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13 May 2020

The problem with our response to Covid-19 wasn’t that we didn’t have a plan – it was the opposite

In 2011, in the shadow of the much-criticised swine flu response, officials prepared a new pandemic blueprint.

By Ian Leslie

Last year, public health experts from Johns Hopkins University ranked every country in the world according to its preparedness for a pandemic, following an extensive data-gathering exercise. Out of 195 nations, Britain came second, behind the US. While it’s too early to make a definitive judgement on how countries have handled Covid-19, it’s safe to say the post-pandemic scorecard will differ significantly. But if the UK falls down the list, it will not be because it did not have a plan. It will be because it stuck to its plan for too long.

In spring 2009, a new virus emerged from Mexico: a mix of human, pig and bird viruses that became known as swine flu (H1N1). The UK’s chief medical officer raised an alarm, explaining that epidemiologists at Imperial College had forecast a worst-case scenario of 65,000 deaths. Panic ensued. The National Pandemic Flu service crashed. Ministers spent £1.2bn on urgent preparations, including the purchase of vaccines and treatments. In the end, there were only 457 deaths, a fraction of the number who die in a normal flu season.

Afterwards, the government faced widespread criticism for overreacting. The TaxPayers’ Alliance called the response a “hugely expensive farce”. Labour MP Paul Flynn denounced “scaremongering”. The official inquiry, led by Deirdre Hine, was sober but pointed. It described the response as proportionate and effective while noting that ministers should not necessarily act on the basis of the worst-case scenario. An alternative approach, said Hine, was to calibrate the response carefully according to the data coming in. 

In 2011, in the shadow of the much-criticised swine flu response, officials prepared a new pandemic plan. It was written with influenza in mind, since that was deemed the most likely threat. The plan adopts the more calibrated approach proposed by Hine. It puts a great stress on the need for “proportionality” and not overreacting. Read it now and you’re struck by how much it seems to have determined the current government’s initial reaction to Covid-19. What became known as the herd immunity strategy is outlined here: the 2011 plan states that “it will not be possible to stop the spread of, or to eradicate the virus”. It declares, “The UK government does not plan to close borders, stop mass gatherings or impose controls on public transport during any pandemic.” There is no mention of social distancing.

The plan emphasises the need to avoid spreading fear, and to encourage people to “carry on with their normal daily lives”. It is sceptical about the value of face masks, banning travel to the UK and closing schools. It finds little evidence that stopping mass gatherings would slow transmission – indeed, it says keeping such events “may help maintain public morale”.

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People make plans, but plans exert power over people. Covid-19 is not a flu virus but something new for which we don’t yet have effective medications, and it is more infectious than Sars and Mers, the other two coronaviruses to have emerged since the turn of the century. Faced with the novel problem of an untreatable, highly transmissible virus, the government’s current advisers seem to have found it hard to break with the plan they had – now unfit for purpose – and think anew.

Ours wasn’t the only sluggish government. According to a study by public policy scholars, the European countries with less sophisticated governing capability reacted most swiftly; as soon as Lithuania, Cyprus or Bulgaria detected cases, they imposed restrictions. Countries that incorporate scientific advice into their policy process, like the UK, Spain and the Netherlands, were on average more likely to have responded slowly.

When making decisions, people often use simple mental short-cuts, such as copying what others are doing or running at the first hint of danger. Such behaviour, once classified by psychologists as irrational, actually springs from a deeper rationality. Weighing options takes time and energy, both of which come at a cost that can be higher than that of deciding prematurely. Sometimes it’s best to act first and think later.

This is particularly true in an emergency, when the cost of inaction can be lethally steep. The longer someone takes to decide whether the cinema really is on fire, the more likely they are to die in the flames. People who seem to be acting in a rational, evidence-based way, always awaiting more data (“Have I seen smoke?”), are in fact practising a kind of higher stupidity.

In February, Western governments were still attempting to find a middle way between the risk of a coronavirus epidemic and the risk of a wasteful overreaction, without grasping that the two risks are not the same. One involves a couple of billion pounds and some bad headlines; the other, tens of thousands of deaths and the worst recession for 300 years.

The same blindness is evident in Britain’s failure to build stocks of PPE, or to prepare care homes for overflow from hospitals, both of which were identified as potential problems in Exercise Cygnus, the government’s 2016 simulation of a flu epidemic. Spending to prepare for events that are unlikely to happen soon, if at all, can feel wasteful. But as the author Nassim Nicholas Taleb has remarked, you buy fire cover for your property because insurance is much cheaper before a fire than during it. Striving too hard for efficiency can lead to terrible waste. 

The idea we could cleverly optimise our response to Covid-19 was a dangerous chimera that the government, hypnotised by its own plan, clung to for too long. Pandemic responses do not need to be proportionate; they need to be effective. In March, World Health Organisation official Mike Ryan summarised what he had learnt from fighting Ebola outbreaks: “If you need to be right before you move, you will never win.” 

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This article appears in the 13 May 2020 issue of the New Statesman, Land of confusion