First 2 years of the COVID-19 pandemic response

On 11 March 2020, the World Health Organization (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) a pandemic. The first cases of this disease caused by a novel coronavirus – belonging to a family of viruses causing respiratory tract infections in humans – had been reported in Wuhan, China, in December 2019.

Many people with COVID-19 were asymptomatic or experienced mild symptoms, such as a cough, fever and fatigue. A minority of people developed severe symptoms requiring hospitalisation and sometimes resulting in death. While many people recovered from the disease, some developed ‘long COVID’, experiencing symptoms for more than 12 weeks after initial infection. Some people were at a higher risk of contracting COVID-19 and of having worse clinical outcomes if infected. Important factors included age, gender, comorbidity and ethnicity. For example, mortality rates were higher among older adults. 

Response in England

On 31 January 2020, the Chief Medical Officer, Chris Whitty, confirmed the first two cases of COVID-19 in England. Government initially aimed to ‘contain’ the spread of the virus. Self-isolation requirements were introduced for people who had travelled to affected countries.

Chris Whitty reported the first death of a patient with the virus on 5 March 2020. In mid-March, government announced a change in approach to move away from testing and contact tracing members of the public, instead introducing self-isolation measures for anyone with COVID-19 symptoms and reserving active contact tracing for high-risk settings. Government subsequently began work to expand testing capacity and announced closures of schools (for most children) and entertainment, hospitality and indoor leisure premises.

On 23 March 2020, Prime Minister Boris Johnson announced the first national ‘lockdown’ to limit the spread of the virus. People could only leave their homes for a small number of purposes, non-essential shops were closed and public gatherings of more than two people were banned. Essential services, such as GP practices and court proceedings, modified their operations to mitigate the risk of infection.

Throughout 2020 and 2021, policymakers in England introduced a wide range of legislation, interventions and guidance in response to the pandemic. Measures included national and regional lockdowns, self-isolation requirements, COVID-19 testing and contact tracing, and financial support for people unable to work or needing to self-isolate. Government variously eased and strengthened measures as: the prevalence of COVID-19 and pressures on health and care services fluctuated; the political context changed; more was understood about viral transmission and the impact of the pandemic response; and the COVID-19 vaccine programme began. 

Government invested significant resources in the development, procurement, manufacturing and administration of vaccines against COVID-19. In December 2020, an extensive COVID-19 vaccination programme was launched – over 90% of the UK population received at least one dose of the vaccine by February 2022. From 24 February 2022, government implemented a ‘Living with COVID-19’ strategy, stating that the vaccination programme had enabled the removal of all restrictions to limit viral spread and the transition to an endemic phase of the virus.

Impact on people’s health and health care services

By the time that the ‘Living with COVID-19’ strategy was introduced in February 2022, over 140,000 people in England had died within 28 days of a positive COVID-19 test and over 16 million COVID-19 cases had been reported. COVID-19 death rates were highest in 2020/21, during the first two ‘waves’ of the pandemic in England. Lower death rates from COVID-19 after April 2021 were due to a combination of growing population immunity from either previous infection or vaccination, different circulating viral strains and changes to clinical management.

As part of the pandemic response, there were significant changes to NHS and social care service delivery and working practices to limit the spread of the virus, including increased capacity to treat COVID-19 patients and the use of clinical staff to vaccinate the population. Alongside additional IPC (infection, prevention and control) measures, many services including non-urgent hospital care were postponed, national recruitment campaigns were implemented, visiting was restricted, and digital and remote services were introduced more widely. 

Alongside the postponement of some health and care services, people avoided accessing some services, particularly in the first half of 2020. As a result, the ‘backlog’ of elective care and people’s unmet need for health care increased. People’s mental health and wellbeing were also affected, with evidence of increased levels of psychological distress compared to before the pandemic.

The pandemic response also influenced government reforms to health and care systems, for example the decision to dissolve and replace Public Health England, the government agency responsible for health protection and improving population health, announced in August 2020. 

Later developments and criticisms

There were high levels of uncertainty regarding the transmission of COVID-19, its clinical consequences and the appropriate public health response to the pandemic, particularly in the early months. The government’s pandemic preparedness and its decisions about the response came under considerable scrutiny. The National Audit Office stated in November 2021 that government ‘was not prepared for a pandemic like COVID-19’. The timing of decisions to introduce and ease lockdown measures were also subject to significant debate, including the decision to implement the ‘Living with COVID-19’ strategy in February 2022 rather than continuing with tighter measures to limit viral spread. 

There were shortages of personal protective equipment (PPE) for health and care staff at the start of the pandemic and later concerns emerged about value for money and transparency in national procurement processes. There were also concerns about the timeliness and effectiveness of national programmes for COVID-19 testing and contact tracing. The government was widely criticised for delays in acting to protect social care services and for restructuring the national public health system during a public health emergency.

In its assessment of the vaccine programme’s progress until October 2021, the National Audit Office stated that it had provided value for money and that ‘uptake had exceeded expectations’. It also highlighted that uptake was lower among certain minority and deprived population groups, and that around 3.7 million adults remained unvaccinated. 

In June 2022, an independent inquiry into the COVID-19 pandemic response was set up. Its remit was to produce an account of the pandemic response and the impact of COVID-19 in the UK and identify lessons to inform preparedness for future pandemics.