Coronavirus Series: What can we say about the UK’s coronavirus strategy?
In the first of her article series about the coronavirus outbreak, Tharani Ahillan explores the evolution of the UK’s pandemic strategy, and the reactions of experts and UCL students.
On 12th March 2020, Boris Johnson stepped onto the press conference podium and levelled with the UK population: Covid-19 had resulted in “the worst public health crisis in a generation”. Johnson then announced a package of measures aimed at reducing the spread of the virus. Fast forward almost two months and the UK’s strategy has been under close scrutiny at home. The “Keep Calm and Carry On” motto central to its approach for many weeks has led to cases exceeding 250,000 and deaths set to climb over 40,000. From a country frequently touted as a global health leader, it begs the question, how did we get here?
The UK’s pandemic response strategy has four stages: contain, delay, research, mitigate. This approach, based on the pandemic flu strategy, has gone strangely unmentioned in recent weeks by the government who touted it so much at the beginning.
Is this because it was the wrong strategy? The “UK Influenza Pandemic Preparedness Strategy 2011”, which a UK government spokesman said was still relevant, relies on the “working presumption that the Government would not impose any restrictions … the emphasis is on encouraging all with symptoms to stay at home.” Sound familiar? That’s because that was exactly the message at the beginning of the UK outbreak, when anyone with symptoms was told to self-isolate for seven days. It’s an assumption that might have been a blunder – Covid-19 is fast turning out to be more than just a “nasty flu”, a virus that could perhaps have been stopped before it unleashed its deadliness on the population.
Instead, milder interventions were put in place because British scientists assumed that drastic actions like a lockdown would not be acceptable in a democracy like the UK. The New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), some of whose members advise the government as part of the Scientific Advisory Group for Emergencies (SAGE), agreed that “tough measures in the short term would be pointless, as they would only deal with the UK outbreak, not prevent it.” It was a response that initially allowed mass gatherings to still take place. It was only after the hugely influential model was released by epidemiologists at Imperial College London, which suggested more than 200,000 people would die, that the government began to shift its approach.
John Edmunds, a professor of infectious disease modelling and a key adviser to the government, known for his work on tracking Ebola, reported other reasons for the shift. He said that a lockdown in Italy “opened up the policy space” coupled with new studies demonstrating that lengthier tougher measures by the British government, perhaps relaxed periodically, could reduce the size of the epidemic. In short, it wasn’t just the numbers in critical care that prompted the policy shift, but also new studies suggesting that it could work well in the background.
Another argument against imposing a lockdown immediately came from some behavioural scientists, who were worried that “fatigue” would occur if strict infection-control measures were implemented too soon. The “nudge theory” utilised instead, where the government eschewed social distancing measures for behaviour modifications, was initially criticised. Experts who disagreed with the government’s approach insisted that the fear of death would be a strong motivator in keeping our distance. Now we’re coming to almost two months in lockdown, and reports claim that more are testing the boundaries of the lockdown, with some outright breaking the regulations. Perhaps the government had the right idea easing us into a lockdown?
Still, it’s hard to miss the fact that the delay in imposing a lockdown was stark contrast to the advice of many members of the UK public health community. NERVTAG had concerns about the “pandemic potential” of the virus as early as January. David Hunter, Professor of Epidemiology at the Nuffield Department of Population Health, Oxford, commented in the New England Journal that “quite frankly the UK approach was completely out of step with almost all other European countries.” This sentiment is echoed by much of the population, including at UCL; Iresh Bhaskar, a recent graduate of Biochemical Engineering said: “the initial ‘herd immunity’ guidance by the government showed the disconnect between reality and their strategy.” The UK made the significant decision to deviate from advice of the World Health Organisation – but was it a fatal one?
It’s also perhaps time to turn our focus towards quite how ill-prepared our NHS was: it has fewer hospital beds per 1000 population than most other European countries and staff are reporting a severe shortage of personal protective equipment (PPE) throughout the country. Operation Cygnus in 2016 identified availability of PPE, ventilators, and ICU beds as shortcomings, yet nothing was done. In fact, various groups have been set up independent of the government’s drive to acquire PPE: one such scheme, MedSupplyDrive UK, has reported that many of its frontline doctors have been forbidden to talk to the press about PPE shortages, and have instead had to turn to the charity in a desperate attempt to protect themselves as they treat patients.
UCL students are angry at the government too, with one UCL medical student who is volunteering on the frontline saying: “They’re making you believe they have done their best. When in fact they’ve royally effed up. They had time to prepare. They had time to protect the frontline workers. But they didn’t.” Dr Natasha Azzopardi Muscat, Senior Advisor at the World Health Organisation, also cited the fragmented healthcare system in the UK as a contributing factor.
More recently, we’ve seen England, Scotland, Wales, and Northern Ireland taking different approaches to the next stage of the coronavirus crisis. England’s “Stay Home” message has been replaced by “Stay Alert.” Yet the Scottish First Minister, Nicola Sturgeon, delivered her own message before the Prime Minister’s, saying that this campaign was not being deployed in Scotland – their message is still very much “Stay at Home”. The ambiguity about the lockdown now entering the next stage was described as “awful” by Iresh: “Boris’ farcical address suggesting that people “Stay Alert” has brought even more confusion and uncertainty to the British public.” His opinion about the lack of clear communication from the government reflects that of many members of the UK public.
The government insists that it is too early to make a judgement on its strategy. But Iresh disagrees: “the fact that we have the second highest number of cases and deaths worldwide shows how ill-prepped we were in dealing with the crisis.” Sabeera Dar, a 5th Year UCL Medical Student agrees, and added: “I am deeply worried about being released into any semblance of normality without the [right] infrastructure in place. It feels treacherous.”
The World Health Organisation’s recent report suggested that we need to learn from our existing responses in order to ease restrictions and manage the transition. Unless the government identifies what we could have done better, it’s hard to see how we’re going to be able to move forward and prepare for a possible second peak.