Book excerpt: Providing an account of the policy response to COVID-19 in England, this book analyses the political and long-term systemic factors associated with the failures to control the first wave of the pandemic during 2020. It explores the part played by key policy actors, particularly politicians and scientists, and focuses on two difficult policy issues during the first wave: the establishment of a ‘test, trace and isolate’ system and responses to the high death rate in care homes for older people. Drawing on a wide range of documentary evidence, including parliamentary papers and SAGE minutes, this book draws attention to the importance of longstanding structural problems in public health and the care sector, especially the impact of outsourcing and privatisation.