Why the UK COVID Alert Level System will fail

By C.J. Fearnley

A recent global survey of the public relations industry put New Zealand’s prime minister Jacinda Ardern at the top of the list for COVID-19 response communications. Aside from a fantastic communications team, frequent open, empathetic, and transparent public briefings and postings on social media, the alert level system has played a key role in the strategy to move towards reducing severe lockdown measures in New Zealand. The survey established that “the early setting out of the four alert levels, linked to the progress of the virus and the restrictions that each level would entail, set expectations at the beginning and have given people a framework for thinking about how their futures might look and feel. Very few countries have done that, which is one of the reasons why other governments have found it so much harder to manage expectations and get and maintain compliance to restrictions” [1].

Joining the ranks of Singapore, Vietnam, South Korea, South Africa, and New Zealand, on May 10th the UK Prime Minster Boris Johnson introduced the new COVID Alert Levels (see fig. 1), following growing interest from Wales to introduce a traffic light system to manage the easing of lockdown measures on 24th April [2]. The new slogan ‘stay alert, control the virus, save lives’ has already generated confusion among the UK public and has been ruthlessly mocked. With no broader framework on restrictions and timeframes the COVID Alert Level System is likely to cause confusion across the UK, and become an unused tool that does not relate to actions or changes in policies. This article discusses how failure has been designed into the UK COVID alert system so that it fails to work as a functioning system, fails to cover territorial scope, legibility, and accountability, and at the heart of it all, fails to help people. It is a tragically lost opportunity to bring hope and unity to the UK to face the continued challenge of managing the COVID-19 pandemic back to a new normality.

Fig. 1. New UK COVID Alert Levels (UK Government) as of 10th May 2020.

In the five days since the alert level system was launched there has been little discussion or analysis of the system and as of 15th May the alert level appears to be assigned new actions, or measures in place, see fig. 2

Figure 2. Coronavirus alert levels as of 15th May [3]

Alert level systems are tools used for a range of different purposes but in essence they provide a framework to public and civil authorities that can be used to gauge and coordinate response to a developing emergency. They can be ascribed as tools to provide public awareness about both escalating and deescalating crises. Globally countries are adopting COVID-19 or more generic infectious disease alert level systems to clearly communicate with the public on what measures are restricted to help prevent second, or further waves of the pandemic overburden health infrastructure. It is easy to say the system looks simple but with over 14 years spent studying alert level systems like these I can state they are inherently complex: margins for error are high and the stakes enormous. We live in a post-normal science world and the COVID-19 crisis is no exception [4].

Following the first registered COVID-19 transmission on 28 Feb in the UK, the alert level system faces stiff challenges. The newly formed Joint Biosecurity Centre states that ‘the government has not yet said what the new centre will publish or how transparently it will operate, beyond saying that the new COVID-19 alert level will “communicate the current level of risk clearly to the public”’ [5]. It would appear that this alert system has been rushed with little consultation with experts or consideration for the significant amount of work required to enable such warning systems to work, and currently the level of risk is far from clear. I identify seven areas of weakness to the alert level system.

1. The alert level criteria is uncertain: At first, it may appear that the ‘stay alert’ aspect of the logo may infer keeping a close awareness of what the alert levels are, but to date, there is little government published information about the alert levels aside from an update on 15th May linking alert levels to measures in place [3]. The new UK COVID alert level system (presumably for COVID-19) has 5 levels, based on traffic light colours; the UK is currently in level 4 (or potentially 3/5 according to the address by the PM on the 10th May). The criteria for assigning the alert level has been stated as:

COVID Alert Level = R (rate of infections) + number of infections.

Whilst this isn’t a literal definition, (L = f(R,N,...) with L stepwise increasing in R & N would be a stronger mathematical representative), it is clear that the rate and number of infections are the basis for each level. This alert level is therefore dependent on ‘scientific’ criteria of determining the R rate and number of infections which, is actually subjective. The availability of the tests, the number of people tested, the frequency of tests, accuracy of those tests will all determine different R values. Without a comprehensive testing program that includes a contact and tracing systems to establish the R value, it is expected that any R value may be rather meaningless, yet determine a change in alert level, thus potentially affecting restrictions. The traffic light design is typically used to assist a wide understanding of the dangers involved, as it mimics the traffic light system familiar in everyday life. The UK COVID-19 alert level system assigns actions to each level which has a general description e.g. ‘A COVID-19 epidemic is in general circulation’, with ‘gradual relaxing of restriction and social distancing measures’, but what does this mean? The alert level cannot work on its own without additional details so the public can establish what is going on. For example, the New Zealand’s colour-coded COVID-19 Alert Level System, which comprises of four alert levels: prepare, reduce, restrict, and lockdown, provides clear guidance on the risk assessment, and range of measures in place. Each alert level has specific outcomes, summaries, and measures for public health, personal movement, travel and transport, gatherings, public venues, health and disability care services, workplace, and education so that there is clarity in what can and cannot be conducted at each alert level. It provides a clear, unified source of information giving authorities the credibility, accountability and transparency required so that everyone knows what to do. It is also clearly available to find online [6]. If establishing an R-value wasn’t hard enough, the alert level is supposed to based on risk. However, the R value is sadly only part of the risks – the numbers alone do not tell the whole story, and do not help in terms of aiding an elimination strategy of the disease.

2. The alerts only apply to England: The new UK COVID-19 alert system is only implemented in England and will have local differences depending on locality. To date Scotland, Wales, and Northern Ireland are not required to adhere to the alert level system. Such stark differences in policy make the implementation challenging within the United Kingdom. If Wales and Scotland devise their own alert levels there will be significant potential for confusion, potentially triggering organisations and people to take actions not deemed safe. The alerts are supposed to be locally relevant but it is not clear how the local alert will be communicated and acted on when this is a national threat/issue with key workers still mobile, some frequently moving between the four nations. Many alert level systems, be they for volcanoes, tsunami, the weather, or terrorism are adopted nationally as standardised systems where the associated policies apply nationally, or at least in part nationally. Whilst I am an advocate for the value of the local to be most relevant in any form of disaster management there is a need for everyone to be ‘singing off the same hymn sheet’ or there will be confusion. Local variations can be accommodated even within single standardised systems with sufficient flexibility [7] but this requires a suite of communication tools attached to the alert level to help all stakeholders know what each alert level means and what actions need to be taken so to accommodate local contingency, while also adhering to national / international policy. Irrespective of this, the alert level system applies only to England.

3. It is not clear who decides the alert level and how: The UK COVID-19 alert level system is set up by a new "Joint Biosecurity Centre”. To date there is little known about this centre, and who will be in it, what they will do, other than communicating an alert level as a measure of risk. It is also unclear whether it is the individuals that make up the centre that will make the decision to change alert or whether this will be directed by an independent panel, or central government. However, Tom Hurd, the director general of the Office for Security and Counter-Terrorism, has been appointed as a temporary head to the new unit, reinforcing the ideas surrounding the alert level system being used in ‘defence’ rather than taking action (see point 6 below). Documents released on 11th May stated that ‘the centre would have an “independent analytical function that will provide real time analysis and assessment of infection outbreaks at a community level, to enable rapid intervention before outbreaks grow’ [8]. Will this centre make decisions on local alert levels or will it only be at the national level (e.g. England)? The same document states that ‘the centre will also identify specific actions to address local spikes in infections, working with local agencies and advising ministers, businesses and local partners to close schools or workplaces where infection rates have spiked’. By the end of May the South African COVID alert level system is expected to move to an area-specific assigned alert level [9], but such systems in past have caused problems as populations do not know where boundaries exist, what the implications of a change in alert level means in different locations, and generally more confusion can result than taking a broader approach. Having regionally different alert levels would be incredibly challenging to do under an England wide alert level system, partly because a virus does not comply with regional zones, it passes through them creating higher risks for all across the UK. Whoever makes the decision, there are lots of challenges involved in knowing when to change alert level, and how to inform various stakeholders of the change in alert level [10]. The decision to change an alert level is challenging as often scientists encounter difficulties in interpreting scientific data to establish what a hazard is doing, and that the decision to move between alert levels is based upon a complex negotiation of perceived political, economic, and environmental risks rather than the scientific details. This also makes the criteria of R values even more complex to use as criteria for changing alert level.

4. The public do not see the value of the alerts. The COVID-19 alert system has a new slogan to help raise awareness of the system: ‘stay alert, control the virus, save lives’. Aside from the ruthless mockery it has already received, and the perceived political messages behind this slogan, the alert level system seems to have little application with the policies of social distancing. Following various TV briefings, it appears each level has a series of steps (3 according to fig. 2) set out by the UK prime minister that are used to establish whether we can progress to lighter restrictions on social distancing. These are commonly shown on the expected curve of reducing R values. What is odd, and in contrast to the alert level system used by New Zealand is that these steps are not the different alert levels, why not alert level 4,3,2 rather than steps 1,2,3 in fig. 3? It is as if there are sub-levels within each alert level. Confused?

Fig. 3. Steps of adjustment to current social distancing (UK Government).

How transparent the alert level system is will be vital to how credible the public will regard it and believe it, and adhere to any associated policies. Without integration into clear policies at the moment there seems little point to the alert system other than to give a very vague indication of how bad the epidemic is, and some indication of the level of actions required, but again no specifics as seen in the New Zealand system. With an unclear purpose within the overall COVID-19 management strategy, I suspect the alert level system will be hardly used, with the focus being on steps that are not pre-defined. It is worth reflecting that the New Zealand systems success has been that it has been ‘a framework for thinking about how their futures might look and feel’ [1]. To date the alert level system provides no such framework or timeline.

5. The alert system cannot successfully operate independently: The alert assigned is designed to give a wide range of stakeholder’s vital information to inform their policies and practices. Multi-directional communication is required to ensure that all involved in assigning and responding to the alerts understand what information is credible and relevant. Common communication tools adopted to achieve this include cooperation plans, protocols and procedures established so that actions can take place instantly. This requires two key elements. First, preparedness and discussions between all stakeholders so it is clear what needs to be done at each alert level. Second, these activities are themselves dependent upon everyday dialogues between stakeholders using differing formats (social networking, internet, phone), and the establishment of joint information centres, meetings, and workshops. It is not clear how possible it will be for these vital aspects to be established if the Joint Biosecurity Centre has no transparency, or resources to engage with the many stakeholders that will use the alert level information. It is also unclear how the Alert Level system links with our policies and procedures, such as work health and safety. For example in New Zealand extensive policies were put into place prior to changing the last level so business, government agencies, and individual could prepare [11].

6. The alert system has been placed under the security rubric: If the Alert Level system looks slightly familiar, that is because it has a design and iconography similar to that used for the UK Terror Alert System; five levels also progressing from high to low as you read down the page. The UK Pandemics is part of a broader movement, over centuries, around protecting the 'security' of working populations, in other words securing working economies. What this means is that individual bodies are not in fact the 'secure' priority (your safety is not the concern here), rather, the return to normal of working bodies en masse is the priority, hence the steps being tied into activities that return working bodies to normal. The irony is that the 'alert' message of being vigilant does speak to individual bodies, but this is a matter of you being responsible for not infecting the mass of working bodies. You are responsible, and hence any failings of the system are on you, not working as a united nation together to look after one another, as previously promoted with the prior UK slogan ‘Stay Home, Save Lives, Protect the NHS’. In addition, terrorism alert levels have been said to be at times meaningless [12], as many have remained at the highest levels for years, thereby not really conveying any sense of real or local level of risk. For example a study by LSE providing Analysis of the Impact UK Threat Levels have on the Public Perception of their Safety found that ‘the current UK threat level system increases public uncertainty regarding their own safety’ [13]. Alert systems that follow a terrorism model are likely to be responsive, defensive, and underutilised based on prior experience, and it comes down to what is the objective or outcome that is desired from having the alert level in the first place, prevention, or action?

7. Understanding alert levels depend on how it is used in the media: Alert level systems sit in a 'media ecology' of TV announcements, newspaper articles, social media networks to name a few, each shaping how that alert system is communicated and is 'read'. Some offer quick glances, some longer engagements. They have different attention spans, and speak to different visual literacies. A major operation around social media communications is required to manage the use of the alert, but it is unclear where the expertise will be coming from (e.g. academia, consultancies, civil service) and how it will be monitored / engaged with. Alerts and associated information bulletins provide key messages but how these are interpreted by the user of the system is variable. Establishing the key message, and understanding how this information is likely to be interpreted into an alarms language of text and signs is vital. It is unclear what theory of social behaviour the UK government are working with, and will this alert be a 'nudge', an order, an appeal, or request. Without further clarity it is clear that an alert will be open to interpretation and misrepresentation.

As many countries slowly reduce and even eliminate the prevalence of COVID-19 there will discussions around whether international travel can be accommodated. Ultimately a global alert level system may be needed to facilitate the opening of borders and international travel to manage infection rates. Other nations will review each other’s alert level systems to seek out the most effective. Whilst the concept of a UK COVID alert level system has significant potential to help the UK build a roadmap to recovery, to use alerts as an effective communication tool to a wide range of stakeholders and the public uniting the four nations, it remains under-utilized, confusing, and unrelated to actions. There is much already established on how to make alert level systems effective and valuable in other contexts such as natural hazards, terrorism, warfare, and internet security. It is a lost opportunity, especially when other nations are doing so well in providing effective examples. So whilst Alastair Campbell (former press secretary for the UK prime minister Tony Blair) credited Jacinda Ardern with delivering a “maserclass in crisis communications” [14] supported by the introduction of the alert level system in New Zealand, I suspect the UK COVID Alert Level system will not even make it to class; it’s such a lost opportunity.

References

[1] T. Manhire, NZ ranked first in world for Covid-19 response communications, The Spinoff, 2020 https://thespinoff.co.nz/politics/06-05-2020/nz-ranked-first-in-world-for-covid-19-response- communications/, 2020 (Accessed 14/05/2020)

[2] BBC Coronavirus 'Traffic light' system to lift lockdown in Wales’. https://www.bbc.co.uk/news/uk-wales-politics-52396683, 2020 (accessed 28th April 2020). [3] BBC Coronavirus: How will the Covid-19 alert system work? https://www.bbc.co.uk/news/explainers-52634739, 2020 (accessed 17th May) [4] Funtowicz, S. O., & Ravetz, J. R. Science for the post normal age. In Perspectives on ecological integrity (1995) (pp. 146-161). Springer, Dordrecht. [5] Institute For Government, Joint Biosecurity Centre https://www.instituteforgovernment.org.uk/explainers/joint-biosecurity-centre, 2020 (accessed 17th May 2020) [6] Unite Against COVID-19 Alert System. https://covid19.govt.nz/alert-system, 2020 (accessed 28th April 2020). [7] C.J. Fearnley, W.J. McGuire, G. Davies, J. Twigg, Standardisation of the USGS Volcano Alert Level System (VALS): analysis and ramifications, Bull. Volcanol. 74 (2012) 2023–2036. https://doi.org/10.1007/s00445-012-0645-6. [8] Beckie Smith, Civil World Service https://www.civilserviceworld.com/articles/news/counter- terrorism-director-general-lead-coronavirus-risk-response-unit, 2020 (accessed 17th May 2020) [9] South Africa is moving to an area-specific coronavirus lockdown – this map shows the areas which have been hardest hit, BusinessTech https://businesstech.co.za/news/trending/397735/south-africa-is-moving-to-an-area-specific- coronavirus-lockdown-this-map-shows-the-areas-which-have-been-hardest-hit, 2020 (accessed 17th May 2020) [10] C.J. Fearnley, Assigning a volcano alert level: Negotiating uncertainty, risk, and complexity in decision-making processes, Environ. Plan. A. 45 (2013). https://doi.org/10.1068/a4542. [11] COVID-19: Alert Level 2 – starting the ‘new normal’ in the retail sector, JDSUPRA, https://www.jdsupra.com/legalnews/covid-19-alert-level-2-starting-the-new-10704, 2020 (accessed 17th May 2020) [12] C.J. Fearnley, Standardising the USGS volcano alert level system: acting in the context of risk, uncertainty and complexity (Doctoral dissertation, UCL (University College London). [13] M. Beaney, A. Choudhury, P. Pasricha, A. Rafiq, P. Sullivan. “Too little too late, useless words”?, LSE https://info.lse.ac.uk/staff/divisions/Teaching-and-Learning- Centre/Assets/Documents/GROUPS-papers/GROUPS-2017/Group-2-Too-little-too-late-useless- words.pdf, 2020 (accessed 17th May 2020)

[14] Alastair Campbell, Jacinda Ardern’s coronavirus plan is working because, unlike others, she’s behaving like a true leader, https://www.independent.co.uk/voices/coronavirus-new-zealand- jacinda-ardern-cases-deaths-leadership-a9460591.html, 2020 (accessed 17th May 2020)