The Challenge of Controlling COVID-19. Lewis, Jane

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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

Politicians 9

Scientists and politicians 11

      2. The position of public health and the problem of ‘test and trace’ 23

       Public health 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

       Acknowledgements

      I am grateful to Celia Davies, David Piachaud, Anne West and three anonymous reviewers for helpful suggestions.

       Preface

      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

       Introduction

      

      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 СКАЧАТЬ