Writer’s Note 10th May – The Guardian published the report a day or so after I wrote this piece, so perhaps Jeremy Hunt knew what was coming!
I’ve started a few pieces on the response from government and how the US retreat from world is bad news for the rest of us, however I’ve mentioned before how there appeared to be nothing done from Exercise Cygnus and I came across an interview today (5th April 2020) that has not gathered much traction which I thought was worth writing about. Its revealing in that we can understand why the UK has been hit relatively hard by COVID-19.
Cygnus was the NHS Pandemic test in 2016 and then Health Secretary Jeremy Hunt has been on the radio talking about this test and what was recommended. Unbelievably its TalkRADIO that had the pleasure of getting something out of government despite it being a cross party exercise (so surely someone on the Labour benches could tell us) but perhaps that is the damning thing about it, it barely recommended anything. The full interview is on Facebook which discusses a variety of points, I have focused on the Cygnus element with the following transcript (apologies for any missed words), the segment is from 7:16 to 10:57:
Ian Collins [TalkRADIO Host] “Just a word on what happened when you were Health Secretary. 2016 the Cygnus exercise, the dry run of what would happen if a Pandemic happened. We understand a lot of the information that came from that is being kept secret but we understand some of the headlines were that this could be serious, it could be terrible, there’s not enough PPE, there’s not enough ventilators, it will be chaotic. That turned out in some respects to be true. What happened there? You were the Health Secretary, you would of seen the results of this dry run, how are you ascertaining that now, what do you make of those headlines?”
Jeremy Hunt “Well it was a very important and very thorough exercise and we learnt a lot of lessons from it and the recommendations that I was asked to put in place as Health Secretary I did. The main recommendation was about preparing emergency powers, emergency legislation, to help the NHS cope in that situation which is what we did and what subsequently became law with the Coronavirus act. So, we did what was asked but I think that was an exercise that was looking at Pandemic flu and it wasn’t looking at a SARS like virus.”
Ian Collins “But it did conclude you needed ventilators and PPE and that’s appeared to be lacking at the beginning of this”
Jeremy Hunt “Yah, and we have a big stockpile of PPE and I think that… [“You’re saying there hasn’t been a PPE crisis?”] but there were no recommendations made that said you know, Health Secretary you need to buy all this extra PPE that was then vetoed by politicians. We were aware of those pressures, we will definitely say one of the learnings from Coronavirus is to rethink our approach to PPE because it has been one of the biggest challenges and I’m sure Matt Hancock will be the first to say that”
Ian Collins “But just on that point and this is only for clarity and transparency has been sort of central to some of this if a dry run takes place Jeremy Hunt and it says within there somewhere, I don’t know how it was written obviously that, we could have a severe lack of PPE, is that information just left hanging there. You said there was no directive to say that the Health Secretary at the time i.e you needed to buy more PPE so what happens to that paragraph, does it just sit there in a file somewhere?”
Jeremy Hunt “Well that exercise was modelling what would happen if the country was overwhelmed with pandemic flu and we were actually modelling 750,000 deaths so absolutely massive amounts of deaths. What happens if we run out of doctors, nurses, hospital beds, ventilators everything that’s what we were modelling and on the basis of that modelling officials put together recommendations which we implemented but I’m the first…”
Ian Collins “That makes it even worse then doesn’t it if you were modelling it based on the fact three quarters of a million people might die we’d of been even more ill prepared?”
Jeremy Hunt “I’m the first to say that we’re going to have to learn a lot of lessons from this [“We had Hornby Trains and Dyson offering to make ventilators”] Yes but I think in fairness the capacity of the NHS has held up extremely well. We haven’t had a situation where anyone has run out of ventilators, there are going to be lessons, by the way lessons not just for the time when I was Health Secretary but the government we had prior to that was when we had Swine Flu and that’s when we the original stocks of PPE were built up. I think we’re all going to have to look at these and say what are the lessons we can learn going back decades, and its very very important we do”.
Recommendations, what recommendations?
The key take away from Cygnus is clearly that whilst there were a variety of issues identified (lack of PPE etc.) the only “official” recommendation was to grant emergency powers to the Government. Not more stockpiling. Not more ventilators, just emergency powers. That’s it. Now granted, that did actually happen but is that really a significant policy change? Is Jeremy Hunt really saying that in a time of national crisis the government has never considered using emergency powers, that it wasn’t already a part of the government’s playbook for something that’s a priority as high as a Nuclear Attack? Maybe it wasn’t from a pandemic perspective but considering every other nation in Europe has the same policy in place it doesn’t seem like this is exactly ground breaking – its more akin to giving the Government permission to perform damage control, to act after the fact.
The Cygnus test was clearly inadequate – Transparency non-existent
Jeremy Hunt states that the model used was based on 750,000 deaths. It would be mildly understandable that the UK would be unprepared for a toll that large, I don’t think its feasible anywhere in reality, but the UK has “only” had 29,427 deaths thus far. The question needs to be asked – how on earth were we so unprepared for a virus that really was “just a flu” compared to our modelling?
Stating that the model “was looking at Pandemic flu and it wasn’t looking at a SARS like virus” as justification for the adequacy of Cygnus is incredible. COVID-19 spreads via droplets, the pandemic Flu eluded to would probably have been modelled as an airborne disease (based on the sheer number of deaths) – effectively the modelled version would have been far faster in spreading and would’ve needed even more PPE. The problem is we just don’t know because the report is still not being released, which means we can’t answer the question of if there were PPE shortages, what was the extent of them?
This question is incredibly important – if there was a minor shortage the exercise was clearly inadequate as a model because COVID-19s shortages for a much smaller spread have been at times severe. If it was a major shortage, then why was nothing done, why was there not an official recommendation made to increase the national stockpile?
Reading between the lines my guess is that the model was woefully, woefully inadequate. You could almost certainly understand a PPE shortage in a situation as per the model, which is why a recommendation may only have been made if it was deemed the NHS was catastrophically short. Its not in catastrophe mode at the moment but imagine if it had been as virulent as the model Jeremy describes, that really would have been a nightmare. It must be said in this case you would rather the model was found to be inadequate with COVID-19 instead of Spanish Flu.
This is why the report needs to be released. We need to know what the model was and how it compares to other diseases that have cropped up such as Swine Flu and MERS, along with our knowledge of COVID-19. Clearly, the model was a poor one that has left the UK unprepared.
A shot against Labour
One of the last lines which went “by the way lessons not just for the time when I was Health Secretary but the government we had prior to that was when we had Swine Flu and that’s when we the original stocks of PPE were built up.” To me this reads as a way of dragging Labour into it.
Now, you can blame Labour for a few things. You can blame them (and the other parties) for not kicking up more of a fuss in the commons for demanding answers to Cygnus, especially as it was a cross-party report. You could almost blame Corbyn for not demanding tighter restrictions at Rishi Sunak’s first budget reading on 11th March. You can blame the lack of direction from SARS in 2003 until they conceded power in 2010.
But to blame the previous government based on Swine Flu seems almost folly. As reference Swine Flu was in 2009 and there is a blog post on the LSE website detailing that response here. The key takeaway from that seems to be Labour reacted too quickly to a threat that wasn’t all that serious (better safe than sorry surely?), basing their fears off of an avian flu and information from Mexico that was indicating a much greater threat than actually was the case. As a note, Labour didn’t introduce mass testing just a “treat all” approach – anyone who came into contact with anyone with the virus had to take antivirals on the assumption they had it as well. Obviously that strategy is not applicable to COVID-19 but bare in mind, the US had anywhere between 9,00 to 19,000 deaths as opposed to the UK’s 392.
In review of that pandemic with the incoming Coalition government, somewhere along the line PPE must have been raised as an issue to compel a Conservative government to stock up on the equipment but it seems somewhat unfair of Jeremy Hunt to have mentioned Labour in this context. Wider strategy you could say the Swine Flu response was still to only manage and not prevent an outbreak, but Labour actually handled Swine Flu relatively well.
The main problem
However the main problem that has now been identified, and I believe is the key moving forward, is understanding that with this interconnected world we have to act fast. You can excuse the world until the 23rd January for not acting sooner but after that date, when it was obvious this was spreading human to human, not shutting down air travel immediately ultimately sealed the fates of many people across the globe. We had been lucky that previous diseases like SARS and Swine Flu were not as virulent as Spanish Flu but the risk is still there that COVID-19 could mutate into something far more deadly.
What Cygnus shows is that despite whatever is modelled the true reality of a virus will be very different than to the one on paper. This exercise modelled what could have happened if a Spanish Flu-like virus had infected this island. Why, if you are modelling 750,000 deaths, are you not more concerned with the protocols to stop the spread to these shores than to focus on just treating the symptoms? We have historically had a Navy capable of stopping foreign invasion, and whilst occasionally the Frogs will land in Wales, why did we allow flights to continue to circumvent our natural border? Don’t tell us it couldn’t be done as New Zealand did exactly that; Jacinda Ardern puts Boris, Emmanuel, Angela and Donald to absolute shame.
We absolutely need effective measures in the UK for when a virus does take hold and South Korea’s model shows how that can be done, how to limit lockdowns and “live” with the virus. What we did by leaving our shores open was almost invite the virus in, accepting a reality we didn’t need to accept. We might have had to go on holiday to Skegness, but that’s much better than having virtual holidays to Santorini, at least life could have gone on. Its just three steps from the moment the WHO declares human to human transmission and a global threat:
- Shut down incoming travel except for Expats & Diplomats
- Test, Trace and Quarantine
- Ramp up PPE and Testing capacity
If it still blows up no-one could blame a government at that point, that would be a virus of truly exceptional qualities. COVID-19 on the other hand is not, from a virulence perspective, all that special and yet we’ve let it become that through a lack of imagination, action and preparedness. Preventing masses of cases would mean we would not need to test 100,000 people a day – South Korea only test 15,000 a day, and PPE would not be in such short supply.
Soon I will have a piece up about the WHO’s official responses to the virus and how that didn’t exactly help but I was inspired to write this one due to the comments Mr Hunt made. It was on his watch that Cygnus recommended that instead of treating the problem at source, we look to mitigate the issue once it has taken hold. From the fact we do not have the report we can only speculate, but based on the UKs response clearly there has been a lack of focus on preventative measures.
Our lack of action doesn’t just seal the fate of our own people but also that of many others. Had we protected our island we could have been shipping PPE and Ventilators to places in Africa, places that we have a long way to go to pay off our historical debt. Instead, we and our friends in Europe and the US put their preparedness in jeopardy by hoovering up all the available PPE. We laughed at China, I dare say they are probably laughing at us now.
So no Jeremy, these continued appearances on TV and Radio trying to change the narrative of your premiership of this country’s health provision and subsequent events do not imply the adequacy of Exercise Cygnus. The COVID-19 disaster is a part of your legacy. We can infer Cygnus was not fit for purpose from the very recommendations that have been outlined and that a test that modelled 750,000 deaths would infer that we should have been able to cope with a virus that’s nowhere near as virulent. Releasing the report may help save some face but its probably being kept hidden due to the true extent of the problems identified.
Labour and the rest of government are implicit in not getting Cygnus published, not questioning appropriately at the time and not challenging the entire stratagem that was policy for years. As those questions are only getting asked now, clearly no one was paying enough attention at the time (and to be fair, neither was I but I’m not paid to do that). If there is a lesson that will be learnt it will be pandemic prevention will be one of the top priorities in this country – at the next election numbers of PPE items in the national stockpile will be a pledge in almost every manifesto.
Matt Hancock will likely be sacrificed atop the pyramid in Parliament Square once this is over. Hancock had a bad hand, and should have done more, but his legacy will in part not be completely of his own making. Decades of ignorance and poor decision making will be his downfall – its just a shame the man at the helm for 6 years’ only contribution to parliament’s pandemic response was merely to give the PM executive powers, instead of a plan to prevent needing to implement those in the first place.