Has the pandemic response been different across the four UK nations?

The Nuffield Trust’s Sarah Scobie analyses data which could tell us about the relative effectiveness of the varying restrictions

CREDIT: This is an edited version of an article that originally appeared on the bmj

In broad terms, the pandemic has been similar across the UK. Shifts seem to have been driven by the course of the virus – for example, the exceptionally transmissible Omicron variant and the introduction of vaccines.

The extent to which high case rates have translated into hospital admissions and deaths also depends on demographic and social factors – for example, Northern Ireland has a younger population, and Wales has an older one than England and Scotland. 

Divergences

In the first wave, lockdown restrictions were similar across the UK but Northern Ireland had fewer deaths and hospital admissions; this could be because the lockdown began earlier in Northern Ireland, helping to reduce the peak.

In the second wave, Scotland had fewer cases, hospital admissions, and deaths than England and Wales. Scotland also had the most consistent set of restrictions in place between September and December 2020, which may have helped to delay the spread of the Alpha variant. 

From the middle of 2021 to February 2022 Northern Ireland consistently had the highest rates of hospital admission in the UK – although case rates and mortality were broadly similar. This suggests that hospital care for patients with COVID-19 was organised differently in Northern Ireland, resulting in a higher admission rate. 

Policy differences

It is hard to identify the direct effects of restrictions and guidance in each country.

Each country shared the same evidence base and scientific advice – for example, the Scientific Advisory Group for Emergencies and the Joint Committee on Vaccination and Immunisation provided advice to all UK countries. Based on the current evidence, it is difficult to say whether one UK country’s policies worked much better or much worse than the others over the first two years of the pandemic. 

While tighter restrictions in the second wave in Scotland coincided with reduced circulation and severe disease, the reverse has been the case in more recent months, despite recent stronger guidance applied there.  This could reflect the scale and enforcement needed for interventions to make a difference – or the tendency for behaviour to be consistent across the UK, even without legal requirements.

Looking ahead

There is no room for complacency in the UK’s response to COVID-19, even now.

Future variants have the potential to cause damage, despite vaccination and previous infection. Evidence is increasing of the disease’s long-term effects on health; the milder disease seen in recent months is still causing health problems. 

The pandemic is still here and COVID remains a problem. Trying to understand population inequalities and the resulting differing experience is still a challenge. We can reduce inequalities in the future. Alongside inequalities between ethnic groups and deprivation, international data indicate that the UK has unusually high excess mortality in younger age groups.