How (not) to respond to a pandemic – Part Two

The decision to institute a national lockdown in the UK in response to the coronavirus pandemic, announced via televised address on the 23rd March, came far too late. 

A late lockdown

Pandemics spread exponentially; as more people get infected with a virus, there is an even greater number of people that the virus can infect, and if that larger pool get infected as well, there is in turn an even bigger group that the virus has access to. This exponential growth is characterised by R, the effective reproduction number. When R is above 1, the pandemic is growing exponentially. When it is below 1, it is decaying exponentially. At a time where R is above 1, decisions must be taken proactively and decisively, because every day the threat becomes substantially greater than before. 

Neil Ferguson, Imperial’s lead epidemiologist who advised the government in the early days of the pandemic, told MPs on the Science and Technology select committee that if the lockdown had been instituted a week earlier, it could’ve halved the death toll. The key assumption for this estimate was based on analysis that the epidemic was doubling every three to four days – locking down a week earlier would’ve been at a time when infection rates were about four times smaller than they were on the day of lockdown. Unfortunately, a lot of time was wasted on a faulty ‘herd immunity’ strategy in the critical days of the pandemic, as covered in last week’s piece. 

Care homes and PPE 

Care homes look after some of the most vulnerable in our society, particularly those most at risk from COVID-19 – the elderly, and particularly those with dementia who may struggle to adhere to new public health advice through no fault of their own. In July, statistics from the Office of National Statistics (ONS) showed that 30,000 excess deaths took place in care homes during the pandemic up to that point, with COVID-19 being responsible for two thirds of these. Previous work from the ONS suggested that many of the cases in the remaining third could also be due to coronavirus. 

But the government did little to prevent it. In fact, their policies actively encouraged it; in June it emerged that until mid-April, NHS policy was to discharge patients back into care homes without needing a negative COVID-19 test. This meant that many of the patients discharged back could have been carrying the virus straight into the enclosed spaces where some of the most vulnerable people live. This was nothing less than an extraordinary dereliction of duty that was not rectified until the peak of the first wave. 

As care homes are privatised, care home companies have responsibility to procure adequate personal protective equipment (PPE) for their staff. Shortages of PPE in care homes meant that both staff and residents were put at increased risk of infection. However, these companies often shirked responsibility; the youngest MP, Nadia Whittome, spoke out about the shortage of PPE at the care home she worked at as a second job. She was promptly sacked and accused of spreading misinformation by the care home, a claim that proved false months later as the care home admitted that they did indeed have a shortage of PPE at the time. 

A summer of spreading 

While lockdown came too late, it’s also possible that it lifted too early. Experts, such as those from the Government’s own Scientific Advisory Group for Emergencies (SAGE), and those in a letter published by the British Medical Journal, called for lockdown to be eased much more gradually, coupled with an effective test and trace system. Professor Michael Baker of the University of Otago, who advised on New Zealand’s world renowned COVID response, also echoed the same message. 

Yet the Government was adamant to see children returning to school in June/July, despite it being the end of the academic year, a period where not much learning takes place anyway. The Government also encouraged people to return the office, despite there being no need to do this for companies that had adapted to operating remotely. This encouragement further put workers at risk, many of whom, particularly in densely populated London, take public transport to go to work. 

Even more bizarrely, the Government were quick to open pubs, and their popular Eat Out to Help Out scheme applied only to dine-in meals. This incentivised people to crowd into restaurants, many of which were not even observing proper social distancing. Queues formed outside of restaurants in August as Britons flocked to get half price discounts. Was the dine-in stipulation really necessary for this scheme? Surely the same restaurants could’ve gathered even more profit if the Government allowed the offer on takeaways, reducing the burden on waiting staff? 

The test and trace travesty 

Public health experts are generally unified on the same message: we cannot rely on lockdowns, the best way out of this is to have an effective testing and tracing system. That’s how New Zealand and Vietnam have less coronavirus cases than the White House, while also experiencing a degree of return to normality. 

Lockdowns have negative socio-economic effects, such as with mental health, domestic abuse, lack of access to education... the list goes on. The first lockdown was a sacrifice by the people to give this Government time to boost our historically underfunded healthcare system and to build a world leading test and trace system so that any new infections can be isolated before they spread far, ideally keeping R below 1 and seeing domestic transmission come to an end. 

Yet the Government failed, outsourcing this by handing over £10 billion in contracts to private firms such as Deloitte and Serco who have produced a system that, according to the Government’s own experts on SAGE, is experiencing delays so severe that the system is having only a “marginal impact” on transmission. The system was telling many residents to drive hundreds of miles to get a test, leaving those with symptoms to either not get a test or to get tested privately, further exacerbating the class divide caused by this pandemic. 

The app that was released only a couple weeks ago has also had a variety of issues reported, from false alerts to a lack of information about local restrictions. It isn’t supported on older iPhones, although this is more due to how Apple and Google designed the API that facilitates the contact tracking. 

In the end, despite massive amounts of goodwill from the public and healthcare workers, the Government has wasted billions from the public purse on a dysfunctional test and trace system, and we are back at square one, staring down the barrel of a second wave. 

Round Two 

Three weeks ago, SAGE recommended that universities move to online teaching where possible. Yet the Government ignored this and universities, including Imperial, continued to tell students about “mixed learning”. Students moved into halls believing that they would get some level of in-person teaching as well, and in the past couple weeks we have seen the largest outbreaks take place in student halls. Official case numbers have now overtaken those of the first wave, and statistics imply that these are being driven particularly by the 16-29 age group. 

In response, the Government has instituted a localised three tier system of restrictions, with the Liverpool city region being placed under the highest tier of restrictions. Yet experts, both independent and on SAGE, say these measures do not go far enough. They, along with the Leader of the Opposition, have demanded a national “circuit breaker” lockdown to stop the epidemic spiralling out of control. 

A second lockdown was not inevitable. It could’ve been avoided with a functioning test and trace system. Yet the Government’s failure to learn from the lessons of the first wave means that it is the only option left to us in order to save lives. Except this time, when we emerge from the other side of lockdown, we need to have test and trace.