Leadership and responses to COVID-19: now and planning ahead

Sciana members and foundation staff take part in first webinar since COVID-19 outbreak

Kickstarting a new webinar series on COVID-19, Sciana members discussed initial responses to the pandemic in the UK, Germany, and Switzerland.

On April 28, 2020, more than 50 people, including Sciana members and foundation staff, took part in a virtual convening held under Chatham House Rules. Ilona Kickbusch, chair of the Sciana programme and John Lotherington, programme director, moderated the discussion.

As of May 3, 2020, data from Johns Hopkins Coronavirus Resource Center showed the UK had the majority of COVID-19 cases (187,842) compared with Germany (165,664) and Switzerland (29,905). The number of COVID-19-related deaths was also significantly higher in the UK (28,520) than Germany (6,866) and Switzerland (1,762). Participants shared reflections on how governments were perceived to be handling the crisis.

Germany entered full lockdown on March 23. Webinar participants were cautiously optimistic about the government’s response, with cases apparently under control, but concerns were growing about the economic fall-out from the containment measures. In Switzerland, meanwhile, the government was seen to have acted quickly by delivering financial relief to individuals and companies swiftly and without complication. There was also good cooperation between federal government and the cantons.

Perceptions were less optimistic in the UK, with growing criticism of the political leadership, particularly the slowness to respond at the beginning of the pandemic. In all countries, members noted parliaments and opposition parties had played a limited role to date, but opposing voices were emerging. Some voices on the right questioned placing a higher value on preserving lives against the importance of the keeping the economy open.

Participants heard how profoundly the hospital sector in all countries had been affected to care for patients ill with COVID-19. In Germany, where some hospitals had switched over to treating seriously ill COVID-19 patients, concern was growing that patients with non-COVID severe conditions were not seeking care, such as those suffering strokes or heart attacks. Returning hospitals to normal functioning will reduce the workforce for ICU. Participants from the UK also reported a drop in emergency attendances for urgent conditions among all age groups. Hospitals in the UK reported ongoing problems in securing personal protective equipment (PPE) for their workforce, which was not reported by members from other countries. Switzerland had enough ICU capacity throughout the pandemic and was re-opening hospitals to non-COVID-19 services, such as outpatients.  

The situation facing care homes and long-term care was worrying for participants in all countries. In the UK, deaths in care homes had accelerated as deaths in hospitals were declining. Deaths in care homes rose 48.5% in the week ending April 17, while fatalities in hospitals increased by 10%. Until late April, the official daily death data did not include deaths in care homes. In Germany, a third of all reported deaths, at the time, had been people living in care homes, but the true number is likely to be higher. In Switzerland, the care home sector is playing a vital role in keeping hospital admissions down but has not had the same access to information and equipment as the hospital sector, a pattern familiar in the UK.

In all countries, there is a need for better support for care home staff as well as health care staff, many of whom are experiencing high levels of stress as they care for the most vulnerable. There were also examples of excellent cooperation between hospitals and care homes that need to be captured, along with other examples of hospitals taking a much broader role in coordinating non-medical help with the most vulnerable in their communities. One speaker defined the hospital as an "anchor institution" during COVID-19.

Concerns are increasing about the population health impacts of COVID-19, both direct and indirect. In the UK, deaths from COVID-19 are disproportionally high in black and minority ethnic communities, including health care workers, and research has begun to understand why. In all countries, there are growing concerns about the side effects of social distancing measures and economic contraction on people's health, coupled with the disruption of regular services for people with serious mental illnesses, or children with disabilities but also all other pre-existing illnesses by not seeking care.

Participants suggested they were learning many lessons on leadership during this crisis. In some countries, new leaders and spokespersons had emerged who engendered trust - especially in Switzerland. Cooperation between policy sectors occurred rapidly as did social measures, especially in Switzerland and Germany. Some leaders are at risk of being overstretched however. Participants from the UK mentioned staff faced a large, sometimes overwhelming, volume of official clinical guidance from national bodies.

Despite the challenges, the pandemic has highlighted the resilience of individuals. The rapid reshaping of hospital services has shown the power of a common mission to bring together professionals who wouldn't typically work together. It has also revealed the strength of underlying values, as professionals have been willing to learn new skills at a rapid pace to help. Understanding how governance needs to change to allow flexible and rapid innovation in health care institutions is important to capture.

Participants spoke of the importance of flexibility during the crisis, and striking the right balance between visibility to front-line staff and knowing when to get out of the way, and trust local staff to make changes quickly. Participants wish to consider how to maintain this new sense of common purpose moving forward.

Participants heard health professionals have become more visible in the UK, Germany, and Switzerland than ever before. The pandemic has also raised awareness of issues that had previously been neglected by the media. In the UK, there has been increased coverage of the challenges facing social care and care homes. Speakers reflected further on the interaction of public health experts and institutions with politics, the role of the media, and – in some cases - nationalism, which had become apparent. Members made observations of the poor level of international cooperation during the crisis in Germany and Switzerland, concerning economic support between countries and measures to control the virus.