Coronavirus: strategic failure

03/04/2020

In a breathless "exclusive", the Telegraph can "disclose" that public health officials in charge of defending the country from a major pandemic never drew up plans for mass community testing.

All this is "revealed" by Prof Graham Medley, Chairman of the Scientific Pandemic Influenza Group, who says that emergency planners "did not discuss" the need for community testing.

This is confirmed by "senior Whitehall officials" who say that the need for mass testing "did not figure in our thinking" when drawing up plans to protect the country, even though a new strain of flu-like disease has long been recognised as "one of the biggest biological threats of our time", with even the 2011 plan failing to provide for mass testing.

You really have to admire the chutzpah of these drama queens in the newspaper, though, coming up with what amounts to statements of the bleeding obvious, days after I "revealed" much the same thing, through the simple expedient of reading the official, published plan for dealing with a pandemic.

The newspaper's "revelation" thus illustrates a general inability of the media to discover things for themselves, needing a "person of prestige" to tell them what is going on before they deign to "discover" the information. And it characterises the usual arrogance of the legacy media in asserting that nothing is news until they have published it, despite the fact that this blog got there two days earlier.

However, thanks to the laborious efforts of the Telegraph, a wider, spoon-fed audience is now aware that government planners failed to make any provision for mass testing in a pandemic, which explains why we are where we are today.

As I said yesterday, it is very difficult to set up a mass testing programme, de novo, in the middle of an epidemic. This is rather like trying to redesign the engine of an F.1 car while it is racing round the circuit.

Had things been different, the implementation of a large scale testing programme would not have been that difficult, as there are more than sufficient resources. But it would have required planning well in advance, to make sure the laboratories were primed and organised, the personnel were available and the administration was in place.

The actual mechanics of taking the tests would also have to be organised, together with systems for rapid allocation to the testing laboratories (to ensure the smooth flow of work), and the processing, reporting and distribution of results.

In its rush to tell us how clever it has been, however, the Telegraph has fallen into the trap of accepting that the lack of a testing programme arose from "a lack of investment", not realising that the actual costs of setting up a programme were minimal. The major burden comes when you implement it, when, as we see now, cost is no object.

Thus, the real reason why planners did not provide for an emergency testing programme is because they didn't see the relevance; there was no intention of seeking to control the emerging epidemic. Instead, the plan was to take the hit, mitigating the effects as far as possible with heroic medical intervention, and by making plans to bury the dead on a massive scale.

Even then, there doesn't seem in the Telegraph to be any real understanding of what a testing programme is for. We have the egregious Prof Medley tell us that "Testing can be extremely powerful … at a population level to be able to understand what's going on", but this is a typical academic view of what is in fact a real practical need.

By reacting quickly to reports of illness, suspected cases can be tested and isolated, contacts identified, tracked down, isolated and tested. With efficient and fast testing in place, those suspected cases and contacts who show up as negative can be quickly released from isolation if appropriate, and positive cases can be re-tested at intervals and released once clear.

But this would suppose that the organisation was in place to ramp up contact tracing, and since no provision has been made for this, ramping up the testing capability is of less value than it might otherwise be. For sure, people can be returned back to work earlier, but there is little contribution to the control of the epidemic.

And here, there is the third lacuna, which has hardly been recognised – the insistence of the UK authorities of treating this epidemic as a single outbreak. Yet, even in the London epicentre of the UK epidemic there are obvious variations between districts. Lambeth, for instance, reports 516 cases, while Havering claims a mere 142.

There are, in fact, 32 London boroughs (33 if you include the City of London), each with populations roughly the same as Iceland. And, by treating each borough as its own epidemiological centre, the figures would remain manageable. But, in the hands of Public Health England, the whole city is served by a single office, whence the epidemic is unmanageable.

As to other areas in the country, we see a similar pattern. The People's Republic of Sheffield reports 602 cases, while the East Riding of Yorkshire – which includes the city of Kingston on Hull (situated some 60 miles east of England) can only manage a mere 56 cases. Clearly, there are multiple outbreaks in England alone and with 342 local councils outbreak management at that level, backed by efficient laboratory facilities, is a realistic proposition.

Even in Italy, we are seeing much the same thing, where the major hotspot is in the northern part of the country, with some other breakout areas further south, but with other provinces at containable levels.

Thus to have the focus now almost exclusively on the deficiencies in the testing programme, with Matt Hancock emerging from his self-isolation to promise zillions more tests – rather in the manner of Soviet despots announcing tractor production figures - is rather to miss the point.

Hancock, it seems, can dimly perceive that more testing could be A Good Thing – especially at a political level - but, like his supposedly expert advisors, only has a very vague idea of what the testing is for. As to the other defects in the management of the epidemic, these are getting hardly any attention at all.

Nevertheless, this has given Richard Horton of Lancet fame a renewed platform. Having had a "good" epidemic so far, Horton pronounces that Hancock now agrees that the UK entered this pandemic unprepared. "We did not have the scale", for testing, the secretary says so: "We have had to build from a lower base".

With that, Horton gets a fabulous "money quote", roundly declaring that, "This is a huge admission of strategic failure" – delivered just in time to make the evening headlines of all the major newspapers.

As it stands, though, the tractor production plan amounts to a promise of 25,000 PCR tests provided by the NHS and Public Health England - up from 10,000 daily tests now. But these, plus an unspecified number produced by new private sector partners, will only be delivered at that rate by the end of April.

With the current case level recorded at 33,718, with a cumulative total of 2,921 deaths, increased on the previous day by, respectively, 4,344 cases and 569 deaths, this hardly seems enough. By the end of April, at the current rate of increase, we could be seeing a daily case rate of 60,000.

By then, of course, we expect to be seeing the effects of the lockdown, so even from next week, the figures will be anxiously scrutinised for signs of levelling off and then a downturn.

If that is taken as cue to relax the lockdown, though – bolstered perhaps by "immunity passports" relying on as-yet unproven antibody tests – what's left of an already overstressed system could unravel completely.

By failing to recognise that we are dealing with multiple, distinct outbreaks at different stages of development, the easing of restrictions could lead to the spread of infection into hitherto lightly affected areas, which could then exhibit exponential increases in case rates, returning us to crisis levels.

Basically, this isn't going to be over until the government decides to change tack completely and start controlling this epidemic, instead of playing at "flattening the curve". Without that, we're looking down the long end of 18 months before a vaccine starts to be available, and another six months after that before it is available in sufficient quantity.

In two years' time, though, we could be looking at a world changed beyond all recognition. Coronavirus could even be the least of our problems, with the EU for once sharing the pain.