The world is often said to have prepared for the wrong kind of pandemic, anticipating a new strain of influenza. 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

Blanco Jimenez, Celia

English

LSE Research Online

Why	didn’t	pandemic	planning	anticipate	the	need	forlockdowns?The	world	is	often	said	to	have	prepared	for	the	wrong	kind	of	pandemic,	anticipating	a	new	strain	of	influenza.	Infact,	says	Celia	Blanco-Jimenez	(LSE),	a	number	of	plans	were	in	place	for	the	rapid	spread	of	a	respiratorydisease.	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	completelyunprepared.	Nonetheless,	the	government	carried	out	extensive	planning	for	a	pandemic,	mostly	focusing	oninfluenza.	We	knew	that	an	airborne	pathogen	of	unknown	lethality	was	highly	likely	to	emerge.	In	the	event,	theworld	ultimately	departed	from	its	pandemic	planning	and	took	unprecedented	steps	to	contain	the	virus.Numerous	reports	warned	of	the	high	likelihood	that	a	new	virus	of	unknown	severity	would	spread	from	animals	tohumans	and	create	a	pandemic.	A	report	from	the	Home	Office	stated	the	‘high	probability’	of	this	occurring	as	longago	as	2008.	The	World	Health	Organisation	reported	“a	world	at	risk”	in	2019,	and	the	Johns	Hopkins	Center	forHealth	Security	Preparedness	for	a	High-Impact	Respiratory	Pathogen	Pandemic	warns	about	“a	very	real	threat	ofa	rapidly	moving,	highly	lethal	pandemic	of	a	respiratory	pathogen”.	In	2011,	the	Department	of	Health	said	apandemic	could	arise	in	any	location,	although	many	previous	pandemics	had	originated	in	China	or	SoutheastAsia.So	why	were	we	not	better	prepared	for	COVID-19?	A	popular	hypothesis	is	that	we	prepared	for	the	wrongpandemic,	and	an	outbreak	of	influenza	was	most	likely.	According	to	the	WHO,	both	coronavirus	and	influenza	are“transmitted	by	droplets	and	fomites,	and	the	same	public	health	measures	are	important	actions	all	can	take	toprevent	infection”.	The	UK	preparedness	plan	for	influenza	is	also	alert	to	the	possibility	of	a	novel	virus	with	anunknown	incubation	time,	which	in	a	“reasonable	worst-case	scenario”	would	have	a	fatality	rate	of	2.5%	(higherthan	COVID-19),	spreading	over	one	or	more	waves,	causing	high	levels	of	work	absence	and	disruption	to	theeconomy.	It	also	anticipates	that	vaccines	will	take	at	least	four	to	six	months	to	develop.Moreover,	the	SPI-M	report	warns	that	“pandemics	are	heterogeneous,	the	next	pandemic	will	be	unique	in	manyways	(…)	and	we	should	ensure	that	all	intervention	strategies	are	able	to	accommodate	the	full	range	of	possibledisease	parameters…”,	and	warned	against	using	the	experience	of	the	H1N1	virus	in	2009	to	predict	the	severityof	the	next	pandemic.	The	Global	Preparedness	Monitoring	Board	(GPMB)	and	the	World	Bank	(2006)	anticipateda	“worst	case	scenario”	of	a	novel	virus	similar	to	the	Spanish	flu,	killing	50-80	million	people.So	the	world	was	aware	that	there	was	a	high	likelihood	of	a	new	virus	emerging,	that	it	would	probably	be	arespiratory	virus,	would	spread	quickly	and	was	likely	to	emerge	from	Southeast	Asia.	It	had	reports	modelling	thepotential	social	and	economic	loses	for	a	pandemic	much	more	virulent	than	COVID-19	that	would	require	similarnon-medical	interventions.	Why,	then,	were	we	only	prepared	for	influenza?What	were	the	plans?Most	of	the	measures	recommended	in	national	and	international	pandemic	plans	can	be	summarised	as	detection,assessment,	and	Personal	Protective	Equipment	(PPE)	supply	for	healthcare	workers.	For	the	general	public,	thefocus	is	on	handwashing,	voluntary	isolation	when	ill,	and	waiting	for	the	development	of	a	vaccine.	All	thesemeasures	should	serve	as	a	benchmark	that	could	be	adjusted	for	different	pathogens.The	National	UK	Risk	register	in	2017	and	the	UK	influenza	pandemic	preparedness	strategy	2011	(most	of	whichwas	not	updated	in	subsequent	years,	although	a	2017	update	provided	for	school	closures	and	the	cancellation	ofmass	events),	highlighted	several	action	plans,	mostly	relying	on	detection,	hygiene,	pharmaceutical	interventions(vaccines),	and	protective	equipment.	In	terms	of	non-medical	interventions,	this	report	argues	there	is	not	enoughevidence	to	justify	mask-wearing	by	the	general	public,	rejects	closing	borders	in	the	event	of	a	pandemic,	suggestsmodels	that	impose	a	90%	restriction	on	all	air	travel	will	only	delay	a	pandemic	wave	by	1-2	weeks,	and	arguesthat	the	economic,	political	and	social	consequences	of	border	closures	would	be	very	substantial.LSE Covid 19 Blog: Why didn’t pandemic planning anticipate the need for lockdowns? Page 1 of 3		Date originally posted: 2021-03-17Permalink: https://blogs.lse.ac.uk/covid19/2021/03/17/why-didnt-pandemic-planning-anticipate-the-need-for-lockdowns/Blog homepage: https://blogs.lse.ac.uk/covid19/Boris	Johnson	and	chief	scientific	adviser	Patrick	Vallance	on	their	way	to	a	Cobra	meeting	atNo	10	on	12	March	2020.	Photo:	Number	10	via	a	CC-BY-NC-ND	2.0	licenceInternationally,	the	WHO	report	on	non-pharmaceutical	interventions	(2019)	gives	similar	advice.	The	mainrecommendations	are	hand	hygiene,	mask-wearing	by	symptomatic	individuals,	surface	cleaning,	ventilation,voluntary	isolation	of	sick	individuals	(highlighting	the	ethical	considerations),	and	travel	advice.	Home	quarantine,screening	for	travellers,	and	contact	tracing	are	not	recommended,	while	school	and	workplace	closures	should	bebased	on	severity.	Internal	travel	restrictions	are	only	recommended	during	the	early	stage	of	a	localised	andextraordinarily	severe	pandemic,	and	for	a	limited	period	of	time.	Border	closure	is	not	recommended	as	“it	can	leadto	discrimination	and	stigmatisation	of	individuals	from	affected	areas”.But	were	we	prepared?The	United	Nations	and	WHO	define	preparedness	as	“the	ability	(knowledge,	capacities,	and	organisationalsystems)	of	governments,	professional	response	organisations,	communities	and	individuals	to	anticipate,	detectand	respond	effectively	to,	and	recover	from,	the	impact	of	likely,	imminent	or	current	health	emergencies”.The	2019	Global	Health	Security	Index	declared	the	UK	one	of	the	best-prepared	countries	in	the	world	for	apandemic,	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	wereneeded	to	improve	the	ability	of	the	health	and	other	sectors	to	cope	with	an	outbreak,	as	well	as	changes	andeasements	to	assist	with	the	implementation	of	a	response.	The	report	also	identified	a	lack	of	joint	tactical	plansand	a	lack	of	capacity	among	local	responders.	Interestingly,	the	report	was	classified	until	October	2020,	when	itwas	published	following	public	pressure.At	an	international	level,	the	GPMB	warns	that	respiratory	pathogens	pose	“global	catastrophic	biological	risks”,	andthat	the	world	was	not	prepared	for	a	fast-moving,	virulent	respiratory	pathogen	pandemic.	It	also	claimed	that“preparedness	is	hampered	by	the	lack	of	continued	political	will	at	all	levels”,	and	that	the	great	majority	of	nationalhealth	systems	would	be	unable	to	handle	a	large	influx	of	patients	infected	with	a	respiratory	pathogen	capable	ofeasy	transmission	and	high	mortality.	Similarly,	the	Johns	Hopkins	Center	for	Health	Security	(2019)	claims	that“International	Health	Regulations	(IHR)	core	capacities	are	unlikely	in	their	current	formulation	to	adequatelyprepare	countries	and	the	international	community	for	high-impact	respiratory	events”.	So	were	we	really	wellprepared	for	a	potentially	severe	influenza	epidemic,	as	is	claimed?Furthermore,	none	of	the	reports	highlighting	the	gaps	in	systems	or	plans	identified	a	lack	of	stronger	socialdistancing	measures	or	travel	restrictions	as	potential	problems.	They	did	not	even	consider	national	lockdowns	orcompulsory	quarantine.LSE Covid 19 Blog: Why didn’t pandemic planning anticipate the need for lockdowns? Page 2 of 3		Date originally posted: 2021-03-17Permalink: https://blogs.lse.ac.uk/covid19/2021/03/17/why-didnt-pandemic-planning-anticipate-the-need-for-lockdowns/Blog homepage: https://blogs.lse.ac.uk/covid19/What	actually	happened?In	the	event,	the	Wuhan	Municipal	Health	Commission	made	its	first	statement	about	a	‘viral	pneumonia’,	laterconfirmed	to	be	a	coronavirus,	on	31	December	2019.	This	was	confirmed	by	the	WHO	as	an	outbreak	on	30January.	During	January	numerous	countries	confirmed	their	first	cases,	closed	their	borders,	and	evacuated	theirnationals	from	Wuhan,	while	China	imposed	quarantines	on	five	cities.	In	the	WHO’s	Strategic	Preparedness	andResponse	Plan	on	3	February	2020,	the	WHO	seems	to	detract	from	previous	recommendations,	and	timidlyrecommends	restrictions	on	movement	due	to	the	high	uncertainty.On	10	February,	the	UK	declared	COVID-19	a	serious	threat.	Nine	days	later,	Italy	closed	public	spaces	before	thefirst	death,	when	there	had	only	been	2,129	recorded	deaths	globally.	On	9	March	it	announced	a	nationwidelockdown.	Travel	bans	to	and	from	China	were	brought	in.	On	11	March,	COVID-19	is	declared	a	pandemic	by	theWHO.	By	mid-March,	many	countries	have	banned	mass	gatherings,	cancelled	events,	closed	borders,	andsuspended	flights	to	infected	areas.	On	17	March,	the	EU	closed	its	borders.	Six	days	later	the	UK	imposedlockdown,	and	by	25	March	a	third	of	the	world’s	population	was	in	lockdown.	Although	medical	supplies	wereessential	to	most	international	pandemic	plans,	during	March	2020	the	world	suffered	severe	shortages	of	PPE.Only	a	month	and	a	half	after	COVID-19	was	declared	a	pandemic,	most	countries	had	ignored	their	previousplans,	both	national	and	international,	and	imposed	measures	that	had	not	been	recommended	even	in	the	event	ofa	much	more	virulent	pandemic.	In	the	UK,	in	particular—despite	numerous	warnings—the	preparations	that	weremade	underestimated	the	impact	the	virus	would	have	on	the	NHS,	the	public’s	aversion	to	the	prospect	of	healthservices	being	overwhelmed,	and	perhaps	the	relative	ease	with	which	some	in-person	activity	could	move	online.This	post	represents	the	views	of	the	author	and	not	those	of	the	COVID-19	blog,	nor	LSE.	LSE Covid 19 Blog: Why didn’t pandemic planning anticipate the need for lockdowns? Page 3 of 3		Date originally posted: 2021-03-17Permalink: https://blogs.lse.ac.uk/covid19/2021/03/17/why-didnt-pandemic-planning-anticipate-the-need-for-lockdowns/Blog homepage: https://blogs.lse.ac.uk/covid19/

Why didn’t pandemic planning anticipate the need for lockdowns?

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Why didn’t pandemic planning anticipate the need for lockdowns?

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