An editorial in the prestigious British Medical Journal (BMJ) condemns the Johnson-led government for the way it has handled the coronavirus (Covid-19) pandemic and for ignoring the science. It amounts to possibly the most damning criticism of the government’s management of the pandemic so far.
Moreover, a set of slides seen by The Canary reveals that the Scientific Advisory Group for Emergencies (SAGE) referenced a document, issued in 2019, that provided detailed projections for a major UK epidemic. Yet, this doesn’t seem to have informed the government’s response to the crisis.
Early failings
The editorial, entitled The UK’s public health response to covid-19, is authored by Kamran Abbasi a doctor and BMJ executive editor, Bobbie Jacobson, senior associate and Gabriel Scally, visiting professor of public health.
It argues that the government’s handling of the coronavirus outbreak has “neither been well prepared nor remotely adequate”. And the authors point out that the government’s lack of preparation was “exposed in 2016 by Exercise Cygnus, a pandemic simulation, and the necessary remedial steps were not taken”.
On 30 January 2020, with the outbreak spreading, the World Health Organization (WHO) declared a public health emergency. That should have been a signal for SAGE and the government to move quickly. Indeed, as the editorial points out, there were case studies that showed “the need for high levels of mechanical ventilation and high death rates… But the UK ignored these warnings”.
Nothing much happened until 12 March, says the editorial, when the UK government “inexplicably” announced it was switching from containment of the outbreak to the delay phase:
Chris Whitty, England’s chief medical officer, explained it was no longer necessary to identify every new case and that all testing capacity across the UK, despite major regional variation in cases, would be “pivoted” to hospital patients.
But that led to chaos, as described in the editorial:
NHS 111 and Public Health England teams working on contact tracing were confused and overwhelmed. WHO’s standard containment approach of find, test, treat, and isolate, which has worked well in countries that have successfully suppressed viral spread, was abandoned; entry via ports and airports remained unrestricted…There was no future plan for community based case finding, testing, and contact tracing. Procurement and delivery of testing resources was ineffective, despite a readymade viral test and offers of help from university and private sector laboratories.
Inexplicably, as the authors point out on 19 March, the outbreak was downgraded from level 4 to level 3, although perhaps with an ulterior motive:
This enabled the required standard of personal protective equipment to be lowered for staff in hospitals and to nurse patients in non-infectious disease settings.
And there were more consequences. For this was soon followed, says the editorial, by a “reckless” policy of “discharging older patients from hospitals to care homes without testing [that] allowed the virus to spread and kick start a second epidemic of community infection”.
Panicked
But things got much worse when Sir Patrick Vallance, the government’s chief scientific adviser:
floated an approach to “build up some degree of herd immunity” founded on an erroneous view that the vast majority of cases would be mild, like influenza… When subsequent modelling estimated that 250 000 people might die in this scenario, but that physical distancing measures could limit deaths to about 20 000, a sharp reversal of policy followed.
The delay in implementing a lockdown meant that “almost two months of potential preparation and prevention time had been squandered”. Furthermore, the government failed NHS staff “by not delivering sufficient amounts of personal protective equipment (PPE) of the right specification, again deviating from WHO advice”.
Different approach
The editorial is scathing in its criticism of SAGE and the inclusion of political advisers Dominic Cummings and Ben Warner:
The involvement of two influential political advisers makes a mockery of SAGE’s claim to provide independent scientific advice to the government. To date, we do not even know the details of that advice. Such is the furore about SAGE’s composition and operations, that David King, the UK’s former chief scientific adviser, established an alternative “Independent SAGE”
The authors go on to offer suggestions by which the outbreak can be better managed. For example, that SAGE must “exclude political advisers and recruit more public health experts”.
Also, it advises that the government should commence a strategy based on “case finding, testing, contact tracing, and isolation” prior to any relaxation of the lockdown. These plans “must be adequately resourced, decentralised, and led by local public health teams”.
The editorial, subtitled Too little, too late, too flawed, concludes:
A UK government that prioritises the health and wellbeing of the public will see the importance of rebuilding the disempowered and fragmented infrastructures of its public health system. Anything less is an insult to the tens of thousands of people who have lost their lives in a pandemic for which the UK was forewarned but not forearmed.
Forewarned
“Forewarned but not forearmed”, indeed. For the UK government was not only warned by WHO, but also by its own commissioned report. That 2019 report by the government’s National Security Risk Assessment (NSRA) team, headed by Vallance, warned of a likely pandemic, whether flu or coronavirus, and issued recommendations on how to deal with the outbreak.
According to an April 2020 article in the Guardian, these recommendations included:
the need to stockpile PPE (personal protective equipment), organise advanced purchase agreements for other essential kit, establish procedures for disease surveillance and contact tracing, and draw up plans to manage a surge in excess deaths.
The NRSA report stated that the pandemic would consist of three waves, with each “expected to last 15 weeks”; that “50% of the population would be infected” (with more who are asymptomatic); there could be up to 65,000 deaths if the pandemic was of “moderate virulence”; and it could take months or years for the NHS and social care services to recover. Moreover, the NRSA predicted that the total cost of the pandemic would come to around £2.35 trillion.
The Guardian added that:
The government declined to provide specific details of the preparations that had been made prior to the pandemic, but said it would be unfair to say they were “starting from scratch”, pointing to planning exercises carried out in recent years.
There again, as one source reportedly told the Guardian:
The really frustrating thing is that there were plans [to deal with the outbreak by the government]. But over the last few years emergency planning has been focused on political drivers, like Brexit and flooding.
Total failure
Everything the BMJ editorial says can be backed up by evidence.
In particular, a set of slides, dated 26 February 2020, show that the current SAGE group clearly referenced the 2019 NRSA report as part of its planning. The figures quoted in the slides’ comparison charts are shocking.
Furthermore, the slides show that the BMJ editorial is correct in highlighting the lack of preparedness by SAGE to deal with the pandemic. The BMJ authors equally highlight the gross inadequacies of the government in implementing a workable plan. And, of course, it didn’t help that this came after years of underfunding and under-resourcing of the NHS.
Whatever the final outcome, coronavirus pandemic remains a tragedy of unbelievable proportions, enacted by a government and its advisers that have failed on every count.
