Coronavirus: the smoking gun

05/04/2020

It is a cynical but perhaps accurate observation on the ways of the media that the best way for government to keep a secret is to publish it in an obscure document, and then post it on the internet without bothering to tell anyone it exists. The media will never bother to come looking and, unless some enterprising hack "reveals" it, the secret will remain to the end of time.

That much can be said for the reasons why the government did not prepare a comprehensive testing programme as part of the preparations for the Covid-19 epidemic that is now upon us, and for its refusal to carry out tracing and isolation of contacts.

Thus, while the media puzzles over the reason, a clear statement of the rationale for its actions has actually been published and can be found in its "Scientific Summary of Pandemic Influenza & its Mitigation ", produced in 2011 by the Cameron coalition government.

The Summary backs up the 2011 Strategy which became finalised in the 2014 version. This is the plan currently in force and forms the basis of the government response.

The fact that the "scientific summary" document even exists, however, is wonderfully ironic in this post-Brexit world, as it was produced and prepared in accordance with Decision No 2119/98/EC of the European Community, later augmented by Decision No 1082/2013/EU.

The document itself comes with "Underpinning Evidence Base components", conveniently listed here by the EU's European Centre for Disease Prevention and Control (ECDC). The fact that it is to be found on the EU's Europa website almost certainly guarantees protection from media curiosity.

As to the contents of the document, the "smoking gun" can be found on page 7, under the heading: "Mitigation strategies". This starts with the reasonable statement that, "because a novel influenza viral strain could arise at any point in time and in any location; it is not considered feasible, at present, to prevent such a strain occurring in the first place".

It goes on to say that it "is also considered highly unlikely to be able to “contain” such an outbreak at source, which would most likely be overseas, perhaps in Southeast Asia based on historical analyses". As would most likely be the case with a newly-arising pandemic that was spreading through the UK, it then says, "multiple and parallel cases of infection would have already been imported from initial overseas epidemics".

And so it concludes that: "There is, therefore, no scientific rationale to support the notion that such a pandemic in the UK could successfully be 'contained' by currently-available interventions".

"This", it says, "would be especially true where the severity of infection was mild, such that many infected people did not seek care and, if found by contact tracing, did not meet the case definition for laboratory testing, so were never diagnosed and, hence, never treated, nor their contacts traced".

Thus do we see the scene set for current policy, with the document stating: "once a pandemic is present in the UK and depending on its nature, there is scientific evidence to suggest that its impact might be somewhat suppressed, or mitigated, by the judicious use of a combination of behavioural and pharmaceutical interventions".

"Depending on the impact of the pandemic", it adds, "a range of interventions are available. These vary considerably in their potential effectiveness and mode of action. Some impact on the disease by limiting spread of the virus, whilst others reduce the severity of clinical symptoms".

While conceding that much of the evidence on which the policy relies "is still characterised by uncertainty and extensive gaps in our knowledge", it then sets out a "diverse range of measures", which it refers to collectively as "defence-in-depth", but which I have already called: a recipe for failure.

We then see a twelve-point plan set out, the contents of which are, from recent experience, recognisable and eerily familiar.

Right up front it includes: "effective communication to the public, including skills training, to promote habits of stringent respiratory etiquette and hand hygiene, particularly amongst children", which explains the prime minister's enthusiasm for singing "Happy Birthday" (twice) while washing his hands in a somewhat forlorn attempt to ward off infection.

This was reinforced by "environmental restructuring" to "consolidate habits of stringent respiratory hand hygiene via cues, prompts and improved access to respiratory and hand hygiene facilities, such as tissues and soap", locking in that almost obsessive concern for hand washing, together with "increased cleaning of solid surfaces potentially contaminated with virus, such as door handles or light switches".

The plan also included "prophylactic use of antiviral drugs, especially in the earliest stages of the outbreak" and "widespread treatment using antiviral drugs, in combination with behavioural and communication interventions to encourage pharmaceutical uptake", two measures which, sadly, have proved ineffective with this particular version of coronavirus, even when augmented by "widespread antibiotic treatment of secondary bacterial infections".

Here also one also sees the reliance on awaiting the cavalry, as the document looks for "pre-pandemic vaccination, should an appropriate vaccine exist as the pandemic commences", and "pandemic-specific vaccination, initially targeted at at-risk groups, in conjunction with behavioural and communication interventions to encourage vaccine uptake".

With these measures ruled out, all we have left is "the use of facemasks and respirators to protect healthcare workers and encourage their attendance at the workplace", plus "school closures, especially when they can be instigated early in a pandemic that is severe and where transmission is disproportionately high amongst children", and "restrictions on mass gatherings, including travel, especially in the event of a severe pandemic".

Interestingly, the use of facemasks is largely considered of only marginal value, which possibly explains why there was no particular rush to issue all NHS staff with the masks.

On a technical note, here, although strictly speaking Covid-19 is not influenza, for policy and planning purposes it is treated as such, with reliance placed on the influenza pandemic preparedness work. This was certainly the case with the previous coronavirus infection involving the MERS-CoV virus. The infection was first identified in a patient in Saudi Arabia in 2012, and the disease was also called "camel flu".

What seems to have evaded planners in dealing with this current epidemic is that they would be confronted with a virus against which most established antivirals are ineffective and for which there is no immediate prospect of a vaccine.

Therefore, with no recourse to testing and isolation of cases and contacts, the only tools left in the locker – after the hand washing permutations have been exhausted - are "social distancing" and an increasingly severe lockdown.

As we see the case rate of Covid-19 increase to 41,903 (up from 38,168 the previous day), with the death toll rising by 708 to 4,313, it is all too easy to lay the blame on the current institutions and structures, but the roots of this failure go back decades and more.

We can see the roots of failure in this complacent article dating from July 1988, in which a WHO technocrat declares, on the basis of improved vaccination technology, that influenza is preventable.

Also showing up is our old friend Neil Ferguson from Imperial College London, offering his view in 2005 that a flu pandemic is "lethal yet preventable", based on his modelling of the effects of the widespread use of the antiviral Tamiflu.

We saw the BBC at the same time stressing the need for vaccines, and with the increased reliance on computer modelling well evident by 2008, the die was cast well over a decade ago for the failure we are witnessing today.

The point that so many miss is that policies to deal with major events such as pandemics take decades to develop. The genesis of the current UK policy seems to lie in the response of the Blair government in 2005 to a call by the WHO for increased preparedness for pandemics, with the production of strategy documents.

Going through several iterations, but with only minor changes, we ended up with the policy in its final form on 2014, supplemented by multiple planning documents for all levels of government – with the EU taking a close interest in developments. And, with policy essentially locked in stone, any government would have been committed to following it.

Now that Starmer has won the Labour leadership contest, he has stated that he is prepared to work with Johnson to fight Covid-19 "in the national interest".

That is perhaps just as well. The current policy belongs as much to Labour as it does the Conservatives, so it is entirely appropriate that Starmer, in between demanding that this government comes clean on the "serious mistakes" made, should own up to the mistakes made by the previous Labour administration.