28 April 2021

Failures of State by Jonathan Calvert and George Arbuthnott

I finished this book a couple of weeks ago but it is one that has stayed with me. You know how it is — your mind keeps drifting back to a book, it won’t quite let you go. This is one of those. It is all the more remarkable when you consider it is recounting events that we’ve lived through, or at least most of us have, in recent months. A lot has happened.

I’m not quite sure where to start with my outrage. There are so many avenues down which it can be channelled. Perhaps my greatest disgust is reserved for the repetitious nature of the mistakes. Pandemics are not common and we can allow a certain latitude. Yet the abject refusal to recognise the inevitable and to vacillate while people died is unforgivable. One of the bleakest passages is the description of the clandestine Sunday evening rendezvous with the prime minister” with four academics in September as Johnson considered a circuit breaker. Following the science? Read it and weep. Three academics put the case for a more liberal approach. They don’t come out looking good. The fourth academic advising Johnson and Sunak, Professor John Edmunds, if he re-iterated the advice in a co-authored Sage report, would have been recommending an immediate two-week circuit break. (He declined to report to the authors what he said in the meeting.)

The political bunfighting continues but the COVID situation is widely held to be brightening. As long as you are myopically squinting at the UK and that you don’t care too much about the rest of the world. At the time of writing the WHO is pointing out that the pandemic is a long way from over, indeed it is accelerating”. The situation in India is horrendous. But it surely can’t be any secret that the problem of unchecked infection will come back to stalk us in the form of variants?

I’ve picked out some of the quotes I highlighted with some comments.

The initial response

Those months in early 2020 were excruciating as we waited to go into lockdown. It was perfectly obvious it had to happen and the delay seemed inexplicable. Meantime, the infection was spreading and that, of course, means that the death toll will have been ticking up. It was initially quiet and easy to be lulled into a complacency but it was baked in. Calvert and Arbutnott are scathing about the early response and Johnson’s efforts.

He did not attend any of the first five meetings of Cobra, the key national crisis committee that commanded the UKs response to the pandemic. The first Cobra meeting Johnson attended was on 2 March and by then the virus had already firmly gained its foothold in the country. As many commentators would point out after our first article: this was an extraordinary dereliction of his duty as a prime minister, which would have enormous consequences.

A study by Southampton University has shown that 190,000 people flew into the UK from Wuhan and other high-risk Chinese cities between January and March and were allowed to travel across Britain at will. The researchers estimated that up to 1,900 of these passengers would have been infected with the coronavirus — guaranteeing the UK would become a centre of the subsequent pandemic.

In fact, according to the analysis, there were only three occasions in the last 10 years when a prime minister, who had been in Westminster, had skipped a Cobra meeting.

The lack of action was described by Doris-Ann Williams, chief executive of the British In Vitro Diagnostics Association, which represents 110 companies that make up most of the UKs testing sector. Amazingly, she said her organisation did not receive a meaningful approach from the government asking for help until 1 April — the night before Hancock bowed to pressure and announced a belated and ambitious target of 100,000 tests a day by the end of that month.

As part of 26 key recommendations from Cygnus, the NHS was told it needed to make urgent and drastic improvements, which would have to be paid for with money the government was advised to specifically ring-fence for that purpose. That did not happen.

There was also a critical lack of laboratory testing capacity. According to Martin Hibberd, a professor of emerging infectious disease at LSHTM, a key reason for that had been money. The NHS had moved away from using its own laboratories in the years before the pandemic and had increasingly farmed out its work to privately owned facilities in an effort to cut costs.

The herd immunity fallacy

We lost valuable time at the start of the 2020 as the herd immunity fallacy played out. While few would dispute that the CMO and CSO are people of integrity the sense is that they have grown into their roles. One wonders how hesitant and how diffident they were at the start; and for all the denials there seems to have been a strong flirtation with herd immunity in many who were looking at the early signs.

One well-known senior Conservative confided: I had conversations with Chris Whitty [the chief medical officer] at the end of January, and they were absolutely focused on herd immunity. The reason is that with flu, herd immunity is the right response if you haven’t got a vaccine.’

Whitty denies that he has ever been an advocate of herd immunity other than as part of a vaccination programme. But herd immunity was a view that appears to have infected the government.

The concept of herd immunity is toxic politically because it effectively means that the weakest in society — the ill and the elderly — are left to perish.

Herd immunity was a dangerous experiment with no proven upside, but Johnson’s government was willing, nonetheless, to try it.

Since herd immunity was self-defeating, the government’s strategy of delaying the introduction of measures to suppress the virus was a calamitous miscalculation.

The Domoscene conversion

Dominic Cummings had initially favoured the government’s delay-and-mitigate approach, but he changed his mind. Dominic himself had a conversion,’ a senior Tory said. The Domoscene conversion’, as it became known, was said to have happened at an earlier meeting with scientists.

It is difficult to imagine a man who could be much more reviled in public life than Dominic Cummings after his Barnard Castle. There can be few who were genuinely persuaded by his performance in the Rose Garden on Downing Street. This caught my eye at the time as it is a reminder that our Dom is very much his own man. There is little likelihood that he can ever be rehabilitated in the public’s eye but some on the left may find themselves cheering him on and he is catnip for the commentariat. And, given his apparent willingness to hang Johnson out to dry, any testimony he offers to a future inquiry will be box office. We’re going to be hearing a lot of Cummings for a good while to come.

The NHS was overwhelmed

Most people think we got away with it and we coped. The NHS weathered the storm. Yet, when the system gets overwhelmed it wouldn’t typically collapse in a televisual way.

Downing Street was anxious that critical care units should not be visibly overrun as they had been in Italy, Spain and China, where patients in the city of Wuhan were photographed dying in corridors. So a veil of secrecy was now placed over Britain’s hospitals. The publication of critical care capacity figures was suspended, which meant nobody outside the corridors of power would be able to tell whether hospitals were being overrun, and a general ban was imposed on information being passed to the media without sign-off from central command. The NHS management had shifted to a war footing.

There may well have been efforts to downplay the scale of the problem but one graph is revealing. It’s difficult to shift away from this — logical reasons for this drop, other than a form of rationing, are very thin indeed.

This is a compelling image. That drop down to 6% involves a staggering amount of loss, grief, and pain. It also screams of the missed opportunities. If anyone, like the government, ever tells you that ICUs weren’t overwhelmed then remember this dismal curve. Thousands of decisions were made that meant people weren’t sent to ICU who otherwise would have been.

The evidence was buried away in data collected from 65,000 people who were admitted to UK hospitals with the virus up to the end of May and that had been analysed by the Covid-19 Clinical Information Network (Co-Cin), which reports to the Sage advisory committee. This data produced by the Co-Cin team is the government’s best record of how patients with the virus were treated in hospitals during the outbreak. Overall, it showed that just one in six Covid-19 patients who lost their lives in hospital during the first wave had been given intensive care treatment. This suggests that of the 47,000 people who died of the virus inside and outside hospitals, an estimated 5,000 — just one in nine — received the highest critical care, despite the government claiming that intensive care capacity was never breached.

In the middle weeks of March, 13 per cent of that age group admitted to hospital with the virus were given an intensive care bed. By the start of May, that figure had more than halved and was down at 6 per cent.

In October we had revealed evidence that access to intensive care had been rationed in hospitals across England, which had led to patients being denied life-saving ventilation. This had sparked an intemperate reaction from Professor Stephen Powis, the NHS national medical director, who claimed our story was untrue’ and was deeply offensive’ to health service workers. Powis was adamant that even at the height of the pandemic there was no shortage of ventilators and intensive care.’ The consortium’s findings suggest he was very badly informed.

The Inquiry will come

The government is in no rush for an inquiry. It is, obviously, an entirely political decision. There may be a skimpy argument that we are still fighting through and now is not the time. There is certainly some credibility in recognising that the pandemic has a way to go. You don’t have to be over-cynical to feel that the government is unlikely to come out well from an inquiry and they are delaying the moment. It will be much easier to bear the political cost if lives have returned to normal and people are focusing on getting back to the quotidian concerns of family, work, and leisure.

History is unlikely to be kind to Johnson and his government’s stewardship of Britain’s response to the pandemic.

Weatherby and Abrahamson believe that Johnson’s conduct could also amount to the criminal offence of gross negligence manslaughter’, although they believe it is unlikely that the Crown Prosecution Service would take up such a case. That may change, they note, if further evidence emerges at a future public inquiry.


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