BMJ: Too little, too late, too flawed – UK’s COVID-19 response

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The UK’s response to COVID-19 so far has neither been well prepared nor remotely adequate, argue experts in The BMJ. Public health experts, Gabriel Scally at the University of Bristol and Bobbie Jacobson at the Bloomberg School of Public Health at Johns Hopkins University, together with The BMJ’s executive editor, Kamran Abbasi, say the UK was “forewarned but not forearmed” and call for a clear, locally led strategy of case finding, testing, and contact tracing to minimise further harm.

They discuss some of the UK government’s decisions since the World Health Organisation (WHO) declared a public health emergency on 30 January, and ask how did a country with an international reputation for public health get it so wrong? These included rejecting lockdown measures, abandoning contact tracing, and downgrading the COVID-19 threat level, so that a lower level of PPE was required to treat patients.

“By the time the UK formally announced a lockdown with a huge package of economic support measures, almost two months of potential preparation and prevention time were squandered,” write Scally and colleagues.

They point to an absence of public health experts on scientific advisory groups coordinating the UK’s response to covid-19, and the government’s decimation of public health during years of austerity, as factors in a flawed response.

But, for now, they say the focus “must be on a strategy to minimise harm from ill-advised relaxation of physical distancing in ways that will trigger further epidemic spikes with prospects of a vaccine or treatment still distant.”

As such, they call for an end to political involvement in scientific advisory groups and recruitment of more public health experts. A clear, locally led, strategy based on case finding, testing, contact tracing and isolation is also needed “to inform and justify future decisions about how the lockdown can be safely relaxed.”

They warn that meaningless political soundbites promising to recruit 18,000 contact tracers, test 200,000 people a day, or invest in unjustified contact tracing apps, “divert focus and could lead to more deaths.”

The most serious public health crisis of our times requires a strong and credible public health community at the heart of its response, they write. “A UK government that prioritises the health and wellbeing of the public will see the importance of rebuilding the disempowered and fragmented infrastructures of its public health system. Anything less is an insult to the tens of thousands of people who have lost their lives in a pandemic for which the UK was forewarned but not forearmed,” they conclude.

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