Richard North, 08/08/2020  

For me, this has been the year of the book. I started with Booker's unfinished work, Groupthink and then, when that was finished, I moved on to work on the second edition of Scared to Death, updated to include a chapter on Covid-19. No sooner was that done then I started work on the revision of The Great Deception, on which I'm currently engaged.

Such is the span of human attention – or mine, at least – that I can't remember when life was any different from an endless cycle of book, blog, bed – with the occasional meal in between. If the lockdown hadn't been invented, I doubt I would have noticed.

Occasionally though, it is good to see that the work occasionally comes to fruition with an actual material product. I have my treasured copy of Groupthink to remind me that it was a real project and now, as of 6 August when it was published, I have the second edition of Scared to Death.

Between actually finishing it, months ago, and now, I hadn't looked at it but now, with publication, I've cast my eye over the new work – the chapter on Covid-19 and a revised conclusion, and I'm quite pleased with what I read. That isn't always the case. Sometimes, I can't bear to read stuff that I've written.

With such a fast moving issue as Covid-19, though, material even written a few months ago can look dated, but the text so far seems to be standing the test of time.

It is ironic, or perhaps prescient, that in 2007, when the book was first published, Booker and I highlighted in the prologue to Part One an example of a contemporary scare that had two years earlier been dominating the headlines. This was what was then the mysterious new disease: "Asian bird flu".

It was a long-familiar fact, we noted, that certain strains of influenza could be deadly to humans. The "Spanish flu" epidemic of 1918–19, for instance, had killed between 20 and 40 million people (and possibly as many as 100 million); more than the death toll of the First World War.

And, by 2005, in Asia, people had been dying from what the media had come to call the "deadly H5N1 strain" of the bird flu virus. In Asian domestic poultry flocks, it had been estimated that more than a billion birds could have been infected with the disease that was seemingly fanning out across the globe.

As we remarked in our opening, the emergence, or re-emergence, of H5N1 – which had been first isolated in 1996 – was hailed by the World Health Organization (WHO) as "the greatest single health challenge" to mankind, greater than HIV/AIDS or malaria.

A severe pandemic, it estimated, could wipe out 2 percent of the global economy. In Britain, the government's chief medical officer, Sir Liam Donaldson, claimed that such a pandemic was now "a biological inevitability" – "no longer a matter of 'if' but 'when'".

To cut a long story short, however, by 2007 only 385 people around the world had been infected, with 243 deaths. Most of the cases had been in Asia, where people had been in close contact with infected poultry. Despite the fears, the virus had not been able to cross the species barrier and pass easily between humans. It was to remain a zoonosis – a disease transmitted from animals to humans – with no evidence of human-to-human transmission.

That year, a House of Lords Select Committee had been looking at the handling of the disease and of the risks in general from pandemics. Its report recalled "sobering" advice from government ministers that: "While there has not been a pandemic since 1968, another one is inevitable".

It had been estimated that the next one could kill between 2 and 50 million people worldwide, and between 50,000 and 750,000 in the UK. Socio-economic disruption, it said, would be "massive".

From the evidence given to the Lords, it was clear that the government was very well aware of the scale of the potential threat. So was the global community and, in particular, the WHO. In fact, the WHO had been ahead of the curve. In 2005, even as the H5N1 virus was threatening to burst into the human race, this venerable organization – established on 7 April 1948 – was making plans to deal with another pandemic.

Specifically, it had taken the step of publishing a new set of International Health Regulations, replacing the 1969 set, which in turn had been preceded by the International Sanitary Regulations adopted in 1951. The 1969 Regulations had covered six "quarantinable" diseases, which over the years had been reduced to three: yellow fever, plague and cholera. The last amendment in 1981 had marked the global eradication of smallpox.

Then – in recognition of the growing threat in this "interconnected" world, where air travel had grown exponentially – the WHO created a list of diseases, the emergence of which "may constitute a public health emergency of international concern". Only four were listed: smallpox; poliomyelitis due to wild-type poliovirus; human influenza caused by a new subtype; and – with some considerable foresight as it turned out – an entirely new illness known as severe acute respiratory syndrome, or SARS.

SARS, as a pandemic disease, emerged in 2002, only a few years before the most recent bird flu epidemic had gripped the attention of the global health community. The causal agent was a virus from a group known as the coronavirus, codenamed SARS-Cov.

The original outbreak is believed to have started in Guangdong Province, China, in November 2002. Over the following months, the illness spread rapidly to more than two dozen countries across Asia, North America, South America and Europe.

By the time it was contained in July 2003, over 8,000 people had been affected, of whom over 750 had died. The majority of cases occurred among close family members associated with an initial case, and hospital workers who had cared for infected patients.

In the UK at the time, the front-line body responsible for managing a pandemic was the Health Protection Agency (HPA). Set up in 2003 as a non-departmental body, in 2007 it acknowledged the WHO's changes to its regulations, noting that they had been made "in the light of the global SARS experience".

And there was no equivocation in the WHO's demands. In respect of SARS and the other listed diseases, including pandemic influenza, each member state was required to "develop, strengthen and maintain … the capacity to respond promptly and effectively" to the newly defined public health emergencies of international concern to public health.

To the UK's credit, it had not been slow in responding to one of the WHO's requirements. In October 2005, the Blair administration had delivered a 177-page Influenza Pandemic Contingency Plan. Confusingly, in the March, it had already published a supplement for planners in England – this one a more modest 24 pages.

The publications spanned the tenures of two Secretaries of State for Health, initially John Reid, who was in office until 6 May 2005, and then his successor Patricia Hewitt, during whose tenure the ban on smoking in public places became legally enforceable.

Here, it would appear, was the start of a fatal confusion that would end up hampering the government's response to the Covid-19 epidemic when the disease emerged in the UK in late January of this year. The UK plan – the introduction stated – built on "previous experience of managing events such as SARS in 2003", also taking into account the WHO guidance that had also been published in 2005.

With multiple references to SARS throughout the body of the work, the authors were unwittingly conflating two very separate diseases. While they had been advised to plan for SARS as well as for a pandemic influenza, the government was planning for influenza only.

And that is the story behind the lamentably inadequate response to Covid-19, one that has crippled the nation and caused unnecessary deaths, disruption and economic strife. And still, before this day, it hasn't been properly told in print. But now it has.

Interestingly, at the very time that Blair's administration was getting it so wrong, the man himself was bogged down in a time-consuming and expensive spat over Britain's contributions rebate, ending in him "surrendering" £1 billion of our rebate and agreeing to a massive hike in the EU budget.

One likes to think that, had he not been so all consumed with this issue, he might have spent a little more time on his home turf, looking at what his people were doing to protect us from pandemic disease.

Oddly enough, in his biography, Blair does talk about the run-up to the 2005 election when, he writes, "we nearly had a vast panic over the approaching flu pandemic". As to his response, he adds: "I'm afraid I tried to do the minimum we could with the minimum expenditure. I understood the risk, but it just didn't seem to me that the 'panpanic' was quite justified".

In his second entry, it gets seven lines, with him observing that, "As with the flu pandemic, you have to steer an ever-so-careful line between overreacting and underreacting". There is, he added, "always a torrid deluge of bureaucracy for those caught up in an overreaction".

Sadly for us all, when it came to SARS, he didn't react at all. And that's one of the reasons why we are paying the price we are.

Also published on Turbulent Times.

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