From the increased vulnerabilities in the population due to austerity measures to the lackadaisical conduct of Boris Johnson as the threat of disaster loomed closer, grotesque failures of governance are not hard to find in the first report of the Covid inquiry, released on July 18. But some of the problems Baroness Hallett’s committee has identified in the UK’s rather dismal response to the Covid pandemic look more systemic. These range from the “labyrinthine” structure for emergency planning that left command and responsibility unclear, to a lack of autonomy and freedom for dissent in advisory groups.
The report is damning of the strategy devised for the Department of Health in 2011, saying that it failed “to identify clearly what may and may not be a proportionate response to a range of pandemics with a potential range of impacts on health”. In other words, it considered too few scenarios. This plan was in any event soon abandoned in the Covid pandemic.
Perhaps the most serious shortcoming of the 2011 strategy is said to have been that it anticipated the “wrong pandemic”: an outbreak of lethal flu. Scares over bird flu and swine flu had biased expectations towards a particularly nasty form of flu as the biggest threat. It was blithely assumed that the strategy could easily be adapted to other respiratory diseases, but in the event flu was not a good model for Covid.
It is not as if there was no warning of other risks. The outbreaks in East Asia of SARS (Severe Acute Respiratory Syndrome) in 2002 and MERS (Middle East Respiratory Syndrome) in 2015 showed that coronaviruses like the SARS-CoV-2 responsible for Covid could be infectious and deadly. It was partly because of their experience with those diseases that some Asian countries, notably South Korea, navigated Covid with far lower mortality rates.
But saying that the plan anticipated the “wrong pandemic” is arguably not quite the point. If – this seems disturbingly possible – a lethal form of flu virus were to begin spreading through human populations, it is likely that the strategies countries would adopt to mitigate it would not now differ too much from those used for the Covid pandemic: social distancing, reducing contacts, masks, and perhaps lockdowns in the final resort, to slow or prevent spreading. After all, those “non-pharmaceutical interventions” during Covid worked also to reduce the spread of other infectious diseases like flu and colds.
The problem was rather that many experts, taking their cue from the example of the catastrophic 1918 “Spanish” flu, assumed that handling a pandemic would be all about coping with the casualties: dealing with high death rates and providing care for the ill. No one gave much thought to the idea that spreading itself could be suppressed. “The 1918-based assumption was that transmission could not be reduced sufficiently to stop a large epidemic,” says mathematical epidemiologist Adam Kucharski of the London School of Hygiene and Tropical Medicine.
This failure even to consider suppression strategies, as much as Johnson’s indolence, was why it took so long for the UK to impose a lockdown. South Korea and China, meanwhile, did so without delay. The foolish and indeed borderline-racist groupthink that led experts to insist that freedom-loving westerners would not stand for such constraints was unforgivable. But while a pandemic like this was still a hypothetical exercise, measures of that sort weren’t even on the agenda.
“The Covid response was really a paradigm shift, because it showed that a novel respiratory infection that spread easily and often without clear symptoms could be suppressed – and in some cases eliminated – after an outbreak had established,” says Kucharski. Of course, suppression through lockdown came at an enormous cost, economically, societally and psychologically. In the future the cost-benefit analysis of such interventions, especially in terms of wage loss and education, could be much more nuanced given what we have learned. But the pandemic “showed that many countries had a wider range of possible futures than they’d considered pre-Covid,” he says.
In the UK there was surely a political dimension – lockdowns were always anathema to a libertarian like Johnson, especially when he was hoping to bask in the “freedoms” of getting Brexit done. But the scientific experts need also to ask themselves why they did not take the option more seriously and push back against their political leaders. All the talk from spring 2020 of “flattening the curve” looks now like perverse fatalism. There is no reason to make the same mistake again.
