Artillery Row

Sprinting in the coronavirus marathon

Europe escaped SARS in 2003 – and duly failed to plan for the next pandemic

Is the British government’s response to tackling coronavirus really so dilatory and inadequate when compared to the measures implemented by its European neighbours? The tone of questions directed to the Prime Minister and his experts at the now daily Downing Street press conferences would certainly suggest so.

One problem with international comparison is the different ways in which countries gather and define their data or what the details of their policies really involve. Take social distancing, for example. Keep 2 meters apart is the advice in the UK. Keep 1.5 meters apart is what Germans are asked to observe. Whereas in Singapore – lauded as the country with the most impressive response – signs are up across the island state indicating that a distance of only 1 meter apart is required.

Nor is there an industry-standard on locking-down. Among Europe’s worst affected countries, Italy instituted a national lockdown on 9 March and Spain five days later. A further eight days elapsed before Germany introduced its lockdown response, a mere one day ahead of Boris Johnson announcing similar measures in the UK. This timeline does not necessarily suggest Angela Merkel and Johnson are “behind the curve.” Each government responded at a roughly similar time after the take-off point of the virus in their country.

By selectively picking your international example, you can make the British response look good, bad, or just about on par. Germany is ahead of the UK in testing its population and currently has more ventilators too. But France has not engaged in systematic testing, indeed its government experts have consistently downplayed the advantage of doing so (although a u-turn seems imminent). France also has no more ventilators than the UK. Is Emmanuel Macron receiving a daily pasting for being behind the Boris curve?

Is Emmanuel Macron receiving a daily pasting for being behind the Boris curve?

Some of the most aggressive questioning of the British government’s response has been predicated on a belief that the marathon will be won by an introductory sprint. This strategy has yet to be adopted by any known long-distance champion. But in epidemiology, it does have a logic behind it. By moving quickly, a country can avoid the virus spreading rapidly. Thereby, it can avoid the long-term imposition of the draconian measures that are now in place across Europe.

Although it has the considerable advantage of only having to cover an area slightly larger than the Isle of Wight, Singapore is held-up as an exemplar. Because it was quick to test and track, it was able to identify virus carriers and those with whom they had come into close contact. The border was quickly shut, but despite being a tiny crowded island whose people by necessity live cheek-by-jowl and are heavily dependent on public transport, Singapore’s shops, offices and schools are open. So far, the virus has been contained and only two Singaporeans (out of a population of 5.6 million) have died from it.

Singapore describes itself as the “Smart Nation.” This is not so much a boast about its people’s IQ as a government initiative in which mass participation in state-supported data gathering and sharing informs a range of technologies to make provision easier and more intuitive to need. A government able to access invasive amounts of data to better provide for its people’s needs also involves it knowing a lot more about its citizens. To cynics and critics, “Smart Nation” is a clever rebranding of “Surveillance State.”

At times like these, this surveillance is life-saving care. Singapore has been using the data on its citizens’ mobile phones to track who else virus-carriers have met or been close to – and to isolate them accordingly. There are even apps like TraceTogether that allow users to proactively share their data with the Ministry of Health. By such measures Singapore has avoided the far greater curtailment of people’s liberty currently required through European lockdowns.

Tracking people’s movements only has value if you are able to expeditiously test them, preferably before they are in intensive care. Which brings us to the question of why – to varying degrees – so many European countries were slow to live up to the exhortation on 16 March of Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation, that “we have a simple message for all countries: test, test, test.”

To hear the tone of some of the accusations being levelled at the British government it might be imagined that coronavirus testing was a long-established norm practiced everywhere but here. In reality, three months ago there was no such thing as a test for coronavirus. It is, after all, a new virus.

Having the capacity to test when a test becomes available is really the issue, however. This is where the UK, like many European countries, has awoken late to the danger.

So far, the UK has tested more than France, but less than Italy and Germany. Whilst Boris Johnson’s government is now racing to increase the level of testing (which now exceeds 6,000 a day in its goal to reach 25,000 a day) it is far behind where it should be – with frontline NHS staff the top priority for weekly testing.

The UK is, however, taking a lead in the perfection of antibody testing (which could be ready next week). This would give an indication of who has already had the virus and thereby developed (at least temporary) immunity.

Rightly or wrongly, the suspicion is gaining ground that many Britons contracted mild forms of coronavirus earlier this year without realising it. The gulf between what the epidemiological projections from (not yet peer-reviewed) modelling by researchers at Oxford University’s department of zoology (which hypothesises that half the British population could have developed immunity) and the starker modelling from Imperial College London (which has thus far informed the expert advice to the government), illustrates that policy is having to be made on perilously little hard fact.

Speaking in the House of Commons on Tuesday, Jeremy Hunt, the chairman of the health select committee (and former health secretary) drew attention to a stark reality. That tracking is manpower-intensive and NHS England only has 280 people dedicated to it. This is a fraction of those needed to do it effectively.

tracking is manpower-intensive and NHS England only has 280 people dedicated to it.

Hunt called for the diversion of local government employees doing non-essential work to be urgently enlisted in the task as well as the Crick and Sanger institutes. The truth is that Britain, like many European countries, should have developed capacity for pandemic testing and tracking years ago. Blame Boris Johnson or Matt Hancock if you must for being a few days behind what might have been technically possible. But the failure to plan adequate capacity is a charge to be laid at previous governments.

European countries, unlike those of Southeast and eastern Asia, did not have to deal with SARS, the respiratory epidemic which spread from mainland China and Hong Kong in late 2002 and threatened to engulf the Asian continent the following year.

Singapore was one the countries (South Korea was another) that learned from the experience and got itself in a state of readiness for future epidemics with a range of far-sighted measures. These included a network of public health clinics across the island staffed by primary care physicians ready to test and handle outbreaks and the institution of enforceable self-quarantining of those showing symptoms.

Europe was lucky to escape SARS in 2003, but not so wise as to see it as a wake-up call. When the time comes for a Royal Commission into the Johnson government’s handling of the crisis of 2020, a useful starting point might be what the Blair government (and its Brown, Cameron and May successors) did not learn from SARS in 2003 or H1N1 in 2009. The countries that now have the capacity to comprehensively test and track coronavirus developed that capability years ago, not sometime between mid-February and early March this year.

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