COVID-19: What needs to happen now?

The UK is now in its third week of a three-week lockdown. But as we see the mounting number of people diagnosed with the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and with that, the growing number succumbing to Coronavirus Disease (COVID-19), I think most of us know that this will not be the last week that we need to stay at home.

While we’re in the throes of this pandemic, we need to focus on three things: reducing the spread of the virus, protecting people who are at most risk of contracting the virus and ensuring that those who do contract it have the treatment and care that they need.

Overall, most people are being sensible and following the requirement to stay at home. When we’re not at home, we’ve all been told how important it is to maintain at least 2 metres between us to prevent the virus spreading. But the focus on enforcing this has been on individuals, whether in parks, at work or on beaches. Why are we still allowing businesses undertaking non-essential work where social distancing of at least 2 metres is almost impossible to observe, to stay open, potentially spreading the virus between workers and their families? Italy stopped non-essential production on 23rd March, why haven’t we? Serving a constituency where warehousing and distribution are key industries, this is one of the biggest concerns of my constituents who work in this sector.

Personal Protective Equipment (PPE) is essential in stopping the spread of the virus. But as I said when I wrote to Matt Hancock three weeks ago, thanking him for his efforts, the lack of PPE for our health workers could mean that not only do they contract the virus themselves, they also transmit Covid-19 to their family, colleagues and vulnerable patients. Over the last 3 weeks, I have had doctors and nurses contacting me about the inadequate PPE supply from masks to gloves and gowns. One A&E doctor told me that whenever he carried out an aerosol-generating procedure, which he does routinely every shift, he risked contracting the virus as he doesn’t have the recommended FFP3 respiratory mask. A nurse reported that she was caring for a patient dying from Covid-19 with a mask which just wasn’t fit for purpose and no gown at all, just a flimsy apron. We’re now seeing our doctors, nurses and frontline carers dying as a result of the inadequate protection they’ve been issued with, when this was entirely preventable. We need to be asking why we didn’t start to stockpile PPE in January when we saw how infectious this virus was, why it took so long to join the EU procurement programme to access PPE and other medical equipment more promptly and how we’re going to ensure adequate PPE supplies get through to health and care workers at the frontline from the regional pandemic supply hubs that have now been set up. Last year over 151 million items of PPE were used by the NHS; this gives a sense of the hundreds of millions that are needed now for this crisis.

Another tool in public health’s armoury is contact tracing. This involves tracing and contacting whoever an infected person has had interactions with in the previous 10 days or so, and then getting them to self-isolate and prevent the further spread of the virus. With under 300 people in Public Health England to do this, contact tracing was scaled back in the middle of March as soon as it was clear Covid was spreading within the community, whilst for other countries, notably Germany, Ireland, Singapore and South Korea it was a cornerstone of their work to prevent Covid from spreading. I’ve been told the Republic of Ireland are recruiting thousands of people for this task.

Together with testing it enables us to understand the dynamics of the virus, preventing it from re-emerging in the future.

On testing, we know the World Health Organisation (WHO) has said all countries should ‘test, test, test’ not just to diagnose who with symptoms has the virus and needs to self-isolate, but also to understand its prevalence in asymptomatic people. WHO even provided guidance of how to develop tests and testing regimes at the beginning of March. Once again we have been behind the curve on this. Contact tracing could have prevented the virus’ spread back in February, but as soon as it was being transmitted within communities, the demand for diagnosis was always going to outstrip supply. Now we need to prioritise the testing of vulnerable people presenting for hospitalisation and our NHS and care workers. But even then our testing facilities to diagnose Covid positive people are struggling and we really need to be taking up all available offers from labs such as the Crick Institute. Separate to this, the developments for antibody tests to tell if we’ve had the virus and are now afforded some immunity, needs to be escalated, without compromising reliability.  We don’t want a test which has more than 2% of false positives, potentially allowing the virus to re-emerge.

Ventilators, oxygen and now swabs are all in short supply, and are needed to treat the most poorly Covid patients. In addition to the public health infrastructure that was hollowed out as a result of the 2012 Health and Social Care Act, the shortcomings of responding to a pandemic from a Westminster command and control centre has been shown. In areas where health and social care funding has been devolved such as in Greater Manchester, there has been the flexibility to procure their own PPE and other equipment. Although whether additional funding will be allocated to Greater Manchester by the Government to cover all these and other additional costs is yet to be seen.

This emergency has shown us a lot about our society. We’ve seen the best of people – our selfless NHS and care workers, those who have volunteered or are looking after neighbours. But we’ve also seen the worst: deceiving and stealing from isolated vulnerable people, shops profiteering, individuals stockpiling goods leaving the health workers who we rely on with nothing. And this is being replicated at a global level with some countries gazumping other countries’ medical supplies that they’ve bought and paid for. I heard about one country (I won’t name them) that literally hijacked much-needed PPE and ventilators on a runway!

More than ever, we need strong, principled leadership – leadership that recognises that we can only beat this virus, and others like it, through international co-operation and collaboration, by sharing data and expertise, even resources. We are an interconnected world and viruses don’t recognise borders – they travel where we travel. This health emergency, that we have yet to see peak in the UK, will be followed by an economic and potentially a social one lasting most of this decade. And we need to be planning for this too.

Globally, it is estimated that the Covid pandemic could cost as much as $10 trillion and for each percentage point lost in the economy typically 10 million more people fall into poverty. To quote others,

‘As the global economy plunges deeper into an economic crisis and government bailout programmes continue to prioritise industry, scarce resources and funding allocation decisions must aim to reduce inequities rather than exacerbate them.’

We must make sure that the poor who are predicted to suffer disproportionately in this crisis, also don’t suffer in its aftermath through widening socioeconomic inequalities, as well as the inequalities in life expectancy and healthy life expectancy.

Out of this emergency and the tragedy and heartbreak that so many will endure, we must take the opportunity to reflect on the type of society we want, what this means for our economic response and for our welfare state.


Debbie Abrahams MP for Oldham East & Saddleworth,

Former Public Health Consultant and Fellow of the Faculty of Public Health,

9th April 2020.

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