There may, at some point in the indefinite future, come to be a consensus about how 'well' the COVID pandemic was dealt with in the UK. Right now however, no one is in a position to deliver that consensus. Events are still playing themselves out, masses of data have yet to be critically crunched, and context will always be difficult to establish. A historical perspective is only available to historians.
However, that said, we can endeavour to identify some of the themes and issues which may be relevant.
It worth considering what we mean when we talk about things gone wrong. 'Wrong' is a word that has strong moral implications. But I want to try and avoid moral judgement here as far as is possible. I will tie my definition of 'wrong' to a quantity that is, at least in theory, measurable ( i.e. it's a 'metric' ). The quantity I will use is 'excess deaths'. In other words, the greater the proportion of excess deaths, the more 'wrong' things are.
On this basis alone, it is certainly possible to assert that things have gone wrong, since the number of excess deaths has been positive for a large part of the pandemic to date.
However, even with this very concrete metric, we must still be careful to note that this measure of 'wrongness' needs context. Where we should look for appropriate context is a question in itself. For example, excess deaths is sometimes positive for a certain period of the year corresponding to influenza season, so the mere presence of excess deaths doesn't mean that anything dramatic has happened. There are measures of excess deaths for other point-in-time epidemics, and there are excess death metrics for other nations experiencing COVID.
A thick tangle of issues surrounds the question of comparing one nation's statistics with another, so I will just slice that Gordonian knot and state that I will consider the UK's excess deaths in the context of the excess deaths for other European nations as analysed by EUROMOMO ( there are other sources of excess death analysis - e.g. see https://www.health.org.uk/news-and-comment/charts-and-infographics/understanding-excess-deaths-countries-regions-localities, and several other articles from this site ).
The organisation EUROMOMO ( to which the UK belongs ) monitors excess deaths for about 30 European nations ( most of Germany and Poland being the main omissions ), and also provides a statistical analysis of deviations from the mean in terms of a per-nation 'z score', which is equivalent to a standard deviation. This assumes a normal distribution of scores, which is debatable, but it's the easiest way to compare the relevant nations.
By this measure, it is clear that the UK, and in particular England, stands out at the time of writing ( Jan 30th 2021 ). In the second week of January, for example, England had a z score greater than 15 ( fifteen ), qualifying as an 'extraordinary high excess' of deaths. Portugal was the only other nation in this category. The UK was also very prominent in this ranking over the period of weeks 17 - 22 of 2020 ( April - June ), although not in the intervening period.
So it appears quite clear, by means of comparison of excess death z scores with other European nations, that indeed something did go wrong in the April - June 2020 timeframe, and is going wrong in the Jan 2021 timeframe.
Note that at other times, other nations have featured more prominently than UK nations, and there was a period at the beginning of the pandemic when all nations were doing very badly, so it is not safe to assert that the UK has in general underperformed the European average by this metric.
A huge amount of information has been emitted by the UK government concerning the details of it's actions during the pandemic. Numerous legal instruments are available online, numerous quangos have made their own contributions, various government departments have published various recommendations for various purposes, the NHS has published information, PHE has published information, the ONS has published information, etc etc.
However, the government has said very little about any overarching strategy it may have. I'll deal with the question of strategy here, although it is related to the question of communication that I'll deal with later on.
The concept of strategy is often misunderstood. A strategy is a coherent set of high level principles and objectives that will guide you when working out the specific steps you should be taking in a particular context or contexts. When a strategy is developed in response to a real-world problem, it will always rely on a set of assumptions about how that world works - and if these assumptions are incorrect, the strategy will almost certainly fail. What does 'failure' mean here ? It means that if you develop policies and processes in accord with the strategy, those policies and processes will not have the desired effects, and the real world problem will not be fully addressed.
If I define the real world problem faced by the government as 'minimising excess deaths due to COVID', then the conclusion of the previous section is that this problem has not been fully addressed in at least two periods of time since the beginning of the pandemic.
It could certainly be argued that no strategy can cope with unanticipated events. However, it's not apparent to me that any events occurred which were incapable of being anticipated. Development of a new virus strain perhaps ? No, this is normal behaviour for infectious diseases, and eminently capable of being anticipated for planning purposes.
COVID itself was anticipated many years ago by the WHO, who produced voluminous advice for member governments in the wake of the SARS and MERS epidemics on the topic of how to prepare for and handle novel zoonotic respiratory diseases.
So an inability to anticipate events cannot be used as justification for failure of strategy in this case.
But what is that strategy ? It appears to me that there are three elements.
Minimal regulation
The strategy appears to assume that minimising the scope and period of any regulation is inherently preferable.
Minimal enforcement
The strategy appears to assume that enforcement should be considered as a 'last resort'.
A reactive stance
The strategy appears to prefer reactive, as opposed to proactive, regulation. That is, regulation happens only after the circumstances requiring it are already apparent, as opposed to being triggered in anticipation of those circumstances.
Let me examine these elements in a little more detail.
< TBD >
There are two quite different questions relating to enforcement. Firstly, there's the question of how much enforcement is intended, and then there's the question of how much enforcement is feasible. Clearly it makes little sense for there to be a major mismatch between these things - i.e. it's not sensible to have strategy that requires enforcement for real effect if actual enforcement is not feasible.
Enforcing regulation in the UK is difficult. There are relatively few police in England and Wales. 200 officers per 100000 head of population is amongst the lowest in Europe.
There is also the question of court capacity, which is finite, and made all the more so by the need to minimise social contact within the legal system itself.
Reactive strategies are very easy to justify, because the relevant circumstances are staring people in the face. They are an easy sell, in political terms. The form this justification takes is constant reference to a dependency on 'evidence'. It sounds good - by referring to the need to base decisions on evidence, the need for decisions can be put off until after the evidence is deemed to have appeared, and those decisions can be presented as 'forced by the circumstances'. Putting off difficult, consequential, decisions is often seen as one of the primary skills of politics - the way to make a problem that you have no politically comfortable answer for go away is to push it as far into the future as possible and then make it seem that you have no alternative.
But there are numerous problems with this approach in the circumstances of COVID. The main issue is that 'evidence', in this context, constitutes real deaths of real voters. In other words, any reactive strategy can only be a reaction to an already tragic situation, no matter that the strategy may reduce the scale of the problem going forwards. A secondary, but also important, consequence is that virus propagation is non linear - accepting a relatively small number of deaths in order to obtain evidence invariably means accepting a very much larger number of deaths before any reaction can take effect.
One technical get-out-of-jail card here would be the ability to test populations, since this would allow the formulation of evidence based strategy on the basis of exposure to a pathogen as opposed to death. However, deployment of testing at sufficient scale depends on having well developed testing technology and test infrastructure, neither of which was available in the UK at the start of the pandemic, although it was much more feasible by the end of 2020.
Therefore, if it is not possible to employ evidence based formulation of strategy without accepting that many will die in order to provide the necessary evidence, what alternatives are there ?
The inverse of reactive is proactive. This is an approach which involves taking measures which seek to avoid harm, rather than reacting to it. This is sometimes called the 'precautionary principle' - assume that bad things may happen, and attempt to head them off. It's essentially the approach that is required by health and safety regulation the world over.
Why, then, would a government faced with the possibility of a public health nightmare not adopt a proactive stance ?
Almost certainly both. < TBD >
The high excess death rate in the UK during the both the initial peak and the Christmas peak is attributable to at least three key factors ;
© Mark de Roussier 2021, all rights reserved.
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