Dithering, Incompetence, Lies and Austerity: How the UK Government Failed to Tackle COVID-19: Part 2
The Outbreak in China, Onwards
Some British commentators have blamed the intransigence and dishonesty of the Chinese government for the severity of the outbreak in Britain. Some amongst the far right press even began demanding reparations, aware but not caring that the British state has long opposed reparations in principle because of how many trillions of pounds it would end up owing the hundred-odd nations of the planet it has colonised, exploited and warred with. Informing or convincing the public is not the point of such an argument. The political benefit of saying such things is that blaming China shifts scrutiny from the British Government, which ultimately bears responsibility for public health policy. Unfortunately, shining a light on China limns how unnecessarily, catastrophically lacklustre Britain’s response has been.
There is a great deal of evidence that, in addition to legitimate confusion over this particular coronavirus’ nature in the early days of its being detected in humans, the Chinese government did indeed downplay the emerging tragedy, censured incredibly brave whistle blowers, covered up failures to implement policies and manipulated figures and statistics. But the notion that this misled the Government of the UK in particular is false. The swift publication of information by Chinese researchers is testament to the experience gained after the SARS outbreak, reinvigorating as it did the value placed in rigorous scientific investigation and transparency with the rest of the world. The research conducted and published by Chinese scientists has been vital for the capacity of other nations to make ready an effective response. The UK had ample time to observe, understand and prepare for the pandemic.
Chinese scientists published a flurry of academic papers in late 2019 detailing the likely origin of the new coronavirus outbreak, its symptoms and its potentially deadly nature. By the 10th of January its genome had been sequenced and shared with the world. By the 17th of January the MRC Centre for Global Infectious Disease Analysis (MRC GIDA) of Imperial College, London, had already published a report determining that:
It is likely that the Wuhan outbreak of a novel coronavirus has caused substantially more cases of moderate or severe respiratory illness than currently reported. […] This analysis does not directly address transmission routes, but past experience with SARS and MERS-CoV outbreaks of similar scale suggests currently self-sustaining human-to-human transmission should not be ruled out.
Report 1: Estimating the potential total number of novel Coronavirus cases in Wuhan City, China
By the 24th of January there was sufficient evidence that COVID-19 was especially highly transmissible and deadly and quickly becoming an epidemic. The WHO, by this time, stated that it:
[…] assesses the risk of this event to be very high in China, high at the regional level and high at the global level.
On the same day, The Lancet published a study detailing the specific threat of the virus, followed a week later by a study analysing how it spread:
The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality.
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
Independent self-sustaining outbreaks in major cities globally could become inevitable because of substantial exportation of presymptomatic cases and in the absence of large-scale public health interventions. Preparedness plans and mitigation interventions should be readied for quick deployment globally.
Published on the 25th of the same month, MRC GIDA stated that:
Self-sustaining human-to-human transmission of the novel coronavirus COVID-19 (previously termed 2019-nCoV) is the only plausible explanation of the scale of the outbreak in Wuhan.
By this time individuals with COVID-19 were being reported across much of Asia, including South Korea, Hong Kong, Thailand, Taiwan, Macau, Japan, and in the United States of America.
By February researchers had already well-demonstrated what the world would be dealing with. A joint Chinese and WHO task force reported the necessary scale and nature of effective ‘non-pharmaceutical’ and clinical countermeasures.
Without a vaccine on the horizon, China instituted a co-ordinated and enforced lockdown on public movements in cities believed to be at risk. Vast stocks of personal protective equipment (PPE) were rolled out to prevent hospital staff from becoming infected or spreading infection and to maintain quality of care. Medical staff and resources were distributed to where they were needed most. Testing, contact tracing, monitoring, quarantining and a high level of community co-operation were indispensable in China limiting and controlling the disease. Its exact implementation varies, but contact tracing is, as explained by the ECDC:
The purpose of identifying and managing the contacts of probable or confirmed COVID-19 cases is to rapidly identify secondary cases that may arise from transmission from the primary known cases and to intervene to interrupt further onward transmission. This is achieved through:
• the prompt identification of contacts of a probable or confirmed case of COVID-19;
• providing contacts with information on self-quarantine, proper hand hygiene and respiratory etiquette measures, and advice around what to do if they develop symptoms;
• timely laboratory testing (all those with symptoms and, if resources allow, asymptomatic high-risk exposure contacts) […]
The valuable information garnered from the Chinese experience prompted the WHO-China Joint Mission to highlight the fact that:
Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans.
Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)
Whatever lies were concocted by the Chinese government, the UK had enough information to understand the threat it would be facing, months to gather the requisite resources and roll out its strategy, and a great deal of information about what it could and should be doing.
Indeed, many of the governments of other countries that had the chance to prepare seized that opportunity, and have thereby saved lives that would otherwise have been lost. Before its first death New Zealand instituted a programme based on information gathered during the aforementioned China-WHO joint mission and from subsequently infected countries, which led it to believe that the best option would be a strategy of complete elimination of the virus that focused on breaking chains of transmission, on mass testing and on contact tracing. This decision was astonishingly effective: two people are known to have died with coronavirus in New Zealand.
This elimination strategy is a major departure from pandemic influenza mitigation. With the mitigation strategy, the response is increased as the pandemic progresses and more demanding interventions such as school closures are introduced later to ‘flatten the curve.’ Elimination partly reverses the order by introducing strong measures at the start in an effort to prevent introduction and local transmission of an exotic pathogen such as COVID-19. This approach has a strong focus on border control, which is obviously easier to apply for island states. It also emphasises case isolation and quarantine of contacts to ‘stamp out’ chains of transmission. If these measures fail and there is evidence of community transmission, it then requires a major response (physical distancing, travel restrictions and potentially mass quarantines or ‘lockdowns’) to extinguish chains of transmission.
New Zealand’s elimination strategy for the COVID-19 pandemic and what is required to make it work
Singapore instituted an enviably expansive testing, contact tracing and quarantining regime. So successful was this strategy that a lockdown on businesses and schools was resisted until April, during a second wave of infections. South Korea rolled out the most comprehensive testing and contact tracing system in the world to similarly exceptional success. Both countries credit an efficient and prepared healthcare system with strict protocols at hospitals to mitigate infection, and clear messaging about social distancing.
The experience of South Korea, which managed to get its COVID-19 outbreak under control relatively efficiently, may be informative. Duk-Woo Park, MD (Asan Medical Center, Seoul, Korea), explained to TCTMD that his hospital, the largest in Korea, implemented strict infection control practices that allowed for more selective use of N95 masks. People with recent travel to a high-risk geographical area; those who had received a text message warning of close contact with a COVID-19-positive case; those who had visited any location also visited by a known COVID-19 patient; and those with fever or respiratory symptoms were not allowed access. For that reason, N95 masks were generally reserved for clinicians working in the emergency room or selective triage centers; healthcare workers in other hospital areas made do with dental masks.
‘Terrified’ Healthcare Workers Fear Lack of Protection Against COVID-19
Both Greece and Denmark were quick in instituting their lockdowns, shutting down private businesses, large gatherings and schools in an effort to keep people at home and break transmission chains.
The list goes on. Taiwan, Japan, Vietnam and Australia have also controlled the outbreak admirably. While strategies have varied, the successes from each are clear and consistent: early, widespread testing, contact tracing and quarantining are key and must be combined with closing borders promptly. Good personal hygiene and social distancing practices must be presented to the public clearly and intensively. Healthcare systems must be prepared for the outbreak with PPE, infection control protocols, resources and staff. Where the disease cannot be contained with these measures, or these measures cannot be implemented, a comprehensive lockdown of businesses, social gatherings, travelling and schools can very quickly become necessary and must be supplemented with financial and other care packages for the most vulnerable to make staying at home viable. Openness with the public is fundamental in encouraging good practice and trust.
The way in which these measures are instituted matters in protecting lives and mitigating suffering. Collectively, their cost in social and financial damage would be difficult to overstate. It takes a bold, informed and decisive leader to accept that this cost vastly outweighs the price of allowing COVID-19 to continue unchecked, or even of half-measures. It is a fact that numerous countries learned from earlier pandemics, from China’s experience, and from each other. They had that bold, informed and decisive leadership.
Despite its numerous advantages as an island nation with vast amounts of capital, with months to prepare and being home to some of the finest infectious disease research teams, the UK is in the midst of one of the very worst COVID-19 outbreaks in the world. As a consequence thousands of people have died and will continue to die who did not have to, who would not have died with bold, informed and decisive leadership. So in the time given to it, what did its leadership do?
This is part 2 of a series.
Part 1, Why the Government’s Actions Matter is here.
Part 3, The Johnson Government, or Rabbits in the Headlights is here.
Part 4, Government Timidity and Opacity Kills is here.
