Boris Johnson’s government repeatedly did “too little, too late” in response to the covid pandemic and could have saved 23 000 lives in England if a lockdown had been imposed a week earlier, the UK Covid-19 Inquiry has concluded.1
Delays in imposing measures to combat the SARS-CoV-2 virus were “inexcusable,” said the inquiry’s chair, the retired appeal court judge Heather Hallett. Had the government put in place stringent restrictions by 16 March 2020 to limit its spread, mandatory lockdown from 23 March might conceivably have been avoided altogether, the report added.
Advisory restrictions such as contact tracing, self-isolation, household quarantine, face coverings, and respiratory hygiene could have avoided the need for a full lockdown, said Hallett. Lockdowns in 2020 and 2021 became inevitable only because of the acts and omissions of the UK government and the devolved administrations in Wales, Scotland, and Northern Ireland, she added.
Despite clear signs that the virus was spreading globally, all four UK nations failed to take sufficiently timely and effective action, and February 2020 was “a lost month,” the inquiry concluded.
“Limited testing capacity and a lack of adequate surveillance mechanisms meant that decision makers did not appreciate the extent to which the virus was spreading undetected in the UK and they failed to recognise the level of threat posed,” said Hallett. “This was compounded by misleading assurances from the Department of Health and Social Care and the widely held view that the UK was well prepared for a pandemic.”
The report—the second from the multistage inquiry—covers core decision making in government. It criticises Johnson, prime minister of the Conservative government at the time, the then health secretary Matt Hancock, and Chris Wormald, then permanent secretary at the Department of Health and Social Care. Hallett also accused the Scientific Advisory Group for Emergencies (SAGE) of being at risk of “groupthink” because of its narrow membership.
Chris Whitty, chief medical officer for England, and Patrick Vallance, government chief scientific adviser, had suggested that the public would not maintain compliance with restrictions over a long period, said the report. But it added, “This concept of ‘behavioural fatigue’ had no grounding in behavioural science and proved damaging, given the imperative to act more decisively and sooner.”
Lasting scars
None of the four UK governments had a strategy for exiting the lockdown, and none gave enough attention to the possibility of a second wave of covid, said the report. It also concluded that there had been a “toxic and chaotic culture” at the centre of the UK government.
A lack of trust between Johnson and some leaders from the devolved nations had affected the collaborative approach to decision making, it said, adding that allegations of rule breaking by ministers and advisers had undermined confidence in government.
While the report concluded that the four governments were right to impose a mandatory lockdown on 23 March 2020, it emphasised that they were in that position because of their failure to act promptly and effectively at an earlier stage. Had the four governments not imposed a lockdown then, it would have led to a loss of life “on a scale that was unconscionable and unacceptable,” said Hallett.
She wrote, “While the nationwide lockdowns of 2020 and 2021 undoubtedly saved lives, they also left lasting scars on society and the economy, brought ordinary childhood to a halt, delayed the diagnosis and treatment of other health issues, and exacerbated societal inequalities. The covid-19 lockdowns only became inevitable because of the acts and omissions of the four governments.”
The report makes 19 recommendations, including ensuring that decisions and their implications are clearly communicated to the public, greater parliamentary scrutiny of the use of emergency powers, and broadening participation in SAGE.
Future preparedness
Commenting on the report’s findings, the BMA’s chair of council, Tom Dolphin, said, “This report is a terrible indictment of the government’s almost incomprehensible failings and incompetence. It also outlines several lessons learned, and the BMA welcomes the emphasis on the need for future pandemic preparedness plans to have clear objectives and a set of detailed actions for those responding to the emerging crisis.”
The figure quoted by the report, of 23 000 lives that could have been saved by an earlier lockdown, is based on 2021 modelling from researchers at Imperial College London.2 But David Spiegelhalter, emeritus professor of statistics at the University of Cambridge, urged caution over the interpretation of this figure.
“The report states that modelling ‘established’ that approximately 23 000 fewer deaths would have occurred had lockdown been implemented a week earlier,” Spiegelhalter told The BMJ. “But modelling does not ‘establish’ anything—it is just an estimate based on numerous and challengeable assumptions, such as assuming that changes subsequent to lockdown were due to the lockdown itself.
“And yet the models themselves [figure 2 in the 2021 modelling paper from Imperial]2 estimate that daily infections were falling prior to lockdown on 23 March 2020, presumably due to the measures already in place. No doubt many lives would have been saved by earlier action, but this estimate from 2021 should be taken with caution.”
The Conservative Party was approached for comment.
