Britain was not ready for Covid, says former chief medic
Dame Sally Davies, the former chief medical officer, identifies key failures in the handling of the Covid crisis, but refuses to take blame
THE former chief medical officer has said the UK was left ill-prepared for Covid-19 because Public Health England told her a coronavirus epidemic would “never travel this far”.
Dame Sally Davies is set to accuse PHE of misleading the Government into practising for “the wrong pandemic” at the forthcoming public inquiry into Covid, The Daily Telegraph can disclose.
She will say that the scientific advice to focus instead on the threat from influenza meant the UK never put in place plans for mass testing and contact tracing, unlike other countries that have managed to keep Covid largely under control.
In her first interview since handing over the job to Prof Chris Whitty last September, Dame Sally admitted “we were not as well prepared as we should have been”. Her most damaging allegation is that she asked PHE officials around 2015 whether the Government should rehearse for an outbreak of Severe Acute Respiratory Syndrome ( SARS) but was assured the disease would “never travel this far in big numbers” from Asia. Had the UK practised its response to a Sars-like virus that could be suppressed through mass testing and contact tracing, Dame Sally said, it would probably have been far better prepared for Covid.
This week, Dame Sally will publish proposals urging ministers to use Covid to make the “biggest leap forward for our society since the NHS was set up in 1948”. Her ideas will be laid out in a new book Whose Health Is It, Anyway?
A Department of Health spokesman said: “This is an unprecedented pandemic. There is a huge amount of work going on behind the scenes, all of which would not be possible without years of preparation.”
A PHE spokesman said: “The claim that PHE ignored threats other than flu is wrong. Dame Sally Davies participated in exercises which planned specifically for a MERS coronavirus scenario in the UK among other health threats.”
When Dame Sally Davies stepped down as chief medical officer last September, she felt she had done a pretty good job.
As Downing Street’s most senior medical adviser for nearly a decade, she had worked hard to protect the nation’s health: tackling sugary foods, problem drinking and the creeping menace of antimicrobial resistance.
Yet only five months after Dame Sally handed over the reins to Prof Chris Whitty, her tenure arguably failed its greatest test.
At some point next year, the 70-yearold is certain to be brought back to Westminster to face a public inquiry, where she and other former Whitehall mandarins will be asked three inevitable questions: Why were the people of this country, one of the world’s richest, left so defenceless against a disease like Covid-19? Why were countries like South Korea and Taiwan so much better prepared? And who was responsible?
Today, with the economy crippled by a second catastrophic lockdown and more than 50,000 dead, Dame Sally launches her defence, while urging ministers to seize the “Covid moment” to launch the most radical reforms in the history of the NHS.
“Compared to other countries, we’ve been found wanting. We were not as well prepared as we should have been,” she tells The Daily Telegraph.
“I think the public deserves to know everything.”
When Dame Sally stepped down to become Master of Trinity College, Cambridge, she appeared to have left the UK in world-beating shape. A month after her departure, the Global Health Index rated this country as the second best prepared for a pandemic, behind only the United States.
Yet when Covid-19 swept in, our defences were overwhelmed.
Unlike Singapore, Taiwan and South Korea the UK failed quickly to instigate travel restrictions, social distancing and contact tracing so the virus could be contained. And unlike Germany and much of Scandinavia, our capacity in terms of testing, tracing and ICU beds was found wanting. We have been struggling to catch up ever since.
Dame Sally’s defence at the coronavirus inquiry will be simple, and potentially devastating. She will accuse Public Health England (PHE) of telling her to prepare for the wrong pandemic.
“We didn’t practise how to stop a coronavirus spreading because we were told by PHE that the next big one would be influenza,” she says.
“One day we will certainly get another flu pandemic, so we prepared for that; and I think we prepared well. But none of the experts seemed to think a coronavirus would be relevant.
“I mean, to some degree I kind of accepted it. I’m not a trained public health doctor; my background is haematology and sickle cell disease. You can’t be an expert at everything, even if you’re the chief medical officer.”
It proved to be a fatal mistake. A year after Dame Sally took up her role, the UK’S 2011 Pandemic Preparedness Strategy concluded it would be “a waste of public health resources and capacity” to try to halt a new pathogen, because influenza would spread too quickly. Instead, passengers arriving at UK airports would not need to be quarantined, face masks were unnecessary, and mass events including live concerts and sporting events would be allowed to continue to “help maintain public morale”. A national stay-at-home order was not even considered.
Perhaps most importantly, a system of testing and contact tracing beyond initial “detection and assessment” was dismissed as impractical, again because influenza would spread too swiftly.
“The general view among the infectious disease people was that flu spreads terribly, much worse than a coronavirus,” Dame Sally says.
“It spreads not only respiratory wise, but it spreads on surfaces much more than it turns out Covid-19 is doing. The other feeling was that you wouldn’t bother to test for it because you’d know pretty much beyond doubt that it was flu from the symptoms, and it would crowd out other infections.
“And of course we had Tamiflu and pandemic vaccines, whereas when Covid arrived we had nothing.”
It should be said that this is disputed. The idea that an influenza pandemic – the type of disease Dame Sally was told to plan for – could not be slowed through similar measures has been described as “colossally stupid” and “palpably false” by experts.
Indeed the social distancing instigated across the world to fight
Covid has also knocked much influenza transmission on the head. In 2016, Dame Sally and Jeremy Hunt, the then Health Secretary, took part in a major three-day exercise code-named Exercise Cygnus to test whether their strategy would work.
Set seven weeks into an outbreak of imaginary “swan flu”, the scenario imagined that thousands of people had already died and hospitals were overwhelmed. Yet it never challenged ministers and officials to stop a deadly disease spreading in the first place.
“You also have to understand how these exercises go,” Dame Sally says.
“PHE goes away, and makes up an exercise. They make up what’s going to happen at each stage, which disease, and they do the modelling. So you sit in a room with the minister and the others, and you’re told this is the situation and you debate what needs doing.
“But we weren’t driving it – we were responding to it. The exercise was focused on the illness end, rather than preventing a disease spreading. And that has to be one of the failings of scenario-planning in that way, because what you’re doing is responding rather than thinking, how do I intervene? It didn’t cross my mind at the time, but that’s the truth. I still think Cygnus was useful because it showed a number of areas where work was needed. But of course I have regrets that we didn’t look at a coronavirus.”
Perhaps Dame Sally’s most damaging claim, however, is that she did ask PHE officials around 2015 whether it was worth practising for an outbreak of Severe Acute Respiratory Syndrome (SARS), but was assured it would “never travel this far in big numbers” from Asia.
SARS is a coronavirus like Covid-19, and shares many of its characteristics. Had the UK practised its response to a Sars-like virus, Dame Sally argues, the country would likely have been far better prepared for Covid.
“I felt as chief medical officer that we should practise a number of things,” she said. “I did ask during a conversation in my office in around 2015, should we do SARS? But I was told no, because it wouldn’t reach us properly. They said it would die out and would never travel this far. So I did ask, but it was the PHE people who said we didn’t need to do it, and I’ll say that to Parliament.
“That advice meant we never seriously sat down and said, will we have a massive pandemic of something else? You could argue that various people should have been asking that question. But both the minister and I had to take advice from PHE. That was their job.”
When the virus began to spread, it was discovered that the country simply did not have the capacity to quickly step up mass testing and contact tracing, and both were abandoned in March before being revived after much of the damage had already been done.
Dame Sally points out that the PHE experts advising her and Mr Hunt in those critical years before Covid were not alone in ignoring lessons from other countries. Instead she suggests that Britain’s scientific community as a whole failed to spot the danger.
“We didn’t follow what Asia was doing closely enough. Perhaps it was British exceptionalism,” she says.
“But … countries like Spain, France and Italy made the same mistake.
“And to be fair to PHE, no other experts came to me and said, ‘Hey, have you prepared for SARS?’”
Exercise Cygnus was marked “Official – Sensitive” and kept quiet for years until this newspaper reported its existence on Mar 28. Last month, the Government finally published a summary after losing a battle with the Information Commissioner’s Office.
The document showed that Cygnus had forewarned of the crisis in care homes, raising concerns about their ability to handle patients discharged from hospitals, and adding that the sector could easily be overwhelmed without increased capacity. Yet care providers complained that they had never heard of Cygnus or its findings.
“With hindsight, we know care homes should have been told, although that wasn’t my area,” Dame Sally says.
“But NHS England were in the room, and local authorities were in the room. If you’re in a big meeting, and you make a recommendation, you kind of assume people will have a think about it. In this case, it appears that they didn’t.”
Dame Sally also spoke of her “shock” that hospitals and care homes ran out of personal protective equipment (PPE) so quickly during the first wave, when hundreds of health workers died and nurses were reduced to wearing bin bags. Later it was discovered that the value of the UK’S pandemic PPE stockpile, estimated at £831 million in 2013, had declined by 40 per cent over the past six years.
“No health staff should have died because they caught Covid in a health facility,” Dame Sally says.
“When we had Ebola in 2012, I made sure that everyone in the NHS knew how to use PPE and made sure there were supplies. I would have assumed a few years later, that people knew how to use it and there were still decent supplies about the place. So I was shocked that there weren’t.
“After 2012, I did not think to make sure that the PPE work was still continuing. Maybe I should have done, but I was quite busy with other things. However, it seems a reasonable presumption that having made such an effort, some of that might have lasted.”
Dame Sally refuses to shoulder the blame for the UK’S “lack of agility” in those critical first weeks of the pandemic in March and early April.
“I’ve stayed out of the public eye partly because I didn’t want to be one of those talking heads complaining on television rather than understanding the difficulty of doing these jobs,” she says. “But I will say that Covid overtook us because we didn’t react when we knew it was happening. If we’d moved quickly, it would have been very different.
“There was an article in The Lancet at the end of January from the China CDC [Centre for Disease Control and Prevention] laying out the risk. So it was there. We could have and we should have locked down earlier, so I would argue that we need to be more agile and responsive. They told university labs not to get involved in testing, labs that had done far more testing than PHE ever have. When the review happens, there will be horror stories.” Dame Sally now faces the prospect of having her 10-year legacy picked apart at the upcoming public inquiry into the handling of Covid-19. Yet she claims not to be “worried”. “They may feel they have to maul me because I was the CMO, but people deserve answers, and I will answer to what I did,” she says. “If you’re asking me whether I think I failed, I think I did quite a good job, but I wish I’d presided over a structure that delivered well now.
“Of course, I wish we’d prepared for a coronavirus. Everyone wishes that. But inside myself, I’m not sure that I personally could have done a lot more.
“I feel I did a good job in preparing for pandemic flu. In the end, I was not advised by the experts that we should do other diseases.”
A source at Public Health England insisted officials had worked with Dame Sally on an exercise preparing for a coronavirus in 2016.
“It was the whole government who prepared for a flu pandemic, not just PHE,” the source added.
Dame Sally blames the UK’S high death rate on a serial lack of investment in public health over many decades.
“We have one of the highest levels of obesity, of heart disease, of diabetes. So that shows you that we weren’t prepared,” she says.
This week, she will publish radical new proposals urging ministers to use the “Covid moment” to make the “biggest leap forward for our society since the NHS was set up in 1948”.
“Health is our primary asset for happiness and economic success, both as individuals and as communities, and as a nation we ought to value it,” Dame Sally says. “Health shouldn’t be a drain on our resources – it is our most untapped opportunity for prosperity. And that’s why we ought to measure it, and we ought to invest in it.”
Her ideas will be laid out in a new book titled Whose Health Is It Anyway, published this week by Oxford University Press and co-written with Dr Jonathan Pearson-stuttard, vice-chairman of the Royal Society for Public Health.
For Dame Sally, the pandemic has brutally illustrated “deep-rooted and entrenched inequalities” between the haves and the have-nots.
“Poorer people and those from other disadvantaged communities are catching Covid more often and they are getting ill and dying more often,” she says. “We can’t go on as we are – it’s crippling the health service. We’ve got to do something structural about this, and we’ve got to do it now.”
She argues that the National Health Service has become the “National Illness Service” – forever responding to sickness rather than preventing people from becoming ill.
Meanwhile, the average growth in life expectancy has left people spending longer in poor health toward the end of their lives.
To fix the problem, she proposes a new expanded system of “Total Health” to add “life to years not just years to life”.
“We need to be asking people what they need to stay healthy rather than waiting until they are ill,” she argues.
To pay for a huge expansion in programmes to promote healthy living, Dame Sally proposes forcing “freeloading” firms who sell unhealthy products to pay a percentage of their profits into a newly-created National Public Health Investment Fund.
Decisions about where and how to spend the money would be made by a newly created body called the National Bank for Health, Dame Sally suggests.
Under her proposals, the National Bank for Health would invest money from the National Public Health Investment Fund into supporting public health, through schemes including exercise classes, parenting classes or vouchers for essential food. Food and drink companies would be incentivised to clean up their act.
Dame Sally proposes that a new set of metrics called the National Health Index (NHI) – already in late-stage development at the Office for National Statistics – should sit alongside national GDP as the key indicator of the nation’s long-term health.
To improve support for people with chronic health conditions, they should no longer be treated in hospital unless they need urgent care, Dame Sally says, but monitored at specialised “one-stop shops”, coordinated services closer to home. “You want to give people the care they need where they need it, and that’s not always in a hospital.”
Baby boomers should pay more in taxes to fund the expanded service, Dame Sally suggests, partly to repair the “intergenerational contract, which has unintentionally been broken”.
“Many of the older ones, including myself, are comfortably off,” she says.
“The polls actually show that the majority of people support paying more for the health service.”
If Dame Sally had stayed on as chief medical officer for a few more months, she would now be in Prof Whitty’s position, battling the nation’s most serious health crisis for a century.
Asked if she has any regrets about leaving, she shakes her head.
“My successor is an infectious disease expert, and that’s a good thing. And he’s 18 years younger than me.
“I’m glad I dodged the bullet.”
‘Covid overtook us because we didn’t react when we knew it was happening. If we’d moved quickly, it would have been very different’