Coronavirus: no lessons learnt.

A recent report by MPs entitled ‘Coronavirus: lessons learned to date’ has pointed out major shortcomings in the response to COVID-19. Despite the title, it is however not obvious what lessons have actually been learnt. By Martin Michaelis and Mark Wass.

The report ‘Coronavirus: lessons learned to date’ by the House of Commons Health and Social Care and Science and Technology Committees reports on a range of failures that have contributed to the high death toll of COVID-19 in the UK.

The report rightfully points out that the pandemic preparedness plans were not fit-for-purpose, that the first lockdown was introduced too late, that testing and tracing was ineffective, and that sending patients from hospitals into care homes without testing or proper quarantine caused many avoidable deaths. It could also have mentioned other issues such as confusing communication and policies on the use of face masks.

However, many of the early decisions in the run-up to the first lockdown were taken in the face of tremendous uncertainty and some failures have only become obvious with hindsight. Although data suggested early on that COVID-19 was transmitted via the air and by asymptomatic individuals, those responsible for political decisions doubted the validity of such evidence for a considerable time. Although face masks intuitively make sense, the actual scientific evidence was not that solid at the beginning of the pandemic. Moreover, there were concerns about potential shortages of face masks that were needed in hospitals, if everybody started to wear one.

Pandemic preparedness plans were probably affected by a certain level of complacency, as the UK and Europe had not faced such a serious pandemic for a long time. There was a perception that in countries with developed health systems, such devastating pandemics were a thing of the past. Such perceptions probably limited the willingness to invest significant funding in preparing for a large pandemic, of which many thought it would never happen.

In the report, the development of ‘group think’ among politicians and ministers was suggested to have contributed to an initially ‘fatalistic’ approach towards a pandemic that was considered to be impossible to stop, which resulted in the first lockdown being introduced too late. Although the devastating impact of the pandemic could already be witnessed in Northern Italy, such measures still seem to have been ‘unthinkable’ for those in charge at the time. Only the realisation that the health system was about to collapse seems to have finally changed thinking.

Taken together, it is difficult to judge objectively with hindsight what happened until the introduction of the first lockdown, without being biased by all the knowledge that is now easily available but was not at the beginning of 2020. Notably, the UK was one of the first countries that was seriously hit by COVID-19 in Europe, and data from Italy initially seem to have been wrongly interpreted.

Instead of blaming people with the benefit of hindsight for difficult decisions at the time, however, it is much more important that we learn from this experience, so that we deal better with the ongoing pandemic and are better prepared for future pandemics. However, this is exactly what is not happening.

After the first lockdown, the nation sleepwalked into the second one. The resurgence of COVID-19 cases was even actively supported by the government’s ‘eat-out-to-help-out’ scheme and a drive to send workers back to their offices. If the vaccines had not turned out to be as effective as they are, we would be in another lockdown now. This shows that our approach towards COVID-19 and pandemics in general has not changed. We only act, if we have to because the health system would otherwise collapse. There is no obvious indication that any lessons would have been learnt.

Although we have moved on from a herd immunity approach, which basically means just letting an infectious disease spread through the nation more or less unhindered, our approach is still that everything is fine as long as there is an intensive care bed for every seriously ill COVID-19 patient to die in. Serious attempts to reduce virus spread have been stopped.

In a nation that leads international scientific research, the lack of ambition when it comes to the public health response to COVID-19 is astounding. UK COVID-19 data are among the most comprehensive and detailed in the world. Clinical trials were almost immediately organised, and the UK has sequenced the biggest fraction of the available SARS-CoV-2 genomes. However, the UK is also one of the top nations with regard to the COVID-19 death toll among industrialised, high-income countries.

The development of vaccines, including the early governmental investment, and the vaccine roll-out were rightfully praised in the report as a great success. However, we have to be realistic here. Still today, nobody exactly knows why these vaccines are effective. This has something to do with the virus and the immune response that it induces, something that we do not fully understand. Hence, it would have been entirely possible that the developed COVID-19 vaccines failed in clinical trials, without us being able to predict this upfront. Therefore, we have to be realistic enough to accept that vaccines may not come to our help in the same way in a future pandemic.

We will only demonstrate that we have learnt from the pandemic when we make the investments that are needed to deal better with future pandemics. This includes the infrastructure and staff needed to deal with a sudden large wave of infectious disease patients. This includes the sustainable availability of personal protective equipment and medication, including sufficient stockpiling to cover an emergency situation. This includes the establishment and maintenance of diagnostic facilities for testing and tracing.

Further, this includes the proper education of the public on how to act in a pandemic, including why adherence to the measures is essential to ensure the best possible outcome. And finally, this includes a plausible plan that enables the nation to go into a lockdown with maintaining a basic infrastructure, which ensures the availability of basic supplies to everyone, including a plan of how to avoid the economic devastation that was caused by the COVID-19 pandemic.

Morbidity, mortality, restrictions of personal freedoms, and the damage to the economy will be higher, when we underestimate the extent of a disease outbreak. Hence, we need to be prepared to err on the safe side, instead of avoiding any measures until the health systems is on the brink of collapse.