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Richard Horton: the system has failed

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Richard Horton, the longstanding editor of the medical journal The Lancet, is scathing about the establishment’s handling of the coronavirus crisis. He told Socialist Worker why.
Issue 2711
Warnings about the virus were heeded too late
Warnings about the virus were acted upon too late

What do you make of the government’s moves toward ending the lockdown?

RH: They are trying to exit lockdown at a moment when there are still a very high number of infections every day. 

The most reliable data suggests that there are something over 3,500 new infections a day across Britain.

That’s a very high number. 

And so to exit lockdown and see people in the streets going about their normal business when you’ve got that amount of virus in the community is super dangerous.

It’s even more dangerous when you don’t have a test, trace and isolate system that’s fully functioning.

We are rolling the dice and gambling with people’s lives. 

And to me, that is an extraordinarily reckless policy.

Why do you think that Britain was so badly prepared for a pandemic, given the government’s own reports had issued warnings as far back as 2016?

RH: There were two principal reasons. First is that they assumed the pandemic was going to be influenza, which although an unpleasant disease, has a relatively low death rate and is something that happens every year.

What our scientists and politicians did not think about was the possibility of an epidemic similar to the Severe Acute Respiratory Syndrome of 2003.

A second issue is that there was a general disbelief of the evidence coming out of China. 

There was a scepticism that medicine in China could deal effectively with an epidemic like this, and a degree of racism against China.

The evidence for that is the five papers from Chinese scientists that we published in The Lancet in the last week of January.

They laid out clearly the threat—and described the urgency of getting PPE, test, trace and isolate systems, intensive care capacity and health systems ready for the epidemic. So there is no excuse for British politicians or scientists to say that this was a surprise. 

I can only conclude that when our scientists read those papers, they simply didn’t believe them.

That’s why this charge of racism against Chinese scientists has to be seriously considered.

Was this a failure of individuals or something wider?

RH: I think there was a systemic failure. We have a very complicated set of scientific committees giving advice to government, and all contain excellent individuals. 

But when the system came together it failed, and it failed catastrophically.

If you read [Chinese medical] papers like that in a scientific journal, you would think they would have immediately contacted those individuals in China and asked, what is going on? Asked, can you confirm the severity of this?

And if they had done so,they would have got a clear message back, that this was a brand new virus. 

That it was tipping thousands of people into hospitals and intensive care units. There was no treatment. There was human to human transmission and there was a mortality rate much higher than for influenza. 

If we’d asked those questions, if we’d read those papers, we would not have waited till 23 March to lock down Britain.

How did the previous ten years of austerity play into the crisis?

RH: There are two parts to that. First, the National Health Service. Although its funding has increased, it’s barely increased enough to be sustainable. And that means that it was not a resilient health service.

The only way it could cope with a pandemic was to throw over 30,000 patients out of hospital and to pretty much shut down routine care.

That it was tipping thousands of people into hospitals and intensive care units. There was no treatment. There was human to human transmission and there was a mortality rate much higher than for influenza.

Second, an even more appalling story is the fact that we’ve had over a billion pounds taken out of the public health system over the last decade.

We now have no local public health service of any capacity or credibility. And that’s why we’re in this ludicrous position where we are building a test, trace and isolate system from scratch. And, we’ve outsourced it to Serco. How wrong is that?

Given the economic costs of these epidemics, why do you think there’s such political resistance to spending on public health?

RH: We’ve been living through 40 years of a neoliberal ideology which is all about the intensification of markets as the solution to every social problem.

In the DNA of neoliberalism is the idea that the state is evil and has to be cut back and we should instead be outsourcing to the market.

Now that 40-year ideology, which goes back to Margaret Thatcher and Ronald Reagan, has been shown by Covid-19 to be corrupt.

It has left us vulnerable to the most appalling human catastrophe since the Second World War. 

And it’s no coincidence that the two countries that have seen some of the worst mortality rates, and which have handled this epidemic in the worst possible way, are the two countries that have championed neoliberalism. These are the United States and Britain.

And so I hope that one of the lessons of this will be that we need a mass movement of resistance to say that enough is enough. 


Richard Horton
Richard Horton

Why did some scientists aid politicians pushing a ‘herd immunity’ strategy?

RH: Because all of the scientists’ models of the pandemic were based on the coming pandemic being influenza when they plugged-in mortality rates and expectations of severe illness, they got out figures which were relatively manageable—and that was the message communicated to politicians.

That’s why you had Boris Johnson talking about, “Take it on the chin!” 

I don’t think that’s a defensible position for either the scientists or for the politicians. If you’re a politician, it’s not a question of just taking what scientists say and then not questioning it.

We have an embassy in Beijing. Would you not expect the foreign minister to have contacted the embassy to provide an assessment of what was actually taking place in Wuhan and other Chinese cities?

There was this strange collusion between the scientists and the politicians who acted together apparently to protect the government.

Tory Covid-19 moves will mean more death
Tory Covid-19 moves will mean more death
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We had a situation where medical officers and scientific advisers were appearing at press conferences defending the government line, which was wholly inappropriate for independent advisers. 

What about the way the pandemic impacted on the poor and disadvantaged?

RH: This pandemic held a mirror up to society. It has accentuated and exploited every inequality in society.

I don’t think we ever thought before about the notion of a key worker. But as some of us have been able to work at home, society has only been able to continue thanks to some of the lowest paid workers in our communities going to work.

And what was worse was that they were not protected. The inequalities in society have been cruelly exposed, especially for the black and minority ethnic population.

Where were the policies to protect these vulnerable key workers? 

Never before have people been so cruelly exposed and yet so taken for granted in our society.

What has to be done now to prepare for a second wave?

RH: We have to remember that over 40,000 people have died, and that’s a minimum figure, and they didn’t need to die.

So first and foremost, we have to protect those vulnerable groups and I have not heard that anybody in government is coming to talk about a plan to protect them. 

We also have to build health systems that truly can protect the public.

Security isn’t about having nuclear weapons travelling around the British Isles in submarines. 

Security starts with an effective system of social and health protection—and clearly we still don’t have that.

We need a national conversation about what kind of society we want to live in. 

We really have to end this exploitation and using the markets as the magic bullet to solve every social problem.

I hope that there will be a politician to have the courage to ask that question and lead a national conversation on it. 

Otherwise, we will not have learned the lessons of this terrible pandemic.

Richard’s newest book-The COVID-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again is available now. More of Richards books are available from Bookmarks Bookshop.

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