Richard North, 02/04/2020  
 


The Covid-19 epidemic continues to break new records, with 29,474 reported tested positive for coronavirus yesterday (up 4,324 on the day) with 563 dead, bringing the total to 2,352, an increase of 31 percent on the previous day's figures.

There is definitely a sense of urgency in the air now, as the scale of this epidemic begins to hit home and the Mail reports the building of  another new morgue – this one about the size of two football pitches in East London, capable of holding the bodies of thousands of Covid-19 victims (pictured).

This is perhaps just as well as, by Sunday, we expect deaths to be up 1,000 a day, while the nation will be scanning the daily figures for early signs of a downturn in the case rate, indicating that the lockdown and other measures are beginning to take effect.

But yesterday was the day that much of the media decided to focus on the perceived inadequacies of the testing regime, with even the previously loyal Telegraph telling us that there is understood to be "frustration" within government over Public Health England, which is responsible for testing and is not thought to be rising to the challenge.

With dozens of expert and not so expert analyses to choose from, newspapers can be in no doubt as to where the attention lies but this is a media that never really got to grips with the technicalities of Brexit. And now, we're experiencing the same lack of grip.

For sure, testing is vitally important and, to that extent, the calls for more testing – and especially of NHS staff seeking clearance to go back to work – make absolute sense. But what is being neglected is that, in terms of controlling the epidemic, the testing is only one part of the equation.

The full package, of course, requires following up every suspect case, which – as a notifiable disease, must be reported to the authorities by GPs – testing them to see if they are positive and keeping them isolated until cleared. Then, as many contacts as possible must be traced and tested, and again isolated until cleared.

And, as we have reported so many times, even if there was the capacity to deal with all the tests, there simply are not the trained and experienced personnel within the Public Health England field epidemiology service, to carry out all the necessary visits and administer the tests.

Expanding the capability is not as easy as it sounds as there is no administrative or managerial infrastructure to handle a sudden influx of additional staff. And, as anyone who has been at the sharp end of an outbreak, administration is everything. If that is not up to the task and breaks down, as it can so easily do under pressure, then the system cannot deliver.

As to ramping up the testing, the Mail makes unfavourable comparisons between the UK's "disgraceful" performance and the "efficient Teutonic planning" of the Germans, and their "ruthless determination to work together".

But while it is easy to rail at the "staggering incompetence" of what the Mail calls "our public health fatcats", things really are not that straightforward. The implementation of a large scale testing programme is really not that difficult, as long as it is planned well in advance, and there are more than sufficient resources. An emergency programme could easily have been arranged.

At the heart of the problem, therefore, is neither a lack of capacity nor capability. The real reason for the failure to mount an extensive programme lies in the document I introduced yesterday setting out the "Pandemic Influenza Strategic Framework".

Close scrutiny of this shows that there was no provision made for mass testing. The testing was to be deployed in the initial stages only to provide early estimates of the likely severity and impact on the UK of the epidemic, and then to provide data in an "attempt to model the course of the pandemic".

When one then looks at the "planning assumptions" it is easy to see why this stance is taken. From the very start, the planners concede defeat, stating that stopping "the spread or introduction of the pandemic virus into the UK is unlikely to be a feasible option".

They then work on the basis that, once the virus is established in the UK, sporadic cases and clusters will be occurring across the country in 1-2 weeks and about 50 percent of the population may be affected in some way or another. Chillingly, they also suggest that up to 50 percent of [NHS] staff may be affected over the period of the pandemic, "either directly by the illness or by caring responsibilities".

What is not spelt out though are the necessary consequences of this stance. For these, one has to go to the guidance site for local planners, to whom is passed the gruesome work of dealing with the casualties.

Under the heading "Management of deaths", we are told that scientific modelling estimates that the UK could experience up to 750,000 additional deaths over the course of a pandemic. These figures, the guidance adds, might be expected to be reduced by the impact of countermeasures, but the effectiveness of such mitigation is not certain.

Thus, we learn that local planners "have been set the target" of preparing to extend capacity on a precautionary but reasonably practicable basis, and aim to cope with a population mortality rate of up to 210,000 to 315,000 additional deaths. As to timescale, these deaths may possibly occur "over as little as a 15 week period and perhaps half of these over three weeks at the height of the outbreak".

I am minded of that epic scene in the film Independence Day, where the President of the United States is brought face-to-face with one of the invading aliens, whence the President asks of it, "what do you want us to do?" The alien replies with brutal finality: "Die!"

That, it seems, was our role in this epidemic. Originally, no serious plans were made to control it and, while some mitigation was anticipated, the main practical response was to plan for the mass disposal of bodies. This was not outbreak management – it was the strategy of defeat.

We even have a carefully-drafted 59-page document setting out "a framework for planners preparing to manage deaths, which is only thirty pages shorter than the entire Pandemic Influenza Response Plan.

Clearly though, there has been a change in direction. Once the media, the public and the politicians got wind of the general direction of the plan, dressed up in the language of "herd immunity", the government was forced into a U-turn which required the implementation of control measures not mentioned in the original plan.

Unsurprisingly, though, it is very difficult to set up a mass testing programme, de novo in the middle of an epidemic. This is rather like trying to redesign the engine of an F.1 car while it is racing round the circuit. And therein lies the root of the "frustration" within government over Public Health England. The organisation is being asked to do something that is almost impossible.

And nor can this be put down simply to underfunding, as some are trying to do. Rather, we must look back to 2014, when the current influenza plan was published.

I do not recall then, any cries from the critics who are now so voluble in their condemnation of Public Health England – not the medical specialists, nor the opposition parties, nor the select committees, nor even the media. And now, even with so many wise after the event, they still have very little idea of what is necessary to make the system work.

Let us hope that the management of the morgues is more efficient than the management of this epidemic.






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