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How the Alarm Went Off Too Late in Britain’s Virus Response

Britain had time. Academics, disease specialists and critics say the prime minister wasted it.

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Boris Johnson and Rishi Sunak leave a news conference addressing the government’s response to the coronavirus outbreak on March 17.

Photographer: Matt Dunham/AFP via Getty Images

On Monday, March 16, a secretive group of Britain’s top scientists, health experts and government officials gathered to discuss the unfolding coronavirus pandemic. They knew they had a problem.

For days, Prime Minister Boris Johnson had brushed aside a crescendo of calls from politicians and academics to close the country’s more than 30,000 schools. He had repeatedly refused, insisting that the scientific advice he was so publicly heeding showed such disruption wasn’t necessary.

But shocking new data modelling presented to those gathered in the gray government offices on London’s Victoria Street suggested the policy needed to change—and fast.

For two hours over takeaway cups of coffee, the members of the Scientific Advisory Group for Emergencies debated the evidence showing transmission between children, parents and teachers was higher than they thought. Moreover, radical social distancing—the lockdown measures being put in place across much of Europe—would be needed very soon.

In that tense meeting, though, the concern was political. Among those present were Chris Whitty, the chief medical officer for England, and Patrick Vallance, the government’s most senior scientific adviser. Flanking Johnson at press conferences broadcast live, they had become the public faces of Britain’s war with Covid-19. They agreed it was the right time to pursue the U-turn on school closures, though worried about a loss of credibility.

Daily Coronavirus News Conference From U.K. Government
Boris Johnson, center, with chief medical officer Chris Whitty, left, and lead science adviser Patrick Vallance at a daily coronavirus briefing on March 19.
Photographer: Leon Neal/Getty Images

Now at the peak of the outbreak, the U.K. has just recorded its highest weekly death toll in 20 years and is failing in its hope of keeping fatalities below 20,000. Some university models suggest the U.K. could well experience the highest in-hospital death toll in Europe.

Amid shortages of vital medical kit, the government even sent a military plane to Turkey to bring back protective clothing for health workers. Johnson remains off work, recovering after the Covid-19 infection he caught a month ago left him fighting for his life in intensive care.

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The initial decision to delay closing schools is just one chapter in the story of the British response to the pandemic that Johnson’s critics say was far too slow. The government waited longer than many countries before deciding to shut restaurants, bars and stores and banish people to their homes. While other countries chased down every case of infection they could find, Johnson’s administration failed in its attempt to test the population and track the spread of the virus.

It’s too early to fully judge the success or failure of efforts to tackle the pandemic, and despite starting out behind in capacity compared with other countries, the National Health Service is coping with the surge in cases so far. A government spokesperson said it took the appropriate action when needed and was driven by the scientific advice.

Yet what is clear is that Britain had time. According to specialists, academics and Johnson’s political opponents, he wasted it. They say an opportunity was missed in February to stock up on vital equipment when the international competition was less fierce. And then, over the course of a critical period in March, the virus got away from the people running the country.

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Health workers transfer a patient from an ambulance into The Royal London Hospital on April 18.
Photographer: Daniel Leal-Olivas/AFP via Getty Images

Even though they knew the infection was spreading unchecked in the community, it was still more than a week before the government shut the pubs and schools, and 11 days before the fuller lockdown was brought in.

“We closed down too late—that’s clear from the maths,” said Martin McKee, professor of European public health at the London School of Hygiene & Tropical Medicine, who is advising the World Health Organization on the pandemic. “English exceptionalism has been really damaging.”

Based on minutes from parliamentary committee hearings, conversations with senior government ministers and officials, data comparisons with other countries and conversations with virus experts and doctors, this article charts the opportunities that were missed to prepare for the worst and prevent the spread of the disease.

At the start of the year, the official message from Johnson’s government was that the new illness taking hold in China was nothing to worry about. All the political focus was on Britain finally completing its tortuous departure from the European Union after more than three years of wrangling.

“The whole of the U.K. is always well prepared for these types of outbreaks,” Health Secretary Matt Hancock told the House of Commons on Jan. 23, as China moved to quarantine its most-affected region. Government officials had just raised the risk to the population to “low” from “very low.”

The U.K. for weeks looked out of sync with the rest of Europe in trying to keep life as normal. After a conference call on Feb. 21, the day Italy reported its first death, Public Health England put the risk at “moderate.” Not everyone was so relaxed. John Edmunds, a professor of epidemiology at the London School of Hygiene & Tropical Medicine, emailed the group after to say it should be raised to “high.”

One senior emergency medicine doctor at Hillingdon Hospital in west London, Meng Aw-Yong, said he was already dealing with infected patients around that time. He looked at the X-ray of one case and realized in retrospect it was coronavirus, he said.

“I was seeing Covid patients without realizing,” said Aw-Yong, who has 28 years of experience and is also a medical director for the Metropolitan Police. “If I was seeing Covid being unprotected, and he was spreading it around, we missed the opportunity. I would have been exposed. His friends and family would have been exposed. Somewhere we lost the opportunity to grip this early on.”

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Racegoers attend the final day of the Cheltenham Festival on March 13.
Photographer: GLYN KIRK/AFP

Yet the March 10-13 Cheltenham Festival, an annual horse racing meet, drew 250,000 attendees just after Italy imposed a national quarantine. A Champions League soccer match between Liverpool and Atletico Madrid was watched by 50,000 fans on March 11, the day the WHO declared Covid-19 a pandemic.

The government’s view was that people were more likely to catch the virus watching sports in a confined space such as a pub than in the open air. There was no national lockdown until March 23.

“As soon as it happened in China, there should have been an awareness that we needed to move swiftly,” said David King, the government’s chief scientific adviser from 2000 to 2007. “The actions should have been: get the ventilators in, get the protective gear in for the medical staff and we should have also got going on delivering the tests.”

Johnson encapsulated the British “keep calm and carry on” approach with his instruction to “wash your hands” while singing “Happy Birthday” twice. At the beginning of March, the 55-year-old premier proudly boasted of “shaking hands with everybody” during a visit to a hospital with coronavirus patients, while washing his hands regularly. On April 6, he was admitted to intensive care after failing to shake off the virus.

By March 12, Johnson’s tone had fundamentally changed. He somberly addressed the nation from the wood-paneled state dining room inside 10 Downing Street to say it was now too late to stop Covid-19 taking hold and claiming many lives. The only hope was to slow its spread and avoid the catastrophe of hospitals being overwhelmed.

That day marked the moment the government gave up trying to contain coronavirus and instead moved into what officials termed the “delay” phase of its response plan. The government also gave up attempts to test the wider population. Speaking alongside Johnson, Whitty said testing in the community was no longer the priority and efforts would instead focus on confirming the infection in patients in hospitals.

UK In Fifth Week Of Coronavirus Lockdown
A woman wearing a face mask walks past a piece of street art depicting an NHS worker, in London, on April 21.
Photographer: Andrew Redington/Getty Images Europe

The next day, Vallance provoked an outcry by suggesting the government’s aim was to acquire “some degree of herd immunity,” in which as much as 60% of the population—40 million people—would become infected. The government now insists herd immunity was never official policy, but on the same day that Vallance made his explosive remark, Hancock’s actions suggested otherwise.

The health secretary dialed into a conference call for Group of Seven countries as governments across the world sought to coordinate their responses and share their experiences. Hancock asked the Italian representative if Italy was also working on a herd immunity plan.

The Italian representative was blunt: Allowing the virus to run riot would result in thousands of excess deaths and there was way too much uncertainty about the nature of the virus to be sure that such a gamble would even work. Hancock was shocked. The damage was done. Medical experts accused Johnson of failing to act soon enough.

Dropping widespread testing ran counter to WHO advice, and experience elsewhere. In South Korea, where contact tracing is in place, the government managed to contain the outbreak to a much lower level than in most European nations. By halting the tracing of people in the U.K. who had contact with patients who had tested positive, those without symptoms were able to keep spreading the virus.

Three days after Hancock’s G-7 call came the loudest alarm bell of all. On March 16, a team at Imperial College London, led by researcher Neil Ferguson, warned that Britain could face 250,000 deaths, with the health service inundated, if it did not take more aggressive steps to suppress the virus.

That day, the Scientific Advisory Group for Emergencies, known as SAGE and whose members and minutes aren’t disclosed publicly, met in London to decide on school closures and wider lockdown measures.  

Johnson ordered the first phase of social distancing, telling the public to work from home where possible and not to meet friends in pubs and restaurants. The virus was spreading far faster than expected. The U.K. did not have the time it thought it had.

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A government sign advising people to “Stay Home, Protect the NHS, Save Lives” is displayed on the advertising boards in Piccadilly Circus in London on April 13.
Photographer: Glyn Kirk/AFP via Getty Images

By now it was clear: the decision announced four days earlier to abandon wide testing left the U.K. with a huge problem.

“I think we need a big increase in testing, and that is what I am pushing for very hard,” Vallance told a Parliamentary committee on March 17. Johnson himself conceded the point two days later when he promised an improbable 250,000 tests a day, without setting a target date.

Why did the U.K. give up on testing in the community, in another move that defied all the mainstream international advice? Vallance told the committee that testing capacity, at 4,000 a day, was “clearly not going to be enough going forward.” Efforts needed to be focused on those most seriously ill in hospital.

Scientists already believed there were thousands of cases they didn’t know about, rendering contact tracing a lost cause.

“This is an unprecedented global pandemic and we have taken the right steps at the right time to combat it, guided at all times by the best scientific advice,” a government spokesperson said in response to questions on the handling of the crisis. “From mid-January, the government’s scientific advisory groups started to meet to grip the emerging threat.”

On March 27, the virus struck at the top of the British government. Johnson and Hancock both announced that they had tested positive and were self-isolating. Whitty said he too was in quarantine with symptoms, though he had not taken a test.

In Johnson’s case, the infection became severe. A little over a week later, he was in hospital and then taken to intensive care and given oxygen treatment to help him breathe. The disease could have gone either way, he said later, as he thanked the medics who saved his life.

On April 2, Hancock emerged from self-isolation to find a government in disarray. Without leadership, the cabinet was losing control of the narrative, and the politically toxic question of failures on testing were growing louder.

According to one person familiar with the matter, Hancock hatched a plan to get back on the front foot. He would pledge 100,000 tests a day by the end of April. That target unleashed another controversy.  

Johnson’s team was unhappy, the person said. They warned Hancock’s allies against setting such a lofty target, fearing the government would be castigated if it failed to deliver. Hancock pressed ahead. Another person involved questioned this version of events, blaming Johnson’s office for setting what at the time looked likely to be an impossible target.

NHS Nightingale Hospital Is Officially Opened To Treat Coronavirus Patients
Matt Hancock stands on a social distancing mark at the opening of the NHS Nightingale Hospital at the ExCel centre in London on April 3.
Photographer: Stefan Rousseau - WPA Pool/Getty Images

Despite weeks of political pressure and frantic efforts from ministers to make amends for what they conceded was an inadequate testing regime, the picture is slowly improving.

The U.K. had tested 425,821 people as of April 23, of whom 138,078 came back positive. That’s only marginally more in total than Germany has been conducting on a weekly basis. On April 22, 23,560 tests were carried out in Britain, up from the day before. The death toll stood at 18,738, not including those dying in care homes.

Hancock said on Thursday testing capacity is on track to reach 100,000 by the end of next week, and he expanded the list of people eligible to get them to all key workers in an effort to match demand to capacity.

The main challenge has been to increase the capabilities of laboratories to produce them, unlike Germany, which has a decades-old relationship with an established diagnostics industry, according to two government officials. It’s “breakneck speed logistics,” one of them said.

Yet private laboratories were offering to help and getting no response, said McKee at the London School of Hygiene & Tropical Medicine. “One problem with testing is Public Health England has insisted on doing it itself,” he said. “Lots of veterinary and university laboratories and others in the private sector offered their services but no one got back to them.”

For sure, Britain is competing with countries around the world to gather the resources needed and has blamed a shortage of chemical reagents for the slow progress in boosting the test capacity. As part of its effort to ramp up testing in April, the government has engaged laboratories, universities and industry.

One minister involved in the response conceded that mistakes have been made, though pointed to the pressures of decisions that need to be taken instantly, without sufficient data or time to weigh up options. “You have to do it on instinct,” the person said.

Boris Johnson's Government Faces First Political Test of Lockdown
A protester stands outside the gates of Downing Street in London, on April 22.
Photographer: Hollie Adams/Bloomberg

But as the pandemic accelerated, more deficiencies became clear and the government was left scrambling to catch up. Professional medical representatives warned that the crisis exposed a clear dearth of critical care nurses. Ministers heaped praise on former doctors and nurses for coming out of retirement to help.

The government began trying to order more supplies in late January and February, though many medics on the front line still do not have the equipment they need. The government says it’s now delivered more than 1 billion pieces of personal protective clothing, such as face masks and gowns, but acknowledges that distributing it more widely than hospitals has been a logistical challenge. 

Austerity since the financial crisis has also taken its toll. The number of doctors, nurses, beds and scanners were all below the European average after a decade when health-care spending rose 1.3% a year in real terms in the U.K. compared with annual growth of 6% in the preceding 13 years.

Lagging Behind

Source: Organisation for Economic Co-operation and Development

Hancock says Britain now has 12,000 ventilators to help the worst-affected patients breathe, compared with 6,600 before the pandemic struck. Data from health ministries show that other countries were better prepared.

Germany had about 28,000 ICU beds with ventilators prior to the coronavirus crisis, and that’s risen to about 30,000. Italy, the first European country to bear the brunt of the pandemic, had about 18,300 ventilators in public and private hospitals combined before the crisis struck.

The British government initially estimated it needed 30,000 ventilators to deal with the peak of the pandemic, and Johnson held a call with manufacturers on March 16 asking them to make thousands within a month. Responses came from Airbus, Siemens, Nissan, Dyson and Babcock among others.

A month later, a modified machine made by Penlon Ltd., which already worked in the field, received approval after an expedited process, but the volume sought by the government hasn’t been delivered.

The good news is that although the U.K. is forecast to have the highest number of deaths in Europe, the rise in cases is slowing, suggesting projections could be revised downward. Demand for ventilators hasn’t exceeded capacity.

Yet by the time Johnson imposed the lockdown, on March 23, the U.K. had recorded 335 deaths, fewer than the 463 toll in Italy when it ordered its quarantine, though more than three times the number of fatalities in France (91) and Germany (94) when they told people to stay at home.  

The delay in imposing distancing measures hurt the U.K., along with the fact that London is a busy international metropolis, said Ali Mokdad, a professor at the University of Washington’s Institute for Health Metrics and Evaluation.

“The delay in retrospect was a mistake,” Mokdad said. “It’s like a deck of cards, and you have to play the cards you are dealt. Yes, England is at a disadvantage being a hub for business and with people coming from everywhere, but then you have to be more aggressive with restrictions.”

Social Distancing As U.K. Coronavirus Deaths Increase
Customers use social distancing markers as they stand in line to enter a supermarket in London, on April 4.
Photographer: Simon Dawson/Bloomberg

The government won quick praise for its financial response to help struggling businesses and households as the economy went into freefall. A poll published by YouGov Plc last week revealed that 68% of Britons thought that the leadership was handling the coronavirus outbreak well. 

But with Johnson still recovering at his country retreat—Hancock said on Friday he was “raring to go”—a leaderless government has extended the lockdown with no end in sight. That doesn’t stop ministers clashing over the best way forward. Some fear the economic damage will far outweigh the health benefits of prolonging the restrictions.

The scientists also are well aware their own judgments are under the microscope. Johnson and his team have insisted the government is following all scientific advice—but in recent days the experts themselves have been at pains to point out that it is the politicians who are responsible for taking all the final decisions.

Worst Since 1709

The U.K. economy could shrink 13% this year if the lockdown persists

Source: OBR, BOE, ONS

OBR scenario assumes lockdown remains in force for three months

One minister, who declined to be identified when discussing internal politics, said the lockdown had worked too well for the health of the economy. “The problem is that compliance with the rules has been too much,” the minister said. “We didn’t say ‘don’t work.’ We said ‘stay home, but work away from home if you can’t work at home.’”

Having been attacked for acting too late, Johnson himself is now reluctant to ease the social distancing measures, fearing that moving too soon could unleash a devastating second wave that would overwhelm the NHS. Whether guided by the science or not, the political risk of such a second peak might prove too great.

In London, emergency doctor Aw-Yong said the worst of the outbreak looked “much like a war zone.” He saw five or six Covid-19 deaths a day on his shift. “They can’t see their relatives. They can’t speak to anybody. That must be such a horrible way to die.”

— With assistance by Kitty Donaldson, Eric Pfanner, Joe Mayes, and Andrew Atkinson