Session 3: Summary

Did the Government adopt the right public health strategy?

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Introduction
 

Louise Irvine

Dr Louise Irvine, GP introduced the session. She spoke of Keep Our NHS Public’s support for a public inquiry but stated that the People’s Covid Inquiry was needed right now so lessons could be learned.

 

Louise Irvine told the Inquiry that she had lost her father to Covid last April, and both her mother and husband had been seriously ill in hospital with Covid - thankfully they survived. As a GP she has seen many of her patients become seriously ill, and several died from Covid. Deaths in the UK from Covid 19 since the start of the pandemic now exceed 126,000. She stated that we all deserve to know how and why this happened. Was the scale of this tragic loss of life avoidable? Did we respond appropriately?

 

Michael Mansfield QC, Panel Chair

Michael Mansfield spoke about the demand for a public inquiry which had been prominent in the media the last week, this being the anniversary of the first lockdown.

 

While supporting a public inquiry, he pointed out that there are numerous misconceptions all of which emphasise the need that the People’s Covid Inquiry is fulfilling.  

 

Boris Johnson the Prime Minister spoke of the possibility of a public inquiry in July last year but since then there hadn’t been a mention of it.

 

Secondly, even if Johnson ordered one now, such an inquiry would take time to set up, to line up the team of lawyers, to hold the hearing, which could take two years, and to report. The inquiry would be historic. The families of the bereaved, workers on the frontline and ordinary citizens want answers now, not in six years’ time. The People’s Covid Inquiry does not have powers of compulsion, but this is not needed as people are queuing to give evidence. The format of the inquiry is close to but not the same as a judicial inquiry. The Inquiry is endeavouring to ask the questions that everyone is asking right now, before we face any future wave of this pandemic or future pandemics.

 

Witness 1: Rehana Azam

Witness statement
Rehana Azam is National Secretary of GMB Union, the third largest trade union in Britain, and is head of Public Services.

Rehana Azam’s evidence focused on key areas of worker safety, particularly PPE and sick pay and in the context of low-paid NHS, contracted out and care staff.  She spoke of the GMB’s role, the enhanced role of trade unions during the pandemic and what is now needed to raise pay and conditions for key workers.

 

Decades of cuts

  • There were over 100,000 vacancies in the NHS and over 110,000 vacancies in social care before the pandemic. Years of underfunding before the pandemic had led to chronic staffing shortages and to a workforce and system already at breaking point.

  • On average, NHS staff have lost about 15% in real value of their pay over the past decade, local government workers have lost 23%. In the social care sector, or sectors that have been outsourced, the vast majority of workers are on minimum pay and conditions, are predominantly women, and people from black, Asian and minority ethnic backgrounds,


Sick pay during the pandemic

  • The unsatisfactory level of Statutory Sick Pay (SSP) put workers in the unbearable dilemma of having to choose between going to work ill and potentially endangering their colleagues, and those they care for, or staying at home and not being able to put food on the table. This issue wasn’t addressed swiftly enough in February by the Government.

  • The GMB, other unions and Labour Party made the  argument to Government regarding the 3 waiting days before being eligible for SSP and successfully made the case for sick pay from day one.

  • Failure to fully underwrite pay is still a health and safety issue, for thousands of workers on minimum terms and conditions who cannot afford to self-isolate on statutory sick pay.

 

Safety and PPE

  • Government wasn’t prepared for the pandemic despite being warned years earlier of this fact. There weren’t the required response procedures in place to deal with it. There were not enough PPE supplies.

  • In mid-March 2020 the Government seemed to de-escalate their response. They said they were going to procure PPE and flood it the across the NHS and care sector but this did not happen.  The care sector was the poor relation with rationing of PPE and some care settings were not able to access it at all for a period.

  • Workers caught the virus because they weren't protected in their workplaces, and PPE has not appeared at all in the school sector.

  • The government was too slow to protect workers, sadly some died unnecessarily. We need to get justice for their families.

 

Going forward

  • We need an end to privatisation and to bring back in-house services. Privatisation has led to a hugely fragmented public sector with a race to the bottom for pay and terms and conditions.

  • A recovery plan needs to put the value of the workers at its heart. This includes proper pay, safe workplaces and time to rest and spend time with their families.

  • We need to bring the care sector back into public ownership and have a proper integrated health and social care sector and an end to privatisation.

 

Role of trade unions

  • Trade unions over the past year have come into their own. In the absence of government and employers’ safety assessments trade unions have been able to step in and challenge employers.  

  • The GMB is calling for NHS staff to get 15% as a pay rise as a minimum - as pay justice - and for  local government workers to get back the wages that they've lost.

  • The Union is asking for key workers to be recognised as such and for Covid-19 to be classified as an industrial disease.

  • Key worker status should be written into immigration regulations because workers from many different backgrounds have been badly treated and affected – there had to be a fight for migrant workers to force the Government to do U-turns on health surcharges and immigration visas.

 

 

Witness 2: Professor Anthony Costello
Witness statement

Anthony Costello is Professor of Global Health & Sustainable Development at UCL, a paediatrician by training. For 3 years he was Director of Maternal Child & Adolescent Health at the World Health Organisation. He is a founder member of Independent SAGE.

 

The main areas of discussion in Professor Costello’s evidence were on the issues of containment and mitigation versus suppression, at the beginning of the pandemic; the Government’s failure to establish contact tracing; and failure to involve public health and the NHS primary care system.

 

Elimination and suppression
(For full discussion see Anthony Costello’s witness statement)

  • Since early February 2020, the UK government strategy had been focused on containment and mitigation. In contrast, WHO policy, and that of states like South Korea, Taiwan, Japan, Singapore, China and Hong Kong, Vietnam, Thailand, New Zealand, Australia, and (to some extent) Finland, Greece, Norway and Denmark, was to suppress the virus through effective public health measures.

  • The UK government experts on SAGE (Scientific Advisory Group for Emergencies) had no independent public health voice.

  • SAGE was unanimous that measures seeking to completely suppress spread of Covid-19 would cause a second peak. "SAGE advises that it is a near certainty that countries such as China, where heavy suppression is underway, will experience a second peak once measures are relaxed." That did not happen.

 

Test and trace

  • SAGE and the government did not respond to alternative views of the need for more aggressive epidemic control, especially the alternative analysis submitted to SAGE on March 9 2020 by Professor Steven Riley from Imperial. There was a failure to mobilise an appropriate contact tracing response to the virus in February 2020 successfully used in countries in Asia.

  • Testing, tracing and the Covid 111 systems were set up which didn't have data linked into primary care. People  were being told that they had a potentially fatal disease, yet their GP was not being told, and they were not being linked together. If we had had contact tracers and volunteer medical staff to help out with primary care networks, we could have set up a system that would have been much more comprehensive in locking down the virus.

  • On 12 March the Government decided to abandon all attempts at test and trace at a time when more than 50 districts in the country had fewer than 10 cases – very low levels (which could and should have been managed).

  • And so basically we ‘took it on the chin’ and we are up to 147,000 deaths. ONS figures]

  • Professor Costello stated that he had recently (March 2021) written to a Public Health Director in the North of England asking how many people he had on contact tracing work. The Director replied that he had 19 contact tracers for 150,000 population. If he had the equivalent of what happened in Wuhan he would have had 100 contact tracers, as part of a team managed by Public Health, and linked with the primary care networks.

  • At present the only local Public Health funding is through the standard allowance: local teams haven't had any of the £37 billion.

  • Professor Costello stated that the UK had never even tried to get on top of contact tracing: even now we don’t have a tracing or an isolation system that works because there's no incentive there for many poorly paid people to isolate. Many won’t even get tested because they'll lose income.

 

Global Vaccines

  • We need the mechanisms to ensure that everyone in the world who needs it can get a vaccine. At the moment COVAX [the global risk-sharing of procurement for equitable distribution of vaccines] can only commit 2 billion doses by the end of this year, of which 1 billion will go to low income countries - this will only deal with 20% of the population.

  • It’s been disappointing to see that the G20 have not come together to really pull together a strategy, and the finance to ensure that this happens. We’ve seen the economic damage that countries that have not suppressed the virus, like the UK, have suffered, compared to those who are now having pretty normal economies and lives because they acted quickly.

 

 

Witness 3: Professor Michael Baker

Witness statement

Michael Baker is a specialist public health physician and Professor of Public Health at the University of Otago, Wellington. He is a member of the New Zealand Ministry of Health Covid-19 Technical Advisory Group (TAG).

 

Professor Baker focused mainly on how the New Zealand response had developed and its implied lessons for the UK.

 

  • In approaching a pandemic, it is core thinking to look at control or elimination; you reach a ‘fork in the road’. if you have the resources, it is feasible and desirable to eliminate the infection in the population.

  • New Zealand started off with a 'mitigation' model but, by early March, seeing the success in Asian countries in containing the virus, and the WHO report from the mission to China, New Zealand changed course to containment or 'elimination' strategy.

  • The New Zealand quarantine system has now allowed about 120,000 people to cross the border into New Zealand in relative safety. People usually have three tests before they're allowed out into the community. This system is not perfect, there is an occasional incursion, a border failure, but it has been manageable.

  • New Zealand has achieved what can be regarded as zero-Covid; that is, they are aspiring to maintain elimination. ‘We define that as 28 days without any particular case in the community, despite high volume testing, and we have achieved that for most of the last year in this country.’

  • The proposal to the Government was to have a short intense lock down with the explicit goal of having no transmission in the community. And they emerged, after seven weeks of people with a stay at home order, with no virus in New Zealand that could be detected.

  • A four-level alert system was introduced, adapted from the system being used in Singapore. Michael Baker and some colleagues argued to use the system in reverse – to start at the highest level of containment to basically eliminate the virus, rather than going in the other direction [of reactive step-wise escalation]. And that is what the government adopted.

  • Countries that have achieved elimination through strong public health measures protected their population and suffered lower Covid-19 mortality. But they also they have had less economic contraction.

  • The terms ‘control ‘ and ‘elimination’ are used, because the terms have been in infectious disease thinking for three decades. The World Health Organisation uses that framing consistently. Much of the world has a polio elimination goal, contributing to global eradication.

  • Michael Baker described as his ‘greatest surprise, how the Western world assessed the pandemic’. He had thought that ‘every country on earth would be saying, we will follow the success of China in elimination, and other well-documented sources’.  He stated that the strategy the World Health Organisation itself produced was sitting on their website at the end of February and New Zealand followed it.

  • Traditional public health measures can eliminate this virus over large regions of the world, and the second amazing accomplishment of course is development of vaccines. Pressure from variants will be greater as we roll out vaccines. So, Michael Baker stated, this would strengthen the need for a global elimination, or progressive elimination.

 

Witness 4: Janet Harris
Witness statement

Janet Harris is a semi-retired public health professional currently working with a group which is called the Sheffield Community Contact Tracers, and her specialist area of expertise is community mobilisation.

 

  • The group consists of retired Directors of Public Health and nurses, academics, public health specialists, GPs and other medics who came together because they could see there was a problem with the contract tracing system.

  • Janet Harris gained a great deal of experience working with the HIV/AIDs epidemic in Massachusetts, an area roughly the size of Yorkshire. At that time they had had to get off the ground quickly as HIV/AIDs was an epidemic that moved to different population groups in a very short period of time. They had had a difficult time reaching different ethnic groups, because of the stigma and a difficult time recruiting people for surveillance, HIV counselling and testing.

  • Their Sheffield group had queried the government policy of setting up a national top down, test and trace programme.

  • They decided therefore to set up a pilot project to see whether they could recruit and train local volunteers to be community-based contact tracers, to a standard that is acceptable according to WHO Covid guidelines, and to assess what kind of support would be needed to keep these people on the ground continuing to do work. They found that contact tracing needs to be integrated with the other aspects of find, test, trace, support and isolate [FTTIS]. They also worked in Sheffield hospitals where contact tracing had not been taking place.

  • Since summer 2020 they have been working with the voluntary and charitable sector, looking at whether it is possible to link into the existing workforce. They are developing a cadre of people who can create Covid confidence for contract tracing, so that once contacts are interviewed and people identified, they can very much step in and support people to isolate, and to keep in touch with them while they're isolating.

Reasons for distrust of Government messages

  • Some people are immigrants and refugees and may come from governments and systems where they originally did not trust the government. They may be victims of abuse, political abuse, asylum seekers.

  • Lack of trust also happens with people in lower socio-economic groups that are accustomed to being in positions where they really don't have any power and control. There can be a reaction to government or public health professionals who are trying to hand out messages, advising people what to do.This doesn't just happen in pandemics.

  • People from the different communities are receiving many messages from many different layers of government which are hard to understand, because they are not in many of the community languages of the people they are trying to reach, and even where they are written some people have issues with literacy.

  • When the messages are translated it doesn't mean that the message is connecting to people in terms of helping them know what to do. There’s a difference between telling people what to do - 'self-isolate, ventilate your house, wash your hands' - and the lived situation of people in the circumstances they’re in, and how this is translated on the ground into something that they are able to manage to do.

  • Janet Harris and her group are working on co-production of truly meaningful information. Then, the people who've worked on it with you feel like it's theirs, they own it.

  • She talked about community organisations who in Sheffield are funded to have Covid champions, to start talking to members in every community, key opinion leaders about the fact that local contact tracing is going to start and to explain to them how it works and how relationships are established.

  • There is a role of course for Government, but weekly sharing of information on a local basis must not just be about case rates or hospitalisations, but about who's doing what, how much is being done and how much of it can be linked to success achieved. Government needs to be supporting it as a facilitator on a national level, and removing the barriers.