116,000 and Rising

“The catastrophic pandemic reminds us that any large-scale emergency involving infectious disease will require mobilization of public health resources and civil infrastructure.

…we are due for another fatal flu and that we must be prepared.”

- Hunting the 1918 Flu – Kirsty Duncan (2003) Professor of Medical Geography, University of Toronto

A couple of weeks ago, the United Kingdom passed a grim milestone. Tombstone might be a better word. The country passed 100,000 deaths from Coronavirus. The UK sits in the group of countries with the highest death tolls with the likes of the United States, India and Brazil. Alarmingly the UK has the highest per capita death rate in the world. What makes these figures even worse is that they are based on the Government’s fiddled definition of a Covid-19 death introduced a few months back. We all note that the figures reported on television news each evening are subject to the proviso of a “death within 4 weeks of a positive test”. We also know from news reports that many die outside this period so do not get counted. One can only speculate this was done to suppress the bad news. We will have to wait until the Office of National Statistics releases its next update on deaths that mention Covid-19 on the death certificate. Sadly, this will be regarded as historical data and will be largely ignored.

However, it did not have to be like this. Many countries in the world have handled the pandemic better than us – some spectacularly so. Australia, New Zealand, Finland and many south east Asia countries to mention a few. Defenders of the Government would say such criticism is unfair as some of these countries have smaller populations than the UK and do not have the same large number of concentrated centres of population. Was there nothing we could have learned from them – nothing at all? Are we saying that Vietnam and South Korea, which both have large teeming cities and are handling the pandemic better than us, have nothing to teach us?

The other excuse offered is that only totalitarian regimes suppressed the virus successfully by depriving citizens of vital liberties. Since when have Finland, New Zealand, Australia, South Korea, and Taiwan been totalitarian regimes?

The reality is the UK’s handling of the pandemic has been littered with errors, delayed decision making and mixed messaging for nearly a year and innocent citizens have paid with their lives as a result.

Before exploring where it all went so wrong, let us have a look at how the 100,000 death mark was handled by the Government, as it says so much about what went on beforehand.

The Prime Minister held a press conference. He turned up late and did not bother to comb his hair. Perhaps the message was that I am working so hard on your behalf I have no time to reach for a comb. He apologised for the deaths without sounding too empathetic and took responsibility for them without sounding as if he really did. He then bowed his head for a few moments in a Japanese pose of contrition. His apologists in the sycophantic Tory-supporting print media leapt on the opportunity. The following morning the Daily Mail, Daily Telegraph, Sun and Daily Express all led with a picture of the bow. Clearly, they were showing their support for the true victim of the pandemic – Boris Johnson. The uncombed hair, the little boy lost look, the dough eyes all carefully orchestrated so we should believe our old Etonian leader is doing his best for us and, at the end of day, the deaths are everybody else’s fault but his. I just wonder what the families and friends of the deceased thought of how the newspapers handled the press conference. There was little attention given to the heartache and misery of lives taken before their time and the suffering that will live with the survivors for the rest of their days.

For the Tory Party managers this would matter little as, at the end of the day, the number of Tory voters sitting down for breakfast with their Daily Mails far exceeds the number of deaths from COVID-19 so a bit of Boris worship at this tricky time was quite timely.

Pandemic Planning

We know two things about pandemics – they do not happen very often but they are inevitable. The last was in 1918/19. Scientists for years have been warning that the world was overdue for a pandemic. There was a near miss with the SARS outbreak in the early 2000s. Sensible countries have contingency plans. Barack Obama had one prepared for the United States, but President Trump tore it up. The UK had one which was reviewed under May’s stewardship but, it appears, the necessary follow up never took place. An exercise known as “Cygnus” in 2016 found the UK’s preparedness for a major flu outbreak was “not sufficient”. As a consequence, once the Government took the COVID-19 outbreak seriously they discovered much of the personal protective equipment stock was out of date. Use by dates had not been checked when they should have been. Checking and turning over of the stock was not taking place. As a result, the Government immediately found itself in a world-wide scrum for protective clothing. Those countries who had experienced the SARS outbreak learnt the lessons and, one year further on, remain those best positioned to contain and suppress the virus. There was no reason why the UK did not have an effective plan in place. It was a political decision not to have taken the required action.

The Impact of Austerity

Since 2010 the Tory Government has been telling voters that the financial crash of 2008 was the fault of the public sector. The state was spending too much on public services and was not in a good position to deal with the crash. This is nonsense of course. The crash was a crisis of the financial sector encouraged by weak Government regulation. The Tories were never going to admit that it was their love of deregulation that caused all the problems. So much better and easier to blame police officers, nurses, doctors, fire fighters, public health inspectors, health and safety officials and social workers. We so easily forget Cameron’s cynical campaign to out any public servant who earnt more than the Prime Minister. The Daily Mail, Sun and Express all to willing to name and shame. What Cameron somehow forgot to mention was that on top of his PM salary he retained his MP’s salary and generous expenses.

As a result of 10 years of relentless attack on the public sector it was not well placed to handle a national emergency like the arrival of Covid-19. The public health service had been chopped up, handed to local authorities and then decimated. The NHS had significant shortages of doctors and nurses. Critically the care sector was tragically underfunded. Endless promises of Government reform coming to nothing. It was in a terrible position to deal with the coming crisis.

Not Taken Seriously

Back last January and February the Government appeared not to be taking the potential arrival of the pandemic seriously. The Secretary of State of Health spoke before the House of Commons to tell MPs the Government was well prepared for what may be coming but the risk to the UK was deemed to be “low”.

The Prime Minister behaved as if his usual mixture of bluster, waffle, joke telling, and head scratching would see off any threat. After all it had delivered Brexit for him, won a General Election so a little matter of a pandemic would be easily seen off. For all his love of history he clearly had read little about the 1918 flu pandemic as he chose to miss meeting after meeting of the Cobra committee – 5 in all. At the very moment leadership from the top was required the Prime Minister was missing. The opportunity for effective preparation through February and early March had been missed.

On 3rd February Johnson criticized “medical irrational” lockdowns. He made it clear he did not want to shut down the economy even though that was exactly what Governments around the world were doing to protect the health of their citizens. In a speech in Greenwich Johnson announced the UK would be “the supercharged champion of the right of the populations of the earth to buy and sell freely among each other. There is a risk the new diseases such as Coronavirus will trigger a panic and a desire for market segregation that go beyond what is medically rational to the point of doing real and unnecessary economic damage. Then at that moment, humanity needs some government somewhere that is willing to make the case powerfully for freedom of exchange”.

In other words, shutdowns are for wimps. Keeping the economy open at all costs is the priority. If other Governments shut down, the UK would seek to take advantage. There is no reason to believe he still does not think this even a year and 100,000 deaths later.

Early on, Government advisors cautioned against hand shaking as it could be a means of transmission. On the day this message was pushed, Johnson appeared on television to report he had been to a hospital with Covid-19 patients and he been shaking hands with “everybody” and that he would “continue to shake hands”.

During the early weeks a call went out for ventilators as it was feared the NHS did not have enough. Johnson was reported as describing this as “operation last gasp”.

Mass Testing

There has not been an expert at any stage of the pandemic who has not advised that the best way to control infection is through mass testing with rapid turn around of results, tracing of contacts followed by appropriate isolation. On March 12th, the Government stopped widespread testing to focus on people in care homes and hospitals. At a critical point mass testing was stopped for over a month. The reason is to be found back in the austerity programme when the resources local authorities would have needed were gutted. At a critical time, the UK was driving blind – its only way to monitor the spread of infection was via the ambulance queues outside hospitals.

Contact Tracing

For mass testing to work effectively it needs to run alongside a contact tracing service. The Government awarded Serco and Sitel a contract worth £720m to run “NHS” Test and Trace. The title was a bit of marketing as the service was nothing to do with the NHS and was not responsible to it. The person who was responsible had no public health experience but was a Tory Party peer.

Contact tracing has worked fitfully failing to reach contacts on a consistent basis.

Government studies have suggested compliance with isolation has been poor.

As with so much we will never know how much disease and death was spread as a result of failed tracing and isolation.

Lock Downs

So far, the UK has had three lock downs. Each was entered too late allowing infection to become well embedded in the community. If the first lockdown had started on March 16th rather than March 23rd thousands of lives could have been saved. As infections and deaths began to rise again from September, Johnson resisted calls for a circuit breaker lockdown. He accused the Leader of the Opposition of playing politics with the Pandemic for demanding such a thing. Predictably the pressure for a second lockdown grew week by week and in November Johnson went into reverse gear and agreed a short lockdown. Infections and deaths began to fall but not significantly and when the lockdown was lifted four weeks later the virus went on the rampage again. Johnson just did not want to be the Grinch that stole Christmas and initially agreed to a five-day Christmas period lifting of all restrictions. Under pressure this was eroded down. Deaths and infections continued to rise and in January Johnson agreed to a third lockdown that remains in place today.

It took from March to November for the first grisly target of 50,000 deaths to be reached. Two months later that number had doubled. Johnson now faces pressure from some of his backbenchers to lift the current lockdown. Will he give into libertarian and populist demands or follow the example of those countries who maintained lockdown until the virus had been well and truly suppressed?

We may never how many deaths could have been avoided if the Prime Minister had not been so reluctant to lockdown and so keen to lift them, but it can be counted in the thousands.

Masks

For months Johnson was against mask wearing despite growing international evidence that they played a significant part in restricting infection. Johnson refused to wear one. The public were actively encouraged not to acquire them. As with so much of the pandemic response, Johnson eventually changed his mind. Again, another example of mixed messaging. Again, we will never know how much infection could have reduced if mask wearing had become mandatory earlier on.

Care Homes

Approaching a third of deaths so far have been of care home residents. Johnson brags his Government “put their arms” around homes. One can only shudder at the possible number of deaths if the Government had failed to do this! From the early stages one of the objectives was to take pressure off the NHS. We can only speculate this was because Johnson did not want TV crews prowling the corridors of hospitals filming the seriously ill waiting for a bed to become vacant. The solution was to transfer hundreds of elderly people to care homes.

It subsequently emerged many moved without a Covid-19 test. This seeded the infection in homes which spread like wildfire amongst the most vulnerable groups. Residents were also vulnerable to infection spreading asymptomatically in the community. The government claimed in guidance issued to homes in February that “there is currently no transmission of Covid-19 in the community”. The guidance added that there was no need for staff to wear masks – this was not withdrawn until March 13.

Some homes were under twin attack – from infection transferred in from patients coming from hospitals and from infection spreading in local communities brought in by staff and visitors. Homes suddenly found themselves having to provide a level of care that they would not normally deliver often in premises not designed for isolation. To make matters worse, for weeks they were victims of the national shortage of protective clothing and equipment.

The years of neglect and effective reform of the care sector was brutally exposed by the pandemic. If it had not been for heroic levels of care provided by home staff, many more lives would have been lost. Even after a year many homes are still battling daily to prevent infection getting into or re-entering their home.

Test and Trace App

We clever Brits were not going to use a tried and tested system from abroad driven by the technology already in place from the big tech providers. We were going to design our own and the Isle of Wight was going to be the pilot area. The weeks drifted by and millions was spent. It was due to be operational by the end of Spring but this slipped. Johnson told the Commons the “world beating” system would be up and running by 1st June.

The Isle of Wight project was abandoned. 1st June came and went. The clever technology was dropped in favour of pre-existing but workable technology. The new app entered service in September. Over 3 months late.

Personal Protective Equipment (PPE)

The early months of the pandemic were marked with chronic shortages of PPE in hospitals and care homes. Staff worked without, were told it was not necessary and many improvised. Photos of home-made gowns assembled from bin bags filled social media. An NHS Trust CEO rang the BBC News for the phone number of a supplier.

Some items hastily ordered by the Government turned out to be unusable or not meeting required standards. Contracts were awarded outside the Government’s own procurement requirements. They were offered to companies with no record of producing PPE. Some chosen suppliers were Tory Party donors or the chums of Ministers.

The Government is currently facing legal action for not following their own contract awarding procedure.

We may never know how much infection was spread because of shortages of PPE. What we do know is that it surely happened.

Travel Corridors

One thing we know about the virus is that it cannot swim the Channel, or the Atlantic or Irish Sea come to that. For it to arrive here and for subsequent variants to arrive it needs a human host. The smart countries realised this early on. They introduced travel bans, quarantines and testing and tracing regimes.

It is alleged the Home Secretary wanted to introduce tighter border restrictions last March, but the PM vetoed the idea. As soon as the first lock down was lifted Brits were off to Spain amongst other countries. Cases started to rise alarmingly in that country which led to the sudden, chaotic introduction of quarantine restrictions.

Does this delay have its roots in Johnson’s comments last February about the importance of keeping economies open?

Again, we may never know how much illness and death was spread out of and into the UK because of the lack of a consistent and rigorous quarantine regime. All we do know that it must have happened.

Schools

Surely it the chaos around schools opening and the pandemic will be the subject of a book. Suffice to say that a year after the pandemic’s arrival the Government is still running around trying to secure computers for home learning for poorer families.

The ongoing fiasco is best summarized by events before the most recent lockdown. On the previous Friday schools were deemed to be safe (although few outside Government Ministers believed this), on the following Monday they opened and the next day they closed.

The Government also become involved in a totally avoidable spat with the footballer, Marcus Rashford, over the availability of free school meals to poorer families during half terms. Yet another example of political expediency trumping what was the right thing to do.

Dominic Cummings

Boris Johnson is a self-professed libertarian. To him rules are for little people. When his chief adviser drove to Durham at the height of the pandemic and, while there, drove another 30 miles to a beauty spot to test his eyesight, this was the opportunity for the PM to make an example of a close colleague and to reinforce the message (which he had been championing) that stay home meant exactly that.

Predictably he did not. In fact, the PM found words to sympathise with his adviser’s circumstances. Inevitably this led to an outbreak of stories of people making far greater sacrifices than was expected of Cummings because they wanted to act in the national interest.

This single incident undermined public trust in the Government’s handling of the pandemic. Furthermore, analysis by University College, London found Cummings’ actions reduced people’s willingness to follow social distancing rules.

Eat Out to Spread it About

After three months of lockdown the PM decided enough was enough and it was time to return to normal. He wanted to hear “bustle” in the High Streets again. Although infection and deaths had fallen the virus was far from fully suppressed. The economy was to be the priority.

The Eat Out to Help Out Scheme was born. The middle classes who could well afford to eat out if they so chose were given money to further encourage them to do so. The scheme was a great success with restaurants bursting at the seams once again. Political expediency and the economy coming together in one hit – what was not to like?

A Warwick University study claimed the scheme drove new infections up by between 8% and 15%.

Again, we will never know how many deaths could be attributed to infection spread as a result of the scheme. However, it was hardly an example of what Johnson claimed in a press conference he was “doing everything” to prevent Covid-19 deaths.

All these missteps led towards a UK high all-time record of 81,523 confirmed Covid-19 cases on December 29th. It was if we had learnt nothing from the early months or, indeed, other countries’ experiences. Which, of course, we had not.

A Public Inquiry

Boris Johnson currently rides high in the opinion polls. He is enjoying a bounce from the successful roll out of the vaccination programme. He is milking it for all it is worth with plenty of photo opportunities in vaccine production factories, research labs and jab centres. Perhaps the success is due to the NHS being in charge rather than one of Johnson’s pet private companies. No photos have yet emerged of Johnson digging a grave, visiting a funeral director or holding the hands of patient gasping for breath as they die from Covid.

The 10 months of dither, delay, vital shortages, strategic errors and avoidable deaths are as nothing compared to getting needles into arms and Johnson knows it.

He and his Government are facing various law suites from bereaved relatives and those with an interest in the proper governance of the Government’s affairs. What will become of them it is too early to say.

There have been nods towards to a public enquiry. This could provide an opportunity to examine what went wrong and right, to point a finger at the guilty, to learn lessons for the future.

However, when it comes to such an investigation Boris Johnson holds all the cards. It will be up to him to decide the terms of reference, the chair and, critically, the timeframe. If he so wished, he could stitch it up before it even meets. Even if he does agree he will influence the timing so the results are not published in a way that could influence the electoral cycle. It could take years over its deliberations. How long has the Grenfell Tower Enquiry been going? The second part of the phone hacking enquiry has been booted so far into the long grass it is most likely the ball will never be found.

The prospect of a public enquiry not reporting for another 10 years is not beyond possibility. By then all the key players would have vanished off the scene and would well beyond reach.

Academics, researchers, public health experts, virologists, infectious diseases experts, historians etc will wish to learn lessons. Politicians may not although they may signal otherwise.

Will the wider public be interested? Will there be public pressure for an independent reckoning, or will people feel it was a nasty experience stretched over 18 months which is best forgotten? Only time will tell.