What Did Exercise Cygnus Deliver?

The UK carried out Exercise Cygnus – a pandemic drill – in 2016, and it highlighted all the issues we have seen this year, though the conclusions have never been made public. The Guardian has published a document labelled as the final version of the report and it does not make reassuring reading.

Conclusions from the report:

• There is no useful strategy in place, nor is there a useful implementation plan for what strategy there is
• The public reaction has not been considered
• Ethical aspects of decision making have not been considered
• It’s recognised that capacity is inadequate and one area where it is lacking is in subject matter experts

Lessons ‘LEARNED’ from the exercise:

• Organisations should ensure their Emergency Preparedness Resilience and Response training and exercising is consistent with best practice.
• Planning should be considered a multi agency responsibility. Specialist advice from all stakeholders needs to be available. Sector specific advice should be scaled up during a pandemic.
• During a reasonable worst case pandemic responders will struggle to maintain a response using the existing framework
• Meetings between the health ministers of the 4 nations should be considered best practice
• Consideration is needed of population based triage
• Work is required to consider surge arrangements. An NHS plan is being developed. Service plans need to be modelled for health, social care, and community support. A communications plan is needed. A clinical and ethical plan needs to be agreed. Mitigation plans are needed to ensure flexibility. Buy in is needed from those who will actually implement these plans.
• Strategy is needed for the use of antivirals – less relevant since there isn’t one for COVID
• Staff absence should be considered
• Health messaging at the national level was not effective. Procedures for getting the message out should be re-enforced (sic) and practiced. Local messaging was more effective.
• National attitudes to use of social media render their use of it ineffective
• Messaging needs to be consistent, avoid jargon, and consider that people want to make their own decisions. Trust in the message source is important
• Consideration needs to be made to using the voluntary sector
• There’s a need for a cross government group to make the response process effective
• The impact of school closures needs to be considered
• Overseas nationals should be considered
• MoD involvement should be considered
• Process for providing and presenting data to decision makers should be considered
• Social care and surge capacity should be considered
• Expansion of social care real estate and staffing capacity should be considered
• Thought should be given to using the capacity of the voluntary sector
• Capacity for managing excess deaths should be considered
• Work is needed to develop contingency plans and processes for prisons
• Future guidance and plans need to consider the potential response of the public

To all of the above unlearned lessons, the DeliveryDemon says NSS, all basic planning requirements. Such a shame that we have had generations of politicians who failed to consider that their job includes managing the country to the benefit of its population. Can there be any excuse for ignoring such a telling report? Maybe perhaps the astonishing claim made late in the document – ‘The healthcare framework to respond to a pandemic is robust’. Along with the minor bureaucrapic qualification that people need to be briefed of the plans for a similar exercise – seriously, the assumption for a disaster scenario is that there will be time for lots of cosy meetings.

We have seen the theory come up against reality. Will that make our politicians and bureaucraps treat disaster planning as something other than a fun exercise and a source of PR?

What Has Boris Delivered?

The DeliveryDemon actively dislikes listening to political pomposity. Let’s just get at the text and eliminate the waffle. If you didn’t listen to the PR persiflage, here it is edited to the bare factual bones, along with the DeliveryDemon’s thoughts (in italics) of what was said.

I will be setting out more details in Parliament tomorrow and taking questions from the public in the evening.

Given an offline Parliament there’s really no need to hold this info back

Because although we have a plan, it is a conditional plan.

Fair enough, but I’d expect to see a bit more about checkpoints

And since our priority is to protect the public and save lives, we cannot move forward unless we satisfy the five tests.

• We must protect our NHS. Pious wish, not a test
• We must see sustained falls in the death rate. Question as to how reliable that data is
• We must see sustained and considerable falls in the rate of infection. AFAIK criteria being used to determine infections is still pretty inadequate compared to the range of symptoms being reported so again a question as to how reliable the decision data is
• We must sort out our challenges in getting enough PPE to the people who need it, and yes, it is a global problem but we must fix it. Pious wish again, what actions are proposed?
• And last, we must make sure that any measures we take do not force the reproduction rate of the disease – the R – back up over one, so that we have the kind of exponential growth we were facing a few weeks ago. Pious wish again, what actions are proposed?

These are not tests, they are emotional PR.

And to chart our progress and to avoid going back to square one, we are establishing a new Covid Alert System run by a new Joint Biosecurity Centre. What is this Joint Biosecurity Centre? Sound like the renaming of an existing committee. What’s its remit? Who are the members and what are their qualifications?

And that Covid Alert Level will be determined primarily by R and the number of coronavirus cases.

And in turn that Covid Alert Level will tell us how tough we have to be in our social distancing measures – the lower the level the fewer the measures.This actually contradicts what he said earlier about conditionality. For basic risk management, it makes sense to monitor the effect before confirming a reduction in level.

The higher the level, the tougher and stricter we will have to be.

There will be five alert levels.

Level One means the disease is no longer present in the UK and Level Five is the most critical – the kind of situation we could have had if the NHS had been overwhelmed.

Over the period of the lockdown we have been in Level Four, and it is thanks to your sacrifice we are now in a position to begin to move in steps to Level Three.

And if we are to control this virus, then we must have a world-beating system for testing potential victims, and for tracing their contacts. Forget world beating, it’s not a competition. It needs to be effective. The UK carried out Exercise Cygnus – a pandemic drill – in 2016, and it highlighted all the issues we have seen this year, though the conclusions have never been made public. The Guardian has published a document labelled as the final version of the report and it does not make reassuring reading. It is clear from this that the lessons ‘learned’ use a different understanding of the word ‘learned’ from that understood by most people. The DeliveryDemon has summarised the document in a separate post.

And yet when I look at where we are tonight, we have the R below one, between 0.5 and 0.9 – but potentially only just below one. That’s quite a range for a non-linear variable. Just how many people will understand that distinction?

We now need to stress that anyone who can’t work from home, for instance those in construction or manufacturing, should be actively encouraged to go to work. Not all workplaces are equal in their ability to provide a safe environment. What protection is there for those whose employers are not providing a safe workspace?

And we want it to be safe for you to get to work. So you should avoid public transport if at all possible – because we must and will maintain social distancing, and capacity will therefore be limited. May not be an issue initially but as more sectors are expected to return, just what proportion of the working population work in major centres and / or at a distance from work? Are we expecting gridlock and a pollution hike from car usage? Where will all the parking spaces come from? Travel distance and weather will make walking / cycling impractical for many.

So work from home if you can, but you should go to work if you can’t work from home.

And to ensure you are safe at work we have been working to establish new guidance for employers to make workplaces COVID-secure. Guidelines are fine, enforcement is another matter and whistleblowers tend to suffer.

And when you do go to work, if possible do so by car or even better by walking or bicycle. But just as with workplaces, public transport operators will also be following COVID-secure standards. Enforcement?

And from this Wednesday, we want to encourage people to take more and even unlimited amounts of outdoor exercise.

You can sit in the sun in your local park, you can drive to other destinations, you can even play sports but only with members of your own household. How far is an acceptable drive? What guidelines will police have? How will more isolated communities react to an influx?

You must obey the rules on social distancing and to enforce those rules we will increase the fines for the small minority who break them.

In step two – at the earliest by June 1 – after half term – we believe we may be in a position to begin the phased reopening of shops and to get primary pupils back into schools, in stages, beginning with reception, Year 1 and Year 6. No consideration of country-specific differences in school term dates.

Our ambition is that secondary pupils facing exams next year will get at least some time with their teachers before the holidays. And we will shortly be setting out detailed guidance on how to make it work in schools and shops and on transport.

And step three – at the earliest by July – and subject to all these conditions and further scientific advice; if and only if the numbers support it, we will hope to re-open at least some of the hospitality industry and other public places, provided they are safe and enforce social distancing. Fair enough, but it would have been more sensible to state conditions rather than a date – the date is now firmly implanted in people’s minds.

We are going to be driven by the science, the data and public health. It has long been accepted that ethics have a place in this sort of decision making. Why is it excluded here?

And I must stress again that all of this is conditional, it all depends on a series of big Ifs. It depends on all of us – the entire country – to follow the advice, to observe social distancing, and to keep that R down.

And to prevent re-infection from abroad, I am serving notice that it will soon be the time – with transmission significantly lower – to impose quarantine on people coming into this country by air. NSS. But why just air? And why so late?

And of course we will be monitoring our progress locally, regionally, and nationally and if there are outbreaks, if there are problems, we will not hesitate to put on the brakes. Fair enough but a bit awkward after setting so many dates in people’s minds.

The DeliveryDemon has yet to be persuaded that we have a political class which is capable of managing this country in the interests of its population. After decades of hiding behind the excuses of the market and of the EU, there isn’t the will, the culture, or the competency to make that change.