Chronicle of incompetence / New Statesman

By 31 January this year a full month had elapsed since the first cases of a mysterious “pneumonia” had been reported in the Chinese city of Wuhan.

The previous week the Chinese authorities had quarantined Wuhan and its 11 million people in a move the World Health Organisation (WHO) called “unprecedented in public health history”. The previous day, with nearly 8,000 cases of Covid-19 confirmed in 19 counties, the WHO had declared a “Public Health Emergency of International Concern”.

On 31 January a chartered plane flew 83 British citizens home from Wuhan and the first confirmed cases of coronavirus in the UK were found in York, but our government had other things on its mind. That was the day that Britain left the European Union.

The occasion was celebrated with a Downing Street light show, partying in Parliament Square and a cabinet meeting in Sunderland – the first place to declare for Leave in the 2016 referendum. Boris Johnson spoke of “an astonishing moment of hope”, of a “moment when the dawn breaks and the curtain goes up on a new act in our great national drama”, of “unleashing the full potential of this brilliant country”.

As Johnson celebrated Brexit, and as his chief aide Dominic Cummings pursued his vendetta against the BBC, judiciary and civil service, the Prime Minister appeared oblivious to what might be described, using his favoured alpine imagery, as the mighty avalanche building in the mountains above him. He had no idea that within another four months Britain would have suffered one of the highest death tolls, greatest economic catastrophes and biggest losses of reputation of any country in the world.

The government’s attitude as Covid-19 began its inexorable march across the globe in January and February could best be described as arrogant, cavalier and complacent.

The first meeting of Cobra, the government’s top-level national crisis committee, to discuss the coronavirus threat took place on 24 January. Johnson failed to attend. Downing Street insisted afterwards that Britain was “well prepared” and Chris Whitty, the government’s chief medical adviser for England, praised the country’s “strong track record of managing new forms of infectious diseases”.

On 3 February in Greenwich, London, Johnson delivered a speech on free trade in which he proclaimed Britain’s readiness “to take off its Clark Kent spectacles and leap into the phone booth, and emerge with its cloak flowing as the supercharged champion of the right of the populations of the Earth to buy and sell freely among each other”. He made only an oblique reference to the looming pandemic, saying: “We are starting to hear some bizarre autarkic rhetoric, when barriers are going up, and when there is a risk that new diseases… will trigger a panic and a desire for market segregation that go beyond what is medically rational.”

Johnson’s nonchalance continued. On 11 February, one day after the Department of Health declared coronavirus a serious and imminent threat, the Prime Minister told a television crew in Birmingham: “We are a great country. We have a fantastic NHS. We have fantastic doctors… People have every reason to be confident and calm.”

On 13 February he reshuffled his cabinet and shortly afterwards began a 12-day “working holiday” with his girlfriend, Carrie Symonds, at Chevening, the foreign secretary’s official residence in Kent. He interrupted it to announce his divorce from Marina Wheeler and to attend a Conservative Party ball where a game of tennis with the Prime Minister was auctioned for £60,000, but not to visit the scenes of devastating flooding in northern England or to attend another Cobra meeting on coronavirus on 26 February. Jeremy Corbyn dubbed him the “part-time Prime Minister”.

By that stage there were 16 confirmed cases of the virus in the UK, and families returning from half-term holidays in Italy and Spain were unwittingly contributing to its accelerating spread. Scientists were concerned, even if the government was not. “I think from the early days in February, if not in late January, it was obvious this infection was going to be very serious and it was going to affect more than just the region of Asia,” Jeremy Farrar, a member of the government’s Scientific Advisory Group for Emergencies (Sage), told the BBC’s Andrew Marr Show. “I think it was very clear that this was going to be an unprecedented event.”

Johnson did not begin to change his tune until as late as 28 February, when the disease had spread to all four nations of the United Kingdom. He allowed that the disease was now the government’s top priority, but his advice was merely to “wash your hands for 20 seconds”.

****

On 2 March, after a weekend at Chequers during which he and Symonds announced her pregnancy and their engagement, he attended his first Cobra meeting on coronavirus, having missed the previous five. He finally acknowledged that it was “more likely than not that the UK will be significantly affected” and agreed an “action plan” that included contingency measures to free up hospital beds, draft in retired medics, keep essential services going, shield the vulnerable and isolate the infected.

Johnson still exuded complacency, however. “Let’s not forget that we already have a fantastic NHS, fantastic testing systems and fantastic surveillance of the spread of the disease,” he told a Downing Street press conference as the number of confirmed cases in the UK neared 50. He added, to the dismay of his scientific advisers: “I was at a hospital the other night where I think there were actually a few coronavirus patients and I shook hands with everybody, you’ll be pleased to know, and I continue to shake hands.”

On 5 March he discounted tougher measures, telling ITV: “Things like closing schools and stopping big gatherings don’t work as well as people think in stopping the spread.”

On 7 March, two days before Italy ordered a complete lockdown, he and Symonds were among the 80,000 crowd that watched England beat Wales at Twickenham, and he posted a video of himself on Twitter shaking hands with five female rugby players.

On 11 March, as the WHO declared coronavirus a global pandemic, 57,000 racegoers attended the four-day Cheltenham Festival.

On 13 March, shortly before the WHO declared Europe the centre of the pandemic, 52,000 football fans – 3,000 of them from Covid-ravaged Spain – crammed into Anfield to watch Liverpool play Atlético Madrid in a Champions League match.

Spain announced a total lockdown on 14 March – the day before 6,000 runners participated in the Bath half-marathon. France followed suit on 16 March – the day Johnson cracked a joke about “Operation Last Gasp” in a conference call with potential ventilator manufacturers. On 19 March, a Thursday, Johnson said he hoped to visit his mother on Mother’s Day that Sunday – forcing Downing Street to issue a rapid “clarification”. The Prime Minister expressed confidence that “we can turn the tide in the next 12 weeks and… send coronavirus packing”.

Johnson, a libertarian, instinctively recoiled from the draconian measures being taken by other countries. Unlike most other leaders around the world, Johnson thought the British could slow or “mitigate” the spread of the virus so the NHS was not overwhelmed, as some hospitals had been in northern Italy, and closures of schools and businesses could be avoided.

“Our aim is to try and reduce the peak, broaden the peak, not suppress it completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease,” Sir Patrick Vallance, the government’s chief scientific adviser, told BBC Radio 4’s Today programme on 13 March, the day of the Cheltenham Gold Cup.

But 229 UK scientists signed an open letter protesting that “going for herd immunity” was not a “viable option”. And then came the devastating report from modelling experts at Imperial College, London, led by Professor Neil Ferguson, who was a member of Sage. Left unchecked, Covid-19 could cause 500,000 deaths, it stated. Even with “mitigation”, it could cause 250,000.

No government could contemplate losses on that scale. Complacency gave way to panic, and over the course of the following week Johnson and his shaken ministers dramatically changed course. They abandoned the policy of “mitigation” for that of “suppression”, though it took them ten more precious days to implement it.

On Monday 16 March, the government urged people to practise social distancing, avoid non-essential travel, work from home if possible and self-isolate if necessary. The following day, as global markets plunged, Rishi Sunak, the Chancellor, unveiled an emergency aid package on a scale never previously seen in peacetime, and ten times bigger than his giveaway Budget one week earlier. That Friday, schools, pubs, restaurants and allother social venues were closed.

The following Monday, after a weekend during which supermarkets were besieged by panic-buyers and people flocked to parks in the unseasonably warm weather, Johnson finally declared a “moment of national emergency” and ordered a total lockdown.

It was too late. Coronavirus was already rampaging through the land, with 335 confirmed deaths, an estimated 1.5 million people infected and the outbreak doubling in size every three or four days.

“Had we introduced lockdown measures a week earlier, we would have reduced the final death toll by at least half,” Neil Ferguson told the Commons science select committee in June. Professor John Edmunds, an epidemiologist at the London School of Hygiene and Tropical Medicine and another Sage member, told the BBC’s Andrew Marr: “I wish we had gone into lockdown earlier. I think that has cost us a lot of lives.”

The government had two months to prepare Britain’s defences before Covid-19 reached our shores – two precious months that it squandered. Johnson, who spent three days battling coronavirus in the intensive care unit of St Thomas’ Hospital in April, very nearly paid for that negligence with his life. Tens of thousands of others were less fortunate.

****

For all its leader’s bragging, Britain was not remotely ready to fight a potent coronavirus.

In October 2016 Public Health England (PHE) had conducted a three-day training exercise code-named “Cygnus” to test the UK’s plans for countering what the Cabinet Office’s 2008 National Risk Register considered the single most serious threat to Britain’s security – a pandemic. It concluded that “the UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nationwide impact across all sectors”.

Neither Theresa May’s nor Johnson’s government acted on those findings. They and the civil service were preoccupied with fraught Brexit negotiations and contingency planning for Britain leaving the EU without a deal. The NHS was hobbled by years of austerity, and struggled simply to provide enough hospital beds in normal times. As David Alexander, professor of disaster risk reduction at University College London (UCL), told the New Statesman’s Harry Lambert, pandemic preparation involves “telling governments what they don’t want to know, to spend money they don’t have, on something they don’t think will happen”.

Shortly after he succeeded May last July, Johnson abolished the government’s anti-pandemic committee – the threats, hazards, resilience and contingency committee – as part of his plan to streamline Whitehall, according to the Daily Mail. In short, Britain was far from the “international exemplar in preparedness” that Jenny Harries, the deputy chief medical officer, proclaimed it to be.

The most immediate and obvious problem was the shortage of personal protective equipment (PPE), including the face masks, visors, gowns and gloves required to protect front-line healthcare workers. When the pandemic erupted the stockpiles were found to be insufficient, out of date and designed primarily for tackling influenza. There were reports of health workers having to wear swimming goggles, and bin bags for aprons.

Attempts to purchase new supplies were frustrated because most PPE manufacturers were Chinese: they were swamped with orders from their own government, and from other countries that had placed them three or four weeks earlier. British manufacturers say their offers of help were ignored for weeks, and few could produce PPE on the scale required in any case. Some desperate hospital trusts sought to buy their own PPE independently of the health department’s centralised procurement system. In late February the army was drafted in to help with PPE delivery. In March the government quietly downgraded the risk status of Covid-19, raising suspicions that it was doing so because less sophisticated PPE would be required.

On 18 March Johnson insisted that there was “a massive effort going on” to end the shortages. On 20 March, Harries insisted there was a “perfectly adequate” supply of PPE for care workers. But by the end of April the joint chair of the Royal College of Physicians’ trainees committee complained of clinicians being put in “the impossible situation where they have to choose between protecting their own health, or that of their patients”.

It said a quarter of doctors working directly with coronavirus patients were reusing protective kit meant to be used once, and a third were short of gowns and full-face visors – a situation that had “worsened over the past three weeks”. All that in a country that managed to build 2,500 military aircraft a month during the later stages of the Second World War.

There had also been some notable fiascos. Some 400,000 gowns flown in from Turkey by an RAF plane on 22 April were found to be substandard and therefore unusable. A BBC Panorama investigation discovered that the government’s claim to have delivered a billion pieces of PPE included paper towels, detergents and 273 million pairs of gloves that were each counted as two items. The Daily Mail embarrassed the government by importing several tons of PPE for the NHS from China on its own initiative.

At one point, it looked as though hospitals would run desperately short of ventilators as well as PPE.

On 14 March Johnson appealed to leading British engineering companies, including Dyson, Rolls-Royce, JCB and Airbus, to switch to emergency ventilator production. “If you produce a ventilator then we will buy it. No number (you produce) is too high,” the Health Secretary, Matt Hancock, declared. The BBC even donated two ventilators used in the hospital drama Holby City.

In the event, the NHS managed to secure enough ventilators from manufacturers, private hospitals and foreign sources to ensure that its hospitals coped, but it emerged that the government had refused to join an EU procurement scheme for both ventilators and PPE early in the crisis.

Michael Gove, the Cabinet Office minister, claimed that was due to a communication error, not ideology, but EU officials disputed his account. Simon McDonald, permanent under-secretary at the Foreign Office, told the foreign affairs committee it was a “political decision”. He was obliged to retract that assertion a few hours later.

****

A fundamental flaw of Exercise Cygnus and the government’s contingency planning was the assumption that the next pandemic would be a strain of influenza like the Spanish Flu, which killed between 50 and 100 million people in 1918-20, or the Asian and Hong Kong flus of 1957 and 1968. “Everything – government preparedness, the modelling – was based on pandemic influenza,” Graham Medley, a professor of infectious disease modelling and member of Sage, told the Guardian.

But influenza is less lethal and less contagious than some coronaviruses. It also has a very short incubation period, meaning it spreads very fast. That makes efforts to contain it through testing and tracing pointless. By contrast, some coronaviruses have a long incubation period – 14 days in the case of Covid-19 – which means they can be contained if health authorities move quickly and decisively.

This was understood by Asian countries such as South Korea, Taiwan, Singapore, Hong Kong and Thailand that were hit by two other recent coronaviruses: Sars, between 2002 and 2004; and Mers, in 2015. Those nations activated their sophisticated systems for testing and then tracing and isolating contacts of the infected as soon as the Covid-19 threat emerged. They have been strikingly successful in containing the disease: at the time of writing South Korea has suffered 282 deaths, Thailand 58, Singapore 26, and Taiwan and Hong Kong seven each.

The UK failed to follow their example, or that of Germany, which also had a robust testing system. Throughout January and February the government made little effort to increase the country’s extremely limited capacity for testing and tracing – by late February PHE was still able to test and trace the contacts of just five Covid-19 cases a week. It failed to accept offers of help from university and commercial laboratories. Paul Nurse, the director of the Crick Institute, said he had offered to lend his laboratories and staff to the testing effort, but received no reply until weeks later.

Why Britain failed to ramp up its testing capacity has yet to be officially explained, but ministers and their scientific advisers seemingly did not believe that Covid-19 could be contained without a vaccine, and therefore thought it better to slow the virus’s progress and protect the vulnerable while the population developed “herd immunity”. Yet minutes from Sage meetings throughout the crisis have shown that achieving herd immunity was never an objective.

In evidence to the Commons science and technology committee on 25 March, Sharon Peacock, director of PHE’s National Infection Service, promised to share the government’s reasoning for the lack of testing, but she never did, despite repeated requests. “The absence of disclosure may indicate… that no rigorous assessment was in fact made by PHE of other countries’ approach to testing,” the committee noted.

Then, on 12 March, as the number of infections soared, the government took the fateful decision to end community testing altogether, restricting it largely to hospital patients despite the WHO’s advice that countries should “test, test, test”.

In a rare burst of candour Johnson told the Commons liaison committee in late May: “We just didn’t have the capacity in Public Health England. To be absolutely blunt we didn’t have the enzymes, the testing kits. We didn’t have the volume, nor did we have enough experienced trackers ready.”

The science and technology select committee concluded that “testing capacity… was not increased early enough or boldly enough”. It added: “Capacity drove strategy, rather than strategy driving capacity.”

Asked what he would do differently in retrospect, Chris Whitty said in June: “There is a long list, actually, of things that we need to look at very seriously. If I was to choose one, it would probably be looking at how we could speed up testing very early in the epidemic. Many of the problems we have had came because we were unable to actually work out exactly where we were.”

Without testing, health authorities cannot identify and isolate the infected, trace their contacts or measure the progress and prevalence of the pandemic – especially when many of the infected are asymptomatic. As Tedros Adhanom Ghebreyesus, the WHO’s director-general, put it: “You cannot fight a fire blindfolded.”

Matt Hancock finally acknowledged that inconvenient truth on 2 April when he responded to growing criticism by resurrecting the testing programme and setting a target of 100,000 tests a day by the end of the month. It was a headline-grabbing announcement, and it certainly generated a long-overdue surge in capacity, but for all Hancock’s triumphalism on 31 April the target was only met through statistical chicanery and other tricks that earned him a rebuke from the UK Statistics Authority.

A subsequent investigation by the New York Times revealed that in the final days of April hospitals were ordered to test employees and patients with no symptoms at all, simply to drive up the numbers. That frantic effort to meet the target depleted precious supplies of the reagents required for subsequent testing that was genuinely necessary. Several days passed before the 100,000 target was reached again.

A proper test and trace system was finally launched on 28 May – fully 11 weeks after the initial testing programme was scrapped, and even then it was far from the “world-beating” system that Johnson promised. The mobile phone app on which it depended proved unworkable, despite Matt Hancock’s promise on 12 May to have it “rolled out nationwide by the end of next week”. On 18 June the app was abandoned after weeks of development and £12m in expenditure, and the system is not now expected to be fully functional until September.

****

The premature curtailment of Britain’s testing programme was felt most keenly by care homes. These are institutions that are full of old people, often with underlying health conditions and therefore very vulnerable. Again, the potential threat was highlighted in Exercise Cygnus but never acted on. On 25 February the government stated: “It remains very unlikely that people receiving care in a care home… will become infected.” Until 13 March the official guidance was that it was “very unlikely” coronavirus would affect people in care homes.

From the outset the government’s priority was to prevent the NHS being overwhelmed by cases of coronavirus, as had happened in Lombardy, in northern Italy. On 17 March Simon Stevens, the NHS chief executive, announced plans to free up hospital beds by postponing non-urgent operations and discharging some 25,000 in-patients deemed “medically fit to leave”. Many of those patients ended up in care homes without being tested for Covid-19, and in April the New Statesman revealed that coronavirus deaths in care homes were “rising at a faster rate than those in hospitals”. While the official statistics showed that rate quadrupling in a week, “these figures drastically underestimate the true impact of coronavirus in the UK’s care homes”.

Care home owners complained of being pressured into accepting untested hospital patients. “One of my admissions from hospital most likely brought Covid into my home,” a Wiltshire care home owner told the NS. “They didn’t know they weren’t positive [but] they discharged them into care homes, who have the people who should be shielded most… These are the most vulnerable people, they’ve all got underlying health conditions, and they’re elderly. So they’re sitting ducks.” “It’s like everyone’s attention was in one direction, and behind them was a nursing home up in blazes,” Dr Phil Whitaker, a working GP and the NS medical columnist, added.

It was not just discharged hospital patients who went untested. Nor were care home staff, who were in many cases working without proper PPE because it had all gone to the NHS. Nor were the agency workers who replaced those employees when they fell sick or self-isolated. Nor were those friends and relatives who were allowed to make “essential visits” to care homes until 2 April – ten days after the lockdown started.

According to a BBC Radio File on 4 report, PHE ministers knew coronavirus was spreading rapidly in care homes from early March, but they failed to warn care home managers. Only after the government started to include care home deaths in the daily coronavirus casualty numbers on 28 April was the scale of the problem acknowledged. We now know that one in three care homes were infected, and that between 15,000 and 22,000 care home residents have died of Covid-19 – between a third and half of the entire death toll.

At the Downing Street press conference of 15 May Matt Hancock insisted: “Right from the start we’ve tried to throw a protective ring around our care homes.” Meg Hillier, the Labour chair of the Commons public accounts committee, countered: “Residents and staff were an afterthought… out of sight and out of mind, with devastating consequences.”

****

The approach to care homes will doubtless be among the many issues that the almost inevitable public inquiry into the government’s handling of the pandemic will want to investigate.

At the height of the crisis the government was left essentially leaderless for two or three weeks when Johnson was struck down by Covid-19. Dominic Cummings, Matt Hancock and the Cabinet Secretary Mark Sedwill were also infected, while Michael Gove had to self-isolate after a family member developed symptoms. Dominic Raab, the Foreign Secretary, formally assumed Johnson’s responsibilities, but all major decisions were put on hold until the Prime Minister was restored to health.

Johnson failed to sanction Cummings for flagrantly breaching the government’s own lockdown rules by moving his infected family from London to his parents’ estate in Durham in April, and then taking a side trip to a beauty spot on his wife’s birthday – allegedly to test his eyesight. That meant the government squandered precious trust and authority, and found it much harder thereafter to enforce the rules among an angry and restive public.

Quarantine for all arrivals at Britain’s ports and airports was finally launched on 8 June. But why had the government not introduced such a system at the very beginning of the pandemic? Throughout much of lockdown at least 15,000 people a day were flying into Britain without any sort of health checks, some of them from countries with rampant coronavirus.

The government equivocated for weeks on the issue of face coverings. It rejected a call from Sadiq Khan, London’s mayor, on 16 April for them to be made compulsory on public transport, only to adopt that very policy two months later.

Further investigation is needed into why poor, black and ethnic minority communities suffered disproportionately during the pandemic; how the government could have handled its sometimes muddled messaging better; why the public health policies of England, Scotland, Wales and Northern Ireland increasingly diverged; and why there was so little effort to forge a global or international response to the pandemic.

It may transpire that the government has relaxed the lockdown prematurely in its efforts to save the economy. Many scientists, including members of Sage, fear that is the case. Certainly, it loosened the tourniquet before meeting all its own criteria for doing so – the coronavirus alert level was still at four and the “R” number, the virus’s reproduction rate, was only just below one.

The government has also lifted restrictions in a haphazard manner that appears to be driven more by the need to salvage the economy than by science. As Labour leader Keir Starmer has pointed out, theme parks and betting shops will be open long before the nation’s children have all gone back to school. Scandalously, most pupils will not return until September.

****

Almost any government would have struggled to cope with a challenge as huge, complex and unprecedented as this coronavirus pandemic. Most did. The UK has had some achievements, notably the speed with which the NHS and its hospitals adapted to the emergency, and the Treasury’s comprehensive and speedy bailout schemes. Moreover, Britain faced certain disadvantages: a huge international hub in the form of London, an overweight population and a considerable ethnic minority population, for whom Covid-19 has proved disproportionately fatal.

But the incontrovertible fact is that Britain has the highest recorded coronavirus death toll in Europe, and the third highest in the world, with roughly 43,000 confirmed deaths and some 65,000 excess deaths, of which around 300 were health workers. By contrast, Italy has suffered approximately 35,000 confirmed deaths, France 30,000, Spain 28,000 and Germany 9,000. In March, Patrick Vallance said a “good outcome” for the UK would be 20,000 deaths.

“There has been a series of really dreadful mistakes by this government that has led to a vast number of people dying and they need not have died,” David King, a former chief scientific adviser to the government, has said.

The UK’s economy is also expected to be the hardest hit of the world’s developed countries, according to the Organisation for Economic Cooperation and Development. It will be impaired for years by the worst recession of our lifetimes and by everything that flows from that: mass unemployment, enfeebled public services, crushing debts, lower pensions, poorer health, widespread poverty and lack of opportunity.

A recent editorial in the British Medical Journal summed up Britain’s response to the pandemic as “too little, too late and too flawed”, and asked: “How did a country with an international reputation for public health get it so wrong?”

There will be plenty of blame to go round, but much of the answer is that a hubristic and distracted government was slow to act at every turn, preferring empty promises, headline-grabbing announcements and the Prime Minister’s faux-Churchillian rhetoric to detailed planning and the rigorous development and implementation of strategy. Too often Johnson and his ministers appeared to be winging it.

The government’s scientific advisers are unlikely to avoid blame, and from the outset ministers have set them up as potential scapegoats by insisting their decisions have all been based on scientific advice. Critics have bemoaned Sage’s narrow composition. “If independent public health experts had not been excluded from the core committee, which is dominated by modellers, virologists, clinical academics and behavioural scientists, the influenza-driven ‘herd immunity’ strategy might not have materialised,” Anthony Costello, a professor of global health at UCL and a former WHO director, wrote in the Guardian.

But whatever advice was given, the Prime Minister and his cabinet cannot be exonerated. They had a duty to question the advice they received, and to take other relevant social, economic and political factors into consideration. They were the decision-makers.

For the record, Boris Johnson has yet to admit any failures. He says it is “premature” to judge the government’s handling of the pandemic or make international comparisons. He and his ministerial colleagues have repeatedly insisted that they have taken “the right steps at the right time”. In the House of Commons on 27 April, he hailed “our apparent success” in countering the pandemic. On 3 June he told MPs, without apparent irony, that he was “very proud of our record. If you look at what we have achieved so far, it is very considerable.”