Policy for Pandemics 02: Spotlight on the UK
How the UK went from hand-washing to lock-down in just thirteen days
This newsletter is edited by Andrew Potter (AP), associate professor at the Max Bell School of Public Policy at McGill University. This briefing is written by Sarah Lombard (SL), a graduate student in the Max Bell MPP programme who is riding out the pandemic in Liverpool. Today’s main briefing is a five minute read.
Last night Prime Minister Boris Johnson announced a near-total lockdown of the UK, ordering people to stay at home unless it was absolutely necessary. This marks a substantial change in approach since the country saw its first COVID-19 case on the 29th of January. It is worth following the trajectory of the last few weeks to understand how the thinking changed, and why.
“Herd Immunity”
Viruses require a host to survive and to be passed between hosts to propagate. The only way to interrupt this is for the host not to be susceptible to infection (i.e. immune through exposure or vaccination), or to not pass it on. There is no population (“herd”) immunity to COVID-19.
“This virus cannot be stopped until herd immunity builds up”: this was the media’s interpretation of the early approach advocated by British Prime Minister Boris Johnson. In fact, the initial policy focused on slowing the spread (mitigation) so healthcare services could cope but was spun by the media as “throwing the elderly under a bus.” Reference to herd immunity has now been largely dropped from the discourse. It was polarising and the government struggled to control the narrative. Countering the criticisms with technical explanations of controlling the spread of the virus so the healthcare system could cope, and building up immunity in healthier population segments were not broadly accepted. The narrative has now morphed into ‘flattening the curve’; before last Friday schools weren’t being closed and only those over 70 were being advised to self-isolate to avoid exposure.
The initial “requests” by the government for people to socially distance and not attend restaurants or bars had a number of interesting impacts. The general perception was that the restrictions imposed in Italy and France went unheeded by citizens for upwards of a week, and there was an element of government defiance involved. The “nudge” behavioural insights unit within the Cabinet Office is likely to have been a strong contributor to the UK government’s “asking” approach, perhaps inferring that people were more likely to comply with a request as opposed to an attempted lockdown. It may also have been an attempt to introduce staggered measures so that people got used to, and more accepting of, the restrictions being imposed. I definitely saw a response to this, with friends and colleagues leaving the house less. But, does this mean the decision to ask rather than demand worked?
Current COVID Strategy
Many businesses responded to initial calls for social distancing with closures in a sort of “corporate social responsibility” move. However, it was widely reported that many companies could not claim insurance as a result of the closures not being imposed; this proved to be inaccurate as most businesses would not be covered even with a forced closure. This echoes wider misinformation and confusion as to what peoples’ obligations are under the government’s requests for action.
Before March 12th, the UK advice extended only as far as hand and face hygiene. Last week the SAGE group (Scientific Advisory Group for Emergencies) updated their advice to the government alongside modelling showing that relying on naturally developed ‘herd immunity’ would overwhelm the National Health Service. This led to cancellations of large gatherings, working from home where possible, increased social distancing, warnings against all but essential travel, household isolation where infection is suspected, and closures of schools, restaurants, leisure centres and pubs. Despite the increasingly stringent measures, it was a sad sight to see reports of many people having a “last hurrah” at pubs on Friday. Worse still, parts of Wales were overcome by visitors over the weekend with people seeking fresh air and travelling to national parks to get it: contradicting supposed social distancing as trails become overcrowded.
The new measures currently in place include:
A ban on people leaving their homes except to shop for essentials, exercise, receive medical care, or (if absolutely necessary) travel to work
All non-essential shops are closed
Parks remain open (except for some in London) but play structures, outdoor gyms, and other such facilities are closed
A ban on gatherings of more than two people except for members of the same household
In addition
All over 70s and specific vulnerable groups have been asked to go into complete isolation for 3 months.
Retired healthcare workers have been asked to consider returning to work.
Testing
The Government has been advocating increased testing rates. This aligns to the growing discourse that large numbers of people are unknowingly infected and are asymptomatic. A significant shortcoming of this is the limitation on testing capacity. Rates of healthcare worker testing in particular have been criticized, with doctors who had symptoms returning to work after carrying out 7 days of isolation, without having been tested for the virus. This contradiction is a failure in policy design and implementation, that demands quick resolution.
Interesting Emerging Policies
Some streets of households are posting green/red cards in their windows to highlight whether they need any assistance
Supermarkets are prioritising online delivery for elderly and vulnerable consumers and opening for one hour exclusively for these groups.
Supermarkets are setting aside 30 minutes per day for ‘key workers’ (healthcare workers, cleaners, delivery drivers…). Early initiatives meant key workers and vulnerable individuals shared the same exclusive hours for shopping, but this has since been reversed.
One school per region is remaining open for key workers’ children to attend. Teachers have been asked to volunteer one day to cover the staffing needs.
Londoners are launching a campaign to donate their unspent commute fares to charities to support vulnerable groups.
An unprecedented £7bn welfare boost, including 80% payment of salaries for those who cannot work.
This emerging crisis has highlighted significant policy gaps in many countries. A viral pandemic has been widely forecast for some years, particularly after the centenary of the 1918 Spanish Influenza pandemic two years ago. Where some countries did have policies, these have been found to be woefully inadequate to deal with the reality. When the dust settles and the reckoning is over, efforts will be needed to ensure that we have better prepared policy options in future that have considered even the most unlikely and previously unthinkable scenarios.
Related Reading
COVID-19 and the UK’s stiff upper lip — the pandemic response in the United Kingdom, from the New England Journal of Medicine
Why the government changed tack on Covid-19, by Saloni Dattoni for Unherd
A plague of hot takes: Lazy contrarians are putting everyone at risk, by Alex Andreou
What else is going on in the world?
Afghan officials and Taliban hold video conference, as the so-called peace process continues
Distractions
William Shatner turned 89! Here he is singing Pulp’s Common People
A beautiful concert by Martha Argerich presented in 2000 after she beat cancer - Carnegie Hall Solo Recital: Bach, Chopin, Prokofiev:
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Policy for Pandemics is produced and edited by Andrew Potter (AP). If you enjoyed this newsletter feel free to share it with friends or on social media. If you have any feedback or would like to contribute, feel free to send me an email: andrew2.potter@mcgill.ca