COVID-19: state failure is our misery and their jackpot

A research paper this month shows the effect of COVID-19 on health services in Scotland.¹ The result was profound disruption with an impact on non-covid deaths and illness. It is important to begin here because failure to control the pandemic harms health from both direct and indirect causes. Health services are overwhelmed. People die early. Indeed, preventing premature deaths is an important global indicator of health service performance.

But the pandemic response is complex and the debate on how best to manage it is too often simplified to a false dichotomy. To lockdown, or not to lockdown, that isn’t the question. A lockdown or ‘circuit breaker’ is a consequence, an adverse event, a reset switch for a system failure. Lockdown is an endpoint that any sensible expert wants to avoid. Lockdown is the culmination of either being outflanked by an infectious disease or failing to make the best decisions at the right time.

The question then is how best to limit the damage from a new virus, in relation to both health and wellbeing and the economy. The answers are fuzzy, complex, and uncertain. The evidence base is patchy, albeit rapidly accumulating, and needs to be assessed carefully.² But there is evidence to draw on, and to make informed choices on its basis. More importantly, we can learn from the experience of others.³ The countries of East Asia, for example, were best prepared because of the lessons they learnt from SARS. The countries of the Middle East were similarly forearmed by their experience with MERS. Parts of Africa were able to call on their recent memory of Ebola. If a small, vulnerable, island state like Sri Lanka can draw on these lessons to keep itself afloat then what is stopping the world’s rich countries⁴?

One answer is hubris, a grand arrogance that we have better answers, that we are smarter and more resilient, that our technology and economy is too great to be defeated. Perhaps that is why the basic principles of controlling a pandemic were lost in the mists of political and commercial gain? It is increasingly clear that the countries that best controlled the pandemic, protecting population health, experienced the least damage to their economies.

Vietnam, South Korea and China, for example, had relatively few deaths and minimal impact on their economies. They used lockdown sparingly or in a focused way, if at all. Their responses are built on successful test, trace and isolate systems, delivered by boots on the ground or shoe-leather epidemiology. They protect their borders with strict controls. They communicate clear and unequivocal social and physical distancing policies.

Instead, England has failed on all these counts, and in all probability hampered the better policies of the other home nations. The biggest failure is that of test and trace. By introducing management consultants and commercial opportunists, at huge cost to taxpayers, the government has indulged in a level of state negligence that may be unprecedented.⁵ Lives are being lost prematurely. People who recover, young and old, are living with the disease burden of long COVID.⁶ The economy is being hit more than in most other countries.

Lockdowns and circuit breakers are the consequence of this state failure. The troubling question is who got rich and how? The words that have stuck with me perhaps more than any others during this pandemic are simply these: ‘Our misery is their jackpot.’