Jacky Davis reports from the second session of the People’s covid inquiry

“We have a growing confidence that we will have a test track and trace system that will be world beating and it will be in place by 1 June 2020.” — (Boris Johnson to Parliament, 20.5.20)

The first witness at the second session of the People’s Covid Inquiry was David King, professor, government chief scientific advisor from 2000 – 2007, and founder of Independent SAGE (ISAGE). He founded ISAGE because at the time the membership of SAGE (The Scientific Advisory Group for Emergencies) was not a matter of public record, nor was their advice. He also felt that SAGE was very heavy on epidemiologists and very light on healthcare experts.

King began by reminding us that in 2006 the Government Office for Science predicted a global pandemic within the next 30 years, due to a virus mutating from a wild animal to humans.

He then went on to discuss the standard responses to a pandemic. These would normally include quickly testing and isolating. Lockdown is used until a test, trace, isolate and support system (TTIS) is up and running. Many governments responded in this way after Chinese scientists published an article in The Lancet (23.1.20) with information about the virus, including the infectivity rate and death rate.

By contrast the UK government’s reaction was “very tardy.” There appeared to be no understanding of the risks we faced, and the UK prime minister Boris Johnson missed many of the initial Cobra meetings at the start of 2020.

King said that we knew by the start of March 2020 that cases were doubling every 3-4 days, but the UK only locked down on 23 March 2020. He felt that if we had gone into lockdown two weeks earlier then the spread of the virus would have been “massively less.” Meanwhile large sporting events continued, with crowds from Spain (where there was a significant outbreak) attending a football match in Liverpool. Large horse racing meetings also went ahead. This delay begged the question as to whether the real aim was achieving herd immunity

By April and May 2020 hospitals were being overwhelmed, which would have been much less likely with an earlier lockdown. 

“I would have said that at least 20,000 lives out of the 35,000 lost in the first wave could have been saved if we had gone into lockdown earlier, said King.”

Another part of the lockdown process should have been closing UK borders. Other countries such as New Zealand, Australia and Greece did this early on with returning citizens subject to strict quarantine. But the UK consistently failed to manage our ports of entry.

King then discussed the excuse that behavioural or pandemic fatigue favoured a later lockdown. He pointed out that in fact the reverse was true, and that going into lockdown late meant it would last longer and that the economic damage would be greater. Other countries who reacted slowly like the UK, such as the US and Brazil, have also suffered very high fatality rates and significant economic damage.

King finally turned to the test, trace, isolate and support system (TTIS). To succeed this depends on rapid identification of cases, rapid contact tracing and—very importantly—supporting people to isolate. Crucially that support was never offered, thus: “From the beginning we have never had a proper TTIS, said King.”

For several months we had nothing at all in place. Finally it was outsourced to Serco to run centrally.  

King felt any system should have been broken down into local areas centered on trusted GPs, which would have been very effective, but it was never done. We also shouldn’t have come out of lockdown until we had a fully functioning TTIS. 

“We at ISAGE were simply amazed. In the middle of the biggest pandemic in over 100 years we set up private companies with no healthcare experience to run (the TTIS) from scratch. I believe that was a disastrous decision”

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The second witness was Lobby Akinnola, a member of the covid-19 Bereaved Families for Justice Group. They campaign for a public inquiry into the government’s response to the pandemic, in order to learn lessons and to hold those responsible to account.

He described how he joined the group after losing his father to covid-19. His whole family of seven key workers lived together. None of them had access to personal protective equipment (PPE). During his father’s two week illness he contacted NHS 111 and his family GP and the advice was always to stay at home, which is where he died. 

Akinnola felt that the pandemic had highlighted pre-existing concerns in ethnic minority communities, in particular around unconscious bias and preconceptions about Black people. He mentioned in particular that NHS 111 were asking callers if their lips were blue, as an indicator of hypoxia, which is inappropriate and misleading for Black people.

He felt that Johnson had approached the pandemic with a level of arrogance, and had joked about “operation last gasp.”

“My family had to sit and watch my Dad die for two weeks, and then you see the leader of the country stand up and make jokes about the fact that people are being robbed of their breath. He also called on (healthcare workers) to risk their lives and then decided not to provide the support they needed.”

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The third witness was Jan Shortt, General Secretary of the National Pensioners’ Convention (NPC). 

Shortt said that at the beginning of the pandemic the NPC had a number of concerns including the government’s slow response, and the fact that social care was already in crisis. In particular care homes had been struggling for some time due to underfunding and staff shortages. The NPC was also unhappy that all over 70’s were classed together as at risk even though not all over 70s are frail and vulnerable.

She emphatically rejected the government’s claim that they had put a “ring of steel” around care homes. At the beginning older people had been discharged from hospital back to their care homes without being tested for covid-19. Care home staff didn’t have adequate PPE and resorted to wearing bin bags as aprons and sharing masks. They were also getting sick and moving between homes. Then blanket do not resuscitate orders were imposed on care home residents, which was quite inappropriate.

The NPC had been begging the government for years to reform and properly fund social care, but the government never replied to any of their letters. Shortt felt that was due to arrogance or incompetence. 

Going forward she felt care homes should be taken out of the private sector and that local authorities should work with the NHS and good voluntary organisations to run them. That would give value for money and, importantly, accountability.

Shortt thought that 25% of covid deaths had occurred in care home residents.

“The devastation that care home residents have suffered, are still suffering, is unacceptable. It shouldn’t have happened, needn’t have happened and should never happen again.”

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The fourth witness was Helen Salisbury, Oxford GP, and BMJ columnist.

Salisbury felt that the government had made big mistakes from the very beginning. One was to think that the country could “take it on the chin” and go for herd immunity.

Another was to sideline primary care and to fail to use the skills of GPs, particularly their local knowledge and patient contacts.

A decision was made that all covid calls were to go through NHS 111. Patients were told very strongly to ring NHS 111 and not to trouble their GPs. At that stage everyone was on a steep learning curve with regard to covid. For instance people with covid could be dangerously short of oxygen, but not breathless. NHS 111 staff were in a hurry and didn’t get much training.

“I have a horrible feeling that if some patients had been passed on to their GPs we might have saved some lives. People died at home because they didn’t get the medical attention they needed quickly enough.”

Salisbury felt that primary care could also have taken on testing if provided with the resources. They could have worked with public health partners and patients but instead it went to “people who had no idea what they were doing.” 

“Several multiples [of funding] of what primary care gets in a year have gone to Test and Trace which doesn’t seem to have helped at all.”

She felt GPs could also have helped with who got tested when tests were scarce and people were being sent all over the country. There was also a big problem with the centralised test and trace system not providing test results to GPs—“the vaccine programme has shown that running things locally works.”

On the subject of public health messaging, Salisbury felt that people had been very observant of the rules, but that they had often just been the wrong rules. Messaging has been poor but so have the messages. For instance there was a huge spike of avoidable deaths in January because of opening up for Christmas.

“I’m very angry because so many people died who needn’t have. Vietnam has 0.5 deaths/million, and last time I looked we have 1820/million. We didn’t start fatter, poorer, or more ill. It’s about management, how we handled it.”

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A number of themes emerged in this session. The government’s response was far too slow. They were too slow to recognise the threat of the virus and much too slow to adopt basic public health measures, including lockdowns (Feb/March and September) and to manage ports of entry. 

The government bypassed experienced GPs in NHS primary care in favour of NHS 111, to the great detriment of patients, and again when they outsourced TTIS to private companies who had no relevant experience. This resulted in a centralised system which never functioned successfully while costing £37 billion

They failed to protect the elderly, and the pandemic revealed the dire state of the social care system. 

The government repeatedly made poor decisions too late, under pressure to put the economy before the population’s health, not understanding that the two go hand in hand.

Jacky Davis, consultant radiologist, founder member of Keep our NHS Public, panel member of the People’s Covid inquiry.

Competing interests: none declared.