Government indecision is the UK’s greatest health threat

The abandonment by the government of its much heralded and strongly defended Christmas arrangement that involved a lifting of restrictions on social mixing is no surprise to many. The experience from the US of growth in Covid-19 in the aftermath of Thanksgiving celebrations should have given pause for thought, as should the very limited response in case numbers engendered by the national restrictions imposed in November.

There had been many voices raised in criticism of the planned five-day relaxation at Christmas, with Independent Sage in particular pointing out that, just because the government said it was permissible to lower your guard and mix households and generations over Christmas, it didn’t mean it was a good idea. Of particular note was the Public Health England estimate that 25 days of very strict measures would be required to make up for the five days of laxity.

The growing numbers of cases alone should have been enough to cause a major rethink some weeks ago. But delay in decision-making , whether in respect of a Brexit agreement or Covid response, seems to have been a constant characteristic of the government’s behaviour. Delay and indecision in the face of a lethal, highly infectious virus is the greatest threat to health – sometimes even bigger than the threat from the virus itself.

The announcement by Matt Hancock in the House of Commons of the identification of a new and potentially significant variant in the virus was surprising. That is not usually how new scientific information is communicated. The news appeared at a time when the government’s resolve on Christmas relaxation was already beginning to be tested and there was a distinct whiff of yet another U-turn in the air.

There is nothing new in the identification of variants in the SARS-CoV-2 virus. Such variations are part of the natural development of an aggressive pathogenic organism and have been seen previously in this pandemic. A variant identified in Spain in the summer quickly became a dominant strain in many countries. This dominance was subsequently attributed to the lack of controls being in place to contain the virus, rather than an inherent increase in its transmissibility.

It is too early to say definitively what are the reasons for the spread of the new variant in the south of England. It may be difficult to make that judgement as the background growth of the virus across the UK has continued, almost uninterrupted, since early September. What makes any alteration in the transmissibility of, or severity of illness caused by, the virus potentially extremely dangerous is the current poor level of control of virus spread, not just in England but across the UK. Wales and Northern Ireland have both seen exceptional levels of infections and have already announced imposition of strict measures after Christmas.

Little attention has been paid to the success of the Republic of Ireland in avoiding, so far, any major second wave of Covid-19. The quality of leadership displayed, by both political and public health figures, in the Republic has been in stark contrast to that in Northern Ireland where political infighting and the demonstrably poor contact tracing system have led to a second wave of cases and hospital admissions from Covid-19 that seems set to be bigger than the first. The folly of following closely the lead from Westminster has never been more apparent.

It is the most deprived communities in the UK that have most to fear from continued and resurgent spread of Covid-19. Despite this having been clear in England from the early days of the pandemic, local authorities in England have not been given the necessary resources. They are unable to mount an effective outbreak response, nor are they able to ensure that adequate preventive measures are put in place. In particular, the absence of an effective Find, Test, Trace, Isolate and Support system leaves local communities, including their schools and places of work, extraordinarily vulnerable to rapid and lethal spread of Covid-19.

Given the enormous death toll in the UK and the lack of an effective government response so far, it will take a major strategic shift for the government to respond effectively to the steadily worsening situation. We absolutely need the Westminster government to make that shift. If it continues to pursue the policies that have failed so far, it is inevitable that they will fail again.

Professor Gabriel Scally is a member of the Independent Sage advisory group.