 “Coronavirus: lessons learned to date” The new report “Coronavirus: lessons learned to date” from the House of Commons takes a critical look at the handling of the pandemic in the UK. A pandemic which according to the latest figures has resulted in 137,944 deaths. Especially interesting is the report’s attempt to explain the reasons for the delayed full lockdown in the UK, compared to other countries. A lockdown was not ordered until 23 March 2020. The report argues that especially in the beginning scientific advice based upon past experience led to faulty advice and misguided trust in this advice by politicians having to make the decisions. The Government relied on scientific advice from SAGE (The Scientific Advisory Group for Emergencies) and subgroups. With representatives from the Government participating in SAGE meetings (not the least Dominic Cummings, the former assistant to the Prime Minister). Expert advice based on the past experience and faulty assumptions Reliance on existing flu models The Report finds: “The UK’s pandemic planning was too narrowly and inflexibly based on a flu model which failed to learn the lessons from SARS, MERS and Ebola. The result was that whilst our pandemic planning had been globally acclaimed, it performed less well than other countries when it was needed most … much of our preparation was for an influenza-like pandemic—notably one that was not characterised by asymptomatic transmission (and for which testing was therefore not so important).” In the report the former cabinet secretary, Lord Sedwill is quoted as saying: ”Essentially, we took the pandemic flu plan and tried to adapt it for Covid-19. Obviously, the adaptation of that plan continued as we learnt more about the disease. [...] for several months the scientists did not know about asymptomatic transmission, and therefore the focus in the early stages was on measures—social controls, social interventions—to try to impede transmission between people who were symptomatic and to identify early those who were symptomatic.” What was happening in Northern Italy at the time doesn’t seem to have made scientific advisors and politicians realise that they were dealing with something far worse than a flu. Unavoidable herd immunity The views of SAGE may be represented by the advice of Sir Patrick Vallance, The Government Chief Scientific Adviser. As late as the 12 March he argued that it was not possible to stop everyone being infected, and nor was that a desirable objective. The aim of the policy was: “To try and reduce the peak, broaden the peak, not to suppress it completely. Also, because most people, the vast majority of people, get a mild illness, to build up some degree of herd immunity as well so that more people are immune to this disease and we reduce the transmission at the same time we protect those who are most vulnerable from it. Those are the key things we need to do.” To some outside observers this policy was regarded as madness, in light what was happening day by day. Groupthink In the report the former Chief Medical Officer for England, Professor Dame Sally Davies is quoted saying: “Quite simply, we were in groupthink. Our infectious disease experts really did not believe that SARS, or another SARS, would get from Asia to us. It is a form of British exceptionalism.” Lack of data for modelling In the report Professor Neil Ferguson states: “Models can only be as reliable as the data that is feeding into them. However, we know that—especially in the early stages of the pandemic—there was an acute shortage of good data. There was also a limited understanding of the virus early in the pandemic. Key questions, such as the length of immunity conferred by infection, were unknown and hampered accurate modelling. Lockdown seen as ineffective SAGE did not believe that people would be able to follow strict lockdown rules for any length of time. People would get fatigued, protest, and not follow the rules. ”One of the critical things that was completely wrong in the whole official thinking of SAGE and the Department of Health in February/March was, first of all, the British public would not accept a lockdown and, secondly, the British public would not accept what was thought of as an east Asian-style track and trace-type system and the infringements of liberty around that.” On 9 March one of the government’s chief advisors Professor Chris Whitty argued: “It is not just a matter of what you do but when you do it. Anything we do, we have got to be able to sustain. Once we have started these things we have to continue them through the peak and that is for a period of time, and there is a risk that, if we go too early, people will understandably get fatigued and it will be difficult to sustain this over time.” Listen to the science is not be enough in a novel crisis During the many early Covid-19 live briefings on TV Boris Johnson and Matt Hancock, Secretary for Health and Social Care, often claimed that their decisions were based upon the latest scientific evidence, and they certainly met no opposition from the advisors flanking them during the briefings. Matt Hancock later defended this dependence on SAGE’s scientific advice in spite of external criticism, by arguing "Critically, the clear advice at the time was that there's only a limited period that people would put up with it, would put up with lockdown. Now that proved actually to be wrong," …."These are huge decisions; to take those decisions against the scientific advice is an even bigger decision to take." The House of Commons report accepts that it may be difficult to go against scientific consensus among members of SAGE, who was set up precisely to provide scientific advice during a national emergency. “But the early weeks of the pandemic expose deficiencies in both scientific advice and government action. In the early days of an emergency, formulating the best scientific advice is challenging: there are, for example, inevitable lags in acquiring and analysing data. Other countries took early decisions that were more seen as those of Government leaders rather than from established scientific evidence and it is possible that this provided a greater licence to take decisions more quickly, and on a more precautionary basis than happened in the UK—contributing to better overall outcomes” Self-confirming group think The report concludes: “The fact that the UK approach reflected a consensus between official scientific advisers and the Government indicates a degree of groupthink that was present at the time which meant we were not as open to approaches being taken elsewhere—such as earlier lockdowns, border controls and effective test and trace—as we should have been.” (Emphasis added). Scientific advice must be challenged “Accountability in a democracy depends on elected decision-makers taking advice, but examining, questioning and challenging it before making their own decisions. We find it surprising that the fatalistic assumptions behind the initial scientific advice were not challenged until it became clear the NHS [National Health Service] could be overwhelmed, particularly given alternative strategies were being pursued visibly and successfully in East Asian countries. By the way, on 12 March the Danish Prime Minister declared a full lockdown in Denmark, marking a political decision that went directly against local scientific advice. Instead looking to the alarming situation in Italy and the quick rise in infections in Denmark. In a war against a novel but deadly virus it perhaps worth remembering that decisions cannot be based on clear scientific insight, when future facts are shrouded in a fog of uncertainties. Almost as in war itself, as realised by the famous military thinker Carl von Clausewitz in his “Vom Kriege”: Der Krieg ist das Gebiet der Ungewißheit; drei Vierteile derjenigen Dinge, worauf das Handeln im Kriege gebaut wird, liegen im Nebel einer mehr oder weniger großen Ungewißheit. Her ist es also zuerst, wo ein feiner, durchdringender Verstand in Anspruch genommen wird, um mit dem Takte seines Urteils die Wahrheit herauszufühlen. Vom Kriege, Carl von Clausewitz Perhaps we may conclude that when faced with a novel crisis decisionmakers should never fully rely on scientific advice — or a Swedish schoolchild? NB: Criticisms of the UK approach similar to the those raised in the House of Commons’ report can be found in the essay “Corona scenarios – East versus West” published on this blog as early as 21 March, 2020. Showing that the failings of the scientific advice and UK government’s decisions were evident even to someone far removed from SAGE. |
