I thought you said there was no pre-pandemic planning?
No, I never said that.
I said:
This (unofficial) analysis is revealing:
**In fact, says Celia Blanco-Jimenez (LSE), a number of plans were in place for the rapid spread of a respiratory disease. But none anticipated that lockdowns or travel restrictions would be put in place. **
Accounts of the chaos and confusion in No 10 in March 2020 would imply that COVID-19 caught the UK completely unprepared. Nonetheless, the government carried out extensive planning for a pandemic, mostly focusing on influenza. We knew that an airborne pathogen of unknown lethality was highly likely to emerge.
Numerous reports warned of the high likelihood that a new virus of unknown severity would spread from animals to humans and create a pandemic. A report from the Home Office stated the ‘high probability’ of this occurring as long ago as 2008. The World Health Organisation reported “a world at risk” in 2019, and the Johns Hopkins Center for Health Security Preparedness for a High-Impact Respiratory Pathogen Pandemic warns about “a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen”. In 2011, the Department of Health said a pandemic could arise in any location, although many previous pandemics had originated in China or Southeast Asia.
The 2019 Global Health Security Index declared the UK one of the best-prepared countries in the world for a pandemic, even ahead of countries like Japan or South Korea. However, the Exercise Cygnus Report (2016), commissioned by the NHS, predicted shortages of ICU beds and PPE, and stated that regulatory changes were needed to improve the ability of the health and other sectors to cope with an outbreak, as well as changes and easements to assist with the implementation of a response. The report also identified a lack of joint tactical plans and a lack of capacity among local responders. Interestingly, the report was classified until October 2020, when it was published following public pressure.
Exercise Cygnus was a three-day simulation exercise carried out by NHS England in October 2016 to estimate the impact of a hypothetical H2N2 influenza pandemic on the United Kingdom. It aimed to identify strengths and weaknesses within the United Kingdom health system and emergency response chain by putting it under significant strain, providing insight on the country’s resilience and any future ameliorations required. It was conducted by Public Health England representing the Department of Health and Social Care, as part of a project led by the “Emergency Preparedness, Resilience and Response Partnership Group”. Twelve government departments across Scotland, Wales and Northern Ireland, as well as local resilience forums (LRFs) participated. More than 950 workers from those organisations, prisons and local or central government were involved during the three-day simulation, and their ability to cope under situations of high medical stress was tested.
The exercise was named “Cygnus” as the theoretical H2N2 virus was nicknamed “swan 'flu” and said to originate from swans, the Latin name for which is Cygnus.
In the scenario, participants were placed in the seventh week of the pandemic – the peak of the crisis, when there is the greatest demand for healthcare. At this stage, an estimated 50% of the population had been infected, with close to 400,000 deaths. The hypothetical situation was that the vaccine had been made and purchased but not yet delivered to the United Kingdom. Hospital and social care officials were to come up with emergency plans managing resource strain, while government officials were exposed to situations requiring quick decision-making. To make the situation more realistic, COBRA meetings were held between ministers and officials. Simulated news outlets and social media such as “WNN” and “Twister” were also employed to give fictitious updates.
Results from the exercise identified four main learning points and 22 further recommendations. In general, it showed that the pandemic would cause the country’s health system to collapse from a lack of resources, with Sally Davies, the Chief Medical Officer at the time, stating that a lack of medical ventilators and the logistics of disposal of dead bodies were serious issues. In November 2020, the United Kingdom government stated that all identified lessons have been discussed accordingly and appropriately taken into account for its pandemic preparedness plans.
A number of news reports have criticised the government’s handling of the COVID-19 pandemic in the light of the conclusions reached by Exercise Cygnus. There was criticism that no follow-up document was written detailing how to deal with an influenza pandemic after December 2016. In March 2020, the three government documents available for response to COVID-19 were those published in 2011 (“Influenza Pandemic Preparedness Strategy”), 2012 (“Health and Social Care Influenza Pandemic Preparedness and Response”) and 2014 (“Pandemic Influenza Response Plan”) respectively, with no revised report following Exercise Cygnus and no mention of ventilators.
I find it difficult to distinguish from what you said and the quoted sources because the formatting looks similar. Did you say that there was planning or did you say that there was no planning?
a precis of this in your own words?
Summary of findings
Four key areas of improvement
Develop a “concept of operations”
During Exercise Cygnus, the strategy used was a combination of Department of Health and Social Care’s UK Influenza Pandemic Preparedness Strategy 2011, as well as eight or more other scientific documents gleaned from the H1N1 pandemic in 2009. However, the exercise revealed that there was no overview or central management to coordinate all participants. As of October 2016, feedback showed that organisations varied in preparedness, with some relying on corporate memory of the 2009 H1N1 response, and others depending on individual pandemic protocols which may be outdated, missing or incomplete.(Exercise Cygnus - Wikipedia) There was also demonstration of silo planning between and within some corporations, however organisations had different levels of detail and structure that could not correspond well when used simultaneously.(Exercise Cygnus - Wikipedia) It was understood that up to half the population will be implicated should there be insufficient understanding of the severity of a pandemic during the response.(Exercise Cygnus - Wikipedia)
Exercise Cygnus revealed the need to develop a “Pandemic Concept of Operations” to bridge communication between organisations.(Exercise Cygnus - Wikipedia) This aims to manage collective response strategically by delegating specific roles to each organisation and directing their interactions during a pandemic. NHS England recognises that a variety of sectors are implicated, hence a central administration and unified protocol to oversee the whole strategy is required for organisations to work synonymously.(Exercise Cygnus - Wikipedia)
Devolved administrations have separate contingency plans which were not investigated during Exercise Cygnus. In this segment, Wales was also excluded as it had previously investigated its response through “Exercise Cygnet” conducted in 2015.[5]
Ease legislation during pandemic
The proposition to roll back on legislation and regulatory restrictions, particularly within the health sector, is considered.(Exercise Cygnus - Wikipedia) This would aid in managing essential services and operationalising increased health care demands with fewer obstacles. Greater flexibility is recommended especially in a pandemic when situations evolve quickly and decisions need to be made as soon as possible. Key suggestions were for rules to be more malleable and easily adapted to the circumstance at hand. The choices as to which legislation will be amended is determined by pandemic influenza planning assumptions. Previous findings from Department of Health and Social Care provide direction as to what type of corrections are appropriate for health legislation in the midst of a pandemic.
Devolved administrations were advised to adopt similar measures in fields of devolved competence. The need for future work to expand on the types of restrictions affected was noted.
Understand and manage public reaction
Exercise Cygnus was centred around assumptions of public responses that have yet to be validated. Expectations of how the public will react was postulated based on the magnitude of “swan flu”. This may not have been entirely representative of what would have happened in real life.(Exercise Cygnus - Wikipedia) For example, Exercise Cygnus did not involve live broadcasting or widespread coverage which typically characterises an actual pandemic. Hence, its reactions are based around theoretical public reaction. This was identified and understood as a possible limitation to Exercise Cygnus, and the role of public opinion on pandemic response still requires further investigation. It was stated that in reality, moral decisions, such as those involving mass burials or population triage, may differ in face of public reaction.(Exercise Cygnus - Wikipedia)
Further work is required to understand public reaction, so that it can be factored into significant decisions and communication strategies, particularly for ethically charged scenarios. Research into how public perception and response to a pandemic will further aid the trajectory of emergency strategies and how they can be communicated. In 2019, the Moral and Ethical Advisory Group (MEAG) was established to give unbiased guidance to government regarding controversial health issues.(Exercise Cygnus - Wikipedia)
Meet demand for services
A lack of resources and limited ability to increase supply in face of demand was identified in health disciplines.Exercise Cygnus - Wikipedia) This affects how emergency plans can be operationalised at a local level, implicating the revision of the “Pandemic Concept of Operations”.
Little tactical coordination was observed when the need for services outweighed the capacity of local responders, particularly in communities with excess death, social care facilities and amongst National Health Service staff.(Exercise Cygnus - Wikipedia) The need for more precise protocols was identified to guide health care providers at an operational level should there be a need to drastically step up local response. A suggestion was to implement planning at a regional level as opposed to through local resilience forums for crucial aspects of pandemic influenza response (e.g., excess death). This improves coordination across multiple agencies locally.
Logistically, more health workers and resources such as ventilators, personal protective equipment (PPE) and hospital beds are required to face a large pandemic. Investigation also showed that the reverse triage strategy proposed by the NHS, whereby patients are moved from hospitals to social care, may not be well supported by the current social care system.(Exercise Cygnus - Wikipedia) This requires a high level of teamwork across several corporations, which was detailed through a provided framework but may not be viable under the pressure and widespread impact of a pandemic.
Local resilience forums have announced that they depend on subject matter experts for more complicated aspects of pandemic response to implement responses.(Exercise Cygnus - Wikipedia) These professionals do not belong to LRF but give detailed technical support to enable colleagues to comprehend different elements of the response. The Strategic Coordinating Group (SRG) structure is used by experts for holistic contribution. Doubts were raised if this method was sustainable in the case of a fast-moving pandemic, since experts would have to aid more than one SRG.(Exercise Cygnus - Wikipedia)
Further recommendations
The 22 further recommendations, listed as per the report, include:
- Corporations are required to update their “Emergency Preparedness Resilience and Response training and exercising” for optimum performance
- Expert advice from all stakeholders should be readily presented to SCGs for corresponding response. This should occur efficiently so multiple LRFs can benefit from this support.
- Planning should occur on a national level, and take into account how local pandemic flu strategies can be operationalised in implementation.
- The health tripartite (DH, NHS England and PHE) and Chief Medical Officers (CMOs) should have Cobra Meetings incorporated into flu response
- More research needs to be done to investigate if population-based triage is viable during a critical, widespread influenza pandemic
- More work is required to understand surge arrangements when the pandemic becomes overwhelming. NHS England should direct the operational side while DH should give management, guidance and policy direction with advice from the Four Nations CMO meeting.
- DH should collaborate with partners to understand how antivirals may be used in a pandemic.
- PHE and NHS England must cooperate to improve current community guidelines and deliver antivirals within restrictions stipulated by NHS Emergency Preparedness staff.
- All corporations must be prepared for increased staff absence in the midst of a pandemic and make appropriate plans.
- Pandemic plans need to be effectively communicated to public for reassurance, and the right amount of detail of disclosed information should be ascertained.
- Steps to release information to public should be coordinated by DH, NHS England and PHE national teams together with Devolved Administrations
- A variety of stakeholders needs to be involved during communication of the pandemic to public. Special care is needed in the realm of social media.
- Cross-government efforts need to be conducted to avoid repetition and redundancy across departments.
- Department of Education should investigate the impact of school closures on the wider community.
- British Nationals residing overseas should be taken into account during an influenza.
- Ministry of Defence should be required to assist in the worst-case scenario.
- The process and timeline of front line responders need to be made more precise.
- A framework for analysing social care and surge capacity needs to be established.
- The potential for increasing social care real-estate and staff numbers need to be examined.
- Strategies to allocate voluntary resources during a pandemic need to be developed with advice from non-health departments.
- Excess death management needs review.
- Pandemic contingency plans and procedures as a whole require more development.
I said “there had been reports, planning and exercises to investigate the possibility of a pandemic …
the current government failed to learn the lessons from the reports, planning and exercises”
So there was planning? Was any of the planning beneficial? Did we start from zero or was there an infrastructure in place that enabled us to generate a response to the pandemic? NB your own view would be appreciated. I have a habit of only reading the first sentence of each paragraph. This comes from information overload at work.
So without referring back to the original text, can you tell me what number 14 is?
That is the precis.
I have no intention providing anything less than I have done.
ok that is your choice.
In a sentence:
… and selective reading is yours.
OK but I can’t see how that answers my questions : So there was planning? Was any of the planning beneficial? Did we start from zero or was there an infrastructure in place that enabled us to generate a response to the pandemic?
selective answers are mine too?
They will be if you only read the first sentences of a paragraph in a document.
*The first sentence of each paragraph - this only applies in the case of excessive information overload
However, getting back on-topic:
The report concludes:
20 This pandemic has exposed a vulnerability to whole-system emergencies – that is, emergencies that are so broad that they engage the entire system.
Although the government had plans for an influenza pandemic, it did not have detailed plans for many non-health consequences and some health consequences of a pandemic like COVID-19.
There were lessons from previous simulation exercises that were not fully implemented and would have helped prepare for a pandemic like COVID-19.
There was limited oversight and assurance of plans in place, and many pre-pandemic plans were not adequate.
In addition, there is variation in capacity, capability and maturity of risk management across government departments.