Spartacus Blog

Why so many people in the UK have died of Covid-19

On 12th March (updated 17th March, 2020) I posted an article, Why the coronavirus (Covid-19) will probably kill a higher percentage of people in the UK than any other country in Europe. This was largely based on the resources available to the UK at that time of the health crisis and the early way the government responded to the news of the early cases of Covid-19. However, I did expect the government to improve their decision-making and that although eventually we would have the worst death-rate, I did not expect it to be as early as this stage in the progression of the pandemic.

One reason for my prediction was the number of critical-care bed in intensive-care units where patients can be put on ventilators (breathing machines that help keep your lungs working). At the time Germany was ranked as having the best ratio for critical-beds in Europe. Italy was in tenth place, but very short of doctors and nurses. This point is highlighted by the positions of France (12th), Spain (16th) and Netherlands (26th). Whereas those countries like Luxembourg (2nd) and Austria (3rd) were doing well during the crisis. (1)

The UK's place in the table was always very concerning. With a figure of 6.6 critical beds per 100,000 population, we were ranked 24th out of 31 European countries. This was made worse by the fact that we were ranked 29 out of 31 for available hospital beds. Germany has approximately four times as many ICU beds per capita as the UK. Like Italy we also have the problem of staff shortages. In March 2000, the NHS had 106,000 vacancies, including over 44,000 in nursing. (2)

However, a shortage of critical-care beds was not the only factor in this. Greece was ranked 29th in the table. After almost a decade embroiled in debt crisis – years in which its economy contracted by 26% – Greek’s health system was in crisis. It only had 560 intensive care unit (ICU) beds in the whole country. Greece, like Italy, also had a large elderly population, with about a quarter of pensionable age. The Greek government realised that unless they took immediate action, they would be near the top of any table of deaths from Covid-19. The government set-up a 25-strong committee to study the problem. The main advice they gave the government was to impose an immediate lockdown. Greece began its lockdown in late February, before they had recorded one death from Covid-19. (3)

By early March all schools, as well as anywhere where people might gather in numbers, were closed and social distancing was strictly enforced. All this from a country ravaged by years of austerity. Greece, among the poorest of EU members, has spectacularly outperformed the UK in its handling of the crisis. According to the World Health Organization by the 13th May, Greece has recorded 2,770 coronavirus cases and 134 deaths, from a population of slightly under 11 million. They have been so successful that they have began to release the lockdown and since the beginning of the month people in Greece have been able to visit hairdressers, bookshops, repair shops and sporting goods outlets. (4)

The main problem that the UK faced was for the last ten years it is had been ignoring the advice it has been receiving from its scientific experts. As early as 2011 a report warned the government about the shortage of ventilators: "Critical care services… are likely to see increases in demand during even a mild influenza pandemic. In a moderate or severe influenza pandemic demand may outstrip supply, even when capacity is maximised… it may become necessary to make decisions concerning priority of access to some services.” (5)

It had not always been as bad as this. Following an outbreak of Swine Flu in 2009, the government established the UK’s national pandemic stockpile, as an epidemic was seen as the number one threat on the national risk register. Half a billion pounds was spent on hundreds of millions of items to protect health workers in the case of an outbreak. (6) This was a time when pandemic preparedness was identified as a national priority for the NHS. (7)

This all changed under the Conservative-led coalition government that was established in May 2010. An investigation by The Guardian discovered that an "analysis of official financial data suggests £325m was wiped off the value of the Department of Health and Social Care (DHSC) emergency stockpile, reducing it from £831m in 2013 under the Conservative-led coalition government to £506m by March last year (2019)... The findings are likely to renew questions about whether government stockpiles held sufficient quantities of personal protective equipment (PPE) before the Covid-19 pandemic and whether emergency preparations were affected by almost a decade of cuts and reduced public investment." (8)

In another investigation Channel 4 found: "A Consumable Procurement Specification List from 2009 stipulated what should be stored as part of a £500 million stockpile. It recommended 28.1 million respirators, 190 million surgical masks, and 116.5 million combined needles and syringes. However, by 30 January 2020 the stockpile held 10% fewer respirators – at 26.3 million. There were also 19% fewer surgical masks at 154.5 million, and 28% fewer combined needles and syringes at 84.2 million." (9)

Daily announced deaths and excess deaths (16th March- 13th May, 2020) — Daily announced deaths and excess deaths (16th March-13th May, 2020)

In October 2016 the UK government ran a national pandemic flu exercise, code-named Exercise Cygnus. The report of its findings was not made publicly available, but the then chief medical officer Sally Davies commented on what she had learnt from it at a conference in December 2016. “We’ve just had in the UK a three-day exercise on flu, on a pandemic that killed a lot of people,” she told the World Innovation Summit for Health at the time. “It became clear that we could not cope with the excess bodies,” Davies said. One conclusion was that Britain, as Davies put it, faced the threat of “inadequate ventilation” in a future pandemic. She was of course referring to the fact that compared to other advanced nations, the UK was desperately short of ventilation machines. (10)

The report has never been published, but there are indications in reports by local authorities who participated in the exercise that PPE supplies was an area of great concern. "It is not clear whether at a national level the conclusions included recommendations about emergency stockpile funding. But DHSC accounts show that in the three years after the 2016 drill, the value of the stockpile fell by more than £200m." One insider, commented "it was difficult to get ministers to spend money on preparing for high-impact, low-frequency events like pandemics." (11)

Jeremy Hunt, Secretary of State for Health and Social Care at the time, would have known that Exercise Cygnus revealed that it showed the UK’s health system and local authorities were woefully unprepared for such an eventuality. It showed hospitals and mortuaries being quickly overwhelmed, and shortages of critical care beds, ventilators and personal protective equipment for hospital staff. On 28th March of this year, when the "Cygnus debacle came to light, we were told that the projections were not remedied because of worries that beds, ventilators and PPE would become outmoded or obsolete and that the government had worked on securing reliable supply chains. (As we have seen, in a pandemic, reliable supply chains become very quickly overwhelmed.) A 2018 Red Cross conference report on Cygnus and infectious diseases stated: 'The financial and human cost of an outbreak can be staggering and early response reduces the cost.' Our government chose not to act." (12)

One of the major problems concerning PPE started as early as the 1980s, when the government started to privatise laundry, catering and cleaning in the health service – outsourcing staff on worse terms and conditions to save money. As Cat Hobbs has pointed out: "Outsourcing – whether it’s cleaning, facilities management, GP “out-of-hours” services, treatment centres, clinical services or IT – has often damaged the quality of patient care." This continued under Tony Blair and in 2006 the government privatised the NHS supply chain, now responsible for delivering PPE. In 2012, Cameron’s government introduced the Health and Social Care Act, allowing NHS services to be contracted out to "any qualified provider". Private firms, often operating under the NHS logo, were given £9.2bn in NHS contracts in 2018. (13)

Public Health England and NHS Supply Chain’s management company, Supply Chain Coordination Limited, was put in charge of stockpiling. To reduce the costs of PPE, the UK began purchasing it from abroad, especially China. British companies, unable to compete with the prices being charged, either concentrated on producing other products or closed down completely. This was combined with the government's decision to cut billions of NHS funding. Cuts make people think that maybe our publicly owned NHS isn't working, so the private sector starts to look like a solution. As Noam Chomsky has pointed out: "That’s the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital." (14)

Movianto, a subsidiary of the US health company Owens & Minor, won the £55m deal in the summer of 2018. for contract for "stockpiling" PPE. On 6th April, 2020, Movianto, was sold for $133m (£107m) to French company EHDH Holding Group. The fact that Movianto was being sold in the midst of a global pandemic, months after being instructed by the UK government to start mobilising the PPE supply, raises serious concerns. Matt Hancock, Secretary of State for Health and Social Care, seems to have lost confidence in Movianto and on 11th April he announced a new “24/7 military operation” to oversee the supply of PPE to health and care workers. “We’ve had to create a whole new logistics network, essentially from scratch,” Hancock said. (15)

As Keir Starmer pointed out in the House of Commons, not buying from British companies had serious consequences for the supply of PPE: "Over the last few days it has emerged that British manufacturers have got in touch with many members of the opposition, probably members across the House, saying that they offered to help produce protective equipment but they didn't get a response from the government. Now I do understand due diligence and that all the offers could not be taken up but some of those who offered to help are now supplying to other countries so they clearly could have supplied in this country and something is going wrong." (16)

As a Channel 4 investigation revealed, the PPE that we did have in stock was of poor quality: "Channel 4 News has obtained detailed stock lists that reveal exactly what was held, on the day coronavirus was declared an international emergency... Almost 80% of respirators in the national pandemic stockpile were out of date when coronavirus hit the UK.... Around 200 million vital pieces of kit – including respirators, masks, syringes and needles – had all expired in the eight months before 30 January. This included 20.9 million out-of-date respirators, from a total of 26.3 million. The tightly-fitting mouth masks are vital for filtering the air that NHS workers breathe. The documents also reveal that more than half of the national stockpile of surgical facemasks had also expired. In total, 45% of the 19,909 boxes holding PPE supplies had exceeded their use-by dates." (17)

On 17th April, Professor Anthony Costello told Parliament's select committee on health and social care that he feared Britain might have the highest number of deaths in Europe. Costello had estimated 40,000 deaths. As Susie Orbach pointed out: "Costello argued for this figure because we were slow off the mark to take precautionary moves early on. He spoke to the chair of the committee, Jeremy Hunt, who has spent this period appearing to stress about the lack of testing, ventilators and PPE equipment. This is the same Hunt who, as the longest serving health secretary in British history, also had social care in his portfolio, and the pay of doctors, nurses and social care workers. Even more damningly, he was the minister in charge during Exercise Cygnus, the UK government’s drill to test our preparedness for a pandemic, carried out in 2016." (18)

Despite the terrible situation regarding resources we found ourself in when news arrived of the Covid-19 virus in Wuhan, the example of Greece suggests it was still not too late. If we look at the information available, we have done badly if we compare ourselves with countries like Germany. According to the World Health Organisation by the 13th May the UK had 233,151 cases and 33,614 deaths. (19) This compares to 174,284 cases and 7,868 deaths in Germany. Statista calculates that the UK has 499.12 deaths per million inhabitants, whereas the figure for Germany is 94.79. (20)

In early January, with no cases of Covid-19 in Europe, the medically authorities in Germany were already making preparations for the feared pandemic. Germany's view has always been that you have to fund a health service in a way that you have spare capacity in the system. In this way you can deal with unusual events like an outbreak of a new disease. Carsten Brzeski, ING bank’s chief Eurozone economist has commented that Angela Merkel was a scientist before entering politics: "They had the means, but then they also had the political will, and also the very good analytical insights to use the means... I can’t imagine any government better than Angela Merkel’s to deal with this (Covid-19).” (21)

The first case of Covid-19 was in Stockdorf, a German town of 4,000 near Munich in Bavaria, and she worked at car parts supplier Webasto Group. She was a Chinese woman who had caught the virus in Wuhun and then brought it to the company's headquarters on 22nd January, 2020. She quickly passed it to colleagues. The authorities reaction was very fast as they followed the WHO advice of "test, trace and isolate". This approach saved many lives. Italy's first detected local transmission was on 21st February. By then Germany had kicked off a health ministry information campaign and a government strategy to tackle the virus which would hinge on widespread testing. (22)

Germany's regional districts were put on standby. Dr Rainer Schwertz is head of the public health department in the Rhein-Neckar district of Germany, a local administrative region of over 600,000 people, which includes the city of Heidelberg. The crisis began for them on 27th February, the moment the first confirmed case was reported in a local hospital - a person who had just returned from a skiing holiday in Italy. Starting the next day, the public health authority restructured all its departments towards crisis response - staff that usually worked on dentistry or children’s health were moved to public information call centres or processing testing data. The local government seconded 100 staff to public health and told Schwertz that he could have "whatever he needed" to deal with Covid-19. "From the beginning, the plan was clear. Widespread testing had been recommended by the Robert Koch Institute, the national body in charge of infectious disease response, and the state government was recommending the same. The strategy was to test anyone who had symptoms, and track down all the people they had contact with to isolate them as well, snuffing out potential spreaders and keeping pressure off the hospitals and ICU bays. The University Hospital laboratories switched their research personnel and equipment to coronavirus testing." (23)

The main reason for Germany's success was its campacity to carry out tests. On 16 January, before the World Health Organization (WHO) concluded that the Covid-19 virus could be transmitted from one human to another, German scientists had created a test that proved to be one of the first reliable means of detecting the virus. That test was then rapidly produced and adopted by the WHO. Over the next few weeks between 200 and 300 German laboratories had become involved in the rapid testing scheme. The President of the Robert Koch Institute (RKI) announced on 20th March that domestic laboratories were able to conduct as many as 160,000 tests per week. By early April this had reached 500,000 tests per week, with the ultimate goal of 200,000 tests per day. (24)

Germany, like every other major country, carried out mock pandemics operations at regular intervals. Unlike, the UK, Germany published reports on the operation and made the necessary changes to deal with the resource implications of a future pandemic. On 13th March, a crisis meeting was chaired by Merkel, where they discussed economic policy measures to deal with the crisis with employers and unions. Later that day Merkel announced an end to visits to nursing homes to protect the elderly. Germany's theaters, operas, and concert halls were closed and a few days later so were restaurants. (25)

Merkel's speech was a great success. As CNN pointed out: "It has been a real transformation for Merkel, who began the year as a lame duck leader. Her political record had been damaged by the huge backlash against her 'open door' refugee policy, her succession plan collapsed and her party was rapidly losing ground to the fringes." Andrea Römmele, a professor at the Hertie School in Berlin, claimed "She started a massive revival, not just in Germany, but also in the world, because for the first time in 150 years, the world is facing a global crisis and people are not looking towards the US for global leadership, they are looking to Merkel." (26)

Angela Merkel has said the coronavirus pandemic is "still at the beginning" and has warned her country: "We will be living with this virus for a long time." All of Germany's states made the wearing of masks compulsory on public transport, and shoppers will be made to wear them in most states. Germany therefore joined other countries that have enforced or strongly recommended the public wearing of face masks, along with mainland China, Hong Kong, South Korea, Japan, the Czech Republic and Singapore. (27)

By 22nd March, all regional governments had announced curfews or restrictions in public spaces. Throughout Germany, traveling is only allowed in groups not exceeding two people unless they are from the same household. Some German states imposed further restrictions allowing people to leave their homes only for specified activities including commuting to work, exercising or purchasing food. In the early stages of the disease Germany carried out over 70,000 test a day and implemented rigorous contact tracing. This allowed it to identify substantially more cases of the disease than other countries - as the more tests you do, the more cases you identify. (28)

Critical Care Beds in Europe — Excess Deaths registered during the Pandemic

In Germany, just 0.6% of their confirmed coronavirus cases have so far ended up being fatal - the lowest figure amongst any of the most affected countries. Germany's low case fatality rate is partly caused by the fact it has tested more people and, as a result, has identified more mild instances of the disease. In comparison, in the UK, only people who need medical assistance are being tested and as a result the UK's case fatality rate is much higher, at 4.8%. By testing people who might have been exposed to the disease, Germany has been able to identify cases of coronavirus quicker and isolate people who have been infected. This has helped prevent the disease from being spread to vulnerable groups. Another key reason for Germany's low death rate is the way they have protected older people. In Germany, just 20% of patients confirmed to have the disease are aged over 60. (29)

It was very important to protect senior citizens in Germany - whose average population is the second-oldest in the European Union, after Italy. Very early on in the crisis visits and events in nursing homes were canceled in an effort to isolate and protect the over 800,000 seniors who live in around 11,700 facilities across the country. Germany was also in a position to test people in nursing home. (30) This was in stark contrast to the UK whereas 92% of people who have died of Covid-19 are over 60. (31)

Christine Fuchs, a British woman, is currently living in Bavaria. She pointed out the differences in the way the countries responded to the crisis: "The contrast is glaring. German politicians appeal to the public for understanding of their decisions to curb personal freedoms, they don’t need to justify their inaction. German politicians, together with their scientific advisers, explain the reasons for harsh measures, they don’t write off experts. German politicians don’t need to hark back to a glorious wartime spirit, that hardly anyone alive remembers. With their refusal to join an EU procurement scheme for essential equipment, the British government has put Brexit ideology over people’s lives. It is the conceited self-importance of a political elite that regards politics as a continuation of the fun they had in Oxbridge debating societies, that is at the heart of their inability to deal with a serious crisis." (32)

Germany also has the advantage of having a well-funded National Health System. The latest available figures show the UK spent £2,989 per person on healthcare, which was around the median for members of the Organisation for Economic Co-operation and Development: OECD (£2,913 per person). However, of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736). The United States figure is fairly irrelevant because the vast majority of it is private spending and it pays for health-care that is not available to all its citizens. As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries. (33)

Germany and the UK logged their first coronavirus cases within two days of each other - 27th January in Bavaria and 29th January in York - but since then have taken different paths. Whereas Angela Merkel was organizing her team of public health experts, Boris Johnson was celebrating taking Britain out of the European Union on 31st January. He told the British public: "When I look at the potential of this country waiting to be unleashed. I know we can turn this opportunity into a stunning success.... We have obeyed the people. We have taken back the tools of self-government. Now is the time to use those tools to unleash the full potential of this brilliant country and to make better the lives of everyone in every corner of our United Kingdom." (34)

The previous day the World Health Organization declared that Covid-19, which had broken out in China and now spread to 18 countries, was a public health emergency of international concern (PHEIC). The WHO pointed out that this highest state of alert required an immediate response: "The Committee believes that it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk." (35)

On 3rd February, Boris Johnson made another triumphal Brexit speech, in which he even sounded a note against responding too strongly to Covid-19, arguing it ran counter to his vision of Britain as a “supercharged champion” of global free trade. "We are starting to hear some bizarre autarkic rhetoric, when barriers are going up, and when there is a risk that new diseases such as coronavirus will trigger a panic and a desire for market segregation that go beyond what is medically rational to the point of doing real and unnecessary economic damage, then at that moment humanity needs some government somewhere that is willing at least to make the case powerfully for freedom of exchange, some country ready to take off its Clark Kent spectacles and leap into the phone booth and emerge with its cloak flowing as the supercharged champion, of the right of the populations of the earth to buy and sell freely among each other." (36)

Johnson then retreated to his grace-and-favour mansion, the Chevening country residence in Kent. After spending 12 days away he returned to London, but did not attend four of the first five meetings of the Cobra committee, convened to consider Britain’s response to Covid-19. Jeremy Corbyn labeled Johnson a part-time prime minister for spending the parliamentary recess at Chevening, while the coronavirus crisis continued and large parts of the country were affected by flooding. Johnson responded by saying the government was treating the virus as a “top priority” and urged people to try to contain its spread by washing their hands. (37)

At first the government followed the WHO advice of "test, trace and isolate". Then on 15th March, 2020, the policy changed. The UK's Chief Scientific Adviser said a degree of herd immunity will help the UK population as Covid-19 spreads. Patrick Vallance said the aim would be to "reduce the peak, broaden the peak, not suppress it completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission". This view was supported by the UK's chief medical adviser, Professor Chris Whitty. (38)

England’s deputy chief medical officer Dr Jenny Harries, said it was "inappropriate to carry out extensive testing for Covid-19". This is the same woman who had said that it was fine that the Cheltenham Festival horse racing event was allowed to proceed. At one of the daily briefings on the coronavirus outbreak, Harries said "The UK, regardless of the position that we may be in now, has been an international exemplar in preparedness." No wonder, Richard Horton, the editor of The Lancet commented: "When you see supposedly independent medical advisors to government tell what are manifest untruths to shore up a political regime whose credibility is rapidly collapsing, you have to say that those advisors have lost their integrity and our trust." (39)

When Dr Harries appeared before the Parliament's Health and Social Care committee on the 4th May, 2020, she defended the move to stop community testing and tracing in March, suggesting that as the number of cases rapidly increased there was not enough capacity for testing or enough resources to continue to trace contacts of those with the virus. The government said in March they were carrying out actions based on the best "scientific advice". We now know that advice was based on a lack of resources, a result of the failure of the government to respond to the "scientific advice" they had received during the previous ten years. (40)

Speaking before the same committee, UK's Chief Scientific Adviser, Patrick Vallance, expressed regret that Britain did not "ramp" up its testing capacity at an earlier stage of the coronavirus outbreak, failing to follow the lead of South Korea or Germany. Referring to the early stages of the outbreak, he said: "If we had managed to ramp testing capacity quickly, that would have been beneficial. For all sorts of reasons that didn’t happen." We can only speculate what these reasons were, but it is clear that you cannot follow WHO advice of "test, trace and isolate" when the UK only had the capacity to test fewer than 2,000 people a day. “I’d be surprised if when we look back we don’t think, yup, we could have done something different there,” Sir Patrick said. (41)

Britain was left badly exposed by a lack of testing capacity and ended community testing on 12th March to focus on protecting the NHS. To a certain extent was a success because hospitals continued to function during the Covid-19 crisis. However, they have not been very good at protecting the staff in the NHS. According to The Guardian: "The government says there have been 49 verified deaths of NHS staff from Covid-19 during the pandemic, but it is clear that many others have died. The Guardian has recorded 172 deaths that have been reported in the news, but the true figure is likely to be higher because not all deaths will be in the public domain. Many family members of those who have died have complained that health professionals are not being given adequate protective equipment as they deal with coronavirus cases." (42)

In trying to protect the hospitals they sacrificed the care homes. It was reported in several newspapers that in an effort to make sure the NHS had enough critical-care beds, elderly patients were sent to care homes. "Hospitals may have broken the law by sending patients with Covid-19 back to care homes without telling their managers they had the virus. The Care Quality Commission (CQC) has been told that several hospitals returned people despite suspecting – or even knowing – they were infected. Tragically, these patients triggered outbreaks in the homes, claiming the lives of other vulnerable residents. Staff at the care homes would have not realised they had the virus so may not have been wearing adequate protective clothing or taken other infection control precautions." (43)

On 8th May, Richard Coker, emeritus professor of public health at the London School of Hygiene and Tropical Medicine, accused the government of "harvesting" patients in care homes: "Coronavirus is tearing through our nursing home population in the UK. Even if official statistics are opaque, we know this anecdotally. More than 400,000 people live in UK care homes. We are only now beginning to see the statistics in terms of confirmed cases. Estimates that more than 3,000 people had died in care homes by mid-April are likely to be gross underestimates. We can see this when we look at national excess mortality numbers. These statistics, especially when we look at the elderly, paint a horrifying picture. Enormous numbers of deaths among our most frail citizens are the result, both directly and indirectly, of the coronavirus crisis."

Coker goes on to point out: "The initial strategy of allowing herd immunity to develop in the wider community was pursued, but the most vulnerable people were not protected. Though harvesting may not have been the government’s intention, it became the de facto policy in the absence of adequate protections for older and vulnerable people. Had the government monitored care homes, supplied adequate PPE, rolled out testing in care homes and reduced the exposure of their residents to visitors and other carers, the islands of vulnerable and elderly people would have been protected. The government’s initial strategy, therefore, was herd immunity and harvesting. Operational implementation follows a strategy, not the other way round. Only belatedly did the government’s strategy morph into one that sought to protect the elderly and reverse the harvesting, through widespread testing and contact tracing. But by then it was too late. Operations could not catch up." (44)

Chris Giles, the economic editor of the Financial Times, believes the only way to calculate deaths from Covid-19, is by looking at excess mortality statistics. "The Office for National Statistics said that in the week ending May 1, there had been 17,953 deaths in England and Wales recorded, 8,012 higher than the average of the past five years in that week, as the disease killed three times the normal number of people in care homes. This represented the seventh consecutive week that deaths exceeded normal levels and once equivalent figures from Scotland and Northern Ireland were included, takes total mortality across the UK during the pandemic to 50,979."

Excess Deaths in the UK (April-May, 2020)

As Giles points out that at present this is the highest absolute level of excess deaths in Europe. "The official figures from the UK’s statistical agencies are much higher than the daily announcement from the Department of Health and Social Care, which stands at 32,065. Excess deaths is seen by ministers and the government’s scientific advisers as the best ultimate measure of the deadly impact of coronavirus. It includes people who died with the disease, but without being tested, in the community and in care homes. It also includes indirect victims of the pandemic who died, perhaps because they were unable or unwilling to attend hospital for treatment." (45)

Boris Johnson was unhappy with journalists highlighting our poor performance in dealing with Covid-19 by comparing our statistics with other countries. He quoted an article written by Professor Sir David Spiegelhalter, a member of the Sage Committee, for The Guardian. Spiegelhalter pointed out that making comparisons with other countries is difficult. "Every country has different ways of recording Covid-19 deaths: the large number of untested deaths in care homes have not featured in Spain’s statistics – which, like the UK’s require a positive test result. The numbers may be useful for looking at trends, but they are not reliable indicators for comparing the absolute levels. If we were naive enough to take the counts at face value, the new figures propelled the UK past France and Spain into second place in Europe behind Italy, which is not encouraging because we are behind Italy in terms of what stage of the epidemic we are at." (46)

On 4th May, Johnson asked by Keir Starmer why the UK's growing death figures, which today passed 30,000, were so grim compared to other countries. “We’re watching intently what is happening in other countries and it is very notable that in some other countries where relaxations have been introduced that there’s signs of the R (the rate of re-infection) going up again – and that’s a very clear warning to us not to proceed too fast or too recklessly.” (47) The PM said international comparisons shouldn't be drawn yet: "In answer to his question, I would echo what we have heard from Professor David Spiegelhalter and others: at this stage I do not think that the international comparisons and the data are yet there to draw the conclusions that we want." (48)

That night Dr. Spiegelhalter said that Boris Johnson had misinterpreted his article, and asked him and his Cabinet colleagues to stop quoting him. Spiegelhalter insisted that the UK should use statistics from other countries to find out why our performance against Covid-19 is so bad. Spiegelhalter wrote on Twitter: "Polite request to PM and others: please stop using my Guardian article to claim we cannot make any international comparisons yet. I refer only to detailed league tables-of course we should now use other countries to try and learn why our numbers are high." (49)

The Metro reported on 12th May that the latest official statistics showed the consequences of this policy: "The number of coronavirus deaths in the UK has passed 40,000, according to new analysis of the latest official figures, making it by far the worst toll in Europe. Shocking new figures from the Office for National Statistics (ONS) have also revealed that almost 40% of deaths are in care homes. There were 8,312 coronavirus-related care home deaths registered up to May 1 in England and Wales, the ONS said." (50)

At its daily press briefings, the government have attempted to disguise the gap between UK deaths and other countries in Europe. The gap between the 2,000 and 5,000 markers is bigger than the gap between the 50,000 and 100,000 markers – making what should appear to be a huge gap between the UK and the next-worst country look far smaller than it should. (See the chart below.)

Cumulative deaths attributed to UK and the USA (11th May, 2020)

According to hospital whistle blowers report that they are being pressured to classify coronavirus deaths as something else and that their virus death totals are around double what the government is reporting. As one news source points out: "Every country that properly measures its deaths in care homes has found that around half of all their coronavirus deaths take place in care homes – hospital deaths are only half the real toll. Since the UK will be as bad – or probably worse because of the government’s policy of knowingly sending infected elderly people back to care homes to die while infecting others – the real hospital death toll will be only around half of the real UK total. The belated inclusion of non-hospital deaths in the official figure has not corrected the deceit, because the ONS data lag about three weeks behind." (51)

As a result of journalists highlighted the misleading way of using graphs at the daily press conferences, the government stopped comparing the impact Covid-19 was having on different countries. In the House of Commons on the 13th May, 2020, Keir Starmer has accused Boris Johnson of ceasing publication of international comparisons of Covid-19 deaths because of the UK hitting top place in Europe. Starmer said it was "obvious" the government had stopped talking publicly about the figures because they showed the UK was in an "unenviable place". He added: "For many weeks, the government has compared the UK number against other countries." Holding up a print-out of a government chart, he told MPs: "Last week, I showed the prime minister his own slide showing that the UK now has the highest death toll in Europe and the second highest in the world. A version of this slide has been shown at the Downing Street press conference every day since 30 March - that’s seven weeks. Yesterday, the government stopped publishing the international comparison and the slide is gone. Why?" (52)

Starmer also raised the issue of UK’s awful death toll in care homes from Covid-19. He argued that until 12 March, government guidance said it was "very unlikely" that people in care homes will become infected with Covid-19. Boris Johnson said this was not the case. However, Starmer was correct. The initial guidance, for social, community and residential care employers, stated: "This guidance is intended for the current position in the UK where there is currently no transmission of Covid-19 in the community. It is therefore very unlikely that anyone receiving care in a care home or the community will become infected. This is the latest information and will be updated shortly." The same document also said: "Facemasks are only recommended to be worn by infected individuals when advised by a healthcare worker, to reduce the risk of transmitting the infection to other people. It remains very unlikely that people receiving care in a care home or the community will become infected." (53)

Deputy chief medical officer Dr Jenny Harries tried to defend the guidance but her argument (that there was no “sustained community transmission” at the time) didn’t feel like it would hold up in the court of public opinion. Just as damaging was the cardiologist cited by Starmer, who said the NHS discharged known and unknown cases of Covid into care homes without enough testing or PPE. As Paul Waugh pointed out: "Putting the ‘opposition’ into ‘constructive opposition’, Starmer showed a chameleon-like ability to shift easily from loyal public servant, offering support in the national interest, to ruthlessly focused critic. Yes, it was his prosecutorial (you could even call it ‘forensic’) nous that unearthed the pre-March 12 government guidance to care homes. But it was the raw politics of competence that was most on display. No wonder Jacob Rees-Mogg wants the protective wall of cheering Tory MPs to return as soon as possible." (54)

The reputation of Britain's government has fallen to a new low as the statistics show we have the worst record in Europe for dealing with Covid-19. Every year The Fund for Peace, the Washington-based NGO that publishes the annual Fragile States Index, lists criteria for a failed state. Susie Orbach argues "I think we have come dangerously close to fulfilling two of their criteria: the inability to provide public services for the poor, and the inability to interact with other states as a full member of the international community." (55)

John Simkin (15th May, 2020)