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Mon 1 June 2020
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Dr John Ashton, a former director of public health, gives his take on how the next decisions can be made on the UK’s lockdown, the lack of press scrutiny and why the Government’s ‘goal’ of keeping deaths to 20,000 may be affecting their reporting.

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For want of a nail, the shoe was lost 

For the want of the shoe, the horse was lost

For the want of the horse, the rider was lost

For the want of the rider, the battle was lost

For the want of the battle, the kingdom was lost

And all for the want of a horseshoe nail.

When the Coronavirus pandemic is over and its history is written it will be incumbent on its survivors to get to the truth of what will have been one of the most ignominious setbacks this country has endured since Dunkirk.

Each day we are subjected to the cringe-worthy spectacle of ministers of state openly confabulating on national television, easily ducking patsy questions tentatively posed to them by pussy-footing journalists, whilst supported by senior advisors who seem to have all but abandoned their critical faculties. 

With the declared death toll now exceeding 10,000 and seemingly destined to surpass that of all countries – with the exception of Trump’s America – we are asked to believe that we are on course for victory, even as the evidence of our own senses and commonsense tells us otherwise. Whether by design or incompetence, there is a failure to publish real and complete data for the daily numbers of deaths. Such a tally should include those frail and elderly people now screened out of hospital, to die undiagnosed and unregistered at home or in a care home, or indeed those long-term residents of care homes dying in ever increasing numbers from the complications of the Coronavirus but destined to have ‘frailty of old age’ written on their death certificates.

As the daily reported numbers begin to shrink – in defiance of the situation at large in the country – a cynic might be forgiven for thinking that the Government’s goal has become that of keeping the final numbers at around the 20,000 the Chief Scientific Advisor clumsily described as a good result. In reality, even with the optimistic scenario of large-scale testing and adequate volumes of personal protective equipment (PPE) finally appearing and being delivered to where it can make its optimal contribution, the true number of deaths is likely to be a multiple of 20,000.

But it looks as if this is something that we won’t be allowed to know until the emergency is over and politics has returned to its normal dysfunctional state. As it is, the over-promising and under-delivering of essential measures is attaining a daily monotony, only exceeded by the inadequacies of a supine mainstream media.


The Path Ahead is Dimly Lit

So what about that poor horse and the incompetent blacksmith? A set of horseshoes requires six to eight nails per shoe, depending on the size of the horse, to give it secure footwear. In the apocryphal story of a kingdom lost, it took but one nail to lead to disaster, whereas in our own dismal unfolding cock-up it would seem that each foot of the horse has been compromised so much as to resemble the Friday afternoon motorcar from the assembly line.

Against a backdrop of impaired NHS resilience resulting from 10 years of under-funding, the NHS was chaotically reorganised in 2013 – the disastrous creation of a centralising and incompetent Public Health England and a downgrading of public health, epitomised by the failure to update epidemic planning guidance, not least following the revealing 2016 Exercise Cygnus.

Put simply: we began the Coronavirus crisis with four poorly crafted shoes.

The list of flawed nails makes for sad reading: a Prime Minister asleep on the watch, failing to convene and chair COBRA at the beginning of February when the impending disaster became obvious; the ensuing failure to stand back and take stock of our capacity to test for the virus and safeguard our essential workers from it; a reluctance to take proactive measures that might have headed off the epidemic at the pass or at least moderated its dynamic spread; a paternalistic approach to public engagement, openness and transparency and an antediluvian communications strategy – all underpinned by poor political leadership with an over-dependence on a narrow coterie of pet scientists, an ineffectual political opposition and dysfunctional relationships between the key players. A veritable fist full of nails.

Is there any light at the end of the tunnel?

Much is being made of the hope of a coming peak in deaths from the Coronavirus. Sadly, if such a peak comes, it may be a misleading one – coming first in those areas that were first affected, to be followed by those coming later in rippling waves and accompanied by the currently unseen outbreaks in prisons and care homes. 

The pressure for an early easing of the lockdown in these circumstances would almost certainly be a mistake. In the absence of the much vaunted ‘herd immunity’ we could look forward to further epidemic waves later in the year and of unknown severity. We still don’t understand the virus that well and there are early indications that it may not produce high antibody levels, that patients may experience relapse and that those who are asymptomatic may yet give rise to further outbreaks. What is more, simple as it is, it may mutate to produce either a more benign or a more malignant clinical disease as happened with the 1918 Spanish Flu. Such light, as there is, is currently dim.

What is a society to do under such circumstances, in which a short-term-focused political culture and concern about economic prospects give rise to pressure for immediate answers?

I believe that we must look the emergency in the face if we are to have any realistic prospect of coming through this without serious social consequences. The drift towards propaganda and authoritarianism must be halted in tandem with the testing for the virus and adequate personal protective equipment finally turning up. A genuine, all-embracing partnership must take the place of centralised control. The press and the professionals alike, who are currently being gagged, must be set free to engage in public debate. It is a hard road ahead, but there is still time to decide what shoes are best suited to the horse we all have a stake in. 

Dr John Ashton is a leading international authority on public health and a member of the Crown Prince of Bahrain’s Corona Task Force.


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