On 26 Jan. 2020, the death toll from Covid-19 passed 100,000. How did this happen? There is no single, simple answer, but rather a sequence of poor decisions alongside facts about the UK - age profile, obesity levels, travel hubs and more.
How countries record Covid-19 cases and deaths
The criteria for designating Covid1-9 as the primary cause of death varies from country to country. Some countries are thought to have been, or are currently thought to be, under-reporting cases and deaths. In some countries, especially in rural areas, deaths may not normally be recorded anyway. At times, Covid-19 deaths are thought to be overwhelming the reporting systems. Some countries are thought to be deliberately under-reporting the extent of their problem. Countries vary in the amount of testing carried out, which leads to mild and asymptomatic cases not being recorded.
UK Government decisions
The UK government delayed the first lockdown till March 2020, later than much of western Europe. The week between announcement and actual lockdown may have cost more than 20,000 lives as infection rates were high at this point. By May, restrictions were beginning to be eased, but may well have been too soon. Early data on transmission, infection rate and risk factors was limited and contributed to poor decisions, leading to inaccurate accusations of promoting a herd immunity strategy.The promised 'world-beating' test-and-trace network was implemented unevenly and at a low rate. The idea was to shut down new outbreaks with comprehensive tracking by a centralised team of tracers. Unlike some other nations (e.g. South Korea and Taiwan) the UK did not have an established test-and-trace system in place ready to be activated. In the summer the UK system had teething problems in reaching contacts and low testing capacity. And low summer infection levels created a false sense of security.
Despite initial evidence that age was a factor in predicting deaths, there was a lack of protection for care home residents. By the first lockdown, the virus was rampant in care homes. Around 30% of fist wave deaths were in care homes, 40% if care home resident deaths in hospital are included.
Attempting to boost the economy, the Eat Out to Help Out scheme may be partly to blame for an increase in cases. However, testing in the summer shows there were still around 500 diagnosed cases daily, with random testing suggesting the actual level to be twice that. Positive tests rose to c.1,000 a day in late August, to c.15,000 a day in October, and in Jan. 2021 still remained above 10,000 a day on average.
Ministers refused to order a two-week 'circuit breaker' lockdown in September, against SAGE advice. (Short lockdowns can get infection rates down, but rebound once they are lifted.) Schools and universities re-opened, providing new opportunities for virus spread. Lockdown was introduced in November when the virus had already mutated and was spreading faster in south-east England.
Having already announced a 5 day relaxation of lockdown for Christmas 2020, increasing numbers of cases and deaths led to a late decision to cut this to one day.
Deep rooted problems in British society
The UK is among the ten most densely populated big nations - those with more than 20 million people. UK cities are more inter-connected than in many other places,so the virus was able to spread quite quickly. In contrast, Italy's first wave was largely confined to the north of the country.
There are affluent and deprived areas in the UK. Levels of ill health and life expectancy are worst in the poorest areas, and the pandemic seems to have made this worse. Many densely populated areas are ethnically diverse. Official data shows mortality rates twice as high in deprived areas.
Poor state of public health - the NHS has been under-funded for many years.
The UK has an aging population. Adjusting for the size of the population, deaths have risen but not as much as some headline figures suggest. Some older people in poor health may have died of other causes during the pandemic even if they had not caught the virus.
The UK has one of the highest levels of obesity in the world. Obesity increases the risk of hospitalisation and death, with one study finding the risk of death to be almost double for those who are severely obese. [The UK ranks 6th, after the US, Mexico, New Zealand, Australia and Portugal.]
The UK has relatively high rates of other conditions (e.g. diabetes, kidney disease and respiratory problems) that also increase the risk.
UK strengths proved to be weaknesses for viral spread
The UK is a vibrant global hub for international air travel. Genetic analysis shows the virus was brought into the UK on at least 1,300 separate occasions, mainly from France, Spain and Italy by the end of March 2020. Other island nations (e.g. New Zealand, Australia and Taiwan) were able to prevent the virus getting a foothold and keep deaths to a minimum by introducing strict border restrictions and lockdowns before the virus spread too far, but they did not have the same level of virus infected travellers. UK quarantine rules for all arrivals were only in force from June 2020, and even these were relaxed for travellers from certain countries until Jan. 2021.
How have other countries fared?
Countries such as Australia have been more successful with milder first and second waves. The US never brought its death rate down in the summer as the UK did, and its death toll is catching up. Countries that had very few deaths in the first wave (e.g. Germany and Poland) are now seeing spikes and overall death rates far above usual levels.
Source: various, including BBC News report.
