This is the bleak assessment of the UKs public health response to Covid 19 in the British Medical Journal 23 May 2020 (p269). The editorial documents a series of failures of decision making, on a background of the decimation of public health services and austerity in the last decade. Another editorial in the same edition criticises the mixed messages from government and cautions against premature easing of the lockdown. As they point out, no action plan around social care could undo decades of political neglect of the sector but sorting out social care is now an imperative. The BMJ’s editor (23rd May) writes “There will be things the UK has got right in managing the pandemic, but it’s hard to see what those are”.
There is more “cheery” reading in the BMJ of May 30th. Whilst everyone wants the opportunity for life to return to some sort of normality and there is an understanding of the economic hardship caused by the lockdown,(as well as health problems), the medical opinion on the whole is that it is too soon to be easing the restrictions. “England is in confusion. The public’s confidence in official advice is shaken” writes the BMJ executive editor. ”England’s decisions seem rooted in a desire to restart the economy rather than an overabundance of science” Testing and tracing with reliance on unreliable apps is not yet robust-this needs to be in place before lockdown should be cautiously eased.
The Royal College of Physicians this week documented four possible scenarios from here on in.
1.Things stay reasonably under control over the summer then there is a second wave of infection in the autumn. That seems to be the most likely.
2.There are localised outbreaks clustering around health care and social care institutions.
3.“The lockdown wheels fall off” and the R number goes out of control. There is a second spike. Clear and consistent messaging and public compliance with social distancing rules is needed to avoid this.
4.The virus disappears over the summer –this is highly unlikely.
Other voices in the medical and health press are this week saying similar things –don’t ease the lockdown until test and tracing is working well, , make use of local mechanisms to test and trace(using local public health rather than a centralised -and privatised- system,) keep the messaging clear, and don’t be too optimistic too soon.
I know the public are tired of the restrictions –I am too, but the populism of easing the rules just to make people feel better (and maybe to distract from the Cummings debacle) seems a gamble too far. We still have a high infection rate and a high death rate. A more cautious approach would seem to be wise- this is the health of the nation, individual peoples well-being, not a political game.
I really want the government to get this right. It would be reassuring to feel in safe hands, as I’ve said before, to trust that the right decisions are being made at the right time. For the right reasons. Alas; I don’t think this is the case.