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Inside an ICU in one of Britain's worst hit regions
04:05 - Source: CNN
London CNN  — 

The British government has claimed a win in its battle against coronavirus.

Health Secretary Matt Hancock asserted on Friday that it had met a headline-grabbing aim of conducting 100,000 daily Covid-19 tests by the end of April. The figure was 122,347, he said – although officials conceded that 40,369 of those were sent to people’s homes or to satellite testing centers, and had not necessarily been processed by labs.

The government argued, with some justification, that the huge expansion in testing capacity – up from 10,000 a day at the beginning of April – was a huge achievement.

But the fact that the target was needed at all, critics say, only served to illustrate the inadequacies of Britain’s testing regime in the first place.

Whether the target was hit or missed, there are other failings. The UK is on track to have one of the highest coronavirus death tolls in Europe, with more than 26,000 deaths recorded by Wednesday. Its patchwork of care homes for the elderly has been ravaged by the disease. There have been near-daily reports of insufficient personal protective equipment on the front line, meaning doctors, nurses and care home workers risk catching it every time they go to work.

The country’s leader himself contracted the disease, becoming so ill that his advisers were not completely sure that he would recover from it. At the time, daily briefings breezily proclaimed Prime Minister Boris Johnson was in “good spirits” when in fact – by Johnson’s own account later – the situation was significantly more grave.

Boris Johnson, center, is flanked by the Chief Medical Officer for England, Chris Whitty, left, and Chief Scientific Adviser Patrick Vallance at a March 12 news conference.

And, despite ministers’ repeated insistence that they are being “guided by the science” in their coronavirus response, secrecy still shrouds the nature of that scientific advice. The current membership of the Scientific Advisory Group on Emergencies (SAGE), the government’s main scientific advisory body, which changes depending on the crisis, has not been listed publicly. The group hasn’t published the basis of any of its advice for more than a month. There is, as yet, no published framework for exiting the lockdown that has brought the fifth largest economy in the world to a grinding halt.

So far, the government appears to have successfully batted away suggestions that its coronavirus strategy has been a failure by pointing to one, crucial measure of success: The country’s beloved National Health Service (NHS) has so far ridden out the crisis without being overwhelmed. The desperate scenes witnessed in northern Italy, where a world-class health system was brought to its knees, have not been repeated in the UK.

“This is an unprecedented global pandemic and we have taken the right steps at the right time to combat it, guided by the best scientific advice,” a government spokesperson told CNN, in response to a request to address the criticisms raised in this article. Ministers and officials have been “working day and night to battle coronavirus, delivering a strategy designed to protect our NHS and save lives,” the spokesperson said. “We have provided the NHS with all the support it needs, [and] made sure everyone requiring treatment has received it.”

But could more have been done to prevent the scale of loss of life? Should ministers have acted sooner? And could there be more transparency in the overall strategy?

A crucial date

Historians might look back on March 12 as the most significant date in Britain’s coronavirus response. This was the day the UK formally abandoned the “contain” phase – an attempt to stop the virus in its tracks by tracking every outbreak and tracing its origins; and moved to the “delay” phase – an effort to “flatten the curve” and prevent the health service from being overloaded.

On that day Johnson stood before journalists, flanked by his scientific and medical advisers, and admitted that “many more families are going to lose loved ones.” But he didn’t go as far as ordering a lockdown – that would come over a week later.

Ths stands were packed during day four of the Cheltenham Festival on March 13. (Tom Jenkins/Getty Images)

As he spoke, tens of thousands of people gathered at the Cheltenham racecourse for its annual festival, an early fixture in England’s social calendar. Was that wise, he was asked? “It is very important that we’re guided by the science,” Johnson said, using a phrase that was to become a favorite of government ministers. “There is very little epidemiological or medical reason at the moment to ban such events.”

Johnson’s chief medical officer, Professor Chris Whitty, admitted that even people with “really quite mild symptoms” could be contagious. Despite this, the chief scientific adviser, Patrick Vallance, agreed with Johnson that canceling large events was “not a major way to tackle this epidemic.”

Indeed, the next day, Vallance told BBC Radio 4’s flagship morning news program, in a now-infamous interview, that a “key” aim would be to “build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission.” Government sources have told CNN that herd immunity was never official policy.

On March 23, in a televised address to the nation, Johnson switched course, announcing the most sweeping set of social restrictions in the UK since the end of World War II. By that time, 335 people had died from Covid-19 in the UK. Given the weeks-long gap between initial infection and death, it’s clear now that by the time Johnson spoke, coronavirus had taken hold in Britain.

Three key questions

Critics are zeroing in on three key areas as they seek to find out what went wrong in the UK.

First, there was the abandonment of mass testing.

At the start of the outbreak in the UK, public health officials tracked and traced every known case. Ministers have never offered a clear reason for why that policy was abandoned. Was it because the testing capacity had been reached? Was it because the system could not cope with the expected upturn in demand? Was it structural, since the public health system in England has, over the years, gradually been centralized?

“Abandoning testing gave the virus the green light to spread uncontrollably,” says the Royal Society of Medicine’s Gabriel Scally. “If you don’t have access to testing, you won’t know that you have an outbreak until a lot of people are ill.”

Some in the scientific community say an obsession with central control led officials to set up the testing regime initially in just a few labs, rather than allowing local hospitals to do it themselves.

“Sadly, it seems likely to me that once the government models showed how bad the crisis would be, our testing capacity wouldn’t be anywhere near able to cope with the coming surge,” a leading microbiologist told CNN on condition of anonymity to describe confidential discussions. “God only knows what their thinking was not telling hospitals to get ready. It was a mistake.” Downing Street declined to provide an on-the-record explanation to CNN on this issue.

The second crucial question is whether the government failed to order a lockdown early enough.

Even though the government did not know by that March 12 briefing just how many people were infected, Whitty said it was still too early to lock down because “if people go too early, they become very fatigued.” If tough restrictions came too early, the theory went, the British public would begin to tire of it just as they were starting to become effective, and demands for them to be lifted would become impossible to resist.

Government sources defended that course of action to CNN, pointing out that some mitigation measures were put in place between March 12 and the full lockdown on March 23, like advising vulnerable groups to stay at home and requiring people with certain symptoms to self-quarantine.

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

The third big question is the pursuit of so-called “herd immunity.”

“It’s not possible to stop everybody getting it,” said Vallance at the March 12 briefing. However, the experience of countries like South Korea and Germany, where testing and tracking systems have been significantly more rigorous, and in New Zealand, where lockdown measures were taken at a much earlier stage, suggest that it has been possible to stop quite a large number of people from getting it.

Medical experts both inside and outside the government’s circle of trusted advisers have admitted to CNN that they believe the government waited too long to enter lockdown. “Many of the decisions the government has made ignore basic public health science,” says Dr. Bharat Pankhania, senior clinical lecturer at University of Exeter. “From abandoning track and trace, to the timing of the lockdown, to providing the correct protective equipment, ignoring basic public health science may have led to more deaths than necessary.”

Pankhania believes that despite government claims it has been guided by science at every step, the decision to delay lockdown was likely “governed by economic consideration, rather than public health science.”

This conflict between the government’s claim that it has followed the science from day one, and some in the scientific community’s skepticism as to how good that evidence is, has become a key battlefield between those inside and outside the UK government.

Following the science

One of the most controversial decisions during this crisis has been to keep private the membership of the SAGE, and not to publish minutes of its meetings, in a departure from standard operating procedure for almost all other UK advisory groups. “I don’t personally understand why,” said Peter Openshaw, an immunologist who sits on the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), a panel that advises SAGE.

This secrecy has led to speculation from prominent members of the public health community about the quality and breadth of evidence that is reaching the top levels of government. “The government’s decisions show no characteristics of public health input. I wouldn’t be surprised if the public health voice was marginalized both within SAGE and in government,” says Scally, of the Royal Society of Medicine.

It’s “driving the public health guys mad,” said another scientist who has contributed to the UK’s 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 has been that the government has at times even sidestepped the normal groups of scientific advisers. “Things are moving so fast that they’re rather going direct to the modelers,” said Openshaw. “The epidemiological modelers have got a very direct line into government.”

However trivial it might seem, disagreements between public health experts and scientific modelers are a significant part of the story. “We’re seeing a struggle that has been going on for about 20 years between modelers and epidemiologists,” a scientist who advises SAGE told CNN on the condition of anonymity to discuss confidential government business.

It’s no secret that Dominic Cummings, Johnson’s top adviser, has a personal interest in scientific modeling. So it’s little surprise that public health experts were enraged when the government was forced to admit last week that Cummings had attended SAGE meetings, which are supposed to be independent advisory forums. The government said he attended in order to understand the scientific debate around the virus and its behavior.

Multiple members of SAGE and groups that advise it defended their impartiality to CNN. “The debate is robust, and everyone sets out their case clearly and articulately,” said one member, requesting anonymity to discuss sensitive matters. “There are lots of people criticizing from the sidelines, but I think it’s possible those people are angry they have been left on the sidelines.”

A source who advises SAGE said: “Frankly, I find it hard to see that the presence of Cummings makes much difference. We’re not talking about shrinking violets.”

However, the source went on to express concern at how scientific evidence is being presented. “Science is not homogenous… The best SAGE can do is present imperfect material. The government has been able to take advantage of the public view of science as a voice of certainty, and present some of its decisions as being taken with more concrete certainty than they have.”

This has prompted fears that at some time in the future, the government might try hiding behind the science for decisions they’ve taken – or worse, throw members of SAGE under a convenient bus. “It certainly does seem to be an anxiety of some of my colleagues, but I am less worried. Many politicians are not exceptional thinkers. Should a public inquiry come, I would be surprised if it’s the scientists who do a bad job of making their case,” said a member of SAGE.

What next?

That public inquiry seems inevitable, once the worst of the crisis is over.

And when it comes, the government will stick to its line that the decision to prioritize the protection of the NHS was the right course of action, and that it succeeded. While it’s true the NHS didn’t fall over during what look like the worst weeks of the crisis, a cynic might claim that focusing on hospitals ignored what was happening in the wider community.

“People might well reply that it protected the NHS at the expense of shifting deaths elsewhere. Not to mention the physical and mental suffering experienced across the country,” said one of the scientists advising SAGE.

In the short term, the government is under pressure to tell the public how lockdown will end. It will not simply be a matter of easing social distancing measures.

Pankhania says the government must not be too influenced by economic pressures to bring back normality. “It is important to note that economics can be rebalanced, but lives lost cannot be bought back.” He stresses that even if lockdown is lifted, the government must be prepared to “shut it down again.”

Robert Dingwall, professor of social science at Nottingham Trent University and a member of NERVTAG, says: “The biggest challenge for the government is levels of fear and anxiety in the general population, which may make people reluctant to go along with the release from lockdown.”

The UK’s coronavirus story has been dramatic, even by international standards. While Johnson was off sick, legitimate questions concerning his government’s handling of the pandemic were asked with few satisfactory answers from those stepping in to fill his shoes.

Johnson’s inner circle hope his return to work will bring about a refreshed sense of energy and urgency. But many irreversible key decisions have already been made. When, how and why will determine the next phase of this story – and how successful Johnson’s government was when facing the nation’s worst crisis in decades.

This article has been updated to reflect the most recent testing figures.