Act quickly, act decisively, trust people, communicate clearly, tackle inequality and be prepared.
First published in March 2021.
A year after the UK went into its first lockdown, its four nations are all locked down again. It has been a year characterised by indecisiveness and missteps that have left the UK with one of the highest COVID-19 death rates in the world.
Before the first wave, despite coronavirus arriving weeks after it had reached other European countries, the UK was arguably caught unprepared. No such excuse holds for the second wave, yet nevertheless cases soared and a long lockdown has followed. Lessons from the first wave weren’t heeded.
As the countries of the UK begin to emerge from this latest set of restrictions, here are some things it should learn from this chastening pandemic experience, to avoid repeating the same mistakes again.
1. Act quickly
In England, every lockdown has come too late. Professor Neil Ferguson – formerly a modelling expert for the government’s Scientific Advisory Group for Emergencies (Sage), and whose own group’s modelling was hugely instrumental in influencing the government to implement the first UK-wide lockdown – suggested that locking down just one week earlier in March 2020 could have saved 20,000 lives.
On September 22 2020, Sage advocated a two-week circuit breaker lockdown to arrest the rapid rise in cases during the autumn. But instead of heeding the advice of its own scientists, the government sought the more optimistic but fringe views of scientists who advocated allowing cases to increase.
England did not lock down until November 5, by which point average daily cases had already exceeded 20,000. It has been estimated that more than one million extra infections and 20,000 deaths resulted from this six-week delay.
In early December, the health minister, Matt Hancock, was alerted to the possibility that a more transmissible strain of COVID-19 was spreading in the south-east of the country, but the government pushed ahead with plans for three households to be able to mix over five days around Christmas. On December 18, scientists confirmed that the new B117 variant was significantly more transmissible than previous strains. Despite being forced to make a U-turn on Christmas plans, the government again delayed taking national-level action – until January 4 2021.
“In the face of an exponentially spreading disease”, the mantra goes, “the best time to act was in the past, but the second-best time is now.” The government’s repeated delays in taking action have led to the UK’s enormous death toll.
PM Boris Johnson. | Number 10
2. Act decisively
It took more than a year for England to implement a form of managed isolation for passengers arriving in the country to try to limit the introduction of concerning new variants of the coronavirus. However, these measures have only been implemented for arrivals from a select group of “red list” countries.
In fact, as of mid-March, passengers from only 11 of the 64 countries where arguably the most concerning variant – the South Africa variant – has been detected were being asked to undergo ten days of managed isolation. As the country begins to lift lockdown and the reproduction number inevitably rises, these porous border control measures leave open the possibility that variants of concern will be imported and allowed to gain a foothold.
When it comes to controlling COVID-19, as well as being swift, action must be decisive. There is no room for half measures. The UK should either institute managed isolation for arrivals from all countries or none at all.
3. Trust people to follow the rules
Perhaps part of the reason behind the delay in locking down during the first wave was that very few people either in the scientific community or in government believed the sort of extreme interventions that would be required to bring the disease under control (such as school closures and stay-at-home orders) could actually be implemented in the UK.
In a retrospective interview with Channel 4 News, Professor John Edmunds – another of Sage’s modelling experts – said: “We weren’t sure what levels of compliance with various social distance measures were possible… In some senses it was difficult to imagine just how easy the lockdown was.”
Fears of “behavioural fatigue” were unfounded. During the UK’s first lockdown, the reproduction number fell well below one. Even during the country’s current lockdown, in the face of the more transmissible B117 variant, the R number has been calculated to be as low as 0.7. This strongly suggests that people do follow the rules when they are made clear. As Australia and New Zealand have shown, non-pharmaceutical interventions that are reliant on the behaviour of the general public are able to completely eliminate the spread of SARS-CoV-2.
London’s Oxford Street. | Wikimedia/Kwh1050
4. Communicate clearly
Clear and consistent communication is vital for increasing adherence to and engagement with COVID-19 guidance. At different stages of the pandemic the UK government has been guilty of a range of public messaging mistakes, from the now-infamous trip by senior government adviser Dominic Cummings to Barnard Castle – a 60-mile round trip that he said was to check he was well enough to drive, and which damaged the public’s will to adhere to the rules – to the government’s updated “stay alert, control the virus, save lives” messaging. This message led to confusion about social distancing rules, among other problems.
The government’s messaging has at times been imprecise, inconsistent, contradictory, untimely and vague. This has led to mistakes, misunderstandings, frustration and non-adherence. Communication must be clear enough for the public to understand exactly what they are expected to do. Precise messaging is more readily understood which, in turn, enables people to adhere to the rules better.
5. Tackle inequality
As the UK’s epidemic has worn on it has become increasingly clear that the disease is having a disproportionate impact on the most deprived communities. In England, COVID-19 mortality rates have been more than twice as high in the most deprived communities than in the most well-off.
Similarly, people with the lowest-paid jobs are significantly more likely than those with better-paid jobs to die from COVID-19. As the vaccine rollout continues apace, it is becoming apparent that these same disadvantaged sections of society have the lowest rates of vaccine uptake.
These are trends the UK must rapidly reverse, otherwise it risks COVID-19 – like tuberculosis before it – becoming a disease of poverty. In order to do this, the country must improve access to primary healthcare services, provide adequate financial support for those self-isolating, conduct occupational risk assessments and then act upon them, and collect better data on health outcomes, population demographics and environmental risks.
Covid-19 & lowest paid jobs. | Flickr/jon crel
6. Be prepared
In 2016, NHS England undertook Exercise Cygnus, a three-day pandemic preparedness simulation. The aim of the exercise was to identify strengths and weaknesses in the UK’s health system and emergency response, with the goal of suggesting improvements that would leave the UK better prepared for the next pandemic.
The resulting report suggested four key improvements: creating a single “concept of operations” to guide a pandemic response across the many organisations that would be involved; changing laws and regulations to make responding to a pandemic easier; understanding better how the public would respond to a “worst case” pandemic scenario; and creating capacity to “surge” resources into key areas as needed.
An inquiry by the House of Lords in June 2020 raised several concerns around whether the recommendations of Cygnus had been executed prior to COVID-19. The inquiry highlighted a lack of medical equipment at beginning of the pandemic, which had been highlighted as an issue in Cygnus.
Perhaps most starkly, Professor Dame Sally Davies – the chief medical officer at the time Cygnus was carried out – specifically drew attention to a shortage of medical ventilators. This deficiency had clearly not been addressed by the start of the pandemic, with Hancock telling British manufacturers on March 14 2020, “If you produce a ventilator, we will buy it. No number is too high.”
This final lesson of preparedness is perhaps the most important of them all. Despite a failure to prepare appropriately for this pandemic, it is important that the UK does not forget the lessons that have come with such a high price. It is imperative that an independent public inquiry be carried out in the near future in order to accurately document these lessons, both in preparation for future pandemics, but also to aid the UK in the next stage of its response to the ongoing crisis.
Over the course of the past year, people in the UK have been in lockdown at least as long as they have been out of it. Even when people have officially been free from full lockdown, they have been living under some form of restrictions. It is absolutely vitalf that this third and longest lockdown is also the last.
Each stage of unlocking must be assessed to ensure that cases do not begin to rise rapidly and put excess pressure on the NHS. Allowing COVID-19 to spread unchecked through the partially vaccinated population risks applying selective pressure to the virus that favours new vaccine-resistant strains. There is also the risk that the long-term debilitating effects of long COVID will afflict a significant proportion of the unvaccinated population if the virus is allowed to spread out of control again.
The UK must use the lessons that have cost it so dearly over the past year to guide us as it moves forwards cautiously into the next stage of the pandemic.
- Exercise Cygnus, October 2016 | Public Health England
▫ Dr Christian Yates, Senior Lecturer in Mathematical Biology, University of Bath.
GET THEM INVOLVED:
[This piece was originally published in The Conversation and re-published in PMP Magazine on 29 March 2021, with the author’s consent. | The author writes in a personal capacity.]
(Cover: Flickr/Number 10. - The Number 9 Downing Street briefing room. | 25 March 2021. / Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)