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Mike Buckley sets out the Government’s strategy towards the COVID-19 outbreak so far and explores why its handling of it already raises much bigger questions about the country’s governance – concerns which have been there all along.
The UK has wasted seven weeks. This is the judgement of Richard Horton, the editor of The Lancet.
The UK’s new Coronavirus strategy of “suppression” is the course of action recommended by the journal in its first report on the issue on 24 January. It is the strategy followed by China, South Korea, Taiwan and other countries that have seen some success in reducing the rate of infection. It is the strategy recommended by the World Health Organisation (WHO), which it has been clearly stating would be far preferable to the course of action chosen by the UK Government until yesterday.
The Government’s line is that the science has changed, but this is merely an excuse for its own miscalculation and unwillingness to follow the examples or recommendations of others. It is citing a report by Imperial College which clearly sets out the implications of the Prime Minister’s former policy of “mitigation” –allowing the virus to spread in order to create ‘herd immunity’. The report states that this would lead to 250,000 deaths, both from the virus and because people otherwise ill would be denied treatment by an overwhelmed NHS.
But this data was already available. Foreign governments, the WHO, teams of scientists and our own NHS professionals have been arguing for weeks that the Government’s strategy would lead to disaster. We have lost seven weeks which could have been used to order and make ventilators, testing kits and protective gear for medical and care staff. We have lost seven weeks which could have been used to retrain staff and build capacity. We have allowed the Coronavirus to spread for seven weeks when we could have held it back.
Had the UK followed WHO guidelines and the best practice of other states we could have kept infections to a much lower rate. WHO advice is abundantly clear, based on existing guidelines and the experience of countries which have successfully contained and turned back COVID-19 and previous pandemics. The essential elements for success are mass testing, the isolation of the sick and those carrying the virus, contacting and testing people who may have been exposed to it, and social isolation to prevent its spreading by people yet to show symptoms. This is not theory, it is fact.
The experience of Asian countries which lived through Sars, Mers and H1N1 has informed these guidelines and it is no coincidence that countries which learned lessons in the Sars outbreak of 2003 are the same countries which have been most successful in containing the Coronavirus. They have had time to develop systems and structures for the next infection. The only surprise is that Western countries have been so slow to follow their lead and to learn from their former failures and present success.
Taiwan, for example, as of 15 March, had just 59 confirmed cases and one death. It has managed to avoid a major outbreak of a disease which all but paralysed neighbouring China. Apart from most people wearing masks on public transport, life there goes on as usual.
South Korea has tested more than 248,000 people for COVID-19. Drive-through testing is followed by test results within a matter of hours, helping to reduce crowding and contamination exposure at hospitals. Widespread testing means that new infections are caught quickly and the person isolated. Hong Kong’s Government suspended classes, closed most public facilities and told residents to avoid public gatherings when the number of confirmed cases was below 20.
Early travel restrictions, aggressive testing and the screening of contacts and strict quarantine rules have been key. The result is that the infection has been contained in Taiwan and Singapore and that the rate of increase has been slowed or reduced in South Korea, Hong Kong and Japan. Even China – which was slow in its initial response – now has the infection largely under control after 80,000 cases and 3,213 deaths. For the country where the outbreak started, the worst appears to be over – but for the West it is just beginning.
The ‘Herd Immunity’ Mistake
Even now, the UK is still far behind where it needs to be because suppression only works if it is total. Any deviation simply increases infections, devaluing the whole process, endangering lives and putting health services under increased strain. The UK has still not banned public gatherings, closed schools or restricted travel. Other European nations, which were themselves in many cases slow to act in response to the crisis, are now implementing full suppression including lockdowns, closed bars and restaurants, and effective isolation at home for all but key workers.
Meanwhile, the UK is still trying to tread a line between containing the virus and keeping the economy going – a strategy which, if unchanged, will likely be catastrophic both for our health and the economy.
Just as importantly, the UK is not conducting mass testing, which has been a key element of all successful attempts to contain the virus. If we don’t know who has had it, we don’t know who’s immune. If individuals don’t know they have it, they will be careless with others. If we don’t know where an outbreak is located, we cannot quarantine people. Even NHS staff cannot get tested, putting them under increased pressure and leaving them fearful of infecting people by accident or passing the virus on to family members.
The good news is that UK policy is belatedly moving in the right direction. It must now surely be a matter of days before schools are closed, bars and restaurants are forced to shut down and an economic package of support for affected businesses is put together.
But, what this does not address is why our Government chose to ignore available evidence for so long and why it felt that it could choose to go its own way – despite the chorus of expert voices telling it to reconsider and follow international best practice.
Its former strategy was not just ill-judged, it was astoundingly, obviously wrongheaded. The Government publicly stated that it expected 60-80% of the population to get the virus. At 80%, that would be 54 million people and, at a 1% death rate, 540,000 deaths. Although more than 80% of COVID-19 infections are mild, more than six million people would be at risk of severe symptoms. According to a Chinese study of 44,415 confirmed cases, around 5% of people experience critical illness including respiratory failure, septic shock or organ failure.
The Government was right to believe that herd immunity is something to aim for – but neglected to take into account that it has never before been achieved through mass exposure to a disease. It is normally created through vaccination. To attempt to create herd immunity through mass infection for a disease with at least a 1% mortality r