John R Ashton: Covid-19—One minute to midnight

At 8.30 pm on Monday 23rd March 2020, the UK’s prime minister Boris Johnson addressed the nation and finally put the UK into lockdown. To many people this was yet another example of a prime minister, his government, and advisers being slow to act. We are witnessing the increasingly apocalyptic speed with which covid-19 is spreading around the world and some remarkable achievements in bringing covid-19 under control in China, South Korea, and Taiwan by implementing strict lockdown measures. The UK’s response in comparison seems slow and we are now playing catch-up.

It will be for historians to assess the set of political and professional failures that may potentially cost tens of thousands of lives and cause the economy to meltdown. As with most major disasters it will turn out to have had a terrible inevitability about it, given a convergence of a whole range of contributory causes. Years of austerity have had a huge impact on the resilience of the NHS.  The fragmentation and incoherence of the 2012 Health and Social Care Act has weakened the NHS and public health. The failure of Boris Johnson to convene and chair regular COBRA meetings from early in February, once the enormity of what was unfolding emerged from China, put us on the backfoot. This combined with the resulting lack of grip, a failure to look ahead and see what was coming, and to adequately assess capacity and capability have left the country struggling. The failure to order sufficient equipment, reagents, and enzymes for testing, or Personal Protection Equipment to protect frontline workers and stop hospitals from becoming contaminated, has put healthcare workers at risk. And the failure to adopt a full-engagement strategy with the public, based on openness and transparency, has led to confusion with the public struggling to adhere to the necessary “social distancing” rules. 

All this is made worse by the UK’s response being based on a narrow reference base, dependent on questionable modelling. The government seemed to have looked around the world at effective action, wondering whether what worked in practice could possibly work in theory. This has been combined with a hopeless communications function from an inadequate Public Health England. 

But the blame and recriminations must wait for another day. The UK’s epidemic is accelerating. Cases presumably originating from February half-term skiing holidays in Italy, and those brought from Madrid to Anfield by football supporters coming to watch the Champions League match on 11th March, are starting to manifest themselves. We must buckle down, set aside our differences, and work together for the sake of ourselves, our fellow citizens, and the very economic future of the country.

Making the new measures on physical distancing stick is but one of the priorities for the immediate days and weeks ahead. The rapid introduction of rationing is now essential to ensure both that essential frontline key workers, and the poor, disadvantaged, and vulnerable are able to access everyday necessities and are not able to be elbowed out of the way by those better off and those with sharper elbows. The real measure of food security in the net importing UK, post-Brexit is about to be tested.

So what are our priorities now? First and foremost, we must protect the health and wellbeing of our frontline health and social care workers by ensuring that they all have adequate personal protection, are routinely tested for covid-19, and are kept in good mental and physical health by being cherished, well fed, and having adequate down time. Sadly this may now prove difficult to achieve given that our hospitals are themselves in danger of becoming the centre of further outbreaks as a result of contamination. We may soon reach the point where it is safer for patients who do not have the virus to be treated for other conditions elsewhere, while the overwhelming incoming tide of cases may mean that in a matter of weeks many patients will need to be treated at home or in the community.                

Second, WHO’s Director General Dr Tedros’ incitement to “Test, Test, Test” must be made an urgent reality. This should form the basis of minimising the oncoming disaster by systematic intervention and quarantining, as well as containing it in areas such as the north-east of England, where the virus does not seem, so far, to have got a foothold.

Thirdly, with the shutdown of everyday life outside the home, the bulk of further transmission will begin to occur between mobile frontline workers, volunteers, and the vulnerable in their domestic environments. To prevent this from happening, older people, and especially those with diabetes, cardiovascular and respiratory disease, together with other causes of compromised immunity, will need to be isolated. Many of the essential key workers and volunteers will need to be billeted separately wherever space can be found. Special attention must now be paid to the bio-security of their home and immediate surroundings.

We are undoubtedly about to see a huge increase in death rates from covid-19 during the next few weeks, bringing with it extreme logistical, cultural, and emotional challenges. With families now thrown together in what may amount to months of confined time together, all sorts of family tensions are likely to surface, with resultant impacts on domestic violence and mental health. We will need to respond as best we can as family, neighbours, and friends, remotely and online.

The opening lines of Charles Dickens classic “A Tale of Two Cities” set in the grim days of the French Revolution come to mind on this beautiful spring day with the birds nesting, the sheep beginning to lamb, and the daffodils in profusion “it was the best of times, it was the worst of times, it was the age of wisdom, it was the epoch of belief, it was the epoch of incredulity, it was the season of Darkness, it was the spring of hope, it was the winter of despair…” Throughout the ages humans have been confronted with awful challenges and disasters, yet we have always come through as a species ready to live another day despite the toll on individuals, families, and groups. 

While we are immersed in this public health disaster, everything has changed. When it is over those who are here will have an opportunity to transform our way of life for the future based on different values from those that have dominated recent decades. We could rebuild society as more respectful of each other and of the planet that nurtures us, or we could go back to our flawed ways of exploitation and neglect. Let us make sure we make the right choice.

John Ashton is the Public Health Adviser to the Merseyside Police and Crime Commissioner. He was formerly regional director of public health for the North West of England and president of the UK Faculty of Public Health.

Conflicts of interest: None declared