I thought this book review was interesting from today's Sunday Times:
When in late January a small group of Chinese doctors and scientists produced a research paper documenting a worrying cluster of pneumonia cases in Wuhan, its choice of publisher for a first clinical description of a new strain of coronavirus came as no surprise to epidemiologists. The initial study appeared on the website of The Lancet, the elite British medical journal founded in 1823.
Since that study was published on January 24, The Lancet has occupied a privileged position at the forefront of the coronavirus crisis. Its website, shorn of its normal paywall, has become a crucial source of research, not all of which has turned out to be wholly reliable.
The journal’s editor, Richard Horton, a 58-year-old former physician, has made the most of his platform to comment, criticise and complain about the global response to a lethal threat. He has become a prominent watchdog of government policy-making and hasn’t been afraid to show his teeth.
Richard Horton provides an angry response to a crisis
ALAMY
In
The Covid-19 Catastrophe, Horton expands the themes that have filled his editorials and newspaper columns of the past four months into a 107-page roar of outrage. He empties his thesaurus of synonyms for “failure” and “farce”, something that has exposed his journal to accusations of political bias.
No one escapes his fury. He describes the World Health Organisation (WHO) as “an imperfect institution … a bureaucracy that puts diplomacy before advocacy and compromise before perseverance”. He says the WHO should have convened an “emergency Covid-19 summit” as soon as the threat of pandemic emerged. “It absented itself from its global leadership role, leaving countries to struggle to respond to Covid-19 alone .”
He argues that China reacted much more swiftly and effectively than after the Sars outbreak of 2002, but he identifies “a gap in the [Covid-19] timeline… what really took place in Wuhan in December? Did local Communist Party officials suppress evidence of a new virus? Did they delay telling the national government in Beijing? The verdict on the virtues of China’s response remains to be written.”
He has no hesitation about “the calamitous response” of the US administration, which he describes as “spectacularly unprepared”.
All of which pales by comparison with his scorn for the British government and the UK medical establishment. He accuses the government’s Scientific Advisory Group for Emergencies (Sage) of failing to recognise the magnitude of the threat emerging from Chinese studies in January and February. The group “luxuriated in elite insouciance”. The failure of another key committee, the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag), to sound a risk alarm in February was “a genuinely fatal error of judgment”.
As for Boris Johnson and his cabinet, they “wasted the whole of February and most of March, when ministers should have been preparing the country for the arrival of a deadly new virus .” The subsequent devastation at care homes unfolded “without any politician seeming to know or understand what was happening”, he writes.
He is scathing about what he portrays as the wilful disregard by politicians of pandemic alarms that stretched back many years. “It was within the power of governments to have prevented this human crisis,” he says. He is close to apoplectic about the scientific advisers he accuses of colluding with ministers “to give the illusion that the UK was an ‘international exemplar’ in preparedness”.
The advisers became “the public-relations wing of a government that had failed its people”, he argues. “Why was testing capacity so poor? Instead of saying honestly that the government had ignored the WHO’s recommendation to ‘test, test, test’, the adviser would say that testing wasn’t appropriate for the UK.” He concludes: “The UK’s response had been slow, complacent and flat-footed. The country was glaringly unprepared … is there no alternative to this broken system of obsequious politico-scientific complicity?”
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If there was a “miserable failure of government”, as Horton insists, how and why did it happen? He accuses politicians of claiming to “follow the science” while doing nothing of the kind. The most basic failures were of preparation — no personal protective equipment, panic over ventilators and intensive care beds. “Health workers were shockingly unprotected.” He reserves a special mention for the “astonishing irresponsibility” of President Trump, and his enthusiasms for ultraviolet light, untested medications or bleach.
He also examines the uncomfortable issue of the NHS’s role in the tragedy. Horton is as appreciative of nurses and doctors as everyone else, but he claims to have received hundreds of messages from NHS staff as the epidemic took hold in March, “a collective cry of anguish about their abandonment by government”. The messages make depressing reading: “We are literally making this up as we go along … it feels as if we are actively harming patients … sleepwalking into this totally unequipped.”
“Despite the very best efforts of health workers, the NHS certainly did not cope,” Horton concludes.
The book is too short for a detailed examination of individual failings — the government’s early enthusiasm for herd immunity comes and goes in a single paragraph. Nor is there much room for detailed proposals on how we might do better next time.
Beyond the practical need for better preparation and swifter responses, his main concern is that a world splintered by “ruthless, inward-looking nationalism” offers little hope for combating global health threats. Horton, thumping his political fist, variously blames the West’s vulnerability to the pandemic on capitalism, nationalism, “estrangement and prejudice” and the pursuit of wealth instead of health.
Since he delivered his manuscript, Horton has become embroiled in an embarrassing row over a flawed study published but later retracted by The Lancet on the supposed dangers of hydroxychloroquine, an anti-malaria drug touted by Trump as a treatment for Covid-19. The data supporting the study may have been manipulated, prompting wild accusations from Trumpian conspiracy theorists. No mention of that is made here.
Yet for all its omissions, and its patently partisan political outlook, this book strikes me as a valuable response to a crisis that in one respect is utterly bewildering. At this time last year, the two countries rated by most of the world as the best prepared to deal with a lethal pandemic were the United States and the United Kingdom. The death tolls tell a different story. It is no longer good enough to pretend, as Johnson continues to do, that Britain is on the verge of “world-beating” breakthroughs in testing and tracing or anything else. It’s far too late for jingoism, and you don’t need to be as angry as Horton to wonder what went wrong.
The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again by Richard Horton
Polity £12.99, ebook £12.99 pp107
www.bbc.co.uk
