Where is UK error for coronavirus?

Health Secretary Matt Hancock reiterated on Friday that his party had fulfilled the main goal of conducting 100,000 Covid-19 tests every day at the end of April. The number is 122,347, he said – although officials admit that 40,369 of them were sent to people’s homes or to satellite testing centers, and were not necessarily processed by laboratories.

The government argues, with some justification, that a large expansion in testing capacity – up from 10,000 per day in early April – is a big achievement.

But the fact that the target is needed at all, critics say, only serves to illustrate the inability of the British testing regime in the first place.

The country’s leader himself contracted the disease, became so ill that his advisers were not entirely sure that he would recover from it. At that time, the daily briefing which blatantly proclaimed Prime Minister Boris Johnson was in “good spirits” when in reality – by Johnson’s own account later – the situation was significantly more serious.

And, although ministers repeatedly insisted that they were “guided by science” in their response to the corona virus, secrecy still enveloped the nature of scientific advice. Current Scientific Advisory Group Membership for Emergencies (SAGE), the government’s main scientific advisory body, which changes depending on the crisis, has not been publicly registered. The group has not yet published the basis of its recommendations for more than a month. Until now, no framework has been issued to break out of the lock that has stopped the world’s fifth largest economy.

So far, the government seems to have dismissed the notion that its coronavirus strategy has failed by pointing to one, crucial measure of success: the National Health Service (NHS) loved in the country has so far managed to overcome the crisis without being overwhelmed. The scene of despair witnessed in northern Italy, where the world-class health system is bent on its knees, has not been repeated in England.

“This is an unprecedented global pandemic and we have taken the right steps at the right time to fight it, guided by the best scientific advice,” a government spokesman told CNN, in response to a request to overcome the criticisms raised in this article. . Ministers and officials have “worked day and night to fight the corona virus, providing strategies designed to protect our NHS and save lives,” the spokesman said. “We have provided the NHS with all the support needed, [and] make sure everyone who needs treatment receives it. “

But could more have been done to prevent the scale of death? Should the ministers act faster? And can there be more transparency in the overall strategy?

Important date

Historians might look back on March 12 as the most significant date in the British coronavirus response. This is the day the UK officially leaves the “contain” phase – an effort to stop the virus by tracking every outbreak and tracing its origin; and move to the “delay” phase – efforts to “level the curve” and prevent overloaded health services.

On that day Johnson stood in front of the journalists, flanked by his scientific and medical advisors, and acknowledges that “more families will lose loved ones.” But he doesn’t go as far as ordering a lockdown – which will come a week later.

This stand was packed on the fourth day of the Cheltenham Festival on March 13. (Tom Jenkins / Getty Images)

As he spoke, tens of thousands of people gathered at the Cheltenham racetrack for his annual festival, the initial schedule on the British social calendar. Is that wise, he asked? “It’s very important that we are guided by science,” Johnson said, using a phrase that would be a favorite of government ministers. “There are very few epidemiological or medical reasons at this time to ban such events.”

Johnson’s chief health officer, Professor Chris Whitty, acknowledged that people with “very mild symptoms” can be contagious. Nonetheless, the chief scientific adviser, Patrick Vallance, agreed with Johnson that canceling major events was “not the main way to overcome this epidemic.”

Indeed, the following day, Vallance told BBC Radio 4’s main news program in the morning, in an interview that is now well known, that the “key” goal was to “build up a kind of herd immunity so that more people are immune to this disease and we reduce transmission. “Government sources told CNN that group immunity is never an official policy.

On March 23, in a televised address to the country, Johnson switched directions, announcing the most extensive set of social restrictions in Britain since the end of World War II. At that time, 335 people had died of Covid-19 in England. Given the long gap between initial infection and death for weeks, it is clear now that by the time Johnson spoke, coronaviruses had survived in England.

Three key questions

Critics focus on three main areas when they find out what is wrong in Britain.

First, there is the abandonment of mass testing.

At the start of the outbreak in the UK, public health officials tracked and tracked every known case. The ministers never offered a clear reason why the policy was abandoned. Is that because the testing capacity has been reached? Is that because the system cannot cope with the expected increase in demand? Is this structural, because the public health system in the UK has, over the years, been gradually centered?

“Abandoning testing gave the green light the virus to spread uncontrollably,” said Gabriel Scally of the Royal Society of Medicine. “If you don’t have access to testing, you won’t know that you have a plague until many people are sick.”

Some in the scientific community say that the obsession with central control led officials to set up a testing regime initially only in a few laboratories, rather than letting local hospitals do it themselves.

“Sadly, it seems to me that once the government model shows how bad the crisis is, our testing capacity will not be close to being able to overcome the impending surge,” a leading microbiologist told CNN on condition of anonymity to explain confidential discussions. “God only knows what they are thinking, who didn’t tell the hospital to get ready. That was a mistake.” Downing Street declined to provide CNN with an on-the-record explanation of the problem.

The second crucial question is whether the government failed to order closure earlier.

Although the government did not know on March 12 that it gave a briefing on how many people were infected, Whitty said it was still too early to lock in because “if people leave too early, they become very tired.” If severe restrictions come too early, according to the theory, the British public will start to get bored when they start to be effective, and demands that they be lifted will be impossible to reject.

Government sources defended the action to CNN, pointing out that some mitigation measures were enacted between March 12 and full closure on March 23, such as advising vulnerable groups to stay at home and requiring people with certain symptoms to quarantine themselves.

The British government ordered a full closure on March 23. (Victoria Jones / PA / AP)

The third big question is to pursue what is called “herd immunity.”

“It is impossible to stop everyone from getting it,” Vallance said at the March 12 briefing. However, the experience of countries such as South Korea and Germany, where the testing and tracking system is significantly more stringent, and in New Zealand, where locking steps are taken at a much earlier stage, shows that it is possible to stop large enough. the number of people who get it.

Medical experts both inside and outside the government’s trusted advisory circle have admitted to CNN that they believe the government is waiting too long to get locked up. “Many decisions taken by the government ignore basic public health sciences,” said Dr. Bharat Pankhania, senior clinical lecturer at the University of Exeter. “From leaving traces and traces, to locking times, to providing the correct protective equipment, ignoring basic public health sciences may have caused more deaths than necessary.”

Pankhania believes that although the government claims to have been guided by science at every step, the decision to delay locking is likely “governed by economic considerations, not public health science.”

The conflict between the government’s claim that it has followed science since day one, and some people in the scientific community’s skepticism about how good the evidence is, has become the main battleground between those inside and outside the British government.

Follow science

One of the most controversial decisions during this crisis was maintaining the confidentiality of SAGE membership, and not publishing the minutes of its meeting, in deviation from standard operating procedures for almost all other British advisory groups. “I personally don’t understand why,” said Peter Openshaw, an immunologist sitting there New and Emerging Respiratory Virus Threat Advisory Group (NERVTAG), a panel that recommends SAGE.

This secrecy has led to speculation from prominent members of the public health community about the quality and breadth of evidence that reaches the top levels of government. “The government’s decision does not show the characteristics of public health input. I would not be surprised if the voice of public health is marginalized both at SAGE and in government,” said Scally, from the Royal Society of Medicine.

This “drives health people crazy,” said another scientist who has contributed to the UK National Risk Register, an overview of the potential threats facing the UK.

Signs supporting the National Health Service have been displayed by an artist in east London. (Matt Dunham / AP)

Another criticism of the process is that the government sometimes even overrides the normal group of scientific advisers. “Things are moving so fast that they will go directly to the modelers,” Openshaw said. “Epidemiological modelers have had a direct relationship with the government.”

But it seems trivial, the disagreement between public health experts and scientific modelers is an important part of the story. “We see a struggle that has been going on for about 20 years between modelers and epidemiologists,” a scientist who suggested SAGE told CNN on condition of anonymity to discuss the government’s secret business.

It’s no secret that Dominic Cummings, Johnson’s chief adviser, has a personal interest in scientific modeling. So it is not surprising that public health experts were angry when the government was forced to admit last week that Cummings had attended the SAGE meeting, which was supposed to be an independent advisory forum. The government says he is here to understand the scientific debate about the virus and its behavior.

Many SAGE members and groups suggested that they defend CNN’s impartiality. “The debate is strong, and everyone explains their case clearly and clearly,” said one member, asking for anonymity to discuss sensitive issues. “There are many people who criticize from the sidelines, but I think maybe those people are angry because they were left on the sidelines.”

A source who suggested SAGE said: “Frankly, I find it hard to see that the presence of Cummings makes a lot of difference. We are not talking about violet shrinkage.”

However, sources continue to express concern about how scientific evidence is presented. “Science is not homogeneous … The best that SAGE can do is present imperfect material. The government has been able to take advantage of the public’s view of science as a voice of certainty, and present some of its decisions as being taken more concretely. Certainty than they have. “

This raises the concern that at some time in the future, the government might try to hide behind science for the decisions they have taken – or worse, throwing SAGE members under a comfortable bus. “It seems to be a concern for some of my colleagues, but I am less worried. Many politicians are not extraordinary thinkers. If a public inquiry comes in, I will be surprised if scientists do a poor job in making them cases,” said a member of SAGE.

What is next?

The public investigation seemed inevitable, once the worst crisis was over.

And when that arrives, the government will stay in line that the decision to prioritize NHS protection is the right course of action, and it works. While it is true that the NHS did not fall during the worst weeks of the crisis, a cynic might claim that focusing on hospitals ignores what is happening in the wider community.

“People might answer that it protects the NHS by sacrificing death elsewhere. Not to mention the physical and mental suffering experienced throughout the country,” said one of the scientists who advised SAGE.

In the short term, the government is under pressure to tell the public how the closure will end. It’s not just a matter of easing social distance.

Pankhania said the government should not be too influenced by economic pressure to restore normality. “It is important to note that the economy can be rebalanced, but lost lives cannot be bought back.” He stressed that even if the lockdown is revoked, the government must be prepared to “close it again.”

Robert Dingwall, professor of social sciences at Nottingham Trent University and member of NERVTAG, said: “The biggest challenge for the government is the level of fear and anxiety in the general population, which can make people reluctant to follow the release of the lockout.”

The story of the British coronavirus has been dramatic, even by international standards. When Johnson was sick, legitimate questions about the handling of a pandemic by his government were raised with a few satisfying answers from those who entered to fill shoes.

Johnson’s inner circle hopes that the return to work will bring a fresh sense of energy and urgency. But many important decisions that cannot be changed have been made. When, how and why will determine the next phase of this story – and how successful the Johnson government has been when facing the country’s worst crisis in decades.

This article has been updated to reflect the latest testing figures.