A touch of John le Carré

Alan Thornett reviews Spike: The Virus vs the People, by Jeremy Farrar of the Wellcome Trust and Anjana Ahuja formerly of The Times. Published in July by Profile Books at £14.99

 

This book is essential reading for those interested in the politics of the Covid-19 pandemic and its long-term consequences.

Jeremy Farrar, the lead author, has been the director of the Wellcome Trust – one of biggest medical charitable foundations in the world with £29 billion to spend on research – for 8 years. Previously, he ran the Oxford University’s research unit in Ho Chi Minh City for 20 years where he was able to identify a dangerous bird flu epidemic.

He was also a member of SAGE – the UK government’s Scientific Advisory Group for Emergencies. When the Covid-19 crisis broke he became a strong critic not only of the British government but of sections of the scientific community as well.

The book deals with two key aspects of the pandemic. First, where did it come from? Was it a zoonotic spillover from a wet market in the Chinese city of Wuhan, or was it – as the ultra-right were to maintain – a creation of the Chinese government either by intent or by negligence. Second the appalling response of the Johnson administration in Britain in the early stages of the crisis which created one of the highest per-capita death rates in the world, and the battle over herd immunity.

Farrar was one of the first to know about and respond to the new virus. He saw a report that a novel virus had been identified in a Chinese hospital whilst travelling back from a visit to ebola vaccination centres in Rwanda, on New Year’s Eve 2019.

He immediately texted an old friend – George Gao, a prominent Chinese virologist who had been Director of the Chinese Centre for Disease Control and Prevention (no less) since 2017 in Beijing. Gao confirmed the substance of the issue. The world, he said, would soon be hearing about a cluster of cases of such a virus from Wuhan – a Chinese city of 11 million people. They concluded that it was ominous but at least it was not SARS – a deadly disease for which there was no vaccine or cure with which they had both been involved.

The book then begins to read like a John le Carré novel.

When he returned to the Wellcome Trust on January 3^rd he emailed its chairperson – who (remarkably) was none other than Baroness Eliza Manningham-Buller the former Director-General of the UK Security Service MI5 – and Mike Ferguson her deputy. If it turned out to be a serious outbreak the Trust would be in the middle of it. He assumed, he told them, from what George Geo had said, that China CDC would make an announcement within 48 hours. “I reassured Eliza and Mike” he says “that it is not SARS, although it’s probably a known relative”… “There was nothing for Wellcome to do at the moment.”

Farrar comments: “News of a novel corona virus outbreak in China at the start of 2020 chilled the blood of scientists, including me, who had witnessed the appearance of SARS nearly two decades before.”

The Chinese authorities, however, remained silent. Meanwhile, as he puts it: “The cases of an unexplained and untreatable pneumonia in Wuhan kept growing, matched later by reports of crowded hospital wards and overflowing mortuaries.” … “Reports began filtering in of police crackdowns on those trying to get information out of the heavily monitored internet.”

He then saw a report from ProMED – an internet-based system dedicated the dissemination of information on outbreaks of infectious diseases (dated December 31) – claiming that 27 people were in hospital in Wuhan with viral pneumonia or pulmonary (lung) infection. Two were recovering but seven were critical. Flu and bacterial diseases had been ruled out – but thankfully it was not SARS. All the patents, however, had links to the Wuhan wet market where multiple species were kept in close proximity and in often appalling conditions.

A dangerous situation

Faced with this he says, something had to be done to force the Chinese government to release the information they were holding. It could be dangerous, however. How would the Chinese authorities respond to such a challenge. It was a completely unknown territory. Eliza Manningham-Buller advised everyone involved to increase their personal security. In particular they should get “burner phones” (that could be destroyed after use), cease putting sensitive information in emails and stop using their normal phone contacts and address lists. Burner phones were then supplied to them by Wellcome.

He told his own family: “if anything happens to me in the next few weeks this is what you need to know…”

He made contact with Eddie Holms, a British-born virologist at Sidney university and at the Shanghai School of Public Health who specialised in viral detective work. Also with Yong-Zhen Zhang, a prominent Chinese virologist and professor at Fudan University in Shanghai, and who had built a network of labs dedicated to monitoring new viruses. He was also demanding that the information should be released. There was a problem, however. The Chinese government banned the publication of information about the outbreak and Zhang had already been warned to keep his mouth shut. Some medics had already been disciplined for discussing cases of the new virus.

They decided to challenge the ban by submitting a scientific paper on the issue to the journal Nature – and Nature was more than willing to publish it. This was overtaken by events, however, when Zhang’s team not only sequenced the genome of the virus responsible for the outbreak but were prepared to make it public.

Farrar reports his reaction to this: “Eddie and I had a series of frantic calls between London and Sidney on the night of Thursday January 9^th, which stretched into the early hours. We hatched a plan that Eddie would go back to his collaborators in China and I would go back to George Gao at the Chinese CDC. We would threaten to go public if they refused to disclose the information by Saturday morning GMT.”

Farrar phoned George Geo to seek his agreement to issue the ultimatum. Geo was on the runway at Shanghai waiting to take off for Beijing. He asked for a moment to think about it but rang back within a few minutes to say: ‘OK, let’s do it’.

At 1.05am GMT on Saturday January 11 a post entitled “Novel 2019 coronavirus genome” appeared on virological.org the website of another trusted colleague Andrew Rambaut, an evolutionary biologist at Edinburgh university, under Eddie Holms name. A note with it explained that “he was acting on behalf of a group of scientists led by Professor Yong-Zhang of Fudan University that included hospitals and health authorities in Wuhan, plus the China’s CDC and Sidney university.”

The response was spectacular. Later that day the Chinese government sent the genetic sequence to the World Health Organisation (WHO) and the following day made it public. The following day Zang’s laboratory at Fudan university was shut down by the Chinese authorities for ‘rectification’. It was the price that Zang would pay for defying the Chinese government.

On January 20 China confirmed human-to-human transmission by the virus and that carriers could be both asymptomatic and infectious. Farrar remarked that “the virus had all the makings of a nightmare.

The origins of the virus

The origin of the virus, however, was still not established. Trump was already calling it the “Chinese virus” and “Kung-flu” and pointing to a top-level bio-lab in Wuhan from which the virus could have escaped or which could have manufactured it. Conspiracy theories were circulating and the security services were on the alert for anything that would back this up. He describes his fears this way:

“This was a brand-new virus that seemingly sprang from nowhere. Except that this pathogen had surfaced in Wuhan, a city with a BSL 4 virology lab which is home to an almost unrivalled number of bat viruses. ‘BSL’ stands for ‘biosafety level’ and 4 is the highest designation, indicating authorisation to handle the nastiest pathogens known to humankind, such as the Ebola and Marburg viruses.”

On January 25 Farrar emailed his closest colleagues on the virus: “This cannot be contained in China, and will become a global pandemic over the next few days/weeks of uncertain severity. Since influenza in 1918 things have never turned out as bad as they first appeared … but this is the first time since SARS that I have been worried. I worry that the UK government are underestimating the potential impact.”

On January 30 the WHO recognised the virus as a public health emergency of international concern. They would now have to be notified of cases as they arose.

With the WHO overwhelmed by the pandemic Farrar decided to set-up a panel of globally respected virologists to look at the allegations of Chinese involvement and express a view on it. The panel included some of those he had worked with to force the Chinese authorities to release the information, including Eddie Holmes. (Remarkably it also included Tony Fauci the American physician and immunologist who was the director of the US National Institute of Allergy and Infectious Diseases and chief medical advisor to Trump.) Meanwhile Patrick Vallance, the government’s Chief Scientific Adviser, had informed the security agencies of the fears over China.

The conclusion they reached was that by far the most likely source of the outbreak was the wet market in Wuhan, and that the Chinese reluctance to publish was down to panic management and the impulse to control of the message. The WHO later set up its own inquiry with the same brief. It gained access to Chinese biological facilities, including the Wuhan lab, but drew similar conclusions. Its report published in March 2021 concluded that a lab accident or deliberate release was very unlikely. It suggested that the two most probable are: a jump from the host species, like bats, to humans via an intermediate species.

On January 23 China shocked the world by announcing a total lockdown in Wuhan. Farrar was in Davos representing the WHO at the World Economic Forum. It was completely unprecedented. The 11m inhabitants of the city could only leave it in exceptional circumstances. People were ordered to stay at home or risk arrest. Farrar records that this sent shockwaves through the WHO and the scientific community around the world. It was, effect, the opening shot of what would become a global debate as to the strategic response to the virus: should we seek to eradicate or to live with it by generating herd immunity.

A number of countries including Hong Kong, Singapore, and Vietnam, were to follow the Chinese road.

In Britain the first SAGE meeting that Farrar was able to attend on Covid 19 was on February 25. Lockdown was not discussed, he says, but herd immunity was. There was wide confusion, he says, over whether they were discussing herd immunity via a vaccine, or herd immunity via ‘natural’ infection (i.e. letting the virus rip). In his opinion there was “no precedent in the modern era for populations achieving herd immunity to a novel disease through natural infection”. Herd immunity, he notes, “would become a highly contested issue for weeks to come”.

There was also confusion over face masks. The previous meeting, he notes from the minutes, had discussed masks and had concluded that they were of little benefit in preventing infection.

The next three meetings (which he was unable to attend) discussed lock-downs, but with extreme caution – an attitude which he partly shared at this point. “The lock-downs in China, Hong Kong and Singapore”, he argued, “seemed to be having an effect: their epidemics were slowing, with China already seemingly past its peak. In Hong Kong and Vietnam, remarkably, no health workers had become infected”… “Even if a lockdown worked in a country like China”, however, “could you pull it off in the UK?”

Italy

On Friday March 6 Farrow received a distressing phone call from a contact in Médecins Sans Frontières. “She was calling (he says) not from a conflict zone, or from a devastating natural disaster in a remote part of the global South. She was calling from Northern Italy – watching the health care system of a G7 country fall apart.”

At the SAGE meeting on March 10, he says, he reported on Italy. “It was battlefield medicine” he told them. Doctors were traumatised at having to choose who to save or leave to die or who to put on the last ventilator. It then emerged that there was now between 5,000 and 10,000 cases in Britain. In the coming weeks, he says, “it would be Britons, not Italians, gasping for high-flow oxygen. It was clear he says that the UK was heading down the same terrible path. The country was already more stricken than anyone had realised and was about to be hit by a wave of devastation.

Farrar had hardened his position. If Italy had no option but to copy China, the UK would have to follow suit. I believe, he says, that what happened in Italy, and its decision to copy China in locking down, altered the course of the pandemic in Western Europe and radically changed attitudes in this country. He now wished that SAGE had drawn of a wider group of experts in the course of this discussion, including experts from China and the surrounding region.

There was also complete confusion over herd immunity. David Halpern (head of the behavioural insights team at number 10), Farrar says, was also at the meeting. Later that day he told BBC News: “There’s going to be a point, assuming the epidemic flows and grows, as we think it probably will do, where you will want to … protect those at-risk groups so they basically don’t catch the disease and by the time they come out of their cocooning herd immunity has been achieved in the rest of the population”.

The day after Boris Johnson told breakfast TV that one possible strategy was perhaps ‘to take the virus on the chin, take it all in one go and allow the disease … to move through the population, without taking as many draconian measures. He also quotes Patrick Vallance as saying in an interview: “our aim is to try to reduce the peak of the peak, broaden the peak, not suppress it completely”.

None of this Farrar says, was ever the view of SAGE. It was herd immunity by the back door. If Patrick (Vallance) had come to SAGE, he says, and said: “Our plan is to take it on the chin and go for herd immunity, I would have resigned”.

The next SAGE meeting, on March 13, was told that the epidemic had developed further than anyone had realised. Two important factors clashed for the first time – infection numbers and NHS capacity. It was now clear that not only that Britain was going the way of Italy, but that the NHS was at the point of collapse. He left the meeting convinced that there should now be an immediate lockdown and that he would, in any case, close down the Wellcome buildings.

By this time, he says, Dominic Cummings, who attended SAGE meetings on behalf of No 10 began to have doubts about the government response. Farrar notes that: “while I had no time for his views on Brexit he was a force for good” on this issue. “He listened intently and seemed to be one of the few people who could make things happen across government”.

Cummings had drawn the conclusion that herd immunity would be catastrophic, that and a lock down should be introduced as soon as possible. Farrar quotes him as saying: “I think this herd immunity plan is going to a catastrophe. The NHS is going to be destroyed. We should try and lock everything down as fast as we possibly can.” He later told a meeting in No 10 that unless you change track we are going to kill half a million people”.

Farrar’s understanding from the March 13 meeting was that Patrick Vallance and Chris Whitty would take a clear message to No 10 that preparations for a lockdown should begin immediately.

Nothing happened, however. Cummings told MPs when he met the Commons Health Select Committee that that complete confusion reigned in that whole period in No 10. “The PM (had) spent most of February dealing with a combination of divorce, his current girlfriend wanting to make announcements about their relationship, an ex-girlfriend running around the media… his book on Shakespeare, and other nonsense, because obviously he never took the whole thing seriously.”

The first UK lock down eventually came on March 23^rd when people were ordered to stay at home. Cummings says (and Farrar agrees) that: “In retrospect, it’s obvious that if we had locked down a week earlier it would have been better, two weeks earlier still better… Fewer people would have died, lockdown would have been shorter and we would have had less economic destruction. Latter at his appearance before MPs Cummings apologised that he and others had let the country and that tens of thousands of people had died who did not need to die.

Farrar is especially livid about Downing Street’s “unforgivable” refusal to lock down again in the autumn of 2020, when the data made it abundantly clear that this was needed, causing tens of thousands more unnecessary deaths. It again exposes a chaotic Johnson administration which, whilst claiming to be following scientific advice, was in practice opposed to any such advice that did not fit their right-wing, free trade, small government, agenda.

SAGE, Farrar says, met again on March 18^th, the day on which 999 fresh Corona cases were reported across the UK. We were facing, he says, a terrible situation: “The UK was estimated to be between 2 and 4 weeks behind Italy on the epidemic curve.”

It was not until the next SAGE meeting on March 23, however, he says, that reality would hit home those in power – the epidemic was on a runaway trajectory. That night Johnson announced that a legal stay-at-home order would be put in place immediately. The UK was finally going into the kind of lockdown that Italy, France, Spain and Belgium had already enacted, Farrar noted to his Wellcome colleagues: “The UK Covid 19 policy has finally aligned with global efforts – I do not think you will hear the term ‘natural herd immunity’ is our strategy’ from the UK government again”. Unfortunately, this would be far from the case.

In looking back, Farrar says, he had thought deeply about why his scientific approach was anathema to the government. One reason he says is ideological since they see lock downs as a sign of big government.

Looking back he concludes that the pandemic could have been avoided if things had been run differently. “What we desperately need for the future,” he argues, “is constant surveillance in the “shadow lands” where humans and animals overlap. We need to monitor the viruses that cross between animals and humans.”

“The pathogens that keep me aware at night”, he says, “are those against which humanity is defenceless. We are going through a period in human history in the last 20 years, when global trends are aligning to cause more frequent and complex epidemics. Climate and ecological change, urbanisation, changes in food production and habitat loss are reshaping the way we interact with animals, boosting the chance of new disease. When transmissible ones emerge urbanisation and international travel accelerate their speed”.

He further says “We are going to need for the future a properly structured programme of science and research that can scan the threats in real time. This requires a muscular and independent WHO to set public health standards and act immediately on the information that emerges… We should prepare a store of vaccine platforms against families of viruses, ready to plug the immunity gaps we discover together with strategies to produce vaccines in a hurry. There must be serious financing so that health systems around the world are resilient enough to deal with a surge of disease when it strikes. The cost will be billions – but still only a fraction of the trillions that the Covid-19 pandemic has cost so far.”

With the government still refusing to name the date for an official inquiry into the handing of the pandemic in Britain, this book is a very good start and well worth a read.