Covid-19: Call for a rapid forward looking review of the UK’s preparedness for a second wave—an open letter to the leaders of all UK political parties
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2514 (Published 23 June 2020) Cite this as: BMJ 2020;369:m2514Read our latest coverage of the coronavirus pandemic
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Dear Editor
The call for a rapid review is well-intentioned and may even be desirable but it completely fails to understand, or acknowledge, the type or style of UK government we have at this time. This is not an administration that believes in reflection or deliberation and is certainly not in the business of conceding any errors of judgement or failures of a technical or operational nature. Some of these deficits are inherent in all recent British governments, as analysed by Anthony King and Ivor Crewe in their seminal 2014 study, The Blunders of Our Governments. But others, arguably more insidious and anti-democratic, are more recent and a direct result of the type of government Boris Johnson and his chief adviser, Dominic Cummings, have established.
It is a campaigning style of government applying the lessons (and successes if they can be called that), and populated by many of the same individuals, from the Brexit referendum campaign in 2016. This government does not therefore apply the usual rules or procedures when it comes to their decision-making - indeed, these are impediments to be removed or bypassed. The larger campaign the government has embarked upon, rudely interrupted by Covid-19, is to launch Global Britain. What it means exactly is of little consequence. It plays to its populist base and the message is reinforced by constant focus groups and polling.
Heeding the wise words of a group of eminent health professionals is simply not on this government's agenda and will therefore not happen. If the letter's signatories are serious, as opposed to flying a kite they know will get nowhere and have little impact, then they, and others who seek a different style of governance, are going to have to adopt different tactics. Going high when the government goes low is simply not going to succeed with the current government. Opponents need to consider going low too in order to strike at this government's underbelly and challenge them on their own turf.
For a start, it means being relentless about the gross mismanagement of the crisis from the start and the inheritance of a hollowed out public realm resulting from a decade of Tory-led spending cuts. The result of a lack of sound governance has been a shockingly high rate of excess deaths which the government should not be allowed to forget in its haste to distract us all by easing the lockdown and opening up the economy. Far from seeking to cooperate with this government, scientific experts may need to consider distancing themselves from a regime that has already shown contempt for the public interest. We have not yet reached the depths of incompetence on daily display in the US and hopefully won't. But there is no room for complacency. We are in different territory from previous administrations.
Competing interests: No competing interests
Dear Editor
Taking time to take stock of what is going well, and what needs a rethink is key at this time. We at RCPath, working with many other colleagues, including signatories of the letter above, have been through such a review, looking at testing within health services.
We garnered views and thinking about how things are being done and what needs to happen going forward. Our “Testing - A National Strategy” is the result, and is perhaps one model for a review report that is a constructive and helpful approach to the future. https://www.rcpath.org/uploads/assets/2e8d8771-f85a-408a-b5c8e68969cd21d...
Jo Martin
President RCPath
Competing interests: No competing interests
Dear Editor,
The open letter on COVID-19 published by the BMJ today has attracted considerable media attention. Local flare-ups may well happen. But to describe a second wave as 'a real risk' clarifies little. How big is this risk? And, aside from local flare-ups, what examples can the authors point to of evidence for a second wave elsewhere, especially in those places that stepped down from a full lockdown quite some time ago?
The claim in the letter not to wish to look back or attribute blame appears misleading, followed as it is by a superficially point-scoring paragraph pointing to purported demands for a public inquiry. Quite how many of 'the public now support' this is as ill-quantified as the 'real risk' previously mentioned.
No doubt there is a need to move from a reactive phase to a more proactive one. But that is a technical task and the same could be said in relation to any disease (or other emergency) at any time. Either way, the formulation allows events to lead, while we are exhorted to respond in accordance.
What really matters now is to articulate our purpose as individuals and as a society beyond the immediate demands of the present crisis. It may not be possible to 'prevent further loss of life AND restore the economy' (emphasis added) as the authors suggest. Indeed, an economy is not just about making money but is necessary both to prevent future loss of life and to give meaning to life in the present.
It is not a scientific debate about risk that is needed, nor a technical one about preparations for the future, so much as a political one regarding the type of society the majority wish to live in. There will always be 'a real risk', if not from COVID-19, then from whatever else comes next to challenge our societies.
It is time to debate our values openly and not conceal these behind allusions to risk or assumptions about what the public want.
Respectfully,
Professor Bill Durodie
Competing interests: No competing interests
Dear Editor
The open letter by Lord Adebowale and colleagues has quite rightly called for a Cross-Party inquiry into lessons learned from the first wave of COVID-19 in the UK. Ongoing preventative measures such as social distancing, handwashing and use of personal protective equipment (PPE) are likely to be a given in any strategic approach. There are also major lessons to be learned regarding the vulnerability of care home residents. But, above all, no longer hiding in plain sight, is the spectre of the disproportionate impact of COVID-19 on Black and Ethnic Minority (BAME) Populations.
The new Race and Health Observatory is a positive step forward to tackle racism in medicine. This will need to work hand in hand with the inquiry that is called for. The Black Lives Matter movement and COVID-19 pandemic have shone a brighter and wider light on racism in medicine. It's not just about general preventative measures. It's also about a commitment to a broader approach that involves BAME staff in decision making at the very highest levels of senior management. BAME staff do not expect special treatment, but they do expect equality. This equality means having a say in the policies and procedures that affect their everyday working lives. Lives that need to be protected and respected. We must start not with staring silently at the mountain of injustice but take a steamroller to level out the playing field of inequality.
Competing interests: No competing interests
By mid June 2020, well over 40,000 people testing positive for the SARS-CoV-2 coronavirus had died in the UK. By the same time, and in response to a significant slowing down in weekly numbers of COVID-19 cases and deaths, the UK Government has announced repeated and significant easements of 'lockdown' restrictions. This includes the opening up of most retail establishments and the end of enhanced protective measures for people who are extremely clinically vulnerable to severe COVID-19 illness.
Warnings from health leaders about a 'second wave' of the COVID-19 pandemic have come as no surprise. There are a number of reasons why the UK is vulnerable in this respect.
First, data from the Office of National Statistics in June 2020 indicated that there is little evidence of widespread immunity. As of 13 June 2020, 5.4% of individuals from whom blood samples were taken tested positive for antibodies to the coronavirus. It is also unclear whether effective immunity is conferred by the presence of antibodies.
Second, while progress towards an effective vaccine has clearly been made, there is little evidence that it will be ready for a national roll out within 2020, and crucially, not before the winter season at which time any second wave will be most likely to overwhelm NHS and social care services.
Third, the national Test & Trace system, which is the primary way by which the chain of viral transmission can be broken, is still not operating as effectively as it needs to. Government reports indicate that, as of mid June 2020, contact tracing was not happening in more than 1 in 4 confirmed cases of infection. In addition, the Test & Trace app that was supposed to enable automated notification of contacts was reportedly still some way off being ready for implementation.
A second wave will only be managed effectively if we learn lessons from the first wave:
First, national and local agencies need to operate as one, seamless system, with Central Government taking the strategic role of Local Government and local NHS organisations seriously. Local outbreak plans must be properly resourced, not just with funding, but also with detailed, prompt data flows from national systems.
Second, there must be a recognition that a second wave of infection will bring with it a second wave of inequality. The greater impact of the pandemic to date on those who are socioeconomically deprived or from black, Asian and minority ethnic groups has been stark. Resources must be directed to those communities that most need them. In addition, work to protect vulnerable groups must be done with them rather than to them, fully engaging communities in decision making and utilising the skills and expertise they offer.
Third, we must learn that our pandemic response should not be displaced by politics. Rousing speeches and crass soundbites from national figures, whether they be in support or attack of the presiding Government, must be replaced by calm, factual and transparent leadership from all sides of the political divide. Decision making, and the data that informs it, should be elevated to a shared process that breeds confidence rather than suspicion.
In summary, while it is poses a significant threat to our health and economy, a second wave of the coronavirus pandemic is a second chance to get things right. That means taking this window of opportunity to step our efforts up not down, and working hard to get the funding right, the data sharing right, the contact tracing right and the involvement of local communities right.
Competing interests: No competing interests
Re: Covid-19: Call for a rapid forward looking review of the UK’s preparedness for a second wave—an open letter to the leaders of all UK political parties
Dear Lord Adebowale and leaders of medical professions,
Thank you so much for your open letter to party leaders across the UK. In the Green Party of England and Wales, we are also acutely aware of the urgent need to learn vital lessons from the crisis so far and prepare to avoid the worst impacts of a second wave of COVID-19 infections.
At over 300,000 cases and over 40,000 confirmed deaths, the loss of life and burden of illness on people in the UK is unacceptable, particularly as thousands of these infections were so preventable. The grief and long-term health effects will be with us all for many years, and every effort must be made to do better with our next steps. We are deeply concerned too that lockdown is being lifted while the daily death toll from Coronavirus is at such high levels, and a test and trace system won’t be fully operational before September.
All of us in national leadership positions should step up and work together, and we welcome the clear call you have made as leaders in your professions.
We have sought to forge cross-party work in many areas as the crisis has unfolded. In April we reached out to the Labour leadership candidates in a similar collegiate spirit and we want to make sure everyone sees a better kind of politics supporting them through these difficult times.
In Parliament, Caroline Lucas MP and our Green Party peers have been working cross-party to put forward changes to new legislation, support for small businesses, precarious workers and renters, and have pushed for testing, protective equipment for the NHS and essential workers and for transparency and scrutiny to continue through the crisis. This work has been necessary and important.
Last week, Caroline Lucas joined the cross-party group calling for an urgent public inquiry into the Government’s handling of the crisis so far. With Jenny Jones in the House of Lords, she is also part of the Parliamentary Group on the Green New Deal, which has launched a new Reset initiative to listen to people in all areas of the UK on their needs and ideas for building a new, more resilient country as part of recovery.
In our towns, cities, counties and districts, Green councillors are working hard with their colleagues from other parties to keep public services running, and to support the community-level aid networks that have grown up all over the country. This humanitarian work will continue, and shows that when politicians focus on supporting every citizen to the best of our ability, we really do find that what we have in common is greater than what divides us.
The warnings from senior scientists that the country stands on a knife edge and that we could already be heading into a second wave, strengthen the case for your call in your open letter for a more immediate rapid review of gaps in the response so far and our national preparedness for a second wave. This is a necessary addition and should happen as a matter of urgency.
It is vital to look in a non-partisan and practical way at what will be needed in the next months to prevent not only a much higher toll of death and illness from a second wave, but also the same disproportionate impacts on people with lower incomes, disabled people and those from Black, Asian and other minority ethnicities. Jonathan Bartley has written to the Government asking for more detail on the Government’s Joint Biosecurity Centre and to the National Audit Office asking for an investigation about the way the test and trace system has been set up. Greens have been calling for some time for community level test, track and tracing work to be a priority and this would also seem to be a clear area of focus for the review.
To the policy areas you have suggested, we would also add that we believe close and detailed monitoring and rapid publication of occupational infection rates at a local level is vital, so that public health and policy makers at every level - as well as workers themselves - are alerted immediately when higher risks for people in particular jobs emerge. This will mean they can act to change regulations, guidance and working practices on the ground in a timely way.
We also agree that co-ordination of public governance is a key factor in preparedness for a better response, and want to stress the importance of involving leaders of all parties at all levels of Government in this review. We are sending this open letter to our colleagues in national leadership, to the First Minister of Wales and our sister Green parties in Scotland and Northern Ireland, as well as the Mayor of London and the leaders of each group in the Local Government Association for this reason.
We are determined that your proposal does not gather dust and that this slim window for action ahead of a second wave should not slip by, and believe that an urgent meeting between us all should happen within days.
With very best wishes,
Competing interests: No competing interests