How a distracted government and weakened British institutions let Covid take control
For a couple of days in January 1806, Nelson lay dead in the Painted Hall at Greenwich after a victory at sea that established Britain’s dominance of world trade for the next century. For Boris Johnson the echoes of history were irresistible. In February this year, under a ceiling of nymphs and noblemen and archers, he gave a speech in the same hall that reached back across the centuries to link Nelson’s triumph to Brexit. This was Johnson’s moment; the zenith, as it turned out, of his authority and confidence.
There was one smudge on the horizon – a viral outbreak that China had reported to the World Health Organisation a month earlier, on 3 January. Johnson mentioned it in passing, mainly to mock the “panic” it would cause elsewhere. He assured his audience that Britain would be different. It would “take off its Clark Kent spectacles, leap into the phone booth” and champion the right of peoples the world over to buy and sell freely among each other.
By then 425 people had already died from Covid in China. In Britain, the dying would begin 31 days later.
It started in earnest around 24 March. Covid has since carried away nearly 70,000 people in this country in nine months. It has torn a swath through care homes, filled mortuaries, killed doctors, nurses and bus drivers for want of protective equipment and forced a quasi-libertarian prime minister to shut down the economy not once but twice. His chancellor has raised borrowing seven-fold just to keep people in jobs, but unemployment will still double in the space of a year.
Covid has remorselessly targeted the elderly, people with disabilities and people unable for any reason to shield themselves – to withdraw from the world. It turned Number Ten into what a former cabinet secretary called a “plague pit”, and nearly killed Johnson himself. He turned out to be a slow decision maker even when healthy, and in his absence his ministers were slower still. They proved to be loyalists above all, lacking in experience and competence, working in an over-centralised system with a paradoxically weak centre.
Much thought went into preventing a second wave of infection, but the second wave came anyway. So how can its impact be limited? What are the lessons from the first? Did it have to be so bad? In search of answers, we held an inquiry at Tortoise: 50 witnesses at 15 sessions over three Fridays starting on 20 November, preceded by two months of evidence-gathering from experts, our members and the general public.
The government was not ready to defend itself at the Tortoise Inquiry (even though its French counterpart had already been forced to do so by French courts) so we appointed stand-ins to make the case for those thrown into a hellish situation. In ministers’ defence, their advocates noted that the UK’s excess death rate is not much worse than those of France, Italy and Spain. They noted that the government was given questionable advice by a strangely secretive committee, and on the whole reacted quickly when the advice changed. They noted that the Treasury moved fast getting aid to businesses and individuals in dire need at the peak of the emergency, and that Britain was not alone in hesitating before going into lockdown.
At the start of the pandemic no government was contemplating “stopping the world,” as one witness put it. A strategy of trying to suppress the peak of the infection curve with piecemeal public health measures – such as hand-washing for as long as it takes to sing Happy Birthday twice – was orthodox, and not eccentric.
The trouble was, the virus wasn’t orthodox. It was not pandemic flu, for which detailed plans were written and ready, and it was three times more infectious than MERS, the last coronavirus to threaten a global outbreak. It arrived without a rulebook. The closest approximation was a three-word mantra from the WHO: “test, test, test”. Johnson’s government said Britain had a world-class testing system, but it didn’t. Its ability to trace contacts of infected people was close to zero. At the start of the pandemic it could handle a total of five cases – in principle. In practice the system was defeated by a single superspreader, Steve Walsh, who paused on the way home from Singapore to ski with friends in the French Alps, and gave them all the virus.
Walsh was released from hospital and recovering at home by the second week of February. Nothing was learned from his experience. Instead, as bulletins brought apocalyptic news from northern Italy, Liverpool played Atlético Madrid in a packed Anfield on 11 March and 125,000 people attended the Cheltenham races the same week.
“The mayor of Liverpool, Joe Anderson, knew at the time that it was madness to allow fans from Madrid to travel to Liverpool,” Professor Supriya Garikapati told us. “The mayor of Madrid agreed with this.” They were overruled by their respective governments and national sporting bodies. As for the races, emails seen by Gloucestershire Live suggest the Jockey Club decided to proceed with the festival after seeing Johnson and his fiancée, Carrie Symonds, attend the England-Wales rugby match at Twickenham the previous weekend.
By that time the WHO’s advice was more specific and urgent than simply to test. It declared a pandemic on the day of the Liverpool-Madrid match, and as Professor Hugh Montgomery of University College Hospital noted: “The WHO playbook was very clear for pandemics. You lock down really hard and you lock down really early… When you’ve got a very highly contagious disease and you let it get a grip you end up with a tsunami”.
Britain did not lockdown until 23 March, and ended up with a tsunami. The two weeks leading up to that decision will be studied for years to come as an object lesson in inertia, complacency and incipient panic.
Why two weeks? Because a starting gun was fired on 9 March when Italy announced its own lockdown. Two days before that, three senior Italian critical care specialists had written to the European Society of Intensive Care Medicine with a simple message: “Get ready!” Three days afterwards, Johnson admitted at a press conference for the first time that “many more families are going to lose loved ones before their time”. The pandemic had been declared. The WHO’s advice was clear. And yet he waited.
In fairness, confusion in what passed for bespoke advice to the UK government had set in early. At a meeting on 22 January the Scientific Advisory Group for Emergencies (SAGE) acknowledged that Covid was more serious than flu but advised against screening and temperature checks at airports, even for people flying in from Wuhan, because of the risk of false positives. On 11 February a separate committee, the Scientific Pandemic Influenza Group on Modelling (SPIMO), said banning mass gatherings would have only a “low” impact on the spread of the virus. On the 13th, SAGE concurred and added for good measure that there was no point restricting international travel. On the 17th NHS officials told a parliamentary committee, wrongly, that its supply of personal protective equipment was adequate to keep staff safe and that its stockpiles were sufficient for patients too.
Listening only to this sort of guidance, a reasonable person might have decided Johnson was right, back in Greenwich, to dismiss Covid anxiety as panic. But the prime minister himself had moved on. On 12 March he quietly accepted the advice of his chief medical officer, Chris Whitty, that there was no point in trying to test or trace infection in “the community” (i.e. outside hospitals) any more. They simply gave up.
Asked why, Downing Street’s response to this as to all questions about its Covid strategy was that it was “following the science”. In fact Whitty’s own response was less than scientific. It was about what was feasible, not what was smart. “The first-order question is, can you do it?” he said, meaning, can you test and trace everyone to map the spread of the disease? “If the answer is no, you don’t worry about it any further and you have to move on.”
Other scientists were “flabbergasted” by this decision, says Tom Whipple, The Times’ science editor, who spoke to a lot of them about it. This was the moment when test and trace was needed most, because of the key distinguishing feature of this virus: it’s transmitted by people with no symptoms, so if you wait until symptoms appear before testing you’re too late.
The timeline is revealing and unforgiving. On 12 March Johnson gave up on test and trace and warned the country more deaths were unavoidable, but he didn’t take the logical next step of mandatory lockdown for 11 days.
Professor Neil Ferguson of Imperial College London has said the delay may have cost 20,000 lives. That was in June, arguably with the benefit of hindsight. Yet months earlier, papers prepared for a SAGE meeting in early March indicated that if China had moved decisively against the virus three weeks earlier than it did, it could have prevented 95 per cent of subsequent deaths and infections. If so, the same was true for the UK. Instead, the first wave swept through, exceeding most worst case scenarios and pushing most non-Covid treatment off NHS appointment schedules. One result, as Catherine Furnival noted, is that Breast Cancer UK now estimates 8,600 women in Britain now have breast cancer that is undiagnosed and therefore untreated.
Did it have to be this bad? It’s hard to see why. On a charitable reading Johnson’s government was badly advised, but leadership involves challenging advice. Gus O’Donnell, the former cabinet secretary, says Johnson chose exactly the wrong forums for doing this. He relied heavily on SAGE and Cobra (the Civil Contingencies Committee). He failed to attend Cobra’s first five Covid meetings in person, but the more important point was that those who did were mainly ministers, while SAGE consists mainly of experts. Johnson needed both in one room for the two central tasks in any crisis – collecting evidence and tossing out whatever doesn’t withstand scrutiny.
A more systematic approach might have made for better decision-making, but Johnson turns out to be a reluctant decision-maker anyway. He showed “a presumption not to act early, when action was most urgently needed,” says Alex Thomas of the Institute for Government. And that weakness was compounded by an oddity of the British state: a highly centralised system with a weak centre.
Perhaps Thomas is simply being polite. This was a prime minister who spent the early part of the pandemic going through the final stages of a divorce, welcoming a baby son with Symonds, hunkering down with them in Chevening for two full weeks in February, and then getting Covid himself.
Whether the reasons were structural or personal there is a distinct sense that his government was adrift before, during and after his sickness – a sense conveyed by Tim Shipman in a now-famous Sunday Times report on a meeting between Johnson and his cabinet secretary Mark Sedwill in May. The subject was a plan for lifting lockdown. Johnson asked Sedwill whose job it was to implement the plan.
“Is it you?”
“No,” Sedwill replied. “I think it’s you, prime minister.”
If the machinery of state was running well it might have given Johnson some cover, but vital parts of it were not. In the biggest public health emergency for a century, responsibility for public health was divided between local governments whose spending power has been cut by about a third in real terms in the past decade; and Public Health England (PHE), an awkward merger of smaller agencies which the Department of Health and Social Care has proved unable to hold to account.
PHE was also underfunded, especially compared with its German equivalents. Its budget had been cut by 40 per cent since 2012, says Sir Michael Marmot, author of the Marmot Review of health equity in England. “And in the middle of a pandemic the government said PHE isn’t functioning properly. Well, they cut the budget by 40 per cent.”
Marmot is worth quoting further on the context: “We plundered public services over the last decade,” he says. Public expenditure’s share of GDP fell from 42 per cent in 2009-10 to 35 per cent ten years later. “We rolled back the state and that rolling back of the state was done in a sharply and neatly regressive way… The more deprived the area, the greater the reduction in spending. We can’t expect there to be no bad consequences.”
The state of social care going into the pandemic was even more precarious. Public funding for adult social care had been cut by £86 million in a decade of rapidly rising demand. The sector as a whole, including private provision, is twice the size of the NHS. It has two million employees but is still overstretched – it has 122,000 vacancies – and its staff and residents are among the most marginalised people in society.
Matt Hancock, the health and social care secretary, promised to throw a “protective ring” around the sector. He never did, Lydia Hayes of Kent Law School argues, perhaps because his department collectively “has very little understanding of what care workers actually do”.
Nineteen thousand people died in care homes between 2 March and 12 June. At the time it was assumed that many were infected by residents moved out of hospitals without being tested to clear beds for incoming patients. SAGE has since produced evidence that workers may have infected more people in their care than residents did. Eileen Chubb, founder of Compassion in Care, says another leading cause of Covid death in homes was “an unofficial policy that people could not go to hospital from care homes”. The numbers are unclear. Good data on social care was scarce before the pandemic and inspections were suspended once it started.
Those who did witness this wave of death won’t soon forget it. Chubb says staff told her it was like working in a war zone “or a pre-Florence Nightingale hospital”. They spoke of dementia patients drugged to stop them moving around and infecting others; and of Covid patients unable to swallow, dying for want of a drip.
Tom Redfearn of the Alzheimer’s Society says there wasn’t an action plan for social care until mid-April – “by which point the vast majority of those who died in care homes as a result of Covid had already died”.
Did it have to be this bad? One person adamant that it did not is David Alexander, professor of emergency management at UCL’s Institute for Risk and Disaster Reduction. He has seen the classified National Risk Assessment that ranks “pandemic” as risk number one. He’s steeped in emergency planning documents that are said to be the best in the world, and angered that more use has not been made of them.
“Why are there no emergency managers on SAGE?” he asks. “Fifty-six members and there are no emergency managers. This is an emergency that is effectively being managed by epidemiologists, virologists and politicians. They’re all good at what they do, no doubt, but… there is no point in having a plan if it is pure idealism.
“We knew more than ten years ago that the socio-economic and psychological aspects of a viral pandemic would be as serious as the medical ones. We knew that there would need to be a means of balancing the two. We knew that certain things would have to be worked out in advance, but what we have seen, particularly in the UK, is a massive amount of improvisation, and improvisation is known by emergency planners to be tantamount to negligence.”
The point of having emergency plans is to be ready. It sounds obvious, but Britain wasn’t. It went into the pandemic with roughly half as many hospital beds per capita and half as much surge capacity as Germany. Its health service started the pandemic with 200 million pieces of PPE that turned out to be useless. They had passed their use-by dates in the previous eight months. With no system for getting more at a time when everyone needed it, Whitehall overcompensated by placing orders all over the world for 30 billion more pieces at mark-ups of up to 1000 per cent over normal prices.
As Covid-19 spread, countries scrambled to get their hands on personal protective equipment: the clinical quality masks, visors and aprons needed to keep healthcare workers safe from infection. But the sudden increase in demand for PPE worldwide meant it was hard to come by. On 7 February the WHO declared a global shortage in supply. Even so, a month later Number 10 said it had rejected an offer from the EU to join its PPE procurement initiative. The UK was going it alone – and ended up with shortages of PPE in the NHS, care homes and hospices. In some places, medical staff and care workers were forced to improvise, fashioning PPE out of bin bags and using swimming goggles in place of eye protection.
In the panic about shortages, PPE advice from Public Health England changed abruptly with little explanation, leaving health workers confused.
Palliative care doctor
In the first wave I worked in two settings: an acute hospital setting and also a hospice setting. In terms of obtaining PPE, hospices rank the same as care homes. We all will remember what was being described in March and early April from care homes – we heard of carers who were having to use home-made PPE, they were using bin bags and so on. My hospice testimony absolutely bears out the truth of that. I can state on the record that in very early April – so when we were approaching the peak of our Covid figures – my hospice came within 24 hours of having to close its doors. We would have had to evict all of our patients, many of whom were very close to death, and send them to our local accident and emergency which was of course filled with Covid patients. We literally didn’t have the PPE we needed to carry on safely. The hospice management were put in a situation either of knowing that their staff were at risk of catching Covid because we had not been given the right PPE by the NHS supply chain, or we would have to send all our dying patients away, and both of those [choices] were just intolerable.
There was a 24/7 NHS PPE hotline that was much lauded by the Health Secretary Matt Hancock at the time – he talked about it as though it was this wonderful panacea for any PPE problems people were having. We called that hotline over and over again, and in the end my Medical Director was told that there was nothing they could do. The only reason our hospice didn’t close was because I begged charity contacts I had and we managed overnight to obtain the masks we needed to stay open safely. We also had to beg local veterinary practices, businesses, schools, anyone we could find to supply us the PPE because we did not get it from the NHS supply chain. I know for a fact that our situation was replicated in hospices in other parts of the country because we were all talking to each other, we were appealing on social media for PPE.
In terms of the hospital PPE I was very lucky. In my hospital we did have good supplies of PPE, mercifully, and I don’t know of any instances where people were having to use home-made PPE. But I think it’s worth pointing out that around early March the official Public Health England guidance for what levels of PPE were appropriate in different clinical settings was abruptly changed. In early March, everybody seeing patients with suspected Covid was wearing level two PPE with the best FFP3 masks and proper long surgical gowns, and abruptly the guidance changed to say the majority of frontline staff only needed to wear level one PPE which was only a paper mask and a skimpy plastic apron.
That happened with no warning whatsoever or scientific justification to frontline staff, so doctors were incredibly frightened because all of a sudden, they went from a situation where one day they felt protected and the next they were wearing skimpy plastic pinnies and paper masks with no explanation. There was an attempt to say “this change has happened because the science has changed”. It wasn’t clear where this new science was coming from, and the new UK standards were lower than both the WHO standards for PPE and also the European standards for PPE. We knew that the reason this downgrade wasn’t because the science had changed, it was because the size of the PPE stockpile was found wanting.
Professor of Intensive Care Medicine, UCL
The UK’s preparedness strategy was for pandemic flu and I think if there’s a flaw, in retrospect that was probably one of them because this disease is not like flu, it really isn’t, this is so far from being simple flu.
I think we were also wrong-footed because we didn’t really know how this disease was being spread. It was mainly considered to be droplet-spread, and there were some case reports beginning to appear that there might be a degree of aerosol spread. But given the uncertainty about the R number, how it was spread, the degree of infectivity and the impacts that we were seeing which were not like flu and this really gravid impact on critically ill people, the PPE that got deployed seems to me – and I have no evidence of this – to have been pulled out of what we might call the Ebola playbook. But Ebola is a very different disease and it’s transmitted very differently: you can get it through skin cuts and so forth, and therefore long-sleeve water repellent gowns for that sort of disease are important. It turns out they’re not important for protecting you against Covid and in fact the overkill was part of the problem here. People were desperately worried about spreading this disease and the fact that it could be rapidly fatal. Healthcare workers were terrified, as were patients. This led to mass use of rubber gloves – which it turns out we don’t need and in fact probably contributed to spreading the disease – and long-sleeve water repellent gowns which we didn’t need because there’s no need for them to be water repellent. In wave one we had massive numbers of patients hitting hospitals. And then we had this constant churn of PPE because it’s not just one pair of rubber gloves people are putting on: you put them on, deal with a patient, take them off, put another pair on; and the same with water repellent gowns.
Communication has been a failure throughout this pandemic in my view. If things had been explained clearly there would have been a great deal less panic. When our ITU moved away from this burdensome protection to much simpler forms of protection we just did a very simple video call with an ex-professor of infection prevention control to explain it all, and it was adopted immediately without a wrinkle. No one was concerned because it had just been clearly explained.
Colorectal surgeon, Imperial College London
In terms of PPE you need four key things: you need supply which we did not have; if you’re performing aerosol generating procedures you need to be properly tested to make sure the PPE fits, which happened variably; you need to be educated and trained, which we were not; and you need to have trust, which we did not have.
We didn’t have evidence [about the PPE system] and a lot of that evidence still doesn’t really exist. It was based on SARS and Ebola and other diseases that were not of the correct context. But clinical context is absolutely everything here, PPE is only as good as the system that it’s working within.
Instead of a functioning emergency management system, Alexander says, Britain had a shell of a system. And its closest approximation to a strategy was to fill the shell with money.
People who know Rishi Sunak, the chancellor, say he has much more in common with Tony Blair than Boris Johnson. He’s personable, slick, prepared, determinedly modern and a disciplined communicator. So disciplined, in fact, that when the hand of history touched him on the shoulder and he took the podium at a Downing Street press conference on 17 March on the subject of the UK economy, he made a point of saying he would do whatever it took to save it from the ravages of Covid. “Whatever it takes,” he said – five times in an eight-minute statement.
In that statement he announced a £330 billion rescue package including two huge business loan schemes that he promised would be up and running by the start of the following week. They were.
All told the Treasury has distributed £280 billion in grants, loans and job support schemes for the employed and self-employed. The spending has been funded by the biggest surge in borrowing since World War Two to take the sting out of the sharpest economic contraction in three centuries, and the bulk of it was organised in under four weeks.
Ten million people have been kept in work with the help of furlough payments. Another 2.6 million received income support through the Self-Employed Income Support Scheme (SEISS). A £9 billion boost to Universal Benefit delivered a five per cent increase in income for the poorest fifth of the population, according to Torsten Bell of the Resolution Foundation, ensuring that overall “the income hit has been broadly shared across the income distribution”.
Bounce-back business loans worth £42 billion were at one point being issued at a rate of 7,000 a day. Some went to fraudsters and, separately, hundreds of millions went in panicky payments to self-appointed PPE manufacturers whose only real qualification seems to have been closeness to senior Tories. About three million people who needed support got none, and it’s fair to argue that even though the borrowing and spending was higher per capita than in almost any other major economy, it still wasn’t enough.
How was the money split?
According to the Office for Budget Responsibility (OBR), the UK’s economic output will fall by 11.3 per cent this year – the sharpest economic contraction since the Great Frost of 1709 plunged Europe into a recession. There has been twice as much extra borrowing as during the financial crisis (£394 billion and counting) and the UK government has already spent £280 billion on Covid-related support. The precise numbers are “fiendishly complicated and horribly opaque”, as one researcher puts it. Which makes it all the more important to ask: where is the money actually going?
The cost of Covid
Rishi Sunak, the chancellor, has made 14 spending announcements since the pandemic began, each one revealing a bigger and more elaborate spending plan.
To date, the largest share of Covid spending – £113 billion – has gone to public services. £22 billion of that went on the failed Test and Trace system and roughly £15 billion on PPE procurement, albeit too late to prevent months of shortages.
The Department for Health & Social Care has spent £18.1 billion on private sector contracts for Test and Trace, PPE and other healthcare offerings. Many were with established providers like Randox and Serco, allowing the government to accelerate procurement. Others attracted accusations of cronyism and corruption, including a £252 million deal for face masks with Ayanda Capital, a family investment fund with no track record in healthcare supplies.
Local authorities have received only about six per cent of Covid funds earmarked for the public sector (£6.5 billion). This includes funding for infection control measures for adult social care providers (£1.1 billion), Test and Trace schemes (£300 million) and £919 million for regions that have been in Tier 3 for most of the crisis. The Institute for Fiscal Studies predicts a funding shortfall for local authorities of £1-2 billion.
What about jobs?
A quarter of the government’s Covid spending has gone towards the Coronavirus Job Retention (or furlough) scheme, the Self-Employed Income Support Scheme (SEISS), and a one-year £20-a-week increase in Universal Credit.
At £73.32 billion, these schemes are among the most generous of their kind in Europe and have almost certainly reduced, or at least delayed, mass unemployment.
Roughly three million people got no help at all. Self employed workers earning over £50,000, for example, were not entitled to any income support.
The furlough scheme acted as a wage subsidy for many big businesses. The Institute for Government predicts that the government has absorbed 64.5 per cent of the total income hit that the private sector would otherwise have experienced. The additional cost of business protection was split between the Bounce Back Loan Scheme (£26.6 billion), which supports SMEs, and the Coronavirus Large Business Interruption Loan Scheme, which is estimated to cost £0.5bn this year.
The government has proposed an additional £55 billion in Covid-related funding for 2021, including £18 billion for testing, vaccines and PPE, £3 billion to support NHS recovery and £3 billion on local councils.
While the extra spending will go a long way towards limiting Covid’s impact, the OBR says the economy may not recover until the end of 2022. Should trade talks with the EU end in no deal, the economy may see a further 2 per cent hit to growth.
James Murray, shadow financial secretary to the Treasury, called the package reactive and inadequate. Georgia Gould, Labour leader of the London Borough of Camden, said it could have been transformative if more of it had been channeled to local authorities. Torsten Bell said the undoubted impact of the Treasury’s interventions during the first wave led to “optimism bias” in the run-in to the second. But the initial verdict on Sunak’s crisis response has to be that it was decisive and effective, especially compared with that of his Downing Street neighbour. Pushed by Oliver Dowden, the culture secretary, Sunak even came through in the end with a £1.5 billion boost for the creative sector.
On a personal level he was calm and collected and helped inspire trust. Six weeks into the pandemic, an impressive 90 per cent of the public thought the government’s Covid communications were clear and comprehensible.
Then, ten days after Sunak’s statement, Dominic Cummings was seen running north up Downing Street to the Horseguards’ Parade end.
The story of Cummings’ epic lockdown violation via the A1(M) and a side-trip to Barnard Castle is by now familiar – and that, historically, is the point. A government that seemed to depend on the prime minister’s senior advisor tried and failed to shut the story down, completely misjudging its power as a parable of hubris and hypocrisy.
The lockdown order was to stay at home. Instead, Cummings drove his wife and son from London to his parents’ farm in County Durham, to recuperate from his own bout of Covid. He might have got away with it had he stayed on the family property, but he was spotted by a member of the public in Barnard Castle on what happened to be his wife’s birthday.
The story broke in the Mirror on 23 May. At a press conference in the Number Ten garden two days later, Downing Street minders started by taking journalists’ phones so their editors’ couldn’t suggest questions. Cummings then told his story about driving to Barnard Castle to test his eyesight. Beth Rigby, the Sky News political editor, had the wit to ask whether the whole trip didn’t make it look as though Downing Street observed one rule for its own people and another for everyone else. Generally though, Cummings didn’t get the going-over he deserved. The Lobby hunt as a pack and the full absurdity of the story hadn’t dawned on them.
Not yet. The press conference was held in the middle of a summer Saturday when five million people had nothing better to do than listen in. The comedian Paddy McGuinness, gave his verdict – “bullshit” – in a tweeted version of Is This The Way to Amarillo / Barnard Castle? that attracted 3.9 million views. Later, Public Health England issued new lockdown rules with specific guidance on castles. “If that isn’t Public Health England trolling this government I don’t know what is,” says Laura Round of Freuds. “This story had huge cut-through.”
Tory MPs’ email boxes had been filling up with angry messages from constituents following the rules only to see Cummings flout them. Even so, a decision was taken the day before the press conference to protect him come what may, says Rigby. The upshot, according to one minister: “The PM’s authority with the British people was draining away in front of my very eyes.”
Looking back on the year, Steve Reicher, a social psychologist and SAGE member, said the difference between the first and second lockdowns wasn’t that people had become less able to put up with the restrictions. It was that they’d lost trust.
There were other factors besides the Cummings affair – a clear message to “save lives” had been replaced by a confusing one to “stay alert”, for example – but the polling broadly bears out Reicher’s view. After Barnard Castle, public approval of the government’s Covid communications fell rapidly from 90 per cent to 56. It’s hard to avoid the conclusion that Johnson should have sacked Cummings there and then, for his own sake if no one else’s. “Johnson had taken a massive political hit at that time in May,” says Rigby. “He never recovered.”
Rigby’s question about double standards resonated. When she got her phone back after the Cummings press conference she saw she’d added 20,000 Twitter followers in an hour. The number was soon up by 100,000. She has since been temporarily suspended herself for breaking Covid rules on a night out, because these rules turn out to be a matter of life and death.
As the infection curve tapered down in the late spring and early summer, the cruel contours of the virus’s impact started to emerge. Lydia Hayes has studied them closely. Black people are three times more likely to die from Covid than whites, she says. People with learning disabilities are four times more likely to die than those without them. Severely disabled women are 11 times more likely to die than non-disabled women. These differences are partly explained by risk factors that apply to everyone – where you live, how much living space you have, whether you live in a multi-generational household, how many people you regularly come into contact with. In principle that should help target resources to where they are most needed. In practice, the data on exposure to the virus has yawning gaps.
More than six million UK residents have no internet access, “and we rely on people having touchpoints with our data architecture in order for us to even build a picture of need,” says Mehrunisha Suleman of the Health Foundation. “There are groups whose needs we have no clear picture of at all.”
From behind closed doors certain data points stick out. Calls to domestic abuse helplines surged by 80 per cent during the first lockdown. Calls by children to the NSPCC rose by a third. Of the 2.3 million children officially classified as vulnerable and therefore eligible to continue to attend school or early years programmes during the summer term (along with children of key workers) only one in ten did.
On 11 April Priti Patel, the home secretary, announced £2 million in help for online services and to promote awareness of domestic abuse under the hashtag “you are not alone”. A total of around £30 million was eventually earmarked in extra funding for charities and victims, but only after the first wave peaked.
By then it was too late to prevent a spike in domestic abuse and homicide. According to the Counting Dead Women project, domestic homicide rates were three times higher than usual during the first few weeks of lockdown in the spring. What was needed from government, says Janaya Walker of Southall Black Sisters, was extra funding in advance, and “a really clear message to women and to the general public – to abusers – that there would continue to be places for people to go, that abuse would not be tolerated”. It didn’t come.
Outside the home, Black and minority ethnic workers were over-exposed to the virus and under-protected from it. They’re over-represented in jobs requiring contact with the public that raise the odds of infection and death. In South Korea public money is used for isolation pay and temporary accommodation for people who would otherwise infect their families. Not in Britain. As Jack Shenker reported for Tortoise in July, Emanuel Gomes, from Guinea-Bissau, died for want of sick pay after catching the virus as a cleaner at the Ministry of Justice. Across London, bus drivers have died from Covid at more than three times the average rate. Many were from BAME groups, but of course the virus isn’t fussy. Nicu Enciu came from Romania to drive a bus and provide for his family. He went home in a coffin.
The bus driver
It is a 1,700 mile drive from London to Brăila, the final resting place of 52-year-old Nicu Enciu. The bus driver Iulian Stroe made the journey in his Nissan Qashqai in May, following a funeral car. He reached Brăila, in eastern Romania, to be greeted by people lining the streets. “It’s hard to explain the emotion you go through,” he tells me over the phone. “You are speechless when you see.”
An ex-firefighter of twenty years, Enciu came to England in 2015 to provide for his wife and two daughters back in Romania. He found work as a bus driver based at an Abellio depot in south London. It was there that he met Stroe, a fellow Romanian who had also recently arrived in England. They moved in together, becoming good friends as well as work mates. “Nicu didn’t deserve to die,” Stroe says. “But at the end of the day, we can’t stand against the gods.”
Enciu developed a high fever in March, at a time when Covid cases in the UK were climbing over 100,000 new infections a day, and when London bus drivers felt unprotected. Many drivers were taking matters into their own hands to minimise contact with their passengers. “We started to use clingfilm to cover the speaker holes,” one driver, Moe Manir, says. “At one point we used the ticket roll as a barrier between the hand poles, so that passengers couldn’t use the front door.”
It wasn’t until mid April that central door only loading – a key demand of drivers at the start of the pandemic – was implemented on London buses, by which time around 15 drivers had already died from Covid-19. “Transport for London were hesitant about revenue if the front doors were closed,” claims Manir. “We were saying: ‘Revenue can wait until after this pandemic’s over.’”
At the time when Enciu was infected – and beyond, well into April – buses were operating close to normal schedules and not even basic PPE such as gloves and masks were provided to drivers. A review by the UCL Institute of Health Equity would later find that between March and May the mortality rate in working-age male London bus drivers was 3.5 times higher than men of the same age across all occupations in England and Wales.
It is unknown where Enciu contracted the coronavirus, but the week before lockdown he was hospitalised with the disease. His oxygen levels had fallen to less than 50 per cent, compared with a normal reading of between 95 and 100 per cent.
When Stroe spoke to him for the last time on 5 April, he promised that a beer was waiting for him back home. The next morning Enciu was intubated and warned by a friend to expect the worst. “Don’t go to ICU,” the friend had told him. “Because everybody who goes off doesn’t come back.” Enciu’s wife was in contact with Stroe as her husband’s condition deteriorated. “Don’t worry,” Stroe assured her. “I’m going to send him back home. No matter what. No matter how.”
On 12 April, Enciu died alone in hospital, and Stroe resolved to make good on his promise. Enciu’s colleagues raised more than £5,000 to pay for funeral transport, and a few weeks after his friend’s death Stroe accompanied the body across Europe – through France, Belgium, Holland, Germany, Austria, Hungary, and finally across Romania, to a small city on the banks of the Danube.
Stroe arrived in Brăila on an overcast spring day, and Enciu’s body was taken to the fire station where he used to work. Cars, vans and engines flashed their lights in respect. The body was delivered to Enciu’s wife and daughters, and they gave him a small Romanian orthodox funeral to say goodbye. Stroe had got Enciu home.
“In the future, when I die, God will probably look after me as well,” says Stroe. “And he’s going to make sure someone looks after my family like I did with Nicu’s.”
Covid is not a leveller. It exposes and exaggerates existing inequalities. This presented ministers with a simple challenge – not to make things even worse. It was a challenge that defeated the Department for Education.
In fairness to Gavin Williamson, when he became education secretary in 2019 he inherited a department obsessed with exams, running a system geared to them. How to assess GCSE and A-level students fairly when schools had been closed for three months and exam halls might turn into super-spreaders was an exceptionally tough problem.
Ofqual, the exams regulator, offered a solution: a 390-page algorithm that would assign grades without exams on the basis of school records, past exams and teacher recommendations. Williamson was warned in July by Sir John Coles, a former director general in his department, that the algorithm plan would produce appropriate results for 75 per cent of students at best, meaning it would be unfair on hundreds of thousands. Williamson went ahead with it anyway. He put his faith in a “robust” appeals system – but abandoned that along with the algorithm in one chaotic week in August when the computer-generated grades were published.
It was clear at once that bright pupils in underachieving schools had been hit hardest by the new system, and that private school pupils had benefited unfairly from it because the algorithm looked kindly on teacher assessments from small classes. (Coles had warned Williamson about this specifically.)
Neither unfairness was politically tenable. All students were granted the grades awarded them by their teachers, regardless of how the algorithm would have adjusted them to account for schools’ track records and to prevent grade inflation. Most grades went up, leaving lower-ranked universities looking at thousands of unfilled places and Russell Group universities scrambling to host more students than they had room for.
There is an argument that Williamson reacted quickly in an impossible situation. His critics say the reverse is true: that his department was only in this position having failed to grasp the potential of remote learning early in the crisis, and refused for months to accept that teacher assessment was always going to be the best alternative to exams.
“At the point when Covid struck there were six civil servants out of 7,000 in the Department of Education who had anything to do with digital learning,” says Peter Hyman, co-founder of Big Education and a former civil servant himself. “Ideologically the ministers in place at the moment think that anything to do with technology is faddy… [so] it’s not surprising that many schools had not seen that as a priority.”
In this analysis it was the reluctance to harness technology that made exams impossible once schools were closed, because some schools were well set-up for remote learning while most were not.
As for teacher assessments, Hyman says the assumption teachers will be too generous is nonsense. “It’s not actually rocket science,” he says, and points to existing moderated marking systems for art, drama and music coursework as a model for other subjects in the future. This sort of advice was available throughout the crisis, but the allegation from the educational establishment that Cummings liked to call the Blob is that the government wasn’t listening. “I know that a lot of teacher unions have been sitting in rooms with DfE and had the sense that DfE pays absolutely no attention to a word they say,” says Gemma Moss of the UCL Institute of Education.
No other European country has had a comparable exam fiasco, and there is no guarantee there won’t be another one next year.
Williamson and Boris Johnson “could not have been less suited to the time we face and we’ve all had to suffer as a consequence of that,” Hyman argues. They left a leadership vacuum in education, but one result is that “a lot of the headteachers have been emboldened: they’ve had a bit of space to think about the purpose of education and have been really on the front foot thinking, ‘actually we’ve got to do education differently’.”
One responsibility that still fell to the secretary of state was school safety. He promised schools they would be able to test all pupils for Covid as they returned after the summer holidays. As things turned out, that wasn’t true.
Last week, after the final day of our Inquiry, the National Audit Office produced an interim report on the UK’s test and trace efforts since the start of the pandemic. It found among other things that some call-handlers in the tracing operation were busy for 1 per cent of the hours they worked; that 70 per cent of test and trace contracts (worth £7 billion in all) were awarded without competition; that as of November only 40 per cent of test results were being delivered within the requisite 24 hours; and that NHS Test and Trace failed to plan properly for a surge in demand for testing as schools reopened in September.
“As schools came back we saw demand significantly outstrip planned capacity delivery,” Dido Harding, the former mobile telecoms executive in charge of test and trace, told a Commons select committee on 10 December. “None of us were able to predict that in advance.”
This is an extraordinary assertion.
To recap: Tedros Adhanom Ghebreyesus, head of the World Health Organisation, reduced the WHO’s message to the world to three memorable words on 16 March: “Test, test, test.”
The UK government had abandoned community test and trace on 12 March.
On 21 May Boris Johnson promised the House of Commons a “world-beating” new system would be up and running in time for schools to reopen on 1 June. In the event schools did not reopen for any of the summer term. Testing capacity flatlined through the summer and Serco, the main outsourcer for contract tracing, laid off a third of the 18,000 call-handlers it had recruited for the job.
On 24 August Gavin Williamson promised home test kits would be available to all schools in time for the autumn term. They weren’t. Furthermore, families wanting tests for their children before term started were on the whole unable to get them, as Harding admitted. But the idea that the demand was not predictable is absurd. The need for testing was clear and constantly emphasised. Ministers had been promising it on a mass scale for months, and in the absence of a vaccine there was no other way for parents to have any confidence their children would be safe back at school.
Tedros had not been alone in pushing for mass testing. The airline industry depended on it. Anxious to support the travel sector, the government announced that once infection rates were under control in the summer, travel for foreign holidays would be allowed along specific corridors. But even within these corridors testing would have to be “massively ramped up” if only to keep aircrew safe, Professor Gabriel Leung of the University of Hong Kong told the Commons’ home affairs select committee.
That was on 10 June. The ramp-up did not begin until September. Before the committee met, SAGE had considered four options for reopening international travel, including screening on arrival. It made no recommendations at all for six weeks. When it finally came down in favour of corridors (and 14-day quarantines, depending on infection rates in the country of origin), it failed to recommend testing on arrival even though this was standard practice in Hong Kong, South Korea, Taiwan, Singapore and other countries that had managed to reopen international air travel relatively early.
The rationale for not testing on arrival was that it might produce a confusing number of false positives. The result was that even when it was clear that large numbers of holidaymakers returning in numbers from Spain had been infected there, they were still not tested. More than half of all new infections in the UK since the summer have been traced to a single cluster in Spain identified as 20A.EU1.
From early in the pandemic airlines had been urging the government to screen travellers in the safest possible way – before departure. The argument fell on deaf ears. Consultation between government and the aviation sector improved in October, says Shai Weiss, CEO of Virgin Atlantic, but until then “it was as if we were on opposing sides”.
Virgin’s suggested protocol is for passengers to be tested within 72 hours of departure and again at the airport immediately before departure. The protocol is now being trialled, but not in the UK. The first certified Covid-free transatlantic flight, operated by Alitalia, took off from New York last week and landed in Rome.
Here was a chance to lead, not taken. The Johnson government’s use of populist rhetoric (“world-beating”) to mask national failure is one of the most frustrating and frankly embarrassing aspects of its Covid response. Attempts to reframe the blunders and omissions of the first wave (abandoning test and trace, running out of PPE) as lessons learned for the second, are another.
Why has it been so slow to act and so reluctant to learn from others? There are structural reasons – and here Sir Michael Marmot’s analysis of the atrophied British state is devastating – but there may be reasons of character as well. Rory Stewart, the former international development secretary and Conservative leadership contender, blames “a certain British smugness”.
“This is a cultural problem that we have in Britain,” Stewart says, “a certain idea that Britain was the best country in the world at public health response and that we didn’t really have anything to learn from other people. When I was saying [while in government], ‘this is what the Italians are doing’, there was a general sense of ‘Why on earth should we listen to the Italians?’. If I was saying ‘this is what the Chinese are doing’, they’d say ‘We can’t trust the Chinese’.
“China has somehow got itself in a situation, despite having a population much larger than us, where they have got almost zero Covid cases at the moment. Their economy is growing. Britain has nearly 20 times the number of cases per head of population and 40 times the number of deaths, and somehow we’ve concluded that we can’t learn from that.”
What, indeed, did Britain have to learn from anyone else, equipped as it was with the world’s best pandemic planning documents, the NHS, and a 111 helpline that meant no one with Covid concerns would even have to leave home?
A lot, as it turned out. The 111 non-emergency line might have helped prevent NHS hospitals being overwhelmed, but at great cost. There is strong evidence that call handlers too often advised callers to stay at home when they needed hospital treatment. Three witnesses at our inquiry told heartbreaking stories of loved ones lost after 111 calls. They urged that the subject be investigated further, and it should be.
As Covid spread through England, the NHS 111 service experienced an unprecedented surge in demand, fielding three million calls in March alone. Nearly 40 per cent were abandoned after callers waited longer than 30 seconds.
Even those who did get through were often let down. Sick people were told to stay at home, only to die there or get to hospital too late to be saved. Black people were asked if their lips were blue, something which they weren’t able to tell.
Many families feel that had the 111 service been better equipped – its operators more carefully trained, less tied to scripts, more cognisant of the Covid danger signs – they wouldn’t be spending Christmas with an empty chair at the table.
I lost my father to the pandemic at the end of April. He was working as a care assistant for Mencap in the West Midlands. He called the 111 service three times just trying to understand what he was supposed to do – and each time he had been told to stay at home.
There was a point when they did refer him to his GP because he said that he was starting to find blood in his phlegm. They prescribed him some antibiotics, but told him to still stay at home and continue resting. Unfortunately, a few days later, he passed away at home.
After my father passed, my mother called 111 to try and get herself a test so she could find out if she had Covid. I am the oldest of five children and she was concerned about what was going to happen to her kids. One of the questions they asked her to see if she qualified for a test was whether or not her lips were blue. She responded that she didn’t know.
We have questions about the appropriateness of the 111 service and also about how they assessed whether people were in need of medical care – and how that applied to people of colour especially, and, for our family, to black people.
Leigh Morgan Jones
Around 24 March dad became ill. He spoke very strongly when we were having a conversation with him, but he was very lethargic, he was getting a little confused at times. There wasn’t much of a cough but we did think it was probably Covid.
Mum rang 111, and they asked her to ring back on day eight of his symptoms. They had worked out for his current symptoms that that was day six, so two days later would have been day eight. Those two days were rather distressing. Dad was okay but he wasn’t the dad that we knew. He’d had several collapsing sessions but would recover quite quickly.
On day eight she rang back as instructed. At that point a doctor came on the line and asked mum if she could take dad’s blood pressure, which she did. The doctor agreed with mum that his blood pressure was very low, but that “he should be okay”. That is a direct quote.
Mum did what she was told but later that day dad was walking upstairs back to bed after having a few spoonfuls of soup. He collapsed backwards, hit his head and his head split open. Mum immediately rang 111 again and they agreed that an ambulance was needed. The ambulance turned up [but] there was still a huge reluctance to take him to hospital. The nurse arrived, took one look at dad, and said: “This man needs to go to hospital and he needs to go now.”
Dad was taken into hospital, and he rang us on his mobile. He said to mum: “I’m now going to go into ICU.” And mum said: “It’s okay my darling, I love you, we’ll see you soon.”
My dad died 30 hours later.
I’m one of the co-founders of Covid-19 Bereaved Families for Justice. We’re a group of 2,000 individuals who are personally bereaved by Covid. I lost my dad on 2 April. He was a cancer patient just undergoing diagnosis and he also had a number of other health conditions which read pretty much like a checklist of vulnerabilities to Covid.
We think he was most likely to have contracted Covid at a hospital appointment on 18 March where – despite knowing that there was widespread community transmission – staff hadn’t been provided with PPE. There were no protective measures put in place at all.
When people began sharing stories [with our group] it became clear that people had huge issues with 111 telling people to stay at home. We’ve since found out that the 111 service in response to Covid was actually run by different companies and didn’t run through the normal 111 processes, and so many of the team fielding the calls were very minimally trained and – it appears – were almost following a very basic flowchart.
Lots and lots of people in our group believe the fact that their loved ones weren’t admitted to hospital meant that it was too late for any treatment to happen when they made it there. And also there are quite a few cases where people passed away at home. Our main aim is to make sure that lessons are learnt so that other people don’t have to go through the same pain that we do.
Patients who did go to hospital in the first wave found wards cleared in anticipation of a massive need for intrusive ventilation. The goal of mass-produced British ventilators to supplement the NHS’s existing stock of 8,000 American ones became a talisman, says Dr Jonathan Williamson, a north London anaesthetist. Little thought given to potential consequences, among them an impossible demand for oxygen at 60 litres per patient per minute. “Our hospital, like many others, isn’t designed for the flows of oxygen that we needed to treat all the Covid patients, so our oxygen supply alarms were going off almost constantly,” Williamson adds. “We couldn’t have handled any more ventilators regardless, especially due to the inadequate staff numbers needed to safely manage the complex care of ventilated patients.”
In the end the so-called Ventilator Challenge produced back-up supplies for the Nightingale Hospitals, but neither the hospitals nor the ventilators were used. The whole scheme was “slightly misguided”, says Fiona Godlee, editor of the British Medical Journal – and was superseded anyway as it became clear that most patients responded better to non-invasive oxygen treatment.
The funeral director
“I had one day where I just cried. I just worked through the day and cried and cried.” How do you look after the dead if they are still contagious? How do you comfort families who cannot be with their loved ones in their last moments? Who cannot touch their bodies?
It’s a question Hasina Zaman, funeral director at Compassionate Funerals in east London, asked herself as the pandemic began gathering pace. “It just knocked us off the ground. At first I thought I just wanted to close shop,” she says.
But she knew she had to carry on. “We had families coming to us saying you’ve got to do the funeral for us, it doesn’t matter how, it doesn’t matter if we don’t see that person, it’s fine, we just want this funeral done.”
At the peak of the pandemic Zaman’s work quadrupled, as deaths accumulated in Redbridge and other hard-hit nearby boroughs, and fellow funeral places shut down – especially in the Muslim community, where almost immediate burial is a funeral rite.
She recalls a call with a senior registrar in Hackney, who said that while they would normally register 12 deaths a week, this had increased nearly sixfold to 70 a week.
She remembers Pandemic Multiagency Response Teams arriving at homes and registering Covid-19 deaths, against families’ convictions that the underlying cause was different.
And she saw in the constraints of her own service the stigma of Covid first hand. “Lots of communities want loved ones to be washed or dressed,” she says. “It’s like you can’t touch them in case you get infected, so these diseased people become unavailable. I felt this deep sense of strain – people saying: ‘It doesn’t make sense.’ I’d never seen this confused grief before.”
The situation was so frantic that Zaman spent days trying to find a dead body. “We had this Egyptian guy who died in a care home down the road. We couldn’t find him.”
The head chef of the care home, who was also Egyptian, had called a local Muslim charity beside himself. Worried that the body would be cremated, the charity enlisted Zaman to help. “It got a bit messy for a couple of days,” she says. She rang every mortuary she could. On the third day she finally found him, and WhatsApp’d his next of kin in Dubai into the funeral.
Doing her job while fasting, she always managed to pick herself up. “I’m a practicing Muslim, I pray five times a day. And sometimes I’ll be praying saying: ‘I can’t do this.’ And then all of a sudden I’ll be illuminated with this verse. It says: ‘I do not give you anything you can’t bear.’ I keep saying it. And all of a sudden I feel alive again.”
There was no debate about the need for PPE. As infection rates took off in March it was clear that the NHS’s assurances about stockpiles of masks, gloves and gowns were worthless. The Department for Health and Social Care reacted by over-compensating. Jolyon Maugham QC of the Good Law Project estimates that the 30 billion items bought in a rush in April represented five years’ supply.
The system was in the end brought under control by Lord Deighton, who showed his management skills delivering the London 2012 Olympics and impressed people in the PPE supply chain by getting personally involved. “Everybody I knew working in this field got a call from him,” Rory Stewart says. “He was extremely good at picking up the phone and testing his ideas.”
Not so Dido Harding, in charge of test and trace. “What struck me about the problem with Baroness Harding is almost nobody I knew in the field got a call from her and that suggests something about [her] curiosity,” Stewart says.
Test and trace was “a real shambles – I don’t know how else to put it,” Godlee adds, and not just because of one individual. She says there were two fundamental flaws to the government’s approach. First, it turned instinctively to centralised, commercial options when local, public sector ones might have worked better. Second, mass testing became the target – but was only one of five components of a “find, test, trace, isolate and support” system that had been shown to work in much of the Far East.
“If you have a positive test [but] you can’t afford to isolate… then that’s pointless,” Godlee says. “And if you don’t then have a system for contact tracing, you’re not going to get the suppression of the virus that the whole test, trace and isolate thing was supposed to provide.”
The starkest lesson from abroad may have been that lockdown gave cover to abusers. “We had forewarning,” says Mandu Reid, leader of the Women’s Equality Party. “We saw the domestic abuse situation peaking and spiking in China. That was several weeks ahead of us having to deal with the same problem on our shores. We saw it happen in Spain, in Italy, in France, creeping closer and closer to us, yet we have this situation whereby when it’s on our frontline we act as if we’ve been ambushed.”
Covid has been unmerciful. Its heaviest burden has been on the 64,402 people who have died from it so far in the UK alone, and on their families. But it has been tough on government as well. No other administration since the war has faced a set of overlapping crises remotely as challenging.
Should allowances be made for the sheer pressure of having to make life-or-death decisions affecting tens of millions every day? Where were the armchair quarterbacks when public health and the economy were imploding at the same time? Who really knew enough about the virus back in March to dismiss the goal of herd immunity out of hand? The case for the defence would be stronger if other comparable countries had not fared better; if this government were not heir to ten years of steady shrinkage of the public sector because of a sincerely-held belief – bound to be tested at some point – that the private sector was more agile; if this government had not staked everything on Brexit.
The UK went into the pandemic with a weakened state, an unhealthy population and a prime minister better at campaigning than governing. It went in with action plans – but only on paper. They were stuck in the contingency secretariat, one witness said. And it went in with an NHS that had been run hot for too long. The service wasn’t overwhelmed, but only because 38,000 cancer treatments were postponed and 50,000 cancer diagnoses missed.
For all his time as mayor of London, Johnson faced Covid as an inexperienced prime minister. This was his first really big challenge. Perhaps he’ll do better second time round, Lord O’Donnell mused. In fact that second time has already come. We’re calling it the second wave and even Germany has been blindsided by its stubborn force.
Whether Johnson has the stomach for much more of this is an open question, but he may need it if he wants to stay in post. “There are over 5200 more of these coronaviruses out there,” says Hugh Montgomery. “And with mass transport – 150 people a second getting on an aeroplane before Covid – we’ve cooked up a recipe book for baking this crisis again and again, and it could be a lot worse.”
Additional reporting by Ella Hill, Xavier Greenwood and Patricia Clarke