Vallance (17.3.20: q114) ‘I do not think any of us have seen anything like this. It is a first in not just a generation but potentially the first for 100 years. None of us has seen this. … This is a daily changing and unique situation where we are learning as we go along’.
Early UK discussions are characterized by the expression of uncertainty about what was happening (based on limited data and the questionable accuracy of the most-used model), and hesitancy about how quickly and substantively to respond. This combination of uncertainty and hesitancy informs continuous discussions about why the UK appeared to pursue a lockdown too late, contributing to an unusually high number of excess deaths.
However, it is worth keeping them separate – analytically – to compare uncertainty about (a) what is happening, and (b) what ministers and the public are willing to do about it (as described in the previous post, in relation to problem definition), which inform hesitancy in different ways. Either way, the wider context is that the UK government eventually introduced measures on social regulation that would have seemed unthinkable in the UK before 2020.
The NERVTAG notes show how much uncertainty there was in January 2020, with initial assessments of low risk before the virus spread to other countries and then the UK. Even by the early stages, and still in March, there was some hesitancy about recommending quarantine-style measures, and a tendency to focus on low impact or low social compliance as a way to reject new measures.
- Compare with Freedman 7.6.20 (‘Where the science went wrong. Sage minutes show that scientific caution, rather than a strategy of “herd immunity”, drove the UK’s slow response to the Covid-19 pandemic).
The oral evidence to the Health and Social Care committee
In the first oral evidence session in March, Whitty (5.3.20: q1) was still describing the virus in relation to China and only providing an initial mild warning that the chances of containment in China (followed by minimal global spread) are ‘slim to zero’ since it is ‘highly likely that there is some level of community transmission of this virus in the UK now’.
Similarly, Willett (Director for Acute Care, NHS England) (17.3.20: q175) described the sense that there was no perceived emergency (in WHO and UK statements) by the end of January, followed by the sense that information, advice, and policy was changing ‘literally every few days’.
The initial oral evidence shows that the science advice was primarily about how to inform and persuade people to change their behavior, focusing heavily on regular handwashing, followed by exhortations to self-isolate at home if feeling symptoms.
Whitty (5.3.20: 2-4) describes delaying the peak of the epidemic via ‘changes to society’ to (a) avoid it coinciding with ‘winter pressures on the NHS’ and boost the capacity to respond, (b) understand the virus better, and (c) hope that it ‘if you move into spring and summer, the natural rate of transmission may go down’ (as with respiratory viruses ‘like flu, colds and coughs’, in which people are less often in small enclosed spaces).
These early discussions emphasise the need for parliamentary and public discussion on more impositional measures, but with no strong push for anything like a lockdown (and, for example, some concern about the measures in South Korea not being acceptable in the UK – Whitty, 5.3.20: q5).
Even on 17.3.20, Vallance (q72) was describing waiting 2-3 weeks to find out the effect of the Prime Minister’s 16.3.20 message, hoping that it could keep the number of ‘excess deaths’ down to 20000 (and Vallance and Whitty had been describing pre-lockdown measures as quite extreme). The same day, Stevens (and Powis, National Medical Director, NHS England) described the PM’s hope that people would act according to the ‘good judgment and altruistic instincts of the British people’ without the need to impose social distancing (17.3.20: q176).
- The need to ramp up testing (for many purposes)
- The inadequate supply of personal protective equipment (PPE)
- Defining the policy problem: ‘herd immunity’, long term management, and the containability of COVID-19
- Uncertainty and hesitancy during initial UK coronavirus responses
- Confusion about the language of intervention and stages of intervention
- The relationship between science, science advice, and policy
- Lower profile changes to policy and practice
- Race, ethnicity, and the social determinants of health