The UK, Italy and France surely have lessons to learn from Germany and South Korea. The aim here is to understand, not judge, criticise or blame I will share a serialised version of the overall slideshow which records facts that merit attention in the UK - UK plans - UK response - Conclusions - Numbers - Political and moral dilemmas Enjoy!

1. UK response to
COVID-19
A point of view (20th April 2020)

2. Contents
UK plans01
UK response02
Conclusions03
Numbers04
Political and moral dilemmas05

3. UK plans
“the virus will inevitably spread”
UK Influenza Pandemic Preparedness Strategy

4. UK’s flu
virus risk
management
• Risk identification
• The risk is well-known and quantifiable
• Every year, c17,000 die of flu in England
alone
• https://www.thetimes.co.uk/article/how-
does-the-coronavirus-death-rate-compare-
with-flu-and-how-long-will-the-outbreak-
last-tlpnwxg89
• Risk mitigation
• Every autumn, the UK vaccinate older
people against flu.
• Risk containment
• Little or nothing is done to contain the flu
virus when it happens.

5. UK
pandemic
risk
management
• Risk identification
• A flu-like pandemic has been number 1 in
the UK National Risk Register since 2008.
• Risk mitigation
• The government had stock piles (to be
discussed)
• Like most other countries, they might have
done more to prepare (to be discussed).
• Risk containment
• The government followed closely the “well-
laid plan” set out in the UK Influenza
• Pandemic Preparedness Strategy

6. UK planning for a pandemic was informed by
Use the hyperlinks to find them
• 2003: WHO report on SARS (the first coronavirus)
• 2008: UK national risk register (pandemic is number 1 risk)
• 2011: UK Influenza Pandemic Preparedness Strategy
• 2016: Exercise Cygnus: a simulation to estimate the impact of a flu pandemic.
• 2018: The WHO checklist for pandemic preparation

7. 2003: WHO concensus report on SARS
(I’m not blaming WHO)
• The first coronavirus
• “striking progress had been made in [understanding] the coronavirus1 that is itscause”.
• transmission can be prevented by adherence to basic measures.
• inc. rapid case detection, case isolation, contact tracing and good infection control.
inc hand. washing and the use of personal protective equipment (PPE).”
• This must have encouraged scientists to think “containment” could work.
The report did not mention mass testing or lock down.

8. COVID-19 differs from SARS
• COVID-19 is harder to contain and more symptomless than SARS
• Wikipedia says SARS reproduction number was 2 to 5.
• “Transmission efficiency [of SARS] appears greatest from severely ill patients [in]
the second week of illness.”
• Wikipedia says COVID-19 reproduction number is 1.4 to
3.9. But many are *symptomless* when transmitting the
virus

9. 2008: UK national risk register
• Published “to inform the public more fully of the risks that we face”
• A pandemic is the number 1 risk

10. 2011: UK Influenza Pandemic Preparedness
Strategy
• “the virus will inevitably spread… local measures taken to disrupt or reduce the spread are likely to have very limited or
partial success”.
• ”“Pandemic-specific vaccine is likely … available within four to six months.”
• Restrictions on public gatherings and public transport
• 4.21 There is very limited evidence that restrictions on mass gatherings will have any significant effect on influenza
virus transmission.
• Large public gatherings or crowded events where people may be in close proximity are an important indicator of ‘normality’
and may help maintain public morale during a pandemic.
• The social and economic consequences of advising cancellation or postponement of large gatherings are likely to be
considerable for event organisers, contributors and participants.
• There is also a lack of scientific evidence on the impact of internal travel restrictions on transmission and attempts to impose
such restrictions would have wide-reaching implications for business and welfare.”

11. COVID-19 differs from flu
• “Many of us have been surprised by the speed, and also the aggression of thevirus.”
• WHO’s European spokesman April15th
• “Britain was following closely a well-laid plan to fight a flu pandemic - not thisdeadlier disease.” Reuters
• A copy of the “UK Influenza Pandemic Preparedness Strategy 2011,” which aspokesman
• said was still relevant, stated the
• “working presumption will be that Government will not impose any suchrestrictions.
• The emphasis will instead be on encouraging all those who have symptoms to follow the advice to stay at home and
avoid spreading their illness.”Reuters

12. 2016: Exercise Cygnus
• “The exercise, which simulated a deadly outbreak of so-called “swan flu”, is believed to have
shown that in the event of a deadly pandemic the NHS would be overwhelmed by a shortage of
critical care beds and vital equipment.” Guardian
• After the exercise, the Chief Medical Officer said serious problems were a lack of medical
ventilators and the logistics of disposal of dead bodies.
• It turns out, today, the NHS is not overwhelmed, there are enough beds and ventilators,and
disposal of dead bodies has not been a problem.
• But PPE supplies are not enough for the 16,000 care homes

13. 2018: WHO checklist for pandemic
preparation (I’m not blaming WHO)
• 40 pages of extensive, worthy, but somewhat bland guidelines. E.g. prepare for xxx Each country
interprets the guidelines its own way.
• On lock down: “voluntary or enforced quarantine” is discussed in terms of isolating individuals - taking ethical concerns
and personal freedoms into consideration. I’ve seen no reference to a nationwide lockdown.
• On resources: “Identify needs for trained staff, equipment (including PPE and reagents).” UK had more health
service resources and stock piles than most countries WHO oversee.
• On testing: “Develop surge plans to manage increased demand for testing”.
• This doesn’t seem to imply mass testing in advance on the scale of Germany or South Korea.

14. Hmm…
• Politicians like to follow (and therefore if
necessary blame) experts if they can.
• UK Influenza Pandemic Preparedness
Strategy didn’t anticipate the impact on policy and
human behavior of a virus that is much more life-
threatening than flu.
• Perhaps the government’s scientific advisors were
too wedded to their strategy.
• The strategy seems to have underestimated
• The willingness of Britons to stay home when
faced with a life-threatening virus.
• Mass testing and resources needed for it
• The needs of care homes as well as hospitals
• Having said, that the plan does seem to be
meeting its objective of protecting the abilityof
the NHS to treat people who need it.

15. Must-read articles on the 2020 virus
crisis
• October 2019, The Global Health Security Index from the Johns Hopkins Center for Health Security and the Economist
Intelligence Unit released ranked the USA and UK 1st and 2nd in preparedness for a disease outbreak.
• This expert talks about the USA’s national plan; note the supply chain remarks.
• This Reuters investigation explains why following the UK Influenza Pandemic Preparedness Strategy
was problematic.
• Some use the virus crisis to bash their government, or the whole of westerndemocracy, some with a utopian vision of the
future. Read Mathew Syed’s excellent article.

16. THANK YOU
Keep watching and reading for the next chapter..