If you think her language is hyperbolic, consider the more sober analysis from the US Institute of Medicine in 2004. She evaluated the lessons of the Sars epidemic in 2003, quoting Goethe: “Knowledge is not enough; we have to apply. Willpower is not enough; we have to do. He concluded that “the rapid containment of Sars is a success in public health, but also a warning … If Sars reproduces … health systems around the world will be under extreme pressure … Continued vigilance is vital”.
But the world has ignored these warnings.
Ian Boyd, a former chief scientific advisor to the British government between 2012 and 2019, recently recalled “a practice carried out for an influenza pandemic in which around 200,000 people died. It upset me. But did the experiment spark any government action? “We have learned what could help, but we have not necessarily implemented these lessons,” said Boyd.
Austerity has blunted the government’s ambition and commitment to protect its people. The political objective was to decrease the size and the role of the state. The result was to leave the country fatally weakened. Whatever the reasons why we didn’t follow the teachings of the Sars and the flu simulations, the fact remained, as Boyd summed it up, “we were ill-prepared.”
The global response to Sars-CoV-2 is the biggest failure in science policy in a generation. The signals were clear. Hendra in 1994, Nipah in 1998, Sars in 2003, Mers in 2012 and Ebola in 2014; these major human epidemics have all been caused by viruses that originated in host animals and spread to humans. Covid-19 is caused by a new variant of the same coronavirus that caused Sars.
It is not surprising that the warning signs went unheeded. Few of us have experienced a pandemic, and we are all guilty of ignoring information that does not reflect our own experience of the world. Disasters reveal the weakness of human memory. How can one plan a rare event at random – the sacrifices will surely be too great? But, as seismologist Lucy Jones argues in her 2018 book The Big Ones, “Natural hazards are inevitable; disaster is not. “
The first duty of the government is to protect its citizens. The risks of a pandemic can be measured and quantified. As Garrett and the Institute of Medicine have shown, the dangers of a new epidemic have been known and understood since the emergence of HIV in the 1980s. Since then, 75 million people have been infected with the disease and 32 Millions have died. HIV may not have swept the world at the same rate as Sars-CoV-2, but its long shadow should have alerted governments to prepare for an epidemic of a new virus.
During a crisis, the public and politicians naturally turn to experts. But on this occasion, the experts – scientists who modeled and simulated our possible futures – put forward hypotheses which turned out to be wrong. The UK imagined that the pandemic would look very much like the flu. The flu virus is not mild – the number of annual influenza deaths in the UK varies widely, with a recent peak of 28,330 deaths in 2014-15 – but the flu is not Covid-19.
China, on the other hand, was marked by its experience of Sars. When the government found out that a new virus was circulating, the Chinese authorities did not recommend hand washing, a better cough label and tissue removal. They quarantined entire cities and shut down the economy. As a former Secretary of State for Health in England has told me, our scientists suffered from a “cognitive bias” towards the less serious threat of influenza.
Perhaps that’s why the government’s key committee, the new Respiratory Virus Threat Advisory Group (Nervtag), concluded on February 21, three weeks after the World Health Organization declared a public health emergency of international concern, they had no objection to Public Health England’s “moderate” risk assessment of the disease for the British population. It was a truly fatal error in judgment.
The failed escalation of the risk assessment resulted in fatal delays in preparing the NHS for the next wave of infections. The desperate calls I received from front line NHS staff are painful to read. “Nursing burnout is at an all time high and many of our heroic nurses are on the verge of an emotional crisis.” “It is disgusting that this is happening and that, in one way or another, this country thinks it is okay to let certain staff members get sick, ventilate or die.” “I feel like a soldier going to war without a weapon.” “It’s suicide. “I’m tired of being called a hero because if I had a choice, I wouldn’t come to work. “
The availability and access to appropriate personal protective equipment has been woefully bad for many nurses and doctors. Some hospital trusts have planned well. However, many have been unable to provide the necessary safety equipment for their frontline teams.
At each press conference, the government spokesman always takes the same line: “We have followed medical and scientific advice”. It’s a good line. And that’s partly true. But the government knew that the NHS was not prepared. He knew he had failed to build the necessary intensive care capacity to meet likely patient demand. As a doctor wrote to me: “It seems that nobody wants to learn from the human tragedy that happened in Italy, China, Spain … It is really sad … Doctors and scientists who cannot learn one another.”
We are supposed to live in the Anthropocene, a time when human activity has become the dominant influence on the environment. The idea of the Anthropocene evokes notions of human omnipotence. But Covid-19 revealed the astonishing fragility of our societies. It revealed our inability to cooperate, coordinate and act together. But maybe we can’t control the natural world after all. Maybe we are not as dominant as we thought.
If Covid-19 ends up infusing humans with a measure of humility, we may, after all, be receptive to the lessons of this deadly pandemic. Or maybe we’ll fall back into our culture of complacent exceptionalism and wait for the next plague to come. To come back to recent history, this moment will come sooner than we think.