While the country was preoccupied with the imminent release of the Russia report, the commons health and social care committee was hearing expert evidence on the management of Covid-19 and what further steps were needed to prepare for the winter.
Interestingly, they didn’t recommend bringing in the army to tackle the civil unrest following the “four-way winter disaster” of Brexit, Covid-19 wave two, winter flu and flooding, though this seems to be the current plan.
Health and care committee
The meeting began by reviewing some of the errors in the handling of the pandemic so far, but the focus was primarily on the future. Those giving evidence in the first session were: Professor Sir Paul Nurse, director of the Crick Institute; Professor Sir Jeremy Farrar, director of the Wellcome Trust; Professor Sir John Bell, regius chair of medicine, University of Oxford; and Professor Devi Sridhar, professor of global public health, University of Edinburgh.
All of those giving evidence were keen to stress that the virus was not going away any time soon. The consensus was that it was likely to be around for many years, decades even and it would certainly not be “over by Christmas”. While the vaccine developed by Oxford University marks welcome progress, it does not signal the end of the pandemic. As Prof Bell from Oxford acknowledged, “this pathogen is here for ever … we’ll never be able to eliminate the disease … like polio, it is going to come and go”. He said the vaccine was “unlikely to have a durable effect which will last for a very long time” and there would need to be cycles of vaccines as we have now for the flu vaccine.
While those giving evidence attributed the high death rates to errors made in the early days of the pandemic, they stressed that the primary error was that the UK had been in denial about the likelihood of a pandemic and had “ended up with a system that had no resilience to pandemics”. This lack of preparedness had led to late and indecisive action and the early abandonment of the test and trace strategy as it became clear that the number of infections rendered it impossible to sustain.
Prepare now for winter
There was agreement that over the summer the government had a narrow window of opportunity in which to prepare for the coming winter and also future winters as the virus continues to circulate around the world. They identified a number of strands to effective management of the disease:
- strengthening the public health response to include prevention, contact tracing and supporting local lockdowns;
- twice weekly testing and tracing amongst health and care workers to pick up asymptomatic cases;
- greater and more easily accessed testing for the public and quicker results;
- understanding better the care home sector and putting in place more effective protective measures;
- greater testing and intervention in other high risk areas such as in prisons and in meat processing; and
- managing the country’s borders.
There were concerns that the desire to ‘protect the NHS’ had led to too many people not accessing treatment for other diseases soon enough and that people’s health, including mental health, had suffered over the course of the pandemic. How this might be better addressed in the future was not fully explored although the witnesses stressed the importance of measures short of lockdown such as wearing masks, keeping 1 to 2 metre distances and working from home to reduce community infection. These measures, if properly implemented, would enable greater social interaction and renewal of relationships while keeping the rate of infection low enough to sustain progress and allow other health services to resume. Countries with poor healthcare systems that had to rely on these measures (backed by lockdowns) had been successful in stemming the rate of infections.
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There were many aspects of disease prevention and eradication that the committee might have asked more about but did not (the session was booked for an hour), including the disproportionate impact on people with underlying health problems and/or from black, Asian and minority ethnic groups, and on those living in poverty or alone. Sridhar suggested that given the high rate of transmission between those living in crowded conditions, the government should offer quarantine places in hotels or similar for those who would find it difficult to quarantine in shared accommodation, or those who are living with vulnerable people.
Farrar and Sridhar emphasised the need for “consistency in the messaging and trust in the messenger” as well as good information to ensure people complied with regulations. All agreed that although public health figures on death rates may not be completely accurate (and excess deaths was the preferred measure), their withdrawal from publication was unhelpful. Nicola Sturgeon was commended for her honest information-led approach and for modelling desired behaviour by wearing a mask and keeping her distance.
The main messages from the expert evidence provided to the committee, are that the government and the country remain too complacent about the severity of the disease. We are not yet over the worst and it is not clear that we have learned the lessons from this first wave. Much more needs to be done to build resilience for the winter. Scientific advances are important and need to continue and be supported, but are not a panacea. Well informed, trusted leadership and direction backed up by clear and honest information and guidance is key.
