There are around 16 million over 60s living in the UK, nearly a quarter of the UK population. They are the most at risk from COVID: catching the virus could be a matter of life or death. To them the government’s handling, or rather mishandling, of the pandemic should be a matter of acute personal concern. It certainly is for me. Around 60% of over 60s voted Conservative in the last election.
The NHS is currently at breaking point. Tired and demoralised after almost a year of COVID, doctors and nurses find their hospitals are full and we haven’t yet seen the impact of Christmas and New Year. Whereas Johnson acted in March to save the NHS, this winter he decided to save Christmas instead, until he was forced to backtrack at the last minute. You can blame people for not following the rules, but the government should plan for how people actually behave, not how they should behave.
There are so many errors that led us to this dreadful crisis. Let me list the main mistakes, ordered by time..
March itself, while Johnson dithered about whether to follow SAGE advice. That is estimated to have cost around twenty thousand lives but it also was a factor in subsequent mistakes. By allowing cases to build up he made things much harder subsequently. The government’s policy seemed far too laid back at the time, but we now know there were crucial delays between the science changing and policy changes (see also here).
Because cases were so high, it took some time to get them back down. The longer it takes, the more impatient populist politicians and small-picture Chancellors become. What should have happened in April was that the government promised to get cases right down to very low levels, so that subsequent flare-ups would be more manageable. An eradication strategy would have been better, but to be fair that only became a consensus policy among experts around late summer. What Johnson and Sunak did was relax the lockdown too soon, so we ended up with a significant caseload that was not falling in the summer. They also weakened compliance as a result of a well known episode.
Another way you can deal with flare-ups in cases is to have a very good test and trace system. The government promised one, but ended up doing the opposite while spending far more than they needed. It reflected their ideological obsessions: a hatred of government and a conviction that the private sector could always do better. They couldn’t, and local government health teams were left to do the tracing the government’s centralised system failed to do, but by then it was all too late. What it should have been able to do is reduce cases over the summer, but it failed. Rather than accept their error, they kept on with their failing system wasting huge amounts of money. As Chris Giles has noted, the UK spent more and achieved less than other countries.
When cases stabilised in the summer, the government should have started thinking about how it would deal with the return of schools and universities. Instead they seemed to act as if the pandemic was over! They told people to stop working from home, and Sunak even devised a scheme to get people back into restaurants which research suggests significantly increased cases.Once again they ignored what was happening in other countries.
This and the return of schools and universities led to a significant increase in cases. It started to become difficult or impossible for people to get tests. SAGE recommended on 21st September a two week circuit break to try and reverse the upward trend. Sunak was against it and Johnson ignored the advice of his experts. Sunak in particular seems to be in denial, insisting that the furlough scheme will be brought to an end, causing many people to lose their job.
Cases continued to increase exponentially, because the government was doing nothing. Johnson said that people had become “complacent” and “a bit blassé” about transmission, perfectly describing himself. In reality if cases were stable in summer (R=1), you would expect cases to be rising as summer ends (people spend less time outdoors) and schools and universities return. There is nothing unpredictable about the second wave the government is allowing to develop, yet even when it becomes clear the government shows no interest in doing anything to stop it besides blaming the public.
Finally in mid-October the government moves, but rather than a national lockdown it introduces different levels of local control: the tier system. Which tier you are in seems largely based on how many cases there are, rather than the speed at which they are increasing. This system formalises what many have feared, that the government is content to see cases rise up to a certain point.
As a result, the tier system becomes a kind of escalator. The lower tiers don’t do enough to stop local cases rising (in part because people move between tiers), so they become just staging posts before the inevitable move to a higher tier. The tier system slows the pace of the national increase in cases, but national R remains above one. To state the obvious, that allows hundreds to continue to die, and makes a national lockdown all but inevitable.
At the end of October, the Prime Minister bows to the inevitable and announces a national lockdown, although not as strict as in March. The lockdown begins to work, and cases start falling. Yet foolishly he states an end date for the lockdown, when any sensible lockdown should end when cases have been largely eliminated, and not by some arbitrary date.
At the start of December the lockdown had brought cases down from an average of nearly 25,000 a day to something like 15,000 a day (based on specimen date data). The Prime Minister stuck to the beginning December end date for the lockdown, and the country moved back into much the same tier system that had previously failed, with London in Tier 2. As Johnson was intending to allow a Christmas break, this was an almost criminal decision.
The warning signs were immediate. Cases started rising again the moment the lockdown ended, if not slightly before. We now know that this was partly due to a much more infectious strain of the virus. The more virus there is around, the more likely it is to mutate. The government, by allowing a high caseload to persist, and provided the environment that made mutation more likely.
By 12th December the number of cases had surpassed the pre-November lockdown peak, yet the government did nothing except move London into tier 3. The government continued with its plans for a five day Christmas break, in what was obviously now a second wave to rival the first in size. It was madness, just based on the numbers alone, without any knowledge of new variants. Yet we had to wait until the 19th of December before the Prime Minister changed his Christmas plans. We were seeing a repeat of March, but this time the government’s failure to adjust its actions to the data looks like overwhelming the NHS.
Tiers are pointless when you have a new highly infectious strain gradually spreading across the country. We should be in national lockdown, with the start of school postponed, because of the new virus strain, as SAGE advised on 22nd December. Yet once again the government has done too little, too late, because it ignores the science. You don’t avoid lockdowns by delaying them, you just ensure they go on for longer. All the controversy about when to get the second vaccine is only happening because the government has lost control of the virus and refuses to do what is needed to regain control.
You might say it is all very well making these criticisms in hindsight, but that is not true. I, together with many better qualified experts, made these criticisms at the time. In May in the Mirror I said that the first lockdown should aim at getting “daily number of new infections down to single figures” to save lives and the economy. In June I wrote in the Guardian that there was no health/economy trade-off beyond the very short-term. Under many of the points above you will find links to my own blogs making much the same arguments at the time mistakes were being made.
How can a government that lived through March 2020 not just repeat the same mistakes again, but make worse mistakes? There are obvious people to blame. Tory MPs with their head in the sand, following a Death Cult that says all we should do is protect the vulnerable. Much of the right wing press pushing articles advocating the same, by journalists who keep getting things wrong but carry on regardless, like all the people who said there wouldn’t be a second wave based on obvious nonsense. A broadcast media that indulges such nonsense rather than ignoring it or putting it down. But when a Prime Minister, supported by his ministers, ignores medical advice again and again, the responsibility rests entirely with him.
The evidence for other countries is now clear. As New Zealand and Australia have shown, you first drive cases down to as close to zero as you can, and then act quick and hard whenever there is a flare-up. That allows you long periods where everyone can behave normally, and the economy can return to normal. The cost of that policy is to have a quarantine system for people coming into the country, not of the ineffective kind enacted in the UK but proper quarantine as done in the countries that have successfully dealt with COVID. Devi Shridhar estimates that following this kind of policy could have saved over 80% of lives lost to COVID in the UK.
The people most at risk from this pandemic are those who predominantly voted this government in. Their lives are at risk mainly because of government failure. In contrast the Labour opposition has acted more responsibly, following the science. They should be switching their votes from Tory to Labour in their millions. But the newspapers they read are doing their best to hide the truth from them, the broadcast media with a few honorable exceptions chooses not to enlighten them, and recently it appears the government has resorted to trying to hide what is happening in hospitals. So those over 60 will continue to vote for a government that through its failures is literally killing them.
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