Covid Restrictions: how we lost our humanity

Part one of the UK pandemic review mini-series looks at the inhumane use of restrictions to reduce transmission

Probably one of the most frequently asked questions of recent times has been, “Should the UK have locked down?”. This question is a false dichotomy which assumes the possible responses of the UK were either to lock people in their homes or do nothing. We will aim to ask some smarter questions of the restrictions put in place by the UK government.

Did we need any restrictions at all?

It’s clear those in decision making positions grossly underestimated how much Covid-19 had been introduced into the UK by late March 2020, and how quickly cases were rising. This was an honest mistake but a costly one. Due to the multiplicative (exponential) spread of infection, acting twice as fast is more effective than doing twice as much. By the time we realised how many cases there really were, so many people were infected that we ran out of reasonable options.

This is partly because, thanks to poor preparation in Jan/Feb 2020 and years of public health cuts, we never had many reasonable options.

Realistically, the only option remaining in those first few weeks was implementing restrictions aimed at reducing contacts between people - the sledgehammer approach - or face a humanitarian crisis and health system collapse. We managed to avoid this, but lost many lives.

Did we get restrictions right?

No, we most certainly did not. This should be one of the primary areas of focus for official inquiries into the UK pandemic response.

Looking back on some of the measures introduced is almost like reading a dystopian sci-fi script. It was illegal to sit on a park bench. We argued over whether a scotch egg constituted a substantial meal with which you could have an alcoholic drink. We made it illegal for people to see members of their own families in person. Children were forced to say goodbye to dying parents via an iPad. The list goes on.

In retrospect these measures are obviously gross, unnecessary, and even cruel breaches of basic civil liberties.

They caused immense suffering disproportionate to any effect they could have had on transmission.

Law vs Guidance

It appears from the data that people had reduced the number of social contacts they were having prior to any laws being introduced - voluntary changes in behaviour.

It is likely that introducing restrictions into law and enforcing them with the police, added little to nothing to the effectiveness of these measures, but removed any possibility of individual judgement on their proportionality; for example for family members who may have had a terminal illness or been in mental health crisis.

We almost certainly could have introduced most restrictions on social contacts as official guidance with recommendations they only be breached in the case of extreme circumstances, without ever having to introduce them into law.

Proportionality and compassionate exemption

Any restrictions, whether based in law or as guidance should have had a place for compassionate exemptions - this is particularly true in health care. Pregnant women were made to deliver babies whilst wearing masks and without their partner present. Parents of critically ill children were not allowed to accompany them into resuscitation bays in emergency departments. Adjusting protective equipment policies for staff or parents in these situations should have rendered these rules redundant.

These are singular, life changing events for which there is no adequate compensation for being violated.

Ultimately, the whilst the UK found itself in a position where some restrictions on social contacts were necessary to avert disaster, they way these were implemented without exemption was inhumane and, in many cases, grossly disproportionate.

Resources vs restrictions

A recurrent theme of many countries responses to the pandemic was a focus on restricting social interactions, rather than providing resources to those at highest risk or with unmet needs. Resources which enable people to avoid high risk situations, or which make high risk situations safer, are always preferable to restricting their freedoms - especially when this becomes legally enforced.

The lack of sufficient financial support for self isolation or quarantine in particular, is undoubtedly one of the biggest failures of the pandemic. There should have been a much better focus on support and conditions for front-line workers, who are often from disadvantaged communities.

Whilst lockdowns shielded those with the privilege to work from home, those who were most at risk were left to deliver groceries, care for the infirm, and keep our lights on.

The UK should have sought to find the combination of measures with the best benefit to harms profile, which was sustainable, and could maintain low levels of community transmission. At lower levels, a decentralised, expert track and trace system may have been able to more effectively managed local outbreaks.

Failing to learn from failure

The lack of any coherent strategy after the first lockdown was a mistake. The UK entered a brief cycle of “boom and bust”, rapidly removing restrictions as cases fell, but subsequently responding with more drastic restrictions once cases got out of control.

Once it had been decided that the UK would leverage these types of social restrictions as its main pandemic policy leavers, waiting too late to implement them in the Autumn/ Winter of 2020/21 was a blunder. The use of regional “tiered” restrictions was not implemented correctly, and after finally conceding to a nationwide lockdown during November 2020, restrictions were eased before cases had fallen sufficiently and subsequently delayed in a vain attempt to “save Christmas”.

The end result was a prolonged lockdown which for many was more difficult to tolerate than the first. Schools were closed (probably unnecessarily, as France was in a similar situation and managed to keep them open), and thousands of people died. Whilst the unexpected emergence of the Alpha variant certainly compounded the error, it was an error none-the-less

Summary

In summary, in March 2020 the UK had placed itself in a position where it had no choice but to introduce restrictions to avert a humanitarian crisis. However, the nature of the restrictions included gross violations of basic human needs, without appropriate exemptions, and could have been made more flexible by being recommendations without being enforced by the police. These should be a core focus of the official review of the UK pandemic response.

This is part one of the UK pandemic review mini series. For the introduction and to read other parts of this series, you can click here.