Like the Trumpton fire brigade, Britain’s disaster planners have had precious little opportunity to show off their skills over the past few decades. Plans for a nuclear war merely gathered dust. Global pandemics failed to arrive, as did a no-deal Brexit. Just about the only crisis requiring nationwide emergency planning concerned foot and mouth disease in 2001 when six million animals were slaughtered and Labour ministers announced ‘the countryside is closed’, killing off rural businesses, yet still failed to prevent the spread of the disease from Cornwall to Northumberland.
But with UK cases of coronavirus rising from four to eight this week, there is a faint chance that the Hughs, Pughs and Barney McGrews of UK civil contingency planning may finally get their day in the sun. So what would a Britain laid low by a pandemic of coronavirus look like?
We have a good idea, thanks to documents published revealing government planning for a possible influenza pandemic. Many of the plans are updated versions of those prepared in the mid- to late 2000s, when several strains of bird flu and swine flu failed to develop into anything like the crises which the World Health Organization (WHO) had whipped them up to be. The WHO predicted up to 50 million deaths globally when the H5N1 strain of avian flu struck in 2005. In the event the disease killed 455 people.
But what if coronavirus really is the big one? Government planning for an influenza pandemic — equally valid in the case of a Sars-type disease, which coronavirus is — works on the assumption of a worst-case scenario, where 50 per cent of the UK population catch the disease and 2.5 per cent of those people go on to die from it. That would give a UK death toll of 750,000. It is a figure which provides marvellous ammunition for headline-writers. However, as a slightly earlier Cabinet Office document (from 2011)puts it, the 750,000 figure takes ‘no account of the potential effect of response measures such as practising good respiratory and hand hygiene, the use of antiviral medicines and antibiotics, and modern hospital care for those with severe illness’.
In other words, if we go around coughing over each other as if nothing is amiss, and don’t bother visiting the doctor even if we are developing pneumonia, then we might succeed in notching up three quarters of a million deaths. If, on the other hand, we succeed in treating people’s symptoms (without having a vaccine or without using antibiotics for secondary infections), the worse-case scenario falls to between 45,000 and 341,000 deaths. With antibiotics but no vaccine, the worst-case scenario drops to between 33,000 and 220,000. With a vaccine it falls to between 14,000 and 94,000. This assumes a death rate of 2.5 per cent; so far, it appears that corona-virus may have a lower death rate than this, perhaps around 1 per cent.
These are figures for ‘excess’ deaths — on top of the usual 600,000 deaths expected in a typical year. Many victims would be the very elderly and infirm whose deaths were in any case fast approaching, but whose demise was brought forward by catching the flu. The figures need to be set in the context of ordinary seasonal flu, which typically causes 12,000 excess deaths a year — rising to 26,000 in the winter of 1989/90.
The main problem for disaster planners is the time lapse before a vaccine becomes available. The Cabinet Office assumes that it would take four to six months for a vaccine to become widely available, yet, as it puts it: ‘Scientific modelling suggests that it may only take two-to-three weeks from the virus first entering the UK to its being widespread.’ The greatest difficulty would lie in finding sufficient room for those who needed hospitalisation, which government plans estimate would be between 1 and 4 per cent of the total who catch the virus. Assuming the worst case that 50 per cent of the population catch the virus, that would require between 300,000 and 1.2 million people to be admitted to hospital at some point. The government’s modelling claims that up to 22 per cent of these cases could occur in a single week at the peak of the pandemic — meaning that between 66,000 and 264,000 could need to be hospitalised at once. Even without a viral pandemic, the NHS’s 142,000 hospital beds frequently prove to be insufficient. In this respect, NHS planning does not seem to be joined up with government disaster planning — according to the health thinktank the King’s Fund, the number of beds has more than halved over the past 30 years, from 300,000. Where the NHS would find the staff to treat all these people is something of a mystery — though the document does suggest that a Dad’s Army of retired medical practitioners ‘may be of significant assistance for the purposes of death certification’.
More reassuring is the revelation that in 2006 the then Labour government ordered enough anti-viral medicines to treat a quarter of the population — while not as effective as a vaccine, they are predicted to reduce the duration of the disease by one day and to reduce the death toll from complications.
Considering the extravagant death tolls mentioned in government documents, plans for a pandemic propose remarkably few restrictions on everyday life. Planning documents from 2013 state: ‘During an influenza pandemic, the government’s overall aim will be to encourage people to carry on as normal, as far as possible, if they are well, while taking additional precautions to protect themselves from infection and to lessen the risk of spread to others.’ The documents claim that stopping 90 per cent of air traffic to and from the UK would have minimal impact on the number of people who caught virus — at best it would succeed in delaying the peak of the pandemic in Britain by one to two weeks.
Nor do the government’s plans propose a nationwide closure of schools, even though it recognises that schools would very likely make their own decision to shut their doors. The problem is that closing schools creates childcare needs which could then result in a 30 per cent fall in the number of healthcare staff who are able to work.
Government plans work on the assumption that the effect on the economy would be remarkably light — taking just 0.75 per cent off GDP in the year of a pandemic. Considering that the Treasury’s doom–mongers famously claimed in 2016 that a vote for Brexit would result in a hit to GDP of between 3.5 per cent and 6 per cent, it doesn’t suggest economic Armageddon, or even a recession. We can at least be grateful for that — even if we do end up dead.
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