The Coronavirus epidemic is over! Well……..over in political terms. The virus continues to spread, people are still getting ill and patients are still dying but political and media focus is now elsewhere. Things are getting worse but at slower and slower rate. The number of daily press conferences is being run down and so is the number of the great and good put up to answer questions. Comparative data has all but disappeared. In fact, the only performance being measured is the UK’s against the UK. Football is back and Primark is open. Pointless will soon be back on BBC1. The nation is being encouraged to go shopping. The R rate remains between 0.7 and 0.9 as it has for weeks.
So perhaps now is the time to come to some judgements on the Government’s performance in managing the first pandemic since 1918.
The first problem is, what targets are we measuring the Government’s performance against? Helpfully they provided some early on although that may have not been the intention. In January, the Secretary of State for Health stood before the House of Commons and announced that the Coronavirus risk to the UK was “low” and that in any case the country was “well prepared”. A few weeks later the Chief Scientific Adviser informed a House of Commons Select Committee that a good outcome would be to depress the number of deaths to 20,000 or below. So, in summary the risk to the UK was low, we were well prepared, and deaths would be around 20,000. The country could go to the races in safety.
Sadly, we now know that all that confidence and reassurance was misplaced.
Number of Deaths.
The 20,000 deaths target was sailed past weeks ago. It now stands at 42,623 (as at 21st June) and continues to creep up. Even worse if the 20,000 target is measured against the number of excess deaths it looks simply dreadful. In simple terms, the number of deaths where Covid-19 is mentioned on the death certificate in all settings is now over 42,000 but the number of excess deaths during the duration of the pandemic when measured against the expected number of deaths over the same period, according to the Office for National Statistics, at the end of May, is 64,000. This is just staggering and made worse by the apparent lack of outrage. The media silence has helped the Government avoid a crisis of confidence in its ability to handle the crisis.
In summary, the Government was planning on 20,000 deaths, the actual number of deaths where Covid-19 is mentioned on the death certificate is over 42,000 but the number of deaths above the number expected over the pandemic period is 64,000. This indicates that an additional 20,000 people could have died of Covid-19, it was just not mentioned on the death certificate, or some other mystery epidemic is in circulation.
This all gets even worse when the UK’s death figures are compared with other countries. In the early weeks, the daily briefings displayed a graphic showing the UK’s position compared to other countries – particularly Spain and Italy who were supposed to be the bad boys of Europe. Here was a graph showing we certainly were not. It turned out to be this way because the pandemic had been running its course longer in those countries. Suddenly the UK arrow turned upwards, Spain and Italy were left behind, and we were now competing with the United States for the highest number of deaths. The graph disappeared from sight amid mumblings about international comparisons not being helpful. Well, I suppose they are not when your country is showing more of its citizens dying more quickly than almost any other country on the planet. You can bet a penny to a pound that if UK deaths had been at New Zealand levels the graph would have had daily top billing.
Simply, the number of deaths has way exceeded the number the Government was talking about in public back in January.
Test, Track and Trace
“We will have a test, track and trace operation that will be world-beating, and, yes, it will be in place by June 1st” so said the Prime Minister on 20th May. On 18th June he u-turned. The NHS England test and track smartphone app was nowhere near ready. It had not made its way off the Isle of Wight. The key bit of technology that would have allowed the authorities to contact potentially infected patients and isolate them and their contacts is now not going to be available before the end of the year. The only option is to rely on old fashioned personal contact tracing by telephone. What this will not track down are potential infected people who, unknowingly, were sitting opposite an infected person on a train or bus or other close contact.
When you have no effective treatments against a virus and a vaccine is months away, or perhaps never, the World Health Organisation’s advice from the early days of the epidemic has been “test, test, test” as the only route to identifying the infected and isolating them and their contacts.
The Venetians knew this as far back as the early 15th century when they used the islands of Lazzaretto Nuovo and Lazzaretto Vecchio to isolate the potentially infected during a bubonic plague for “quaranta giorni” (40 days) from which we owe the English word “quarantine”.
The UK’s response to the WHO advice has been poor. What little track and trace that was taking place in the early stages of the epidemic was abandoned in mid-March. It has only recently returned and is handicapped by issues with the app.
This has meant in the early weeks the Government was driving blind not knowing where the virus was flaring up and spreading until the most severely ill were brought to hospital by ambulance and then tested.
The Government has twice set testing targets, of 100,000 and then 200,000 per day, and has consistently struggled to meet them. The media has run regular stories about care homes unable to get residents tested, the NHS still cannot routinely test its own staff and GP surgeries do not have access to testing. Once tested a rapid result turnaround is essential but, again, the news has been full of stories of people waiting days for a result.
There has also been some skulduggery with the testing figures with confusion, accidently or deliberately, on whether the published test figures were of tests completed or tests available. It appears that some Government figures included test packs sent to care homes or private homes for self-testing. I might suggest that taking a swab yourself, which involves sticking a straw shaped object down your throat until you gag might be a bit tricky.
So in summary, the once all important app will not be available for months, tracing, which started then stopped, has only recently got going again to any large scale and for weeks testing was limited to those presenting at hospital but, like tracing, is now more widely available.
Personal Protective Equipment
From the outset of the epidemic there has been a shortage of PPE. This might have led to deaths of some NHS and care home staff, but we will never know. The media showed us pictures of staff using bin bags as protective clothing. The crisis of supply to care homes was well documented. Panorama ran an exposé documentary detailing all the problems with the supply and distribution of PPE. Despite Government assurances that equipment would be distributed, care home staff told stories of having to pay inflated prices on the open market. An NHS Chief Executive rang the BBC for the contact details of clothing manufacturers that the hospital could contact directly as they were on the verge of running out. Ministers bragged about a shipment flying in from Turkey which turned out not to be of the required standard. Even after 3 months dental surgeries were without the necessary equipment to re-open on 8th June – a date about which they were not consulted.
Ministers’ response to all this was to quote mind-boggling figures of the numbers of PPE items being distributed daily but failed to disclose that a box of disposal gloves was not one item but 100!
…….and let us remember we were “well prepared” for the epidemic.
Care Homes
The crisis around the spread of the Coronavirus through care homes was well, and tragically, covered by the media as it unfolded. Staff in tears about the shortage of PPE, GPs unwilling to visit, again because of PPE shortages, residents separated from relatives for weeks and hospitals unwilling to take admissions from care homes. Perhaps the biggest scandal was the mass transfer of some 24,000 NHS patients to care homes to free up hospital beds. It now turns out many of these were not tested prior to transfer leaving open the possibility that Covid-19 free homes had it imported in from hospital transfers.
Having worked in care homes, I know that many are just not set up to care for more than one or two residents in isolation. It is just not possible to turn what was once a large residential house that had been converted into a homely environment for the elderly and dependent into a hospital setting. They do not have the space, storage facilities or circulation areas.
I am drawn to the conclusion that the Government’s prime objective was to prevent our television screens filling up with pictures of the NHS crumbling under pressure as had been the case in Italy and other countries. Having reinvented themselves as the Party of the NHS, Boris Johnson did not want this to be undermined by the pandemic. It was by no accident that “protecting the NHS” became one of mantras of pandemic management. When the worse was over, Ministers bragged about the NHS not being overwhelmed. The reality was this was only achieved by pushing the problem into the unprepared care home sector. A sector where there is less emotional and political investment.
An Urgent Inquiry
It has been suggested to me that criticising the Government is unfair. That they are dealing with a once in a century event. That we should all get behind Boris Johnson in the national effort. That our death figures are not as bad as they appear because other countries have fiddled their figures – an evidence-free allegation.
My response is that it was not me that said the number of deaths would be around 20,000, that the UK was well prepared, and the risk was, in any case, low. None of this turned out to be the case.
There have been clear failings with testing, tracing and tracking and personal protective equipment. A tragedy has unfolded in our care homes. Outside of the epidemic-deniers of Brazil and the United States, the UK leads the way in the number of deaths. Why did other liberal democracies such as Germany, Austria, Iceland, Finland, Norway, South Korea, Taiwan and New Zealand do so much better than us?
It appears one of the reasons is they went into lock down earlier and established testing, tracking and tracing quicker as well. Their leaders were not on television floating the benefits of allowing the pandemic to work its way through the population or bragging about shaking hands with Coronavirus patients while telling the rest of us to wash our hands regularly and properly.
The Government treated the last three months more as a public relations crisis rather than a public health one. Each day there had to an eye-catching announcement as money was splashed around on this and that. Each day there had to be a good news item when the realty was very different. This was a distraction from the lack of organisation and shortages.
There needs to be an urgent independent public inquiry so that lessons can be learned and obvious questions about PPE, testing, tracing and tracking and the care home crisis can be answered. There remain major unanswered questions about why the pandemic was so brutal on BAME communities and lower socio-economic groups. There is much to be learned, not just about pandemic management, but the organisation of wider civic society and public policy.
I cannot begin to imagine the agony suffered by those many thousands who have lost loved ones over the last three months. It must be cruel beyond description to see a loved one taken off to hospital in an ambulance and the next time you see them is when you pick their ashes up from the undertaker.
At a minimum we owe it to families of the deceased to learn lessons from what has happened.
Support calls for a public inquiry: www.marchforchange.uk
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