Intended for healthcare professionals

Opinion

An untrustworthy government during a pandemic—a lethal combination

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1011 (Published 20 April 2022) Cite this as: BMJ 2022;377:o1011
  1. Daniel Goyal, consultant physician
  1. NHS Scotland
  1. Twitter: @danielgoyal

It’s difficult to find one aspect of pandemic management that the UK government got right, argues Daniel Goyal

At a time when millions of people were legally restricted from seeing their loved ones, thousands were in hospital, and the body count was growing by the day, the leader of the UK’s pandemic response, Prime Minister Boris Johnson, partied. There is no getting around this fact, despite the continued flimsy defences of Conservative MPs and a feeble apology from Johnson in parliament this week. As we all struggled, losing colleagues and loved ones and were forced to disconnect from our support networks, the mood in Downing Street was one of “wine Fridays,” surprise birthdays, and garden parties.1

The fact that it happened is enough. The fact that Johnson misled parliament and the nation—only admitting his involvement after being caught in the crime—carries potentially greater ramifications. Given that this deception appears to be part of a trail of dishonesty or at least a wilful “spinning” of the truth,2 and that it took place in the midst of an unprecedented public health crisis, we are more than entitled to challenge the new government rhetoric of “We got the big calls right” on covid. Indeed, it is perhaps our duty to challenge this dubious claim as we look to learn and improve our response to this pandemic and prepare for the next.

There are three basic tenets to a pandemic response. First, find those infected through symptom profiles and testing. Secondly, treat those who are infected using triage, follow-up, and best supportive care. Lastly, prevent other people getting infected with contact and trace, supported isolation, and social mitigations. It’s difficult to find one aspect of these basic tenets of pandemic management that the UK government got right.

Until recently, the UK’s official symptom profiles for covid were too narrow, limiting how many people we could reliably identify who were infected and, therefore, how much we could suppress community transmission of the virus.3 Delays in upscaling testing capacity contributed to the devastating care home outbreaks that typified the first wave of the pandemic.4 Even when testing capacity was up and running, the favoured commercial providers were largely disconnected from clinical care pathways, leading to the medico-legally tenuous position of carrying out a diagnostic test on a person without any assured clinical follow-up. To this day, GPs cannot request a covid test for their patients.5

For reasons yet to be explained, clinical triage of patients with covid took place via online automated platforms with dangerously high thresholds for onward referrals to further healthcare.6 Furthermore, instead of strengthening primary care and NHS laboratories to deliver a clinical contact and trace service, the government made the disastrous call of promoting commercial partners to deliver a testing and tracing-only service with no clinical remit. In another remarkable and quite unique move, the government failed to increase basic healthcare capacity, with the repurposing of hospitals for covid during the first wave leading to an 8% reduction in general and acute beds.7 This led to high thresholds for admission and extreme rationing of care that continues to this day.8

The majority of these failures likely have some origin in one of the biggest pandemic calls made early on by this government: the pursuit of herd immunity through mass infection. This was the strategy of choice early in March 2020,9 and even though the government changed course later that month, the pattern throughout the past two years of delaying mitigations until hospitals were visibly overwhelmed suggests it was never fully corrected. This contributed to the UK’s massive all cause excess mortality.10

But of all these grave errors, the one Johnson is currently committing is perhaps the most deadly and damaging. Instead of mourning those we have lost and trying to learn from earlier pandemic decisions so that we can minimise our ongoing losses, in the typical discordant bluster we have come to expect from the current administration, we continue to hear that “covid has been defeated,” how “covid is now like the flu,” and how we can now “live with covid.”

The ongoing attempt by Johnson’s administration to rewrite pandemic history is dangerous. Covid remains the most destructive infectious disease in the UK and is currently the third leading cause of death in England (second only to heart disease and dementia).11 With infection rates as high as they are now, the risk to the public is still considerable. Yet the current rhetoric of “it’s over,” while politically favourable for Johnson, has only resulted in a less protected, less informed public, who are being urged to resume normal life without the encouragement to wear a mask and with no legal requirement to isolate if infected.

There is no sign the UK government has learnt from their many mistakes. Failing to suppress the recent two waves of covid (BA.1 and BA.2), despite the worst healthcare crisis in modern history, is a clear sign of their indifference and inability to admit the mistakes of the past. As well as the thousands of more avoidable deaths we bore during these waves, many more thousands of people are now suffering the effects of long covid. This failure to learn has further compounded the harrowing effects of a decade of underfunding in healthcare and the unconscionable neglect of frontline NHS services during a pandemic, all of which can be witnessed in the crisis in emergency care provision,12 delayed cancer treatment, and a record breaking waiting list of over six million people.13

Amid a failure to strengthen the NHS, a failure to suppress the virus, and now a failure to convey the ongoing risks to the public, we are hurtling towards another catastrophic pandemic year. Spin may be permissible when it is only political careers at stake, but to continue to twist the truth in the face of avoidable death and disability is a level of negligence we simply cannot abide.

Footnotes

  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not peer reviewed.

References

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