Richard North, 08/05/2020  
 


The "secret squirrels" of the Guardian just can't help themselves. To give them their due, they've managed to provoke the government into publishing the Exercise Cygnus report. The downside is that they've failed to understand its significance.

The crucial point, which seems to have eluded the entire journalist collective – and many more besides - is that this was a plan for managing pandemic influenza.

Therefore, whether or not the UK's "preparedness and response" was "not sufficient", as the Guardian triumphantly reports, is somewhat moot. The government was planning for the wrong pandemic. Even had the outcome of the exercise been perfect, it would still have been the wrong pandemic.

Also of significance is that the planners were working to the 2011 influenza pandemic plan, the one that set out the definitive structure for the government's response. It was to comprise five separate stages: Detection; Assessment; Treatment; Escalation; and Recovery. This was known by the acronym DATER.

The point here is that the exercise started at phase three, covering the treatment and escalation phases. Thus, the exercise started only at the point where we'd already admitted defeat. In other words, the crucial steps that involved (potentially, at least) attempts to suppress a novel infection were never rehearsed.

And yet another point is of some concern. The exercise starts at the point where a vaccine has been ordered but has not yet arrived. However, antivirals are being distributed and available for half the population, helping mitigate the symptoms and shorten the duration of the illness in those affected.

In other words, any similarities between the pandemic that the government was preparing for, and the one that has actually happened, are entirely coincidental. They might just as well have been planning for a nuclear incident in a Basingstoke branch of McDonalds.

That then brings us to the work of the egregious Neil Ferguson. According to one apparently informed source, the computer code of his "model" seems to have a number of flaws which would seem to make it somewhat unreliable.

I'm not really qualified to adjudicate here on an issue which looks set to run and run, but I have already made my views known in this area. To a very great extent, it is not so much the "number crunchers" who are the problem, but successive governments which give far too much credence to juju models and neglect the basic principles of epidemiology.

By this means, we see limited concepts such R0 (the basic reproduction number) assume almost magical proportions, with thousands of newly-minted experts on epidemiology pontificating on its significance, fuelled by the inner workings of Ferguson's model that uses it as a measure of the virus's infectivity.

And yet, even though this paper is flawed in its use of terminology, it points to a possible missing link in the study of this epidemic – whether prolonged contact affects the transmissibility of the disease.

If we factor in the virulence of the virus, it opens the way for speculation on whether one factor in the spread of the disease is prolonged contact or multiple exposure – the former being a variation of the latter. Did Ferguson even include this as a variable in his model?

But then, in its rush to condemn the government for not implementing the lessons of Exercise Cygnus, one wonders whether the "secret squirrels" of the Guardian are even on the same planet when it comes to understanding quite how unprepared the UK was in terms of public health resources.

An unlikely but useful comparator comes in the form of an article in MoneyWeek explaining why Japan has been so successful in fighting Covid-19.

As of 28 April, despite being densely populated, jammed with super cities, and late to put in place only a sort-of-non-compulsory lockdown, the article tells us that Japan had recorded a mere 376 deaths – a death rate so low that it even looks good next to Germany.

The explanation for this success, it says, is "all down to cluster busting". In 1935, with funding from the Rockefeller Foundation, Japan opened its first public health centre (PHC) in Tokyo. The country then put in place a programme that led to the building of another 187 nationwide.

These survived the war and the occupation. Both before and after the war, the centres cut their teeth on the surveillance and control of TB, their priority being to "stay watchful all the time". If a case was detected, they were tasked with "rushing to the patient's residence, checking for clusters and sterilising the house".

Seventy-five years on, 469 PHCs are in operation across the country, with each manned, on average, by 64 medical professionals, including one to two licensed doctors. They still locate clusters, track links and conduct tests, now repurposed to deal with Covid-19.

It is this "accumulated wealth of expertise, rarely found elsewhere" that has made the difference, MoneyWeek says. Japan has not had to rely on mass testing strategies because its health care history had already left a "cluster-crushing" strategy embedded in its system.

Compare and contrast the UK system which has contracted from over 300 local authority based public health teams, with about 11,000 professional staff in 1975, to less than 300 Public Health England staff operating from nine regional centres, and you get a taste of how far our capabilities have been degraded.

But then there is another issue, referred to in the Exercise Cygnus report, but almost completely ignored by the "secret squirrels". This is the concept of "surge" planning, where the NHS dumps its workload and rapidly expands its treatment capacity to deal with a major crisis.

This might be fine for a major industrial accident, where hundreds or even thousands of extra beds might be required in a hurry, but it goes against the basic principles of infection control when it encompasses turning over the hospital system to large numbers of people suffering from an infectious disease.

In fact, the whole "surge" concept is fatally flawed (quite literally), yet it attracts no attention at all from the media. Give them a critical quote that they can play with and they are as happy as Larry.

And yet, the famed Cygnus report also says of the influenza pandemic preparedness, that while the exercise did show that the UK's capability to respond to a worst case pandemic influenza should be "critically reviewed", it also went on to say that the response planning system was "robust". For the future, it merely noted that the exercise had "identified a number of aspects of the response that could be strengthened further".

It was this message that was picked up, and undoubtedly the one from which ministers took comfort. This could be summarised as: a bit ragged about the edges, but nothing too much to worry about.

No one in Whitehall, it seems, thought to read the 2011 plan, which said: "It will not be possible to halt the spread of a new pandemic influenza virus, and it would be a waste of public health resources and capacity to attempt to do so".

And nor did anyone appear to have asked what we would do if we were confronted with a novel virus which rendered the stockpiles of antivirals ineffective, for which there was no immediate prospect of a vaccine and, for which the PPE as specified was largely ineffective.

When we come to look back on this epidemic, therefore, what will be inexplicable to future generations is why the media were so intent on obsessing about the failure of the influenza planning, while failing to realise that, when it came to dealing with a disease of the nature of Covid-19, there was no plan at all.

I wonder here whether it is the fact that so many different governments failed, from Blair to Brown, and then Cameron, means that a partisan media can't turn this into party political issue – thus explaining its total lack of interest in the truth.

Both Labour and the Tories have their fingers dirty on this, so real events don't conform with the media narrative. Thus – as always - the facts have to be carefully selected to make them fit. But then, everyone, from the politicians to the modellers and the pundits, seems to be in the same game.

And the clapping goes on.






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