Decisions on lockdowns and social distancing during the early weeks of the pandemic ‘one of the most important public health failures the United Kingdom has ever experienced’
The Commons Science and Health Committees have published a critical report into lessons learned from the UK’s initial pandemic response.
The report found that ‘decisions on lockdowns and social distancing during the early weeks of the pandemic—and the advice that led to them—rank as one of the most important public health failures the United Kingdom has ever experienced’.
The 150-page report makes 38 recommendations, and found that delaying the first lockdown was a ‘serious error’ but that the COVID-19 vaccination programme was ‘one of the most effective initiatives in UK history’.
The 22 select committee members from the Conservative, Labour, and Scottish National Party unanimously agreed the findings. The inquiry began in October 2020 and took evidence from more than 50 witnesses, including the Chief Medical Adviser, Professor Chris Whitty, and more than 400 pieces of written evidence.
Big achievements, big mistakes
In a joint statement, the Committee Chairs, Jeremy Hunt and Greg Clark MP, said: ‘The UK response has combined some big achievements with some big mistakes. It is vital to learn from both to ensure that we perform as best as we possibly can during the remainder of the pandemic and in the future.
‘Our vaccine programme was boldly planned and effectively executed. Our Test and Trace programme took too long to become effective. The Government took seriously scientific advice, but there should have been more challenge from all to the early UK consensus that delayed a more comprehensive lockdown when countries like South Korea showed a different approach was possible.
‘In responding to an emergency, when much is unknown, it is impossible to get everything right. We record our gratitude to all those—NHS and care workers, scientists, officials in national and local Government, workers in our public services and in private businesses, and millions of volunteers—who responded to the challenge with dedication, compassion, and hard work to help the whole nation at one of our darkest times.’
Among the report’s findings:
there was a ‘fatalism’ about the spread of COVID-19 that caused delays in the first lockdown
delays setting up an adequate test, trace, and isolate system hampered understanding of the outbreak, failed to contain it, and didn’t avoid lockdowns
insufficient priority was given to social care early in the pandemic
it was unacceptable that black, Asian, and minority ethnic (BAME) staff did not have equal access to appropriate personal protective equipment (PPE)
vaccine planning and deployment should be a guide to future Government practice
the pandemic highlighted the need to tackle health inequalities
although the UK was said to be well prepared for a pandemic, it performed less well than many other countries.
Other recommendations included:
there should be monitoring of surge capacity as part of long-term NHS organisation and funding
new NHS protocols are needed for infection control, staffing, and bed capacity
the flexible approach to NHS pandemic staffing should lead to subspecialty training, making it easier for staff to change speciality mid-career
an NHS volunteer reserve database should be set up for volunteers who have had appropriate checks who can then be rapidly called up
there should be wider expertise on the Scientific Advisory Group for Emergencies, and precautionary decisions early in a pandemic could be made ahead of scientific evidence
NHS BAME staff should be included in future emergency planning and decision making
better provision should be made for people with learning disabilities
‘do not attempt cardiopulmonary resuscitation’ guidance must be widely understood, especially in cases where carers or advocates cannot be with patients
an assessment should be made about whether regulatory approvals could have been speeded up, including by using human challenge trials.
‘Pandemics like COVID-19 will become more common’, the report concludes. Overall, it said that the UK’s responses were too reactive rather than anticipatory, but the report did ‘not seek to apportion blame’.
Commenting on the report’s finding, Dr Chaand Nagpaul, British Medical Association (BMA) Chair of Council, said: ‘The UK has suffered one of the worst tolls from COVID in the Western world, in terms of numbers of cases, hospitalisations, and deaths. The report gives well-deserved praise to the development and deployment of one of the most successful vaccine programmes in history, which was delivered largely by the hard work and dedication of doctors and healthcare staff.
‘The report also reveals the significance of the failures from the very start of the pandemic. It highlights several consequential mistakes, which have been flagged by the BMA, including delays in implementing robust public health measures such as the initial lockdown, when it was clear the virus was spiralling out of control.
‘Lives were lost due to the Government’s delay to bringing in the initial lockdown, ignoring scientific advice at crucial junctures, and the institutional failures of Test and Trace. The way in which the Government abandoned social care, the inadequate provision and supply of PPE, and the lack of proper health risk assessment, especially for black, Asian, and ethnic minority staff, forced health and care staff to put their lives at risk to protect their patients.
‘The Government must take on board this report’s 38 recommendations and learn from the mistakes it has made, starting now. We are far from out of the woods with the pandemic, with rates of infection, illness and death in the UK continuing to be among the worst in comparator nations.’
Dr Dolin Bhagawati, Vice Chair, Doctors’ Assocation UK said: ‘The lessons learned report holds no surprise for frontline NHS staff, who have spent the last 18 months screaming into a void to be heard about these issues, and have been serially ignored to the detriment of the UK population. People died who didn’t need to. Our colleagues’ deaths may have been avoided.
‘The lessons from this report are being ignored even today. Despite nearly 6 million people on NHS waiting lists, hospitals are bursting at the seams, GPs are overworked, ambulance services are at breaking point, and community/mental health services continue to be ignored. It therefore only needs a small number of COVID-19 hospitalisations to push our services over the edge, yet we are continuing to see the same mistakes identified in this report being made today. This does not bode well.’
Other experts have been responding to the findings via the Science Media Centre.
Professor Penny Ward, independent pharmaceutical physician and Visiting Professor in Pharmaceutical Medicine at King’s College London, said: ‘The report is self-congratulatory on the “success” of the vaccine and of the foresight of the Vaccines Taskforce. However, we have failed to ensure sufficient uptake of the vaccination among younger adults and teenagers and some higher risk communities—most notably, those of African heritage—which is at least one possible reason for the continued circulation of infection, resulting in more than 700 hospitalisations and 100 deaths daily, on average, in the UK currently.’
Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, said: ‘The report concludes that an earlier lockdown would have saved lives. This is likely to be correct but is too simplistic, not least because there is disagreement as to how many lives would have been saved. Recently published analyses have concluded that the additional lives saved due to implementing full lockdown restrictions may have been far fewer than was being suggested at the time.
‘Moreover, lockdowns are harmful in their own right. For example, the delivery of non-COVID-related healthcare was severely compromised, and this is now thought to have cost many lives of itself. The Select Committee report does not examine these indirect harms in any detail.’
Trish Greenhalgh, Professor of Primary Care Health Services, University of Oxford, said: ‘One striking feature of the report as a whole is how it hints at a less than healthy relationship between Government and its formal scientific advisory bodies. There is much to digest, but on a preliminary reading, it would appear that even senior Government ministers were reluctant to push back on scientific advice that seemed to go against common-sense interpretations of the unfolding crisis.’
Robert West, Professor of Health Psychology, Department of Behavioural Science and Health, University College London, said: ‘We can expect Government spokespeople to cherry-pick parts of the report that praised its actions, particularly the gamble that an effective vaccine would be produced. However, there is no escaping the damning conclusion that it failed to take crucial public health advice on key decisions relating to Test and Trace and timing of restrictions, and that led many thousands of British citizens to perish. In some countries, this report would lead to resignations.’
A Government spokesperson said: ‘Throughout the pandemic, we have been guided by scientific and medical experts, and we never shied away from taking quick and decisive action to save lives and protect our NHS, including introducing restrictions and lockdowns.
‘Thanks to a collective national effort, we avoided NHS services becoming overwhelmed, and our phenomenal vaccination programme has built a wall of defence, with over 24.3 million infections prevented and more than 130,000 lives saved so far.
‘As the Prime Minister has said, we are committed to learning lessons from the pandemic, and have committed to holding a full public inquiry in spring.’
This article originally appeared on Medscape, part of the Medscape Professional Network.
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