Expert Speak Health Express
Published on Sep 23, 2020
A very British Disaster (and Collective Denial) To be ranked among the top 20 countries in the world is usually a cause for celebration, but not when it is a ranking of the 20 countries worst affected by the COVID-19 pandemic. As of early September, the United Kingdom—made up of the four nations of England, Scotland, Wales, and Northern Ireland—has 347,152 identified cases, with 41,552 confirmed COVID-19 related deaths.<1>  About 89 percent of these deaths have occurred in England.<2> That the UK, and the US, are among the worst-hit countries is shocking to their citizens and global health experts. The UK was ranked second (with a score of 77.9 out of 100), after the US (83.5 out of 100), in the 2019 Global Health Security Index jointly developed by the Nuclear Threat Initiative, Johns Hopkins Center for Health Security and the Economist Intelligence Unit.<3>  In light of the catastrophic experience of both countries, the makers of the index clarified in mid-April that all countries were low performers across all their indicators, so even the highest-ranked countries were actually poorly prepared.<4> It remains unclear why the three institutions proceeded with the index and to rank countries if the highest score of 83.5 out of 100 still meant that the country was not adequately prepared for a globally catastrophic biological risk. Clearly, the metrics and aims for index need a re-think.

The numbers

In contrast to the metrics of pandemic preparedness plans and other health security indexes, there are some numbers that reveal truths that are not fungible, such as deaths. According to UK government sources, the official number of deaths due to COVID-19 is 41,552, which only includes those who died within 28 days of testing positive. The greatest number of deaths in a single day (peak) occurred on 8 April 2020, when 1,445 people died.<5> However, another calculation is that about 65,700 excess deaths (deaths that are above what was average from previous years) occurred since the start of the UK epidemic.<6> Based on death records, this number also includes deaths that have occurred outside hospitals, with or without tests, and directly or indirectly due to COVID-19. Whether directly or indirectly caused, and whichever kinds of death statistics one chooses to use, what is clear is that the UK is among countries with the highest death tolls in the world.<7> There will likely be other waves of infections in the months ahead. And, importantly, there will also be deaths and other illnesses from the economic and social consequences of the pandemic and the policies that are being implemented—mortality and morbidity from the ‘social determinants of health.’<8>

The politics

This pandemic has provided a real education for people residing in the UK about the diverse institutions at the federal and other levels. To some, Brexit was about wrenching free from the European Union (EU) headquartered in Brussels, or what seemed like an external and foreign government structure pushing down from above on the central government in London. Yet, just when Prime Minister Boris Johnson and other Brexiters planned to celebrate the withdrawal from the EU, the epidemic arrived in the UK. Some have stated that Johnson disregarded initial warnings about the imminent threat as he was more focused on Brexit celebrations and meetings. Nevertheless, despite formally withdrawing from the EU, people in the UK have learned that their health and wellbeing will still be significantly affected by what happens in European countries as well as in countries far away and inside international organisations. Despite formally withdrawing from the EU, people in the UK have learned that their health and wellbeing will still be significantly affected by what happens in European countries as well as in countries far away and inside international organisations The pandemic has also taught ordinary citizens much about the governance structures in the UK at the centre and from the devolved governments in Northern Ireland, Scotland and Wales to local and city government authorities. This is because different organisations and the authorities did not work together smoothly and seamlessly, with frictions between them all too visible. For instance, as initial pandemic policies were announced, there was no transparency about the membership of the Scientific Advisory Group for Emergencies (SAGE).  This group of experts is meant to evaluate the latest data and recommend policies to the chief scientific advisor and the chief medical officer for England, who in turn recommend policies to the prime minister. Johnson and his advisors were initially keen to pursue a policy of achieving ‘herd immunity,’ immediately raising questions over whether there was any or sufficient public health expertise on SAGE. When the group’s membership was revealed through a leak to the Guardian newspaper, two things became clear—first, there was indeed a lack of sufficient public health expertise; and second, the group included political advisors to the prime minister, meaning that discussions were likely influenced by political considerations instead of only by science.<9> This raised public questions over whether SAGE was fit for its purpose, and the capacities of the chief medical and scientific officers to carry out their roles.<10> In response to the SAGE membership issue, the policies being pursued and the unclear leadership during Johnson’s hospitalisation and recovery from COVID-19, Sir David King, a former chief scientific advisor to former prime ministers Tony Blair and Gordon Brown, set up an group called Independent SAGE, an independent group of scientists working together to “provide advice to the UK government and public on how to minimise deaths and support Britain’s recovery from the COVID-19 crisis.”<11>  One of the issues that the group initially highlighted was the disproportionate number of COVID-19 related deaths among Black and minority ethnic population groups.<12> While this source of experts and expertise outside of government has been welcomed, there is also a view that the group is mostly made up people aligned with the main opposition party (Labour).<13> Since recovering from COVID-19 and returning to work, Johnson has been facing regular crises, almost a new one every week—his political advisor not following stay-at-home orders while self-isolating,<14> poor planning and roll-out of testing,<15> high mortality rates in care homes,<16> physical distancing guidelines,<17> and return to school plans.<18>

The money

The UK’s first COVID-19 death was confirmed on 5 March, with a full lockdown going into action over 20 days later (on 26 March) initially for a period of three weeks.  The stay-at-home orders aimed to reduce transmission of the disease. People could leave their homes only for activities such as essential shopping, limited exercise, to seek medical care, to take care of vulnerable people, and to and from essential work. While this intervention aimed to protect public health, other aspects of social functioning also came to a halt, most notably economic activity. For businesses and activities that could not have employees work from home—such as manufacturing, education and sports—the implication was to stop functioning entirely and, consequently, suffer heavy losses. Any sector that involved physical human contact suffered enormously, including tourism, hospitality, arts and entertainment. It is estimated that by the end of June, GDP had plunged by 20 percent and 275,000 jobs had been lost.<19> The UK’s first COVID-19 death was confirmed on 5 March, with a full lockdown going into action over 20 days later (on 26 March) initially for a period of three weeks.  The stay-at-home orders aimed to reduce transmission of the disease Hopes for a revival of businesses, small and big, and the UK economy lie in the hands of Rishi Sunak, who became the chancellor of the exchequer on 13 February. Overall, the UK has committed to spending over £175 billion as immediate fiscal stimulus as part of its COVID-19 response.<20> Sunak’s first economic intervention was the announcement on 11 March of a £30 billion package, £12 billion of which was to counter the economic impact of the pandemic. Soon after, he announced a further £330 billion in support for businesses and wage subsidies for people currently out of work. In July, a further £30 billion programme was announced, including a pause on property sales below £500,000, cuts to VAT, and bonuses to businesses that retained employees. The amount of government spending since March is the greatest since World War II, and very atypical of the Conservative Party. Moreover, COVID-19 fiscal spending has pushed the UK government debt above £2 trillion for the first time.<21> Sunak has already indicated that he is planning for a second wave of infections in the autumn.<22> A return to normal is unlikely any time soon, and the government will be expected to continue to step in as and when needed.

The people     

By mapping the pandemic journey—along with the phases of discovery/denial, panic, response, adaptation, recovery and renewal—guided by a framework based on established academic theory, one can look across the world to see how people have been reacting to COVID-19.<23> In the UK, people initially were unable to understand the severity of the threat. But Italy’s experience, particularly the shocking images of crowded hospitals and lorries full of coffins, brought the message home. Soon, grocery stores ran out of dry goods, and the only sound in the streets was from ambulances. People quickly understood the health crisis and were quick to show their public and collective appreciation for healthcare workers who were on the frontlines of the pandemic. Most UK citizens and residents have understood that containing the spread of the infection requires behavioural adjustments, whether it is staying indoors, protecting the vulnerable at home, or wearing masks. However, like in most other countries, there are groups of people who still deny that there is a pandemic, and believe and propagate various conspiracy theories about its multiple aspects. Some groups of people have also said they are against using a COVID-19 vaccine, which will become a bigger problem when a vaccine does, hopefully, become available. It is by looking at how average UK residents have responded, rather than at politicians and experts, that it becomes clear that this is not just a health crisis. It is also equal parts a political, economic and psychological crisis It is by looking at how average UK residents have responded, rather than at politicians and experts, that it becomes clear that this is not just a health crisis. It is also equal parts a political, economic and psychological crisis. For every individual and family, the situation has made it necessary to reflect on their relationship with the government—is the government trustworthy?<24> Is it doing what it is supposed to? Am I, my family and friends being treated fairly and justly during this crisis?  How people are answering these questions will undoubtedly affect and transform UK politics in the years to come. The lack of jobs and recession will profoundly affect the economic and psychological wellbeing of the UK’s youth, and consequently also their politics.  Those who have been working at home or those that have lost their jobs and have had to rely on government assistance have primarily adapted.  The problem is that the government wants them to adapt again by going back into the world to work and spend money to restart the economy. As from the start of the pandemic, those with little choice about their work have to take the risk. While others who can stay at home, continue to shop online and wait for safer times to prevail.  However, across the social spectrum, there is still heightened fear of becoming infected with COVID, and suffering its many consequences.<25>
This essay originally appeared in Rebooting the World
<1> Public Health England and NHSX. Coronavirus (COVID-19) in the UK. Public Health England, 2020. <2> UK COVID-19 Statistics. <3>The Global Health Security Index”. GHS Index, October, 2019. <4>The U.S. and COVID-19: Leading the World by GHS Index Score, Not by Response.GHS Index, April 27, 2020. <5> Robert Booth, and Pamela Duncan. “Nearly 1,500 Deaths in One Day: UK Ministers Accused of Downplaying Covid-19 Peak.The Guardian, June 19, 2020. <6> Cale Tilford, Martin Stabe, Steven Bernard, Aleksandra Wisniewska, Joanna S Kao, John Burn-Murdoch, Max Harlow, David Blood, Alan Smith, and Adrienne Klasa. “Coronavirus Tracked: the Latest Figures as Countries Fight Covid-19 Resurgence: Free to Read.Financial Times, September 2, 2020. <7> Cross, Ghaith Aljayyoussi; Kate. “Revealed: How, on Every Measure, Britain's Response to the Covid Pandemic Has Been Woeful.The Telegraph, August 30, 2020. <8> Michael Marmot, “Society and the Slow Burn of Inequality”, The Lancet, May 2, 2020. <9> Severin Carrell, David Pegg, Felicity Lawrence, Paul Lewis, Rob Evans, David Conn, Harry Davies, and Kate Proctor. “Revealed: Dominic Cummings on Secret Scientific Advisory Group for Covid-19.The Guardian, April 24, 2020. <10> Kupferschmidt Kai, “U.K. Government Should Not Keep Scientific Advice Secret, Former Chief Adviser Says.Science, May 11, 2020. <11>What is Independent Sage?”, Independent Sage, August 3, 2020. <12>  “Disparities in the impact of Covid-19 in black and minority ethnic populations: review of the evidence and recommendations for action”, Independent Sage, July 3, 2020. <13> Guy Adams, “Ex-Science Tsar Sir David King Told Us to Switch to Diesel.Daily Mail, May 5, 2020. <14> Steve Bird, “Did Dominic Cummings Actually Break Any Lockdown Rules?The Telegraph, May 23, 2020. <15> James Ball, “The UK's Contact Tracing App Fiasco Is a Master Class in Mismanagement”, MIT Technology Review, June 19, 2020. <16> Katie Grant, “Care Home Coronavirus Deaths 'Being Kept Secret to Protect Providers'.inews, August 27, 2020. <17> Heather Stewart, “Boris Johnson Ditches 2m Physical Distancing Rule in England for '1m-plus'.The Guardian, June 23, 2020. <18> Toby Young, “The Government's Cowardly U-Turn on Schools Is a Fiasco.The Telegraph, June 10, 2020. <19> Antonio Voce, Ashley Kirk, and Richard Partington. “UK Coronavirus Job Losses: the Latest Data on Redundancies and Furloughs.The Guardian, August 18, 2020. Delphine Strauss, “UK Sheds Nearly 750,000 Jobs during Coronavirus Crisis.Financial Times, August 11, 2020, <20> Julia Anderson, Enrico Bergamini, Sybrand Brekelmans, Aliénor Cameron, Zsolt Darvas, Marta Domínguez Jíménez, Catarina Midões. “The Fiscal Response to the Economic Fallout from the Coronavirus.Bruegel, August 5, 2020. <21> Andrew Atkinson, David Goodman, and Alex Morales, “U.K. Government Debt Tops 2 Trillion Pounds for First Time”, Bloomberg, August 21, 2020. <22> George Parker, “Sunak Weighs Delaying Autumn Budget on Second Covid Wave”, Financial Times, August 11, 2020. <23>Truth About Coronavirus”, McCann Worldgroup, 2020. Lucy Burns, “Elisabeth Kübler-Ross: The Rise and Fall of the Five Stages of Grief.” BBC News, July 2, 2020, <24>Government Approval” YouGov <25>COVID-19 Fears.” YouGov, March 17, 2020.
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