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Coronavirus: paying the price

2020-04-24 06:13:18

From a standing start, where I started focusing on what became known as Covid-19 at the beginning of March, it took only a month before I was able to write with confidence that the government, in its response to the epidemic, had been preparing for the wrong disease.

Going all the way back to 2005, when the Blair administration under the aegis of health secretary John Reid first produced a pandemic preparedness plan, the emphasis had been on influenza, even though the World Health Organisation had advised member states to prepare for this disease and for a lesser-known and more recent condition known as Severe Acute Respiratory Syndrome (SARS for short).

There was no "secret squirrel" stuff here; no moles buried deep in the heart of government, to give me a steer just the slow, methodical tracking of published documents, following the direction they took me.

Now, weeks later, it takes an interview with a former secretary of state for health, Jeremy Hunt, for the legacy media to wake up to what my blog readers have known for weeks, where Hunt tells The Times that the "Whitehall pandemic strategy focused too much on [the] flu threat".

Thus does Hunt, now chair of the health select committee, inform us that the government response to coronavirus was "flawed", telling us that he wished the government had "looked more deeply" at how Asia had dealt with SARS. He thus says that Britain should have focused more on the threat of a new respiratory virus rather than an influenza outbreak in its pandemic planning.

To be fair to Hunt, although he signed off the 2014 Pandemic Influenza Response Plan, this was a linear descendant of the 2005 plan, which had undergone several iterations before landing on his desk, each version perpetuating the original flaw.

Interestingly, at the time he signed off the plan, he was being advised by CMO Sally Davies, formerly a consultant haematologist, unusually with no background as a specialist in public health.

In all respects, therefore, this is a classic example of a system failure, where no single person can be held responsible. Had Booker still been alive, he might have seized on the planning process as another example of groupthink where, once the machine had gone off the rails, there was no corrective mechanism that could bring it back into line.

Even then, I don't think that Hunt has fully grasped the extent of the failure, and it is certainly the case that The Times hasn't a clue. The article cites the National Risk Register 2017, the most recent version of what is said to be an annual government report that assesses serious threats to the country. Publication of the reports, though, tends to be erratic, but is roughly at two-year intervals.

The paper claims that the 2017 edition of the report states that the likelihood of a new disease like SARS spreading to the UK was low, but if an outbreak of an emerging infectious disease occurred in the UK, and preventative measures were not put in place swiftly, the impact seen could be on the scale of the SARS outbreak in Toronto, where there had been 251 cases.

Typically, though, The Times hasn't checked its facts. The reference to SARS which they cite comes from the 2008 edition of the risk register. In the 2017 edition, SARS is not mentioned at all.

The effective downplaying of the threat entirely contradicts the stance of the World Health Organisation which in 2005 revised its International Health Regulations to list SARS as a disease which "may constitute a public health emergency of international concern" only one of four, alongside pandemic influenza, which was so listed.

But, according to the current Times narrative, while the initial government response seemed to follow the influenza plan, with the adoption of a "herd immunity" approach - allowing the disease to spread through the population and natural resistance to develop when the scale of infection and death in Italy became apparent, ministers "suddenly changed direction and moved towards lockdown and isolation to stop the spread".

The inference there is that ministers had recognised the error of their ways and had started to deal with the real issue on the ground that we were confronting a SARS pandemic rather than influenza, a disease that required a fundamentally different strategy.

Yet that is not the case. Not only does the 2005 WHO checklist for influenza pandemic preparedness planning recommend social distancing and quarantine, the 2014 UK plan also allows for an element of "social distancing".

In fact, the great lockdown was triggered by businesses and the public at large, with F1 and the Premier League leading the way, but with ever-more businesses sending their employees home, and schools and universities shutting down, the government had no real option but to impose order on what would have been a patchy and incoherent response.

The fact of the government imposing a lockdown, therefore, is no indication that it had recognised the SARS threat or that it was adapting its strategy to deal with it. The government was, in the main, still following its influenza plan relying on the timely production of a vaccine to resolve the crisis.

Only now, when Hancock at last seems to be taking contact tracing and isolation seriously, are there signs that the government is moving away from a slavish adherence to its influenza plan, and starting to embrace the real-life measures which are required to control SARS outbreaks.

Despite that, Hunt is relatively forgiving of the government's tardy response, generously asserting that: "No one can reasonably expect governments to have a crystal ball with a brand new virus, so full credit to the government for being willing to learn from international best practice, first on ramping up testing and now on mass contact tracing".

Bearing in mind that Hunt himself is part of the failed planning process, however, there must surely be an element of back-covering here. The government didn't need a crystal ball. It had been warned by the WHO to prepare for SARS and, instead the British government (along with many others, it must be said) chose to lump this very different disease in with influenza.

At the heart of the government's current difficulties is this core error, repeated not once but many times. It was missed by a succession of experts, the civil servants and politicians, none of whom thought to refer back to the original WHO regulations which categorised SARS separately from influenza.

Even with that, where planning was so much reliant on the rapid ability to produce a vaccine - along with the expectation that we would get plenty of warning of a new viral outbreak - no one thought to ask how we would deal with an epidemic where there was no immediate prospect of a vaccine and where antiviral drugs to aid in treatment would not be available.

The point here is that, in terms of dealing with communicable diseases, the influenza plan is the outlier. Only because technology has become so advanced have we been able to abandon the basic principles of epidemic management. For too long, we have rested on the complacent belief that we can treat the victims of the disease and hold the fort long enough, without attempting to suppress the epidemic, until a vaccine becomes available.

Not once then in fifteen years have the legions of highly-paid, self-important officials, scientists and politicians addressed the nightmare scenario that we have been facing for decades, where we were challenged by a highly infectious and potentially lethal novel virus, for which there was no vaccine.

And yet, in 2002 when the world was confronting a novel virus in the form of H5N1, it was hailed by the WHO as 'the greatest single health challenge' to mankind, greater than HIV/AIDS or malaria.

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

Then, in 2007, 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, published in 2008, 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 pandemic could kill between two and 50 million people worldwide, and between 50,000 and 750,000 deaths in the UK.

Twelve years later, we are in the grip of that pandemic and will be able to count ourselves fortunate if the death rate can be contained between 50,000 and 750,000. As for the socio-economic disruption, the Committee was uncannily prescient: "massive" is almost an understatement.

Despite Hunt's generosity, therefore, this pandemic was both predictable and predicted. But when it came to the crunch, government was unprepared. And while it is all very well being wise after the event, there were an awful lot of people wise before it happened. This and many other governments chose not to listen.

As the recorded case total reaches 138,078, with hospital deaths alone at 18,736, we the people are paying the price and the final account has yet to be rendered.