A week before the official UK lockdown began on 23rd March, my partner and I decided the time had come to do it for ourselves. We took our children out of school, relied on online food ordering, and barely ever ventured beyond the front gate.
This is why the claim by Neil Ferguson, the Imperial College epidemiologist who was an adviser to the government until he resigned for flouting lockdown rules (oh, there’s so much backstory now…), that deaths from Covid-19 in the UK would have been halved by locking down a week earlier sends a chill down my spine. The coronavirus has hit households of my youngest daughter’s school class hard—no fatalities, thank goodness, but some parents are still suffering the effects many weeks later. I am a very far from young man, and therefore in one of the demographics at considerable risk. Had we not acted as we did, things could have gone very differently for us.
I don’t want to smugly claim prescience (and God knows we’re not out of this yet). We were extremely fortunate to be in a position to have taken this course. For one thing, I had been “following the science” for weeks myself, speaking to experts about the severity of the pandemic. But also, since both my partner and I are at home anyway, and having previously home-educated our kids, we were privileged with the resources to go it alone. Most people could not stop going to work until the government made it mandatory. Many who have lost loved ones and friends in the pandemic will now be left asking whether things would have been otherwise if the government had acted more swiftly and decisively.
That’s the case for Dean Burnett, a neuroscientist and writer whose father died of Covid-19 at the age of 58. “He was a hard-working entrepreneur,” says Burnett, “and I imagine many of the people he met up with that week had been to Cheltenham [the horse-racing event permitted to open on 10th March], or some other mass gathering that was already illegal in neighbouring countries.”
Ferguson claimed in March that up to 250,000 people might die if the government pursued what appeared to be its strategy of allowing the virus to progress through the population until “herd immunity” was developed. (Health Secretary Matt Hancock’s subsequent attempt to distance the government from this notion does not square with comments made at the time by the Government Chief Scientific Adviser Patrick Vallance.) Whether, as was suggested back then, Ferguson’s conclusions were instrumental in changing the government’s course is unclear—but they surely played a part.
That claim was based on the mathematical models of the spread of infection used by Ferguson’s team, which contributed to meetings of the government’s scientific advisory group Sage. In contrast, his latest comments on the effect of an earlier lockdown, made to the House of Commons select committee on science, are a straightforward extrapolation of what we know about the rate at which the disease spreads—specifically that, while life went on as normal, the number of infected people doubled every three to four days. This exponential growth rate, which means that every day lockdown was delayed had a big effect, was apparent in mid-March, even if the exact numbers were not. It now seems, however, that the extent of infection already present in the country at that time was greater, perhaps much greater, than thought.
Ferguson tells me that his estimated figures of the deaths that could have been avoided are “with the benefit of hindsight”—because “that was the context within which the select committee was asking its questions.”
His conclusions are shared by others. David King, the former chief scientific adviser who convened the “Independent Sage” group of experts after it was revealed that the supposed independence of Sage itself might be compromised by the active participation of Dominic Cummings, told Newsnight that the death rate could have been cut by half if the lockdown was just three days or so earlier, and by more than half if had been brought forward a week. “Whatever the cases were on 23rd March, there were half that on 19th March,” infectious-disease modeler and Sage member Graham Medley of the London School of Hygiene and Tropical Diseases (LSHTM) tells me. Another Sage scientist, epidemiologist John Edmunds of the LSHTM, has said “I wish we had gone into lockdown earlier. I think that has cost a lot of lives, unfortunately.”
For those who, like Burnett, lost loved ones to Covid-19, the knowledge that things could have turned out so differently with different decisions at the critical moment in March will be very hard to swallow—although Burnett says Ferguson’s announcement is “not as hurtful as it perhaps could have been, because it’s been obvious the whole time, so is hardly a revelation.”
The key question is whether the government could be expected to have acted differently at the time, given what was and was not then known. Ferguson says this question is “not one I feel I am best placed to answer. It requires an objective review of the processes, data and decision-making—preferably when everyone concerned is not still working flat out on the response.”
In early to mid-March, he says, “we had much poorer data, particularly regarding the extent of infection in the UK. We knew the doubling time was relatively short (under five days), but comprehensive NHS-based surveillance was not yet operational.”
What we did know, however, was the experience in Italy (and rapidly developing in Spain), where Covid-19 infections had ballooned very quickly and in some regions totally overwhelmed health services. We also knew in early March that infections in the UK were closely following the initial trajectory in Italy.
But most of all, we knew the advice of the World Health Organisation for a deadly pandemic like this: to lock down hard and fast. Professor of global public health Devi Sridhar of the University of Edinburgh has pointed out that “the WHO had declared a public health emergency of international concern on 30th January… and [said] you’d better prepare for it.”
“There’s a tried and tested public-health playbook for how you deal with outbreaks,” Sridhar adds. And this is what countries in east Asia followed, with considerable success: “aggressive containment, do your testing, do your tracing.”
Moreover, there were plenty of well-qualified professionals advocating such measures in early March. On the 11th, John Ashton, former professor at the LSHTM and a past president of the standards-setting charity Faculty for Public Health, told Newsnight that “we’ve got a complacent attitude… and we’ve wasted a month. We should have a got a grip on this a month ago.”
And on 20th March, a group of leading epidemiologists and public health experts signed an open letter to the government saying that “The UK is losing a very small window of opportunity to minimise the morbidity and mortality from the COVID-19 outbreak and to prevent a health system collapse… we urge the UK government to implement an urgent enforced lockdown in the areas highly affected by the virus, while ensuring those most vulnerable in society are fully supported.” Had that been done at once, it now seems that even at that stage the mortality count could have been roughly halved.
Moreover, the paucity of information about the extent of infection in the UK in March was itself partly a consequence of the government’s decision not to test extensively at the time—seemingly because it had not created a capacity to do so.
“Early surveillance data in the UK were very patchy,” says Adam Kucharski, an infectious-disease modeler at the LSHTM. “On 13th March there were just over 200 new cases reported, but in reality there were probably over 10,000 new infections.”
That’s not to suggest that more testing would have supplied all the answers needed at the time. “Wider testing would have been very useful for situational awareness during this period,” Kucharski says, “but even in hindsight it’s unclear how many of the early transmission chains established before the 21st February would have been detectable before causing outbreaks in UK, especially given that returning travellers were likely to be in younger groups, generally with less severe disease.”
All the same, it wasn’t hard to see by late February that the issue was deeply serious, and that what we saw happening in Italy, Spain and France would very soon be repeated in the UK. “I remember when Italy reported their first local cases on 21st February, thinking that there must have been a lot of undetected spread to several other places in Europe too,” says Kucharski. “Until that point, there was still hope that it might be possible to contain transmission within [east] Asia, but Italy and the two deaths in Iran a couple of days later made it clear that wasn't going to happen.” A study at the Universities of Oxford and Edinburgh now bears this out, showing that around 34 per cent of detected chains of infection in the UK arrived via inbound travel from Spain, about 29 per cent from France, and 14 per cent from Italy. “I want to know why we’re not testing those people coming back from Italy,” Ashton had said on 11th March, “and who are now amongst us. We’ve got a recipe for community spread here.”
All this failure to take fast and strong steps to curb the spread is before we even take into account the discharge of elderly patients from NHS care into care homes, some of whom surely carried the virus. It is before we reckon with the lack of provision of personal protective equipment for hospital staff, the confusing public messaging, and now the undermining of the authority of lockdown measures by Cummings’s road trip to Durham.
Even the undeniable uncertainties that did exist in February and March themselves make it hard to excuse the confidence (if not clarity) with which Boris Johnson presented his decisions, says Burnett: “Why did the prime minister, who many people, like my dad, trusted to do the right thing by them and know what he’s talking about, so firmly say we needed to carry on as normal, when he had no rational basis for being so sure that would be the best move?” By confidently insisting that it was fine for most of us to keep shaking hands (if you washed them), keeping schools and public gatherings open, and otherwise going about your life as before, Johnson “encouraged countless people to carry on mingling and interacting, which undoubtedly spread the virus much further and wider.”
Johnson made no secret of his reluctance to instigate full lockdown; his dismay at taking away “the inalienable right of free-born people of the UK to go to the pub” was a rare occasion when one of his statements during this crisis seemed heartfelt. During the period that the government claimed to be “following” (rather than, as now, “listening to”) the science,” it could shield behind the authority of Vallance and the Chief Medical Officer Chris Whitty. But evidently it was possible back then to pick “the science” you chose to “follow”—on the one hand the discredited idea of herd immunity, on the other the international experts advising the WHO. The performance of Vallance and Whitty so far gives no confidence that they would have opposed any tendency for the government to select this “science” out of political expediency.
Arguments about lockdown are often presented as a balance between saving lives and saving the economy. It is now clear—in truth it was always clear—that this is a false dichotomy. “If you know are going to shut down the country eventually, there are huge returns to doing it quickly,” wrote economist Joshua Gans in March. Prioritising public health in the short term, he said, “can be consistent with superior long-run economic performance.” As the UK watches other countries that handled the pandemic well now reopening for business while we look set to take the worst economic hit in Europe—even before the looming no-deal Brexit towards which the government has steered resolutely throughout the crisis—the truth of that could not be starker.
In a sense, then, Ferguson’s remark to the select committee is not the bombshell it has been made out to be in some media reports. But that is precisely the problem: it has long been clear that the government’s Covid-19 strategy, especially the delay in locking down, has been disastrous. We have already had some intimation of how that grave error is going to be spun. On 19th May, Work and Pensions Secretary Therese Coffey implied in an interview to Sky News that the scientific advice the government received at the time might have been wrong. And in another Sky News exchange on Wednesday, presenter Kay Burley told health minister Helen Whately that “you can’t stick this on the scientists,” only to receive the reply “Well, I can.” Whately quickly tried to backpedal, but her unguarded, instinctive response spoke volumes.
The same intent to shift the blame onto the scientists was evident in the government briefing on Wednesday night, when Sky News’s Beth Rigby asked Johnson, in the light of Ferguson’s latest remarks, “Do you not regret going into lockdown earlier, given what you know now?” His reply? “We made the decisions at the time on the guidance of Sage, including Professor Ferguson, that we thought were right for this country.”
Perhaps it is in anticipation of such scapegoating that the scientists seem now to be finally standing firm on the need for extreme caution in the face of demands to relax the lockdown. Vallace and Whitty have advised that the two-metre rule for social distancing be maintained, despite demands from Tory MPs that it be dropped for the sake of the economy.
But this pushback from the chief scientists is far too little, far too late—especially for people like Burnett. The clear truth is that the frustration those Tory MPs, and many others, feel at seeing other countries exit lockdown and resume a kind of normality while the UK stays stuck with emergency measures is the straightforward consequence of abysmal choices made three months ago—and which will in all likelihood continue to claim many lives and strangle the economy for at least the rest of the year.
“It can’t be anything other than gut-wrenchingly painful to know that a parent’s premature death was avoidable, if only those in authority had made a different call,” says Burnett. “That’s very much the case here.”
