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'Biggest failure in a generation': Where did Britain go wrong?
Even after a dire warning of 250,000 deaths under business as usual, the nation was not put into lockdown.
Health Secretary Matt Hancock was midway through a radio interview when the phone call came through live to air. On the line was Intisar Chowdhury, whose father Abdul had made a prescient public plea to Boris Johnson in late March.
Through a Facebook post, the 53-year-old consultant urologist for a London hospital had urged the Prime Minister to make sure every health worker in Britain would be given protective equipment during the coronavirus pandemic. Abdul Mabud Chowdhury died just three weeks later, after contracting the disease.
In his phone call, the doctor's grieving son asked for answers and an apology: "The public is not expecting the government to handle this perfectly," he told Hancock. "We just want you to openly acknowledge that there have been mistakes in handling the virus, especially to me and to so many families that have really lost loved ones as a result of this virus and probably as a result of the government not handling it seriously enough."
Abdul Mabud Chowdhury, a consultant urologist at Homerton Hospital, died weeks after pleading with the government to provide PPE for healthcare workers.
Chowdhury seemingly spoke on behalf of a growing chorus of health experts, MPs and members of the public who think Britain's response to the crisis has suffered from a series of deadly mistakes and miscalculations.
The charges focus on four areas: that healthcare workers struggled to access personal protective equipment, that Britain was too slow to implement a lockdown, that it bungled testing, and that vulnerable care home residents were not properly protected.
Downing Street and key ministers such as Hancock have been reluctant to concede many errors, although their tone has shifted over recent days as the official death toll hit 28,446, one of the highest in the world and well above the 20,000 figure Chief Scientific Adviser Patrick Vallance once said the government hoped to not exceed.
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Says Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine and an adviser to the World Health Organisation: "The countries that moved fast have curtailed the epidemic. The countries that delayed have not. It's as simple as that."
Dr Richard Horton, editor in chief of The Lancet medical journal, is even more damning: "The handling of the COVID-19 crisis in the UK is the most serious science policy failure in a generation."
Hancock and Johnson had their first discussion together about the virus on January 7. The government's crisis committee, COBRA, would meet several times over the following weeks and the Scientific Advisory Group for Emergencies started crunching the numbers. The government knew a threat existed but did it fully understand just how bad it could get?
By March 12 a full-scale outbreak had taken hold in Italy and the illness was spreading across Europe. More than 1000 Italians had already died and thousands more were gravely ill in packed hospitals in the country's hard-hit north. The deadly potential of an invisible killer was becoming more obvious by the hour.
That day, Johnson announced Britain would move from the "contain" phase of the emergency to the "delay" phase. This decision would prove a pivotal moment. The shift meant contact tracing would be abandoned, and testing would be restricted to those only in hospital with symptoms. The move was at odds with the WHO, which urged countries to "test, test, test", as well as Germany's much-lauded program of mass testing.
The Prime Minister warned at the March 12 press conference that the "worst public health crisis for a generation" was about to hit the country and that "many more families are going to lose loved ones before their time".
What he did not announce was a lockdown. Or anything close to it. Tougher measures would come but not yet, Johnson said, citing the need to introduce measures when they would have the most impact. But his chief scientific adviser also cast serious doubt on whether closing schools, banning mass gatherings or stopping international flights would ever be effective levers to pull.
Instead, Brits were encouraged to wash their hands and stay home for seven days if they had symptoms. Schools remained open, restaurants and bars traded as usual, and visitors were still allowed into care homes. Flights were arriving from mainland China, even though Australia had banned them six weeks earlier. Heaving public events were still allowed. A Champions League match in Liverpool drew a crowd of 52,000, about 3000 of whom came from Madrid, where a partial lockdown was already in force. More than 250,000 tickets were sold for the Cheltenham horse racing festival. Both events are now being investigated by health officials who suspect they may have contributed to the rapid spread of the disease in the areas surrounding the venues.
Prime Minister Boris Johnson at a March 16 press conference.Credit:Bloomberg
By March 16, the government's advice abruptly strengthened. People were told to stay away from pubs, theatres and clubs, to avoid non-essential travel and to work from home if possible, although the orders were not yet mandatory.
Why the sudden change? The government had just been handed a bombshell piece of research by scientists from Imperial College London warning that taking a light-touch approach to the virus would cause 250,000 deaths in Britain and overwhelm the National Health Service (NHS). Any hope of defeating the virus by building "herd immunity" in the community was smashed. The only way to prevent 250,000 deaths was through draconian measures, the researchers concluded.
Even then, Johnson would not put Britain into lockdown until one week later on March 23. By that point, many other European countries with a much smaller death toll had already been locked down.
Says David Hunter, an Australian-educated professor of epidemiology and medicine at the University of Oxford: "It's very easy in hindsight to state the obvious, which is that the lockdown came too late.
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"The British response so far is not a model to follow. It has one of the worst epidemics in Europe and the world. That may have happened anyway. There's no way to know for sure, but some aspects of the response have almost certainly contributed to the high mortality."
A former Australian high commissioner to Britain, Mike Rann, says crucial mistakes were made right when they had the most damaging impact: "The earliest stages were handled negligently," Rann says. "A shambles of mixed messaging, poor organisation and a complacent attitude that what was happening in Italy wouldn't happen here."
Hunter says border closures in Australia and New Zealand stood in stark contrast to Britain, which only briefly imposed restrictions on people flying in from Wuhan. Even today, the few passengers still arriving in Britain are under no obligation to self-isolate.
"Good public health practice would be to, if not close the borders, then at least have some sort of mandatory self-isolation for people coming in during the very early stages of the pandemic," Hunter says.
"The reasons why the UK did not do it are unclear. Australia, albeit at a different stage of the epidemic, has been highly successful in closing its border, as has New Zealand, and that has almost certainly played a role in the much much lower number of cases."
Arrivals at Heathrow Airport were half what they normally were in March but still, 3.1 million landed there over the month. Nearly half a million came from the Asia-Pacific; 875,000 were from the European Union, and 711,000 came from North America.
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Home Secretary Priti Patel supported a ban on travellers who had been in hotspots but was slapped down by Downing Street, which cited scientific advice that doing so would have little impact on the spread of the infection. When this spat was under way, Australia's borders had already been closed for a week to all foreign travellers. Australia banned flights from China as early as February 1.
The decision on March 12 to abandon mass testing meant the government could only guess who was infected with the virus and how it was behaving. Government experts at one point estimated as many as 55,000 people had contracted coronavirus, even though there were just 2000 confirmed cases. The extent of its spread would not become obvious until hospitals started to fill with seriously ill patients.
A patient is taken from an ambulance outside St Thomas' Hospital in London.Credit:AP
Of the few tests that were available, the results were initially processed by a small number of government-run laboratories. Private sector labs and universities offered to help but now say they were given the cold shoulder before the government eventually embraced them as the answer to ramping up testing.
Nobel prize-winning geneticist Sir Paul Nurse told the BBC's Question Time program that testing was "absolutely critical and hasn't been handled properly".
"We know that with this particular disease, you can be infected and have no symptoms. Now, this makes absolutely no sense. We were allowing, potentially, for front-line workers to be on the wards, potentially infecting people, because we weren't testing."
Nurse, who is the director of Britain’s largest biomedical research lab, the Francis Crick Institute, likens the addition of private facilities to the flotilla of small boats that rescued British soldiers from the beaches of Dunkirk and says their call-up was long overdue.
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One of the strongest critics of the testing system has been Jeremy Hunt, the health secretary under former prime ministers David Cameron and Theresa May. Piers Morgan, a polarising morning television presenter and former tabloid newspaper editor, repeatedly mauled government ministers on his Good Morning Britain program about the deficiencies.
Under pressure, Hancock announced a plan to lift the number of tests conducted each day to 100,000 by the end of April. He achieved it − sort of. The government reported 122,000 tests on April 30. The devil is always in the detail, though: about 40,000 were tests mailed to people but not yet returned to labs for results. Regardless, Hancock's ambitious goal has transformed Britain's approach to testing and, if sustained, it will make it one of the world's most prolific testers. The government is also hiring 18,000 "contact tracers" by the middle of May.
Despite the recent surge, those early delays mean Britain has conducted just 10.13 tests per 1000 people, the lowest rate in western Europe. Italy's rate is 32.73, Ireland's is 31 and Germany's is 30.4.
Australia's testing effort has been double the relative size of Britain's, despite having a far less serious outbreak. And for all the criticism of the US response to the crisis, the rate of testing there never fell below the rate in Britain in April.
Britain's press has been highly critical of the testing regime and difficulties in supplying PPE to healthcare workers.Credit:AP
In his first address from Downing Street after his own battle with the virus, Johnson said the government was determined to fix the "challenges" that "have been so knotty and infuriating".
"I’m not going to minimise the logistical problems we have faced in getting the right protective gear to the right people at the right time, both in the NHS and in care homes. Or the frustrations that we have experienced in expanding the numbers of tests."
The additional testing capacity has allowed the government to get a better grip on the unfolding toll in Britain's care homes. It was previously flying blind. Only three weeks ago, even symptomatic care home residents and staff did not qualify for a test. For many weeks, patients were discharged from hospitals and into care homes without being tested to check whether they would be taking a deadly virus to a place where it could unleash havoc.
The Office for National Statistics, which compiles death data based on whether COVID-19 was mentioned on death certificates − believes 4343 care home residents died in England alone in the fortnight ending April 24. In the week ending April 17, 7316 people died in care homes from all causes. This was 2389 more deaths than the week before and almost double the week before that.
Care home deaths were not added to Britain's official death toll until late last week, and the true extent of the loss is still unclear. In early March, Johnson and his team spoke of "shielding" care home residents during the worst of the epidemic. They have since failed, but are not alone: all badly affected countries in Europe have experienced a wave of death in care homes.
While the Prime Minister has enjoyed a sharp rise in his personal approval ratings since the outbreak began, polling firm Ipsos MORI has recorded a "significant rise" in the number of people that think the government acted too late. Two weeks ago, 57 per cent felt that way but that figure now stands at 66 per cent.
Pre-dug graves for COVID-19 deaths at Maker cemetery in Cornwall.Credit:Getty
Johnson and Hancock have been keen to stress that Britain has passed through the peak of the virus without the NHS being overwhelmed, pointing to a massive and rapid expansion in capacity and the early purchase of thousands of ventilators.
Chief Medical Officer Chris Whitty says the only way to truly compare Britain's response will be once the pandemic has run its course not just in Britain but in other countries that may yet experience serious outbreaks.
"We are nowhere near the end of this epidemic. There is a very long way to run for every country in the world on this and I think let's not go charging in to who's won and who's lost."
