Richard Horton, Editor-in-Chief of The Lancet Journal. Image from Wikimedia Commons.
According to Richard Horton, editor of The Lancet, scientists have been sounding the alarm on the coronavirus for “months”. “Why did Britain fail to act?” he wants to know.
Writing in the Guardian last Wednesday, Horton said that the warnings from China and Italy had been “loud and clear” but that politicians and their advisers wasted valuable time – “and lives will be lost as a result”.
Is this true? If so, the advice must have been issued behind the scenes, where the rest of us couldn’t see it.
Hindsight is, of course, a wonderful thing. Were the Guardian’s science and medical staff aware of the risks of the coronavirus in the “months” prior to the outbreak? Were alarm bells sounding? I don’t think so. But maybe they don’t read The Lancet. Specifically, did the Guardian follow up on stories the journal reported? No, it did not. So far as I can see (and correct me if I am wrong), the first substantial story on COVID-19 appeared in the paper on 31 January under the headline, “Coronavirus: health officials announce first known US case”.
The story, in reference to screening services set up by the Atlanta-based Centre for Disease Control, concluded: “CDC officials said the risk to the American public is low. According to Reuters, officials round the world have implemented similar screenings to contain the virus ahead of the Lunar New Year travel season.”
As for The Lancet itself, which prides itself (rightly) on keeping its finger on the world’s pulse, the earliest full-length report on COVID-19 that I could find on their archive appeared on January 24 under the headline, “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. It translated the findings of a group of Chinese specialists.
“A recent cluster of pneumonia cases in Wuhan, China,” it began, “was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients.”
The article was scholarly and wide-ranging. It’s conclusion, though sobering, was less than alarmist.
“The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies.”
The Lancet’s own view of the crisis (as of January 24) was equally measured.
“‘There is an emergency in China, but it has not yet become a global health emergency…WHO [the World Health Organisation] is following this outbreak every minute of every day’, said Dr Tedros Ghebreyesus, Director-General of WHO, on Jan 23. A novel coronavirus (2019-nCoV) outbreak is emerging, but it is not yet a Public Health Emergency of International Concern (my italics).
“As we went to press, more than 500 cases have been confirmed in China, as well as in Japan, South Korea, Thailand, and the US. The virus can cause a severe respiratory illness, like SARS and MERS, and human-to-human transmission has been confirmed. These characteristics are driving China’s urgent public health actions, as well as international concern. But much remains unknown. The pieces of the puzzle that is 2019-nCoV are only now beginning to come together.”
Not exactly a call to arms!
On 31 January, another report appeared, which opened much as its predecessor:
“Since Dec 31, 2019, the Chinese city of Wuhan has reported an outbreak of atypical pneumonia caused by the 2019 novel coronavirus (2019-nCoV). Cases have been exported to other Chinese cities, as well as internationally, threatening to trigger a global outbreak. Here, we provide an estimate of the size of the epidemic in Wuhan on the basis of the number of cases exported from Wuhan to cities outside mainland China and forecast the extent of the domestic and global public health risks of epidemics, accounting for social and non-pharmaceutical prevention interventions.”
Based on research carried out in China in January and February of this year, when Beijing was pretending that nothing was happening, the report is highly technical and likely either to have been filed away or else not noticed by either UK government officials or media specialists. Needless to say, this was not the fault of The Lancet, but nor is it the case (so far as I can tell) that the government was blithely ignoring a litany of warnings.
A spate of articles next appeared in The Lancet in mid-to-late February, all based on the Wuhan experience, one of which concluded: “There is more to be learnt about this novel contagious viral pneumonia; more research is needed into the correlation of CT findings with clinical severity and progression, the predictive value of baseline CT or temporal changes for disease outcome, and the sequelae of acute lung injury induced by COVID-19.”
To specialists, including the chief medical officer Chris Wyatt and the chief scientific adviser Sir Patrick Vallance, this will have made a lot of sense. To the rest of us, including a government obsessed with Brexit, not so much.
Undaunted, The Guardian knew exactly who to blame. Not, it should be noted, “months” ago, but rather a few days ago.
“It was clear that if Britain could not slow down the contagion, the disease would overload hospitals and kill hundreds in a few weeks, as it has done in northern Italy. That Boris Johnson did not fathom the depth of the danger is worrying. The policy to combat a virus must be guided by science, but it is ultimately a political decision. What was obvious in Lombardy only became clear to Downing Street in the form of an analysis by epidemiologists at Imperial College London.”
If only the Guardian had been in charge!
Horton’s emergence as a retrospective prophet of the coming doom is also at odds with his own advice from late January. He himself called in a (now-deleted) tweet on 24 January for “caution please”, regretting that “Media are escalating anxiety by talking of a ‘killer virus’ + ‘growing fears’. In truth, from what we currently know, 2019nCoV has moderate transmissibility and relatively low pathogenicity. There is no reason to foster panic with exaggerated language.”
But now, Horton reliably informs us, we should have seen the global health crisis coming all along. He now bemoans that “We have wasted 7 weeks. This crisis was entirely preventable.” And as recently as Friday, 20 March, he told us to “Forget lockdown – we are going into meltdown.”
I can’t imagine what his bedside manner would be like.
Am I wrong about this? Unlike Richard Horton and his media-medical colleagues, I make no claim to be an expert. But if The Guardian and The Lancet (closely followed by hordes of Facebook warriors) are going to accuse the government of not heeding repeated warnings of the horror to come, then could they please point out to me where, and – more importantly – with what prominence these warnings appeared?
For a siren to be heard, it must first be sounded.
According to a lengthy report in the 15 March edition of the Sunday Times, the first that Peter Openshawe, professor of experimental medicine at Imperial College London, knew of the coronavirus was at the tail-end of last year when he happened to spot a string of “alarming messages” about something unpleasant happening in China. (Coincidentally, it looks to have been the Sunday Times report that alerted the Guardian to the existence of what Imperial College was doing.)
Within days, we are told, Openshawe and his colleagues were working full-time to come up with information in the hope of formulating a response. The Sunday Times describes Openshawe as a leading figure in “a little-known network of British epidemiologists who have been quietly preparing for another pandemic since the swine flu outbreak of 2009-10”. Exactly the sort of people, in other words, needed to confront the crisis and come up with the answers.
Around the same time, Peter Horby, a leading epidemiologist from the University of Oxford, tweeted that the outbreak was “one to watch,” while Sir Jeremy Farrar, director of the Wellcome Trust research charity, noted that what was happening in China was “a real worry”.
My guess is that the Department of Health, medical researchers, pharmaceutical companies and the NHS were well aware by then (but not before) of the seriousness of the situation and starting to ramp up their response. The difficulty was that the virus was entirely new. It had yet to manifest itself in Italy. Nobody at that stage knew how quickly it would spread or what approach needed to be taken.
Not that this stopped either the Lancet or the Guardian – and they are far from alone – from pointing the finger of blame straight at the government and the medical Establishment. If there was such a thing as a Nobel Prize for Wisdom After the Event, I know who I would nominate.