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The Challenge of Controlling COVID-19
Public Health and Social Care Policy in England During the First Wave
Jane Lewis
First published in Great Britain in 2021 by
Policy Press, an imprint of
Bristol University Press
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© Bristol University Press 2020
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ISBN 978-1-4473-6251-7 ePub
ISBN 978-1-4473-6252-4 ePdf
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Contents
Acknowledgements v
Preface vii
Introduction 1
1. The approach to the early stage of the pandemic by politicians and scientists 9
2. The position of public health and the problem of ‘test and trace’ 23
The problems with the test, trace and isolate system 26
3. Care homes for elderly people 45
The Government’s policy response 47
The structural position of social care 55
Conclusion 67
Notes 81
References 85
I am grateful to Celia Davies, David Piachaud, Anne West and three anonymous reviewers for helpful suggestions.
My text offers an analysis of the first wave1 of COVID-19 in England.2 It is neither a diary nor journalism. Rather, it seeks to take account of as many of the key documents relating to the policy response as possible, focusing on the approach taken by the Government and the position of other key actors, particularly scientists and public health practitioners. It looks in detail at two issues of particular importance and concern: the performance of the test, trace and isolate system, and the heavy toll exacted on the residents and staff of care homes. I hope that the account and the conclusions regarding the policy problems that have been experienced may become a point of reference for those offering a comparative analysis of all the countries of the UK and beyond in the future. I look only at the first wave of the pandemic. The main part of the text was written between late July and October 2020, with some additions up to late December. It will be interesting to see the correctives offered by those taking the longer view in the future.
Jane Lewis
31 December 2020
COVID-191 has proved an altogether more threatening and deadly disease than the new strain of influenza that had been expected at some point and for which plans, if not adequate preparations, had been made. Better understanding of the way in which COVID-19 behaves has rapidly emerged, but many questions have been difficult to answer: for example, why the virus is so highly transmissible, how far being infected will give immunity, and why some individuals are more vulnerable to infection and death. This makes control difficult. But public health structures and expertise are longstanding in the UK and the control of epidemics has long been recognised to come within the purview of government, requiring a coordinated response between central and local government, and between public health and clinical doctors, healthcare managers and government officials.
The pandemic has laid bare socioeconomic fault lines and exposed major divisions in western societies. In the UK, it became clear early on that older people, those on low incomes and black and minority ethnic communities suffered the highest rates of sickness and death, while young people have suffered major disruption to their education and many of those of working age, especially the self-employed, face high levels of unemployment and/or debt.
The interests of different groups as to how the virus should be controlled – by strict rules about individual behaviour or a more laissez-faire approach – have often been perceived to be in conflict by commentators and politicians, many of whom also tend to take a strong position on the vexed issue of freedom versus responsibility. Attitudinal surveys of opinion and of personal behaviour show that there are also fault lines in the wider population on this issue.2 There are therefore real problems for the state in attempting to control the pandemic. Setting rules and telling people what they must and must not do (for example, get tested for the virus and self-isolate if they test positive); how they should behave (for example, not visiting elderly relatives in a care home); and how far to enforce such behaviours are not necessarily straightforward for liberal western democracies. It is particularly difficult for the Conservative Party in the UK, which has long been committed to individual freedom and choice and would wish to avoid any charge that it is behaving as a ‘nanny state’.
It is also difficult for governments to make well-founded decisions in a timely fashion during a fast-moving pandemic, and this has proved particularly problematic for western countries. Decisions about how to deal with a new virus like COVID-19 – whether to try to suppress it, eliminate it or ignore it as much as possible