Its been a couple of weeks since I penned Economic Depression and in that I eluded to the idea that a global strategy may have helped saved lives and the economy from a shock that will take years to fully recover from. I still think this is the case and if anything, the ongoing saga in the UK has emboldened that view. In fact, Theresa May agrees with me, a glowing endorsement if there ever was one (narrator: its not).
What this piece will look at is a timeline of the advice given from the World Health Organization (WHO). The WHO are a public body and thus anything that comes from them should probably be considered in a nation’s pandemic response. The WHO’s mission is to coordinate responses to global health problems – they have done excellent work with Ebola and provide healthcare to millions who live in places that do not have sufficient state run resources to cover their needs. In a global pandemic they appear to be the natural choice to follow, they have offices in every region, experts in every field, provide guidelines on a range of issues and are funded by donations from every major country in the world.
The principle aim is not necessarily to critique the actual treatment of the virus once its taken hold, its to assess whether there was a method which could have prevented such a large outbreak in the first place and compare that to what is being said by the WHO at the time. The idea is that a rapid response may have prevented large scale outbreaks and whether there was a window of time which could have been used more effectively. Essentially, what was the advice being given at the time, because the message that is sent to world leaders who are not trained epidemiologists is vitally important.
The reason to look at this is because whatever target the UK tries to get to with testing (and Boris’ 200,000 a day pledge at PMQs is genuinely an impressive target) South Korea, with a population of 52m (vs 67m), only appear to test 15,000 a day – so it lends itself to the idea that the UK was too slow to react. If we had different measures in place earlier, maybe they could have prevented lockdown altogether. That’s not just for the UK either, did the West completely drop the ball or was the messaging coming from the East difficult to interpret?
January 2020 – The WHO are hamstrung by China
The very start of the outbreak, or at least the start of the epidemic (isolated cases have been traced into late November 2019), is hampered by a cover up from the Chinese Communist Party. There’s no question it happened and its effect has so far been devastating. A timeline of events in January:
There are two key dates highlighted. The 20th January because this is the first time human-to-human transmission has been confirmed from the WHO. The 27th because the WHO has assessed the disease risk as “High at the Global level”. Prior to these dates there was not enough information for governments to act albeit there had clearly been some activity, including a short visit to Wuhan. The US even offered to send a team to help the Chinese on the 6th – imagine if they had been allowed in.
Everything before these dates signals a cover up and what is most disappointing is that people in the WHO had suspicions from the start. Dr Galea, the WHO Representative in China, conceded that between the 3rd and 16th of January “Is it likely that there were only 41 cases for that period of time? I would think not” – sadly he admitted this 3 months later. On the 14th the WHO announced there had been no clear evidence for human-to-human transmission, and yet Dr Galea is either using revisionism or the WHO were genuinely unable to find out. Its difficult to ascertain which one it is, but the fact the WHO have not been invited in the CCP’s quest to find the source raises eyebrows.
So why did the WHO not say anything? Why did they not call out China? Well its crucial to understand that the Director-General position of the WHO is not purely a medical role, in fact it is equally a political position. Its effectively an elected Health Secretary for the world – which is why global politics matter. Tedros is the first non-Doctor to hold the role. He is a micro-biologist and well regarded malaria researcher, but he’s not a physician like Chris Whitty. Crucially, he was backed heavily by China in the voting for this post along with the African Union – in fact everywhere that isn’t considered the democratic West. The election was supposedly “nasty” but of course losers may say that in retrospect. Things could have been different had the Briton standing against him won – when a European was in charge in 2003 China was savaged for its SARS cover up, Xi Jinping has no desire for key roles at the UN to be calling out his country anymore. Its something I will look into in another post.
This is why these two dates are really important – Tedros should have used his position to call out the CCP, but he didn’t. Granted, its difficult, the WHO will almost certainly be given a picture the CCP want to portray and whistle blowers were being shut up everywhere, but this lack of critique really hurts the WHO’s image as an independent body going forward. There is a small defence of the WHO because what else could they have reasonably done outside of applying political pressure, and claiming the CCP was “lying” early on would invite criticism if it turned out the disease was not all that threatening, but it should have certainly been pressing for full transparency.
This is not saying the CCP has undue control of the WHO, far from it, but it does seem the WHO are very happy to call out the bungling of other nations instead of the egregious cover up that has led to the deaths of hundreds of thousands. The cover up is monumentally serious because no one had (or still does have) any accurate data to truly gauge what was going on – in fact we would have to wait 6 weeks until Lombardy shut down to truly appreciate what was happening.
I identified these dates as from the 27th January it is the WHO and International Community’s responsibility to act from this point on.
The Sully Effect
Its important to note that hindsight is a really dangerous thing to use, if used incorrectly. The world would have probably taken more stringent measures such as shutting flights down a lot sooner than they did and in the future that is likely to be one of the first things governments will do (and those that did will consider applying that globally, not just to countries with infections), but for this outbreak they had barely any of the facts required to make an informed decision. We can see some airlines stopping flights to China but what we now know is that this disease had been spreading far further afield – it incubates for 5 to 14 days undetected, just shutting flights to mainland China would not have prevented widescale spread.
That is, however, really easy to say now. To explain the issue its best to refer to 2016s Sully, the film documenting the US Airways Flight that landed in the Hudson after a bird strike shortly after take-off. The National Transportation Safety Board conduct an investigation and in front of Captain Sully show two possible routes the flight could have taken to land at two different airports, instead of in the river. However, Sully challenges the NTSB:
“I’m not questioning the pilots. They’re good pilots. But they’ve clearly been instructed to head to the airports immediately after the bird strike. You have allowed no time for analysis and decision making. And with these sims, you have taken all the humanity out of the cockpit. How much time did these pilots spend making their plans for this event? Hours, Days? You’re looking for human error… then make it human.”
The NTSB agrees to run the simulations again with a 35 second period for the sim pilots to confer and then attempt to go to the two airports mentioned. Both end up crashing into New York.
So when we consider what governments could have reasonably done we have to consider that these people are trying to make the best of a situation that they had no previous experience with and to a large extent limited data at the beginning. This is why the WHO is so important – they have the relevant experience, they have been involved in every outbreak of disease for decades. SARS, Ebola, MERS, Swine, Bird and all the small diseases that crop up they have had someone from their organisation assessing the impact.
It is why the response from governments has been so mixed. Certain Asian countries knew from experience what the signals from China meant without needing the WHO, the rest of us needed them to guide us in what to do. There is certainly a naivety from the West when it comes to Asia, and perhaps swallowing some pride in following Vietnam’s lead was too bitter a pill for some. Nonetheless, most of the country will have faith in their medical officers but even they are limited in the advice they can provide without the relevant data i.e what is the WHO saying, because they should have had more accurate data to work with from China that wasn’t coming out of official channels.
Thus, just like the pilots of Flight 1549 the world was unsure of the extent of the problem and trying its best to understand what were the next best steps to take – all of that based on limited and suspect information. Therefore the WHO is the most important body on the planet from the 27th January because it is meant to transcend political allegiance and provide rational, meaningful advice.
February – What did the WHO say and what did the WHO do?
February is the month that would decide whether or not this virus would spread to the point of shutting down the world’s economy or not, but most critically whether it would be minor or major disaster in terms of the human cost.
It is the crucial month which dictates the direction of travel 2020 would take. When reading the timeline bear in mind that anything that says “first case” will have incubated for 5 to 14 days, so you can assume the virus has arrived earlier and has spread further. Lets see what the WHO said and some stories at the time to contextualise the announcements being made:
In the timeline we can see that, on the global perspective, the end of February saw the beginning of the pandemic taking hold in Italy and South Korea had already experienced quite a large COVID-19 spread. The other notable nations such as the US, UK and Spain have yet to experience the outbreak that they would two weeks later. Thus its important to note that the global figures for cases and deaths are still predominantly what is coming from China, but let’s pick out some key themes from the WHO’s communications (which I’ve bolded in the text):
Travel Advice – Keep Travelling
Highlighted in the January timeline on the 23rd January was a note from the WHO regarding travel i.e keep travelling, and this was echoed on the 30th. This is a consistent theme throughout February. Tedros in early February tells the WHO board travel restrictions are not required, whilst on the 29th the WHO again publishes advice that travel restrictions are not required. This is despite on the 21st February stating to the public that “we are concerned about the number of cases with no epidemiological link, such as travel history to China”. To be fair to the WHO, UK CMO Chris Whitty has stated to the UK Parliamentary Panel that he did not believe that restrictions made a big difference, and thus it appears from an outsider’s point of view that stopping international travel does not have a lot of support in epidemiological circles.
Yet, that seems utterly contrary to almost all the evidence we have had since, in fact even within the month of February. Dr Bruce Aylward, Special Advisor to Tedros, headed the WHO team to China and they commented in the press conference on the 25th February of how effective travel restrictions had been, that you couldn’t get anywhere without various passes etc. Now we’ll come on to the findings from that visit shortly because there are a lot of questions that need to be answered, but that does appear somewhat contrary to everything that is coming from the WHO, even if its passing comments in press conferences.
On the 26th they discuss “Points of Entry” as one of the 8 pillars of a response and I’ve included that below:
What is striking here is that countries should focus on “supporting surveillance and risk communication activities” yet in all the steps there is no real discussion about whether Points of Entry should be closed to travellers. Its true that this is what South Korea, Singapore and Taiwan have done, and still to this day isn’t being done in the UK, but also it feels the WHO are unable to comprehend the idea that perhaps air travel, in a virus that is not detectable for 5 to 14 days, might just be a problem. Surely step one should actually be to close points of entry, with step two to be prepare your ports of entry to be able to execute the plan below. Publishing this strategy on the 26th February is too late for most countries – this should have been available in January.
If anything they appeared overconfident and I highlighted the comment made to the press on the 11th February to emphasise that. Whilst the WHO were dismissing the need to change the risk assessment of the virus based on the evidence of the UK Super Spreader, South Korea was applying stringent travel restrictions that matched Israel’s effective cut off from Asia entirely. I wonder which one worked out better in the end.
Also within these timelines is a subtle pattern emerging. In January the first cases had reached either countries immediately around China, such as Thailand and Japan, or they had reached the UK, Australia, the US, Spain, Italy, India, Russia and France. What do all of these have in common? They have huge international hub airports with multiple links across the globe. Outside of Belgium a few days into February, the next “wave” of newly infected countries starts on the 14th and continues with a huge cluster at the end of the month in nations that are not as well connected. Just rudimentary dot-to-dot analysis suggests that the virus is spreading through air travel and as discussed, its probably been around for 5 to 14 days already in each of these countries so it doesn’t make sense to not at least publicly consider air travel to be restricted. In fact the Point of Entry pillar advice is given out over a month since Wuhan went into lockdown, did anyone reasonably stand a chance with that advice?
You can understand Tedros’ position, he doesn’t want to shut down the globe if the disease isn’t all that potent as it puts the WHO in a difficult position in future epidemics, which is why this role is more political in slant than a purely medical one. Surely, however, the writing was on the wall by February 29th – Italy had imposed a lockdown on the 21st of 50,000 people. Yet, the WHO still refused to state travel restrictions were required, if anything they explicitly stated the absolute opposite on leap year day.
The worst part is that we know now that travel bans can work. Whilst the timelines have shown that airlines acted independently (largely for operating cost reasons) you only need to look at how New Zealand shut down foreign travel on the 19th March to see the effect that’s had. The virus can’t get in if those infected can’t get in. You may not be able to stop the spread entirely but by reducing the number of infections you admit into your country reduces the number of tests and PPE you need to contain the epidemic. Does a government want to prop up the airline industry, or the whole economy? You would suspect the latter. Look at other nations with strict travel bans. Israel, 235 deaths. Australia, 97. New Zealand, 21. Swathes of Africa currently, albeit we have to wait and see the full result there.
Of course that can be countered by examples such as the US, who did implement bans from various countries albeit slowly, but by then it was already too late. It must be said the bans made by New Zealand for example came into force on the 19th March, which would have been too late for the UK, but that was made post realisation of just what was going on in Italy and Spain when we had a true indication of what we were dealing with. With reference to the Sully effect, no one could have reasonably made a case to ban travel at the end of January but surely by the 23rd February, when Italy locked down a portion of Lombardy, that should have been at the forefront of everyone’s minds? To not shut down air travel is surely endangering everyone on the planet? People picking up COVID-19 in Singapore, in chalets in the Alps, surely nowhere with any amount of travel was safe at that point?
The WHO on the other hand were not making any gestures that would suggest even contemplating the idea. Whilst organisations took things into their own hands by applying travel restrictions on their employees (I was “lucky” that Sweden was not included in my firm’s ban in late February, but northern Italy was) the WHO appeared to have no interest in the idea. If you’re stating you are concerned with cases being transmitted with no clear link of travel to China, then why on earth are you not saying to stop travel because we can’t trace it?
A small outbreak would be manageable for the world, even the UK might have been able to manage that, but the reason we have to “Test, Test, Test” Tedros is because we let this disease run rampant. At the point when you were stating on the 5th February that “There is a window of opportunity because of the high measures, the strong measures China is taking at the epicentre, at the source. So let’s use this opportunity to prevent further spread and control it,” you then told the WHO executive board 6 days later that travel bans were not needed. How else can the world stop the spread of a disease undetectable for 5 to 14 days? Especially a world that is unprepared?
That opportunity should have been heeded to by governments globally, but there is little motivation in the “phony war” period for them to shut air travel because the WHO is also not telling the world to stop travelling. Hindsight is difficult to combat, but surely, because we had no reliable data at that point in time on what this disease actually was, what it was doing, how virulent it was but could see it spreading well beyond Asia and eventually Italy beginning localised lockdown proceedings indicates that to keep travel open was a grave mistake. To advise on the 29th February that no restrictions are recommended is borderline negligent.
Of course its also difficult to react without reliable data and it’s the WHO’s responsibility to report to the world what was going on in China, and the WHO had the chance to do that with their WHO-China joint mission on the 16th to the 24th February.
The World Needed Answers – Did we get any?
By far the biggest issue at the start of this outbreak was the information coming from China. Whether it was a directive from the top or not, actions by the CCP and the experiences we have had with COVID-19 globally suggest that the true picture of what went on in Wuhan has not been released to the public.
Dr Bruce Aylward’s WHO-China mission was a chance for the WHO to assuage fears that it had been too positive with regards to what the CCP was reporting. It was critical for the world to know what exactly had occurred because governments can finally make informed decisions. We needed to know the following:
- How long has this been around for?
- How virulent is it?
- Who does it effect? How deadly is it?
- Are the Chinese numbers accurate? Has there been a cover up?
- Do we need to consider tighter restrictions now to prevent larger spread?
These questions are pivotal. Announce to the world that the data was heavily under reported and some nations would have taken action much sooner. There does already seem to be a degree of scepticism around the WHO’s mission out there, but on further investigation of the report and the press conferences made, the world might not have stood a chance.
What I’ve gleaned from the report and Dr Aylwood’s press conferences suggest that this was a poorly led, poorly focused plan. In fact it suggests to me that this was more of a PR exercise by the CCP, leading the team around certain areas, not one of the most important missions performed since the Second World War.
My expertise is in Audit – the most unglamorous of professions. When we plan an audit we look at areas of risk and where we should focus our attention in the information that is used to create Financial Statements. Say it’s a business that has lots of real estate. This is very hard to value without experts (and the experts rely on accurate underlying information coming from the cleints), with a few debtors here and there, some expenses, a bit of payroll, essentially most of that you can trace to an invoice. What would you focus on?
Hopefully you chose the very tricky and specialist real estate valuations that would take up most of your time – that would also include looking at the underlying processes, where the data comes from, talking to people and testing the “control environment”, was the information sent to the valuers correct and did anyone check it?
So you’re planning a trip to China to understand the outbreak and get some answers that you know the world wants – a world which knows that there has been a degree of covering up by virtue of the treatment of Li Wenliang. If you have 9 days in China you’d probably spend over half of that time, maybe a week, in the most affected area of Wuhan:
Out of 9 possible days, the team spent 17% of their time in the place that has, at that point, 90% of the total known cases globally. Just what on earth were they doing. How is that anywhere near sufficient time to get any answers the world desperately, desperately needed. Let’s see the actual itinerary:
Whilst I’m not in a position to critique everything on this list, what strikes me quite clearly is how planned this is and where they actually take the teams in the country. In fact they even visit a wet market in Guangzhou. Visiting Beijing is completely fair enough, but Guangdong and Sichuan? These are provinces that do not even neighbour Hubei province.
Its completely reasonable to send a team out into one of the provinces to investigate how they are dealing with the virus because that gives information to the world on what to do with relatively small outbreaks. Dr Aylwood’s description of how Chengdu deal with the virus is actually very impressive – albeit how accurate a picture he received we do not know, but I’d hope Matt Hancock has read or listened to that. But it does lead to the question why was he not parked in Wuhan for at least a week with the others doing tours where needed?
The issue with the itinerary is the world doesn’t really want to know about the provinces, it wants to know about Wuhan and yet they spend such little time there. Its telling that “Select team members only” were dispatched to Wuhan and we have no idea who these people were. So of course a lot of the fellow scientists that went would have a relatively positive outlook on the situation because if they all didn’t go to Wuhan, and those that did barely spent any time there, how are we meant to get an accurate picture of what happened and how it happened?
You would expect this visit to go to the Wet Market in Wuhan, you would hope it would visit the laboratory nearby to confirm that its safe (and honestly, I think it really is). With such little time how can they ask any “difficult” questions? How can they investigate the chain of reporting from death to the national statistics office? The simple answer is they can’t, at least from an audit perspective they wouldn’t of been able to effectively. It feels like a tour and less an actual “mission”. In fact, Dr Aylward effectively admits they did not speak to anyone on the front line:
This is not to disparage the science within it as we can clearly see some items that seem to be consistent with what we know, incubation periods of 5-14 days, reproductive factors between 2 to 2.5 and various other stats that are indeed pretty much what we’re seeing elsewhere, but the main doubt is the magnitude of the virus – there’s been revisions to the counting system numerous times and the below graph’s explanation in the text for the spike reads “[cases] have been steadily declining since then [the peak], apart from the spike that was reported on 1 February (note: a major hospital in Wuhan, fever clinic patients fell from a peak of 500/day in late January to average 50/day since mid-February)”.
That explanation just doesn’t feel right, in fact it doesn’t even make sense. The first thing we’d ask as an auditor is why is that there? I can tell already they were told something and they believed it, the most common pitfall for junior auditors. This number would be investigated and if a deficiency was found, it would be checked for in the others – that’s why it needs a reasonable explanation otherwise it undermines the integrity of the data set. That’s when the difficult questions get asked because you start probing the systems, the data that’s sent in, who controls it, who can edit it – they clearly did none of that and have just blindly used and relied on the numbers in the National Disease Reporting System.
Finally, and probably the most concerning, is that in the Chinese Response section there’s no critique of the initial cover up, no withering shots critiquing the handling of the initial outbreak as being a direct threat to the globe. There is no mention of Li Wenliang, but a very clear message that Xi Jinping “personally directed and deployed the prevention and control work” – yes, about 2 weeks after they tried shutting up their doctors. Previously in 2003, a lady of iron will refused to back down. Dr Gro Harlem Brundtland publicly called out the CCP for its cover-up of SARS – we have heard nothing of the sort this time around.
The advice at the end of the paper is what we’ve all come to experience but it misses the crux of the problem, there’s no mention of shutting international travel, the primary reason this has spread in the first place. Why comment on travel restrictions and how useful they are, but not bother to include them in a list of recommendations?
The CCP have performed some mammoth feats and quite rightly some of their procedures can be looked at as an example to follow (albeit in a far more humanitarian light), but lets not forget the real reason this outbreak has occurred in the first place and how, on reflection, devastating the cover up has truly been.
The WHO report claims there were only 50,000 active cases when they left – there has been numerous reports of undercounting appearing from China, that the fact there were much larger numbers of funerary urns in the tens of thousands than usual delivered to families and the Lancet recently predicted that there would have been 232,000 infections as of February 20th just highlights a perception that the WHO team were told a controlled “story” of the epidemic rather than asking the difficult questions that needed answering.
There is so much smoke there’s surely a fire. Numbers of deaths were revised and some estimates suggest 47,000 deaths, so I’m sorry Dr Aylward it just doesn’t add up. I probably would be nicer about Dr Aylward, but he also did this when asked by a Hong Kong paper about Taiwan. Either the WHO is under Chinese influence or its incredibly naive about the CPP. Its most likely not the former, and almost certainly the latter.
As an auditor reading this report and watching the conferences it made my heart sink a little. It may on paper be a perfectly reasonable and plausible excursion backed up by numbers, but believe me this is exactly what a good fraud looks like, or at least a report that is “liberal with the truth”. There are lot of well qualified individuals on this trip but the whole paper is undermined by the lack of focus on Wuhan, it doesn’t feel we ever get a true sense of the scale of the epidemic in that area.
It meant that it would be a further 3 or 4 weeks before we truly understood the magnitude of the disease as Italy went into lockdown. Information that has been coming out of China from non-government sources, the scepticism from its Asian neighbours and our own experiences with COVID-19 suggest this trip was little more than a PR exercise and not an objective view of the situation. Had they come back with a sense of disaster, and not one of praise and awe, then perhaps the world would have sat up. Surely, instead of praise for the treatment of the symptoms, the WHO should have come back emphasising the need to prevent the virus in the first place. It did to a degree, but stopped short of the one measure that has proved the most effective, almost contradicting itself in the process.
Why Shutting air travel is relevant
If you want excellent updates on the current COVID-19 situation you should follow Dr. John Campbell. He has been following this pandemic since January and provides excellent updates not just from the UK but globally, and crucially links in the research that is being performed elsewhere.
A very interesting piece has come from Canada that has looked at the origins of infection, i.e was it linked from international travel, domestic cases etc. This has been published by the Canadian government. The below is the latest set of data with some annotations included:
Up until the Canada flight ban on the 18th February a very large proportion of Canadian cases are due to international travel. There is also this big group of people with an “unkown source” of contraction, I would argue a proportion of these would be from those international travellers but without extreme contact tracing it will be hard to ever know the extent of that. But clearly, especially in the early going in March, over half of cases have some link internationally and the fact this tails off after the flight ban seems to indicate that there is an effect for shutting this form of travel.
The peak of international cases around the 15th March will have contracted this virus 5 to 14 days previously, i.e at the end of February/beginning of March. What advice was the WHO giving? It was publically stating that travel restrictions are not required. The evidence since undermines their advice.
Shutting travel may not have prevented outbreaks from occurring but peaks will have moved further into 2020 allowing better stock piling, more preparation time and more study into the virus to help protect more people when the time comes for lockdown. In a lot of cases lockdowns may not have even been necessary.
The Wider Context
Building on the Canadian data, a quick look at what happened with cases globally in relation to key events:
The WHO’s responsibility in February was to prepare the world and instead its advice may have helped the incubation of COVID-19 in the world’s population. Governments will rightly be pilloried first, but the WHO can not, and should not, be free from the same outpouring of discontent.
Its true that had surveillance measures been put in place at Ports of Entry as advised that would have helped detect the virus, but the WHO will have known outside of a few Asian states this was not possible. Best practice is one thing, understanding the practicalities of the world around you is another entirely. World leaders do not naturally understand epidemics, let alone pandemics with most nations ignoring pandemic preparedness entirely. The point of having international bodies such as the WHO is to educate and advise countries on what steps they should take – there was clearly a failure in understanding what the world was capable of. Is it the international community’s fault? In that respect yes, but firmer language was needed to account for the fact Point of Entry protocols are simply not well developed and if it wasn’t possible, the closing of travel should have been the first precaution advised, not (and quite unbelievably) advised against.
When I mentioned Sully those 35 seconds they added to the simulation is the equivalent to governments across the globe between the 23rd January and the 23rd February – this was the time to get the data in and to assess our options. We had limited information coming from China and the WHO blew the one chance it had to prove its objectivity and has since been facing an uphill task in the PR department. Tedros may have been worried about the response from the CCP, especially as they backed him in his bid for Director-General, but it was his job to call them out for the cover up. The head of the WHO when SARS hit did that for a disease that is merely a blip in our timeline, this one has ramifications that we are still yet to truly discover.
The WHO failed to understand that the world was not waiting to see the epidemiological analysis. If there’s one thing most can agree on, the Chinese data regarding the virus itself is broadly in line with what is being seen everywhere else. However, what the world wanted to know was just how bad was it, what is your impression of the numbers we have seen? There’s no doubt on the science but there was and still is doubt on the magnitude. Had it been revealed they believed it was in the hundreds of thousands of cases and deaths much closer to what we’re seeing elsewhere, governments could then realise just how far this would have spread. Travel restrictions might not save every country from devastation but it may have abated the worst.
I wrote in Economic Depression that Western Governments should have known better – and acting faster may have prevented the very worst of this event. Two days ago I assessed why comments made by Jeremy Hunt proved Exercise Cygnus was woefully inadequate. The UK, amongst many others, has got this wrong and places like New Zealand just about got away with it in terms of the virus coming to their shores in droves. Unfortunately we won’t know how wrong for another 2 years at least.
However, you can also see how the WHO hindered any sort of effective international response that was so very needed. Here’s the thing, most democratic nations followed guidelines with regards to travel restrictions, so in fact South Korea and Vietnam flew in the face of those recommendations in February and disregarded the body. The US doesn’t impose its European travel ban until the 13th March – had the report from China came back saying travel restrictions are a necessity, then perhaps even 2 or 3 weeks would have been enough to stop the worst everywhere else. Remember it’s the countries that have by and large the most international connections (outside of Iran) that are currently worst affected.
It leads you to wonder just what the UK government was doing, were Matt Hancock and Dominic Raab taking any notice of the words and reports coming from the WHO? Could they not see the flaws in their words and how other nations had acted against their now clearly inadequate advice? Had they hauled up that drawbridge in February, would we be concerned with PPE right now?
Ultimately it is up to individual governments to act, not the WHO. The body cannot compel a nation to do something and it was right to highlight the need for good contact tracing and testing facilities. Yet, it erred on giving the one piece of advice that stops transmission spreading cross-borders. I remember being in the audit room in February feeling that this virus was obviously spreading human-to-human, shocked at images in Wuhan of people being “bolted in” to their buildings. It made me think of an old flash game called Pandemic II, where you’d try and spread the virus as much as you could before governments shut down airports. Ironically, our Health Secretary could’ve had more effective advice from a video game than the WHO itself.
This is not to excuse any government for their responses from the moment Italy started locking down – if we weren’t sure before then we should have been after that. Shutting air travel should have absolutely been implemented then at the very latest. Logically, less infections coming in, less infections spreading, less need for PPE and less testing is required. As a reminder, South Korea test 15,000 a day and had been doing so since February – it took the UK until late April to get to that figure, a true indictment at just how unprepared we had been. Prevention would have been the cure, surely, as it has been in places like Poland, Ireland and Austria. As I have said previously thought, we do need to wait a year or so before we can start to claim success anywhere in the world.
On balance there was very little the WHO could have done in January other than publicly insist adequate disclosure from the CCP. Once Wuhan goes into lockdown it is then the WHO’s responsibility to come up with advice that can mitigate the spread of the virus – travel restrictions in hindsight should have had been recommended and yet the complete opposite was put forward; airlines and national governments had to guess the extent of their own measures as they had no one guiding them from the very institution that was meant to do that. Some went just for Asia. On reflection, a global shutdown of air travel may have saved many more lives. Add to that a somewhat foregone conclusion of a visit to China, which really (in my biased opinion) needed some auditors to go with them, and it just feels the WHO wasted what Tedros described as “a window of opportunity”. You were worried about infections not related to travel to China, that means its spreading due to travelling, and yet there seems to have been a cognitive break down in understanding the implications of that. Maybe the WHO gift shop had run out of dot-to-dot books, or maybe they felt it would just be another SARS, maybe they themselves didn’t know either.
Theresa May is right, a global response is required for times like this. Actual leadership in those “35 seconds” may have temporarily halted our lives for a month or two but instead we suffer the great unknown of prolonged lockdown and subsequent economic carnage. The world was effectively flying blind in January, but the autopilot was still left engaged by a WHO unwilling to act. Of course, it’s the responsibility of the governments sitting in the First Officer’s seat to avert disaster when the Captain appears to lose control, and sadly Boris & Co took the stick too late, hitting the Hudson at an angle that meant not every passenger will survive.
In the future there should be a body that solely deals with Pandemic response, or at least a group of nations willing to unite their responses to help lead the way. The WHO clearly is not designed to do that and will never be if its role in the world is to be a political football kicked about by the US and China. I genuinely believe Tedros is doing everything he can and is in a difficult position, its just at times he and his team have not helped themselves. Its hard to say it, but if this is the true extent of global coordination in a time of crisis, we don’t stand a chance with climate change.
Finally, I can’t help wondering if Theresa May was ultimately robbed of her time to shine – a disaster needing full, timely, Thatcher-esque control, sounds like something she’d relish.
Instead I suspect Xi Jinping will be calling our response complete wiff-waff.
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