Britain’s original pandemic sin
4 August 2020
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5 August 2020
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In 2019, fearing it was “likely that the world will continue to face outbreaks that most countries are ill positioned to combat,” the Global Health Security Index ranked 195 countries’ capacities to address a pandemic. The US came out on top, the UK a close second.
A year later, the Index’s predictions were tested by the Covid-19 pandemic, and amongst the worst-performing countries were the two that had been ranked 1st and 2nd. By mid-April 2020, the U.S. was reporting some 30,000 new cases and nearly 2,000 deaths a day. Most states had locked down, and some 20 million jobs were lost. The UK, meanwhile, was reporting some 5,000 new cases and nearly 900 deaths a day, and a lockdown.
By June 22 2020, Britain had reported the highest rate of excess deaths in the industrialised west since the start of the pandemic (945 excess deaths per million population in the UK versus 37 for Austria, which had reported the lowest). The U.S.’s excess death rate was 387, but by June 22 its Covid-19 incidence was rising again, and the ‘positive case rate’ was suggesting the rise was real and not a reflection of increased testing.
These failures were not inevitable. South Korea and Taiwan, which adjoin China, escaped lightly. South Korea’s worst day came on 29 February, which saw just over 1,000 new cases and 5 deaths; but thereafter the numbers of new cases fell, and by mid-April they were down to around 20 a day. And no lockdown.
Taiwan escaped even more lightly: its worst day, on 19 March, recorded 27 new cases, and by mid-April Taiwan was recording only some 5 new cases a day (and no lockdown).[1] Some days in April the country reported no new cases at all.
How did we get here?
On December 31, 2019, Chinese officials informed the World Health Organization they had identified an unknown pneumonia, and on January 10, 2020, Professor Yong-Zhen Zhang of Fudan University, Shanghai, published the virus’s RNA sequence. On January 20 South Korea reported its first case of the disease, the next day both Taiwan and the U.S. reported their first cases, while nine days later on January 30 the UK reported its first case. The four countries, therefore, were infected at similar times.
The outbreak of HIV/AIDS (1981-), and the more recent outbreaks of SARS (2002-2004), MERS (2012-2015) and Ebola (2014-2016), have shown that such viral eruptions can often be handled pre-emptively, by ‘test-isolate-trace,’ by which individuals are tested biochemically for the disease and, if found positive, they and their contacts are isolated until they cease to be contagious.[2] A biochemical test can be based on an RNA sequence, and it transpires that the epidemiology of SARS-CoV-2 renders it susceptible to testing.
Biochemical testing plays only part of a national response to a dangerous virus (travel controls, clinical diagnoses, face masks, social distancing et alia also play their parts), but the speed by which a nation develops an effective biochemical test will not only reflect the overall efficiency of its pandemic response, it will also hugely reinforce that response. So, let us ask how efficiently the four countries developed and deployed such a test.
South Korea
On January 27 the authorities in Seoul invited representatives from 20 South Korean biotech companies urgently to develop a diagnostic test. At the meeting, the companies were assured that any tests they developed would be rushed through the accreditation procedures.
By February 4 Kogene Biotech, which had anticipated the need for a test, had not only developed one but had also had it approved by the Korean Centers for Disease Control and Prevention (KCDC), which by February 10 was reporting its findings on the first 2,776 people to be tested. By the end of February, moreover, three more companies had got their test approved: South Korea was testing extensively. And such testing-isolating-tracing ensured that, by April, the numbers of new cases were falling to around 20 a day. With no lockdown.
Taiwan
Here is the President of Taiwan’s account of how her country managed:
“Last December, when indications of a contagious new respiratory illness began to appear in China, we began monitoring incoming passengers from Wuhan. In January, we established the Central Epidemic Command Center to handle prevention measures. We introduced travel restrictions, and established quarantine protocols for high-risk travellers. Upon the discovery of the first infected person in Taiwan on January 21, we undertook rigorous investigative efforts to track travel and contact history for every patient, helping to isolate and contain the contagion before a mass community outbreak was possible.”
By early January, President Tsai Ing-wen had introduced no fewer than 124 measures, which was how—with no lockdown—Taiwan was by mid-April sometimes recording days with no new cases at all.[3]
The United States
Ed Yong, the Cambridge biochemistry graduate who writes for the Atlantic, reported of the U.S.:
“The Centers for Disease and Control and Prevention [CDC] developed and distributed a faulty test in February. Independent labs created alternatives, but they were mired in bureaucracy from the FDA [Federal Drugs Agency] […]
The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure”
The story in the U.S., therefore, is of the federal government’s agencies not only failing to produce their own tests but also of obstructing the tests of the private sector.
The United Kingdom
Christian Drosten directs the Institute of Virology at the Charité Hospital in Berlin; he was a member of the team that discovered SARS in 2002; he released a test for Covid-19 on January 13, only ten days after Kogene of South Korea;[4] and he has since guided Germany’s response to Covid-19. In April he said:
“Public Health England was in a position to diagnose the disease very early on—we worked with them to make the diagnostic test—but rollout in Germany was driven in part by market forces, which made it fast, and that wasn’t the case in the UK.”
By which Drosten meant that Germany (with only 9% of the excess deaths that Britain has recorded) galvanized its biotech industry to produce enough tests by which the authorities could test the population. Britain did not. Instead, the British health secretary Matt Hancock said, “We have the best scientific labs in the world but we did not have the scale” to develop mass testing.
That statement is untrue. Britain’s pharmaceutical and biotech industries are about 10 times bigger than those in South Korea, yet not until April 1 did the British government ask its biotech industry to upscale the production of tests for use nationwide, which was far too late to prevent the pandemic from sweeping the nation.
The story in the UK, therefore, is of the government failing to engage the private sector to upscale the test to meet the needs of the people. In the words of Jim McConalogue and Tim Knox of the think tank Civitas, Britain’s original pandemic sin was ministers’
“resigned and ineffectual response to an epidemic in January-February when a genuine government response was required on testing and contact tracing.”
To cut a long story short, in terms of their capacity to handle the pandemic, all four countries had similar starting conditions. The stark differences in performance is explained by differences in how they chose to utilise that capacity. Different policy responses, not different external conditions, explain the differences in outcomes.
[1] Jason Wang et al (March 3, 2020) Response to Covid-19 in Taiwan: Big data analytics, new technology, and proactive testing. JAMA 323: 1341-1342.
[2] Joel Hellewell et al (April 1 2020) Feasibility of controlling COVID-19 outbreaks by isolation of cases and testing. The Lancet Global Health 8: E488-496. Published electronically on February 28 2020.
[3] Jason Wang et al (March 3, 2020) Response to Covid-19 in Taiwan: Big data analytics, new technology, and proactive testing. JAMA 323: 1341-1342.
[4] Anon (May 2 2020) The explainer-in-chief. The Economist, p 26 UK edition.
A year later, the Index’s predictions were tested by the Covid-19 pandemic, and amongst the worst-performing countries were the two that had been ranked 1st and 2nd. By mid-April 2020, the U.S. was reporting some 30,000 new cases and nearly 2,000 deaths a day. Most states had locked down, and some 20 million jobs were lost. The UK, meanwhile, was reporting some 5,000 new cases and nearly 900 deaths a day, and a lockdown.
By June 22 2020, Britain had reported the highest rate of excess deaths in the industrialised west since the start of the pandemic (945 excess deaths per million population in the UK versus 37 for Austria, which had reported the lowest). The U.S.’s excess death rate was 387, but by June 22 its Covid-19 incidence was rising again, and the ‘positive case rate’ was suggesting the rise was real and not a reflection of increased testing.
These failures were not inevitable. South Korea and Taiwan, which adjoin China, escaped lightly. South Korea’s worst day came on 29 February, which saw just over 1,000 new cases and 5 deaths; but thereafter the numbers of new cases fell, and by mid-April they were down to around 20 a day. And no lockdown.
Taiwan escaped even more lightly: its worst day, on 19 March, recorded 27 new cases, and by mid-April Taiwan was recording only some 5 new cases a day (and no lockdown).[1] Some days in April the country reported no new cases at all.
How did we get here?
On December 31, 2019, Chinese officials informed the World Health Organization they had identified an unknown pneumonia, and on January 10, 2020, Professor Yong-Zhen Zhang of Fudan University, Shanghai, published the virus’s RNA sequence. On January 20 South Korea reported its first case of the disease, the next day both Taiwan and the U.S. reported their first cases, while nine days later on January 30 the UK reported its first case. The four countries, therefore, were infected at similar times.
The outbreak of HIV/AIDS (1981-), and the more recent outbreaks of SARS (2002-2004), MERS (2012-2015) and Ebola (2014-2016), have shown that such viral eruptions can often be handled pre-emptively, by ‘test-isolate-trace,’ by which individuals are tested biochemically for the disease and, if found positive, they and their contacts are isolated until they cease to be contagious.[2] A biochemical test can be based on an RNA sequence, and it transpires that the epidemiology of SARS-CoV-2 renders it susceptible to testing.
Biochemical testing plays only part of a national response to a dangerous virus (travel controls, clinical diagnoses, face masks, social distancing et alia also play their parts), but the speed by which a nation develops an effective biochemical test will not only reflect the overall efficiency of its pandemic response, it will also hugely reinforce that response. So, let us ask how efficiently the four countries developed and deployed such a test.
South Korea
On January 27 the authorities in Seoul invited representatives from 20 South Korean biotech companies urgently to develop a diagnostic test. At the meeting, the companies were assured that any tests they developed would be rushed through the accreditation procedures.
By February 4 Kogene Biotech, which had anticipated the need for a test, had not only developed one but had also had it approved by the Korean Centers for Disease Control and Prevention (KCDC), which by February 10 was reporting its findings on the first 2,776 people to be tested. By the end of February, moreover, three more companies had got their test approved: South Korea was testing extensively. And such testing-isolating-tracing ensured that, by April, the numbers of new cases were falling to around 20 a day. With no lockdown.
Taiwan
Here is the President of Taiwan’s account of how her country managed:
“Last December, when indications of a contagious new respiratory illness began to appear in China, we began monitoring incoming passengers from Wuhan. In January, we established the Central Epidemic Command Center to handle prevention measures. We introduced travel restrictions, and established quarantine protocols for high-risk travellers. Upon the discovery of the first infected person in Taiwan on January 21, we undertook rigorous investigative efforts to track travel and contact history for every patient, helping to isolate and contain the contagion before a mass community outbreak was possible.”
By early January, President Tsai Ing-wen had introduced no fewer than 124 measures, which was how—with no lockdown—Taiwan was by mid-April sometimes recording days with no new cases at all.[3]
The United States
Ed Yong, the Cambridge biochemistry graduate who writes for the Atlantic, reported of the U.S.:
“The Centers for Disease and Control and Prevention [CDC] developed and distributed a faulty test in February. Independent labs created alternatives, but they were mired in bureaucracy from the FDA [Federal Drugs Agency] […]
The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure”
The story in the U.S., therefore, is of the federal government’s agencies not only failing to produce their own tests but also of obstructing the tests of the private sector.
The United Kingdom
Christian Drosten directs the Institute of Virology at the Charité Hospital in Berlin; he was a member of the team that discovered SARS in 2002; he released a test for Covid-19 on January 13, only ten days after Kogene of South Korea;[4] and he has since guided Germany’s response to Covid-19. In April he said:
“Public Health England was in a position to diagnose the disease very early on—we worked with them to make the diagnostic test—but rollout in Germany was driven in part by market forces, which made it fast, and that wasn’t the case in the UK.”
By which Drosten meant that Germany (with only 9% of the excess deaths that Britain has recorded) galvanized its biotech industry to produce enough tests by which the authorities could test the population. Britain did not. Instead, the British health secretary Matt Hancock said, “We have the best scientific labs in the world but we did not have the scale” to develop mass testing.
That statement is untrue. Britain’s pharmaceutical and biotech industries are about 10 times bigger than those in South Korea, yet not until April 1 did the British government ask its biotech industry to upscale the production of tests for use nationwide, which was far too late to prevent the pandemic from sweeping the nation.
The story in the UK, therefore, is of the government failing to engage the private sector to upscale the test to meet the needs of the people. In the words of Jim McConalogue and Tim Knox of the think tank Civitas, Britain’s original pandemic sin was ministers’
“resigned and ineffectual response to an epidemic in January-February when a genuine government response was required on testing and contact tracing.”
To cut a long story short, in terms of their capacity to handle the pandemic, all four countries had similar starting conditions. The stark differences in performance is explained by differences in how they chose to utilise that capacity. Different policy responses, not different external conditions, explain the differences in outcomes.
[1] Jason Wang et al (March 3, 2020) Response to Covid-19 in Taiwan: Big data analytics, new technology, and proactive testing. JAMA 323: 1341-1342.
[2] Joel Hellewell et al (April 1 2020) Feasibility of controlling COVID-19 outbreaks by isolation of cases and testing. The Lancet Global Health 8: E488-496. Published electronically on February 28 2020.
[3] Jason Wang et al (March 3, 2020) Response to Covid-19 in Taiwan: Big data analytics, new technology, and proactive testing. JAMA 323: 1341-1342.
[4] Anon (May 2 2020) The explainer-in-chief. The Economist, p 26 UK edition.
2 thoughts on “Britain’s original pandemic sin”
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We got here by having a lying greedy semi-facist thug (Trump) & and a permanenlty bullshitting windbag (BoZo the clown) in charge.
BOTH countries had pandemic-handling systems that were either scrapped or abandoned (USA / GB )
Oops
This article misses the role scientist advisers had on policy response . The UK government was following the advice of it’s scientific committee (SAGE) which badly advised and misunderstood the threat (as the inevitable inquiry will show). The fundamental mistake was a western arrogance that things were under control here and ‘no need to overreact’. In reality, there was a complete absence of data coming in to SAGE to the extent that by the end of February Public Health England were messing around contract tracing some skiers whilst 100,000s were getting infected in London unbeknown to everyone.