The Final Verdict on the UK pandemic

Characterised by extremes of success and failure, how has the UK fared overall so far?

Covid-19 is now with us for the foreseeable future. Many places are clearly not ready or able to step away from the emergency response phase of the pandemic. There is still plenty of time for fortunes to turn, for better or worse. For now, the UK has stepped away from a public health emergency phase, and we can take a broad look at how it has fared so far.

It is important to remember that not all failures or successes are down to the government, or have a specific individual or group of people to blame.

The Good

Some of the clear successes have been the UK’s investment and drive to vaccinate the population (as mentioned in part 4), and it’s scientific contributions more widely to the global effort to respond to Covid-19. No country has contributed as much valuable scientific information.

In disease surveillance, the UK remains the only country to have a national, representative surveillance system based on mass testing, including asymptomatic people. In fact, we had two, comprising both the Office for National Statistics Covid-19 Infection Survey, and the Imperial College London REACT study. The UK generated the majority of the worlds genetic sequencing of the SARS-Cov-2 virus. The coronavirus dashboard and national metrics compiled by the UKHSA have provided open access, clean, reliable data for an assortment of important studies, including some of the worlds best observational data on vaccine effectiveness.

In therapeutics, the UK funded several randomised controlled trials to evaluate efficacy of different Covid-19 vaccine schedules, aside from it’s investment in vaccine development and manufacturing. The RECOVERY trial, among others (AGILE, Panoramic, etc) remain the gold standards in determining the most effective treatments for Covid-19. Much of this was made possible through the UKs existing, world class infrastructure through the NIHR and it’s clinical research networks.

Despite the controversy over the use of rapid tests, they were made available to the public for free ahead of most other places in the world. The loss of this service is now being lamented by many of their initial detractors. The UK even ran trials to evaluate their utility (including one of the worlds only randomised trials of a non-pharmaceutical intervention - the use of daily contact testing in schools)

We can, and should, give credit to the incredible UK scientific community for this astonishing output. We should remember this all required funding, much of which was delivered or allocated by the government.

The Bad

We have already discussed in depth the disproportionate legal restrictions, and the de-prioritisation of schools in depth in previous parts of the series.

The decision to deliberately incite fear through public health messaging early in the pandemic was disastrous, and the effects are still being felt today. Many people feel too frightened to emerge from their more reclusive pandemic lifestyle even once vaccinated.

The lack of adequate sick pay or financial support for those having to quarantine or isolate is one of the most uncontroversial errors of the UK pandemic. Despite clear evidence of how this influences the risks of transmission, no-where near enough effort has been made to address this issue.

Although it is recognised SARS-CoV-2 is often transmitted through the air, and that there are multiple benefits to upgrading building ventilation, there have been no serious efforts to either invest in upgrading existing ventilation systems, or improve regulation to ensure higher standards are adhered to in future.

Confusion over the meaning of epidemiological modelling scenarios and their limitations has been rife throughout the pandemic so far. This has led to the dual and conflicting issues of both treating them as forecasts, and dismissing them as irrelevant (this discussion between Prof Graham Medley and Fraser Nelson of The Spectator is intriguing).

The management of care-homes and their residents at the start of the pandemic, including discharging patients back into homes without knowing their Covid-19 status, is nothing short of disastrous. It has even be declared the government broke the law in its failings.

Covid-19 outcomes

In terms of addressing the burden of disease, the UK cannot claim any great victories. In my view, the three greatest failures in this regard were:

1. Failure to seriously prepare in the months leading up to to the pandemic, off the back of years of serious underfunding of public health services

2. An honest, but costly mistake in not realising how much Covid-19 was in the country already by the end of March 2020

3. Once deciding “lockdown” restrictions were the main policy lever, this was used far too late in Winter 2021, and this mistake was compounded by the emergence of the Alpha variant

As it stands, the UK is roughly mid-table of excess deaths per capita. One could argue whether it is good or bad for the UK to end up in this position, given where it started. A wealthy country with a National Health Service and our level of scientific expertise could be expected to do better. However, a densely populated, internationally integrated country, with a relatively elderly population could be expected to do worse.

Conclusion

To me, it seems the UK has done a pretty average job during the pandemic so far. However, this “average”, is the result of both amazing successes and disastrous failures. There are ways in which we played a good card very badly. In other ways, we set ourselves up to be dealt a poor hand long before the pandemic began.

Perhaps the groups who were most deeply failed those we should have worked hardest to protect: our youngest, and our most elderly.

Some of this is much easier to assess in hindsight. When people look back on how things panned out, they would do wisely to differentiate between:

- What we got wrong because we had the wrong information, or honestly misinterpreted the information we had, and how can we ensure we do better next time

- What we got wrong because bad choices were made, and why

Importantly, we don’t need to know the answers to these to see the existing harms which have accrued over the past 2 years, and which we need to make much more effort to redress. But that is a topic for another time…

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