At some point in the next few months, we can expect the Government to set up a review of the impact that the coronavirus COVID-19 pandemic had on the UK and the effectiveness of our response to it. What kinds of things should the review look at? What lessons should we be learning? Here are some of the areas that I would like to be looked at.
How did we use data and the problem of comparisons with others?
One of the things I’ve found rather unseemly throughout the virus has been the tendency to treat the pandemic as some kind of competition with league tables of cases and deaths showing Britain as one of the worst performing on the one hand whilst on the other hand the Government has made claims about the country being world beating in areas such as vaccination. It is worth observing again the actual data concerning countries. It is best to compare like for like and so, this list compares the UK with other Western European countries which are likely to have similar demographics, population density, culture etc.
It is clear, as I’ve been saying throughout the pandemic that the UK sits within a range of data. Mortality rates are between 0.10% for German and the Netherlands through to 0.21% for Belgium with a mean of 1.6%. If a normal distribution curve were to be drawn, the UK whilst on the higher end of the data would be within the curve and not an outlier.
If you add in the Scandinavian countries, then you see that their mortality rates look slightly better but remember we are talking about differences of about 0.1% the problem with such small differences is that it is difficult to be certain that there is a significant statistical difference that cannot be accounted for by factors outside of the Government’s control such as climate and population density.
The risk is that when we create league tables, then this encourages people to treat a crisis like this as a political football and it also encourages national self interest rather than international co-operation.
Infrastructure investment and PPE
A review will need to ask questions about how we did in terms of providing equipment including PPE and ventilators. It will need to ask searching questions about our ICU provision, long term investment and surge capacity. It is worth noting that whilst we were able to set up Nightingale hospitals, we never tested our ability to run these at capacity and one suggestion is that although they were set up quickly, we would have struggled to resource them.
This is probably the place to look at things like how we handle procurement in a crisis. There’s been a lot said about cronyism and whilst I don’t think personal moral culpability can be ignored, we may also do well to consider the affect of systems here. In other words, if you are in crisis mode and you don’t have effective and transparent processes then the temptation is to “call a mate.” Indeed, the issue with the James Dyson calls and texts is less so much that the PM was having those conversations, it’s that the possibility of getting involved in the effort could depend on having Boris’ number and that questions about worker mobility and tax costs had to be raised in that way.
Protection and Quarantine
There are two big questions that have long been identified and must not be ducked in any inquiry. They are, could we have done more to restrict the spread of COVID-19 to those particularly vulnerable. There were three aspects to this. First of all, the length of time it took to get any form of effective track and trace in place. Given the possibility of a flu pandemic at any point, this is something we should have been preparing for. Secondly, we have the question about whether or not we could have closed the borders and put controls in place to prevent infected people entering the country. Of course, it is worth noting that the WHO advice for some time was to keep borders open.
Then we have noted before the high number of deaths in care homes. There are questions to answer about whether people were returned too quickly to the homes to free up hospital beds. There are questions to answer about the reliability of information and advice communicated to Care Home managers and there are again the issues with PPE. Furthermore, discussion here may lead into a wider conversation about social care policy in general.
One question I have is whether or not there should have been further quarantining. In effect, we had people with COVID treated in close proximity to the rest of the population. Key workers were both at risk of exposure to the virus due to work and also travelling on public transport and returning home. What would have been the effect of providing COVID care away from the main population?
The place and effect of lockdowns
I was a lockdown sceptic. Note I’m not a COVID sceptic. I believe that the virus is real and dangerous and that Non-Pharmaceutical measures were needed prior to the arrival of a vaccine. However, I have extreme reservations about the wider social, emotional and economic impact of lockdowns. I am also not convinced that the lockdowns we had were necessary or effective. Data suggests that both waves peaked before lockdown measures could take effect. Would social distancing, facemasks, restrictions on large events and a level of voluntary home working done the heavy lifting of flattening the curve?
My view is that if you are going to enter the world of lockdowns that the short, sharp shock is likely to work best. In effect you have to do what China did and completely shut everything down within a location. Furthermore you need secure boundaries on that. I could never understand the point of local lockdowns when people could travel freely between zones. For example, what was the point of having Kent in a lower category of restriction than London when people could travel freely in and out of London?
This partly brings us back to the starting point. I think we need to do better at analysis, at being able to spot where there are actual rather than just apparent variations and then to understand the causes.
Therefore, in terms of within the UK, we need to ask two, potentially related questions.
- Why did we see variations so that the virus disproportionately appeared to affect certain ethnic groups? It is important that this does not become the basis of racial profiling. We have heard already too many stories of Chinese people being racially abused. But we need to acknowledge what the data shows and ask deep questions including about the affects of social policy.
- Why did we see variation between areas in terms of the impact of the pandemic, particularly when first coming out of lockdown. There were areas in West Yorkshire, the North West and the Midlands that quickly went back into local lockdown suggesting that the first lockdown had not been effective in those places. As I said at the time, it felt like we were applying the same remedy without asking why it had not worked.
The wider impact of a pandemic
Any consideration of the affect of COVID-19 must consider not just the direct consequences of the pandemic in terms of serious illness, hospitalisation and death from the virus. It must look at how the pandemic and our response affected other aspects of health care as resources were prioritised and the affect on good governance, on mental health, on social cohesion and on the economy.
There needs to be a debate about the way that Governments balance protection against physical harm with protection of freedoms, how decisions are made and how they are scrutinised. The pandemic resulted in restrictions on personal liberties. I have no objection to a government making those decisions in the midst of a crisis but how do we ensure that this doesn’t set a precedent for misuse of such powers or their continuation of them beyond what is needed?
I hope that a full inquiry will address these types of questions. Whilst it might be that arising out of it will be cases where people need to take responsibility and carry blame for specific failings. However the risk is that if we simply get into the blame game then it will distract us from learning all the lessons learnt. The temptation for governments is to set up such inquiries with a narrow remit in order to protect their own reputation. I would encourage the Government to resist such a temptation and to set up a fully independent inquiry with a wide and far reaching remit. Our aim should be to learn lessons that will better protect the country in the future.