There is not enough action. It can’t be “business as usual” if Britain is to combat the outbreakby Paul Wallace / March 4, 2020 / Leave a comment
As someone who seldom misses the opportunity to name-drop across the millennia to the ancient Greeks and Romans, Boris Johnson will be familiar with Fabius “Cunctator” (which translates as “delayer”) and his strategy in combating an enemy. Delay, he will recall from his studies at Eton, was how Fabius managed to fend off the challenge posed by Hannibal after his crushing victory over the Roman legions at Lake Trasimene. Delay featured heavily in yesterday’s “action plan” as a way to tackle the modern adversary of coronavirus. The only thing is: the delay is itself being delayed, which may make it harder to cope with the disease as it spreads more widely.
Introducing the plan, Johnson made clear that it “does not set out what the government will do, it sets out the steps that we could take at the right time and on the basis of the scientific advice.” The prime minister identified four “strands”: containing the virus, delaying its spread, researching its origins and cure, and mitigating its impact if it becomes more widespread.
Since research is already under way and will continue, there are in effect three stages in the strategy: contain, delay and mitigate. The contain phase is what is happening now. Patients testing positive for the disease are isolated and cared for in specialist hospital units, with kit and procedures to protect staff and prevent further spread of the infection. Previous close contacts of the patients are traced in order to limit further transmission.
This bespoke treatment and painstaking tracing makes sense when you have a relatively small number of patients. But if the number escalates a lot more than its current level—by Tuesday the number had risen to 51—then that will mean containment is not working. That’s why the plan envisages a second stage, in which efforts are focused on delay, slowing the spread of the disease.
As Fabius showed long ago, delay has many merits. The main benefit is that it should lower the peak number of cases, easing the potential pressure on the NHS. Hospitals should in any case be better able to cope once the winter months are over and seasonal flu subsides. Delay provides more time for research into how best to combat it.
But delay also imposes costs, both economic and social. It will require unpopular measures such as reducing the number of big public gatherings—tell that to football fans. There may have to be extensive closures of schools—tell that to parents. It could also involve much more home working—and setting an example with the public sector.
All that will be unwelcome. But if the disease does spread much further, things will get far worse. In what the plan calls “a stretching scenario,” it envisages businesses possibly having to cope with up to a fifth of employees absent from work during peak weeks. If that is the case for businesses, it could well be higher still for health and social care workers, who will be more exposed to the virus.
In these circumstances the plan envisages the “mitigate” phase, in which “the chief focus will be to provide essential services.” This is likely to result in delaying non-urgent health care. Other public services would be curtailed. For example, “with a significant loss of officers and staff” the police would have to concentrate on maintaining public order and tackling serious crimes.
Johnson insisted yesterday that Britain was “extremely well prepared.” But good preparation is not enough. Resources are crucial. The epidemic has struck at a time when the NHS is only just starting to get the kind of funding it needs to keep abreast of demand, after almost a decade of inadequate budgets. Indicators such as waiting times show a health service already close to buckling.
Given that underlying vulnerability, it is risky to stick with containment rather than moving swiftly to try to delay the spread of the virus. Patrick Vallance, the government’s Chief Scientific Adviser, argued yesterday that intervening too early could cause unnecessary disruption. With the number of cases still in double digits that might appear plausible. However, we have seen elsewhere how swiftly infections can spread. In Italy, the confirmed cases have jumped from just three (fewer than in Britain then) to 2,500 in less than two weeks.
Johnson said yesterday that at this stage “for the vast majority of the people of this country we should be going about our business as usual.” That is a judgment he may come to regret.