By Stephen Grey and Andrew MacAskill
LONDON, April 7 (Reuters) - It was early spring when British
scientists laid out the bald truth to their government. It was
"highly likely," they said, that there was now "sustained
transmission" of COVID-19 in the United Kingdom.
If unconstrained and if the virus behaved as in China, up to
four-fifths of Britons could be infected and one in a hundred
might die, wrote the scientists, members of an official
committee set up to model the spread of pandemic flu, on March
2. Their assessment didn't spell it out, but that was a
prediction of over 500,000 deaths in this nation of nearly 70
million.
Yet the next day, March 3, Prime Minister Boris Johnson was
his cheery self. He joked that he was still shaking hands with
everyone, including at a hospital treating coronavirus patients.
"Our country remains extremely well prepared," Johnson said
as Italy reached 79 deaths. "We already have a fantastic NHS,"
the national public health service, "fantastic testing systems
and fantastic surveillance of the spread of disease."
Alongside him at the Downing Street press conference was
Chris Whitty, the government's chief medical adviser and himself
an epidemiologist. Whitty passed on the modelling committee's
broad conclusions, including the prediction of a possible 80%
infection rate and the consequent deaths. But he played them
down, saying the number of people who would be infected was
probably "a lot lower" and coming up with a total was "largely
speculative."
The upbeat tone of that briefing stood in sharp contrast
with the growing unease of many of the government's scientific
advisers behind the scenes. They were already convinced that
Britain was on the brink of a disastrous outbreak, a Reuters
investigation has found.
Interviews with more than 20 British scientists, key
officials and senior sources in Johnson's Conservative Party,
and a study of minutes of advisory committee meetings and public
testimony and documents, show how these scientific advisers
concluded early the virus could be devastating.
But the interviews and documents also reveal that for more
than two months, the scientists whose advice guided Downing
Street did not clearly signal their worsening fears to the
public or the government. Until March 12, the risk level, set by
the government's top medical advisers on the recommendation of
the scientists, remained at "moderate," suggesting only the
possibility of a wider outbreak.
"You know, there's a small little cadre of people in the
middle, who absolutely did realise what was going on, and likely
to happen," said John Edmunds, a professor of infectious disease
modelling and a key adviser to the government, known for his
work on tracking Ebola. Edmunds was among those who did call on
the government to elevate the warning level earlier.
From the outset, said Edmunds, work by scientists had shown
that, with only limited interventions, the virus would trigger
an "overwhelming epidemic" in which Britain's health service was
not going "to get anywhere near being able to cope with it. That
was clear from the beginning."
But he said: "I do think there's a bit of a worry in terms
you don't want to unnecessarily panic people."
Johnson, who himself has sickened with the virus, moved more
slowly than the leaders of many other prosperous countries to
adopt a lockdown. He has been criticised for not moving more
swiftly to organise mass tests and mobilise supplies of
life-saving equipment and beds. Johnson was hospitalized on
April 5 and moved to intensive care the next day.
It is too soon to judge the ultimate soundness of the UK's
early response. If history concludes that it was lacking, then
the criticism levelled at the prime minister may be that, rather
than ignoring the advice of his scientific advisers, he failed
to question their assumptions.
Interviews and records published so far suggest that the
scientific committees that advised Johnson didn't study, until
mid-March, the option of the kind of stringent lockdown adopted
early on in China, where the disease arose in December, and then
followed by much of Europe and finally by Britain itself. The
scientists' reasoning: Britons, many of them assumed, simply
wouldn't accept such restrictions.
The UK scientists were also mostly convinced - and many
still are - that, once the new virus escaped China, quarantine
measures would likely not succeed. Minutes of technical
committees reviewed by Reuters indicate that almost no attention
was paid to preparing a programme of mass testing. Other minutes
and interviews show Britain was following closely a well-laid
plan to fight a flu pandemic - not this deadlier disease. The
scientists involved, however, deny that the flu focus ultimately
made much difference.
Now, as countries debate how to combat the virus, some
experts here say, the lesson from the British experience may be
that governments and scientists worldwide must increase the
transparency of their planning so that their thinking and
assumptions are open to challenge.
John Ashton, a clinician and former regional director of
Public Health England, the government agency overseeing
healthcare, said the government's advisers took too narrow a
view and hewed to limited assumptions. They were too "narrowly
drawn as scientists from a few institutions," he said. Their
handling of COVID-19, Ashton said, shows the need for a broader
approach. "In the future we need a much wider group of
independent advisers."
Michael Cates, who succeeded Stephen Hawking as Lucasian
Professor of Mathematics at Cambridge University, is leading an
initiative by the Royal Society, the UK's leading scientific
body, to bring modellers in from other scientific disciplines to
help understand the epidemic.
"Without faulting anyone so far, it's vital, where there is
such a lot at stake, to throw the maximum possible light on the
methods, assumptions and data built into our understanding of
how this epidemic will develop," he told Reuters.
In a statement to Reuters, a spokesperson for the Department
of Health and Social Care said the government was delivering "a
science-led action plan" to contain the outbreak. "As the public
would expect, we regularly test our pandemic plans and what we
learned from previous exercises has helped us to rapidly respond
to COVID-19."
A LOW RISK TO THE PUBLIC
When news came from China in January of a new infectious
disease, Johnson had reason to believe his country was well
prepared. It had some of the world's best scientists and a
well-drilled plan to deal with potentially lethal pandemics.
Perhaps, some scientists say in hindsight, the plan made them
slow to adapt.
For many years, the Cabinet Office - a collection of
officials who act as the prime minister's direct arm to run the
government - took the threat of pandemics seriously.
Presciently, it rated pandemics as the Number 1 threat to the
country, ahead of terrorism and financial crashes.
At the centre of planning was a small group of scientists,
among them Edmunds. His research group at the London School of
Hygiene and Tropical Medicine runs one of the two computer
modelling centres for epidemics that have mostly driven
government policy. The other is at nearby Imperial College.
Edmunds remembers that early in the outbreak, the data from
China were sketchy, in the period "where the Chinese were trying
to pretend that this wasn't transmissible between humans."
Edmunds and his colleague at Imperial, Neil Ferguson, were
part of an alphabet soup of committees that fed advice into the
Cabinet Office machinery around the prime minister. Both were
founders of the flu pandemic modelling committee, known as
SPI-M, that produced the March 2 report warning of more than
500,000 deaths. This committee had met together for nearly 15
years.
Ferguson did not respond to a request to be interviewed for
this article.
Edmunds and Ferguson were also part of NERVTAG, the New and
Emerging Respiratory Virus Threats Advisory Group. Both too were
members of the Scientific Advisory Group for Emergencies, known
as SAGE, that advises the government in times of crisis. SAGE
reports directly to Johnson and the government's main emergency
committee, COBRA.
At first, when NERVTAG met on January 13, it studied
information from China that there was "no evidence of
significant human to human transmission" of the new virus,
according to minutes of the meeting. The scientists agreed the
risk to the UK population was "very low."
The evidence soon changed, but this wasn't reflected in the
official threat level. By the end of January, scientists in
China began releasing clinical data. Case studies published in
the British medical journal, The Lancet, showed 17% of the first
99 coronavirus cases needed critical care. Eleven patients died.
Another Chinese study, in the same magazine, warned starkly of a
global spread and urged: "Preparedness plans and mitigation
interventions should be readied for quick deployment globally."
Edmunds recalled that "from about mid January onwards, it
was absolutely obvious that this was serious, very serious."
Graham Medley, a professor of infectious diseases modelling at
the London School and chairman of SPI-M, agreed. He said that
the committee was "clear that this was going to be big from the
first meeting." At the end of January, his committee moved into
"wartime" mode, he said, reporting directly into SAGE.
Dr Jon Read, a senior lecturer in biostatistics at the
University of Lancaster, also a member of SPI-M, said by the end
of January it was apparent the virus had "pandemic potential"
and that death rates for the elderly were brutal. "From my
perspective within the sort of modelling community, everybody's
aware of this, and we're saying that this is probably going to
be pretty bad," he said.
But the scientists did not articulate their fears forcefully
to the government, minutes of committee meetings reveal.
On January 21, scientists on NERVTAG endorsed the elevation
of the UK risk warning from COVID-19 from "very low" to "low."
SAGE met formally for the first time the following day about the
coronavirus threat. So did COBRA, which was chaired by Matt
Hancock, the health secretary, who would contract the virus
himself in late March. He told reporters after the meeting: "The
clinical advice is that the risk to the public remains low."
In response to questions from Reuters, the government's
Department of Health declined to clarify how the risk levels are
defined or what action, if any, they trigger. In a statement, a
spokesperson said: "Increasing the risk level in the UK is a
belt and braces measure which allows the government to plan for
all future eventualities."
Two days later, China put the city of Wuhan, where the
outbreak began, into a complete lockdown. Hubei, the surrounding
province, would follow. But already, 17 passenger flights had
flown directly from Wuhan to Britain since the start of 2020,
and 614 flights from the whole of China, according to
FlightRadar24, a flight-tracking service. That meant thousands
of Chinese, some of them potential carriers, had come to
Britain. On April 5, scientific adviser Ferguson said he
estimated only one-third of infected people reaching Britain had
been detected.
As they watched China impose its lockdown, the British
scientists assumed that such drastic actions would never be
acceptable in a democracy like the UK. Among those modelling the
outbreak, such stringent counter-measures were not, at first,
examined.
"We had milder interventions in place," said Edmunds,
because no one thought it would be acceptable politically "to
shut the country down." He added: "We didn't model it because it
didn't seem to be on the agenda. And Imperial (College) didn't
look at it either." The NERVTAG committee agreed, noting in its
minutes that tough measures in the short term would be
pointless, as they "would only delay the UK outbreak, not
prevent it."
That limited approach mirrored the UK's longstanding
pandemic flu strategy. The Department of Health declined a
request from Reuters for a copy of its updated pandemic plan,
without providing a reason. But a copy of the 2011 "UK Influenza
Pandemic Preparedness Strategy 2011," which a spokesman said was
still relevant, stated the "working presumption will be that
Government will not impose any such restrictions. The emphasis
will instead be on encouraging all those who have symptoms to
follow the advice to stay at home and avoid spreading their
illness."
According to one senior Conservative Party politician, who
was officially briefed as the crisis unfolded, the close
involvement in the response to the coronavirus of the same
scientific advisers and civil servants who drew up the flu plan
may have created a "cognitive bias."
"We had in our minds that COVID-19 was a nasty flu and
needed to be treated as such," he said. "The implication was it
was a disease that could not be stopped and that it was
ultimately not that deadly."
While the UK was prepared to fight the flu, Asian states
like China, Hong Kong, Singapore and South Korea had built their
pandemic plans with lessons learned from fighting the more
lethal SARS outbreak that began in 2002, he said. SARS had a
fatality rate of up to 14%. As a result, these countries, he
said, were more ready to resort to widespread testing, lockdowns
and other draconian measures to keep their citizens from
spreading the virus.
Scientists involved in the UK response disagree that
following the government's flu plan clouded their thinking or
influenced the outbreak's course. The plan had a "reasonable
worst case" scenario as devastating as the worst predictions for
COVID-19, they note.
Mark Woolhouse, a professor of infectious diseases
epidemiology at the University of Edinburgh, and a member of the
SPI-M committee, said COVID-19 did behave differently than an
expected pandemic flu - for example school closures proved to be
far less effective in slowing the spread of the coronavirus.
But, broadly, "the government has been consistently responsive
to changing facts."
By the end of January, the government's chief medical
adviser, Whitty, was explaining to politicians in private,
according to at least two people who spoke to him, that if the
virus escaped China, it would in time infect the great majority
of people in Britain. It could only be slowed down, not stopped.
On Jan 30, the government raised the threat level to "moderate"
from "low."
The country's medical officers "consider it prudent for our
governments to escalate planning and preparation in case of a
more widespread outbreak," a statement said at the time. Whitty
did not respond to questions from Reuters for this article.
A TIME TO PREPARE
On the evening of January 31, Boris Johnson sat before a
fireplace in 10 Downing Street and told the nation, in a
televised address: "This is the moment when the dawn breaks and
the curtain goes up on a new act in our great national drama."
He was talking of finally delivering Brexit, or what he
called "this recaptured sovereignty." Until that moment,
Johnson's premiership had been utterly absorbed by delivering on
that challenge.
With Brexit done, Johnson had the chance to focus on other
matters the following month, among them the emerging virus
threat. But leaving the European Union had a consequence.
Between February 13 and March 30, Britain missed a total of
eight conference calls or meetings about the coronavirus between
EU heads of state or health ministers - meetings that Britain
was still entitled to join. Although Britain did later make an
arrangement to attend lower-level meetings of officials, it had
missed a deadline to participate in a common purchase scheme for
ventilators, to which it was invited. Ventilators, vitally
important to treating the direst cases of COVID-19, have fallen
into short supply globally. Johnson's spokesman blamed an
administrative error.
A Downing Street aide told Reuters that from around the end
of January, Johnson concentrated his attention increasingly on
the coronavirus threat, receiving "very frequent" updates at
least once per day from mid February, either in person or via a
daily dashboard of cases.
In the medical and scientific world, there was growing
concern about the threat of the virus to the UK. A report from
Exeter University, published on February 12, warned a UK
outbreak could peak within four months and, without mitigation,
infect 45 million people.
That worried Rahuldeb Sarkar, a consultant physician in
respiratory medicine and critical care in the county of Kent,
who foresaw that intensive care beds could be swamped. Even if
disease transmission was reduced by half, he wrote in a report
aimed at clinicians and actuaries in mid-February, a coronavirus
outbreak in the UK would "have a chance of overwhelming the
system."
With Whitty stating in a BBC interview on February 13 that a
UK outbreak was still an "if, not a when," Richard Horton, a
medical doctor and editor of the Lancet, said the government and
public health service wasted an opportunity that month to
prepare quarantine restriction measures and a programme of mass
tests, and procure resources like ventilators and personal
protective equipment for expanded intensive care.
Calling the lost chance a "national scandal" in a later
editorial, he would testify to parliament about a mismatch
between "the urgent warning that was coming from the frontline
in China" and the "somewhat pedestrian evaluation" of the threat
from the scientific advice to the government.
After developing a test for the new virus by January 10,
health officials adopted a centralised approach to its
deployment, initially assigning a single public laboratory in
north London to perform the tests. But, according to later
government statements, there was no wider plan envisaged to make
use of hundreds of laboratories across the country, both public
and private, that could have been recruited.
According to emails and more than a dozen scientists
interviewed by Reuters, the government issued no requests to
labs for assistance with staff or testing equipment until the
middle of March, when many abruptly received requests to hand
over nucleic acid extraction instruments, used in testing. An
executive at the Weatherall Institute of Molecular Medicine at
the University of Oxford said he could have carried out up to
1,000 tests per day from February. But the call never came.
"You would have thought that they would be bashing down the
door," said the executive, who spoke on condition of anonymity.
By April 5, Britain had carried out 195,524 tests, in contrast
to at least 918,000 completed a week earlier in Germany.
Nor was there an effective effort to expand the supply of
ventilators. The Department of Health told Reuters in a
statement that the government started talking to manufacturers
of ventilators about procuring extra supplies in February. But
it was not until March 16, after it was clear supplies could run
out, that Johnson launched an appeal to industry to help ramp up
production.
Charles Bellm, managing director of Intersurgical, a global
supplier of medical ventilation products based outside London,
said he has been contacted by more than a dozen governments
around the world, including France, New Zealand and Indonesia.
But there had been no contact from the British government. "I
find it somewhat surprising, I have spoken to a lot of other
governments," he said.
Countering such criticism, Hancock, the health minister,
said the government is on track to deliver about 10,000 more
ventilators in the coming weeks. One reason Britain was behind
some countries on testing, he said, was the absence of a large
diagnostics industry at the outbreak of the epidemic. "We didn’t
have the scale."
GAME OVER
It was during the school half-term holidays in February that
frontline doctor Nicky Longley began to realise that early
efforts to contain the disease were likely doomed.
For weeks now, doctors and public health workers had been
watching out for people with flu-like symptoms coming in from
China. Longley, an infectious diseases consultant at London’s
Hospital for Tropical Diseases, was part of a team that staffed
a public health service helpline for those with symptoms. The
plan, she said, had been to make all effort to catch every case
and their contacts. And "to start with, it looked like it was
working."
But then, bad news. First, on Wednesday the 19th of
February, came the shock news from Iran of two deaths. Then, on
Friday the 21st, came a death in Italy and a bloom of cases in
Lombardy and Veneto regions. Britain has close links to both
countries. Thousands of Britons were holidaying in Italy that
week.
"I don't think anybody really foresaw what was happening in
Italy," Longley said. "And I think, the minute everybody saw
that, we thought: 'This is game over now.'"
Until then, Longley said, everyone felt "there was a chance
to stamp it out" even though most were sceptical it could be
done long-term. But after Iran and Italy, it was obvious
containment would not work. The contact tracing continued for a
while. But as the cases in London built up, and the volume of
calls to the helpline mushroomed, the priority began to shift to
clinical care of the serious cases. "At a certain point you have
to make a decision about where you put your efforts as a
workforce."
Edmunds noted that Iran and Italy had hardly reported a case
until that point. "And then, all of sudden you had deaths
recorded." There was a rule of thumb that, in an outbreak's
early stages, for each death there were probably 1,000 cases in
a community. "And so it was quite clear that there were at least
thousands of cases in Italy, possibly tens of thousands of cases
in Italy right then."
Amid the dreadful news from Italy, the scientists at NERVTAG
convened by phone that Friday, 21st February. But they decided
to recommend keeping the threat level at "moderate," where it
had sat since January 30th. The minutes don't give a detailed
explanation of the decision. Edmunds, who had technical
difficulties and couldn't be heard on the call, emailed
afterwards to ask the warning to be elevated to "high," the
minutes revealed. But the warning level remained lower. It's
unclear why.
"I just thought, are we still, we still thinking that it's
mild or something? It definitely isn't, you know," said Edmunds.
A spokesman for the government's chief scientific adviser,
Sir Patrick Vallance, didn't directly respond to Reuters
questions about the threat level. Asked whether, with hindsight,
the scientists' approach was the right one, the spokesperson
said in a statement that "SAGE and advisers provide advice,
while Ministers and the Government make decisions."
HERD IMMUNITY
On Sunday, March 1st, Ferguson, Edmunds and other advisers
spent the day with NHS public health service experts trying to
work out how many hospital beds and other key resources would be
needed as the outbreak exploded. By now, Italian data was
showing that a tenth of all infected patients needed intensive
care.
The following day, pandemic modelling committee SPI-M
produced its "consensus report" that warned the coronavirus was
now transmitting freely in the UK. That Thursday, March 5, the
first death in the UK was announced. Italy, which reached 827
deaths by March 11, ordered a national lockdown. Spain and
France prepared to follow suit.
Johnson held out against stringent measures, saying he was
following the advice of the government's scientists. He asserted
on March 9: "We are doing everything we can to combat this
outbreak, based on the very latest scientific and medical
advice."
Indeed, the government's Scientific Advisory Group for
Emergencies, SAGE, had recommended that day, with no dissension
recorded in its summary, that the UK reject a China-style
lockdown. SAGE decided that "implementing a subset of measures
would be ideal," according to a record of its conclusions.
Tougher measures could create a "large second epidemic wave once
the measures were lifted," SAGE said.
On March 12 came a bombshell for the British public. Chris
Whitty, the chief medical officer, announced Britain had moved
the threat to UK citizens from "moderate" to "high." And he said
the country had moved from trying to contain the disease to
trying to slow its spread. New cases were not going to be
tracked at all. "It is no longer necessary for us to identify
every case," he said. Only hospital cases would, in future, be
tested for the virus. What had been an undisclosed policy was in
the open: beyond a certain point, attempts to completely
extinguish the virus would stop.
The same day, putting aside his jokey self, Johnson made a
speech in Downing Street, flanked by two Union Jacks and evoking
the spirit of Winston Churchill's "darkest hour" address. He
warned: "I must level with you, level with the British public -
more families, many more families are going to lose loved ones
before their time."
For most Britons, it came as a shock. Several of the next
day's newspapers splashed Johnson's words on their front pages.
Vallance, the government's chief scientific adviser, who
chaired SAGE, said in a BBC interview on March 13 that the plan
was to simply control the pace of infection. The government had,
for now, rejected what he called "eye-catching measures" like
stopping mass gatherings such as football games or closing
schools. The "aim is to try and reduce the peak, broaden the
peak, not to suppress it completely." Most people would get the
virus mildly, and this would build up "herd immunity" which, in
time, would stop the disease's progress.
But by now, the country was rebelling. Major institutions
decided to close. After players began to get infected, the
professional football leagues suspended their games. As Johnson
still refused to close schools and ban mass gatherings, the
Daily Mirror's banner headline, summing up a widespread feeling,
asked on March 13: "Is It Enough?"
The catalyst for a policy reversal came on March 16 with the
publication of a report by Neil Ferguson's Imperial College
team. It predicted that, unconstrained, the virus could kill
510,000 people. Even the government's "mitigation" approach
could lead to 250,000 deaths and intensive care units being
overwhelmed at least eight times over.
Imperial's prediction of over half a million deaths was no
different from the report by the government's own pandemic
modelling committee two weeks earlier. Yet it helped trigger a
policy turn-around, both in London and in Washington,
culminating seven days later in Johnson announcing a full
lockdown of Britain. The report also jarred the U.S.
administration into tougher measures to slow the virus' spread.
Ferguson was now in isolation himself after catching the
virus. Testifying by video link to a committee in Parliament, he
explained why he and other scientific advisers had shifted from
advocating partial social-distancing measures to warning that
without a rigorous shutdown, the NHS would be overwhelmed. The
reason, he said, lay in data coming out of Italy that showed
large numbers of patients required critical care.
"The revision was that, basically, estimates of the
proportion of patients requiring invasive ventilation,
mechanical ventilation, which is only done in a critical care
unit, roughly doubled," he said.
Edmunds had a different explanation for the policy shift.
What allowed Britain to alter course, said Edmunds, was a
lockdown in Italy that "opened up the policy space" coupled with
new data. First came a paper by Edmunds' own London School team
that examined intermittent lockdowns, sent to the modelling
committee on March 11 and validated by Edinburgh University.
Ferguson's revised Imperial research followed.
Woolhouse, the Edinburgh professor, confirmed the sequence.
Edmunds said these new studies together had demonstrated
that if the British government imposed a lengthy period of
tougher measures, perhaps relaxed periodically, then the size of
the epidemic could be substantially reduced.
Still, without a vaccine or effective treatments, it's going
to be hard to avoid a substantial part of the British population
getting infected, said Edmunds. "Until you get to a vaccine,
there is no way of getting out of this without certainly tens of
thousands of deaths," he said. "And probably more than that."
Now subject to intense public scrutiny, the modelling teams
at universities across Britain continue to work on different
scenarios for how the world can escape the virus's clutches.
According to Medley, the chairman of the SPI-M pandemic
modelling committee, no one now doubts, for all the initial
reservations, that a lockdown was essential in Britain.
Medley added: "At the moment we don't know what's going to
happen in six months. All we know is that unless we stop
transmission now, the health service will collapse. Yep, that's
the only thing we know for sure."
(Reporting by Stephen Grey and Andrew MacAskill; Additional
reporting by Elizabeth Piper in London, Gabriela Baczynska in
Brussels; editing by Janet McBride)