Even through this dark month of unimaginable shocks, one thing is still guaranteed to make British ministers and officials bristle: mentioning the Germans. “Arrgh,” sighed one senior adviser, stung by unflattering comparisons.
With the pandemic bearing down, Boris Johnson on March 17 called on Britain’s captains of industry to start building ventilators to supplement the country’s stock of 8,000, lightheartedly dubbing the scheme “Operation Last Gasp”.
But almost a week before the prime minister spoke, Germany had ordered 10,000 from an established manufacturer, adding to its existing 20,000 machines. This week Germany had more than twice as many critical care beds vacant — around 15,000 to 20,000 — as England has in its system overall.
Even more stark is relative performance on testing. The UK and Germany entered the crisis in lock-step, working together on virus tests, some of the first developed in the world. But Germany’s labs ran at more than five-times the NHS rate, completing 918,460 tests versus Britain’s 163,194.
Only on Thursday did Matt Hancock, the health secretary, declare Britain would “ramp up” efforts by harnessing private facilities — just as the global supply of chemicals and testing equipment was being squeezed. “Germany had 100 test labs at the start, largely thanks to Roche, but we had to start from a lower base,” he said. “We are going to build a British diagnostics industry at scale.”
Experts say it is too early to judge how different policy choices have affected countries during this global pandemic. Germany’s advantages stem from decades of higher health spending, alongside an industrial base better able to scale-up for an emergency. Even with this head-start, German ministers admit they are in “the calm before the storm”; in terms of deaths, the country is on a similar coronavirus trajectory to the UK.
But Berlin’s strategy has nevertheless held up an unforgiving mirror to Britain’s government. This is not just with regard to NHS capacity — tuned more for resource efficiency than resilience — but the quality and pace of decision making. The charge: that Britain’s strategy twisted and turned, squandering precious time.
“It just wasn’t consistent. They tested various strategies and rejected them,” said Martin Stuermer, a virologist at IMD Labor in Frankfurt. “They had this plan to allow life to go on but ensure that elderly people were protected. But then they abandoned that. And they weren’t prepared for mass testing. but the main problem was that the government just didn’t chart a clear course in this crisis — unlike the German government.”
The implications may soon become terrifyingly clear. UK infections are expected to peak by Easter Sunday.
Mr Johnson was slow to grip the coronavirus crisis. Evidence coming out of China about the disease in February was deemed unreliable and there was a hope it would burn itself out, like Sars in 2003.
Although Whitehall had started working up contingency plans from the start of 2020, the lack of urgency was summed up by Mr Johnson’s decision to disappear for a week in late February to his grace-and-favour Chevening home. It was only on March 2 that he chaired his first coronavirus emergency meeting.
At this point advisers were envisaging a spread of the virus through Britain — controlled by escalating social distancing measures — with a peak around mid-May to early-June. “Glastonbury should be all right,” one minister told anxious colleagues, referring to the world’s biggest music festival in late June.
Rather than following countries like South Korea in taking immediate draconian action to stop the disease — including the use of mass testing — Mr Johnson’s team thought a more modulated approach would ultimately save more lives and cause less economic harm.
Patrick Vallance, the UK’s chief scientific adviser, found a willing ally in Dominic Cummings, Mr Johnson’s chief adviser, in embracing the concept of “herd immunity”, where the disease passed through healthy members of the population. Mr Cummings referred to the concept in a 2013 blog.
“There was an element of British exceptionalism to it,” said one Treasury official.
Crucially during this time, Public Health England, a government agency, also advised that mass-testing was not feasible. Neil Ferguson, a professor at Imperial College and government adviser, told parliament it was “very clear from messages from PHE that we would have nowhere near enough testing capacity to adopt that strategy”.
Unlike Germany’s decentralised and at times unwieldy system, the UK chose to concentrate efforts in superlabs, in part to ensure reliability. Sharon Peacock of PHE said it was preferable to “dissipating our efforts into a lot of laboratories”. One senior academic said PHE struggled to delegate one of its core functions; the service had been “hanging around waiting for the next epidemic. That is what they are paid to do,” he said.
But in practice it meant that while Germany broadened its testing strategy to cover all those with mild symptoms — the core of a strategy to test, trace and isolate people infected with the virus — by March, Britain was struggling to scale up. The approach was narrowed to testing only hospital admissions. Only 5,000 of approx 500,000 frontline NHS workers had been tested by Thursday.
Donald Trump was to say later that if Britain had persisted with the herd immunity approach it would have been “catastrophic”. But that had already become clear to Mr Johnson and his team by the weekend of March 14-15.
New data from Italy confirmed the disease was spreading faster than previously thought, with more patients ending up in intensive care units: Imperial College warned about 250,000 people would have died in the UK without a change of course. Worse still, ministers were advised that even if NHS intensive care capacity was doubled or trebled, it would be overwhelmed three times over.
Mr Hancock, Michael Gove, cabinet office minister, and Mr Cummings now urged Mr Johnson to put aside his libertarian instincts and effectively lock down Britain. “The three of them saw it immediately,” said one Number 10 official. Another official involved in the strategy change said: “When the facts change, you change your mind.”
Restrictions on social life lagged some of Germany’s states by a week or so, but the differences with Britain were less pronounced than with some other countries.
More consequential for Britain was the gaping flaw the strategy-change exposed in Britain’s preparations. The only exit strategies from the lockdown appeared to be a vaccine or antiviral treatments — still thought to be many months away — or mass community testing to allow restrictions to be eased without triggering a second wave.
“If you follow a herd immunity strategy, why would you not build treatment and testing capacity? That’s what puzzles me,” asked Devi Sridhar, professor of global health at Edinburgh University. “I think it is because they were taking everything from the flu playbook. In flu you don’t have to chase every case down, you don’t test in the community or medical staff . . . But coronavirus is not flu.”
To expand treatment, Britain has already doubled its critical care bed capacity this month and aims to acquire up to 50,000 ventilators in total. Some 30 are due to arrive this weekend but 8,000 are expected in the next few weeks. But time is very short. Since the beginning of the outbreak Germany has amassed 10,000.
Mr Johnson appealed to household names such as Airbus, Nissan, Dyson and McLaren to aid the effort. But some established medical equipment makers felt left in the cold. “They’ve overlooked the real manufacturers in the system,” said one person at a medical devices maker who asked not to be named. Ministers insist they have pursued all avenues, engaging with industry since February.
Blame over testing mis-steps is being directed by ministers at the NHS bureaucracy and PHE. “They’re proud of their independence and won’t yield for anyone,” said one minister of health officials. “The same is true for Public Health England: they’re the reason we don’t have more testing. They want to control the whole tedious process.”
For doctors a long way downstream from the decisions in Whitehall, the impression has overwhelmingly been one of dithering and delay caused by theoreticians being left to manage an emergency.
“To us on the frontline, it feels like this is what happens when you let epidemiologists in charge of the real world,” said an NHS Consultant from Hertfordshire on the Covid frontline. “What has never been explained to those working in respiratory care is why there wasn’t ‘test, test, test’, then isolate, contact and trace again, which is the absolute basis of public health and infection control. Now they seem to have reacted, but it’s all too late.”
By Alex Barker, George Parker, Laura Hughes, Sebastian Payne, Laura Hughes, Camilla Hodgson, Peter Foster, Michael Pooler, David Blood and Chelsea Bruce-Lockhart in London and Guy Chazan and Tobias Buck in Berlin
