Humankind has always been at the mercy of pandemic outbreaks of infectious disease. Historians have recorded them in detail, from the plague that devastated Athens in 430 BCE, causing the death of perhaps a quarter of the city’s population, to the plague of Justinian which, according to the Byzantine historian Procopius, “swept through the whole known world… leaving a trail of desolation in its wake” in the years 541-549 CE. Most devastating of all was the Black Death, between 1347 and 1351, which arrived in England by June 1348 and killed between a third and half of the population – up to two million people. Like the plague of Justinian, it was caused by the bubonic plague bacterium Yersinia pestis, carried on the so-called Oriental rat flea. The pandemic recurred at intervals up to the Great Plague of 1665, graphically recorded in the diaries of Samuel Pepys. “But Lord! How sad a sight it is to see the streets empty of people, and very few upon the ’Change. Jealous of every door that one sees shut up lest it should be the plague.”
Contemporaries noted that the plague frequently arrived in a country through its seaports and, from the 14th century, European cities responded by requiring incoming ships to isolate for 40 days – the so-called quarantine – as well as establishing “pesthouses” or isolation hospitals for sufferers. In the London plague of 1665, authorities locked the infected in their houses and painted a red cross on the front door.
These have essentially been the methods used by the state to combat pandemics ever since. Infectious diseases are spread in a variety of ways: the carrier of typhus, for example, is the human body louse, while cholera and typhoid are spread through water polluted by infected human excretions. Most common of all is infection by the tiny, invisible droplets people exhale when they cough or sneeze, as with tuberculosis.
For many centuries, however, the state was also guided by contemporary medical understandings of disease, which considered infection the result of an imbalance of “humours” in the body (hence the practice of bloodletting, to restore the balance) or the product of atmospheric factors (so the fumigation of streets, or ringing of church bells to stir up the supposedly polluted air). But during the Black Death and the plague of 1665, none of this had any effect.
It was not just trade but also war that spread infections. Not until the 20th century did wars occur in which more soldiers were killed by the enemy than perished from disease. Armies – large numbers of men living in unhygienic conditions and moving rapidly across large swathes of territory – spread diseases, especially typhus, with terrifying rapidity. By the 19th century, it was cholera that almost invariably followed armies across the European continent, most notably in the Crimean War of 1853-56. In that event, the state was doing more to spread disease than to prevent it. In 1918 the Spanish flu, so called because, during the First World War, neutral Spain was almost the only country in Europe that was not trying to suppress news of the disease’s ravages, was spread by troops. The flu was first reported in Kansas in the spring of 1918, and was soon carried across the Atlantic by masses of troops sailing to Europe, following America’s entry into the war. From there, it was taken by soldiers returning after the end of the war to far-flung parts of the British and French empires and further afield.
The impact of the Spanish flu was blunted by the fact it overlapped with the final stages of the First World War, though it had little effect on the war itself: the German spring offensive had already run into the sands by the time the flu reached Europe, and the disease did not, in any case, discriminate between the combatant nations. Four years of war, privation and economic blockade did take their toll, however, and the second wave of the epidemic that began in the late summer of 1918 was far deadlier than the first. It is likely that between 17 and 20 million people died worldwide; in Britain, the figure was 228,000; this compared with nearly 750,000 military personnel killed or missing in action. Huge efforts had been made to ensure the health of the troops from the start: hygiene and cleanliness were a priority and, on the Western Front at least, typhus and cholera, the traditional scourges of armies, were kept at bay. In the face of the enormous suffering and mortality among the troops, commemorated in war memorials across the country, the influenza epidemic barely registered in the national consciousness. Until late in 1918, it was not even discussed in parliament.
By the time the Spanish flu arrived, medical knowledge of disease had been transformed by the new science of bacteriology, aided by technological innovations such as the microscope and chemical dyes for staining bacteria samples. Led by pioneering scientists, notably Louis Pasteur and Robert Koch and their pupils, medical research had discovered the causes of a wide range of diseases, from anthrax and cholera to syphilis and typhus, and worked out how to control or even prevent their transmission. Governments began deploying preventive strategies, aided by the “hygienic revolution” – the great clean-up of the burgeoning cities of the late 19th century – driven as much by civic pride as by medical imperative. While antibiotics that cured bacterial infections would not be mass produced until the end of the Second World War, the incidence of major diseases such as cholera and tuberculosis had been drastically reduced in Britain, and western Europe more generally, long before.
But little progress was made in the study of viruses before the 1930s. In the absence of secure knowledge, all health officials had at their disposal was their experience of previous epidemics, if they had any. There was no national strategy, so it was up to local authorities to fight the Spanish flu. Some succeeded. In Oldham, for example, the chief medical officer of health, James Niven, drew on his memory of the so-called Russian flu, a viral infection not dissimilar to Covid-19 estimated to have killed a million or more people worldwide, including around 100,000 in the UK, in the late 1880s and early 1890s. Niven had controlled that outbreak in Oldham with prompt isolation of the sick and disinfection of places where they lived or worked. In 1918 he deployed a similar raft of measures, with the support of the local council. As a result, deaths in the first wave were restricted to around 300 in Manchester and the surrounding area. Few other areas followed suit. But the lessons were clear: act promptly, learn from past experience and follow the dictates of medical science.
A century later, medical science has made huge strides in understanding viral infections and dealing with pandemics. Scientists can now genetically sequence viruses remarkably soon after they first appear, and within a few months can develop vaccines to limit their spread. Unlike our forebears in 1918, or medical science in the Middle Ages, we know precisely what we are dealing with, and we know how to combat it. We are no longer at the mercy of pandemic outbreaks of infectious disease. Even the briefest glance at the history of previous epidemics is enough to provide us with the lessons we need to combat them.
And yet, in Britain, these lessons have clearly not been learned. In January 2021 the United Kingdom has reached two grim milestones in the year-long history of the Covid-19 pandemic. The absolute number of deaths from the disease has passed 100,000, a figure exceeded only in Brazil, India, Mexico and the US, which all have much larger populations. That is more British civilians than died in both world wars combined. Second, Britain has also recorded one of the highest death rates – the number of coronavirus deaths per million people – in the world. The virus may be raging out of control in the US, but its coronavirus death rate is still substantially below Britain’s. Brazil, led by a populist president who dismissed the disease as “a little flu”, did not even appear on the Daily Mail’s 18 January list of the 30 most severely affected countries in terms of deaths per million population.
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What are the causes of this shameful situation? Why is the impact of Covid-19 in Britain worse than elsewhere in the world? Can differences in the incidence of the disease between countries be put down to differences in the susceptibility of the population?
On 25 January the Pensions Minister Thérèse Coffey claimed the age and obesity of the British population were to blame. Certainly, most coronavirus deaths in Britain have been among the over-65s, but the proportion of the elderly in the population of New Zealand, say, with its low rate of Covid deaths, is no smaller than it is in the UK.
Then there are “underlying conditions” such as obesity, type 2 diabetes and chronic respiratory problems, conditions that are also highly prevalent among older age groups. Around 28 per cent of Britain’s adult population is estimated to be obese. But there are also plenty of countries with high obesity levels, such as New Zealand again (31 per cent), where Covid-19 death rates have been extremely low. Even before the virus mutated into a more rapidly and more easily transmissible form of disease, Britain was already one of the worst- affected countries in the world in terms of death rates.
What has made the difference has been government. It is an obvious lesson to be gleaned from previous pandemics that where the state was weak or disorganised, many people died. Cholera, for example, has raged in situations in which the state has broken down, as in Haiti after the devastating earthquake of January 2010. Similarly in Yemen, where a civil war has led to the collapse of basic infrastructure, cholera has spread in contaminated water, leading to at least 2, 500 deaths.
All countries have contingency plans in place to deal with major epidemics. In this sense, we have learned from history. Having experienced a less deadly example of a new coronavirus, Sars (severe acute respiratory syndrome) in 2002-03, health authorities in China (after a short-lived attempt to suppress news of Covid-19’s presence) had preventive measures in place: lockdowns, mass quarantines and the mandatory wearing of face masks. These measures helped reduce infections and deaths. In New Zealand, the country was in lockdown and borders were closed by the end of March 2020, even before the first death had been registered. Testing measures were deployed and deaths have been kept to a mere 25 to date.
How different the reaction of the British government has been. A year ago, as the pandemic was raging in Italy and spreading across the continent, the Health Secretary Matt Hancock, speaking on 24 January, announced the risk to the British public was “low”. The Cobra emergency committee, normally chaired by the Prime Minister, met to discuss what should be done, but Boris Johnson missed five meetings in a row before finally appearing at one on 2 March. A senior Downing Street adviser said: “What you learn about Boris was he didn’t chair any meetings. He liked his country breaks. He didn’t work weekends. It was like working for an old-fashioned chief executive in a local authority 20 years ago. There was a real sense that he didn’t do urgent crisis planning. It was exactly like people feared he would be.”
Britain’s Covid-19 crisis has been a failure of basic statecraft, a lethal combination of incompetence and inaction. We sleepwalked into mass death. A senior Health Department official said in April 2020: “I had watched Wuhan, but I assumed we must have not been worried because we did nothing. We just watched. A pandemic was always at the top of our national risk register – always – but when it came, we just slowly watched… We were doomed by our incompetence, our hubris and our austerity.”
In April, Anthony Costello, a former senior official at the World Health Organisation, attacked the UK government’s response. “We should have introduced the lockdown two or three weeks earlier,” he said, “but we didn’t. It should be combined with testing, tracing and digital apps that have been used so successfully in South Korea… It is a total mess, and we [the UK] have been wrong every stage of the way.”
By the time measures were slowly introduced, it was too late. It was not until 5 March that the number of cases surpassed 100 and the first death was reported. A few weeks later, the entire population was ordered to stay at home. Police were empowered to levy fines on those who refused to comply. But Johnson was optimistic. “I think, looking at it all,” he said on 19 March, “that we can turn the tide within the next 12 weeks and I’m absolutely confident that we can send coronavirus packing in this country.” A few weeks later, he was himself in intensive care after contracting coronavirus.
On 17 March, Patrick Vallance, the government’s chief scientific adviser, said that keeping the number of UK deaths below 20,000 would be a “good result”. The country passed 20,000 deaths just over a month later. But on 30 April, Johnson announced the UK was “past the peak” of the outbreak. Deaths did begin to fall (15 people died on 22 June after testing positive for Covid). The government began to relax restrictions and encouraged people to go back to work. So-called travel corridors were announced to and from places where it was deemed safe to travel. The country began to think it was all over. But in September, with the arrival of cooler weather driving people indoors again, the downward trend in cases was abruptly reversed. Public health experts demanded a “circuit breaker” lockdown for two weeks in order to stop the spread of the virus; one was imposed in Wales, but the government rejected the idea for England. A second wave of the pandemic began to gather force. Then, in December 2020, a new variant of the virus appeared. It has spread more rapidly than the original strain and, according to the government’s New and Emerging Respiratory Virus Threats Advisory Group (Nervtag), may increase the death rate by up to 30 per cent.
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A four-week lockdown began in England on 5 November, a fortnight after Johnson had dismissed Keir Starmer’s demand for one as “the height of absurdity”. The English lockdown ended on 2 December and Johnson promised a five-day relaxation over Christmas, but this proved unsustainable and was reduced to a single day in England, and scrapped altogether for parts of the south-east. The restrictions were widely ignored. Medical officials advised the closure of schools, a policy resisted by ministers until they were forced to change their minds by the continued spread of the virus. A third national lockdown was imposed early in the new year.
A significant cause of this catastrophe can be ascribed to sheer incompetence on the part of the UK government. Johnson, an effective campaigner, has proven ineffective as a national leader and inconsistent as a policy manager. A fair-weather politician who excels in optimistic rhetoric, he is clearly incapable of steering the country through a serious and prolonged national crisis. While paying lip-service to scientific advice, he has frequently refused to follow it, in part because he does not want to offend the libertarian right wing of the Conservative Party.
Beyond this, the government has been concerned to minimise the impact of the pandemic on the UK economy. It has sought to do this not only by introducing generous schemes to keep people employed and companies in business, but also by deliberately not intervening. On 3 February 2020, Johnson expressed his fear that the pandemic might lead to government interventions “that go beyond what is medically rational to the point of doing real and unnecessary economic damage”. The result of the twists and turns, hesitations and abrupt reversals of government policy in the face of Covid-19 is that the UK economy has been more seriously damaged than that of any other European country.
The choice – keep the economy going or stop the virus spreading – is a false one, and we are all now paying the price. It is often said that history has no lessons to teach, but in this case it does. If the UK government had paid heed to them, we would not be in the calamitous position we find ourselves in now.
This article appears in the 27 Jan 2021 issue of the New Statesman, The Lost