If you happen to live in England and are baffled by the latest official guidance on Covid-19, you are in good company, and for good reason too. Much confusion has been caused by government advice that can seem unclear to many, combining as it does discretionary, and at times even contradictory, advice with threats of punitive fines, arrest and even imprisonment. More specifically, you then have the ‘rule of 6’, ‘support bubbles’, evening curfews, a variety of local restrictions, local lockdowns in virus hotspots, and “circuit-breaker” lockdowns to contend with, all further complicated by sudden and forced “U-turns” in matters of policy. You just have to read the long list of exceptions when it comes to the rule of 6, for example, to appreciate why it can prove difficult to comply with the government’s instructions. While you struggle to understand your personal responsibilities during the pandemic, you might want to reflect on how we got here in the first place.
The first reports of Covid-19 from Wuhan in China in January 2020 were received in England with some interest, but it seemed more of an exotic illness in a faraway place at the time. But it wasn’t long before the first two cases of Covid-19 in the UK were to be confirmed, on 31 January. SARS-Cov-2 was shortly declared a serious and imminent threat to public health, as early as February 10. However, during the month of February, even with all the bad news coming from nearer home- in northern Italy- a spirit of optimism prevailed, with Health Secretary Matt Hancock repeatedly reassuring citizens that the nation was adequately prepared for any possible public health emergency. Prime Minister Boris Johnson even took the opportunity to praise “a fantastic NHS, fantastic testing systems and fantastic surveillance systems”.
Come March, things started heating up. Mr Johnson finally chaired his first emergency coronavirus COBRA meeting on March 2, having missed five earlier ones in late January and February. Journalists were called to 10 Downing Street the following day, when a Coronavirus Action Plan was launched. Covid-19 was declared a notifiable infection on March 5. On the same day, the first death in the UK from Covid-19 was confirmed, from Reading in Berkshire. Between March 2 and 29, a succession of European states began implementing a range of lockdown measures, with the UK a relatively late entrant to the process.
During the first three weeks of March, Mr Johnson’s libertarianism, accompanied by a certain light-heartedness and jocularity of approach, complemented expert warnings of “behavioural fatigue” and a view that things were best left to take their course, so that any peak in infections could be delayed until the summer, by which time “herd immunity” would have set in. All of this meant that it was largely business as usual. Large gatherings, such as the Cheltenham Festival (March 11 to 13), which attracted sixty thousand visitors a day, still went ahead. Appeals to “common sense” accompanied any public advice, which was grounded in “the science”, provided by a secretive group of public health doctors, epidemiologists, statisticians, psychologists and others, appropriately referred to as SAGE (Scientific Advisory Group for Emergencies). Much of this initial science appears to have been dominated by mathematical modellers and behavioural psychologists, with relatively little public health input.
Advisory restrictions started to be issued from March 16 onwards. Schools were closed on March 20, except to vulnerable children and the offspring of “key workers”. A national full lockdown followed on March 23, underpinned by the slogan “Stay Home, Protect the NHS, Save Lives”, and with plans to review the lockdown rules every three weeks. The Coronavirus Act 2020, published on March 25, invested the government with a wide range of sweeping powers, unprecedented during peacetime conditions. All non-essential retail businesses were shut down, along with entertainment and leisure venues, gyms, libraries and places of worship. This full lockdown was to last for seven weeks, until May 10, when restrictions gradually started to be lifted. One curious feature of the lockdown was an unwillingness to screen new arrivals at airports and seaports, despite some restrictions on international travel.
The sound public health policy of community testing for cases, followed by contact tracing, came to end on March 12, as diagnostic capacity was by now overwhelmed. Just at a time when the infection rate was rising rapidly, testing was restricted to patients admitted to hospital and contact tracing was confined to carefully selected complex or high-risk situations. This decision to abandon “test and trace” was widely criticised by health care professionals. In a change of direction, the Health Secretary then went on to announce a “five-pillar” plan for testing on April 2. Pillar 1 referred to testing in hospitals, while the all-important Pillar 2 was the centralised community testing system that was to be run in due course by the private sector via newly set up Lighthouse Laboratories and is now the centre of so much unfavourable attention.
The government prioritised protection of the National Health Service, which for a time became the National Covid Service. Elective activity was cancelled, hospital doctors and nurses were redeployed, retired health care professionals were recalled, and even an impressive half a million citizens volunteered for NHS duties. Seven temporary military-style NHS Nightingale hospitals were set up. In the event, only two were to be used before going into ‘hibernation’, for reactivation in the future if needed. An anxious public stayed away from emergency departments, outpatient clinic waiting times lengthened, and important diagnostic testing and surgical procedures for other life-threatening conditions, especially cancer, were delayed. GPs began to assess their patients by telephone triage or via video links, restricting personal encounters to a carefully selected few. For a time, non-Covid-related activity in the NHS almost ground to a halt.
The need to prepare the NHS for a large influx of patients required the emptying out of hospital wards in order to create capacity. Around 25,000 elderly people, without any knowledge of their Covid status, were moved from hospitals to care homes between March 17 and April, transforming the homes into hotspots of infection, where many were to die all alone, without any family members nearby. The “care homes scandal” is one aspect of the Covid-19 pandemic for which the government has faced, and will continue to face, severe criticism of the way it handled the pandemic.
Hospitals generally coped well when it came to meeting the demand for beds and ventilators, but a shortage of personal protective equipment for front-line staff in both hospitals and care homes exposed the fragility and lack of resilience of NHS supply chains. The government began to respond in panic mode, sending for example a cargo plane to Turkey in April to collect 400,000 medical gowns, which turned out to be inadequate for the purpose. To use a cliché, there seems ample scope for lessons to be learned for the future when it comes to the matter of procurement and storage of supplies within the NHS.
At the height of the crisis, on April 5, the Prime Minister himself became another statistic and joined the ranks of Covid-19 patients requiring hospital treatment, ten days after being diagnosed positive for the virus. He ended up staying in St Thomas’ Hospital in London until April 12 and required help with his breathing for some of this time. He may have knowingly decided his fate, having proudly announced that he had shaken the hands of all Covid-19 patients while visiting a hospital three weeks before his diagnosis.
Despite compliance being generally good, the lockdown guidelines seemed unclear to some, even at the highest circles. This lack of clarity even prompted Mr Johnson’s special adviser Dominic Cummings to undertake a car journey in April, at the height of the lockdown, for the laudable purpose of testing his eyesight in the wider interests of public safety. Luckily, most people stayed at home and soldiered on, in a collective display of public spirit.
People started to return to work, in staggered fashion and depending on their type of work, from May 10 onwards. “Super Saturday”, July 4, saw the much awaited reopenings of pubs and restaurants, and much unrestrained behaviour. Schools went back in September. But the lockdown has not gone away completely. It continues to linger on, in various forms, with some sources predicting the re-imposition of a full lockdown sometime in the near future.
There has been much criticism of the English response to the pandemic at its height. This appears to have been partly the result of an early complacence and misplaced optimism, a lockdown that came too gradually and too late, and a lack of clarity in messaging from the very beginning, as well as to the “freedom”-loving instincts of a minority, who resented being dictated to by the government to wear facemasks in public and to maintain safe distances during social encounters. Irrespective of what turns out to have mattered the most, the UK, and especially England, was hardest hit among the G7 nations, with the highest excess all-cause death rates per 100,000 population and the highest death rates among “cases”, including a disproportionate number of these involving people of BAME background.
With newly emerging evidence of a resurgence of infections, the government has come under increasing fire in recent weeks as even many elected officials, including MPs and mayors, have begun to declare their opposition to new lockdown measures. Inefficiencies in the new contact tracing system are also exposing the government to critical scrutiny. It seems certain that rocky times lie ahead. It is unfortunate that partisanship, rather than partnership and collaboration, is hampering England’s efforts at hastening recovery. After all, both World Wars, often cited as times of display of national resolve and fighting spirit, were fought by coalitions, rather than being guided by the ideologies of a solitary governing party. One hopes that at least some good may eventually come out of the sorry predicament we currently find ourselves in.
Ashis Banerjee