In this thorough and damning account of the government's catastrophic failures dealing with the coronavirus pandemic, Dr Raisa Ahmed argues we cannot return to 'normal'
I am a Paediatric doctor working in the NHS: I am scared, angry and shocked. It has been very difficult for me to pen down my thoughts. I am anxious about my friends and colleagues all over the country, many of who have been redeployed across specialties and are working in war-like zones without adequate protection. During the last 4 weeks, I along with many others have been horrified by the government’s response to Covid-19. This pandemic has undoubtedly clarified that we cannot go back to how things were before. We must reject the neoliberal philosophy that places money over human life and individualism over society. In the aftermath, we must strive for new political and economic systems that value humanity over profit. If there is one positive in this nightmare situation, it is the demonstration worldwide of what can be achieved through collective action.
The government’s inaction
The UK government was warned at the end of January about a novel virus in China with the potential to cause a global pandemic, published in the Lancet, a leading British medical journal. The author strongly advised, “preparedness plans and mitigation interventions should be readied for quick deployment globally.” Despite the terrifying scenes from Italy and repeated warnings from Italian medical professionals to take it seriously; the British government’s strategy has been woefully incompetent, dangerous and arrogant. The UK chose to ignore World Health Organization (WHO) advice: mass testing and rigorous isolation measures, as evidenced by China successfully managing to contain the virus and other countries such as South Korea and Taiwan, which have avoided mass outbreaks. WHO director, Tedros Adhanom was emphatic: “you can’t fight a virus if you don’t know where it is. That means robust surveillance to find, isolate, test and treat every case, to break the chains of transmission.”
Instead, Boris Johnson pursued ‘herd immunity’ and even boasted about shaking hands with coronavirus positive patients in hospital. Telling the nation that many of us will lose our loved ones, Boris Johnson flanked by the Chief Scientific and Medical Officer announced there is no need for quarantine. Their justification: social distancing measures should be introduced as late as possible because people will fatigue and once restrictions are lifted, a second wave will follow. Just how bad was this plan? On hearing the UK's policy, William Hanage, a British professor of the evolution and epidemiology of infectious disease at Harvard, thought it was satire:
“second waves are real things, and we have seen them in flu pandemics. This is not a flu pandemic. Flu rules do not apply. There might well be a second wave, I honestly don’t know. But vulnerable people should not be exposed to a virus right now in the service of a hypothetical future.”
Such was the British arrogance that we are somehow uniquely different to the rest of the world, the UK kept calm and carried on. One day prior to the first major government press conference, 3000 Madrid fans were permitted to travel to Liverpool for a Champions League match. This was around the same time an acute outbreak was happening in Madrid, which later became the epicentre of Spain. A few days later, 250,000 people gathered at the annual horse-racing festival at Cheltenham.
The UK trajectory is extremely worrying, the death rate is steeper than Italy and the UK has half the number of ICU beds as Italy. There have been concerns about under reporting of cases and deaths due to various factors, including lack of testing and omission of deaths occurring in the community. Currently, the hotspot is London followed by the West Midlands. In January, Health Secretary, Matt Hancock asserted: “…risk is low… we are well prepared and well equipped… the NHS is ready to respond appropriately…”: This could not be further from the truth – as we are now seeing.
Healthcare professionals (HCPs) all over the country are being forced to work without adequate personal protective equipment (PPE) with multiple unthinkable accounts of staff having to hold their breaths or share masks, whilst being threatened with disciplinary action for speaking out publicly about their concerns. The guidelines regarding PPE appear to change almost every week, according to what is available rather than evidence about what provides the best protection. NHS staff have described feeling like, ‘lambs for slaughter’. HCPs have struggled to get testing resulting in significant numbers of staff self-isolating, exacerbating the existing staffing shortage. HCPs are also frightened that they may unknowingly be infecting their patients. I know of several people who have travelled back from hotspots, such as Madrid, and were instructed to return to work as normal without testing or self-isolation.
The Lancet’s editor-in-chief, Dr Richard Horton, has called the government response a national scandal:“we wasted February when we could have acted. Time when we could’ve ramped up testing. Time when we could’ve got personal protective equipment ready and disseminated. We didn’t do it.”
His frustrations were echoed by Professor John Ashton, former regional director of Public Health England (PHE) who described, “tearing my hair out… we’ve got a complacent attitude, it feels wooden and academic, and we’ve wasted a month…” The British Medical Association (BMA) warned that GPs and hospital doctors will die without proper PPE. It is astounding that in a developed nation, HCPs are having to crowdfund their own PPE.
Conservatives have been demanding that people not 'politicise' Covid-19. This is a convenient move to avoid any scrutiny as well as cover up any government failures. The pandemic is sure to challenge the best well-funded healthcare system, but the truth is we have been left extremely vulnerable after a decade of austerity. Government apologists will try to tell you, 'there is a global shortage of PPE, we can't do anything about it.' There are several problems with this excuse.
Firstly, it means Public Health England has been lying that we have enough PPE. In October 2016, a drill simulating a flu pandemic was carried out (Exercise Cyngus) and revealed gaping holes in Britain’s Emergency Preparedness, Resilience and Response (EPRR) plan. Shortages of intensive care beds, vital equipment and even mortuary space were highlighted. The report was buried and never published. A senior government source with direct involvement in the exercise reportedly said the results were “too terrifying” to be disclosed.
In 2017, official documents showed the Department of Health under Jeremy Hunt, rejected medical advice about providing HCPs with protective eye equipment during an influenza pandemic because they felt stockpiling it would be too expensive. Very recently, the UK refused to join a joint EU scheme to acquire ventilators. After being criticised about prioritising 'Brexit over breathing', the government proceeded to blame it on a 'communication error', later rubbished by the EU commission. It has been estimated that we will need another 30,000 ventilators to cope with the peak of cases in April, of which only 30 have been secured. Just this week, I have heard from two medic friends that oxygen is running out at their hospital. The overall callous attitude of this government can be summed up by Boris Johnson referring to the procurement of more ventilators as 'Operation Last Gasp’.
This disaster has not transpired overnight. A decade of gutting public services means a potentially manageable health emergency will turn into a human and economic catastrophe. Before Covid-19, the NHS and social care were on its knees. Every winter, we somehow manage to get by purely because of the goodwill of overworked and dedicated staff who are propping up a dilapidated system. In the last 10 years, we have lost 17,000 hospital beds and there are currently 100,000 NHS staff vacancies. Retired doctors are returning to work even though they are at higher risk and final year medical/nursing students are being graduated early to help on the frontlines.
Chronic underfunding and fragmentation of NHS services has been deliberate whilst increasingly ushering in backdoor privatisation: a sinister move permitting the government to secretly undermine the NHS and publicly cheer it on for political purposes. This has made it even more difficult to coordinate an effective public health response, including the upscaling of testing. During an interview with Sky News, Dr Guddi Singh, a Paediatric doctor in London aptly said,
"what does it mean to get through this? I think there will be lots of excessive and avoidable deaths as a result of what happened here and that to me doesn't feel like getting through or a success… I don't want anyone to come to harm as a result of a failure of the system."
The grim reality is that yet again, it will be NHS staff who will have to pick up the pieces following years of government neglect and no doubt will do everything they can to save as many lives as possible, often at jeopardy to themselves. Many of my friends and colleagues are making huge sacrifices, for example, moving out of their homes to protect vulnerable family members so they can continue working.
Money before people
An exclusive report in the Sunday Times revealed that in a private meeting at the end of February,
Dominic Cummings (unelected Chief advisor to the Prime Minister) pushed for herd immunity, summarised as: “herd immunity, protect the economy, and if that means some pensioners die, too bad.” Though No.10 denied these allegations, it is transparent the crux of the Covid-19 response has been 'money before people.' When it materialised that the disease was accelerating faster than the government had anticipated and would certainly cause a public uproar, they performed a u-turn and finally implemented a half-baked lockdown. Matt Hancock even tried to claim on national television that the strategy had never been herd immunity.
This crisis has displayed the flaws of neoliberalism and disaster capitalism in all its glory: shockingly, the stock markets do not have a magic cure for a deadly virus and so, the government was forced to intervene. It was surreal watching the new Chancellor of the Exchequer, Rishi Sunak, announce ‘relief packages’ (given his history of profiteering during the 2008 global economic crash when he worked at Goldman Sachs). Several days later, Matt Hancock announced the NHS’s £13.4bn debt was being written off.
Like many others, I wondered where they had finally managed to find that elusive money tree. It reinforced how austerity had been a failed political choice, a choice that has caused over 130,000 avoidable deaths and shattered the moral and social fabric of our society. The consequences are damning. The most vulnerable who were barely surviving on the fringes of our broken society are even more defenceless. Individuals and families relying on food banks are at risk of being starved, including many children whose one hot meal a day comes from school. Thousands of homeless people are in danger.
Worldwide, domestic abuse has shot up as a result of lockdown and after severe cuts to vital women’s aids services in the UK, women have been left without a safety net. With no extra capacity, non- essential appointments/surgeries in the NHS have been cancelled; patients who had been waiting for months will now have to wait even longer. There are grave concerns that cancer patients will not receive the care they need because of a lack of staffing and resources.
Of course, the economic stimulus package does not go far enough. Statutory sick pay remains a measly £95.85 per week, one of the lowest in Europe. The government is doing the bare minimum to create an illusion that it is doing something. Construction work in many places has not been halted and workers are unnecessarily being exposed. Several companies like ASOS have remained open, forcing workers to choose between their own health and livelihood. Companies are laying off staff without pay, for instance, Wren Kitchens fired hundreds of workers on the pretext of ‘underperformance’. Owner of Amazon and world’s richest man, Jeff Bezos was slammed when he tried to ask for charity to pay his workers. Rather than compelling companies to shut down and pay their workers, this government has started scapegoating individuals to cover up their colossal mismanagement and criminal negligence.
The government has tried to change the narrative to a positive story about supporting our heroic key workers on the frontlines. Ironically, these are the same underpaid, overworked and undervalued key workers that the Home Secretary, Priti Patel, called “low skilled” just several weeks ago. This is also the same government that cheered loudly in parliament after blocking a pay rise for nurses.
Many NHS workers, including me, were very moved by the loud clapping and cheering on our streets. It was a small gesture that meant a lot to so many staff who constantly feel unappreciated. However, we are not just struggling now; we have been working in increasingly difficult and stressful conditions for years.
Carers, social workers, public transport drivers, supermarket staff and other key workers, in addition to NHS staff, have not been given adequate PPE and are being expected to work without any protection. Social workers have been taking to social media desperately pleading for basic things like hand sanitizers so they can do urgent home visits. Ten Transport for London workers have already died after testing positive. There are reports of several care homes refusing to pay carers who have been instructed by the government to stay at home because they are high risk. Key workers need more than just theatrical clapping from this government. If it truly values them, they must step up and do everything possible to supply suitable PPE. Notably, the list of key workers did not include millionaire/billionaire tax evading CEOs or bankers. The crisis is highlighting who the real heroes are and how we must never forget them again: hollow government gestures will not suffice.
The UK recently declared any doctor, nurse or paramedic whose visa runs out before 1st October will have their visa renewed for one year. The cynical move demonstrates how the Home Office treats foreign health workers as disposable items for their convenience. For years, Priti Patel and former Home Secretary Teresa May have demonised immigrants through toxic and racist immigration policies; creating a hostile environment, which has led to a haemorrhaging of staff in vital health and social care services.
This hate campaign has been fuelled by the media, including mainstream networks such as the BBC giving unlimited airtime to hardened racists like Nigel Farage. It turns out that Britain needs immigrants after all. The very least this government can do is offer them indefinite leave for putting themselves in harm’s way for the British public. But what can we expect from a government that has been embroiled in the Windrush scandal where hundreds of migrants were wrongly detained and deported? This is the same Windrush generation that helped rebuild this country after World War Two (WW2) including the NHS. The NHS has one of the most diverse workforces in the world and the pandemic has reinforced that diversity is our strength, which should be cherished and celebrated.
How does the UK compare internationally?
It will be difficult for the UK to hide their ineptitude when other countries are getting it right. South Korea has become a role model. Even though their outbreak started around the same time as Italy, they managed to turn it around through mass testing. They had testing kits available, which helped save time and manufacturing resources were immediately thrown into producing more. Having learned from the previous MERS and SARS outbreak, South Korea has an incredible infrastructure set up to perform testing and contact tracing. This was crucial as early detection meant asymptomatic cases could be isolated to prevent spread.
Closer to home, Germany is showing other European countries the way forward. Performing 5 times as many tests as the UK, Germany currently has over 130,000 positive cases and suffered just over 3,000 deaths. Not only is Germany an example of political will in action, it reflects a well-funded public health system, which has facilitated a rapid public health response. Germany also has the highest number of ICU beds in Europe (29.2 per 100,000 capita of population compared to 6.6 in the UK).
Another country which is doing exceedingly well is New Zealand. Leader Jacinda Arden has been praised for her fast and hard response. As the outbreak spread across the world, New Zealand watched carefully by 25th March, the country was in a full lockdown for a minimum of 4 weeks. Currently, New Zealand has just over 1,300 positive cases and 9 deaths.
Remarkably, the southern Indian state of Kerala is putting some developed nations to shame. As Jason Hickel, economic anthropologist, tweeted: “Kerala Covid-19 response has been humane, caring and successful…” The Communist State government pursued a strategy of aggressive testing, intense contact tracing and quarantine measures. They also built thousands of shelters for migrant workers, introduced a comprehensive economic package and distributed millions of cooked meals. Even though Kerala was one of the first Indian states to report Covid-19, the number of new cases in the first week of April has dropped by 30% and there have been 2 deaths. This is radically different to Indian Prime Minister, Narendra Modi, who has not only failed to do mass testing but introduced a haphazard lockdown all over India, which has left thousands of migrant labourers stranded without any food or shelter. The far right government has even managed to turn it into a communal issue, blaming Muslims for the spread of disease. Modi would do well to heed Kerala’s example before Covid-19 rampages out of control in India. The success story of Kerala reflects years of investment in public services by the Communist State government, evidenced by Kerala having the best performing public health system in the country.
If further proof is required, one only needs to look next door to Ireland. Despite having a comparable health system, the number of deaths in Ireland is 2.5 times lower than the UK. Ireland implemented a lockdown 1-2 weeks earlier and even cancelled St Patrick’s Day celebrations. Concerted efforts are also being made to increase testing and create a robust contact tracing system. There is a clear demarcation: all the places that have acted on WHO advice are doing significantly better than those who haven’t bothered.
It’s a class issue
I am furious and heartbroken. As I write this, the UK tally sits at over 90,000 positive cases and over 12,000 deaths. If this trend continues, I fear we will all either lose a loved one or know someone who has. It is easy to misdirect your anger to individuals and the government has begun pointing the finger at the public to deflect responsibility. Individuals should absolutely be sensible, responsible and heed advice to social distance but isolating is a privilege that many cannot afford. As with most disasters, the most vulnerable will suffer the greatest loss. Newsnight reporter, Emily Maitlis succinctly summarised:
“they tell us coronavirus is the ‘great leveller’, it’s not, it’s much, much harder if you’re poor. This is a myth which needs debunking. Those who have been on the front line right now, bus drivers, shelf stackers, nurses, care home workers, hospital staff and shopkeepers are disproportionately the lower paid members of our workforce. They are more likely to catch the disease because they are more exposed. Those who live in tower blocks and small flats will find the lockdown tougher. Those in manual jobs will be unable to work from home. This is a health issue with huge ramifications for social welfare, and it’s a welfare issue with huge ramifications for public health.”
People must channel their anger into pressuring the government to introduce mass testing, enforce the closure of non-essential workplaces, provide comprehensive financial relief, and deliver proper PPE to all key workers. Dr Antony Costello, a former director of maternal and child health at WHO explained:
“without community surveillance and testing in place to detect new outbreaks and isolate individuals once the current lockdown is lifted, we face hugely damaging national lockdowns, over and over again.”
If governments can bail out banks that caused a global economic recession with taxpayers’ money, they can provide economic assistance to workers during a pandemic in order to save lives. An investigation by the Times revealed that MPs have been authorised to claim an extra £10,000 in expenses to help them work from home, in addition to the extra £26,000/year they can claim to cover their office costs. The obvious disparity exhibits what is fundamentally wrong in our society.
The UK is being projected to have the highest death toll in Europe. Unsurprisingly, Black and Ethnic Minority backgrounds are being hit harder, reflecting the socioeconomic and health gap in a grossly unequal and polarised society. The only way we will get through this is to galvanise our communities, reminiscent of the grassroots-driven efforts seen during WW2. It is time to end the toxic philosophy of Thatcherism and individualism which has destroyed our communities. If anything, the crisis has shown we all have our part to play and that we need each other.
There will be further pandemics in the future and only investment in our public services will help protect us. I know we will get through this crisis. However, we cannot let the government manipulate it into a success story or inevitable tragedy: the reality is thousands of deaths will occur that could have been prevented. In the aftermath, we must remember and fight for the heroes who get us through it. At least 20 HCPs and many other key workers have already died; we cannot let their sacrifice go in vain. We must protest and demand a public inquiry to hold the government accountable and ensure this debacle is never repeated. As Dr Antony Costello bluntly stated: “any self-respecting Cobra, UK Sage or pandemic crisis team should have realized the importance of mass testing from the onset, and never allowed this to happen.”
Covid-19 has turned the world upside down as we know it. Tedros Adhanom said, “with solidarity, humility and assuming the best of each other, we can and we will overcome this together." There have been many positive acts of global solidarity. As always, Cuba is leading the way with medical humanitarianism, by sending medical equipment and teams to Italy. Cuba also allowed a cruise ship with 682 British passengers onboard to dock in Havana and fly home after the US refused due to confirmed cases on board. Empty words of gratitude are not enough: the international community must now put pressure on the US to end their illegal and inhumane economic embargo on Cuba.
Collective action within countries is also widespread, for example, in the UK, 750,000 people signed up to volunteer for the NHS. It is precisely this unity that is required to tackle our biggest existential threat of all: climate change and covid-19 has established that it can be achieved.
Where will we go from here?
Undeniably, there will be a global economic recession, and this will be the test if we have learnt anything from this global emergency. Predictably, it has been business as usual for disaster capitalism, with hedge funds raking in billions as thousands of people die, including UK MP Jacob Rees-Mogg. Richard Branson is demanding the government bails out Virgin Atlantic using taxpayers’ money; this is the same billionaire who successfully sued the NHS for £2million in 2016. In a ray of hope, Spain has taken a step in the right direction and promised to introduce universal income to mitigate economic losses, in what could become a permanent fixture. The question is: will we revert to our old ways or will we finally create a global network that values and protects all existing life?