Health

UK has plans to deal with pandemic causing up to 315,000 deaths


Emergency planners have drawn up proposals to deal with “excess deaths” of between 210,000 and 315,000 over a 15-week period as part of longstanding measures to ensure the UK can cope with a deadly pandemic.

The “reasonable worst-case scenario” was first established a decade ago and still forms part of the underlying planning, supporting the coronavirus action plan announced by Boris Johnson at an emergency Cobra meeting on Monday.

Politicians and officials have been reluctant to speculate on how many could be at risk if coronavirus spread into large numbers of the British population, but health officials pointed to documents that spelled out the worst-case assumptions.

Excess deaths at this level would amount to about 0.4% to 0.5% of the British population and are based in part on a 2.5% mortality rate, although this week Chris Whitty, England’s chief medical officer, said he anticipated a mortality rate of no higher than 1%.

The figures are set out in a special document for emergency planners from 2013, which states that “the government judges that one of the highest current risks to the UK is the possible emergence of an influenza pandemic” – long considered a more deadly national risk than terrorism or a disaster.

Crisis planners around the country are expected to have liaised with everybody in what is called the “death management process” – coroners, funeral directors, mortuary managers, and burial and cremation authorities – to ensure they have plans to cope in a pandemic outbreak.

A wide range of services would have to contend with a coronavirus emergency, although emergency planning is a local council activity and there are questions about how well it has been resourced over years of austerity, with £15bn of cuts to council services since 2010.

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Mike Granatt, a former head of the civil contingencies secretariat, said the confused and sluggish initial response to the Grenfell disaster in 2017 demonstrated that “emergency planning has certainly taken a hit” in the past decade.

Emergency planners insist, despite the challenges, that they are prepared. Jacqui Semple, chair of the Emergency Planning Society, said: “All public sector services have been reduced because of austerity and that includes emergency planning.”

Semple added: “What it doesn’t mean is that the job in hand has not been done.” She argued that everybody in the emergency services sector from the NHS to police would say the same. “We could always do with more money,” she added.

The document also makes clear schools might have to close on a precautionary basis – although that is not current official advice – and says all organisations would have to deal with high level of sickness if a flu-like illness such as the coronavirus spread widely. Sickness rates could hit 20%, rising to 35% in small organisations, at a peak point.

Emergency planners report up into the Cobra system, used by ministers and officials to consolidate information and take decisions in times of crisis. On Monday, Johnson chaired a meeting of the committee for the first time since reports of the illness emerged from China in January.

That authorised a 28-page action plan, focused on containing the spread of the disease, only for Whitty to admit by Thursday the government was moving towards a “delay phase”, which happens when officials believe an epidemic was becoming inevitable.

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Experts questioned whether the political machine was responding quickly enough to the coronavirus crisis. Bob Kerslake, a former head of the civil service, said the dilemma for Downing Street was that by the time the need to close schools or halt public gatherings to disrupt the spread of the disease became obvious, it could easily be too late because the virus would have spread too far.

The crossbencher warned that “if ministers believe that emergency measures will be necessary, they should act now”. Lord Kerslake added: “Their problem is that by the time we know for sure how serious the coronavirus outbreak is, it’ll be too late, because such measures will be unable to halt its transmission.”

What is Covid-19 – the illness that started in Wuhan?

It is caused by a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. Many of those initially infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city.

Have there been other coronaviruses?

Severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals. In 2002, Sars spread virtually unchecked to 37 countries, causing global panic, infecting more than 8,000 people and killing more than 750. Mers appears to be less easily passed from human to human, but has greater lethality, killing 35% of about 2,500 people who have been infected.

What are the symptoms caused by the new coronavirus?

The virus can cause pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. Recovery depends on the strength of the immune system. Many of those who have died were already in poor health.

Should I go to the doctor if I have a cough?

UK Chief Medical Officers are advising anyone who has travelled to the UK from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau in the last 14 days and who is experiencing a cough or fever or shortness of breath to stay indoors and call NHS 111, even if symptoms are mild.

Is the virus being transmitted from one person to another?

China’s national health commission has confirmed human-to-human transmission, and there have been such transmissions elsewhere.

How many people have been affected?

As of 4 March, the global death toll was 3,190, while more than 93,000 people have been infected in more than 80 countries.

The death toll has passed 3,000 in China, where there have been over 80,000 cases. South Korea, the nation worst hit by the outbreak outside China, has had 5,328 cases. More than 44,000 people in China have recovered from Covid-19.

There have been 87 recorded cases and no fatalities to date in the UK. There are 53 confirmed cases in Australia, with two deaths.

Why is this worse than normal influenza, and how worried are the experts?

We don’t yet know how dangerous the new coronavirus is, and we won’t know until more data comes in. The mortality rate is around 2% at the centre of the outbreak, Hubei province, and less than that elsewhere. For comparison, seasonal flu typically has a mortality rate below 1% and is thought to cause about 400,000 deaths each year globally. Sars had a death rate of more than 10%.

Another key unknown is how contagious the coronavirus is. A crucial difference is that unlike flu, there is no vaccine for the new coronavirus, which means it is more difficult for vulnerable members of the population – elderly people or those with existing respiratory or immune problems – to protect themselves. Hand-washing and avoiding other people if you feel unwell are important. One sensible step is to get the flu vaccine, which will reduce the burden on health services if the outbreak turns into a wider epidemic.

Is the outbreak a pandemic?

A pandemic, in WHO terms, is “the worldwide spread of a disease”. Coronavirus cases have been confirmed outside China, but by no means in all 195 countries on the WHO’s list. It is also not spreading within those countries at the moment, except in a very few cases. By far the majority of cases are travellers who picked up the virus in China.

Should we panic?

No. The spread of the virus outside China is worrying but not an unexpected development. The WHO has declared the outbreak to be a public health emergency of international concern. The key issues are how transmissible this new coronavirus is between people, and what proportion become severely ill and end up in hospital. Often viruses that spread easily tend to have a milder impact. Generally, the coronavirus appears to be hitting older people hardest, with few cases in children.

Sarah BoseleyHannah Devlin and Martin Belam

A small number of schools have been closed when cases have been detected, while a nervous public have been panic-buying hand sanitiser, soap and dry food staples such as pasta and rice in supermarkets.

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Critics also say the government is struggling with communications, having just reversed a post-election boycott of the BBC Radio 4 Today programme. On Wednesday, it decided that it would not release a regional breakdown of coronavirus cases but had to perform a U-turn after objections that the public was being denied transparency.

Granatt, also a former head of the government information service, said the imperative was “to generate and reinforce trust every day”, and argued that the previous boycott “was exactly the worst thing to do” particularly because older people, who are among those most at risk, turn instinctively “to trusted broadcasters and newspapers, and particularly the BBC”.

Cobra stands for Cabinet Office briefing room A, but in reality it describes a system for handling any national crisis. In fact, key meetings tend to take place in room F, the largest, which sits about 20 people, surrounded by screens for presentations or remote attendees. Sometimes gallows humour can take hold, even in the worst situations, as happened at a meeting on Friday last week, where other participants noted wryly that Whitty, the most senior doctor in England, appeared to have a cold.



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