2020 in Review: Covid-19 in England

Date: 31/12/2020


At the time of writing, there have been 49719 deaths in English hospitals related to Covid-19 with over 80,000 deaths above the annual average across the whole of the UK. The estimated R-number for England currently lies between 1.1 and 1.4 meaning that infections are continuing to rise.

Wuhan, the ground zero for the Covid-19 outbreak, recently celebrated becoming "Covid free" yet most families in the UK were unable to visit each other at Christmas. How did the sixth-largest economy in the world end up having one of the largest number of deaths from Covid-19 per capita?

Let's review some of the successes and failures of the UK response to Covid-19 over the past year and their impact on England. We have also made a Covid-19 2020 Timeline in which you can see when key events happened in relation to the daily number of Covid-19 cases, deaths and tests.

Lockdown

As can be seen in our Covid-19 timeline, the number of daily deaths from the virus was highest in April during the first wave and was significantly worse than the European average. It is now reasonably well accepted that delays in putting the UK into lockdown resulted in more lives being lost.

Some may point to this as simply being hindsight. But one could argue that the UK had been provided with ample warning from neighbouring EU countries of what was to come and yet was one of the last EU countries to enter lockdown. When Italy entered lockdown on the 9th of March the UK had only had three deaths from the virus. However, the Government waited until deaths rose to 356 before going into lockdown.

While the Government has claimed at every stage to be following the science, many believe that initially a plan of "herd immunity" was pursued in which the virus would be allowed to spread in order to build up a societal immunity to the virus. This plan was criticised as not being a "viable option" by over 500 scientists in an open letter to the Government. Further, it would take the Government 13 days to act on the advice of Prof Neil Ferguson and the Imperial College COVID-19 Response Team for mass home-isolation. In the same report, they estimated that the Governments original plan could have cost as many as 250,000 lives.

As shown in our Covid-19 timeline,the UK is suffering fewer daily deaths in the second wave than it did in the first. This time the numbers are much more similar to the European average. However, the number of people hospitalised with the virus has recently exceeded that of the first wave. This suggests while hospitals have learned how to better treat covid patients, the Government has learned few lessons about how to prevent the spread of the virus.

The Government chose to lift the second lockdown in England on 2nd December when the virus was still far from under control with hundreds dying every day. Further, the Government designated London to be a comparatively low Tier-2 zone. Only a few weeks later the capital was placed in the newly created Tier-4 category proving that attempts to keep the UK's economic centre open were, at best, short-sighted. Both cases and deaths continue to rise across the UK.

PPE

The lack of personal protective equipment (PPE) was a big problem from the very start of the pandemic. Many countries faced similar problems. However, investigations have shown that the UK Government had ignored its own advisors about their failure to stockpile PPE. Doctors and nurses were therefore unable to access vital equipment such as gowns and masks as the number of patients rose.

The British Medical Association found that nearly half of doctors were forced to find their own PPE. In the absence of proper equipment, many NHS staff resorted to wearing bin bags. This put both health workers and patients at risk.

Testing

Initially, the UK was slow in providing tests for the virus. Back in April the country was "playing catch up" with other countries. However, since then the UK has done comparatively well. Our timeline shows that the daily number of tests provided exceeds both the global and European average.

It can be argued that we should expect the UK to be leading on testing due to its comparative wealth and this is true. However, the UK is currently providing almost double the number of tests per person as Germany, a country of similar size and GDP. At the time of writing the UK is the ninth leading country in the number of tests provided per person. Some might argue that the sixth-largest economy in the world can and should do better.

Testing in the UK hasn't been without problems. There have been reports of the government's Track and Trace service instructing families to drive over a hundred miles to find testing facilities. Furthermore, in November, a BBC investigation found that in some areas the "world-beating" Track and Trace system was finding as few as half of all close-contacts. Some have blamed these failings on "cronyism" and "outsourcing".

Vaccination

After nearly a year of lockdown Hokey Cokey, the rollout of the first vaccines has come as a huge relief to many. On the 8th December, 90-year-old Margaret Keenan became the first person to receive the Pfizer Covid-19 jab outside of testing. The question of whether the country's swift approval of the vaccine should be considered a UK success has been an issue of much contention. Regardless, there can be little doubt that the vaccine will save lives and bring us closer to a post-Covid world.

The UK is currently a leading distributor of Covid-19 vaccines. Ontop of this, the Medicines and Healthcare products Regulatory Agency has recently approveda second vaccine produced in Oxford. The current number of Covid-19 vaccines administered stands at 800,000.

History of Neglect

The NHS was ill-prepared for a pandemic of this scale. Over the past decade, the number of overnight beds owned by the NHS England has fallen by more than 20%. A study into the critical care beds of Europe found that the UK has one of the lowest numbers of acute care beds per capita in Europe. The UK has fewer than half the number of acute care beds per person as Germany and, more importantly, fewer than a quarter of the number of intensive care and intermediate care bed units.

Numbers of acute care beds for countries in Europe

Years of underfunding, a lack of staff, and rising demand for healthcare had pushed the NHS to the brink before the pandemic had started. December 2019 saw A&E waiting times, a typical barometer for the overall performance of the NHS, reach record levels with 900% more people waiting over four hours than in 2011.

Along with the insufficient stockpile of PPE discussed, these factors have meant that the NHS has been unable to respond as effectively to the pandemic as it should have. With increasing patient numbers due to the coronavirus, many hospitals across the UK have been forced to cancel non-urgent surgery.

One might therefore welcome the Governments "radical NHS shakeup". However, instead of simply providing the NHS with better resources, the British Medical Association warned that shakeup was a "plan for a market-driven healthcare system". Other experts have criticised both the timing and the lack of transparency involved in the planning.


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