Exactly five years ago Boris Johnson announced that the United Kingdom was being placed in lockdown. “From this evening I must give the British people a very simple instruction – you must stay at home because the critical thing we must do is to stop the disease spreading between households,” the PM told the nation.
That lockdown, Britain’s first of the Covid-19 pandemic, lasted until June. People reacted in myriad ways: with manic outpourings of video calls; obsessive outbreaks of bread baking and pet dog purchases; or simple, quiet desperation as they tried to fend off the isolation imposed on them. More lockdowns were to follow, but the first defined the sudden, chilling, unwelcome seclusion that individuals were forced to experience as social contact was halted across the country.
“We’ve made it to the life raft,” wrote the epidemiologist Marc Lipsitch. But, he added: “Dry land is far away.”
It was a grim time for most people. But having experienced that lockdown, it is now pertinent to ask, five years later, what did we learn? What were we taught by an ordeal that touched every aspect of our lives? And, in particular, what have the scientists got to tell us now about the lessons of lockdown?
One: Give the NHS some slack
In 2020 we were operating the NHS without slack. Wards and intensive care units were at full capacity before the virus arrived on our shores. When it did, the NHS faced being overwhelmed as Covid-19 threatened to trigger hundreds of thousands of new cases of seriously ill individuals to add to the health service’s already overstretched capacity. This was the prime reason for imposing lockdown.
As the pandemic subsided experts demanded the NHS be supported and funded so it could be better prepared to take future outbreaks in its stride. This has not happened.
“Every winter, even before Covid, hospitals were run very close to the edge,” said Professor Rowland Kao, an epidemiologist at the University of Edinburgh. “When the disease arrived, the NHS was simply not in a position to take any more. And there are no signs it will be different next time. Indeed, it is likely to be worse.”
Two: In people, we trust
During lockdown the public was asked to give up freedoms that, until March 2020, we had taken for granted. Individuals were only allowed to leave home for essential work or to shop for necessities.
“If you don’t follow the rules the police will have the powers to enforce them,” Johnson announced. And the public complied.
“Concerns from policy makers that people would experience ‘behavioural fatigue’ and not comply with lockdowns were proven to be unfounded, as compliance levels were very high,” said Professor Daisy Fancourt, a psychobiologist at University College London.
Antonia Ho, a professor of infectious diseases at the University of Glasgow, agrees. She said: “We learned that the general public are willing and can be trusted to test themselves – be it using lateral flow tests or finger prick blood tests.”
Similarly Professor Tom Solomon, director of The Pandemic Institute in Liverpool, praised local people for their willingness to participate in big public health research studies.
Three: Getting advice right
Scientists, in general, came out of the pandemic looking good. Nonetheless, the advice from Sage – the government’s Scientific Advisory Group for Emergencies – has come in for criticism from leading experts such as Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh.
On two occasions, in summer 2021 and in the following winter, scientific advisers warned that the nation faced “alarming” jumps in cases and hospitalisations. In neither case did peaks in hospital admissions occur.
“Its network of scientific advisers got it wrong,” writes Woolhouse in his book, The Year the World Went Mad. These events led him to call for a reorganisation of the UK’s scientific advisory system. Britain needs to separate evidence generation from evidence evaluation, and that was not happening during the pandemic, he argues, adding: “Next time, we need to have proper independent scrutiny of evidence from modelling or any other source.”
Four: Each pandemic differs
In 2020 most modelling for the arrival of a pandemic assumed it would be flu-like in behaviour. This would not be the case with Covid as Professor Adam Finn, a paediatrician at Bristol University, pointed out. He said: “The main lesson that we learned in 2020 is straightforward: when you get a pandemic, don’t assume it’s going to be like the last one. Five years ago, everyone expected the next pandemic would be flu, and so models assumed we had to shut down schools and keep children at home because they would be the ones spreading disease. That would have been true for flu, but it wasn’t for Covid.”
In fact, Covid affected very few children and instead had a heavier toll on the elderly.
“What we need to do is keep an open mind in future and not assume that the last pandemic is going to happen again,” said Professor Thomas House, a mathematical epidemiologist at Manchester University. “The next one will be something else again and we should be prepared for that. I think that is the single most important lesson we can take from Covid and lockdown.”
Five: Try to keep schools open
The closing of schools, colleges and nurseries in March 2020 has become one of the most hotly debated decisions of the Covid lockdown. At the time, it was feared children would become major vectors in the transmission of the Sars-CoV-2 virus, the cause of the disease. This did not happen, though worries that reopening schools could threaten teachers with serious illness picked up from pupils persisted.
These were legitimate fears but there is no escaping the dire impact that school closures had – and will continue to have – into the mid-2030s. An analysis, published last year by the Association for School and College Leaders, warned that the after effects of the pandemic would continue to hit schools in a series of waves, with different age groups requiring varying solutions for their problems with learning, behaviour and absence.
“While secondary schools are reporting an increase in reading difficulties among year 7 pupils, poor personal organisation and challenging patterns of interaction, staff in primary schools are reporting very serious problems of arrested language development, lack of toilet training, anxiety in being in social spaces, and depressed executive function,” said Tim Oates, the report’s author.
Six: Think of the wider impact
Most scientists accept that the 2020 lockdown played a key role in the fight against Covid. But it should have been imposed in a more carefully controlled way, they argue.
“Lockdowns are a vital component of any pandemic response toolkit,” said Dr Michael Head, a researcher in global health at Southampton University. “But we need smarter lockdowns in place earlier to better reduce transmission and which are therefore shorter.”
This was echoed by Andrew Shepherd, director of the Chronic Poverty Advisory Network, who said: “Lockdowns are not suitable for every country. In the pandemic, richer nations pressured low- and middle-income countries to introduce lockdowns, with disastrous consequences.
“Most of these countries were not in a position to mitigate the accompanying loss of jobs, income and businesses in the way we could in the UK, and the result was massive impoverishment which will take years to recover from.
“In any future pandemic, public health restrictions in low- and middle-income countries need to be informed by a greater understanding of what impact they will have on people living in poverty.”
Seven: Take a step back from social distancing
During the pandemic, non-pharmaceutical interventions (or NPIs) such as social distancing, mask-wearing, and lateral flow tests played a key role in mitigating the spread of the virus although the exact extent of their effectiveness remains unclear.
Paul Hunter, a professor of medicine at the University of East Anglia, said: “My big regret is we still have not reached scientific consensus on the value and effectiveness of non-pharmaceutical interventions.
“We know that NPIs do reduce transmission. But whether the benefits outweigh the harms is still far from clear.”
Eight: Consider the psychological cost
Lockdowns may have helped reduce infection, but they greatly underestimated the human need for connection, contact and community.
“There seemed to be almost no strategy to meet those fundamental needs. The social and psychological scars remain extensive and deep,” said Dominic Abrams, professor of social psychology at the University of Kent. He said research clearly showed that communities that had invested in social cohesion protected their citizens from these effects far better than elsewhere, adding: “This is a powerful lesson for the future.”
Nine: Care for the care home
Between early March and early June in 2020, nearly 20,000 care home residents in England and Wales died with Covid-19, a third of all care home deaths during that period. The government said at the time it had “tried to put a protective ring” around care home residents, a claim strongly disputed by families affected, and which is now the focus of a number of legal actions.
Ten: Defend science
The arrival of the first Covid vaccine, developed, tested and trialled in less than a year, was an extraordinary scientific achievement. Previously the fastest vaccine to go from development to deployment was the mumps vaccine in the 1960s, a process that took about four years.
”We were lucky to get a vaccine as quickly as we did in 2020,” said Kao. “Nobody, as far as I recall, thought it would happen that quickly – and what a difference it made.”
Professor Emma Thomson, director of the MRC-University of Glasgow Centre for Virus Research, said: “Science produced the major alternative to lockdown – which was vaccination.”
However, cuts to science budgets are happening globally, in particular in the US, but also in the UK – and this puts us all at risk, Thomson said, adding of another pandemic: “The threat is now likely to be higher than at any time in human history – because we move around the planet at greater speed and because of climate change – and that threat outweighs almost every other major risk to human health.”
