Nafeez Ahmed speaks to Dr Anthony Costello about where the approach of the UK and US Governments to the Coronavirus pandemic is faltering and why both administrations have been relying too heavily on modelling.
“We know we can get this under control,” says Dr Anthony Costello, a former Director at the World Health Organisation (WHO), where he headed up maternal, child and adolescent health. “The problem is that Europe has been too slow to act compared with Asia; and America is now facing a huge crisis.”
Costello, who is Professor of Global Health at University College London where he previously headed up the UCL Institute for Global Health, spoke to me via telephone from Yorkshire, where he is currently isolating from his family members, many of whom are experiencing symptoms of the novel Coronavirus.
Having worked at the WHO from 2015 to 2018 before returning to UCL, Costello pulls no punches about the failures that, he says, have allowed the virus to rampage across Western countries.
“America is now the epicentre of the pandemic,” he warns, arguing that the US may experience the highest rate of fatalities anywhere in the world. London, too, he tells me “will face a health service disaster within two to three weeks, because it’s been allowed to let rip there. I really fear for our people and my health colleagues”.
The reason the US and UK are on track for disaster is due to the failure to take early action, explains Costello. This allowed the Coronavirus to spread undetected among communities for as long as two months, setting us up for levels of exponential growth which are now bound to overwhelm healthcare facilities.
“We know that the virus has been circulating in the US at least since mid-January, when a guy flew into Seattle from Wuhan,” he says. “He seems to have seeded the virus, and since then we have had exponential community transmission.”
But he insists that it’s not yet too late to regain control of the situation and that the data suggests that we could do this in as little as seven to eight weeks.
Too Great a Focus on Modelling
The administration of Donald Trump rapidly changed course on its previous inaction after White House officials read a paper published on 16 March by Imperial College London’s COVID-19 Response Team.
That paper, produced by the same scientists advising the UK Government, used a mathematical model to estimate the consequences of the US and British Governments’ prior strategies of minimalist mitigation.
The findings were frightening, forecasting that as many as 1.1 million Americans and 260,000 Britons would die even if more ambitious measures were pursued to slow COVID-19. The only way to avoid this outcome, the Imperial College team recommended, is a comprehensive epidemic suppression strategy enforcing social distancing for 18 months – until a vaccine becomes available.
Since then, the US Centres for Disease Control have adopted the 18-month suppression strategy as part of its official response plan. Meanwhile, Trump has already expressed his reluctance to pursue such a protracted lockdown due to its impact on the global economy.
Seemingly vindicating his approach was a separate model produced by Oxford University which made national headlines, claiming that as much as 50% of the British population may have already been infected and built up “herd immunity” to the virus – implying that social restrictions could be lifted far more quickly.
The study was also amplified by conservative commentators in the US, who suggested that it meant the US lockdown policy should be ended.
But, according to Costello, “both these mathematical models cannot be right. I suspect that the truth might in fact be somewhere in the middle”.
While the Imperial College’s modelling of the potential high fatality rate of a ‘do nothing’ approach has been widely accepted by the scientific community, its 18-month solution strategy has been questioned – as has the Oxford model’s opposite approach assuming a build-up of immunity.
A study by the New England Complex Systems Institute at New York University found that the Imperial College scientists had ignored data from East Asia demonstrating the efficacy of mass testing and contact tracing in suppressing the outbreak and minimising fatalities within around five weeks. Epidemiologists and public health experts had also pointed out that the Oxford paper’s optimistic modelling was already contradicted by fatality data from Italy. And neither model has supported the best tried-and-tested responses to dealing with an epidemic.
As a result, says Costello, “the United States is now the epicentre of the pandemic. Currently, Britain is a bit ahead of the US, and two-and-a-half weeks behind Italy, which is only a few days ahead of Spain, France and Germany”.
“The problem is that government has placed the modellers in the forefront of decision-making,” he explains. “SAGE [the UK Government’s Scientific Advisory Group on Emergencies] strikes me as having downplayed the public health view. Which is that you’ve got to act fast, find the virus, test test test, trace the contacts of those who are infected, isolate and quarantine, and implement strong social distancing. You do all that and what we’ve seen in East Asia is that you can really contain this, suppress this within seven weeks.”
This won’t make the virus simply disappear, but it buys valuable time and drives down the death rate. According to Costello, while there is nothing wrong with bringing in theoretical experts to do mathematical national modelling, the real problem is that the UK Government’s scientific experts lack significant experience in staving off real-world epidemics:
“They are all good academics. I have a great deal of respect for them. But none of them have successfully managed a public health crisis like this. The Imperial College paper for instance didn’t model the impact of mass testing, and talked only about case isolation. Yet these are precisely the tactics that we know work so well. Mass testing for the virus is already working in places like South Korea, where they’ve managed to find a way to keep this at bay without draconian lockdowns.”
Costello is sceptical of the official claim that the reason the UK didn’t rapidly bring in mass testing is due to lack of capacity.
He cites virologist Professor Julian Peto, of the London School of Hygiene and Tropical Medicine, who – Costello tells me – has “rightly rubbished the idea that we don’t have the capacity for testing. Just one real-time PCR machine can be used to undertake as many as 10,000 tests over two weeks. All we would have needed to do was ramp this up, mobilising local research labs around the country to reach hundreds of thousands, if not millions. We haven’t done this, and the question is, why?”
“We knew at the end of January that a crisis was developing in Wuhan, and any crisis management team would ask: is there a chance it could come to London, or Washington?” he adds. “And the answer at that time from public health experts was simple: yes. We should have started preparing for the worse case scenario. We didn’t.”
But, there is still time to get ahead of the crisis, Costello says.
“We have London surging. Many parts of the US are similarly surging. In the UK we also have the West Midlands and some other areas. But there are other places where we don’t really know what’s going on, because we just aren’t doing much community testing. Testing of health workers is essential, but without community testing we can’t see what’s going on, we can’t tell how the epidemic is spreading. It’s being able to tell that which allows us to move in rapidly to isolate cases, and this is the key to being able to slowly return to some degree of normalcy.”
Immunity Testing
After announcing the end of the community testing earlier in March, the UK Government U-turned and declared that it would ramp up community testing, with Boris Johnson promising 25,000 tests a day. But it still hasn’t happened.
“Community virus testing hasn’t properly kicked-off,” Costello says. “We are still doing a maximum of around 5,000 tests a day. This is way too low.”
He is also concerned about tepid Government messaging. “It’s not enough to just have modellers, virologists and behavioural scientists. You need people who can translate this into action. Social scientists. Public health experts experienced in community mobilisation. Right now, we are locked into this strange idea that the Prime Minister or President makes a speech and suddenly the entire country changes its mind. That’s just a fantasy. Throughout my career, I’ve seen that just giving people a few of the right messages won’t necessarily change behaviour. We need a more serious, decentralised approach and to share data with local communities.”
He refers to some of China’s mass communications measures. “The Chinese managed to suppress the virus in provinces outside Wuhan without the same sort of total lockdown by operating quickly. They had a TV station giving out information on the virus round-the-clock on a 24-hour basis. We had policing of supermarkets and pharmacies. But most importantly we had a comprehensive mass testing and contact tracing programme. And proper protection for frontline health workers. And that’s how this was brought under control within seven weeks.”
In contrast, Costello warns that the situation facing frontline health workers in t