work and play, the opportunities for the virus to spread multiply. It is landing in more places, especially in the Americas, and is going to be sufficiently active around the world for the foreseeable future that no territory, other than the most remote, will be spared. If the disease is able to survive during hot summers what will it be like as winter approaches and it can mingle with seasonal flu?

There are more stages to come. The eventual verdict on the UK government’s performance will depend as much on what happens over the rest of the year as on the first half. Clearly the report card for the first half will make uncomfortable reading. The government was too slow to respond to evidence of the growing danger early in the year, and then delayed moving to lockdown. At each stage the country was hampered by inadequate testing and insufficient stocks of PPE. The NHS was spared from being wholly overwhelmed but many care homes were not. The government struggled to find the right words to explain the predicaments and the options. Too many initiatives were labelled “world-beating” in anticipation and then failed to deliver.

Yet the government really should be able to cope better with the next stage. There are no longer reports of PPE shortages. The testing capacity has been enhanced. There may not be an app, but effective contact tracing always depended much more on personnel, and they are in place. All is not yet right with the system but hopefully it is starting to work more efficiently. If it doesn’t, and substantial outbreaks are not detected before they have got a grip on particular communities, then this will be as serious a failure as those of the first stage. If, however, new outbreaks can be reduced then the sectors in which the UK has genuine international strength will become even more important.

The quality of the biomedical science, the experience of clinical trials, a supportive regulator, the large pharmaceuticals and substantial government funding – these factors have already produced one breakthrough on treatments and may yet result in an early vaccine. The painful memories of the past few months cannot be expunged but perhaps we can end on a positive note.

Lawrence Freedman is emeritus professor of war studies at King’s College London

Gabriel Scally: The UK must transform its public health model to be ready for the next pandemic

Last week I was asked: “What do you think that the government has done well?” This is the only question during the Covid-19 crisis that has left me flummoxed. Looking back on the trail of missed opportunity, slow response and secret science, I find myself drawn back to some of the decisions of the 2010 coalition government.

In 2010, the regional offices of government in England were abolished. The 2012 Health and Social Care Act abolished the regional and local infrastructure of the NHS and of public health. The restructure of both public health and the NHS in England created multiple national bodies trying to manage through organisational jigsaws that few observers could comprehend and that made little sense to those working within them.

The weakness in public health functioning at a regional and local level in England was matched across the UK by the paucity of public health leadership in governmental structures. It has been noted that there was an absence of public health input among the external members of Sage.

Bons mots such as, “the right steps at the right time”, “it wouldn’t have a big effect on transmission” and “we are following the science” became triggers for disbelief rather than reassurance. The withering away of trust was a more potent backdrop than the carefully draped Union flags at the daily press conferences.

When the Covid-19 pandemic draws to a close, whether in months or years, the painful fact that it could all happen again with another novel microbiological threat will have to be acknowledged. There is no guarantee we will have years to wait until something similar occurs. The risk remains the same, so we need to start to rebuild our public health capacity and leadership across the UK. We must strengthen the role and powers of local directors of public health and give them genuine influence in both health services and local authorities, re-establish regional organisational (including resilience planning) in England, and build permanent stockpiles of the equipment that we need to cope with the next pandemic.

Gabriel Scally is president of the epidemiology and public health section of the Royal Society of Medicine



Protect and serve: a medical worker adjusts a colleague’s PPE in the

intensive care unit at the Royal Papworth Hospital, Cambridge. Credit: Neil Hall/EPA/Bloomberg via Getty

Dr David Wrigley: Ministers insulted and let down doctors who gave everything

The devastation wrought by Covid-19 is relentless for all: for doctors, other health and social care workers, and the whole country, which has suffered at least 43,000 deaths. Doctors have put all their dedication, skills and professionalism into caring for their patients. Many have carried out their duties at grave risk to themselves, with some losing their lives to the virus.

It is the role of the British Medical Association (BMA) to ensure that we support doctors and voice their concerns and well-grounded fears at this moment of unprecedented need. Many healthcare workers feel that the Conservative government’s response to the pandemic has been inadequate, obfuscatory and confusing. It has been inactive or too slow, from the start of lockdown to the latest climbdown on the promised operation to trace those who have been exposed to coronavirus. This jeopardises the reopening of the UK’s struggling economy and risks a second wave of deaths.

At the start of the crisis, despite ministers’ assurances that adequate supplies of PPE were reaching hospitals, we heard from doctors that they were not. Doctors and other healthcare workers were let down by a failure to provide this potentially life- saving equipment in a timely way. This meant that in the early days of the pandemic 55 per cent of hospital doctors in a BMA survey felt pressured to work in a high-risk area without adequate protective equipment.

Nothing characterises government deafness on the issue better than the Health Secretary Matt Hancock’s urging of NHS workers to “treat PPE as the precious resource it is”, implying a cavalier attitude in its use. This was followed by the Home Secretary Priti Patel’s half-hearted apology over the failure of supplies. As early as 3 April, the BMA called on the government to deal with this problem by repurposing a dormant UK industry to help make vital PPE.

Contact tracing was supposed to be the bridge between lockdown and a vaccine, but we’re now told that the tracing app has been abandoned. The test and trace programme is fundamental to the government’s strategy of identifying cases and isolating infected individuals to stop the virus’s spread. Having invested huge amounts of time, energy and money, the government will instead switch to a decentralised app. More time lost. More lives at risk.

The Westminster government’s handling of the pandemic has also been dependent on the private sector for many important functions, and has been characterised by an excessive emphasis on theatrical politics.

What we need now is public confidence in a proper and competent system of contact tracing that will reduce the incidence of Covid-19. To use the Prime Minister’s words, it is imperative that there is no more “dither and delay”. The government needs to own up and learn from its mistakes, and backed by scientific evidence, take the country forward transparently, collegiately and, above all, safely.

David Wrigley is a GP and deputy chair of the British Medical Association council

Nick Hargrave: The bad news for No 10 is that things are going to get harder

No 10’s response to coronavirus has been in the eye of the beholder; the debate is polarised and many analysts have found it hard to disaggregate their preconceptions from the facts. In reality, the government’s handling of the crisis so far has been a middling one.

On the plus side, the NHS has been more resilient than expected and did not lose control as in Spain and Italy. Excess deaths look high by international standards but there are variations in how the statistics are recorded, as well as underlying factors such as population density and obesity rates to bear in mind. The immediate economic response from Rishi Sunak has been comparative to that of other European countries.

But the UK was slow to embrace large-scale social distancing in early March. There was a lack of forward planning on testing and tracing. Communication has been poor.

Although approval ratings for Boris Johnson and his handling of the crisis have receded, they are still at reasonable levels. Voters seem willing to give the government the benefit of the doubt for most mistakes.

The bad news for No 10 is that things are going to get harder. No one can predict the course of the crisis from here – although I suspect that most would still view a second spike as a natural disaster rather than one generated by the government.

The real problems for No 10 are going to come on the economic front. The pandemic has been a profound shock that will reduce long-term demand for specific products, services and sectors of the economy.

The economics will in turn dictate the politics. Businesses will have to adapt or close and this will lead to real human suffering. The older and lower skilled in the deindustrialised north, who underpinned Boris Johnson’s majority last December, will be hurt by this crisis; so will younger voters at the beginning of their careers. Most will understand that governments do not create jobs, but they will expect Johnson to spend big and tax “other people” to pay for relief.

There is latitude for government borrowing over the next few years but it will eventually have to be brought under control. The timing of this fiscal consolidation, and how it maps against the electoral cycle, is the greatest challenge to the durability of this Conservative government.

Nick Hargrave is a former Downing Street special adviser who worked for both David Cameron and Theresa May

Zubaida Haque The pandemic laid bare our race and class inequalities

Despite more than 70 years of achievements by the civil rights movement in the US, and the establishment of race relations legislation in the UK, racism remains a matter of life and death. Covid-19 has illustrated the realities of racism in a less dramatic way than deaths in police custody, but the number of fatalities is far greater. The pandemic didn’t create race and class inequalities, but has laid them bare for all to see.

The evidence that black and ethnic minority groups in the UK – in particular black, Bangladeshi and Pakistani groups – have been hit the hardest by Covid-19 is indisputable. Almost every data source agrees.

This includes BAME women. A recent study in the British Medical Journal found that more than half of pregnant women hospitalised with Covid-19 across the UK (between 1 March and 14 April) were from BAME backgrounds.

In response to a public outcry about the disproportionate number of deaths among BAME NHS workers and within the community, the government commissioned a review into the possible “disparities” (not “inequalities”) in Covid-19 outcomes among ethnic groups. But even before the review began the terms of reference revealed that the review would be investigating other factors besides ethnicity (including age, gender, obesity and other factors).

Public Health England released the review findings in early June, but there was disappointment and anger among race and faith equality organisations (including the Runnymede Trust), public health professionals, and black and ethnic minority communities who had lost relatives to the pandemic. Out of 89 pages of the review into “disparities in… risks and outcomes”, only 11 addressed the question of why black and ethnic minority people in the UK might be more vulnerable to serious illness and death with Covid-19. There was not a single recommendation on how to save BAME lives.

Despite the equalities minister, Kemi Badenoch, saying that “Public Health England did not make recommendations” due to gaps in the data, the government eventually released a third-party evidence report, Beyond the Data: Understanding the Impact of Covid-19 on BAME Groups. The report, which contained consultations with more than 4,000 stakeholders, highlighted “racism and discrimination experienced by communities and more specifically by BAME key workers as a root cause affecting health, and exposure risk and disease progression risk”.

The irony that the government allegedly withheld a report with seven recommendations – including better data collection by ethnicity, more health risk assessments for ethnic minority workers and disseminating culturally sensitive health messaging – for fear of exacerbating tensions during Black Lives Matter protests was not missed.

BAME communities are over-represented among poorer socio-economic groups. They are more likely to live in densely populated areas, in overcrowded and multigenerational housing, and to work in higher Covid-19-risk occupations. But the government took few steps to protect them. Race and gender equality organisations, and the anti-poverty sector, made recommendations about the need to increase the social security safety net and remove barriers to healthcare. But these measures were met with silence.

When it comes to addressing issues of structural racial inequalities or racism, the government’s first instinct is to kick the ball into the long grass. How can the government save lives if it keeps burying the evidence? The answer is not to commission yet another review; it is to take action.

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