5. Confusion about the language of intervention and stages of intervention

The Health and Social Care Committee sessions highlight two types of confusion about how best to describe stages of government policy. In particular, the difference between mitigate/suppress represents either a profound change in UK government policy or trivial semantics.

The distinction between contain and delay measures.

The Committee probes the idea of a shift in early March from contain to delay, which taps into wider debates in which critics suggest that the UK gave up on containment too soon (discussed in post 1 in relation to testing). In two sessions, Whitty (5.3.20: q2-4 and q55; 16.3.20) emphasizes that the measures to contain and delay are very similar, so the distinction is misleading:

‘At this point in the early stage of delay, the actions are primarily ones of case finding and isolating cases that come from high-risk areas, which is to try to reduce the possibility of seeding into the community and therefore slow down the initiation of an epidemic, then try to pick up cases early and isolate them in hospital environments so we minimise the chance of transmission within hospitals’ (5.3.20: q55).

Vallance (5.5.20: q41) states that the initial plan was to isolate and track to contain the virus. Then, the UK had a ‘massive influx of cases, not from China but from all sorts of other places, partly because of the huge connectivity of the UK … once it went beyond that to being a pandemic you didn’t know where it was going to come from, and we got a very large number of cases coming in right the way across the country from multiple European sources somewhere around late February and detected in early March’.

The distinction between mitigation and suppression measures

It is common for UK media and social media discussions to highlight a U-turn from mitigation to suppression measures in mid-March, summed up to some extent by the Prime Minister’s exhortation to stay home (16.3.20) and then obligation to stay home (23.3.20).

During this time, the Imperial College COVID-19 Response Team report dated 16.3.20 described (a) ‘mitigation’ measures as likely to reduce UK deaths only from 500000 to 250000, and therefore not viable, prompting (b) the need for ‘suppression’ measures to reduce deaths to 5,600-48,000 over two years.

In contrast, Vallance (17.3.20: q67) describes the distinction as mere semantics:

‘It is a semantic difference, whether you call it suppression, delay or mitigation. The aim is exactly the same, which is, how do you keep this thing down, how do you keep it below the level at which you want to keep it, and how do you keep it down for long enough to ensure that you have managed to achieve suppression?’

Vallance suggests that the UK took suppression measures from 16.3.20 without using the word suppress (17.3.20: q84; see also 5.5.20: q432 ‘we are definitely in “mitigate” now’, which suggests that he says ‘mitigation’ when most might say ‘suppression’). Similarly, Hunt (17.3.20: q69) describes ‘the very dramatic social distancing measures that have now been announced’. Whitty is also keen in the 5.3.20 sessions to downplay the idea that there are distinct categories of action associated with different terms.

For me, these discussions highlight two main issues.

First, initial UK government policy was often confusing because its communication was poor. In this case, it seems that the meaning of each term was not agreed from the outset, contributing to some confusion among adviser, advisee, and commentator.

Second, and more importantly, they betray a lack of appreciation of the difference between measures in relation to their likely levels of implementation. Most notably, several discussions (17.3.20: q84-5) equate UK policy from 16.3.20 as the kinds of suppression measures associated with China or South Korea, despite a huge gulf in their level of enforcement (see also Harries, 5.5.20: q440: ‘People seem to think there was a lockdown moment, whereas in fact a series of interventions based on science were recommended’). In contrast, Costello (17.4.20: q298) favours a more compulsory form of isolation associated with ‘a lot of the Asian states’: ‘Just asking people to self-isolate will not achieve the quarantine that you want’.

COVID-19 policy in the UK: oral evidence to the Health and Social Care Committee (5th March- 3rd June 2020)

1. The need to ramp up testing (for many purposes)
2. The inadequate supply of personal protective equipment (PPE)
3. Defining the policy problem: ‘herd immunity’, long term management, and the containability of COVID-19
4. Uncertainty and hesitancy during initial UK coronavirus responses
5. Confusion about the language of intervention and stages of intervention
6. The relationship between science, science advice, and policy
7. Lower profile changes to policy and practice
8. Race, ethnicity, and the social determinants of health