It’s time to learn

“We truly did everything we could,” said the Prime Minister as he announced 100,000 British deaths. That was a deeply worrying statement, because it suggested no insight, no admission of error, no change of strategy for the future. 

His state of denial was challenged the following day with a direct question about the fact that the UK had more COVID-19 deaths than any country in Europe: “Why?”

The Prime Minister’s response to that question should worry you even more:

“I and the Government take full responsibility for the actions that I have taken, we have taken… and yes Mr Speaker, there will indeed be a time when we must learn the lessons of what has happened, reflect on them… I don’t think that moment is now  when we’re in the throes of fighting this wave of the new variant, when 37,000 people are struggling with COVID in our hospitals, and I think what the country wants is for us to come together as a Parliament and as politicians…” 

Politicians, medics and scientists

COVID-19 is both a healthcare emergency and an experiment in disaster management. Most of our leading politicians are graduates in Philosophy Politics and Economics, which makes them particularly poorly trained to deal with either medical emergencies or scientific process.

Every emergency doctor will recognise the fundamental error in the Prime Minister’s response to Keir Starmer’s question, “Why?”.

When doctors are managing a cardiac arrest, we don’t say, “There will be a time to learn from this, but I don’t think that moment is now when we’re in the throes of dealing with this emergency”. We look at the patient’s heart rhythm, we give an electric shock or stimulatory drugs as appropriate, we complete a cycle of treatment, we then look at the rhythm again (because emergencies are fluid and unpredictable), we consider all the possible causes of the arrest and try to reverse them, we assess and then reassess. If possible, one person stands outside of the action and keeps an eye on what’s going on.

Importantly, the best resuscitation leaders are constantly learning and open to new information.

The scientific method of hypothesis-based deduction is also instructive. A scientist will propose a hypothesis and an experiment to test that hypothesis. They will present experimental results to their research group for feedback. If the experiment worked then they will build on it with further experiments, but if the results contradict the hypothesis then it’s time to think again. For important results, the scientist will present them to independent external scientists for peer review.

They will never say, “I think what the scientific community wants is for us to come together…” !! That would be a politicised response which could never successfully address a scientific problem.

Failed learning on pandemic control

Adam Kucharski, a pandemic expert at the London School of Tropical Medicine, reports “if you’ve seen one pandemic, you’ve seen… one pandemic”. He speaks of “underlying principles that drive contagion”, but also acknowledges that every pandemic is different and requires us to learn

Of course Professor Kucharski is correct, every pandemic is different, and any failure to learn in this pandemic will exacerbate the effects of the pandemic and contribute to avoidable  mortality. 

The biggest failure of the UK government throughout this pandemic has been its unwillingness to learn  in any meaningful sense of the word. This failure to learn began well before the pandemic started. In 2016, Exercise Cygnus resulted in 22 “Lessons Identified” and the NHS’s Surge Capacity and Population Triage plan for allocating care in an overwhelming pandemic. This exercise involved 44 UK agencies and was supposed to provide information on our national pandemic capabilities, but was kept secret not only from the general public but from NHS professionals who would have to risk their lives managing future pandemics on the ground. 'The biggest failure of the UK government throughout this pandemic has been its unwillingness to learn in any meaningful sense of the word. This failure to learn began well before the pandemic started'. Click To Tweet

Following Exercise Cygnus, the Government also failed to learn from its own scientists. The SPI-M group’s excellent modelling summary was published just a year before COVID-19 and analysed the impact of interventions in a pandemic influenza.

Crucially, many of their proposed interventions (antivirals and vaccines) could not initially be applied against a coronavirus, which left the Government with only a few options such as PPE and social distancing. 

Despite the fact that social distancing was one of very few interventions available to the Government, and despite the fact that the Italian experience was giving us advanced warning of what lay ahead, the UK incomprehensibly delayed imposing its first lockdown until 23 March. As this graphical analysis from John Hopkins University shows, by 23 March the UK was already accelerating into an upward trajectory following 2 weeks behind Italy.

Lockdown brought the reproduction number of COVID-19 to below 1.0, but research from Imperial College has shown that delaying lockdown by one week cost about 21,000 lives.

The failure to learn was also obvious from the care home debacle. The Government ordered NHS doctors to discharge thousands of elderly patients to free up beds, causing a devastating super-spread effect across poorly-staffed private care homes. This was predictable, and indeed both myself and Professor Pollock petitioned for the Government to take over care homes and protect their residents. The Government closed its eyes to the emerging catastrophe, and the ONS later published data showing that from 2 March to 12 June there were 19,394 deaths involving COVID-19 in care homes.

The outsourcing of pandemic management, particularly test and trace, has shown again the Government’s ongoing difficult relationship with the process we call “learning”. Amartya Sen, Nobel prize-winning economist and one of only 25 elite scholars to hold a Harvard University Professorship, has explained the significant and predictable economic inefficiencies associated with engaging the private sector in healthcare provision in his ground-breaking article Universal Healthcare: The affordable dream'The outsourcing of Test & Trace has shown the Government's ongoing difficult relationship with the process we call 'learning'. Click To Tweet

Amartya Sen on 'Universal Healthcare: The Affordable Dream'

One of the UK’s most eminent public health academic clinicians has critically analysed the UK’s outsourcing chaos. Despite her warnings back in July 2020, experts continue to raise concerns in January 2021 that England’s privatised test and trace system will fail to prevent further surges of COVID-19. For instance, “the use of outsourced call centre staff, often employed on minimum wage by telesales firms contracted by Serco, who have been drafted in to carry out detailed interviews with coronavirus patients”.

Corporate executives continue to be paid enormous amounts of public money for a system which has failed through the first pandemic wave and continues to fail during the second wave. The National Audit Office has found that call handler staff worked for 1% of the time they were paid under the privatised tracing scheme.

The contrast with the UK’s rapid and efficient publicly-delivered vaccine roll-out could not be greater, and one has to wonder what Public Health England could have achieved if the Government had given them £22 billion to test and trace COVID-19 transmission.

Lee Jones has written ‘From Rolls Royce to Skoda’, one of the most interesting analyses I’ve read in years, arguing that the UK’s failures during the COVID-19 pandemic are the result of the transformation of the British State over decades. He points out that the outsourcing of responsibility and decision-making has made the UK at the same time both less democratic (because corporate executives are not accountable to voters) and less able to deal authoritatively with national emergencies.

Failed learning on economic growth 

Perhaps one of the most serious failures to learn has the repeated false dichotimisation between economic success OR pandemic control. Donald Trump said it in his characteristically blunt style early on during the first USA lockdown: “We’re not going to let the cure be worse than the problem”.

However, the Swedish experience gave early indications that reduced pandemic control would lead to higher mortality and  reduced economic growth. You might think this was an “outlier effect” confined to Sweden, but a later analysis of 45 OECD countries showed quite clearly that a lower COVID-19 death rate correlated with increased GDP per capita.

Despite this data demonstrating the co-dependency of the economy and public health, the UK’s Chancellor of the Exchequer decided to introduce the Eat Out to Help Out scheme, incentivising the public to go to restaurants and support the UK hospitality sector. Research has suggested that “Eat Out to Help Out” correlated with clusters of COVID-19 outbreaks.

Astonishingly, it turns out that the Treasury decided to go ahead with the scheme without consulting the Government’s leading epidemiologists on the likely effects on the pandemic, despite the Chancellor saying, “I talk to the scientists every day”. The scheme certainly boosted restaurant sales in the short term, but restrictions were re-imposed by mid-September due to the inevitable rise of COVID-19 cases.

The time to learn is now

The biggest failure of the UK Government during this pandemic has been not only their failure to learn, but their refusal to disclose data so that others can learn. They’ve been always one step behind the evolution of the pandemic, and insisted on keeping us one step behind with them. 'The biggest failure of the UK Government during this pandemic has been not only their own failure to learn, but their refusal to disclose data so that others can learn'. Click To Tweet

We are now at a tipping point in the pandemic. Some of the UK’s most senior intensive care doctors, and organisations such as the Nuffield Centre of Bioethics, have now recognised the urgent need for a national surge capacity plan, but our legal team at Leigh Day Law have been pursuing disclosure of this plan since May 2020.

Early on during the COVID-19 pandemic, I had read the warnings of a second wave in the Government’s brilliant SPI-M modelling summary and I was desperate to get hold of the reports following Exercise Cygnus so that myself and other NHS professionals could prepare ourselves for what lay ahead. The Department of Health has dodged disclosure of this secret NHS policy paper to medics for the last 9 months. In fact, in early November, the Government denied it held any population triage report following Cygnus, prompting us to withdraw from Judicial Review.

I can now reveal that the Department of Health has finally admitted it has the Population Triage document in a letter dated 21 January 2021, but refuses to disclose its contents. As tens of thousands of COVID-19 patients die in NHS hospitals in a matter of weeks, ask yourself a question: Just how many people have to die before the UK Government decides it’s time to learn? 'As tens of thousands of COVID-19 patients die in NHS hospitals in a matter of weeks, ask yourself a question: Just how many people have to die before the UK Government decides it's time to learn?'. Click To Tweet

2 thoughts on “It’s time to learn”

  1. Conclusion upon reading this critique would be to slate the tories for incompetence of the ignorant. I suggest a nastier intent is at play here. From the initial intention to allow laissez faire to achieve herd immunity, private gain has predictably achieved public pain.

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