Three years to the day from when Britain went into formal lockdown, it’s worth reflecting on the historical moment we all lived through: a once-in-a-century kind of pandemic that swept the world over. As analysis and inquiries begin to make sense of what we lived through, it’s clear that different political factions are attempting to rewrite what happened and why. Some are questioning, driven in part by the Telegraph’s lockdown files, whether the Covid-19 pandemic was really that bad. Was the response by government proportionate?
In these debates, there’s a clear survival bias. Those who can ask these questions were affected by restrictions and are likely to have had Covid-19 once, if not several times, and survived. Those who died – an estimated 220,437 people in the UK – don’t have a chance to weigh in on whether government intervention was sufficient, or whether their deaths were preventable. More than a million people suffering from long Covid still face scepticism over their condition and an uphill battle to have it recognised and addressed.
A large part of the problem in Britain’s response was that we wanted it all. We wanted to maintain our pre-Covid-19 life, and, until hospitals were at the brink of collapse, didn’t want to discuss trade-offs.
South Korea moved early towards testing, tracing and isolation in January 2020 (thus avoiding a national lockdown) and its population accepted the necessary infringements on personal privacy. Its total mortality to Covid-19 is 34,000 in a population of 51.7 million.
New Zealand moved early to close its borders and avoid imported cases, thus avoiding domestic restrictions for the bulk of 2020 and 2021. Its total mortality to Covid-19 is only 3,900 in a population of 5 million. Both countries avoided the stringent and long lockdowns that Britain experienced, because their leaders acted quickly to suppress the virus without simply locking people in their homes.
In Britain, community testing and border controls to limit imported cases weren’t even considered until mid-March, when the initial strategy to “just let it spread” failed, given the high hospitalisation rate of Covid-19. Lockdown was the emergency button pressed in panic. Shouting about lockdown, or ignoring Covid completely, didn’t help the challenge every country was facing: Covid-19 waves resulted in too many infections translating into hospitalisations. Vaccines and antivirals did provide the major solution. They managed to change the case conversion from an estimated 20% in January 2020 to 1-2% post-vaccines.
Was there an option to simply do nothing? Looking around the world, no place did “nothing”. Even in Florida, my home state, known for Governor Ron DeSantis’s “freedom” approach, businesses imposed their own mask mandates that were often more stringent than in Britain – for example, in children as young as two – and had to develop their own guidelines for running safely given the absence of state government leadership.
The problem was simply pushed from the responsibility of government for safe workplaces on to businesses and individuals. And the result on the ground looked similar, with businesses using testing, masks and closures. Many businesses had to close because of sick employees, or workers and customers staying away out of fear. Businesses were left to struggle without government support, while the death toll climbed. As the California governor, Gavin Newsom, observed: “Since the beginning of the pandemic, Florida has had a 53% higher death rate than the state of California … and their economy has done worse.”
If we reflect back to three years ago, faced with a lack of government leadership in the early weeks of March, there was a similar “bottom-up” movement in Britain, with parents keeping their children off school, businesses asking their employees to work from home, and conferences and sports and cultural events being cancelled voluntarily. The UK government seemed to just watch and wait, and when the prime minister, Boris Johnson, announced the lockdown, it was following public opinion that stricter action was needed. Unfortunately, given how late this was, and the lack of preparation put into containment, this led to a third of patients admitted to hospital with Covid-19 dying, putting the first wave on a par with diseases such as Ebola.
The dilemma with Covid-19 came back to the fact that this was a virus that spread among humans, and we were most at risk from those humans we live with, love, work with and see regularly. Solutions were difficult, and this is where testing was crucial. Testing could determine who was infectious and who wasn’t, instead of treating all of us as infectious, which is what lockdown did. Speed and volume of testing were key determinants of countries that did better in 2020.
What worked globally? Looking around the world, there are lessons from many countries. From Japan, that masks work at limiting spread, especially on public transport and in workplaces. From South Korea, that testing and tracing and supported isolation could suppress the virus without lockdowns. From Denmark, that schools could reopen quickly if mitigations were put in place to use large, ventilated spaces such as parks and stadiums. From New Zealand, that messaging to the public is vital in pivoting from Zero Covid to mass vaccination. From Norway, to move early and prepare to contain and thus avoid harsher lockdowns later. From Britain, to roll out the vaccine quickly through a trusted institution such as the NHS and cover priority groups first.
What didn’t work? Superficial and morally questionable debates pitting the young against the old. Pitting the healthy against the sick. Undermining the severity of Covid-19 by likening it to a bad cold or calling it a hoax. Telling those with cancer that their lives matter less. Saying the same to parents of children with asthma or diabetes by somehow implying child severe illness or death to Covid-19 is acceptable if there’s an underlying health condition. We wasted time fighting each other instead of finding collective solutions to a common threat.
We are better than that as a society: any talk of herd immunity with Covid-19 in 2020 should have been about how the herd takes care of the weak. “Targeted protection” or “segmentation” – asking vulnerable people to shield while the rest of society got Covid – was a fantasy that didn’t work anywhere in the world, because the truth is, at the start, we didn’t know who was most at risk of death. We know now that it’s a mix of risk factors such as underlying health conditions, weight, age, sex and a genetic lottery. Even if you could identify who was at risk of severe illness, there was no simple way to separate the vulnerable from the healthy. We live together and work together.
Where else did we waste time? In debates over whether masks work, instead of recognising that they do work but that people don’t like to wear them. Instead, we should have debated what kind of masks, in what setting, for how long and in what age groups. In debates over whether lockdowns work, instead of recognising that of course asking people to stay at home stops an infectious disease spreading, but comes at a heavy cost and should be avoided, given the consequential risks of loneliness, financial precarity and domestic abuse. And in pretending that an alternative universe exists where, as we emerge from the pandemic, life continues exactly as it did before without any trade-offs.
Science has almost always found some kind of solution to help manage the impact of infectious diseases on humans: whether it’s vaccines, treatments, better clinical management, or better surveillance and public health containment. It is easy to feel dismayed watching politicians pass blame, seemingly thinking only of the next election and their polling. The public is fatigued, with a clear desire to move on from a collective trauma and loss. But this is too important to forget.
From what I see working in global health security each day, civil servants, scientists and advisers are working hard to protect the public and prepare for whatever may lie ahead, whether that might be avian flu or another emerging threat. Perhaps another lesson from Covid-19 is to trust the people who have made it their career’s work to respond to health challenges, and not those who can’t remember if they were at a party at their own residence during lockdown.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh. Her book Preventable is out in paperback on 6 April 2023
