Failure to focus on COVID suppression led to avoidable UK deaths, says expert

Early in the COVID-19 pandemic, the failure of UK government advisers to follow World Health Organization (WHO) advice and emerging evidence from East Asia that suppression could bring the virus under control quickly led to avoidable UK deaths, argues an expert in The BMJ.

Suppression aims to avoid national lockdowns and maintain economic activity for most of the population by introducing surveillance systems to bring new outbreaks under control quickly, thus reducing the reproductive rate of infection (R0) to below 1 and causing the epidemic to wither.

Anthony Costello, professor of global health at University College London says, had the UK followed a suppression strategy, it might have prevented thousands of deaths. He asks why long-term strategies of suppression continue to be under-recognized and calls for better governance of UK pandemic science advice.

In January 2020, the global threat from COVID-19 was clear and the WHO was advising countries to focus on rapid suppression to avoid an immediate threat from the spread of the new coronavirus, he explains.

Yet while Greece, Germany, Norway, and Ireland took steps to follow these recommendations, the UK government’s Scientific Advisory Group for Emergencies (SAGE) unanimously chose a response based on pandemic flu that ignored the different characteristics of coronavirus transmission.

Nor did SAGE change its advice after reports of rapidly falling cases and infection rates in several East Asian countries that had focused on suppression. Instead, in March 2020, the government published its “contain, delay, research, mitigate” plan based on influenza that would allow the virus to spread to achieve “herd immunity.”

SAGE’s unwavering decision to recommend a response based on influenza has continued to be defended by its co-chairs, Chris Whitty, England’s chief medical officer, and Patrick Vallance, chief scientific adviser until 2023, notes Costello.

Yet their defense is based on three arguably mistaken assumptions: that COVID could not have been suppressed, that a huge second wave could follow even if it was, and that suppression required prolonged national lockdowns.

He acknowledges that SAGE faced a difficult and fast-changing situation in early 2020 but says its advice to government was “flawed” and “arose from systems failure.”

For instance, SAGE did not recommend rapid expansion of testing, form plans to mobilize community health workers as contact tracers at scale to hotspot areas and across district health protection teams, or advise on key financial and support measures for effective self-isolation, he writes.

“Had the UK followed the same strategy and achieved the same excess cumulative death rate by March 2024 as South Korea, 69 instead of 344 deaths per 100,000, it might have prevented up to 180,000 UK deaths.”

The BMJ asked Chris Whitty and Patrick Vallance why they had not recommended a suppression response, given WHO advice and emerging evidence early in the pandemic; about SAGE’s lack of independent experts; why they were not more outspoken about health-harming policies; and whether they stand by the recommendations they made not to focus on suppression, but had not received a response by the time of publication.

Costello points out that, five years on, many of the people who developed the UK’s flawed response are still in post; they have not changed their views on suppression, and little has been done to improve government pandemic advice committees or to introduce detailed governance rules for the UK’s future pandemic response and resilience.

“The COVID inquiry and the UK medical establishment should properly critique this public health failure,” he concludes.

Early in the COVID-19 pandemic, the failure of UK government advisers to follow World Health Organization (WHO) advice and emerging evidence from East Asia that suppression could bring the virus under control quickly led to avoidable UK deaths, argues an expert in The BMJ.

Suppression aims to avoid national lockdowns and maintain economic activity for most of the population by introducing surveillance systems to bring new outbreaks under control quickly, thus reducing the reproductive rate of infection (R0) to below 1 and causing the epidemic to wither.

Anthony Costello, professor of global health at University College London says, had the UK followed a suppression strategy, it might have prevented thousands of deaths. He asks why long-term strategies of suppression continue to be under-recognized and calls for better governance of UK pandemic science advice.

In January 2020, the global threat from COVID-19 was clear and the WHO was advising countries to focus on rapid suppression to avoid an immediate threat from the spread of the new coronavirus, he explains.

Yet while Greece, Germany, Norway, and Ireland took steps to follow these recommendations, the UK government’s Scientific Advisory Group for Emergencies (SAGE) unanimously chose a response based on pandemic flu that ignored the different characteristics of coronavirus transmission.

Nor did SAGE change its advice after reports of rapidly falling cases and infection rates in several East Asian countries that had focused on suppression. Instead, in March 2020, the government published its “contain, delay, research, mitigate” plan based on influenza that would allow the virus to spread to achieve “herd immunity.”

SAGE’s unwavering decision to recommend a response based on influenza has continued to be defended by its co-chairs, Chris Whitty, England’s chief medical officer, and Patrick Vallance, chief scientific adviser until 2023, notes Costello.

Yet their defense is based on three arguably mistaken assumptions: that COVID could not have been suppressed, that a huge second wave could follow even if it was, and that suppression required prolonged national lockdowns.

He acknowledges that SAGE faced a difficult and fast-changing situation in early 2020 but says its advice to government was “flawed” and “arose from systems failure.”

For instance, SAGE did not recommend rapid expansion of testing, form plans to mobilize community health workers as contact tracers at scale to hotspot areas and across district health protection teams, or advise on key financial and support measures for effective self-isolation, he writes.

“Had the UK followed the same strategy and achieved the same excess cumulative death rate by March 2024 as South Korea, 69 instead of 344 deaths per 100,000, it might have prevented up to 180,000 UK deaths.”

The BMJ asked Chris Whitty and Patrick Vallance why they had not recommended a suppression response, given WHO advice and emerging evidence early in the pandemic; about SAGE’s lack of independent experts; why they were not more outspoken about health-harming policies; and whether they stand by the recommendations they made not to focus on suppression, but had not received a response by the time of publication.

Costello points out that, five years on, many of the people who developed the UK’s flawed response are still in post; they have not changed their views on suppression, and little has been done to improve government pandemic advice committees or to introduce detailed governance rules for the UK’s future pandemic response and resilience.

“The COVID inquiry and the UK medical establishment should properly critique this public health failure,” he concludes.