The UK Government is Enabling COVID-19

This post originally appeared on endcoronavirus.org.

Back in 2019, I published an article calling Boris Johnson unfit for the role of PM. I wrote that “his eagerness to pervert the truth” made him a dangerous candidate. In retrospect, it feels like I underestimated the danger.

Unsurprisingly, Johnson has repeatedly proven the case, but he has outdone himself in choosing to drop public health measures. He pushed to reopen as the nation experienced a massive spike in cases, and thousands of members of the scientific community clamored in response as they called for a change in approach. This move should mark the final chapter of Johnson’s time as PM. But if anyone needs further convincing of the abysmal leadership he and his cabinet have provided and the need to reverse course around protective measures, there’s ample evidence for both.

Having finalized Brexit in early 2019, the UK officially left the EU in January 2020 and went looking for trade deals. Given India’s size and its long ties with the UK, the South Asian giant was a natural target. COVID-19 slowed such efforts — the UK canceled a trip to India scheduled for this January due to a spike in cases. Back in mid-March, the Johnson administration organized another trip to Delhi for the week of April 26. Around the time they booked the trip, India had around 25,000 new cases per day as the nation experienced a severe increase in transmission driven by the Delta variant.

On Friday, April 16, the Johnson administration announced that its trip would be "slightly shorter.” The UK canceled the following Monday, with Boris Johnson stating that it was “only sensible” to do so. At the time, the UK already had over 100 confirmed cases of the Delta variant.

On the day Johnson canceled the trip, the UK had just under 3,000 new cases reported. On the same day, the UK announced it would ban travelers from India starting April 23. The announcement triggered a rush of thousands of travelers into the UK from India before the new rules went into force. Whether from India or parts elsewhere, the Delta variant was introduced to the UK at least 500 times. The total number may have been far higher. The UK’s lax travel rules allowed this to happen and they surely aided Delta’s spread beyond their borders.

Back on April 2, the UK implemented similar rules for India’s neighbors, Bangladesh and Pakistan. Both nations had significantly lower absolute and relative infection rates than India, but neither of those nations had a planned trade visit with the UK on the books for April.

In May of this year, UK Health Secretary Matt Hancock was under pressure to explain why his department moved around 25,000 hospital patients to care homes without first testing them for COVID-19. The UK’s Office for National Statistics found that deaths in care homes in England and Wales between March 2 and June 12 rose from under 37,000 in 2019 to just over 66,000 in 2020. Hancock’s excuse for not performing the testing was that there simply were not enough test kits for the need. As he put it, “We set out a policy that people would be tested when tests were available. Then I set about building the testing capacity for us to be able to deliver on that.”

Liz Kendall, the UK shadow social care minister, rejected Hancock’s claim. She noted that “There were over 530,000 tests carried out in the UK by 20 April, yet they couldn’t test 25,000 people discharged from hospitals to care homes, after we saw it sweep through care homes in Italy, France, and America?” Kendall then added, “The reality is, they wanted to free up the beds, and they didn’t prioritise older people.” Multiple leaders of care home facilities followed Kendall with claims that they had repeatedly warned Hancock’s office of the risks related to moving people from hospitals to care homes without first testing them. An email from the Care Provider Alliance, an organization that represents the sector and coordinates around major issues, demanded that all people discharged from hospitals and social care settings “MUST be tested before discharge.”

In May 2020, epidemiologist Neil Ferguson resigned his post as an advisor to the UK government on the pandemic. He did so after news reports claimed he violated social distancing rules to have visits with his lover. At the time, Matt Hancock claimed Ferguson’s violation of the rules was extraordinary as he noted that they were both "there for everyone" and "deadly serious." 

In late June 2021, Hancock resigned from his leadership post at the NHS after similarly breaking social distancing rules. The NHS secretary engaged in an extramarital affair with a close friend from university who he had hired as a non-executive director at the Department of Health.

Prior to becoming PM, Boris Johnson was twice fired for lying, once for fabricating a quote as a journalist, and later as a member of Parliament for allegedly lying about an affair. He took no action when the news broke about Hancock’s violation of the social distancing rules, nor when Dominic Cummings did the same last year. Instead, Hancock bowed to the outrage from a nation that has lost nearly 130,000 people to COVID-19, many of whom died alone during lockdowns. While Johnson took no action against Hancock, he did try to take credit for letting him go before being reminded that he hadn’t taken any action on the matter.

Hancock was replaced by former banker and Chancellor of the Exchequer, Sajid Javid. In his first weeks in office, Javid claimed that “There will never be a perfect time to take this step because we simply cannot eradicate this virus.” Given that the UK has never tried to eliminate the virus within its borders, it's hard to see how he can claim that eradication — elimination of the virus globally — is impossible. The new head of the NHS supported Johnson’s plan to reopen the UK, as he claimed the nation would have to learn to live with the virus. Javid soon did just that as he tested positive for COVID-19 on July 16, just hours after having met with the UK prime minister and chancellor of the Exchequer, Rishi Sunak.

Over the following weekend, Johnson and Sunak were notified of the need to quarantine due to their potential exposure to the virus. A spokesperson announced that Johnson and Sunak would enter a pilot program that would allow them to avoid quarantine while being tested daily for the virus. A swift backlash to that announcement left Johnson and Sunak retreating to quarantine. That backlash might serve as a blueprint for the needed rebuke to Johnson’s reopening fiasco.

On June 28, the PM attended a private event with an exclusive group of donors known as the “Advisory Board.” That group has reportedly delivered “ever-larger cash donations" to the Tories in return for "ever-greater access to the heart of government," as either Johnson or Rishi Sunak meet with the group on at least a monthly basis. The group reportedly pushed the PM to end pandemic-related social support measures and Johnson assured them that he would deliver on their request via "Freedom Day." A Conservative party spokesman claimed: “Government policy is in no way influenced by the donations the party receives. They are entirely separate.” But while Johnson has long been known to have personal financial challenges, an unnamed cabinet minister claimed: "His financial problems will be sorted out in a week after he leaves office." And another colleague claimed he “could become the richest prime minister on record" once he leaves parliament.

On July 12, Boris Johnson addressed the nation as he delivered the government’s plans to lift most of the remaining restrictions. In that, he noted that they had “come to a stage in the pandemic when there is no easy answer and no obvious date for unlocking. We have cases rising significantly, with more than 30,000 per day.” He then announced that the nation would go forward with the plans to open up on July 19 to take advantage of a school term break. 

As he announced those plans, Johnson claimed his government “always did say there would be a third wave,” as he asked his countrymen to “reconcile ourselves to more deaths.” These claims have nothing to do with leadership and everything to do with setting expectations for the bad outcomes the government is fostering. If things go better than expected, he’ll take credit, but if it goes poorly, he’ll blame the people for not being careful. And regardless of warnings, the occurrence of this wave was not preordained. Working to suppress the virus, rather than trying to eliminate it, was a choice. If the UK kept the measures in place that helped end their last wave, they would be dealing with far different circumstances right now. If they had closed the borders before the Delta variant landed, it would not have entered the nation over 500 times. It would not account for anything approaching 99% of the nation’s cases. Nor would there have been nearly 600,000 people infected with COVID-19 in the last week.

Now Johnson is talking about travel rules aimed at keeping new variants from entering the UK. Sadly, he didn't express any concerns about sharing variants abroad. This fits with the vaccine nationalism approach the UK has employed, which has taken care of its own people while telling others to wait. The vaccines are sold as a solution — a path out of the pandemic — but there's no guarantee that they'll prevent the virus from mutating into something that the vaccines can’t handle. As such, Johnson's approach could be sowing the seeds of far greater tragedy.

I have spent multiple years researching a book on the UK’s politics around Brexit and its fallout, so I’m fairly well acquainted with the nation’s current leadership. As a whole, they’ve generally left me with low expectations. Even so, if you had told me back in mid-June that the UK would experience a near sixfold increase in cases over the next month, but the government would continue humming along like all was fine, I would have called you stark raving mad. And yet, here we are.

It’s important to note that while the number of cases skyrocketed prior to the reopening, they dropped significantly in the days that followed. Whether that’s because the virus had hit its peak or it was due to the impact of the school break remains to be seen. But even if Boris Johnson somehow lucks out with his decision, it will still have been a terrible one. The UK needs better leadership.

The reopening move has my alarm bells going off. Removing restrictions during a school break offered the possibility of showing a dip in cases, thanks to the obvious difference in interaction for people working in and attending schools, as well as a 20% reduction in testing. But if the schools return as planned after the break, you’ve merely delayed the full impact of removed restrictions until schools open. He’s acting like he’s somehow fooling the virus, but it’s likely he’s only fooling himself.

And while I am not an epidemiologist, several participated in an emergency international summit a few days before the UK’s restrictions were removed. Dr. Deepti Gurdasani is one of those epidemiologists, and she is also the lead author of a letter that was recently published in The Lancet that has since been backed by over 1,200 scientists. That letter cited important concerns with the plan, as its authors found “any strategy that tolerates high levels of infection to be both unethical and illogical.“ They also noted their belief that “the government is embarking on a dangerous and unethical experiment.”

Further rebuttals to the PM’s announcement were sharp and swift. Christina Pagel, director of Clinical Operational Research Unit at UCL, seemed exasperated as she called the government out for “allowing cases to spiral in the full knowledge that we have safe and highly-effective vaccines after two doses,” when the UK has an “excellent vaccination program.” She added that they need a couple of months to get to the necessary level of immunity without doing so through infection. Pagel then added, “We don't need to let millions more people get infected and then live with the consequences of that down the line, but that seems to be the government's plan. And it's a terrible plan.” Mike Ryan, the Executive Director of the WHO’s Health Emergencies Programme echoed Pagel in stating that, “The logic that more people being infected is better is, I think, logic that has proven its moral emptiness and its epidemiologic stupidity previously.” Richard Horton, the Lancet’s Editor-in-Chief, added, “It will not be FreedomDay, it will be a self-inflicted wound..."

While cases were taking off in the UK as the nation prepared for “Freedom Day,” hospitalizations and deaths rose somewhat, but had not come close to the levels seen back in January. This has led some to support Boris Johnson’s reopening plan. But Matthew Talyor, chief executive of the NHS Confederation, reminded us that even if hospitalizations and deaths do not approach earlier highs, the NHS is still working to reduce a huge backlog of non-COVID treatment, while also citing concerns about further mutations.”

When financial publications like the Financial Times and CNBC sound the alarms with headlines like, “Lifting England’s Covid rules while cases surge is ‘threat to the world’” and "England's lifting of Covid lockdowns is a danger to the entire world, experts warn," maybe it's time to reconsider your plans? If you’re still hesitant to be cautious, it may help to know that on Monday, the day that Johnson ripped off the COVID-19 band-aid from quarantine, Britain's Chief Scientific Adviser Patrick Vallance said statistics showed that “60% of people being admitted to hospital with COVID-19 have had two doses of vaccine.”

The dangers from the UK's removal of restrictions go well beyond their borders. Along with the potential for transmission between travelers to and from the UK, there's also the risk of replication of the nation's public health measures. Two days after the UK's 'Freedom Day,' Alberta, Canada followed suit by removing a number of measures, including the need for close contacts of infected people to self-isolate, people experiencing symptoms will now self-isolate, rather than get tested, and starting August 16, "people who test positive for COVID-19 will not be mandated to quarantine anymore, but the province will recommend it." I'm not aware of evidence of Alberta's leaders taking cues from the UK, but the 'rip off the bandaid and tell everyone to be careful' approach certainly feels familiar. Albertan doctors were reportedly blindsided by the maneuver. As Dr. Shazma Mithani put it, “I’m really just so confused why we’re removing the only safety net we have left in place to protect everybody.”

On Thursday, the St. Louis County Council voted to end a mask mandate that had just been implemented but the County Executive. The County Executive followed the vote claiming the mandate was still in place, while the state's Attorney General backed the Council. Public health measures should never become a political football, but it's happening and that's opening the door to increased transmission.

On Friday, the Governor of Arkansas announced a state of emergency, while saying that masks would not be required. As he put it, "We're going to be wide open."

Whether the UK's moves had any effect on those in Alberta, St. Louis, or Arkansas, there are surely others taking note.

Last week, MP Dawn Butler was removed from the House of Commons for accusing Boris Johnson of lying. Parliamentary rules do not allow MPs to accuse each other of lies, so Butler was sent home for speaking truth. Not only does the system not hold Johnson responsible for his lies, it actively protects him from being called out for them. As Hardeep Matharu put it, “Butler exposed the absurdity of a system which enables those in the highest positions of power to lie with impunity and sanctions those who dare to call this out.” She then added that the system that allowed such was both vulnerable and dangerous.

Hardeep is right. As we recently observed in the US, systems of government that depend on honorable behavior are dependent on honorable leadership to function properly. The UK has such a system of government, but lacks the necessary leadership.

The masks are off for the current UK government as Hancock’s treatment of care home residents has been translated into Javid’s national approach. From the start of the pandemic, the choice has come down to preferencing people by attempting to eliminate transmission or to suppress it in favor of the economy. The new approach drops any pretense of attempting to avoid transmission. The UK now has a banker running the NHS and a Health and Care Bill that would open the door to greater privatization of its healthcare system. As Caroline Molloy put it, “The bill enables a power grab by the Treasury, the money men, the private sector and their lobbyists.”

Given the circumstances, it seems reasonable to think that the government is trying to create a crisis that will overwhelm the healthcare system. The UK’s big picture political challenges are not the focus herein, but thinking about the choices that have recently been made by the nation’s leaders, in the context of their recent trajectory, is critical. 

Covid acceleration seems the chosen path of the Johnson administration and their dangerous choice is spreading. People in the UK cannot trust these 'leaders' with their lives, nor can the rest of the world. That his latest approval ratings are the lowest of his time as PM suggests Britons know this. It’s time to demand the implementation of proper public health measures — things like rapid testing, contact tracing and isolation, face masks, social distancing, limiting gatherings, and avoiding poorly ventilated spaces — and commit to sticking with them until transmission is under control and the vaccination rates are high enough to offer herd immunity. The “Swiss Cheese Model” below is a good mental model for the need. The idea is that no intervention can completely stop the spread of the virus on its own, but that each additional ‘layer’ improves your chances of success.

Aneurin Bevan led the creation of the NHS. As he put it, the health service would “last as long as there are folk left with faith to fight for it.” This moment is the kind he warned about. It is time to fight for the NHS and put an end to the unnecessary suffering and deaths that the government is enabling. Doing so will not only protect people in the UK, but also those in countries that look to the UK for scientific leadership and reasoned responses to challenges. Johnson's dangerous experiment must end. Our shared humanity requires it.

WPC Book #2: What do we do after the pandemic? is available for pre-order.