As things stand, here in late June 2020, more than 0.1% of the UK population has died either directly from or as consequence of the COVID19 Pandemic. This figure is around ten times greater than Germany, Denmark and Romania, and twenty times the death rates of Estonia, Slovenia and Norway. How is it, that a technically advanced and affluent nation has the worst death rate in Europe, and one of the worst in the entire world? What the hell went wrong?
The first part of the answer goes back to May 2010 and a policy of austerity introduced by the then Prime Minister David Cameron, a key part of which involved cuts to the National Health Service budget. Government spending on health would decrease in real terms over the next nine years, creating strains on services tending to an increasingly ageing population. Fast forward to October 2016, and (in response to the SARS, MERS and Ebola crises) the UK Government organised a war-game practice for a global pandemic for a novel virus, named H2N2, which was imagined to cause acute respiratory failure. Notwithstanding that the deadly pathogen was envisioned to be an influenza rather than a coronavirus, Exercise Cygnus was a timely and realistic dress rehearsal for the COVID19 pandemic. Cygnus found that NHS England (and in all probability NHS Scotland, Wales and Northern Ireland) lacked the Intensive Care beds and personal protective equipment (PPE) to manage the great wave of patients that a UK epidemic would generate. The results of the simulation were catastrophic, with the NHS imploding and mortuaries overflowing with dead bodies. Publication of Cygnus was suppressed, but there was no time to lose: the Government needed to act on its very worrying findings. But in view of the cuts to Government spending, the then Health Minister, Jeremy Hunt, decided not to invest in additional ICU beds, respirators, or PPE equipment. It was a calculated gamble, as was an associated decision not to expand the biochemical raw material and laboratory resources to manufacture sufficient test kits to meet the urgent demand generated by a genuine pandemic.
When COVID19 arrived in the UK, most likely at some point in January 2020, the Government’s gamble meant that the country was very ill-prepared. Taking a leaf from the Donald Trump playbook, Prime Minister Boris Johnson announced to the press on 3rd March, “We have a fantastic NHS, fantastic testing, and fantastic surveillance of the spread of the disease… Our country remains extremely well prepared.” In keeping with his reputation for disliking hard work, Prime Minister Johnson neglected to mention that he had failed to attend any of the first five meetings of the Government’s national crisis committee COBRA, convened to combat the threat of COVID19. His words may have reassured several people across the UK, but the Coronavirus could never be contained by fake news. An acute shortage of PPE meant that many front-line health workers would die in the weeks to come, and an equally acute lack of testing kits meant that the UK simply did not have the wherewithal to test, and where necessary isolate, hundreds of thousands of people entering the country from COVID19 blackspots such as Italy, Spain and China. This second point was critical: recent analysis of variations in the virus’s genetic code found that rather than it simply entering the UK just once (the often-imagined “Patient 0” scenario), the Coronavirus had come into the country on at least 1356 different occasions between January and early June. The majority of these importations had occurred in March, but as UK testing was then barely off the ground, no-one in the country had any more than the slightest notion how many people had actually caught COVID19 (it took until 2nd April for the UK, with a population of 67 million, to reach 10,000 tests in a day, more than two weeks after Tedros Adhanom Ghebreyesus, the WHO Director-General, had pleaded with every nation to “Test, test, test”).
Throughout 2020 a group of medics, epidemiologists, virologists, psychologists, and other scientists collectively and perhaps unfortunately named SAGE (the Scientific Advisory Group for Emergencies), was tasked with providing the Government with coherent advice on how best to respond to the virus. But in view of appalling lack of testing, SAGE had extremely limited data to work on. Instead, they fell back on the patchy totals coming back from hospitals. There were no reports from elderly care homes because, disastrously, almost all these homes had no test kits whatsoever. And no PPE either. Meanwhile, a very un-sage-like idea was fomenting in the minds of some of the scientists: Couldn’t we just give up on testing and tracking altogether, and simply let the virus run through the UK? Eventually, they reasoned, enough people would have been exposed to the virus and survived to form a critical proportion of the population. With a diminishing number of potential hosts, the virus would then die back and the UK epidemic would be over. The country would have achieved Herd Immunity. Boris Johnson appears to have liked this low-cost option: no need for an extremely expensive lockdown. The WHO thought the idea insane. As the WHO has at its command many of the finest health scientists from across the whole planet, it makes sense to listen very carefully to what it has to say. It is, after all, the World Health Organisation. But some senior members of SAGE (as yet unidentified) were quite taken with the Herd Immunity idea. It did not seem to occur to them that although they had been fighting the virus for most probably thousands of years, bats had failed to achieve herd immunity: a fact demonstrated by the fact that they had passed the infection on to us. And yet we were going to somehow manage to surpass their efforts in a few short months. Moreover, herd immunity is generally only achievable via vaccination, and there was, and still is, no COVID19 vaccine. From the outside it appeared that these experts (many of whom were employed by the Government) were so eager to please their boss they had abandoned their celebrated higher reasoning powers in an attempt to make the Prime Minister happy.
Boris Johnson, his chief adviser Dominic Cummings (a man who would decide the best thing to do with a family infected with the lethal COVID19 virus would to put them in a car and drive 250 miles along public roads) and the UK’s Chief Scientist Patrick Vallance didn’t play around with this dangerous idea for long for long, but for perhaps just long enough to seal the fate of thousands of UK citizens.
After having little idea of how far the Coronavirus had spread the country – SAGE repeatedly calculated that we were on a similar trajectory to Italy, but four weeks behind, with plenty of time in hand – come the 23rd March an avalanche of cases swamped London hospitals, making it all too clear that rather than being a month behind Italy, we were in fact just ten days behind. And Italy, overwhelmed by the pandemic, had locked down fourteen days earlier. As any epidemiologist will know, if you allow a virus that is doubling its number of victims every four days an additional four days to do its worst, you are almost bound to meet with disaster. Later that day Boris Johnson declared a full lockdown, but he was at least four days and tens of thousands of lives too late.