- The UK has stood out in a few ways for its Covid-19 response. It was quick to ramp up testing and hospital ICU capacity, and its providers bravely volunteered to treat Covid-19 patients.
- But it locked down too late and failed to adequately protect its elderly in care homes.
- Here's how its response ranks overall, according to a dozen locals.
CNBC is looking at how places around the world have tackled Covid-19. By talking to a wide range of experts, as well as everyday citizens, we're taking stock of what's gone well — and what hasn't.
The United Kingdom, the fourth subject of our series, has confirmed more than 290,000 cases and more than 45,000 deaths. That makes it one of the hardest-hit countries in Europe. The country has started to open up, and people are still expected to wear masks in crowded areas like the underground and inside shops. Schools have begun a phased re-opening, and restrictions have lifted on pubs, restaurants and museums.
So far, there have been more than 10 million cases worldwide of Covid-19 and more than 500,000 people have died. The United States has reported more than 3 million cases and more than 130,000 deaths, the most of any country.
The U.K. has several promising vaccine candidates under development through private and public sector collaborations. The University of Oxford's candidate might be through human trials by the fall, and the pharma giant AstraZeneca is expected to produce two billion doses. There's also a team at Imperial College who recently began a vaccine trial in late June when the first healthy volunteer was dosed.
"Whatever happens, we are probably going to need multiple candidates and we'll need the life sciences community to step up and make the doses," said Dr Junaid Bajwa, a UK-based physician and clinical associate professor at University College London.
"Our work with clinical trials and vaccines speaks to our deep expertise in academia and clinical science," added Natasha Loder, a London-based health journalist with the Economist.
Bravery and camaraderie in the medical community
"The medical profession overall enthusiastically jumped into the front lines," said Dr. Jack Kreindler, a London-based physician and founder of the Center for Health and Human Performance, a medical group that works with patients to optimize their health. "Whether it was retired folk, or part-timers, people from all areas of medicine got together and some even volunteered to move to London."
Tragically, some of these medical providers contracted the virus themselves, and several died from the disease. Several of these doctors had come out of their retirement to help out. Many doctors, including Kreindler, have commended their colleagues for their willingness to step up, even despite the personal risks.
Britain rolled out a number of schemes in the early months of the pandemic to help those who had been economically impacted by the virus. The so-called "furlough scheme" has now been extended until October, and employers have filed billions of pounds in claims to provide assistance to workers who have been furloughed. Some people have slipped through the cracks, but on the whole, residents say the support has been fairly robust. "Britain was very quick to help its citizens out economically," added Kreindler.
Providing PPE to medical staff
London-based Dr. Hiba Saleem was one of the doctors who volunteered to work full-time in the early days of the pandemic. But similarly to the United States, she says, there wasn't enough personal protective equipment (PPE) for staff, and the situation was worse at some hospitals over others.
"PPE was changing everyday," she said. "Sometimes there was a lot of re-using for things that were meant to be disposable, and some days there simply wasn't enough for our workers across the NHS."
Saleem said that staff had to be extremely firm that they wouldn't put themselves at risk without proper PPE. Things have now improved, but Saleem feels that the country could have done more to prepare for a pandemic and ensure there was a stockpile of supplies at the outset.
Providing enough ICU beds
Britain opened up a new hospital facility in just nine days to take care of its first Covid-19 patients needing intensive care. An exhibition center in East London was converted into a temporary hospital called Nightingale, which opened its doors on April 3 and is expected to shut down in the coming weeks. Kreindler said it was an impressive effort, but it might have been necessary only because of the lack of resources going to existing hospitals. "But I would definitely rather have had it there than not there," he said.
Dr. Marcel Levi, chief executive of the UCLH NHS Foundation Trust, agreed that hospitals have done a good job with capacity to make space for Covid-19 patients. "We've been able to treat all the patients that knock on our doors and that's been really good," he said.
Ramping up testing
Britain struggled in the early days of the pandemic to get its testing apparatus up and running. Had it done so earlier, the government's scientific advisors told a parliamentary committee in May, it could have made a huge difference in stemming the virus. The UK subsequently stepped up testing in May and June, and citizens can now get their test at a walk-through or drive-through site, or even order a home test kit.
"We managed to get to a good place relatively fast," said Kreindler. "But we should have been investing in this and better prepared."
Bioinformatics and data
Britain's NHS in June provided U.S. tech firm Palantir with access to millions of British citizens' private medical records, including their treatments, allergies, hospital admission and discharge information. Any personal information, however, has been replaced with a pseudonym. The idea, according to a CNBC report, is to give the British government a national platform to understand how Covid-19 is spreading across the UK. Maxine Mackintosh, a research associate with the Alan Turing Institute, notes that the tone has changed regarding national data-sets and the balance between privacy and utility. "The idea now is that we can share data," she said. "And that we can do it as safely and securely as possible."
Mackintosh notes that the government provided an extremely confusing mish-mash of messages about whether to wear masks or continue to shelter in place. "The depth of moral ambiguity is quite intense," she said. "We're facing questions on an individual level like, should you get on a train? Should you wear a mask?"
"There's a lack of clarity," she continued. "And I'm not being given a clear set of rules by the government."
Bajwa agrees, noting that he recently took his family on a walk around Kew Gardens, a botanical garden in southwest London. Most people weren't wearing a mask, but Bajwa and his family chose to do so. On the tube, most people did wear masks -- and it recently became a requirement to sport a face covering in a shop (but oddly, not offices). He and his children are now thinking through the implications of returning to school, which has begun despite the concerns shared by public health experts. If they return in September, he hopes that precautions are taken. "We would want assurances," he said.
The 'lost week'
Prime Minister Boris Johnson introduced the lockdown on March 23, after facing mounting pressure from doctors and epidemiologists to act. But most Brits seem to agree that the UK was relatively slow compared to the rest of Europe to move into lockdown.
"We missed a week or two," noted Levi, "and in places like London, the peak of infections was very high." Some groups have gone as far as to say that the death toll for Covid-19 could have been halved if Britain had taken earlier action.
Kreindler, the London-based doctor, feels that it sent a message to vulnerable populations that the country was willing to let them get sick for the sake of the economy. "For a while we seemed to be pursuing this strategy of herd immunity," he said. "First off, this is a terrible word because we are not a bunch of cows -- we are humans -- and honestly, it felt to me at the time like the strategy was to sacrifice a knight in a chess game."
Kreindler said he lost a loved one in that time-frame, and believes it could have been prevented if Britain had locked down earlier. Likewise, Loder shared that she lost her aunt to Covid-19. "It's clear to me she would be alive had we locked down earlier," she said.
Leaders not following their own advice
The press reported several stories about leaders not following the rules, but expecting the public to do so.
One high-profile example is the epidemiologist Neil Ferguson, who resigned from a government advisory position for breaking social distancing rules to meet his married lover. In another instance, the Prime Minister's most senior advisor, Dominic Cummings, drove more than 200 miles at the end of March to his home in Durham from London while advising the public to stay home. Cummings told the public he made the trip because his wife was sick with the coronavirus and he was worried about childcare for his young son. Cummings later came down with the coronavirus himself.
"Throughout this time," noted Bajwa, "There were high-profile people that appeared to not have been following the same rules themselves."
The U.K. had high hopes for its system of contact tracing, which would allow the country to track down people who might have been exposed to the coronavirus. But the system has been a bit of a disaster, locals say.
"Our capacity for contact tracing is extremely limited and it was never really an option," explained Loder, the journalist. Recent reports show that the contact tracers involved in the system haven't reached a single person. Some say it was rushed out before it was ready, and the staff did not have sufficient training. Things have improved, however, in recent weeks, but the system is still reporting delays.
Meanwhile, the UK started piloting a contact tracing app on the Isle of Wight in early May. More than a month later, almost no one seems to be talking about it.
But some local experts feel that there's still an opportunity to turn things around if staff get better training and more resources. Nicholas Loman, a professor of microbial genomics and bioinformatics at the University of Birmingham, is working to link genomic data to the existing effort in order to help figure out potential sources of infections, whether that's people coming from abroad, community transmission, or another factor entirely.
Treatment of the vulnerable in care homes
Many patients who were elderly and at high risk for Covid-19 complications fell ill at care homes, and thousands died. That's in part due to policies that were designed to prevent hospitals from being overburdened -- but reports have found that it might have just pushed the burden to care for older Britons onto care homes. Some experts say the government overly focused on the hospitals, and not the care homes, which were not equipped to treat sick patients with Covid-19 or other conditions.
"Many more patients died without getting Covid because they didn't go to the hospital for other conditions, and that has sparked a lot of debate about whether it was the right thing or not," said Levi.
We asked every expert we spoke to for their score out of 10. (1 is the extremely poor and 10 is ideal.) It's an extremely subjective measurement, but the average across all of them was 5.
"I think we easily could have been an 8 or 9 but we fell short, compared to countries like Germany," said Kreindler, who graded Britain's response as a 3/10.
"Had we had PPE sorted, contact tracing sorted and locked down earlier, I'd have given a higher score," said Bajwa, who gave the UK a cool 6/10.