THE UK now has the highest absolute excess deaths in Europe, 59,537 more than usual since the week ending 20 March, and the second highest per million people, behind only Spain for countries with comparable data, according to a Financial Times analysis. The total number of confirmed covid-19 deaths at the time of writing was second only to the US, and was still rising by more than 100 a day. But why?
Slow Reaction To The Pandemic
“We have been playing catch-up from the start,” says Helen Ward at Imperial College London. She cites slowness on testing, tracing and isolating people, and on social distancing. A national lockdown wasn’t imposed until 23 March, about two months after the country’s first confirmed case.
Neil Ferguson at Imperial, who was a member of the government’s science advisers, the Scientific Advisory Group for Emergencies (SAGE), until early May, says that while the high number of deaths is partly down to the UK being so connected to the rest of the world, speed was also a factor. “Part of it is clearly down to implementing lockdown relatively later than other countries did,” he says.
Slow Development of Testing
Testing levels are now fairly high, but Conservative MP Greg Clark, chair of the House of Commons science and technology committee, has described them as “inadequate for most of the pandemic”. The bottleneck seems to have been the government’s decision to rely on a small number of centralised laboratories run mostly by Public Health England (PHE), rather than involving the UK’s many private labs, research institutes and universities. The decision was “one of the most consequential made during this crisis”, Clark said.
Yvonne Doyle at PHE has said that tests could at first be done only by labs rated as category level 3, the second highest in the UK’s biosafety standards. “That meant very few laboratories initially could do that,” she told the science and technology committee on 22 May. On 1 March, regulations were relaxed to allow some work to be carried out by level 2 labs, which Doyle says was key to increasing capacity.
Slow on Symptoms & Tracing
Gabriel Scally at the University of Bristol, UK, describes the suspension of tracing in the UK, early in the crisis, as “the single greatest mistake”. Although London had a high incidence of cases then, he says, other parts of the country didn’t and tracing could have made a difference.
Good on NHS Capacity
One bright spot has been that NHS intensive care and ventilator capacity were built up quickly and the system wasn’t overwhelmed.
PPE in Short Supply
Personal protective equipment (PPE) has often been in short supply for health workers, something Scally blames on the UK being “late into the market” to buy more. And communication on PPE from the government to health professionals has at times been “confused or confusing”.
Care Home Population Let Down
After hospitals, most covid-19 deaths have been in care homes. Provisional figures suggest there had been 12,739 deaths involving covid-19 in care homes in England and Wales by 22 May. “I think in common with other countries, we have failed the population in care homes,” says Ferguson, who believes more testing could have stopped the virus entering them. Patients discharged from hospitals to care homes were only routinely tested in England from mid-April.
Communicating on Symptoms
The UK has also been much slower than some countries in telling people what covid-19 symptoms to look out for, with a heavy focus on cough and fever. The virus has been linked to many other symptoms, including sore throat, runny nose, headache, vomiting and diarrhoea. A loss of taste and smell was added to the UK’s list of symptoms on 18 May, more than a month later than in France.
The Public Have Done Well – The Government Probably Less So
Scally says the public’s adherence to restrictions has been exceptional so far. However, King fears that may be undermined by potential breaches of guidance by the prime minister’s adviser, Dominic Cummings. “The potential is many people will take less seriously further public health messages from the government. I fear the moral authority has been lost,” he says.
Given the unprecedented nature of the epidemic, Scally says any government would have made poor decisions at times, but “never have they admitted they got anything wrong, or said they are sorry for an action or inaction”.