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Late: The word that defines the UK’s Coronavirus pandemic management

Picture the scene. We are in Downing Street and the news media are awaiting another coronavirus press conference. Professor Chris Whitty, the Chief Medical Officer for England is ready. Sir Patrick Vallance the Chief Scientific Advisor is ready. Where is the Prime Minister (PM)? Late again.

I have this vision of our PM frantically scurrying around like the White Rabbit in Alice in Wonderland humming “I’m late I’m late for very important date”. We might all smile at this vision but I’m afraid the analogy of being late is not a laughing matter when it is applied as the major theme for the UK governments management of what I described in a previous blog as the worst public health crisis in my lifetime. I also recall the PM famously using the phrase “A stitch in time saves nine” which is indeed true however in a pandemic being late or not sewing that stitch in time can and has cost thousands of lives.

In the week that has seen the UK pass 100,000 deaths it is right to reflect on the tragic loss of life. The call from government saying this is not the time to analyse why the UK has done so badly is in my view the wrong line to take. The government could learn a thing or two from the UK health care professions who for years have developed themselves as reflective practitioners. Donald Schon (1983) wrote extensively about reflection in terms of the creation of learning organisations who can both reflect in and on action. It is the former that has been sadly lacking in the UKs response to the coronavirus crisis. Reflection needs to be on the table throughout the pandemic and had it been, we may not have repeated the same mistakes. The management of pandemics is well documented in the medical literature. Professor Chris Whitty the Chief Medical Officer for England outlines how to manage a pandemic in this useful lecture at Gresham College.

Indeed it is also important to remind us of the words of Sir Patrick Vallance who when recommending the urgency of action in a pandemic implored that we “go earlier than you think you want to, go a bit harder than you think you want to and go broader than you think you want to in terms of restrictions.” My observation of the UK pandemic response leads me to conclude that we failed to do any of these. However, for this blog let’s focus on timing. Going early in terms of restrictions and other actions can have an enormous beneficial impact.

The last year has been to coin an overstated phrase “unprecedented” with many arguing that any government would have been overwhelmed and struggled to manage the crisis. Is this fair? One can look at other countries who have managed the situation better and as such have had better outcomes. New Zealand, Australia, Korea for example. Others will point to the differences between countries in terms of geography, population, culture, transport, relative poverty, healthcare systems, reporting mechanisms and living conditions which make comparisons inherently complex. 

With the current death toll in the UK so high and continuing to rise, and many scientists telling us that things will inevitably get worse before they get better the question everyone is asking is : What has gone wrong? In this blog I’m going to argue that in large part our problems are based on a lack of urgency in acting. I’m arguing that we have not followed Sir Patrick Vallance’s recommendation and in particular we have been late to act throughout. Below I will set out the evidence for this and propose some tentative reasons as to why this has been the case.

Firstly, despite a pandemic being recognised as the largest threat to any country (it will always be top of any country’s risk register) the UK was slow to recognise the impending crisis and late to recognise the implications of a virus of this nature and how quickly it can spread globally.  History informs us of how quickly Spanish flu spread in 1918. The UK was never going to be immune. Late recognition and poor pandemic preparedness meant we were late to get in place the critical infrastructure required to mount a response. Despite several warnings and meetings of the civil contingencies committee (COBR) the health secretary Matt Hancock was dismissive of the threat playing it down. Indeed, the PM failed to attend several early meetings giving the impression that the UK were not taking this as seriously as they should.

When faced with a looming medical/public health emergency it is important that the scientific advisors are in place early (which they were) and that their advice is acted upon. The evidence clearly points to a slow response to this advice which manifested itself in several critical late decisions early in the pandemic. The UK did not close its borders and implement quarantine measures allowing the virus to seed extensively in all parts of the community. Once community transmission had been established it was too late. It did not have in place a substantive testing regime, largely because we were unprepared. It very quickly became clear when we switched from community testing to testing only those in hospital with Covid symptoms that we lacked critical mass testing capacity and hence spent months trying to catch up. Evidence from previous outbreaks of SARS and MERS demonstrated how important mass testing was in controlling the spread, a position advocated by the World Health Organization (WHO). The UK saw case numbers grow rapidly and was slow to get the important public health messages out. Consequently, hospital admissions increased, and the death toll leapt. We were in serious danger of the NHS becoming overwhelmed with critically ill Covid patients.

Public health, medical and scientific experts suggested through their modelling exercises that the death toll, if we didn’t act quickly, could exceed 500,000; a situation socially and politically unpalatable. Therefore, in the absence of no known treatments and no vaccine we would have to resort to the tried and tested traditional methods for the suppression of a respiratory borne virus. Robust hand hygiene, respiratory/cough etiquette and maintaining social distance to reduce close social interaction. The logical conclusion was that to radically reduce social contacts we needed to lockdown. It is widely acknowledged now that the UK was at least a week late in introducing the first lockdown in March 2020.

In the meantime, the virus was sweeping through vulnerable elderly groups in care homes. We were again late to recognise this threat and late to protect them despite Hancock’s claims of throwing a ring of protection around them. The death toll continued to mount. At this stage both the Health (NHS) and care sectors were under enormous pressure and ill equipped to manage. The greatest worry at that stage was lack of adequate Personal Protective Equipment (PPE). Due to our ill preparedness we were late to provide appropriate PPE to both the NHS and the care home sector, exposing healthcare workers to undue risk. The death toll of healthcare workers in any pandemic is high and we were now starting to see this rise in the UK.

Another major criticism during the earlier months was how slow we were in ramping up testing capacity, tracking, tracing cases and ensuring isolation measures were in place. Indeed, concerns about test, trace and isolation continue today. However, lockdown and other public health measures did reduce the case numbers through the summer but inevitably the virus, which thrives in cold damp conditions started to cause further problems as we approached autumn and winter. Combined with this the UK saw a new variant of the virus emerge in the autumn with greater transmissibility. Cases started to rise again along with the inevitable hospital admissions and deaths. It appeared despite warnings from all scientists and health professionals that a second wave was highly possible we were late to recognise the emergence of a second wave of infections. The signs of which were there in September 2020. This led to a second lockdown in November when the advice from the scientific advisors was to lockdown in mid-October or earlier. This decision was compounded by a complex tiered restrictions arrangement to manage outbreaks locally aimed at the avoidance of unnecessary restrictions. Meanwhile the death toll continued to mount.

Notwithstanding the emergence of a new variant of the virus during the second lockdown everyone’s attention was switched to Christmas. The advice offered from government that restrictions would be relaxed for five days was met with incredulity by health professions who argued that this would simply allow the virus to be spread exponentially through greater household mixing. All the evidence at this stage pointed to household mixing as the primary source of transmission. As the situation worsened following the release of lockdown in early December it became obvious that the Christmas guidance had to change. To no ones surprise the advice was changed at the last-minute meaning everyone would have to rearrange their plans. The late change to the Xmas guidance probably meant more family mixing than would have happened had the advice been robust and communicated to the public earlier. Very quickly after Christmas we saw rapid changes to the tier management despite calls for a further lockdown. Cases rose rapidly, hospital admissions were now worse than in the first wave and scientists called for a lockdown. Consequently, we were late implementing Lockdown 3.

Throughout the pandemic the government has provided detailed guidance on restrictions, care homes, travel arrangements and education. It’s difficult to get this right all the time but the issuing of guidance was at times so late it became difficult to interpret the issues with clarity. Probably one the best examples of this relates to the advice provided to schools. Should they stay open or close? What should the Covid secure measures be? How do you construct bubbles of students to reduce social contact? Covid testing of pupils and staff? examinations and assessment guidance? However, the final straw was surely when schools opened in January after the Christmas break to only be told they had to close the very next day as we moved into Lockdown 3.

In conclusion it is said that to manage a pandemic you need a clear, robust strategic plan. The evidence presented here would suggest a lack of strategic planning with crisis decision making on the hoof. Some have argued that we have a PM who struggles to take the big decisions required, who procrastinates and inevitably is left with Hobson’s choice. If you couple this with a group of key ministers who appear to lack the competence to carry their portfolios we have the recipe for a disaster. The consequence of which means the UK has experienced a terrible outcome across a whole set of health, education and economic indicators.

References
Schon, D. (1983) The reflective practitioner: how professionals think in action Basic Books, New York
Whitty, C. (2018) How to Control an Epidemic https://www.youtube.com/watch?v=rn55z95L1h8

How should we honour “Our sheroes and heroes”?*

The British, so it seems, love a statue. Over the last few months we’ve seen Edward Colston’s toppled, Winston Churchill’s protected and Robert Baden-Powell’s moved to a place of safety. Much of the narrative around these particular statues (and others) has recently been contextualised in relation to the Black Lives Matter movement, as though nobody had ever criticised the subjects before. Colston, one time resident of Bristol and slave-trader was deemed worthy of commemoration some 174 years after his death and 62 years after the abolition of slavery. Likewise, one-time military man, accused of war crimes, homophobe and support for Nazism, Baden-Powell suddenly needed to be memorialised in 2008, almost 70 years after the second world world (and his death) and over 40 years since the passing of the Sexual Offences Act 1967. For both of these men profound problems were clear before the statues went up. Churchill, seen as a “hero” by many for his leadership in World War II has a very unsavoury history which is not difficult to locate in his own writings. His rehabilitation also ignores that his status for many of his contemporaries was as a warmonger. His passion for eugenics and his role in decisions to bomb Dresden, Hiroshima and Nagasaki can be wilfully swept under the carpet. Hero-worship is a dangerous game, it is also anti-intellectual. Churchill, like all of us, was a complex human, thus his legacy needs to be explored deeply and contextualised and only then can we decide what his place in his history should be. His statues and soundbites from speeches on repeat, do not allow for this.

Perhaps the most interesting part of this debate is to witness the inflamed defence of individuals who have a clearly documented history as slave owners, or as enthusiastic proclaimers of eugenic ideology, racism, homophobia and so on. As long as they have been ascribed “hero” status, we can ignore the rest of the seedy detail. We are told we need these statues, these heroic men, to remind us of our history….strangely Germany is able to reflect on its history, without statues of Hitler.

It seems as a nation we far prefer these individuals, responsible for so much misery, harm and violence in their lifetimes, than to present Black Britons and British Asians on a plinth. When we are reliant on South African President, Nelson Mandela to take up two of those London plinths, it is evident we have a serious racial imbalance in those “we” choose to commemorate.

Furthermore, the British appear to love an argument about statues, for instance, the criticism levelled at the artist Maggi Hambling’s statue to “Mother of Feminism” Mary Wollstencraft and Martin Jenning’s artistic tribute to Nurse Mary Seacole. For Wollstencroft, much of the furore has been directed at the artist, rather than the subject. There appears to be no irony in women attacking other women, in this case, Hambling, all in the name of supposed defence of The feminism. In the case of Mary Seacole, racially infused arguments from The Nightingale Society have suggested that this statue should not be in sight of that of Florence Nightingale. It seems that even when all important parties are long dead, it is deemed appropriate to use barely disguised racism to protect the stone image of your heroine. Important to remember that patriarchy has no gender. It is evident that criticism revolves around women’s representation in statuary, as well as women’s involvement in sculpture. When statues of men are said to outnumber those of women by around 16 to 1 (and that’s only when Queen Victoria is counted) it is evident we have a serious gender imbalance in those “we” choose to commemorate.

If there’s one thing the British love more than statues, it’s war commemorations. Think of the Cenotaph, standing proud in Whitehall, a memorial to ‘The Glorious Dead’ of firstly, World War I and latterly, British and Commonwealth military personnel have died in all conflicts.

Close by in Park Lane, we even have the imagination to create a memorial to Animals in War. We love to worship at these altars to untold misery and suffering, as if we could learn something important from them. Unfortunately, the most important message of “Never Again” is lost as we continue to thrust our military personnel and their deadly arsenal all over the world.

There is a strong argument for commemorating the war dead of all nations in the two World Wars. All sides, both central powers/axis and allies were comprised in the main of conscripted personnel. These were men and women that did not join the armed forces voluntarily, but were compelled by legislation to take up arms. With little time to consider or prepare, these people, all over the world, were thrust into life-threatening situations, with little or no choice. The Cenotaph and other war memorials mark this sacrifice and to some degree, acknowledge the experiences of those who served in a uniform that they did not consent to, without the compulsion of legislation. Unfortunately, civilians don’t feature so heavily in memorialisation, yet we know they experienced life-changing events which have repercussions even today. From children who were evacuated, to families who experienced fathers and husbands with short fuses, to those whose fear of hunger has never really left them, those experiences leave a mark.

To me, as a nation it appears that we don’t want to engage seriously with our history, preferring instead a white-washed, heteronormative, male-dominated, war-infused, saccharine sweet, version of events. But British people, both historically and contemporaneously, are a diverse and disparate group, good, bad and indifferent, so surely our statues should reflect this?

I recognise the violence which runs throughout British history, I learnt it, not through statues, but through books and oral testimony, through documentary and discussion. I also recognise that I have only begun to explore a history that silences so very many, making any historical narrative, partial, poignant and heavy with the missing voices. I recognise the heavy burden left by slavery, discrimination, war and other myriad violences, understanding the desire to commemorate and celebrate and tear down and replace.

What we need is a statue that recognises all of us, in all shapes and sizes, warts and all? We are living in a global pandemic, the death toll is currently standing at over 2.5 million. In the UK alone, the death toll stands at close to 100,000. Why not have a memorial with all those names; men, women, children, Black, white, Asian, mixed heritage, Muslim, Catholic, Buddhist, Christian, atheists, gay, straight, trans, lesbian, young, old and all those in between. People that have been coerced, through financial impetus, caring responsibility, career or vocation into dangerous spaces, who have not chosen to sacrifice their lives on the altar of bad decisions taken by governments and institutions (reminiscent of the world wars). Such a commemoration would be a way to recognise the profound impact on all of our lives, as drastic as any world war. It will recognise that you don’t have to wear a uniform or conform to a particular ideal to be of value to Britain and every person counts.

* Title borrowed from ‘Our sheroes and heroes’ (Maya Angelou ; interviewed by Susan Anderson in 1976)

The pandemic and me – Lessons I’ve learnt from the #lockdown

This lockdown has certainly given us time to think and perhaps reflect on a variety of topics and situations. I’ve shared a few thoughts below and I wonder just how many are universal in some way.

I need to ensure I have a structure to my day and week.  I think we all need some sort of structure to our lives and that structure is often given to us by work and perhaps other sociable events such as going to the gym or going to a coffee shop.  It may be that the weekly shopping provides us with an anchor, Saturday may be a shopping day or religion might dictate a visit to a place of worship on a particular day.  At times I’ve found myself getting confused about what day it is, Groundhog Day, I think.  However, for the most part, I think I’ve got it sorted out.  My wife and I discuss our schedule every morning over a cup of coffee.  We have sorted out a routine of work, daily chores, fun bits and exercise.

My willpower is tested but I can be determined.  I have never been a heavy drinker, the occasional binge, yes but then who hasn’t?  It is however, quite easy to slip into the habit of having a glass or two of wine in the evening, every evening and perhaps a gin and tonic or two.  I can’t go anywhere so thinking about having to drive the next day is not an issue. It’s not until you start totting up the consumption that you realise maybe you might have to reign this in.  ‘School nights’ are back again, no drinking in the week.  I make up for it at the weekend though.

I’m not risk adverse, I just like to think I’m logical.  I don’t think it takes a rocket scientist or in fact any scientist to work out that the government (particularly a Conservative government) would not enforce the cessation of most business in the country without a very, very, very good reason.  Stay in has been the mantra and of course we all know how difficult it is and we all know that as usual, the most vulnerable in society have been hit the hardest by this pandemic. Logic dictates, well at least to me, that going out to any store anywhere carries a risk.  Some risks are necessary, for instance a trip to the chemist to pick up a prescription, but a trip to a DIY store, really?  I’m sorry but given the risks, I think it’s a no brainer. Not only do I not want to catch the virus, but I would be distraught if I thought that through my own selfishness I had passed it onto someone else.

I never really thought about all those people that are truly special.  We clap every week for the carers and the NHS and all those involved who are truly remarkable. I do ask myself though, would I want to turn up to work in a supermarket? Would I want to be out delivering parcels or the post? Would I be a NHS volunteer?  Would I be happy working on public transport or emptying dust bins? There are so many people doing ordinary, even mundane jobs and volunteering roles that I now appreciate more than ever.  And I would go far as to say I am humbled by what they do and continue to do despite the risks.

I appreciate the world around me. Not being able to go out and socialise in some way, be that work, or friends or family has provided more time for other activities.  Our walks to the next village and back on roads devoid of most traffic has revealed an astonishing array of wildlife to be gazed upon and appreciated.   That is of course if you’re not gasping for breath following a walk up a steep hill (well I call it steep but in a car its barely noticeable).

Some things don’t change.  I’ve also noticed the gate to the footpath across the fields near our house has gone. A heavy wooden gate which, apparently has been stolen.  On our walks we have noticed the increased number of cyclists whizzing along the road.  Most give a wide birth, but some don’t seem to have a care for others, one nearly colliding with us as he flew around the corner. It seems with the reduction of cars; the idiotic driver has now given way to the idiotic cyclist.

What will a ‘new normal’ look like.  At some stage we will get back to normal but its difficult to contemplate when that will be and what it will look like.  Maybe getting back to the old normal is not what is needed.  I’m trying to envisage how I will make changes in consideration of what I have learnt during this lockdown.  What changes will you make? 

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