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It is almost a year since the UK went into lockdown – and the government is facing growing calls to make good on its promise to hold an inquiry into how the country responded to the pandemic.
The Guardian has spoken to people directly affected by the Covid emergency. They spoke about why they want a public inquiry – and why they want it now.
The intensive care doctor
“We lost families, we lost children, we lost a mother and daughter,” said Dr Richard Breeze. “Very early on there was a 30-year-old guy. The median age in our unit was 60. These are not old people.”
Over the last year the impact of decisions taken on lockdowns, testing, social distancing and even on Dominic Cummings trip to Durham, has been felt in Breeze’s intensive care unit at University Hospital Lewisham in south London. He reckons he has broken bad news to 50 families that their loved ones have died from Covid.
What he saw as the ventilator slots filled up last spring and again this winter revealed patterns that he believes must be explored in a public inquiry – framed as learning lessons rather than “as punishing these idiots for doing a crap job”.
“We locked down late and that cost us a unit full of people,” Breeze said. “The lack of lives saved by test and trace were massively outweighed by the lives cost by not sanctioning Cummings for his jaunt and the signal that sent to everyone that lockdowns are something you can pick and choose when you want to.”
He noticed patterns among victims – disproportionately from black, Asian and minority ethnic communities and overweight.
“We had more BAME patients than we should have done and the staff members we lost were all BAME,” he said. “Most of the younger people we lost were black – people in their 30s and 40s.”
There were never enough nurses and shortages were worse in the second wave.
“It caused enormous stress,” he said. “The nurses are normally used to having a patient to look after on a shift and the ratios were at one to three and one to four. As a consultant I was looking after three times more patients. We have done all sorts of surveys on post-traumatic stress disorder and wellbeing and everybody has taken a hit. People are shattered.”
In some areas lessons were not learned between the first and second waves of the pandemic, he said.
“There was a lot of wasted time with second surge plans that weren’t fit for purpose written by non-clinicians not really having listened to us,” he said. “As a general theme top-down didn’t work in this [crisis], bottom-up did.”
The care home manager
This time last year Nicola Richards ran three care homes in Sheffield. Twelve months later, 27 of her residents have died from Covid and one of her homes has collapsed into administration.
“We shouldn’t have been exposed like we were,” she said. “It was a bleak situation.”
Richards, who runs Palms Row Health Care, wants an inquiry to examine why the NHS was given priority over older people’s social care. The discharge of hospital patients into care homes in the first weeks of the pandemic, early government guidance that face masks “do not need to be worn by staff” and the unavailability of testing for months were among the issues she faced as the virus ravaged her homes.
“We just do not get the recognition the NHS have and we did not get the protection the NHS got,” she said. “In hindsight it was incredibly naive. We are looking after the most vulnerable client group – elderly people – and there were admissions into care homes, we were told to carry on as normal with PPE and then when we got hit badly in March and April, we couldn’t get PPE. Suppliers rang us and told us the NHS was the priority. The NHS had testing and we didn’t … If we had access to testing that would have reduced the number of deaths.”
Her care homes rely on council funding to pay for residents’ places and when vacancies and costs rose due to Covid, one home became unviable.
“I had to shut a 60-bed home in the middle of fighting Covid,” she said. “It was absolutely awful. I was asking for help with funding. All my staff were going off, it was chronic. I sent SOS messages asking for additional funding to staff the homes. We had additional PPE costs and we weren’t getting any funding from government.”
She also runs a care worker agency but stopped supplying staff to other homes in April because she feared it would spread the virus. At the time there was no government restriction on staff moving between homes and it was later shown to have spread the virus.
“It was so traumatic for everybody,” she said. “We shouldn’t have been exposed like we were. Why did government fail us like they did? What lessons will be learned from this?”
The bereaved son
Olufemi Akinnola, an otherwise fit 60-year-old care worker from Leamington Spa, died with Covid-19 on his sofa last April. He had been told by the NHS 111 service that staying at home was his best bet. Now his son, Lobby Akinnola, 30, wants a public inquiry to examine, among other things, the quality of advice given to people like his dad.
“When the first wave came to an end, lots of people said how well we did and that the Nightingale hospitals were not even used,” Akinnola said. “That is difficult to hear because my dad died at home. It felt like he was being treated like it was quite a bad flu … Lack of caution and unfounded confidence was a theme of the pandemic response and has been very costly.”
Olufemi Akinnola cared for people with learning disabilities in their homes. He improvised PPE using his winter scarf and gloves. An inquiry could look at PPE availability as well as whether the UK’s health response contained inherent bias against BAME people. Three of Akinnola’s other sons worked in frontline roles, in supermarkets and a factory.
The possibility of bias was brought into focus when Akinnola’s wife, a pharmacist, who was also very unwell with Covid, was asked over the phone whether her lips were blue to check if her oxygen levels were low.
“How can we possibly tell,” Lobby Akinnola said. “We’re black … The health service needs to provide equal care to everyone”.
The death of his father – the family’s leader – had been devastating, leaving “a heavy silence”, he said. Without him there had been “no sense of direction”.
An inquiry might prove “emotionally comforting” by reducing the instinct of the bereaved to blame themselves and show “there were systematic things that happened that resulted in these deaths”.
But he has been “frustrated and angry” that nine months since the Covid-19 Bereaved Families for Justice group, of which he is a member, first called for an inquiry, none has been announced.
“How can we say it is not the time to learn when people’s lives are in the balance,” he said. “What we have seen [since the first wave] is the government didn’t learn, we’ve repeated the mistakes and now so many more people have died and families are devastated.”
Not launching an inquiry now would be “reckless, negligent and dangerous, from the point of view of looking after this nation”, he said.
“It’s been really difficult to see the government saying, ‘We’ll get to that.’”
“Somebody somewhere has done something very wrong,” said Carmel O’Boyle, a nurse who works on an orthopaedic ward in Merseyside, which was switched to Covid treatment in mid-March. “We have enough dead people to fill Wembley stadium and somebody has got blood on their hands.”
She wants a public inquiry to find out why her colleagues were seeing TV pictures of nurses in China and Italy with far more substantial protective gear, why the lockdown didn’t come earlier and why the government didn’t do more to communicate the seriousness of the disease to the public.
“At 4.30pm on a Wednesday [in mid-March 2020] we were told your ward is now going to be a Covid ward and by 6.30pm there were 32 Covid patients in there,” she said. “It was quite scary. At the time the country didn’t have enough ventilators, we were looking at how we were going to care for these people. The patients were fairly young. Some were diabetic or with heart and lung problems so [it was said], ‘Now they’ve got Covid, there’s a ceiling of care and we won’t be able to send them to intensive care.’ It was just horrendous and really sad.”
She said she saw young people die “gasping for breath and begging me to help”.
“On Easter Sunday, I started at 7am and I’d laid out three people [dead] by break time. Their families couldn’t get to them. It’s just heartbreaking.”
She said government messaging to the wider population about the risk was “wishy washy” and she was furious about Dominic Cummings’ trip to Durham.
“I don’t understand why the borders were open and people were hopping on and off planes and I don’t know why someone didn’t make that decision,” she said. “Surely someone needed to engage their brain somewhere along the line. Somebody has to answer for this. It’s a disgrace. In a couple of years’ time the nursing workforce is going to be on its knees with PTSD because of the things they have seen.”
“I had a knot in my stomach every day,” said Prof Christina Pagel, the director of the clinical operational research unit at University College London.
Before the pandemic, Pagel had been helping the NHS improve care for patients with heart disease, and was separately analysing data from intensive care monitors to help hospitals treat some of their sickest patients. When Covid hit, she switched to helping make the London Nightingale hospital as safe as possible, worked to understand the best way to provide oxygen for Covid patients, and joined Independent Sage, a committee set up by the former government chief scientific adviser Sir David King, to provide an outside scientific voice on the pandemic.
It gave her a ringside seat as the UK’s Covid response took shape. Now she wants a public inquiry to prevent a similar disaster in the next pandemic.
“It’s been really frustrating and sometimes frankly unbelievable,” she says. Her assessment comprises a lengthy list of lessons unlearned, actions taken too late, and the failure – even now – to bring in basic measures that have worked elsewhere; adequate support for people to self-isolate and much stronger quarantine measures at the border, to name but two. “It feels like the whole time we’ve been trying to get away with doing just enough and that’s never worked with an infectious disease like Covid. You can never do just enough.”
In February last year, as Covid overran hospitals in northern Italy, NHS colleagues told her “this is coming, this is going to be us”. And yet days later, Boris Johnson boasted of shaking hands at a hospital where Covid patients were being cared for, and the Cheltenham festival went ahead. When the World Health Organization urged countries to “test, test, test”, the UK said the advice was for less developed nations. “There was this weird British exceptionalism that what was happening in Italy and Spain couldn’t happen here,” Pagel said.
“I’m not interested in having an inquiry to punish people, but we need to have a proper, rigorous understanding of what happened, how decisions were made and what is needed for the next pandemic,” she said.
If possible, the inquiry should have legal clout to ensure its recommendations are implemented, and produce a public-friendly version of its findings. “We all lived through this,” she said. “This was a national event, an international event, and we should all be able to understand what happened.”
As a community GP for over a decade in Preston, Lancashire, Dr Arif Dasu watched during the pandemic as existing health inequalities faced by minority ethnic groups were exacerbated by failures of communication. It allowed the virus to spread indiscriminately, resulting in a higher death toll from the disease than he believes was necessary.
Dasu said his own friends, some of his patients and many members of his community went on to pay the ultimate price for these failings. In Preston the black and minority population is 27% higher than the national average and the Covid death toll was 40% higher. Now he is calling for an inquiry to understand why things went so wrong for British minority populations.
“There were instances when I had to reassure patients to go to the hospital,” he said. “They were refusing because they saw it as a death sentence. This was all due to a lack of information and engagement; where people were slow to accept treatment because they did not understand and that has 100% led to more deaths.”
He believes the responsibility of keeping minority communities informed was too often left to volunteers and local leaders with very little governmental support.
“There are lots of questions about what the government could have done, if they had grasped the seriousness of the situation. There needs to be some accountability for this.”
Dasu, who works at the Avenham surgery in Preston, said that over the past year it had been difficult to watch the sometimes painfully slow reaction from Whitehall. Dasu highlights “missed opportunities” with test and trace, PPE, lockdowns and border control.
“These are just some of the big examples but what also needs to be accounted for is all the money and where it was spent- from my point of view it was neither effectively or efficiently invested,” he said. “For BAME communities there was very little in the way of funding to help us.”
“We can now have money for leaflets for patient engagement and we are able to deliver health messaging to communities but this could have been done six months, nine months ago.”
Source: The Guardian
Keyword: ‘Somebody has to answer for this’: voices from the frontline on why we need a Covid inquiry | Coronavirus