The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again

Richard Horton

Polity, £12.99

As the UK comes to terms with one of the worst Covid-19 casualty rates in the world, it is already clear where the main mistakes were made.

The country lacked adequate personal protection - gowns and visors - for care staff, nurses and doctors. We abandoned testing prematurely in mid-March. We forgot to protect the most vulnerable, the elderly, when they were decanted from hospitals to care homes.

The UK government didn't close the borders and allowed 18 million travellers, many from Italy, to arrive here before lockdown on March 23 without proper health checks or quarantine.

More controversially, the UK and Scottish governments delayed lockdown by a crucial week. This effectively doubled the death rate, from 20,000 to 40,000, according to Professor Neil Ferguson of Imperial College.

Richard Horton, doctor, editor of The Lancet and honorary professor at the London School of Hygiene and Tropical Medicine, is in no doubt who is to blame for this “Covid Catastrophe”. “A government’s first responsibility is its duty of care to citizens”, he writes in this new book. “Early government inaction led to the avoidable deaths of thousands of those citizens”. That is possibly the most serious charge you can level at a government.

Horton clearly regards Boris Johnson as personally responsible for fatal dither and delay. He quotes him as saying: “Perhaps you could sort of take it on the chin...” and accuses him of pursuing a reckless policy based on herd immunity. Actually, that isn't quite what the Prime Minister said on ITV's This Morning on 5 March, as as the independent fact checkers, Full Fact, have pointed out.

Johnson said: “One of the theories is that perhaps you could take it on the chin”. He went on to make clear that this wasn't the government's policy and that they intended to take “all the measures that we can to stop the peak of the disease” .

It's a small point, and doesn't disprove Horton's thesis that the government was “slow, complacent and flat-footed”. But he should have used the full quote.

Throughout the crisis, Mr Johnson and Nicola Sturgeon have insisted that they were only “following the science”. The question is: were the government scientific advisers on SAGE slow and complacent? Horton thinks they were.

“SAGE luxuriated in elite insouciance,” he says. “It displayed a very British characteristic: the arrogance of exceptionalism”. Sir Patrick Vallance, the Chief Scientific Adviser, failed in January to study the evidence from the Chinese city of Wuhan; failed to prioritise a testing regime; failed to listen to the World Health Organisation.

However, in Mr Vallance's defence, in mid-January WHO tweeted that there was “no clear evidence” of human-to-human transmission of the virus. Mr Horton himself said on January 24 that Covid-19, while a serious health issue, showed “moderate transmissibility and relatively low pathogenicity”.

On February 21, the government's virus sub-committee, NERVTAG, agreed that the risk from Covid was “moderate”. That was, says Horton, “a genuinely fatal error of judgement”. It also suggests ministers were getting mixed messages.

Recently released minutes from SAGE reveal that as late as March 13 scientists were distinctly cool on the advisability of lockdown. SAGE then were “unanimous" that "measures to completely suppress the spread of Covid-19 will cause a second peak”.

This wasn't full-fat herd immunity, but it reflected the prevailing view that, as Scotland’s National Clinical Director Jason Leitch put it, the disease couldn't be stopped and had to “spread through the population” in the absence of a vaccine. All we could do was prevent the NHS being overwhelmed.

The government's chief epidemiological modeller, Professor Graham Medley, even told Newsnight on March 13 that the old and vulnerable could be sent to Scotland so that “we can have a nice big epidemic in Kent.”. He didn't mean that literally, of course. But Horton sees his remark as evidence that herd immunity was very much in the back of SAGE's mind.

If it was, they were wrong. Covid can be suppressed, at least in the short term. New Zealand rejected WHO advice not to close its borders and slammed them shut as soon as cases of Covid-19 emerged. It then imposed the severest of lockdowns. Last week, Prime Minister Jacinda Ardern “did a little dance” in celebration of “banishing coronavirus”. Only 22 deaths compared with Scotland's 2,500 or, including suspected cases, more than 4,000.

This is where I disagree with one of the main themes of Covid Catastrophe, namely that the pandemic has demonstrated the interconnectedness of countries and the folly of “Trumpist" national solutions. New Zealand's solution was the most radically nationalist imaginable: locking out the rest of the world.

If and when there is a second wave, the first thing governments will do is close their borders. There may be demands in Scotland to close the border with England, or at any rate introduce checks. Covid has been a disaster for globalisation. Nations and borders are back.

Richard Horton avoids direct criticism of China, which is widely believed to have suppressed information about the Wuhan epidemic during December. He admits there is a “gap in the timeline”, but insists he doesn't want to apportion blame, though he is no slouch when it comes to blaming the scientific and political communities at home.

“Covid Catastrophe” is a broad brush polemic that drags in market capitalism, Brexit and misuse of the environment to the Covid story. This may well be justified. But readers might have been hoping that the editor of a prestigious medical journal would have had more to say about the curious nature of this coronavirus.

Where did it come from and how has it mutated as it has spread? Many people seem to carry it without symptoms and, unlike flu, Covid-19 seems not to target people under the age of 40. Why does it make such a mess of the lungs?

What is the state of play on the wearing of masks? The strength of evidence for the two-metre rule? Indeed, for lockdown itself? A recent study by Professor Simon Wood at Bristol University suggests that UK deaths from Covid-19 peaked before lockdown was imposed. What is the point of keeping children effectively off school for perhaps another year when we know they are not at risk? Just how serious is the risk of onward transmission? How likely is the “second wave” that so concerns SAGE?

Horton believes we need to learn to co-operate more and consume less; stop travelling and find more harmonious ways of living with the natural world. I say amen to that. He is righteous in his anger at the complacency and lack of leadership shown by politicians and the medical establishment. But we could also have done with some more ideas about what the hell we do next.