The Challenge of Controlling COVID-19. Lewis, Jane
to these two very different problems are striking. It is also important to remember that the background to these problems was one of austerity over the previous decade, particularly for local government, which has operational responsibility for public health work on the ground as well as responsibility for shaping the social care market.
The aim is not to attribute blame, for example, between Government ministers and scientists (see Cairney, 2020 on this), or to come to conclusions as to what should or could have been done, which would require a much closer interrogation of the scientific evidence available, as well as establishing who knew what about the pandemic when, and to whom the information was passed. Rather, I use primary, documentary sources and historical methods in order to explore the policy decisions on pandemic control that were taken and what characterised the nature of decision-making. I present a chronological, detailed account and analysis of the establishment of the TTI system and the problems experienced by care homes, from which cross-cutting themes are identified and discussed. While chronology in and of itself explains nothing, it is a basic underpinning for the analysis of a fast-moving pandemic. It stretches the concept of contemporary history to attempt analysis of an issue as soon as I do here, but my attempt is closer to this than ‘high journalism’, which necessarily focuses on providing an even more immediate commentary. In short, historical analysis is usually inductive, relying on as extensive an exploration of the documentation as possible in order to arrive at explanatory variables. My analysis is thus not theoretically driven, but provides support for the importance of some of the frameworks that have been used and developed by political scientists in the course of their early inquiries into the policy response to COVID-19, particularly the degree and nature of centralisation, the effect of fragmentation, and the difficulty of securing coordination (see especially Gaskell et al, 2020; Weible et al, 2020). I focus particularly on the period from early March to 19 June 2020, when the threat level from the virus was lowered from 4 to 3 by the new Joint Biosecurity Centre,7 with a somewhat less detailed account of what followed between July and September, when the threat level was once again raised to 4 as the infection rate rose.
1 The approach to the early stage of the pandemic by politicians and scientists
The UK Government had substantial warning about the new coronavirus and, in broad outline, what they might expect. The first death in China was announced on 11 January 2020, and the first confirmed cases appeared in Italy and the UK at the end of January. The first death occurred in England on 5 March. The World Health Organization (WHO) declared a public health emergency of international concern on 30 January and confirmed the existence of a pandemic on 12 March. By the end of January, it was clear that the virus was being transmitted from person to person, that it had a serious effect on those contracting it, and that there was the potential for it to become a pandemic. Commentators have broadly agreed that the UK Government was nevertheless slow to acknowledge the seriousness of the situation and to respond; the editor-in-chief of the British Medical Journal recorded the verdict of their editorial writers as: ‘Too little, too late, too flawed’ (Godlee, 21 May 2020). However, not all contributions from academics have agreed (for example, Cairney, 2020).
The Government considered that it was well prepared for the pandemic. Prime Minister Johnson made this clear after he chaired his first COBRA1 meeting on 2 March – in fact the fifth that had been held on the new coronavirus – when he said: ‘…let me be absolutely clear that for the overwhelming majority of people who contract the virus, this will be a mild disease from which they will speedily and fully recover … Our country remains extremely well prepared, as it has been since the outbreak began in Wuhan several months ago’ (Johnson, 3 March 2020). However, the opportunity to make preparations during February had been missed. It may be that preparations for Brexit on 31 January absorbed the Cabinet’s attention in January, but in February and early March, it seemed that the Government was inclined to believe, and certainly said, that the virus would be moderate in its effects.
While the UK Government was not alone in the lack of urgency of its response, when compared to countries such as South Korea, Singapore, Germany and Ireland, it was desultory. No objection was raised to holding large sporting events: rugby at Twickenham in the first week of March, when cases rose fivefold and deaths eightfold; horse racing at Cheltenham over four days from 10 March; and football involving Liverpool and Atlético Madrid on 11 March (just as the number of confirmed cases in Spain began to rise steeply). From late January to early March, non-mandatory guidance to self-isolate for 14 days was extended to travellers from designated high-risk countries (China being the first), but these did not include Spain. Nor was any testing or screening carried out. Self-isolation guidance at the borders was abandoned on 13 March and not reinstated until 8 June, when a 14-day quarantine system was announced for arrivals from across the world, although a number of countries (the list changed over time) were exempted on 10 July. Between 13 March and 23 March, when the UK ‘locked down’, the evidence suggests that thousands of new infections were brought into the UK from Europe (HoC Home Affairs Committee, 5 August 2020, para 73).
The Prime Minister continued to behave ‘normally’, shaking hands and attending the Twickenham rugby match in early March. But on 12 March the Government performed a ‘screeching u-turn’, when the PM’s television address admitted that this is ‘the worst public health crisis for a generation … many more families are going to lose loved ones’. This prompts further exploration of the relationship between Government actions and the advice that it was receiving; after all, it insisted from the beginning that it was following the advice of scientists. While the details as to how the Government treated advice – for example, which scientific view was favoured when and why must await an official inquiry (although this will likely be politicised) – it is possible to outline some of the issues and the advice that has since become publicly available. It is also possible to consider further the Government’s pattern of thinking about, and the key dimensions of its approach to, controlling the virus. Politicians were slow to react and much in need of advice on controlling the pandemic, but the relationship with scientists was far from easy.
The main debate in the literature so far has centred on the failings of scientific advisers and politicians with the inevitable tendency to blame one party more than the other. But the evidence suggests that there are some difficulties with taking a clear-cut position on this. There was no one ‘scientific view’ on offer and as Salajan et al (2020) have pointed out, while decision makers may prioritise expert advice, they are challenged by scientific uncertainties. The UK Government did not ignore the views of scientists, but they may have had difficulty using often far from united scientific opinion to reach the policy decisions that they, and not the scientists, were responsible for taking. In addition, there may also have been limitations as to the nature of the advice that was offered by those sitting on the bodies that advised Government, probably due in part to the relatively narrow range of specialities represented.
Historically, epidemics have been controlled by public health doctors and their staff at the local level, exercising the authority provided by law, and using above all the well-established tools of testing, tracing contacts, and quarantining/isolating.2 The central public health body involved in the control of COVID-19 was Public Health England (PHE), set up in 2013 by the Conservative/Liberal Democrat Coalition Government as an arms-length executive agency with operational autonomy, but responsible directly to the Department of Health and Social Care (DHSC) and the Secretary of State for Health and Social Care. PHE was created by the 2012 Health and Social Care Act following the then Secretary of State’s (Andrew Lansley) major reorganisation of the NHS and has operated alongside a large number of other central health organisations, most importantly NHS England (NHSE), which