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Coronavirus: perpetrating the errors

The cases reported yesterday were 5,526, with the deaths at 888. This brings the total, officially recognised cases to 114,217, with 15,464 hospital patients dead – and many more besides. Meanwhile, the Sunday Times insight team is on the case, offering a detailed account of the “38 Days When Britain Sleepwalked Into Disaster”.

Whatever transpires in the future, on the basis of this report, it doesn’t look good for prime minister Johnson. The summary reads that he skipped five Cobra meetings on the virus, that calls to order protective gear were ignored and scientists’ warnings fell on deaf ears. Failings in February, says the article, “may have cost thousands of lives”.

For those who have access, this long article is well worth reading. It fills lots of gaps and will be used to fuel the debate about the responsibility for what could accurately be called a debacle. And while there are many elements of interest, one thing that stood out was an assertion, which the writers claim was previously aired in The Times, from an anonymous “senior politician”.

He noted that, “All of our planning was for pandemic flu”, reporting that there had been “a divide between scientists in Asia who saw this as a horrible, deadly disease on the lines of Sars, which requires immediate lockdown, and those in the West, particularly in the US and UK, who saw this as flu”.

Actually, the origin of this claim was Reuters, which we reported on two days after we had already reached the same conclusion on the basis of evidence in the public domain.

In many ways, this points up the divide between the way I tend to work, employing inductive reasoning on the basis of documentary evidence, and media reporters who rely extensively on oral evidence, weighting accounts according to the prestige of their sources, and the number of times the claim is repeated.

When it comes to the legacy media, therefore, their understanding is often blurred or distorted. Oral evidence rarely has the clarity that documentary research will bring, and the lack of inductive reasoning means that journalists often fail fully to appreciate the evidence they bring to the table. They simply report what they are told, rarely testing it or expanding on it.

In this case, there is unequivocal evidence that the government’s planning was entirely focussed on pandemic flu. This arrives from the simple but unarguable fact that the only plans published were devoted to this type of pandemic. We know there was no specific planning for a Sars pandemic on the simple premise that, had such a plan existed, it would have been published.

From there, it requires only a few simple steps to conclude that the behaviour of Sars is very different from flu in the context of a pandemic, and that the responses needed to be very different. In a nutshell, the flu plan relied on holding the fort until a vaccine was developed, something I had deduced on 1 April, while a Sars pandemic required an altogether different response.

In the absence of a vaccine, and no expectations of its early availability, and without the proven antivirals such as Tamiflu which are so useful in mitigating the effects of influenza, controllers have to fall back on time-honoured epidemiological tools, isolating cases, tracking down their contacts, testing them and isolating them as well if they prove positive for the disease.

This is where the ST report starts to go wrong, because it states that “a central part of any pandemic plan is to identify anyone who becomes ill, vigorously pursue all their recent contacts and put them into quarantine”.

That, it says, “involves testing and the UK initially seemed to be ahead of the game”. It adds, “In early February Hancock proudly told the Commons the UK was one of the first countries to develop a new test for the coronavirus”, declaring, “Testing worldwide is being done on equipment designed in Oxford”.

The error here is in asserting that the “test, track and trace” programme is a central part of a pandemic plan. It certainly should have been but, as we have seen by reference to the influenza plan on which the government relied, contact tracing was confined to the initial stages, with a view to demonstrating that community spread had become established.

At that point, it was always planned that contact tracing would be abandoned, as indeed it was, as the government ramped up the NHS “surge” capability to deal with the expected torrent of cases.

But what seems to elude so many commenters is that, having established a faulty paradigm for dealing with a Sars pandemic, there was very little the government could do in the short-term to remedy matters.

To change strategy, the government would have had to call upon a resource to track down contacts which simply did not exist. While, even a decade ago, it could have relied on a network of 10,000 local authority environmental health staff for the purpose, operating from 342 local council offices, transfer of the function to Public Health England presaged a savage contraction of the service, now entrusted to 226 staff in public health protection teams operating out of nine offices.

Thus, even if the government had decided to change tack and major on contact tracing, the infrastructure no longer existed and, even now, months into the epidemic, provision is still not in place and there are plans to develop a completely new and untried system.

And then, since there was going to be no systematic contract tracing, there was going to be only minimal testing, so it was never thought necessary to build up a capability for mass testing. And again, as we are seeing, it is not easy from a standing start, to ramp up testing from the low base with which we entered this crisis.

In other words, trying to change the machinery for dealing with a pandemic is the classic example of trying to change the direction of a supertanker. You can spin the wheel, but it takes an awful long time before anything happens. Governments are unwieldy things and cannot turn on a sixpence.

While we can applaud the enthusiasm of the Sunday Times team for their work, like so many others they are missing the point. In looking at the sequence of failures that led to this current debacle, we cannot start in late January as this narrative does.

We have to start in 2005, when the WHO first called on member states to prepare pandemic plans for influenza and sars. We should then note that the UK responded by producing an influenza plan but failed to devise anything specific for Sars, relying on the one plan to cover both eventualities.

It can be said that, in its original definitions, the WHO did not really make it clear enough that it was expecting separate plans and, when members failed to produce them, it should have spoken out. But when it didn’t, the UK (and others) went on to repeat its original error, right up to 2014 with its final iteration of the pandemic influenza plan.

For sure, there were other errors, not least the failure to hold sufficient stocks of PPE, about which the Sunday Times makes great play. It neither this paper nor any other media organ is picking up on the far greater error of converting district general hospitals into centres for dealing with Covid-19, to the detriment of all the other NHS functions.

In the fullness of time, also, we must explore the extent to which these discharge of untreatable elderly patients to care homes, to avoid overburdening the NHS – thereby spreading the infection to those homes – was a deliberate act of policy. The same might be asked of the number of GPs who were asking the elderly (and their relatives) and the parents of sick children to sign DNR (Do Not Resuscitate) Notices, to keep them out of hospitals in the event that they succumbed to Covid-19.

Doubtless, the situation was made worse by Johnson’s absence from Cobra committees, his focus on Brexit and his failure to engage until 2 March, when he at last chaired a Cobra meeting. But in many respects, the sequence of events that has led to this disaster started in 2005, and we have had a rolling cascade failure running right up to present.

Although we suffer from having an incompetent liar as a prime minister, in view of the longer-term and multiple planning failures, it is unlikely that any prime minister – of any government – would have performed much better in the initial stages of this epidemic.

Where we have just cause for complaint, though, is that as the death toll continues, there is no sign whatsoever that the government has got a grip on what is needed, or has even understood where the failures lie. Not content with merely perpetuating existing errors, ministers seem intent on making things worse.


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