Yesterday Britain passed a grim milestone. A further 1,631 deaths from Covid-19 were recorded, taking the official tally above 100,000, though data from the Office for National Statistics suggests the total number will now be nearer 120,000. In a briefing, Boris Johnson has said his government did everything it could to minimise the loss of life, but these deaths were far from inevitable. While the number of UK deaths has entered the hundreds of thousands, New Zealand has recorded only 25 deaths from Covid-19 so far. Taiwan has recorded seven, Australia 909, Finland 655, Norway 550 and Singapore 29. These countries have largely returned to normal daily life.
In the first year of the pandemic, the UK faced three big challenges. Our national government had no long-term strategy for suppressing the virus beyond a continual cycle of lockdowns. Even now we still don’t know what the government’s plans for the next six months are. In the early days of the pandemic, the UK treated Covid-19 like a bad flu. The government halted testing, and the initial plan seemed to be allow the virus to run unchecked through the population (the “herd immunity” approach). Finally, ministers have pitted the economy against public health, instead of realising that the health of the economy depends upon a healthy population.
Those in the anti-lockdown camp mistakenly believe that we could have traded these deaths for a “normal life” and a strong economy. Yet this isn’t how Covid has played out in any country in the world. Either you reopen the economy before the virus is under control, and endure thousands of deaths, or you manage your public health problem before getting the economy going again. Throughout the pandemic, Britain was overreliant on modelling, cynical fatalism and complicated solutions. The challenge was never what to do when faced with this new virus, it was going out and doing it. The complexity was in logistics, human behaviour, messaging and leadership. Where exactly did Britain go wrong?
First, the UK had no border policies in place for months. When introduced, these were lax and unmonitored. Borders are the first line of defence against a novel pathogen and a way to catch new variants and infections before they have a chance to spread. Countries that managed to effectively contain Sars-CoV-2 implemented screenings of new arrivals and 14-day quarantines for those entering the country. Some even restricted travel to national citizens. In March, when the UK went into lockdown, people were instructed to stay home while passengers from any country could arrive at Heathrow and take the tube straight into London without a Covid test. In the summer, we had a window to prevent future infections. Instead, the UK encouraged overseas holidays via “travel corridors” that contributed to the second wave. We paid for summer holidays with winter lockdowns.
The second fatal flaw in the UK’s response happened on 12 March, when the government made the fatal decision to stop community testing, abandoning its line of sight over who had the virus and where it was spreading. Community testing is absolutely vital for controlling the virus. This was later resumed, but England outsourced testing and tracing to private firms instead of using local public health capacity. Isolation – a key part of the test, trace, isolate response – was only ever an afterthought, and there has been little support for people who would struggle to stop working for 14 days. Even now, the majority of people have been refused a discretionary self-isolation payment, while statutory sick pay is a paltry £95.85 a week. By contrast, Finland and Norway offer 100% and 80% of income to people who are self-isolating. The result of the UK’s inadequate support is that many who have tested positive have ended up going into work and infecting others.
Third, the government made another harmful decision in March when it delayed the first lockdown. Though numbers were already running out of control, the cabinet appeared to think that delaying restrictions would make them less painful, for fear that “behavioural fatigue” would set in. Yet the opposite is true. If a lockdown is necessary it is better to do it earlier so that restrictions can be lifter more quickly on the other side. Wales, Scotland and Northern Ireland seemed to have learned this lesson, unlike England which delayed again restrictions in September and then December when it was clear numbers were taking off.
The fourth error was the lack of appropriate personal protective equipment for many health and social workers who struggled during the first national lockdown in the spring. Many were exposed to Covid-19 on wards, and none had access to testing. At the start of the pandemic, it felt as though health workers were the unprotected goalies on the football pitch; they coped with a massive surge of Covid patients without the necessary safeguards, and 883 health and social care workers have died of Covid-19 since March.
Finally, the UK has continually lacked both clear leadership and messaging, which are vital in a pandemic. Rather than leading from the front, the government seems to only follow public opinion and polling. We spent months debating whether face coverings matter before adopting them and weeks debating whether Covid-19 is indeed serious or just a bad flu. We were encouraged to stay at home, then encouraged to “eat out to help out” in crowded restaurants. We sacrificed seeing our families and were fined for breaking lockdown rules but never heard Dominic Cummings apologise for flouting the lockdown. The result has been a complete breakdown of trust in the UK government.
While it is easy to be consumed by anger, grief, frustration and depression at this moment, we must keep looking forward for a path through this crisis. We must never have a winter like this again, and we need a concrete plan and strategy to make sure Britain does not face a third wave and a fourth lockdown. This must involve suppressing transmission, building a functioning test, trace, isolate and support system, guarding against the reimportation of infections with strict travel restrictions, while trying to reopen schools and as much of the domestic economy as possible.
A country as global and interconnected as Britain faces a particularly painful choice over borders and international travel. It would be a tragedy for the UK to vaccinate the majority of the population by the autumn only to then import a new variant or strain of Sars-CoV-2 that our vaccines can’t guard against. Vaccine companies would need to race to reformulate their jabs, and we would probably be caught in further restrictions to buy the time for that to happen. Let’s learn the lessons of the past year, and not wait for another 50,000 deaths to act.
• Prof Devi Sridhar is chair of global public health at the University of Edinburgh
