There are good things to say about the response to the pandemic. The response of health service staff is beyond reproach. Many people in hazardous occupations – cleaners, refuse workers and police – have carried on despite an almost complete absence of appropriate protections. The public have behaved wonderfully. The central response to a plague is not to ensure 100% compliance from every individual: it’s for enough people to change their behaviour to make an impact, and that’s certainly been happening.
Unfortunately, the same cannot be said for government or for the public authorities. The most obvious problems have been about preparedness – it’s not as if there were no warnings – and procurement. This comes from The Lancet:
February should have been used to expand coronavirus testing capacity, ensure the distribution of WHO-approved PPE, and establish training programmes and guidelines to protect NHS staff. They didn’t take any of those actions. The result has been chaos and panic across the NHS. Patients will die unnecessarily. NHS staff will die unnecessarily. It is, indeed, as one health worker wrote last week, “a national scandal”. The gravity of that scandal has yet to be understood.
Then we have a series of misleading statements from the government about what is happening. Some are prevarications – that discussion of strategy is impossible at this stage, that there is consolation to be drawn from the horrifying figures, and so on. But some have been downright lies: that the Prime Minister was in good spirits and actively engaged at the point where he was about to go into hospital, that 19 members of NHS staff had died when the government already knew there were 36, or that there is a full supply of personal protective equipment when the ministry has deliberately degraded the acceptable standard of that equipment. The government is behaving as if it had a monopoly of information, which it doesn’t, and that it is not open to scrutiny or discussion, which it must be.
And then there are the mixed messages, usually preceded by the fatuous claim that ‘we have been perfectly clear’. Confusion is easy: two prominent public figures have been pilloried for taking steps that were within some guidelines and not within others. For the avoidance of doubt, social distancing (or physical distancing) is not the same as staying at home, and staying at home is not the same as isolation or quarantine. Having a ‘reasonable excuse’ for travelling is not the same as ‘travelling only for expressly permitted tasks’. The government seems to favour ‘stay at home’ as a message, thinking (disputably) that it is straightforward, but it is a message with exceptions; it’s really not clear why they think this is more likely to be effective than ‘keep your distance’.
There’s a bitter lesson to be drawn from France, where the rules have been much stricter but the spread of the disease has been at least as bad and arguably worse. What matters is breaking connections that lead to cross-infections. The current strategy may be having an effect, but what we can’t tell in the absence of decent information is how large that effect is, or whether it’s enough.
That leads us back, in a circle, to the mismanagement of the problem – the failure from the earliest days to test and trace. We have few usable indicators: verified hospital admissions and deaths (the ONS is adding in deaths not in hospital). I very much doubt that the government does not have stats for notifications of COVID-type illness made to NHS 111 – it is, after all, a notifiable disease – and they should be pressed to release them. There may, too, be another indicator that we have the capacity to obtain: the presence of COVID-19 in sewage. The purpose of indicators is not to obtain a precise and accurate individual count: it’s to see the general direction of movement when taken along with other indicators. Indicators travel best in convoys. Given the lack of general community testing, it’s the best we can do.