The UK's public health response to covid-19: Too little, too late, too flawed

[muriel_volestrangler]

Editorial in the British Medical Journal:

The UK government and its advisers were confident that they were “well prepared” when covid-19 swept East Asia. The four-pronged plan of 3 March to contain, delay, research, and mitigate was supported by all UK countries and backed, they claimed, by science.1 With over 30?000 hospital and community deaths by 12 May, where did the plan go wrong? What was the role of public health in the biggest public health crisis since the Spanish flu of 1918? And what now needs to be done?

What is clear is that the UK’s response so far has neither been well prepared nor remotely adequate (see infographic). The weakness of the preparations was exposed in 2016 by Exercise Cygnus, a pandemic simulation, and the necessary remedial steps were not taken. On 30 January, the World Health Organization declared a public health emergency of international concern and governments were urged to prepare for global spread of covid-19 from East Asia. Detailed case studies followed showing the need for high levels of mechanical ventilation and high death rates. But the UK ignored these warnings.


...
One day later, the government inexplicably announced a move from the containment phase in its strategy to the delay phase. Chris Whitty, England’s chief medical officer, explained it was no longer necessary to identify every new case and that all testing capacity across the UK, despite major regional variation in cases, would be “pivoted” to hospital patients. NHS 111 and Public Health England teams working on contact tracing were confused and overwhelmed. WHO’s standard containment approach of find, test, treat, and isolate, which has worked well in countries that have successfully suppressed viral spread, was abandoned; entry via ports and airports remained unrestricted. There was no future plan for community based case finding, testing, and contact tracing. Procurement and delivery of testing resources was ineffective, despite a readymade viral test and offers of help from university and private sector laboratories.

On 19 March, the status of covid-19 was downgraded from level 4, the highest threat level, to level 3 by the four nations group on high consequence infectious diseases and the Advisory Committee on Dangerous Pathogens. This enabled the required standard of personal protective equipment to be lowered for staff in hospitals and to nurse patients in non-infectious disease settings. Meanwhile, a reckless policy of discharging older patients from hospitals to care homes without testing allowed the virus to spread and kick start a second epidemic of community infection.

https://www.bmj.com/content/369/bmj.m1932

There's much more on how public health planning suffered badly during austerity.