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In common with the thousands of people whose lives have been suddenly devastated by Covid-19, Ken Sazuze cannot know exactly when the coronavirus landed in his family and caused its terrible damage. His wife, Elsie, was 44, a well-loved nurse, mother of her children, Anna, 16, and Andrew, 22; she was his soulmate and best friend, a “genuine person,” she says. Elsie died on April 8, on a ventilator, at Good Hope Hospital in Birmingham.
Ken believes he became infected sometime in that creepy and terrifying week after Monday, March 16, when the Boris Johnson government reconsidered its previous approach, which had predicted that 60% of the population (40 million people) would become infected. , and while many would. die, most would recover and achieve “collective immunity”. That week, although Johnson had advised more physical distancing, normal life continued mainly until the mandatory closing; Pubs, restaurants, and gyms remained open, as did the schools, until Friday, March 20. Sazuze, who spent 10 years in the British Army before studying to be a nurse, says he “never liked the idea of herd immunity.”
“During those weeks, the spread of the virus was allowed,” he says. “We have suffered such a painful blow. I firmly believe that if the government had acted faster, we would not have lost as many lives, and my wife could be here today. “
Health Secretary Matt Hancock, supported by Downing Street, has persistently denied that achieving herd immunity by allowing the disease to infect most people has always been a policy, goal, strategy, or even “part of the plan”. Well-placed government sources said the stricter reading of the word “politics” may be true. But they do not understand how the government can claim that collective immunity was not part of their plan.
The Guardian’s report on the government’s response to the crisis is based on interviews with sources in or near Downing Street, the Department of Health and Social Assistance, the Cabinet Office, Cobra and Sage, as well as other advisers and experts. Many asked not to be named because they were not authorized to speak in public. Some said that while they had concerns, they were withholding some of their criticism because they did not want to damage public confidence in the government at such a delicate time. Everyone mistrusts being wise in hindsight and sympathizes with ministers who made decisions they deemed correct at the time.
But with Covid-19 spreading virulently, particularly during the first three weeks of March, more than 21,000 people have died in hospitals alone, and Britain is projected to be arguably the most affected country in Europe. There are deep questions to be answered, why the Johnson government stood alone among the countries of the world, following that approach of collective immunity, and why, when they realized that stricter measures were needed, the blockade was still delay.
Professor Neil Ferguson, the chief scientist for the Covid-19 response team at Imperial College London, whose advisory document of March 16 is credited with convincing the government to change course, extensively answered the Guardian’s questions to this article. He stressed that an alarming estimate in that document was not new: that under the “mitigation scenario,” which apparently viewed herd immunity as a result, and included measures that the government was considering, 250,000 people would die.
Brexit
Viewed from today’s unimaginably changed perspective, the months leading up to this year’s crisis may seem like a parallel world. Johnson’s media backers were celebrating him at the time for winning the “Get Brexit Done” election, and his private life, since criticized by some as a distraction, was portrayed as a cause for national rejoicing when on February 29 he and Carrie Symonds announced their engagement.
However, somehow, the real danger and the need to act quickly were not assumed by the government. The first phase of a plan to contain the virus with testing and tracking ended on March 12, and the policy was moved to try to delay the peak of the infection. Later, the plan was “mitigation,” for a series of steps that would be phased in: seven-day “case isolation” for someone who felt they had symptoms, and then “home isolation” for everyone living. they will be quarantined with them for 14 days, then at some point, to protect the elderly and vulnerable.
The day after the Cobra meeting on March 2 and the SPI-M statement, Johnson held the first televised press conference with Vallance and Chris Whitty, the medical director. Whitty solemnly said that, in the worst case scenario, it is estimated that 80% of people could become infected, and 1% of them could die, but the message that is best remembered is Johnson jokingly telling the nation: “I was in a hospital the other night where I think there were actually some coronavirus patients and I shook hands with everyone. “
Johnson’s advice was, “Basically, we should all get on with our normal daily lives.” He also advised, “The best thing to do is wash your hands with soap and hot water while singing Happy Birthday twice.”
Over the next fortnight, when Italy moved to impose a blockade, France and Spain began to do the same, and Germany embarked on physical distancing measures alongside Europe’s most extensive contact testing and tracking operation, Britain did relatively little. Handwashing remained the top advice, along with isolating people who felt symptoms.
The first official report of someone who died in the hospital and tested positive for Covid-19 captured in the UK came on March 5. Still, older and vulnerable people were given no advice to protect themselves. A member of a Sage advisory committee said that at this time there was a gap between scientific advice and political messages. “The prime minister was shaking hands with the people to demonstrate that there was no problem. There was a disconnect at that point. We were all a little incredulous that this was happening. “
Some experts believe Britain’s exceptional response came in part because government preparations for a pandemic were so affected by an influenza outbreak. Professor Graham Medley, a Sage member and president of SPI-M, who represents the scientific influenza pandemic, modeling, explains. “Everything, the government preparation, the modeling, was based on pandemic influenza. And that is not due to lack of awareness on our part, it is because that attracted the attention of the government and funding. We could persuade them that the flu was important. “The group’s terms of reference were eventually expanded to include different types of pandemics, but the emphasis remained.
Scientists are used to seeing flu spread through populations very quickly, then becoming milder as it mutates, and to seeing people develop immunity and populations becoming resistant. Covid-19 is lethally different, new, its properties more uncertain, and the idea of tackling it by allowing it to move through the population and achieve collective immunity was widely condemned for risking too many lives.
Group immunity
Given the repeated denials, it can be overlooked that the reason the world believes herd immunity was the government’s focus is largely because Vallance said yes. On Friday, March 13, when the virus was spreading exponentially, he set out to publicly explain the government’s strategy.
On March 11, the WHO formally declared Covid-19 a pandemic. Tedros, the director general, maintained that the spread of the virus could still be confronted, and criticized the “alarming levels of inaction” in some countries.
That same day, Dr. David Halpern, a psychologist who heads the team at Behavioral Insights, a company owned by the Cabinet Office, gives a more detailed explanation of the government’s strategy. “There will be a point, assuming the epidemic will flow and grow, as we think it probably will, where you want to protect yourself, you want to protect those at-risk groups so that they basically don’t catch the disease, and by the time they emerge from their cocoon, immunity collective has been achieved in the rest of the population. “
At a press conference the next day, Johnson said: “I must level out with the British public: many more families are going to lose their loved ones prematurely.”
Whitty then announced that the initial effort to contain the disease through testing and tracking had been abandoned, but despite that, and Johnson’s warning, the measures discussed for the new phase of “delay” were almost negligible. People over the age of 70 are advised not to cruise. Johnson said that even “domestic quarantine” would not be necessary until sometime “in the coming weeks.” The plan published by the government said that social distancing and the closing of schools could be considered.
That night, former health secretary Jeremy Hunt spoke on the BBC, saying he was concerned that Britain had become an “outlier.” Hunt says he was now concerned that Whitty was too resigned to the spread of the virus: “He couldn’t understand why they were so sure that nothing could be done to prevent almost 60% of our population from becoming infected, when he had figures that they showed that even in Wuhan, the center of the outbreak in China, less than 1% of the population actually became infected. “
Vallance made his media appearances the following day, explaining the crowd immunity approach. He was asked on Sky News why in the UK “society continued as usual,” and was told that an infection rate of 60% would mean “many people dying.” Vallance replied that it was difficult to estimate the number of deaths, but said: “Well, of course, we face the possibility, as the prime minister said yesterday, of an increasing number of people dying.”
Matt Hancock, the health secretary, issued the first denial that herd immunity was part of the government’s plan, despite Halpern and Vallance having indicated yes days earlier, in a column in the Sunday Telegraph on March 15. “We have a plan, based on the experience of leading world scientists,” Hancock wrote. “The immunity of the flock is not part of it. That is a scientific concept, not an objective or a strategy. “
By then, a dizzying number of experts were sounding the alarm. More than 500 UK scientists signed an open letter issued on March 14 dismissing the herd’s immunity as “not a viable option” and calling for stricter social distancing measures so that “thousands of lives can be saved.”
Finally, the evidence that seems to have caused the change of course was contained in the Imperial College article, published on March 16.
A political decision
Ferguson’s article has been widely reported but misunderstood. He suddenly warned that the NHS would be overwhelmed “eight times”, resulting in “hundreds of thousands of deaths” if the government did not change its mitigation strategy to “repression.” But the reason was comparatively technical: experience in Italy and in the first cases in the United Kingdom had shown that twice as many intensive care beds were required as previously estimated. The document establishes the measures that would apparently comprise a mitigation policy, which the government was planning at the time: “Isolation of cases, domestic quarantine, and social distancing of those at greatest risk of serious outcomes (older people and those with other conditions underlying health) are the most effective policy mix for epidemic mitigation. “
Ferguson made it clear to the Guardian that the estimate in that document of 250,000 deaths was not new and was based on “the mitigation scenario.” The document stated that, in effect, the virus should be allowed to spread initially, so that over time people would become infected, recover and achieve immunity: “Introducing such interventions too early runs the risk of allowing transmission [of the virus] return once they rise (if insufficient immunity has developed in the herd).
Ferguson held a press conference on March 16 to explain the new findings. His colleague, Professor Azra Ghani, said: “Under the strategies we were following, we expected a certain degree of collective immunity to build up. If we now realize that it is not possible to deal with that in the current healthcare system, and it may not be acceptable in terms of numbers, then we should try to reduce transmission. “
The Guardian asked Ferguson how that policy could be envisioned, if it predicted 250,000 people would die. He stressed that he was never optimistic about the deaths of people, and made it very clear that it was the politicians, not the scientists, who decided the policies to follow. “While policy can be guided by scientific advice, that does not mean that scientific advisers determine policy,” he said. “Although I try to make clear to policymakers what the possible consequences of different policies are, to the extent that science allows.”
Professor Graham Medley, another member of Sage, and chairman of his influential modeling subcommittee, agreed that while scientists gave their analysis of the epidemic to inform politicians, deciding what to do was “a political decision” . Medley told the Guardian that Johnson, Hancock and other ministers continually said they had been guided by scientists “sometimes it has happened a little bit.” When asked if he meant the politicians were passing the money, Medley replied, “Yes.”
“Drastic Action” Needed
Even after the stern warning that the NHS would be overwhelmed if the policy did not change, Johnson and his government still hesitated. He delivered another speech that day in which he advised that “drastic action” was now needed, but the measures were advisory and still tentative. People over 70, pregnant women, and those with some health conditions were advised only to “avoid all unnecessary social contact.” The British were asked “where can they” work from home, and Johnson told them that “they should avoid pubs, clubs, theaters and other similar social venues,” although all were allowed to remain open.
The delay in introducing stricter measures, until the closure was finally ordered on March 23, appears to have been based, at least in part, on a misinterpretation of the government’s own scientific advice. In early March, Whitty mentioned the idea that the government should wait to impose restrictions because people could tire of them, and then said that this was based on both “common sense” and “behavioral science.” “What we are moving into now is a phase where we will have to ask members of the general public to do different things than they normally would,” he said. “There is a risk that if we go too early, people become understandably fatigued and it will be difficult to sustain this over time.”
Hancock supported that, suggesting that it was the result of official advice. “Evidence of past epidemics and past crises of this nature shows that people tire of these kinds of social distancing measures, so if we start them too early, they lose their effect and are actually worse,” he said. “Social science and behavioral science are a very important part of the scientific advice we trust.”
However, this concept of “fatigue” was rejected by government-appointed behavioral scientists for Sage’s subcommittee, SPI-B. “The word was never used in any of our committee reports,” said Susan Michie, a member of SPI-B. “It just isn’t a concept that exists in behavioral science, and it wasn’t useful for its use.” Four other SPI-B members also told the Guardian that the committee never advised people to tire of the restrictive measures.
Publicly available summaries of their findings show that the group advised that people should receive clear explanations and reasons for social distancing measures, and cautioned that such measures would affect people unevenly, but nowhere do they suggest that people are “they will tire”. Three behavioral scientists at SPI-B, Stephen Reicher, John Drury, and Clifford Stott, even wrote an article for the journal Psychologist, rejecting the notion of “fatigue” and suggesting that delaying stricter social distancing measures on that premise was a risk to life. . “Psychological considerations were at odds with what medical science demanded,” they wrote.
The Guardian understands that the Halpern Behavioral Perception Team, or “push unit,” also opposed this view that people would tire of the restrictive measures. A leading Whitehall source said Whitty himself was the leading proponent of the notion of “fatigue,” based in part on his own experience of patients in medical practice not seeing prescription drugs until their completion.
A Downing Street spokesperson, responding on behalf of Whitty, emphasized that he was genuinely concerned about the timely interventions and their impact on people’s well-being if they were presented too early, and that Sage had agreed that a balance needs to be struck between the impact of the measures, and the time in which the public could feasibly sustain them.
During the week after March 16, there was a fierce debate within the government over whether it was necessary to impose a stricter blockade. “Several of us thought that the measures should be introduced earlier,” said a source close to the Cabinet Office. Hancock appears to have been under great pressure, stretched between that vision and resistance elsewhere to take really drastic measures. A leading source from the Department of Health and Social Care (DHSC) recalled discussions about continuing the herd’s immunity policy, even though Hancock rejected it, and a senior official still defends it. “His basic opinion was that we were all going to develop antibodies and ultimately the question was how to manage the release of the disease in the population over time.”
Another well-positioned source said the health secretary vigorously argued for a closure at a Cobra meeting, chaired by Michael Gove, with a junior Treasury minister who was resisting due to its huge economic impact and fears that a closure itself would kill many people. The source said Hancock continued to refer to models that predicted that deaths would increase dramatically without a block.
The DHSC source summarizes this period seriously: “They knew we would have to close; They debated when. Every day they wasted, every day we weren’t locked up, resulted in people getting the disease, people who have since died. “
A source from Sage said there was also nervousness among his group that week, a feeling that the virus was spiraling out of control and that they were unsure whether politicians understood its exponential spread. The council communicated, the source said, but they were told that Whitty and Vallance were having to cajole the politicians in the right direction, and there was “friction.”
Reflecting on the presence at Sage of Cummings and Warner, some attendees now say the group’s deliberations were affected by a sense of what could be done, with a government led by politicians for whom a shutdown seemed unthinkable, though others say it was not. they were. Later that week, when stricter measures were needed, some say it was helpful to have Cummings there, because they knew he would report it directly to Johnson.
A source in Downing Street who personally urged the prime minister to stop delaying and go to the confinement that week said his reluctance was due in part to his “libertarian instinct.” “There was also a little ‘rabbit caught in the headlights.'”
Incubation
Ken Sazuze remembers that week very well. He and Elsie, who grew up together in Malawi before coming to Britain and joining the military, were concerned, he recalls, particularly because Elsie works without proper personal protective equipment for Covid-19 and about the spread of the coronavirus in Birmingham. Last year she had gone from working in NHS hospitals to caring for people in nursing homes, so she could have more regular shifts and help Anna with her GCSE. That week, Anna’s school was open, Andrew was traveling by public transport to the University of Wolverhampton, where he is in his third year of finance. Ken was in a placement for the last year of his nursing degree, while Elsie was working.
“Todavía era la vida normal”, dice. “Todo estaba abierto. La gente no era distanciamiento social; No sabían qué hacer. Fuimos al gimnasio, a las tiendas, a la universidad, a la biblioteca “. El miércoles 18 de marzo, fueron a Birmingham, a la plaza de toros, a comprar regalos para Anna, cuyo cumpleaños número 16 estaba a 10 días de distancia. Fueron a Marks & Spencer en busca de perfume, recuerda, y a una tienda de Apple, donde le compraron algunos AirPods.
“No sabíamos que nos estábamos infectando”, dice Ken. “Estoy realmente molesto cuando empiezo a pensar demasiado en ello. Estoy furioso con el gobierno, con las personas que toman decisiones, porque el virus se estaba propagando en ese momento “.
Dado el período de incubación de Covid-19, Boris Johnson también pudo haber contraído el virus esa semana. La nación recibió la demostración de más alto perfil de la fuerza destructiva de Covid-19, ya que el primer ministro ingresó en el hospital días después, luego en cuidados intensivos. Si bien hubo una gran simpatía por que Johnson sufriera esa terrible experiencia personal, algunos expertos han argumentado que el espectáculo de Johnson, Cummings, Hancock, Whitty y otros asesores que contrajeron el virus indicaron que el gobierno no estaba tomando suficientemente en serio el distanciamiento social. Una fuente en Downing Street, la semana anterior al cierre, dijo que estaban sorprendidos de encontrar que el personal en el número 10 todavía se estaba dando la mano a los visitantes.
Un portavoz de Downing Street dejó en claro que no acepta que Johnson debería haber sido más cuidadoso, y dijo que el No 10 hizo cumplir el distanciamiento social cuando era práctico.
Cierre de emergencia
In a response to questions about the government’s handling of the Covid-19 pandemic, and whether Johnson regrets any elements of it, Downing Street did not accept any criticisms. A spokesperson replied in a statement:
“This is an unprecedented global pandemic and we have taken the right steps at the right time to combat it, guided by the best scientific advice. We are so grateful for the response of the public, who have helped us to slow the spread of the virus and stop the NHS from being overwhelmed. The government has been working day and night to battle coronavirus, delivering a strategy designed to protect our NHS and save lives. Herd immunity has never been a policy or goal. We have provided the NHS with all the support it needs, made sure everyone requiring treatment has received it and taken unprecedented steps to support businesses and workers, to protect the economy.”
The spokesperson for Vallance said: “Herd immunity was a scientific point, that ultimately immunity is an important way to tackle infectious disease, ideally through vaccination.”
Ken Sazuze says he understood that this was an unprecedented pandemic, but could not understand how the government could say its response had been faultless. “I’m in a different world now,” he says, “it’s something you can’t believe. I am angry as well. It would help if they accept their mistakes and apologise. It was slow, the testing and PPE was not adequate, and this virus was allowed to spread. Sometimes you just have to stand up and admit your mistakes, as a human being.”
