The Debate over UK Government Messaging During the Covid-19 Pandemic: Part 3 — There be Problems!

The problems with the government’s management of the pandemic: No long-term thinking, useful and effective tools were cancelled and the early day benefits of lockdown were squandered.

Smashicons, CC BY 3.0, via Wikimedia Commons

Since early February 2020, there have been government decisions which were obviously wrong at the time they were made. To date, the mistakes of the UK government in managing the pandemic are encompassed in three main factors:

1. An absence of long-term thinking. This meant there was no long-term plan. There appears to have been no process designed to establish a path from short-term to long-term possibilities and requirements.
2. A loss of vaccination momentum. The effort started well, and was indeed world-leading, but it lost a sense of urgency and importance into the summer of 2021 due to an apparent lack of messaging from the government necessary to maintain the pace and momentum of the vaccination programme.
3. A dismantling the simple tools of greatest effect. This was another key messaging failure which resulted in the failure to actively and successfully manage the expectations of the population.

At the root, is the lack of a long-term plan, combined in addition, with a failure to separate political ideology from the public health policy requirements of a pandemic.

1. No Long-term Thinking

The public was not prepared for the pandemic to be a long-term phenomenon by government because the government itself was not prepared to accept that the pandemic was a long-term phenomenon.

There were attempts to explain the longer term nature of Covid-19 by scientists, such as England’s chief scientific adviser, Sir Patrick Vallance. Early in the pandemic he stated, “This is quite likely, I think, to become an annual virus, an annual seasonal infection”. However, from the most important voice, that of the UK government, there was no attempt to stress or explain in any detail or with any sense of importance, that Covid-19 was here to stay.

The first lockdown, in March 2020, probably arrived at the right time. Some, including myself, argued that the government should have acted sooner and locked-down a week earlier, based on the infection rate and death numbers and my own perception. However, I also agreed that the government could not have acted a sooner because evidence was scant or sketchy, there was naturally some disbelief and denial among people and the public psyche had become more accepting of the idea that life could actually stop. Nevertheless, I was also arguing that the government had not moved fast enough to introduce the population to the idea that lockdown was a distinct possibility, and indeed, had the government had a pandemic plan in place, it would have directed that the idea of lockdown should be promoted as an initial public health measure as a means to gain some orientation in an unfolding situation. It could have been presented as a moment when everyone could stand back in safety while the nature and magnitude of the threat was more precisely identified.

The lockdown was indeed very strange at the beginning. Reaction ranged from total surprise to expectant resignation, but generally, there was an air of relief. People relaxed in the first instance and the lockdown measures were to be reviewed in three weeks.

It continued well into May, and the longer it continued, the more a vague perception developed that the pandemic could end when lockdown ended, and there was mild speculation that the pandemic could, just possibly, be over by summer. There were muted comments that warmer weather would ‘kill it off’, notwithstanding that the UK was enjoying one of the warmest spring periods on record.

These perceptions were allowed to percolate and develop. In mid-March 2020, days before he declared a national lockdown, Mr Johnson told the then daily Downing Street press conference on the pandemic, that the next 12 weeks could “turn the tide of this disease”. He was overly optimistic, which has been a common factor throughout the UK government’s management of the pandemic. He said:

“I think, looking at it all, that we can turn the tide within the next 12 weeks and I’m absolutely confident that we can send coronavirus packing in this country but only if we all take the steps that we have outlined.”

Speech: Prime Minister, Boris Johnson’s opening statement from the press conference on coronavirus (COVID-19): 19-Mar-2020

He then provided more false hope, grasping at research into the virus which was in its infancy, portraying it as further advanced than it was, with a little boosterism to boot. He continues:

“That is vital because that is how we are going to reduce the peak. And once we’ve achieved that, and I think that we will, if we take the steps that I have said, then the scientific progress that we’re making will really start to come into play. And I wanted to discuss a little bit of that this afternoon with you, because we are rapidly becoming so much better at understanding the genomics at the heart of this virus. A lot of that is going on in this country. We’re getting better at understanding the medicines that may treat and cure it.”

Speech: Prime Minister, Boris Johnson’s opening statement from the press conference on coronavirus (COVID-19): 19-Mar-2020

Little of that was true on 19 March 2020. The genome had been published and there were some highly questionable ‘suggestions’ from the US president, Donald Trump, about “promising therapies”, but research into drug therapy, vaccines, and the etymology, signs, symptoms and overall syndrome of the disease, was in its infancy. Indeed, Mr Johnson stated that drug trials had yet to commence. It was wrong to hint that life would soon return to anything that felt like or resembled normal.

From early 2020, there was a strange, evasive style about government, even a sense of disbelief . These of use who subscribed to the ‘Coronavirus (COVID) Updates’, an email update service from the government website, got more than we bargained for — our inboxes were inundated with advice, measures, guidance and new arrangements every hour. Clearly, there were groups of diligent civil servants within government working flat-out, which was reassuring, at first. But the continual torrent of information containing changes and variations became overwhelming. Even at a more digestible level, via news outlets, the repeated adjustment and speed of change to information received only a few hours ago, began to transmit a sense of desperation. Travel bans, and the protocols surrounding them expanded. Travel advice seemed to change twice a day.

The government ploughed on trying to contain the situation by reacting to news as it arrived. But the volume of information pouring into government was such that as soon as it had reacted and produced guidance on an issue, the issue changed again, prompting another reaction and a further issuance of guidance. My Gmail label for government Covid-19 updates for two days in mid-March 2020 is below:

To the time I am writing this, you can see I have over five and a half thousand emails. I am not knocking the service. As you can see, I read what was relevant to me, and although I tried to keep-up, by this point, the volume of information was becoming too much.

It became clear that, certainly initially, the government believed it could combat the virus by regulating the hell out of it! In particular, it seemed to believe that regulating travel would limit entry of the virus, and that it could be contained and eliminated where it existed in the UK. A lot of energy and media attention was devoted to the tracing of a ‘super spreader’ and his contacts, for example, which gave a peculiar impression and some minor but tangible hope that finding him would somehow help to stop the spread of the virus. Other than for a little track and trace practice, it was a complete waste of time. The damage was already done, but it was not until late-March that the government capitulated to the fact that Covid-19 had become well-established in the UK.

There was, and still is, speculation that the Prime Minister regarded the virus as inconvenient or irrelevant, to the point where he lost patience and said, “no more ****ing lockdowns — let the bodies pile high in their thousands” before agreeing to the second national lockdown in November 2020. Downing Street denies these accusations. However, it is certainly true that Mr Johnson was absent from some of the first Civil Contingencies Committee (COBR) meetings, whose prime purpose is to formulate government reaction and strategy to any and all national emergencies, including pandemics. Furthermore, he did not hesitate to expose himself to the virus during a hospital visit in early March.

Events moved quickly. The nation was brought images showing hospitals overrun in Wuhan in China, and there was rolling coverage of worrying scenes from northern Italy’s Lombardy region as quarantines were imposed and its health services were swamped by cases, in late February 2020.

The first two cases in the UK were reported on 31 January. There were nine cases by 11 February and 16 cases by 27 February. On 28 February, the first British death is recorded. By 2 March there were 36 cases and 85 cases by 4 March. A third death was recorded on 8 March.

As the British Pound fell nearly 2% in a volatile day of trading on 10 March, the Bank of England cut its base interest rate from 0.75 percent to 0.25 percent, on 11 March.

Travel advice continued to change daily and became increasingly confusing. There were reports of travellers and tourists becoming stranded abroad as countries closed their borders and air corridors closed.

By 14 March, 1,140 cases were recorded and 21 people had died. Many large events had been cancelled but some, such as th Cheltenham Festival, still went ahead. A new phrase was born: a super-spreader event, of which the Gold Cup was thought to be one.

Deaths doubled in two days, rising to 55, on 16 March. The Prime Minister was now asking people to refrain from non-essential travel, to reduce their social contact, and to avoid pubs, clubs and theatres.

As the heath service struggled to treat the new infection, the government made appeals for more ventilators.

By mid-March it appeared as if the UK government’s initial aim was to achieve herd immunity to the virus.

“What we don’t want is everybody to end up getting it in a short period of time so we swamp and overwhelm NHS services — that’s the flattening of the peak… Our aim is to try and reduce the peak, broaden the peak, not suppress it completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission, at the same time we protect those who are most vulnerable to it. Those are the key things we need to do… This is quite likely, I think, to become an annual virus, an annual seasonal infection.”

Sir Patrick Vallance, chief scientific adviser for England, BBC Radio 4 Today programme, 13-Mar-2020. Source: The Guardian.com

The herd immunity approach was questioned by the WHO but it appears the strategy was regarded as viable and relatively minor by the UK government.

A few days earlier, on 11 March, the Chancellor, Rishi Sunak, in his first budget as Chancellor of the Exchequer, had made the assumption that £30 billion would be enough to protect the economy from Covid-19. This indicates a very narrow and short-term view of the crisis. However, something changed, because six days later his view seemed to have extended much further. On 17 March, Mr Sunak announced a £330 billion package of measures in the form of loan guarantees and grants for businesses directly impacted by the virus.

On 18 March deaths exceeded 100 and the British Pound plummeted below $1.18, an overall drop of around 10 percent since the beginning of March. This prompted the Bank of England to make a further base interest rate cut to an all-time low of 0.1 percent, on 19 March.

Confusingly, also on 19 March, the UK government no longer deemed Covid-19 to be a ‘high consequence infectious disease’ (HCID), following opinion from the UK HCID group and the Advisory Committee on Dangerous Pathogens.

On 20 March, Mr Sunak again extended his view. A ‘furlough’ system was announced, designed to assist employers with the wage cost of workers who were unable to work in businesses which were forced to close by the government. The new word arrived into the British lexicon as cafes, pubs and restaurants were ordered to close.

On 23 March 2020, the UK entered its first national lockdown.

The Benefit of Lockdown Squandered

The onset of a pandemic is understandably chaotic and there will be a natural degree of denial and disbelief — all of which could have been anticipated, managed and minimised under a pandemic plan. However, triggering a national lockdown moves a government, and a nation, into a period of consolidation. It stops the chaos.

The beginning of a lockdown is the most crucial period. Everything has stopped for a moment. It is the quietest period — a period of opportunity, to regroup and, if it doesn’t already exist, to devise a comprehensive, long-term plan. Leaders have time to think, to gather data and evidence, to consult with experts and advisers, and to develop strategies to lead the country forward.

However, this process, if it existed, would have been severely hampered by the absence of the Prime Minister who became ill with Covid-19 on 27 March — the very beginning of the lockdown.

His infection came as no surprise, given that he had deliberately exposed himself to the disease, but by early April, his illness had forced him to fight for his life in hospital.

Some have suggested that his ordeal was exaggerated to sound more dramatic for political effect: the PM would not be here but for the NHS. It is pure conjecture, and no one in their right mind would want the country’s leader away from the seat of power at a time of national crisis. But he was effectively absent for the first, crucial few weeks of the lockdown period, a phase when most of the planning could have been accomplished.

In June, restrictions were relaxed. Businesses reopened with ‘Covid-safe’ environments. ‘Support Bubbles’ were introduced. Self-test kits were in development and quarantine rules for travellers were issued.

Contact tracing, cancelled by Public Health England on 12 March, was to be re-established as the new NHS Test and Trace service to ‘world-beating’ standards with the allocation of colossal amounts of public money under the capable and competent lead of failed chief executive, Dido Harding, or Baroness Harding of Winscombe, as she is also known. A few words about her:

After stints at Tesco and Thomas Cook, she came to public notice as chief executive of TalkTalk, fined for billing customers for services they never received and winning the wooden spoon award for worst public service two years in a row — the first firm to achieve the unwanted double. “In the past, a winner has taken the wooden spoon as a wake-up call and improved its customer service,” noted one business writer.

She stood down 18 months after the firm suffered a damaging cyber-attack, after her pay package had doubled despite the incident costing the company £60m and more than 100,000 customers. The firm was lambasted for weak security and its share price fell almost one-third in a year, but Harding dismissed the attack as “ancient history” and spoke breezily about focusing next on public service.

Lo and behold, she was appointed head of the NHS Improvement Board a few months later despite her lack of health qualifications.

Ian Birrell, “Dido Harding’s bid to lead the NHS is symptomatic of a grim populism”, inews.co.uk, 20-Jun-2021. [Online]. Available: https://inews.co.uk/opinion/dido-hardings-nhs-chief-executive-test-and-trace-1062603. [Accessed: 30-Dec-2021]

The appointment prompted accusations of cronyism given her track record and proximity to the then Health Secretary, Matt Hancock.

The government’s messaging during the emergence from lockdown was abysmal. There were further allegations of biased awarding of contracts during the government’s Covid-19 response which have continued to mar the government’s image.

Face coverings, or masks, had been debated publicly for weeks during lockdown but, as the evidence was gathered, the benefits were never definitively presented by government. People were simply advised to wear a face covering from 11 May. A month later, on 15 June, wearing a mask became mandatory on public transport, but the debate rumbled on for months thereafter.

Financial support for business and individuals was good or good enough, except for the millions who were needlessly excluded. The various packages of grants, loans and furlough were geared to the short-term with all measures scheduled to end in October 2020. By setting this end date, the Chancellor was, perhaps inadvertently, implying that the pandemic would or could be over by Autumn.

Indeed, financial support was not to end before Chancellor Sunak paid for everyone to eat-out in August. Vouchers were issued to the public for use in hospitality venues and covered meal orders up to £10 per head.

Economically, ‘Eat Out to Help Out’ made sense. It was an incentive to spend in one of the hardest hit sectors of the economy. Epidemiologically, it made no sense at all.

The scheme diminished or obliterated any message of caution. It was a direct invitation by government for people to go out, gather and celebrate, which was directly in the face of regulations limiting social contact and gatherings. The ‘Eat Out’ initiative signalled that it was permissible for people to mix again and, it seems that, particularly for younger people, the initiative had the overall effect of implying that the pandemic was all but over.

Younger people ‘let their guard down’. On 7 September, it was reported that one third of Covid-19 cases over the preceding week were among those aged 20–29, which prompted the Health Secretary, Matt Hancock, to warn younger people that they risk causing a second wave of the virus if they do not adhere to social distancing rules.

The pandemic was not over, as we all now know — and the government would have been well aware of this at the time. However, while its words said the pandemic was still happening, its actions said otherwise, particularly to the most mobile section of society, the 18 to 40s.

I said at the time, the ‘Eat Out’ scheme was a big mistake. While releasing the lockdown was absolutely necessary, ‘Eat Out to Help Out’ was a prime example of how the process and messaging surrounding the relaxing of restrictions, and surrounding the pandemic as a whole, was confused and unclear. The Eat Out scheme was so successful for some restaurant chains, including Prezzo, Harvester and Pizza Pilgrims, that they announced plans to extend the scheme into September by funding it themselves once the government backed scheme had ended. Conversely, some restaurants and pubs reported that they had dropped out of the scheme because of “hostility towards staff”.

On 10 May, as an end to lockdown was brought into public view, the very clear and simple message: “stay at home, protect the NHS, save lives” was changed to “stay alert, control the virus, save lives” and accompanied by a less than clear prime ministerial address to the country about a ‘conditional plan’.

The Prime Minister seemed to have ignored the fact that he was addressing a nation which, although eager to hear what he had to say, was suffering the fragilities and nervousness inflicted by weeks of being locked away. The address only added confusion. It clarified very little and arguably contained little which could be merited as leadership.

Releasing lockdown was a critical moment in the pandemic. Messaging needed to be direct and crystal clear. Instead, the Prime Minister presented the country with a series of dates which were “dependent on a series of big ifs”. There were five tests, which few would remember, and a Covid-19 alert level system not dissimilar to that used for signalling the nation’s terrorist threat level. There was little substance.

“And though it is right to be flexible in our response. I believe that as Prime Minister of the United Kingdom — Scotland, England, Wales, Northern Ireland, there is a strong resolve to defeat this together. And today a general consensus on what we could do. And I stress could. Because although we have a plan, it is a conditional plan.

Speech: Prime Minister’s statement on coronavirus (Covid-19): 10 May 2020

From this moment, messaging around the easing of lockdown and any signalling that may have existed about the future management of the pandemic, started to breakdown and fragment. The nation wanted and needed guidance to a path out of lockdown. It needed to hear a clear plan delivered in bite-size chunks which were easy to digest. What follows is a transcript of a snippet of what Mr Johnson said to the country precisely as he said it.

We said that you should work from home if you can, and only go to work if you must.

We now need to stress that anyone who can’t work from home, for instance those in construction or manufacturing, should be actively encouraged to go to work.

And we want it to be safe for you to get to work. So you should avoid public transport if at all possible — because we must and will maintain social distancing, and capacity will therefore be limited.

So work from home if you can, but you should go to work if you can’t work from home.

And to ensure you are safe at work we have been working to establish new guidance for employers to make workplaces Covid-secure.

And when you do go to work, if possible do so by car or even better by walking or bicycle. But just as with workplaces, public transport operators will also be following Covid-secure standards.

And from this Wednesday, we want to encourage people to take more and even unlimited amounts of outdoor exercise.

Speech: Prime Minister’s statement on coronavirus (Covid-19): 10 May 2020

From the transcript, which can be read and re-read, it appears that lockdown has just ended for construction workers. There is a succession of statements in which ‘work from home’ is mentioned. In the first sentence, ‘only go to work if you must’ is a new way of describing the terms and state of lockdown. Up to this point, ‘essential workers’ went to work. Now, he is asking people who do not need to go to work because they must, to go to work. But what of people working from home? Well, they should work from home if they can but go to work if they can’t work from home!

This was not immediately or easily understood by a listening nation. Those who watched the address would have turned to the person sitting next to them and embarked on unpicking what had just been said.

This address left the nation very confused. So, why not say:

"It is time to start getting the economy back on its feet. To do this we shall take things one step at a time by asking certain sections of the Great British workforce to return to their places of work."
This is a primer. It inflates people and prepares them for the message: some people are going back to work.
"Currently, most workplaces are closed because the vast majority of people who work in them — construction or manufacturing — are staying at home to protect the NHS and save lives. Some businesses are working because they have people who are able to continue doing their job by working from home. Then there are business which have been closed by law, like cafes, bars, pubs and restaurants, so their workers cannot work until those businesses is allowed to open again. And not least, there are our frontline and essential workers, who have been doing a heroic job to keep our essential services running throughout the lockdown period."
This clarifies the categories of worker.
For now, those businesses which are closed by law will remain closed. So, if you work in one of those businesses — bars, restaurants and hospitality — you should continue to stay at home.
There is also no change for people who are working from home. So, if you are working from home you should continue to do so.
If you are an essential worker, you should continue doing your essential work.
The change we are making today is for those of you who need to go to your workplace in order to do your job — construction and manufacturing. If you are currently staying at home because you are not an essential worker, then you should now go back to work.

Clarity is a vein which runs continuously through an entire context. Explaining who should go back to work and who should stay put is made harder by the lack of any definition. Clarity requires definitions and a set of standard forms. In trying to be clear in this short excerpt, it becomes clear that types of worker have not been clearly identified.

Who are the ‘work from home’ people? Who are the people who need to go to a place of work in order to work? Who are the people who do not go to work because they must? Who are essential workers?

Providing a name or a tag for each category of worker would make describing changes in their work status — whether they are to remain in lockdown or to start going to work — much clearer.

For the purpose of clarity in the pandemic emergency, it is necessary to assign names or labels to the type of employee or worker you may be.
If you are an essential worker you are GBWF-100.
If you are able to work from home you are GBWF-200.
If you need to travel to a workplace in order to do your job, but are not an essential worker, you are GBWF-300.
If you work in a business which is closed by law, you are GBWF-400.

If nothing else, this introduces the idea and an understanding that there are sections of the workforce which may be locked-down and not working, locked-down and working, or not locked-down at all. It promotes an understanding that different sections of the workforce of the economy have to be managed in different ways during the national emergency. The message could then be more concise and much clearer:

"It is time to start getting the economy back on its feet, etc...
Currently, most workplaces are closed and not working because, etc... But today, we intend to get some of those businesses back on their feet.
For now, there is no change for GBWF-200 and GBWF-400. If you are working from home you should continue to do so, and if you work in a business that is closed by law, you should continue to stay at home.
The change we are making today is for GBWF-300. If you are in this category then you should now go back to work. This includes construction workers, factory workers ...

The first major message to the public about the ending of lockdown was a failure.

Summer came. Holidays returned. People went on holiday and couldn’t get back, or had to come back early or in a hurry. The UKs exam grading computer system was a disaster. Eat Out to Help Out came. And then it went. Summer went.

Entering the fourth quarter of 2020, the UK was once again in trouble. Schools returned but education was a mess. On 4 September, the Transport Secretary, Grant Shapps, acknowledged that rules regarding quarantine in the UK were “confusing”. Infections were rising. Pressure was, once again, building on health services with younger age groups being admitted to hospital. Deaths started to increase. Heavy fines are introduced for those who refused to self-isolate and fines for breaking pandemic rules were increased.

Students returned to university and significant numbers were promptly plunged into self-isolation. Lectures were non-existent and most learning was conducted remotely.

A new three-tier system of restrictions was introduced on 12 October 2020, ranging from 1 to 3, in an attempt to regulate the prevalence and spread of the virus on a regional basis. There were ‘pockets of resistance’, such as Liverpool and Leicester, where infections remained stubbornly high. They were placed in the highest tier which attracted objections over clarity and necessity.

The population was now discussing tier levels and the restrictions they imposed on their movement and social contact. Could they travel in and out of their tier? How many can mix? Who can they see and where? There were no mechanisms to regulate movement and the tiers introduced confusion about who could mix with who. As a result, under the many, varied tiers of restrictions placed on regions, cities and towns, where on a highway which forms a boundary, a pub on one side of the road could be open and a pub on the other side was closed, pandemic rules became scattered, imprecise and diluted. Respect for the rules was being eroded.

The tier system proved ineffectual. Infections continued to rise. 21,915 new cases were recorded on 31 October and accompanied the announcement of another lockdown to commence on 5 November for a month — Lockdown 2.0. The furlough scheme was extended until December, but as the lockdown began, Rishi Sunak extended the scheme until the end of March 2021.

On 11 November the death toll was 50,365 — a milestone.

On 10 November, a new variant found in Denmark was mentioned in Parliament by the then Health Secretary, Matt Hancock. He used it as a reason to be vigilant.

This rang alarm bells! I had my suspicions that this was a precursive tactic, a method for introducing the public to variants of concern, because one was on the way.

Sure enough, on 14 December 2020 Matt Hancock reported a variant of concern, designated B.1.1.7 and known as the Alpha variant. However, it is thought to have originated as early as September 2020 and detected in November from samples taken in September. At the point of announcement, it had already been found in 1,108 cases, and its increased transmissibility meant it quickly became a big problem.

Despite a month-long lockdown, which saw a fall in infections, and a toughening of the tier system in early December, in the week before Christmas it became clear that tiered restrictions were failing. Cases were rising again, and in the space of a week had almost doubled to 35,928.

Christmas was effectively cancelled on 19 December. London and the South East was placed into the new Tier 4 restrictions and household mixing for the rest of England was limited to Christmas Day.

There was an immediate rush to escape London by rail, but many people who had planned to travel home for the festive season found themselves stranded in the South East.

On 6 January 2021, the country entered a third national lockdown.

2020 was a pandemic management disaster, and this was primarily because government thinking was dominated by short-termism.

Arguably, the political ideology of the Conservative government was a significant factor in the government’s approach to pandemic restrictions. Its political beliefs fundamentally conflict with the requirements of the pandemic to restrict and regulate social interaction and geographical movement.

Parliamentary voting on the proposed Covid tier system revealed significant resistance from within the governing political party. Again, arguably, the political views and principles of the government generated a short-term mindset — a desire to apply minimum restrictions for the minimum period possible, and a desire to lift them as swiftly as possible. This deep distaste for restrictions and sustained political pressure from those within the party who believe them to be fundamentally wrong, was an intellectual distraction for the government from a public health crisis.

I would argue that this stoked an excessive sense of urgency in government to escape restrictions and lockdowns, and that it quickly developed a politically driven reluctance to impose them.

Urgency to escape restrictions starved attention to detail and curtailed sufficient thought to strategies for the lifting of restrictions, so that they were released prematurely, with insufficient planning, poor direction, no foresight whatsoever, and contained measures which lacked clarity.

Reluctance to impose restrictions promoted a minimal approach to a national crisis, which saw constant daily changes to regulations, repeated updates and corrections to everything, multiple extensions of end dates, and sluggish or late reactions to both obvious trajectories and sudden changes in an expectedly fast-moving situation. The government was far from nimble.

Government communication was not aided by a Prime Minister, who was recovering from a serious episode of Covid-19, and possibly as a result, appeared tired and slightly confused, at times.

Taking a Long-term Approach

A long-term approach has several advantages. High among them, is the ability to form objectives and to identify targets. Here’s my stab at it:

1. Objective: A vaccine is required. This requirement could have been established as early as April 2020.
2. Time scale: Development and approval of a vaccine will probably take a minimum of one year.
3. Actions: The virus is spread by human interaction, so this interaction needs to be regulated and controlled until a vaccine arrives — at least a year.
   If full interaction cannot happen for at least a year, then a method of releasing people from an initial lockdown (used to gain preliminary control of the spread and incidence of the disease) and to allow the economy to restart in an adequate but limited way, is required.

The proposal from the Treasury designed to stimulate an adversely affected sector of the economy but which encourages people to mix as much as possible — Eat Out to Help Out — is unwise because it encourages people to mix as much as possible, and therefore, is irresponsible. Treasury proposal: rejected.

• If the economy is only going to restart in a limited way, then government support must be available for businesses and people who cannot operate or work at full, or any, capacity. This ‘cost’ needs to be defined as a long-term investment in the country and not a short-term expense (to be paid back asap).
• These established realities can be transmitted to the public to provide orientation and a sense of purpose.
• The target is the vaccine, for which weekly progress reports can be published to maintain public trust, morale and interest.
• The likely cost of the pandemic can be properly assessed and transmitted to the public as a long-term investment in the country by the government, a package of measures designed to finance the country through the national emergency and to transition to a post-pandemic world.
• With the vaccine aim point established in the public consciousness, the importance of ‘restrictive’ measures designed to allow everyone to live some kind of life but which provide a measure o protection for the vulnerable until a vaccine arrives, can be explained and underlined.
• The vaccine endpoint underwrites the restrictions as temporary.
• The prize of a vaccine provides real purpose to all measures, such as masks, social distancing, shielding and limited mixing.
• The endpoint is the justification and the motivating factor.

2. Loss of Vaccination Momentum

At the end of March 2021, the vaccination effort lost momentum.

The initial rollout, which commenced in December 2020, was well-organised, well-paced and exuded an enthusiastic sense of capability.

In April, younger age groups were offered the vaccine and at this point there was a tangible loss of momentum, as the chart below illustrates.

First dose frequency reduced dramatically from the moment the vaccine was offered to age groups under 50. The campaign was not aided by speculation that vaccine stocks could run low into April. Only half of those in their 30s had received a first dose by mid-May.

In an NHS England press release in early June, NHS England chief executive, Sir Simon Stevens, said: “Tomorrow is a watershed moment as the world-beating NHS vaccination programme enters the home straight of our race to offer everyone their first dose.”

It is not that the vaccination effort is not praiseworthy. It was outstanding, and uptake was extremely good, to start with, but the attitude expressed by the chief executive transmits a sentiment of ‘job done’ rather than directly and unequivocally expressing cautious optimism in the full knowledge that Covid-19 is not over. Sir Simon appears more eager to attribute a world-beating accolade to the rollout than to carefully signal and manage public health perceptions. The phrase ‘home straight’ is misleading. It refers only to the first dose being offered to 3 million in “the last group of adults” aged between 25 and 29. With lower age groups still to be vaccinated and rumblings about a ‘booster jab’ for the over-50s, but no clear information, this was no ‘home straight’. There was still some way to go.

In the same press release, politicians did the same. The Health and Social Care Secretary, Matt Hancock said the vaccination programme was “the largest and most successful in NHS history” with “one of the uptake rates in the world”. Vaccines Minister, Nadhim Zahawi said it was “yet another incredible step forward in our journey back to normality”.

These statements are overly optimistic and promote a sense that the pandemic is ending, which has a relaxing, demotivating effect on people. The message is that there is no urgency anymore to get jabbed.

Why not a more sober line: “The NHS vaccination programme continues on track and at pace as we prepare to offer the vaccine to the 25 to 29 age group”?

However, the argument to vaccinate ‘the young’ was already partially lost because since the beginning of the pandemic ‘the young’ have been led to believe that Covid-19 is less severe in the ‘the young’ and therefore, not a threat to ‘the young’. Instilling a sense of urgency to ‘get jabbed’ was always going to be harder in this age group.

It is just as important that the young — 18 to 40s — are as vaccinated as the old because they are the most mobile section of society.

From July, overall vaccination reduced as fewer of the younger population took-up the vaccine. At the same time, the vaccine effort was being optimised into the Autumn with pop-up centres closed and GPs stood-down.

This loss of vaccination momentum is yet another example of the absence of a long-term strategy. Indeed, the scaling-back of vaccination resources indicates that during the Autumn, even the government was beginning to believe that Covid-19 was in its death throws.

3. Dismantling Simple Tools of Greatest Effect

On Monday 13 December, the UK Prime Minister, Boris Johnson, reported the first known death in the UK from the Omicron (B.1.1.529): SARS-CoV-2 Variant.

It was first noted as early as 4 November by South African scientists and was first publicly reported as a variant of concern in the UK media on 25 November. It was designated ‘Omicron’ on 26 November by the WHO.

The UK government’s immediate response was to place a number of African nations on its travel red list, a move which was met with outrage from many of those countries on the list.

The next day, Saturday 27 November, two cases of the new variant were confirmed in England and, in a Covid briefing, face masks were reintroduced.

On Monday 29 November, it was announced that the booster jab would be offered to all eligible adults in the UK by the end of January 2022.

Reintroducing face masks, if only on public transport and in shops, was a huge move backwards by a government which stated that the cancellation of restrictions on 19 July was “hopefully” irreversible. No one will have heard the hopeful sentiment from a government which allowed the day to be cast as ‘Freedom Day’.

Irreversibly scrapping the requirement to wear masks was an unwise position to adopt, even on a ‘hopefully irreversible’ basis, given that most of the world was not vaccinated and would not be inoculated for years to come.

It was a bold move because the government has a significant collection of vocal back-benchers, and a growing number of cabinet members, who would rather let the virus rip and see their public, their nation’s workforce, and their nation’s health service on its knees before admitting that compelling people to wear a piece of cloth over the nose and mouth is not an intolerable and outrageous infringement of civil liberties.

The reintroduction of compulsory mask wearing was an admission of defeat and a demonstration of just how naïve the government had been.

I had already been reading everything I could find about Omicron, but this move to reintroduce masks and what felt like a desperate effort to step-up the booster programme, prompted me to read more.

It quickly became obvious, at least to me, that this was a big moment in the pandemic. Scientists were clearly shaken by the number and nature of the mutations they were observing in Omicron, and by its rate of transmission.

The natural first thought is, how bad is it? South African scientists were quick to indicate that it appeared to be less severe. There were caveats, which have existed ever since, that South Africa has a very different demographic and direct comparisons should not be made. Nevertheless, in keeping with human nature, much has been made of the idea that it may be a less severe version of the disease, in a kind of group or crowd wishful thinking exercise, but the immediately obvious, very troubling potential of Omicron stems from its prevalence and transmissibility. It is simple maths.

For example, if Delta infects 10,000 people in four days and one percent are hospitalised, then 100 people are going to hospital. If Omicron infects 40,000 people in 4 days, because it is four times more transmissible, and if we assume it is half as severe so that only 0.5% are hospitalised, then 200 people are going to hospital. Twice as many people from four-times as many infections end-up in hospital, despite the variant being less severe.

The other branch of optimism that some are clinging to, is that if Omicron is less severe then hospital stays will not be as long. However, if the above maths is correct, there are still twice as many people in hospital with Omicron than with Delta. 100 Delta patients occupying beds for ten days is 1000 bed days. 200 Omicron patients occupying 200 beds for half as long (five days) is still 1000 bed days. However, the pressure on the health service is greater because more beds have to be found/occupied, albeit for a lesser period of time.

What if Omicron, despite all the ‘preliminary results’ and ‘early data’ is not less severe within the UK demographic? What if, in the example given above, the 40,000 Omicron infections present the same one percent hospitalisation risk as Delta? If Omicron is as severe as Delta then 400 people will be on their way to hospital at some point in the near future.

This is why scientists are so concerned and have called for urgent action since the beginning of December. And it could not have happened at a worse time, Winter, when demands on health services are at their highest. The severity of the disease is an important factor, but even if it is half as severe, the numbers of people Omicron is capable of infecting presents a huge potential risk.

So, by late November the UK was coming to terms with the return of face masks and a step-up in the booster programme. In yet another announcement, on 30 November, there was to be a deployment of “at least 400 military personnel to assist the efforts of our NHS”. Matters were moving fast, and although the government was moving swiftly and with urgency, there was also a feeling of desperation in the government’s actions.

Politically, the government had tied its own hands, unable now to take any precautionary measures, or make any ‘just in case’ argument. Such a line of action would, bizarrely, never pass the government’s staunch, anti-restrictions back-benchers, and members of cabinet. It could not do more without further solid scientific evidence, but hard evidence was sketchy and is still forming slowly, at the lagging pace of analysis of the new variant’s progression through the population. With precautionary measures no longer an option the government has put itself in the weakest possible position — reactive. There is a political balancing act between public health and an internal Party political division which is voiding the government’s ability to manage the pandemic. Any decisions it takes or measures it introduces will be too late. All that remains in government is hope — a hope that Omicron turns out to be not too bad!

The impression of desperation in government was also driven by the fact that the vaccination infrastructure which delivered a record number of ‘jabs’ in record time had been dismantled to a point where any required increase in demand would cripple the system in the short-term. This explains the sizeable armed forces involvement.

Cancelling the need to wear face masks was perhaps the greatest mistake. Masks are the clearest and most tangible signal that the pandemic is not over. They portray an underlying level of awareness and preparedness, a resilience, should further challenges arise. This advantage was squandered.

Vaccination is the pathway out of the pandemic but, by late summer, the vaccination effort had slipped into a more laid-back, cruise mode. This loss of momentum is the second greatest mistake.

The tools of greatest effect were squandered and allowed to decline. The messaging advantages of these factors has been missed by government, which is, frankly, astonishing. Even more astonishing is that the government appears to have been ignorant of the fact that bringing back ‘irreversible’ measures and stepping-up declining efforts is not only annoying, but also causes surprise, or worse, strikes fear, even panic.

So we are left only with hope. While other parts of the UK are taking a precautionary approach, in England, the government is hoping that its Plan B will be enough because there is little more it can do.

As I write, the NHS is short-staffed, critical incidents are being triggered across England, and the military is helping-out in places. We can only hope that the government has got this right. The government has little choice but to hope that it’s got it right.