17 March 2020
Rt. Hon. Boris Johnson MP, Prime Minister of the United Kingdom and Northern Ireland
In unprecedented times as these, let me start this communication by wishing you strength and wisdom in dealing with the associated events related to the Covid-19 global pandemic, which now takes to the streets of Britain. In light of the strategy adopted by the UK government announced by the Prime Minister, flanked by Dr. Chris Witty, the UK’s Chief Medical Officer, last Thursday (12 March 2020), a few questions must asked:
- On what basis is the UK’s public health response so vastly different to the already successful examples in Asia, China and Taiwan included, and now to our European counterparts, all of which have taken seemingly draconian measures to, as early as possible, close borders, establish curfews and halt major economic, transport, entertainment, education institutes in order to ‘flatten the curve’ of transmission, whilst schools and the high street remain predominantly opened and functioning?
- Further to this, the World Health Organisation has issued directives to roll out extensive testing – starting with health staff and first-line responders, and eventually throughout the country in an attempt to understand number of incident cases, manage population circulation in highly affected areas, and to break chains of transmission. South Korea, understood as a widely successful case study, has rolled out 10,000 diagnostic tests a day. In view of these examples, why the UK has reserved testing for Covid-19, predominantly to high-risk and hospitalised patients, when surely foci of outbreak can be targeted and prematurely dealt with, before reaching high-risk patients?
- Early data from Italy points to the fact that 12% of the intensive care unit (ICU) beds there were devoted to patients aged 19-50, while 52% dedicated to those between 51-70 years of age. In the meantime, the NHS has 2.5 beds per 1,000 people in the population, whilst France (6), Italy (3.2) and the US (2.8) all have a higher proportion of hospital beds, let alone ICU beds and equipment! Was this data known to your Cabinet, before the design of your strategic decision to Covid-19? If so, could you justify your response vis-à-vis this seeming lack of preparedness?
- Were you aware of the time and need to establish hospital beds and critical care equipment, whilst flattening the curve of Covid-19 transmission, when you decided against the closure of educational institutions, restaurants, cafes and pubs, precisely the very centres where people conglomerate, so to avert the need of ICU equipment for those mostly in need?
- Has the economic uncertainty brought by the current trade negotiations with the EU and other countries across the globe – thanks to the UK’s leaving the EU – influenced the Cabinet against taking a hard approach to tackle Covid-19 (i.e. closure of shops, entertainment, borders, curb the movement of people, etc.) given that these hard measures would forcefully alter the published economic forecast for this financial year? What is the reason for such a delay? Could this potentially have hurt your government’s popularity and harm your governance ultimately?
By now, there are early signs of success from Taiwan, South Korea, Singapore, Hong Kong and China, in terms of an effective public health response, all from which Public Health UK should be learning from. Therefore, I urge the Prime Minister to seriously reconsider the strategy adopted when responding to this threat, accelerate steps to full societal closure, listen to the generous expertise shared by other nations and ultimately protect the public and the National Health Service against Covid-19.
Dr. Gabriel Sapir MD MSc