Offline: It's time to ask questions and learn lessons

Abstract

1 year on from WHO's assessment, on March 11, 2020, that its Public Health Emergency of International Concern (PHEIC) had evolved into a full blown coronavirus pandemic, what can we conclude? Many governments have decided not to conclude anything. They argue that it is still too soon to learn lessons. With over 2·5 million deaths worldwide, and 1 million more predicted by June 1, this political deflection is no longer sustainable. Indeed, it is unconscionable. While governments resist accountability, countries are seeing unofficial inquiries spring up to fill the vacuum. In the UK, Keep Our NHS Public last week held the first evidence session of its People's Covid Inquiry. Chaired by human rights lawyer Michael Mansfield, five witnesses gave testimony. Jo Goodman's father died on April 2, 2020. He received a letter from the government advising him to shield 9 days after his death. His daughter believes he likely became infected while sitting in a crowded hospital waiting room. Staff did not have personal protective equipment (PPE). Her experience led her to join with others who had lost relatives to create Covid-19 Bereaved Families for Justice UK, which has called for an independent, judge-led statutory public inquiry. They have repeatedly asked to meet Prime Minister Boris Johnson. He has repeatedly declined their requests. The lessons of the pandemic are not hard to discern, although they are politically inconvenient for governments anxious to retain control of the political narrative. Johnson hopes to claw back some integrity through a manifestly successful national vaccination programme. But, as Professor Sir Michael Marmot told Mansfield, the UK's poor performance had several possible explanations that deserved further investigation. First, there was a political class distracted by Brexit and that had refused to put wellbeing and equity at the heart of its policies. Second, deepening socioeconomic inequalities had made certain groups especially vulnerable to infection. Third, long-standing disinvestment in the public sector left the health system, and especially the public health system and social care, in particular jeopardy. And finally, poor population health meant that many communities were poorly protected against a new and dangerous virus. Holly Turner, a learning disability nurse, described how the care sector had been fatally weakened after years of neglect. Professor Gabriel Scally explained how the public health system had been “decimated” by a decade of austerity. And John Lister described how those policies had put intolerable pressures on the National Health Service (NHS). The People's Covid Inquiry aims to learn lessons to rebuild the NHS. It will be taking evidence until June. The COVID-19 Genomics UK Consortium has done more than any other organisation to anatomise the severity of those early pandemic months. Well over 1000 separate importation events seeded virus across the country, first from China but later from Spain, France, and Italy. Over 80% of virus importations took place between Feb 27 and March 30, 2020. The consortium concluded that to get ahead of the virus “rapid or preemptive interventions” were needed. The UK Government had 4 crucial weeks after WHO's declaration of a PHEIC to prepare—building testing capacity, securing national borders, delivering PPE to front-line services, readying the NHS, protecting care homes, and pooling knowledge with other countries to ensure a coordinated global response. But the Johnson administration did little during those crucial few weeks. His government's paralysis allowed the country to become overwhelmed by coronavirus. The COVID-19 Genomics UK Consortium found that the largest viral lineages were already in the country by the time of the first lockdown on March 23. Instead of acting decisively, the government deluded itself with a set of comforting myths—that herd immunity would save us, that flattening the epidemic curve (“squashing the sombrero” in Johnson's words) would be sufficient, and that there had to be a trade-off between health and the economy. Western governments, such as Johnson's, were too slow and too indecisive. They didn't follow the science. They displayed erratic leadership. They were consistently unwilling to do what was needed to drive the virus out of communities. And they lost the trust of their publics. Saying sorry is necessary, but it isn't enough. If democracy means anything, those ministers who presided over this human catastrophe must be willing to subject themselves to independent scrutiny. And, if necessary, make way for more competent political leaders.