While President Trump faces continued criticism for his handling of the pandemic as the U.S. struggles to control the virus, his counterpart across the Atlantic is faring no better. It has not been a good week for Boris Johnson.
One of the U.K.’s biggest problems initially was a lack of PPE for nurses and healthcare staff, including those on the frontline within the National Health Service (NHS). Crucial items such as masks had not been stockpiled sufficiently, which led many nurses and doctors to take to social media to share photos and videos of them having to work on coronavirus wards without PPE. More masks were hurriedly ordered. However, earlier this week it emerged that the fifty million masks bought by the government in April will now not be used in the NHS because of safety concerns over a loose fit.
The masks were purchased from supplier Ayanda Capital as part of a £252m contract. As if the loss of much needed pounds was not embarrassing enough, it transpires that the person who originally approached the government about the deal was a government trade adviser who also advises the board of Ayanda.
The masks debacle made national headlines in every newspaper and television broadcast. But a more significant problem has also been uncovered, pointing to a fateful ten days of inaction that had a huge impact on coronavirus cases and deaths in the U.K.
According to data from Johns Hopkins University from August 5, the U.K. has the highest case-fatality ratio in the world (the U.S. is currently in 24th spot). This says a lot about the seriously underfunded NHS as well as Johnson’s initial response to the pandemic. Remember he himself contracted COVID-19 having been seen earlier visiting affected patients in hospital and shaking their hands. Several people he came into contact with, including his pregnant partner, also contracted the virus. But the fact that Johnson was one of those struck down, and quite severely so, is important, and we’ll come to that later.
It is difficult to compare countries, probably impossible to do so reliably at this stage even, yet we can certainly say that some have responded better than others. So where did it all go wrong for the U.K.?
Too little, too late
An inquiry by the Home Affairs Committee which reviews government activity has revealed that the pandemic in the U.K. was “accelerated in the early months by critical errors in the government’s approach to border measures which led to many more people contracting Covid-19”. A pretty damning finding.
The Committee’s new report on Home Office preparedness for Covid-19 focused on border management and particularly criticized the way travel corridor decisions were made.
The review considered all of the government’s decisions on border measures – from the early quarantine of 273 people largely from Wuhan, through the voluntary self-isolation measures applied to travelers from specific countries (including China, Iran and Italy) in February and early March followed by the lifting of all border measures on March 13, to the introduction of mandatory quarantine in June, followed by travel corridors and the most recent decision to reintroduce quarantine for Spain.
Drawing on evidence that thousands of people with Covid-19 arrived in or returned to the U.K. in February and March, the Committee concluded that the U.K.’s experience of Covid-19 has been far worse as a result of the government’s decision not to require quarantine during March, which would have reduced the number of imported infections.
Caught between a rock and a hard place, the government was facing pressure from industry and citizens, as well as from its own scientific advisors. The plethora of contrasting demands and advice pushed it into adopting a softer “wait-and-see” approach that was never going to please everyone and has ultimately pleased no one. Further, this government’s approach to float ideas via controlled “leaks” or media reporting before reaching a decision, does not fit well with a pandemic where swift decisions and actions are vital. Meanwhile, countries who faced the short-term wrath of their citizens for belts-and-braces solutions before their countries were ever in great danger, are now reaping the rewards and reopening their economies successfully while keeping a careful eye on a second wave.
Crucial border errors
The Committee is particularly critical of the government’s decision on March 13 to remove all self-isolation guidance for travelers arriving in the U.K. at a time when other comparable countries were strengthening their border measures, and when hundreds of new Covid cases were arriving every day – particularly from Spain, Italy and France, including many British residents returning home.
The Committee was unable to find any scientific evidence to justify what it calls an “inexplicable decision” and says that the failure to have any special border measures in place in mid March was a serious error. It also found that the decision not to include Spain in the earlier country specific measures in late February was a mistake as doing so could have slowed the virus spread. But wait, does Johnson get a sicknote for this? No he doesn’t. He tested positive on March 27.
On a more positive note, the report welcomes the introduction of the new border measures introduced this summer, supports the development of travel corridors and the application of quarantine requirements for arrivals from Spain given the current rising number of infections there. It is however very critical of the handling and communication of the decision to remove the travel corridor with Spain and warns that the government needs to be much more sensitive to the impact on families and businesses.
The Committee says the government should publish the Joint Biosecurity Centre’s traffic light assessment of different countries so that people can better judge the risk before traveling. It also criticizes the lack of earlier warnings about the potential risks of travel and the mixed messages from government.
Publishing the report, Chair of the Committee Rt Hon Yvette Cooper MP said the government’s failure to have proper quarantine measures in place in March as the infection was spreading fast was “a grave error and meant Covid spread faster and reached more people”. She added that the U.K. was “almost unique in having no border checks or quarantine arrangements at that time”.
Evidence suggests that thousands of new infections entered the country in the 10 day period between March 13 and the introduction of a general lockdown in the U.K. on March 23. Those ten days without restrictions will be forever scrutinized for increasing the pace and scale of the pandemic in the U.K. And it is right to do so as lessons must be learned.
Evidence from genomic studies and referenced by the U.K’s Chief Scientific Adviser Sir Patrick Vallance shows that over 1300 separate strains of the virus were imported largely from Spain, Italy and France during that ten-day period. Other evidence to the Committee suggests up to 10,000 people with Covid-19 entered or returned to the country in March.
The Committee therefore found that not having any special border measures applicable to people arriving from Spain and France during February and March, and only having voluntary self-isolation measures for travelers from Italy until March 13 was a serious error and had a material impact on the number of cases arriving in the U.K., and on the pace and scale of the epidemic.
It is not clear exactly who was responsible for making the decision to withdraw self-isolation guidance on March 13 or on what basis. No Cabinet Minister or official interviewed by the Committee has been able to provide any explanation for the process by which and the basis on which the decision was made. Despite promises, the government has not provided the Committee with scientific evidence that supports the decision to lift border controls on March 13.
The report also berates the government for a lack of clarity over which department or agency is ultimately responsible for coordinating Covid-19 border policy. The Committee recommends that either the Cabinet Office or the Home Office should be charged with lead responsibility for Covid-19 border policy.
The Committee is unconvinced by the Home Office estimate that the compliance rate for quarantine is 99.9%, as the majority of checks are being done at the border even though the majority of the compliance is required in the community. The Committee therefore wants the government to routinely publish the number of people required to quarantine and the number of spot checks, home visits, police referrals and enforcement actions, among other data, to allow oversight of the whole process.
Further, it calls for the Home Office, Department of Health and Social Care and Department for Transport to investigate the viability of introducing widespread or targeted tests at the border and learn lessons from other countries like Iceland, Hong Kong or South Korea.
The report’s findings may not have been good for Johnson and his government, but they were timely. The fact that this review was able to work so quickly, means lessons are already being learned.
Border measures are only part of the response to Covid-19, but will be needed for some time given the scale and changing nature of the pandemic. The U.K. will have to maintain a flexible approach but its reaction time must be improved when responding to emerging circumstances.
The U.K. (along with other countries who are struggling to contain the virus) should also swallow its pride and learn from proven good practice in other countries. The pandemic is after all a global problem.
Johnson’s largely successful tenure as London Mayor has proven that he is willing to change course when required, rather than doggedly sticking to his guns as some former Prime Ministers have done and some heads of state still do today. This leadership style was no doubt amplified by Johnson’s own experiences while affected with the virus. He saw first hand how serious it could be. When he recovered and returned to leading the country, there was a new seriousness about him that told citizens it would take far more than a plucky British wartime spirit to get through this. As well as targeting Covid-19 directly, Johnson has also launched a series of government measures and promises regarding public health and fitness, having experienced how extra weight can make the virus much harder to fight off.
Ultimately, transparency and trust will also be vital if public confidence in self-isolation and quarantine measures following international travel is to be sustained in the long-term. And the people are more likely to trust in their leader if he, or she, is doing a good job.