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Europe Versus Coronavirus - The United Kingdom and the Price of Leniency

BLOG - 4 May 2020
Key Points
1

In early February, the UK government quickly implemented a plan to deal with the coronavirus crisis. It entailed four steps: containing the virus, delaying its spread, researching its origins as well as a treatment, and mitigating the virus’ impact should it spread, so as to be able to strengthen the healthcare system. The second phase of this strategy, delaying the spread of the virus rather than attempting to stop it, is radically different from the stricter approaches, including national lockdowns, that have been adopted by other European countries such as Italy and France.

2

The United Kingdom was affected by the epidemic later than Italy or France, and was slow to increase its medical equipment supplies, in particular with regard to testing kits. The second phase of the strategy, which began on March 12, consisted in accepting that a large majority of the population would be infected before reaching a form of herd immunity. It was therefore no longer considered relevant to contain the virus by testing and tracing symptomatic individuals.

3

Faced with a worrying number of deaths, this strategy was then revised and the United Kingdom belatedly adopted measures similar to those of its European peers, i.e. national lockdown and increased testing capacity.

4

HM Treasury and the Bank of England’s quick joint economic response has helped mitigate economic damage, which is nevertheless expected to be considerable.

Timeline

  • January 30: The UK government raises the risk level from "low" to "moderate" following the WHO's declaration that Covid-19 is a Public Health Emergency of International Concern (PHEIC).
  • January 31: First two coronavirus cases on British soil confirmed in York.
  • February 10: The British government announces new regulations giving health professionals "strengthened powers" to place people in forced quarantine for their own safety.
  • March 3: The British government publishes its "Coronavirus Action Plan" focusing on four main areas: containing the virus, delaying its spread, researching its origins and treatment, and mitigating the impact if the virus spreads.
  • March 4: The National Health Service (NHS) declares the epidemic a "Level 4 incident", the highest degree of urgency.
  • March 5: First Covid-19-related death identified in the United Kingdom.
  • March 10-13: The Cheltenham Festival, a horse-racing event, welcomes 250,000 visitors.
  • March 11: The Bank of England cuts its base rate from 0.75% to 0.25%, bringing it to its lowest level ever. The government announces its 2020 budget, which includes £12 billion allocated to measures to protect the economy from the impact of the coronavirus.
  • March 12: Following WHO's declaration that the Covid-19 outbreak constitutes a pandemic, the government raises the risk level from "moderate" to "high" and announces that it has moved into the second phase of its strategy, aimed solely at slowing the virus' spread. The testing and tracing strategy is modified to give priority to healthcare workers. British citizens with symptoms are asked to observe 7 days of self-isolation.
  • March 13: Local and municipal elections, scheduled for May 2020, are postponed for one year.
  • March 16: During his first daily press briefing, Prime Minister Boris Johnson advises against travel and "non-essential" contacts. He also suggests avoiding pubs, nightclubs and theatres, and working from home whenever possible. A group of Imperial College researchers publishes a study warning that the epidemic could kill up to 510,000 people in the UK if no measures are taken, and will kill 250,000 people based on existing measures.
  • March 17: The government announces a £350 billion emergency business support package, including £330 billion in government-backed loans.
  • March 18: The government announces that from March 20, schools will be shut down until further notice.
  • March 19: The Bank of England cuts its base rate from 0.25% to 0.1%.
  • March 20: The Government orders all cafés, pubs, restaurants, nightclubs, theatres, cinemas, gyms and leisure centres across the country to close their doors for the foreseeable future, and announces grants covering 80% of wages of furloughed workers, up to a maximum of £2,500 per month.
  • March 21: The NHS announces an agreement with private hospitals, securing nearly 20,000 additional qualified staff and thousands of extra beds.
  • March 24: The United Kingdom announces a nationwide lockdown for at least three weeks and announces the preparation of a temporary hospital, the NHS Nightingale Hospital, at the ExCeL London exhibition centre. This will be the first of a series of "Nightingale" hospitals elsewhere in the country and will open on 3 April.
  • March 25: The British Parliament closes its doors for a month.
  • March 26: The government announces the extension of grants to the self-employed (covering 80% of their profits, up to £2,500 per month).
  • March 27: The Prime Minister, Boris Johnson, and the Secretary of State for Health and Social Care, Matt Hancock, announce that they have tested positive for coronavirus.
  • April 2: The government announces a 5-pillar testing plan with the aim of increasing capacity to 100,000 tests per day before the end of the month.
  • April 5: Special televised address by Queen Elizabeth II, for only the fifth time of her reign.
  • April 6: Prime Minister Boris Johnson is admitted into intensive care. First Secretary of State and Secretary of State for Foreign and Commonwealth Affairs Dominic Raab temporarily replaces him at the head of the government. The number of deaths exceeds 5,000 and the total number of reported cases rises to nearly 52,000.
  • April 15: The government launches a new network to provide personal protective equipment to nursing staff in retirement homes.
  • April 16: The government announces a three-week extension of the lockdown until May 7. The number of confirmed cases in the UK exceeds 100,000.
  • April 21: The government announces a £42.5 million investment for clinical trials conducted by Imperial College and Oxford University.
  • April 22: The Financial Times estimates that the actual number of deaths due to the epidemic is more than 41,000, i.e. more than double the official number of hospital deaths.
  • April 23: The government announces that all "essential workers" in England and members of their households who show coronavirus symptoms will have access to tests. A large-scale study of viral infections and antibody tests is launched.
  • April 27: Boris Johnson resumes his duties as head of the government.
  • May 5: The death toll in the United Kingdom becomes the highest in Europe. Worldwide, only the United States has a higher death toll.
  • May 10: The Prime Minister presents the main axes of the government's lockdown exit plan and encourages people who cannot work from home to return to their workplaces.
  • June 1: Schools and shops are authorized to gradually reopen.

 

This article was updated on June 4.

Analysis

On January 2020, the day following its exit from the European Union, and as the very first cases of Covid-19 were detected on British soil, the United Kingdom had a real opportunity to adequately prepare for the crisis looming outside its borders.

While the UK was among the last European countries to be affected by the virus– the first death on British soil was recorded on March 5, a full 20 days after France’s first death – the British government was unable to make the necessary preparations quickly, choosing instead to explicitly slow the spread of the virus (and implicitly aim for herd immunity), rather than attempting to suppress it. The UK was one of the few European countries, along with the Netherlands, to adopt this strategy and thus delay the introduction of coercive measures (including a nationwide lockdown).

The United Kingdom seems destined to be one of the European countries most affected by the coronavirus crisis.

The government waited until mid-March to radically change its strategy. In light of new epidemiological models informed by the progression of the virus in Italy and following the first British deaths, a national lockdown was ordered from March 24 onwards. Initially criticised for its strategy by numerous authorities, the government was now also being criticised for its overall management of the crisis by the media.

In its edition of 19 April, the Sunday Times, one of the most widely read newspapers in the UK, which is traditionally aligned with the Conservative Party, published a long article criticizing the government's strategy and its leader's lack of conscientiousness. In spite of this, the public is much less critical of its government than what has been observed in France. On May 2, an Ifop survey revealed that 62% of British people were satisfied with the government's handling of the coronavirus, compared with 38% of French people. However, the British population’s trust in the government and its Prime Minister was severely damaged at the end of May (-20 points) when Boris Johnson defended the actions of his close adviser Dominic Cummings, after it was revealed that the latter had violated the lockdown rules to visit his parents in the north of England.

On June 4, the United Kingdom reached nearly 40,000 Covid-19-related deaths, and became the most affected European country, second in the world only to the United States. The British government has been playing a balancing act since May 10 with "small temporary steps" to ease the lockdown. While people unable to work from home are encouraged to return to their workplaces, and schools and shops have gradually started to reopen their doors since June 1, numerous scientists have warned the government against prematurely lifting the lockdown. 

Spread of the virus in the United Kingdom

The first cases of Covid-19 on British soil, two Chinese tourists, were recorded on January 31. However, it was the third case, identified on February 6, a British "super-spreader" who imported the virus from Singapore, which accelerated its spread. Nine days earlier, he had stayed at "Les Contamines", a French ski resort. 

The resulting curve of hospital deaths initially followed a trajectory close to that of other European countries such as France, albeit with a few days’ delay. In 10 days, the number of deaths in the United Kingdom rose from 10 to 100 (in France, this tenfold increase took 9 days). 

While the number of deaths per day is starting to decrease in many European countries that have implemented national lockdowns, the death curve in the UK is slow to flatten. Only 15 days separate the 1,000th death from the 10,000th one, whereas the same increase took 23 days in France.

On April 24, the United Kingdom recorded 108,000 cases of contamination and 19,500 hospital deaths related to Covid-19.

On June 4, the United Kingdom recorded 279,850 cases of contamination and 39,700 deaths related to Covid-19 for a population of approximately 67 million. The number of deaths averaged 274 over the previous seven days, and on May 29 the government estimated the infection rate (R0) to be between 0.7 and 0.9.

On the same date, France counted 151,700 contamination cases and 29,000 deaths, and Germany recorded 182,400 contamination cases and 8,550 deaths.

This increase in part is the consequence of the strategy adopted by the British government which, compared to its French or German peers, has been slow to implement strict measures, as illustrated by the Blavatnik School of Government at Oxford University’s government response tracker.

Slowing down rather than suppressing

Inspired by the contingency plans developed for a pandemic influenza, the British government quickly adopted a strategy centred around four key pillars: contain the virus for as long as possible by tracking it, delay its spread if it is not stopped, invest in research to find solutions, and mitigate its progression in order to strengthen the NHS. 

Following the 2008 crisis, the UK entered a decade of austerity policies during which health spending increased by an average of 1.4% per year compared to a historical average of 3.7%. The British health system was therefore weaker and more fragile than others when it entered the Covid-19 crisis. According to the OECD, health spending in the United Kingdom accounted for 9.8% of GDP in 2018, while in France and Germany the same figure reached 11.2%.

This initial strategy was chosen primarily because of the underestimated mortality rate at the start of the pandemic, as well as the government's reluctance to take restrictive measures such as ordering a national lockdown.

From 10 to 13 March, while Italy was imposing a national quarantine, 250,000 people attended the Cheltenham Festival equestrian championship.

On January 31, the date at which the first cases were confirmed, a public health awareness campaign was launched. Amongst other recommendations, it reminded members of the British public to regularly wash their hands for a duration of 20 seconds each time, or; as put by Boris Johnson, the time it takes to sing "Happy Birthday" twice. 

Meanwhile, the country lagged far behind with regards to the preparation of its healthcare system. The development of tests, the supply of ventilators and personal protective equipment (PPE) as well as the study of potential containment measures are particularly affected. 

Minutes of the meetings of the Scientific Advisory Group for Emergencies (SAGE), reveal that national lockdown measures were not considered until mid-March, after the lockdown had started in Italy. Based on advice from psychologists and behavioural experts suggesting that the British public would not comply with strict lockdown measures if these were imposed too early, Johnson postponed this option as late as possible and continued to reassure the British public by stating that the UK was ready to deal with the pandemic. 

In early March, Italian figures, as well as the first cases in British hospitals, suggested that the government's strategy was ill-informed, and based on underestimated mortality rates. However, the government was still slow to change its approach. During his press conference on March 9, Boris Johnson insisted: "As things stand, I’m afraid it bears repeating that the best thing we can all do is wash our hands for 20 seconds with soap and water".

On March 12, the government announced the transition to the second stage of its strategy: delaying the spread of the virus within the population by reducing and broadening its peak, without completely eliminating it. Spreading the virus to a large enough share of the population, estimated at 60% by the government's chief scientific adviser, would create a form of herd immunity. As such, from 10 to 13 March, while Italy was imposing a national quarantine, 250,000 people attended the Cheltenham Festival equestrian championship in Gloucestershire.

On March 16, as a group of Imperial College researchers published their projections, which showed that the epidemic could kill up to 250,000 people should existing measures be maintained unchanged, the government changed its strategy and turned to stricter measures. At his first press briefing on March 16, Johnson called on British citizens to stay at home and not visit public places. Two days later, the government resigned itself to enforce coercive measures. The closing down of schools was announced on March 18, and on March 20 the government ordered cafés, pubs, restaurants, nightclubs, theatres, cinemas, gyms and leisure centres to close their doors. On March 24, the United Kingdom is placed under national lockdown for an initial three weeks, later extended for a further three weeks until 7 May. According to several authorities, the lockdown comes too late, with 422 deaths in the country since the beginning of the crisis. On March 17, the first day of lockdown in France, only 264 deaths had been recorded.

Quick and effective economic measures

Although the government's approach to the health crisis has been marked by several changes in strategy and a delay in implementing stronger measures, the government's economic response has been recognised for its effectiveness. In total, HM Treasury has mobilised over £450 billion, i.e. approximately 21% of its 2019 GDP. On 16 April, France had mobilised just over €622 billion, i.e. almost 26% of its 2019 GDP. The UK government started the crisis with more room for maneuver than France due to its lower public debt and deficit, at 79.5% and 1.8% of GDP respectively in 2018-2019. At the beginning of March 2020, when the epidemic had already begun, the government still planned to reduce the country's debt to 77.4% of GDP in 2021.

An initial response prepared jointly by HM Treasury and the Bank of England was announced on 11 March, when the new Chancellor of the Exchequer Rishi Sunak presented the UK's 2020 budget. £12 billion would be devoted to combating the coronavirus crisis; while the Bank of England reduced its base rate from 0.75% to 0.25%, bringing it to the lowest level in history. 

A few days later, the government, followed by the Bank of England unveiled a second round of measures. On March 17, HM Treasury introduced a £350 billion emergency business support package, including £330 billion in government-backed loans of up to 80% (recently raised to 100% for loans under £50,000). The Bank of England followed suit by reducing its base rate from 0.25% to 0.1%, increasing its bond purchase programme to £200 billion and doubling its corporate bond purchase programme to £20 billion. 

HM Treasury has mobilised over £450 billion, i.e. approximately 21% of its 2019 GDP

In addition to the money dedicated to loans, the government authorised £30 billion in VAT deferrals and is committing to cover 80% of the salaries of employees furloughed during the crisis, up to a maximum of £2,500 per month. This scheme was introduced on March 20 for employees, and extended to include the self-employed on March 26. 

As the crisis progresses, the economic measures are also becoming more targeted. For example, frontline charities have been awarded an extra £750 million in funding, and the Chancellor announced a £1.25 billion support programme for innovative companies hit by coronavirus. 

On April 24, rating agency Standard & Poor's confirmed the effectiveness of the UK's economic response by leaving its AA credit rating unchanged.

Inadequate preparation efforts

After a decade of savings, which resulted in a particularly low ratio of intensive care beds per 100,000 inhabitants – 6.6 compared to 11.6 in France and 33.4 in Germany – the NHS has quickly increased its capacity, as set out in the fourth axis of the government's initial strategy. 

A total of 33,000 beds have been freed up, i.e. a third of the total number of beds in the British healthcare system and the equivalent of 50 hospitals, including 10,000 intensive care beds. A further 8,000 beds were put at the NHS’ disposal by the independent sector. 

On March 24, the first day of its national lockdown, the UK continued this effort and launched the development of temporary "Nightingale" hospitals. The first such hospital opened at the ExCeL exhibition centre in London on April 3, providing an additional 500 beds and a potential capacity of 4,000. A total of seven temporary "Nightingale" hospitals follow elsewhere in the country. At the end of April, while the number of deaths in the United Kingdom was slowing down, they had only received a handful of patients who tested positive for Covid-19 and NHS bed capacity was still far from overloaded. 

While the effort to increase the number of beds was considerable, it lacked the initiatives required to prepare the healthcare system on other critical fronts, in particular the provision of personal protective equipment (PPE), ventilators and testing kits.

In mid-April, health care staff began to report critical shortages of equipment, particularly gowns. Public Health England advised NHS staff to reuse their gowns or replace them with other equipment should they run out. The government announced a delivery of 84 tonnes of PPE from Turkey, of which 400,000 gowns. While this critical delivery was scheduled to arrive on April 19, it was three days late and only included part of the expected equipment.

The United Kingdom is currently running very late in the race for tests, with a total of 6.6 tests performed per 1,000 inhabitants on April 25, compared to 9.06 in France on April 21, and 25.11 in Germany on April 19.

As for the ventilators, the government waited until March 16 to launch its "Operation Last Gasp", an appeal to British manufacturers to build and supply 20,000 ventilators over two weeks, to supplement the 8,000 ventilators the NHS already owned. Criticism of the government's lack of preparedness with regard to PPE and ventilators reached a climax when it was revealed that the UK would not be part of a European Union bulk order for equipment, ventilators and testing kits, which the country had been invited to join. Although concerns surrounding the supply of ventilators were assuaged during the following weeks, the supply of PPEs remained challenging.

 

On testing and tracing, the UK started the battle ahead of other countries, with a system enabling Public Health England to trace the first victims’ contact with the virus and thereby attempt to contain it, as planned in the first axis of the government's strategy. During February and until early March, nearly 4,000 people at risk of infection were warned, based on data collected from approximately 590 positive cases. 

Despite the usefulness of the scheme, the testing capacity, which was restricted to eight Public Health England laboratories, was not increased and was quickly overloaded. Faced with this issue, on March 12, the government changed its approach to testing by deciding to abandon its strategy to track all symptomatic patients, choosing instead to restrict the use of tests to hospitals.

This change of strategy marked the transition to the second axis of the government's strategy: delaying the spread of the virus within the population by flattening the famous curve, without attempting to stop it.

This strategy wasn’t reviewed before April 2, when the testing capacity reached 10,000 tests per day, at which point the government decided to put testing back at the heart of its approach. The proposed plan aims to expand the number of testing centres beyond the eight Public Health England labs to the private sector and universities, to add serological tests on top of existing tests, and to ensure a capacity of 100,000 tests per day by May. The United Kingdom therefore went from 2.4 tests per 1,000 inhabitants on April 2 to 44.4 tests per 1,000 inhabitants on June 2, compared with 47.2 in Germany on May 24 (latest available data). At the end of May the daily testing capacity exceeded 160,000.

This increase in testing capacity enabled the NHS to launch a new testing and tracing service on May 27, allowing anyone who is symptomatic to be tested and then to warn people they may have recently been in contact with. To this end, the government is developing a Bluetooth tracking application, due for national roll-out in June, and aims to recruit 18,000 people to replicate the efforts of Public Health England's 290-strong tracking team on a larger scale.
 

Cautiously and progressively lifting the lockdown 

As early as April, after the lockdown was first extended for three weeks, the government indicated five criteria that would have to be met before the end of lockdown could be considered: 

  1. ensure the NHS has sufficient capacity for intensive care and specialist treatment;
  2. record a "sustained and consistent fall" in daily death rates;
  3. observe a decline in infection rates to "manageable levels", well below 1;
  4. have sufficient testing kits and PPE to "meet demand"; and
  5. be certain that easing restrictions will not cause a second peak of infection that would overwhelm the NHS.

When the British Prime Minister outlined his lockdown exit plan on May 10, the timetable was presented on the basis of an alert system ranging from 1 to 5, defined by the above criteria, in particular the infection rate, and operated by a new Joint Biosecurity Centre. In mid-May, the country switched from level four to level three and people who could not work from home were encouraged to return to their workplaces. From June 1, gatherings of up to six people are tolerated, nationwide travel is authorized, and some shops and schools reopen their doors. As of June 15, all non-essential businesses and the vast majority of schools will once again be able to host their customers and students. Provided that the infection rate and the number of recorded cases allow it, the country could also allow the reopening of certain public places and part of its tourism-related activities could resume from July 3 at the earliest.

Conclusion

While the United Kingdom appeared to be in a good position to deal with a national epidemic when the first case was detected at the end of January, the delay incurred by the government during February and early March in providing the necessary equipment, ventilators and testing kit, as well as in the implementation of restrictive measures to limit the spread of the virus, left the country in a poor position to control the accelerating death toll. 

Following initial difficulties relating to the government’s lenient approach to the crisis, which has left the country among the most affected by the virus, all indicators now seem to be moving in the right direction, and the United Kingdom is moving cautiously but swiftly towards the end of its lockdown. However, while the government is making up for its late preparations, it has now lost the trust of the British people. By maintaining full support for Dominic Cummings after he broke lockdown rules, the Johnson government is compounding the existing economic, health and social risks with the risk of a political crisis. 


 

Copyright: ISABEL INFANTES / AFP

 

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