How the UK went from one Covid-19 death to more than 100,000 in a year

PA

One year ago, 84-year-old Peter Attwood, from Chatham in Kent, died with coronavirus in what is the earliest known death involving Covid-19 on UK soil.

Since then, the toll has spiralled past 100,000 as the nation sustained one of the worst death rates in the world and has been battered by the economic fallout.

Boris Johnson said he accepts “full responsibility” for the Government’s response but has declined to set out where he thinks the nation went wrong until a later time.

There are clear policy areas, however, that will face intense scrutiny going forward as the nation looks to learn from the mistakes and mis-steps to prevent further deaths from the current crisis and any future pandemic.

– Locking down

Lockdown prevented people from leaving their homes apart from for essential travel
Lockdown prevented people from leaving their homes apart from for essential travel

As nations across the world, including Spain and Italy, imposed lockdowns, the Government was hesitant on shutting up the UK.

Experts on the Scientific Advisory Group for Emergencies (Sage) feared that “heavy suppression” of the virus would cause a second peak of infections and chief scientific adviser Sir Patrick Vallance said some “herd immunity” needed to be developed.

But, as understanding of just how deadly the virus was evolved, it was modelling from Professor Neil Ferguson that shocked Mr Johnson into action.

The scientist advising the Government as part of the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag) predicted that merely trying to slow the spread of Covid-19, which was until then the aim, could allow deaths in Britain to exceed 250,000 and overwhelm the NHS.

The lockdown was eased in June after a plateau and decline in deaths, but cases began to rise again and on September 21 Sage recommended a circuit-breaker lockdown to last up to two weeks.

Facing opposition from Conservative MPs sceptical of lockdowns, Mr Johnson rejected Sage’s recommendation and pushed on with the tiered system of restrictions.

But as cases began to spiral out of control, more than a month later Mr Johnson imposed a four-week lockdown lasting until December 2.

England emerged into a new four-tier system, but it ultimately saw most of the nation placed into the highest level of restrictions before a national lockdown was imposed on January 4, as a new highly-infectious strain emerged from Kent.

This week, Imperial College London’s Prof Ferguson told the BBC that “had we acted both earlier and with greater stringency back in September when we first saw case numbers going up and had a policy of keeping case numbers at reasonably low levels then I think a lot of the deaths we have seen – not all by any means – but a lot of the deaths we have seen just in the last four, five months, could have been avoided”.

– Care homes

Care home residents
Care home residents

Health Secretary Matt Hancock said a “protective ring” was thrown around care homes, but their residents have accounted for almost a third of the number of coronavirus deaths in England and Wales.

They were particularly vulnerable to coronavirus from the off because of their age, but several factors may have left them more exposed.

Hundreds of hospital patients were discharged into care homes in England each day at the start of the pandemic, without a policy in place to test all patients before discharge.

This was later described as a “reckless” and “appalling” policy error.

Staffing is another factor thought to have played a part in the spread of Covid-19 in care homes during the first wave of the pandemic, with employees often working between different sites.

Other factors are said to include struggles to access personal protective equipment (PPE) and regular tests.

– Borders

A Border Force officer checks passports of arrival passengers
A Border Force officer checks passports of arrival passengers

Australia, New Zealand, China and other nations that heavily suppressed their death tolls included stringent border protections among their public health measures.

There was a split in the Cabinet, with Home Secretary Priti Patel having said she advocated closing the UK’s borders in March, but was apparently overruled, as the balance between public health and the economy was weighed up.

One paper considered by Sage in April said there was little justification for closing borders while case numbers were high, with imported infections representing a tiny proportion of cases.

But as the pandemic was brought under control a 14-day quarantine policy was introduced in June to guard against a second wave being triggered by outbreaks arriving from abroad.

This policy was eroded by the introduction in July of so-called travel corridors, which provided exemptions to arrivals from nations deemed safe.

Testing formed no part of the border plans until December when the test to release scheme was introduced to allow the isolation period, already cut to 10 days, to be reduced in England by a negative test after five days of isolation.

Then, this month, border protections were bolstered to require a negative test three days before leaving for England from countries not on the travel corridors list.

But as concerning new strains emerged in Brazil and South Africa, ministers acted to ban flights from more than a dozen countries including all of South America.

Then, on January 18, all travel corridors were ordered to close meaning nearly every arrival would need a negative test before departure and then would have to quarantine.

International Development Secretary Liz Truss defended the Government as having been “very tough” on borders but said “you cannot hermetically seal” the UK with a need for the economy to run and fresh supplies to be delivered.

– Masks

Shoppers wearing face masks
Shoppers wearing face masks

One health measure quickly adopted particularly in Asian countries with greater experience of tackling epidemics was the wearing of masks.

Ministers were reluctant to advise the British public to wear coverings, partly out of concern the move would divert equipment away from health workers.

Deputy chief medical officer for England Dr Jenny Harries in March said it is “usually quite a bad idea” to recommend them to the public, warning that they can become contaminated, and there were concerns of unintended consequences.

As understanding of the virus changed so did the policy, with the advice changing on wearing masks in crowded places in mid-May.

But it was not until June 15 when masks became mandatory on public transport and July 24 when they were required in shops across England.

– Dominic Cummings

Dominic Cummings
Dominic Cummings

Ensuring the public complied with the restrictions needing extraordinary sacrifices required trust in the Government.

One event that jeopardised this, according to researchers, was Dominic Cummings’ controversial trip to Durham during the height of lockdown.

Then the Prime Minister’s chief aide, Mr Cummings tried to justify his movements as necessary to seek childcare after his wife developed Covid-19 symptoms, but critics felt he flouted the rules at a time of crisis.

A survey by University College London suggested his actions undermined public trust in the Government’s handling of the pandemic, in what researchers called the “Cummings effect”.

– Eat Out to Help Out

A man passing a sign advertising the ‘Eat Out to Help Out’ scheme
A man passing a sign advertising the ‘Eat Out to Help Out’ scheme

The first lockdown was largely over and the Government wanted a way to stimulate the economy and shore up the hospitality industry that had been ordered to close.

Chancellor Rishi Sunak introduced the Eat Out to Help Out scheme to offer half-price meals during the month of August as part of a stimulus package.

The scheme was widely popular, with businesses claiming around £840 million from the Treasury and customers buying some 160 million cut-price meals.

But some, including the Prime Minister, have suggested it could have contributed to the spread of the virus, with a University of Warwick study saying the scheme “may have substantially worsened the disease”.

Mr Sunak has said it would be too “simplistic” to connect any one scheme to a rise in cases, insisting other European nations were “following similar paths” of infections.

The Treasury said its own analysis suggests take-up of the scheme “does not correlate with incidence of Covid regionally”.

– Test and trace

A person enters the Test and Trace centre in Merthyr Tydfil
A person enters the Test and Trace centre in Merthyr Tydfil

The tracing of close contacts of confirmed cases was halted in mid-March as the infection rates easily raced past Public Health England’s capability.

The Government set and achieved ambitions targets to boost capability, but significant concerns remained about the effectiveness of its new Test and Trace programme and demand significantly outstripping capacity in September.

And, as the lockdown in January struggled to contain infection rates, there were concerns that only a minority of people were obeying self-isolation rules.

Test and Trace head Baroness Harding has admitted less than 60% of people advised to isolate are doing so, while Sage’s Professor Susan Michie said only 18% with symptoms are quarantining for the full 10 days.

Scientific advisers and Labour have called for a more comprehensive package of support, with concerns many were not isolating because of financial pressures.

But Downing Street rejected proposals to extend £500 payments to everyone who tests positive for Covid-19 in England, rather than just those who are on low incomes and are unable to work from home.

– Was the nation prepared for a pandemic?

Workers on the warehouse floor gather supplies at the NHS’ National Procurement Warehouse at Canderside, Larkhall
Workers on the warehouse floor gather supplies at the NHS’ National Procurement Warehouse at Canderside, Larkhall

Whether the UK had a long-term plan for dealing with the emergence of a wave of a disease more deadly than flu has been called into question.

Testing capacity needed drastically scaling up as the nation battled the pandemic, and stockpiles of PPE were short.

The need for an overhaul of the health and social care system was exacerbated by the emergence of Covid-19, and the NHS has been desperately strained.

Questions have also been raised about the health of the nation, with diabetes and obesity both being linked to increased chances of death.

Inequality also appears to have played a factor, with Office for National Statistics data suggesting mortality rates have been twice as high in deprived areas.

An ageing population, and one that is densely concentrated in cities and towns, and the UK being a global hub for transport will also have played a role in how badly the country suffered.

“The UK’s dismal record is telling us something important about our society,” health inequality expert Professor Sir Michael Marmot has said.

– What have the PM and the scientific advisers said so far?

England's chief scientific adviser Sir Patrick Vallance, left, and chief medical officer Professor Chris Whitty, right, and Prime Minister Boris Johnson
England's chief scientific adviser Sir Patrick Vallance, left, and chief medical officer Professor Chris Whitty, right, and Prime Minister Boris Johnson

In an eventual inquiry into the handling of the pandemic, there will likely be a tension over ministers saying they were relying on the science, as the scientists note they were there to provide the advice for the difficult decisions to be made by the Government.

Sir Patrick said the recommendations that he has pushed are: “The lesson is go earlier than you think you want to, go harder than you think you want to, and go a bit broader than you think you want to in terms of applying the restrictions.”

“Waiting and watching simply doesn’t work,” he said during an interview with Sky News.

England’s chief medical officer Professor Chris Whitty has said there were many things he wished had gone differently, but cited a failure to have placed a greater emphasis on testing early on in the pandemic as a key issue.

Mr Johnson has insisted the Government “did everything we could” to “minimise loss of life and to minimise suffering” after the official death toll passed 100,000.

He told MPs he takes “full responsibility” for the response to the pandemic and said “there will indeed be a time when we must learn the lessons of what has happened”.

“I don’t think that moment is now when we are in the throes of fighting this wave of the new variant, when 37,000 people are struggling with Covid in our hospitals,” he added.

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