EEngland is now paying the price for the government’s inability to get ahead of the virus before Christmas. The Prime Minister described the current situation in hospitals as “dangerous and perilous”, with the number of hospitalized patients with Covid-19 in England exceeding 30,000 patients for the first time. The UK reported 1,325 deaths from Covid in 24 hours on Friday – the highest figure since the start of the pandemic. Professor Chris Whitty has since warned the NHS is facing its worst pandemic month yet.
The government’s mixed message about Christmas has likely had an effect on the number of cases we are seeing now. Although plans to allow five days of mixing over the holiday season were halted at the last minute, people with Tier 2 and 3 restrictions were still allowed to mix on December 25. The figures confirm it: the number of people hospitalized with Covid-19 has increased sharply since the lifting of the second lockdown in early December and accelerated up after Christmas, indicating that social diversity has played a role in the current crisis.
The optimism that many people felt in early December about the approval of a Covid-19 vaccine was quickly quelled by the surge in infections, especially in the southeast. The government has blamed the rapid increase in cases on a new, more infectious mutation in the virus. But blaming our current situation on this new variant forgets the fact that there were already worrying increases in the number of cases until December, when it was evident that the level 4 restrictions were not reducing infection levels. . Other than a slight pullback in the second half of November after a second lockdown, cases in England continued to rise throughout the winter. It is also clear that if there had been a much lower level of infection among the population, there would have been fewer opportunities for the new variant to emerge.
The prime minister and his advisers had received clear warnings since September that it would not be possible to avoid a deadly second wave without major changes in the country’s response to the pandemic. Government decisions have helped pave the way for the current crisis: in June, ministers abandoned the 2-meter social distance rule in favor of a less effective “1-meter-plus” approach, while people judged and costly “eat to help“ out ”encouraged social diversity in covered restaurants.
Throughout the pandemic, reaction rather than prevention has been the hallmark of the government’s Covid response. This strategy plays on both the instincts of senior government advisers, many of whom come from clinical rather than public health settings and are therefore trained to respond to individual illnesses rather than population risks, and to the condition. minds of politicians who hesitate to make unpopular decisions. until the very last moment.
Not only was England ill-prepared for the pandemic, with low stocks of PPE, an understaffed and under-resourced NHS, and exhausted and marginalized public health staff, but ever since Covid-19 entered in the country, there has been no real political attempt to formulate a long-term plan to keep the virus under control. As any public health expert will tell you, the only effective way to do this is to take preventative measures. But since the very beginning of the British epidemic, the idea of trying to get ahead of the virus and prevent its spread has proved to be a concept alien to the stubbornly reactive thinking of the government.
One of the main flaws in this thinking has been the continued search for a quick fix. Often the solutions the government grabbed were deeply flawed: we had mass tests, the NHS mobile phone app, the tier system – many of which were accompanied by ‘global’ rhetoric. While simple solutions look very appealing, finding individual fixes is generally flawed in at least two ways.
First, dealing with a complex public health crisis requires the use of several interventions at once, which complement and often reinforce each other. Having a testing capacity, for example, is of limited value if people who test positive cannot afford to self-isolate because they do not have adequate financial support. The second problem is that it is not enough to grasp a putative solution – any intervention must be well planned and well implemented. Sitting in Whitehall to issue proclamations is fine, but over the past 10 years the civil society mechanisms that managed and, in many cases, directed the implementation of such programs have either been abolished, like regional and local NHS bodies or government offices for regions, or without power and funding – like with local authorities.
The only public health intervention that would have helped greatly, and which is still needed to get the most out of the immunization program, is a properly funded and well funded Search, Test, Trace, Isolation and Support (FTTIS) system. locally managed. The task of keeping the virus under control is impossible without such a system. Although the government has invested billions of pounds in a test and traceability system, outsourcing it to companies such as Deloitte and Serco, it has underperformed on several occasions.
At the same time, the government has been relaxed about Covid checks at ports and airports; It was only last week, after 10 months of the epidemic, that border authorities started requiring a negative Covid test for people entering the UK. It could even put tracking and traceability in the hands of local authorities and public health officials. But given its record so far, it seems more likely that the blinding prospect of the vaccine solving all of our problems will continue to dazzle this government – and distract from other important steps it could take to bring the virus under control. .
• Gabriel Scally is Visiting Professor of Public Health at the University of Bristol and a member of the Independent Sage Committee