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Senior health officials who waged war on impact of coronavirus hitting UK, warned four years before Covid-19 started of need for stocks of PPE, computerized system contact tracing and screening of foreign travelers, the Guardian may reveal.
Calls to step up preparations in areas already identified as gaps in the government’s response to Covid, emerged from a groundbreaking report from a health planning exercise in February 2016 that imagined a coronavirus outbreak.
It was commissioned by Dame Sally Davies, then Chief Medical Officer, who attended alongside officials from NHS England, the Department of Health, Public Health England and observers from decentralized administrations.
Participants imagined cases of Middle East respiratory syndrome (MERS-CoV) arriving in London and Birmingham and spreading rapidly resulting in “a large-scale epidemic”. Like Covid, MERS causes life-threatening respiratory illness and can spread asymptomatically; there was no known treatment or vaccine.
Government ministers have previously stressed that pandemic planning focuses more on the flu and therefore does not prepare the UK for the demands a coronavirus places on PPE, hospitals and nursing homes.
The disclosure of the 23-page report on Exercise Alice is expected to trigger a further review of the adequacy of the UK’s preparations.
In August, the government refused to release the dossier, saying it could “result in a loss of public confidence in the government’s and NHS Covid-19 response … based on a misinterpretation of the report.”
However, the case was made public Thursday under freedom of information laws to Dr Moosa Qureshi, a clinician campaigning for greater transparency around government preparedness for the pandemic, who has made it up to present more than 137,417 lives, according to the government’s own figures.
Qureshi is posting official documents online on the pandemic preparedness exercises he has obtained so far.
Some of the key issues raised in the report became issues in the early weeks of the Covid pandemic. In March 2020, nurses and caregivers reported chronic shortages of PPE, raising concerns that they were spreading the virus more than necessary. This led to a scramble for the right equipment as deaths and cases increased.
The UK government has also continued to allow people to enter the country unprotected from Covid hotspots, such as China and Italy, despite recommendations from Exercise Alice.
Health officials involved in the 2016 coronavirus exercise believed PPE levels were “of critical importance to frontline staff” and “pandemic stocks were suggested as a way to ensure that sufficient quantities were available “.
They also explicitly called for consideration of “point-of-entry control” to limit the spread of the virus from abroad, and for health officials to “produce a plan of options using existing evidence and the cost advantages for quarantine versus self-isolation for a range of contacts. types, including symptomatic, asymptomatic and high-risk groups.
The exercise also raised concerns that the UK needs better systems ready to trace contacts of those infected with the virus. They suggested “a web-based tool… a live database of contacts with classifications, current status and other data relevant to the situation”.
So the UK government launched its NHS test and traceability service on May 28, 2020, more than two months after the first lockdown and well after the 1,000-a-day spike in the first wave of deaths.
Even in the summer of 2020, Test and Trace was failing to reach thousands of people in areas with the highest infection rates in England, with the close contact proportion of infected people well below the level of 80% considered necessary for such a system to be effective.
Qureshi said: “Shamefully, the government covered up Exercise Alice – a coronavirus exercise that predicted the importance of isolating patients, tracing contacts, providing PPE, trained staff and adequate NHS beds.
“It doesn’t matter that Covid-19 is a new type of coronavirus, every pandemic is different. But the lessons of Exercise Alice were generally applicable to coronaviruses, including Covid-19, they were agreed upon by general consensus, and political leaders and NHS England leaders failed to implement that consensus. “
The report also called on the government to enter into “sleep contracts” to allow rapid trials of vaccines and therapies and guidelines on how clinicians should prioritize specialist treatments, such as oxygenation.
Tessa Gregory, a partner at Leigh Day, the law firm that represented Qureshi, said the government must now disclose “the follow-up actions that have been taken … and why issues such as a functioning contact tracing system had not already been put in place “.
The pandemic planning exercises that have already emerged have focused on preparing for other types of infections. A report on the three-day exercise Cygnus, in 2016, which leaked to the Guardian in May 2020, revealed problems preparing for an influenza pandemic rather than a coronavirus infection.
Lord Bethell, then Minister of Health, told Parliament at the time: ‘It was a test for an influenza pandemic, not the type that Covid produced, and the demands on PPE, the industry. the health and care sector was deeper than the pandemic influenza trials prepared us for.
Yet Exercise Alice had already concluded: “There was general consensus on the need to identify the capacity and capacity of assets within the health system. The assets in this context would be all the resources that would be required to respond effectively to an outbreak of MERS-CoV, such as trained staff, adequate PPE in sufficient quantity and the required beds with appropriate clinical equipment. “
In 2019, a separate Cabinet Office confidential briefing warned ministers of the potentially catastrophic consequences of a pandemic and included testing for a viral flu.
Exercise Alice, focused specifically on a coronavirus, adds to the weight of evidence that Covid was not a thunderclap.
In May, after months of defying activists’ appeals, the government finally agreed to convene a statutory public inquiry into its handling of the pandemic, saying it would begin in the spring of 2022.
A spokesperson for the Department of Health and Social Affairs stressed that MERS was different from SARS-CoV-2, which causes Covid-19, and said that Exercise Alice “was not a readiness exercise for a coronavirus pandemic ”.
“MERS-CoV does not spread as easily as SARS-CoV-2 between people, the size of epidemics is relatively small and the risk to individuals in the UK remains very low,” they said.
“The results of Exercise Alice have fed into ongoing planning work by DHSC, UKHSA and NHS to respond to potential outbreaks of high-consequence infectious diseases like MERS-CoV. “
They added: “We have always been clear that there will be opportunities to look back, analyze and reflect on all aspects of Covid-19, and a full statutory independent investigation is due to begin in the spring. 2022. “
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