For those who are inclined to be
apologists for the UK approach to deal with Covid: please read this article
from the Financial Times:
When Dr Richard Horton turns up for our Zoom lunch, I feel a pang of disappointment. I am at home but attired for a real-life work meeting: black frock, inoffensive earrings and a dab of make-up. The editor-in-chief of The Lancet, the prestigious British medical journal founded in 1823, “arrives” in a black hoodie. He has apparently forgotten his light-hearted promise to wear a jacket, though happily remembered that we are dining together. “Look, I’ve got my lunch,” he says proudly, thrusting a brown paper bag towards the camera. He offers to wait until mine is delivered. I am not surprised that our loose sartorial agreement has crumbled in the face of his to-do list.
When Dr Richard Horton turns up for our Zoom lunch, I feel a pang of disappointment. I am at home but attired for a real-life work meeting: black frock, inoffensive earrings and a dab of make-up. The editor-in-chief of The Lancet, the prestigious British medical journal founded in 1823, “arrives” in a black hoodie. He has apparently forgotten his light-hearted promise to wear a jacket, though happily remembered that we are dining together. “Look, I’ve got my lunch,” he says proudly, thrusting a brown paper bag towards the camera. He offers to wait until mine is delivered. I am not surprised that our loose sartorial agreement has crumbled in the face of his to-do list.
It was The Lancet that, in January,
first published clinical reports of a mystery pneumonia from Wuhan. Since then,
a trickle of papers on Covid-19 has become a torrent of crucial, freely
accessible information helping to shape the public health response in real
time. That has landed the 58-year-old with an arguably more important secondary
role: critic-in-chief of the UK government’s handling of the Covid-19 outbreak.
Since February, he has accused ministers and their advisers of failing to see
the coming storm, keeping up a barrage of criticism in The Lancet, in
newspapers and on television. The UK response to the pandemic, he told the BBC
on March 26, is a “national scandal”. I go to the heart of the matter: does the
government have blood on its hands? “I’m not going to use those words, but I do
believe lives could have been saved had we acted earlier,” he says. “If we had
used February to scale up capacity for testing and contact tracing, and to
begin surge capacity for intensive-care bed use, it’s absolutely clear we would
have saved lives and saved the NHS. Even if it wasn’t the extreme lockdown we
see now, we should have been reducing social mixing and winding down economic
activity, like promoting working from home and physical distancing, so that we
started to cut the lines of transmission.” We are speaking against the backdrop
of an increasingly rancorous debate over the UK’s response.
He has despaired at how the science
and politics of this pandemic have been handled at every turn: from the lack of
testing at the beginning to what he says is the “charade” of the daily press
conferences and the “strategic failure” of the government to plan adequately.
He, along with others, has demanded transparency on the opaque epidemiological
models that shaped the UK’s originally laissez-faire response, which included
floating the idea of “herd immunity”. I have delegated the catering at my end
to my 17-year-old daughter Rosa. She settles on an Italian via Just Eat. The
doorbell rings; a few minutes later, she serves me four slices of Hawaiian
pizza and waves hello to my interviewee.
Horton and I briefly discuss how
unsettling the pandemic is for children. Horton is sitting in a study with the
obligatory bookshelf in the background. He unpacks his lunch and angles his
camera down to flaunt a carefully arranged Mediterranean feast. His spicy meze
platter comprises chicken, homemade tzatziki and hummus, baba ganoush and fresh
chilli sauce. I can’t help feeling a little jealous. Horton has to be one of
Britain’s longest-serving editors. He joined The Lancet in 1990 and was
appointed editor-in-chief five years later, aged just 33.
He makes no apology for being
overtly political. “Some of the great advances, like the 19th-century sanitary
movement and the birth of the NHS, were not technical accomplishments but
political struggles. The idea you can strip out politics from medicine or
health is historically ignorant. The medical establishment should be much more
politicised, not less, in attacking issues like health inequalities and poor
access to care.” Notably, one of his idols is Michael Marmot, a London-based
academic who has pioneered the study of how social inequality affects health.
The idea you can strip out politics from medicine or health is historically
ignorant It was studying physiology and medicine at the University of
Birmingham that first opened Horton’s eyes to how other people lived. “I can
remember as a student going into high-rise flats where the carpets were soaked
with urine,” he says. “The bathrooms were completely unsanitary, the kitchens
were loaded with unwashed dishes and cutlery, and everywhere was dirt. I’d
never seen anything like it before.” After a middle-class upbringing he only
discovered in his forties that he was adopted, that his birth father was
Norwegian and that he had five half-siblings: “It was a shock. I went from
being an only child to having this enormous family. Being half-English and
half-Norwegian changed the centre of gravity of who I thought I was and I’ve
been having a love affair with Norway ever since.”
Horton has been labelled a
left-winger by his critics. He rejects the tag, saying he has voted
Conservative, Labour, Liberal Democrat and Green. His philosophy is, however,
faithful to the spirit of Lancet founder Thomas Wakley, a surgeon and social
reformer once described as an “honest denouncer of invidious distinctions
betwixt the rich and the poor”. Wakley named the journal after a surgical
instrument and a type of window: it was meant to symbolise piercing corruption
and letting the light in. Accordingly, Horton has shone the light of The Lancet
on a range of political causes: he has praised the climate protest group Extinction
Rebellion, urging healthcare workers to join non-violent protest; he published
an emotively worded letter in support of the people of Gaza penned by a
geneticist in Italy later accused of having anti-Semitic sympathies; and he ran
a study claiming that civilian deaths related to the Iraq war had been
undercounted. None has made him the most popular man in the room. Dr Michael
Fitzpatrick, a GP and former Lancet columnist, described Horton to me as “very
personable and easy to deal with, but a bit of a showboater and a pariah in the
medical establishment”. In truth, Horton has never been forgiven for publishing
a 1998 paper by Andrew Wakefield that raised unfounded doubts about the safety
of the measles, mumps and rubella (MMR) childhood vaccine. Despite years of
controversy, the paper wasn’t fully retracted until 2010, after the General
Medical Council ruled Wakefield had been dishonest (he was later struck off).
The uncertainty caused childhood vaccination rates to plummet and energised the
anti-vaccination movement.
The MMR debacle became one of the
biggest ongoing calamities in public health. “There’s no escaping the serious
damage that was done,” Fitzpatrick tells me. “He [Horton] wasn’t apologetic
enough about what happened.” Does Horton regret what happened with MMR? “I’d be
mad not to, but I can’t simply retract papers I don’t like. There has to be due
process [via the GMC tribunal].” Has he ever come close to being sacked? “I
don’t know,” he smiles. “You’d have to ask my publishers. All good editors get
fired eventually.” It is time to change the subject.
We have a pandemic to discuss. When
we meet, the shortage of personal protective equipment among health workers is
dominating media coverage. Hospital trusts have threatened whistleblowers with
disciplinary action; Horton has offered to act as conduit for their dispatches
from the pandemic front line: “Workers have been bullied and forced to see
patients who clearly have or are suspected of having Covid-19 without PPE. When
they raise concerns, they are belittled or threatened. It’s horrifying to see
the lack of concern by some NHS management.” War zones, one doctor told him,
are better prepared than the world’s sixth-largest economy.
The NHS was left playing catch-up,
Horton says, because the government either ignored or did not act on
information in a timely manner. The first paper suggesting the existence of a
new contagious virus appeared in The Lancet on January 24. Horton now wants to
know why that chilling assessment was seemingly passed over in Whitehall. “Why
wasn’t that paper read by the Scientific Advisory Group for Emergencies, or the
New and Emerging Respiratory Virus Threats Advisory Group, or NHS England, or
the chief medical officer or the chief scientific adviser?” he asks. “We had
all of these committees and all of these offices and all of these
organisations, but somehow they didn’t connect. We’ve had the biggest science
policy failure in a generation.”
He dismisses the idea that such a
devastating outbreak could only have been predicted with hindsight: “How can it
be hindsight? It’s there in black and white on January 24, written in a paper
from China, telling people, ‘Please act now, this is urgent, there’s a crisis.’
” A week later, another Lancet paper warned that, since the virus was no longer
contained in Wuhan, and that “self-sustaining outbreaks in major cities
globally could become inevitable . . . Preparedness plans and mitigation
interventions should be readied for quick deployment globally.” Blue Kitchen
Mediterranean Cuisine 177c Priory Road, London N8 8NB Hot and spicy marinated
chicken meze platter (free-range chicken, fresh organic chilli sauce, tzatziki,
baba ganoush, hummus) £9.50 Highland Spring water Wood Oven Pizza 391 Kilburn
High Rd, London NW6 7QE, via Just Eat Tropicana pizza £7.99 Extra black olives
80p Service charge 50p Total £18.79 Horton’s combative public persona conceals
a personal struggle: in 2018, he was diagnosed with advanced melanoma. His
experience as an NHS patient adds to his sense of outrage at the pressures
facing health workers. “I don’t think I’ve ever been in an institution where
people have been so genuinely kind and thoughtful,” he says. “That’s why I’m so
angry that we didn’t act sooner. I’m angry because I know how good the NHS can be.
Politicians and policymakers and scientists let down the NHS and its staff. And
that’s unforgivable.” The government is clearly rattled by such criticism.
A Sunday Times article entitled
“Coronavirus: 38 days when Britain sleepwalked into disaster”, published last
weekend, drew a lengthy rebuttal from the Department of Health and Social Care.
The rebuttal includes a quote from Horton on January 23 calling for “caution”
and accusing the media of “escalating anxiety by talking of a killer virus” to
dismiss the idea that a scientific consensus around a coming pandemic was
building in late January.
The quote originated, he clarifies,
from a tweet urging caution on lurid coverage rather than government policy.
Besides, the World Health Organization declared a public-health emergency on
January 30. “I do think it’s a misrepresentation, absolutely,” he says.
“Between January 24 and 31, there was daily mounting evidence and concern that
this was tipping into a pandemic.” Meanwhile, the scientific community is
desperate to second-guess what the virus will do next. “We are already seeing
it’s got the potential to come back,” he says, noting China’s uptick in cases.
“That’s very worrying indeed, and it’s why we need a vaccine as quickly as
possible. “But there’s still a vast amount to learn. Why did the outbreak take
off so dramatically in Italy but not Germany? Testing is one possibility, but
we don’t know for sure. Testing is absolutely crucial, and if we’re going to
get out of these lockdowns we definitely need to scale up our capacity.”
Western countries have fared poorly in their coronavirus response compared to Asian countries, he thinks, because they saw the threat through the lens of influenza. China and Hong Kong feared a rerun of Sars, a much deadlier illness, and clamped down quickly. The cognitive bias, he says, has cost us dearly. Horton also worries about complacency setting in once this pandemic has run its course: “It would be very dangerous to say this is our 1918 [Spanish flu pandemic], and to think these things only come around once a century. The conditions still exist in countries for zoonotic diseases [which jump the species barrier from animals to humans] to develop. We’ve had five or six of them in the last 20-30 years.
Western countries have fared poorly in their coronavirus response compared to Asian countries, he thinks, because they saw the threat through the lens of influenza. China and Hong Kong feared a rerun of Sars, a much deadlier illness, and clamped down quickly. The cognitive bias, he says, has cost us dearly. Horton also worries about complacency setting in once this pandemic has run its course: “It would be very dangerous to say this is our 1918 [Spanish flu pandemic], and to think these things only come around once a century. The conditions still exist in countries for zoonotic diseases [which jump the species barrier from animals to humans] to develop. We’ve had five or six of them in the last 20-30 years.
This is the big one for now but
there might be an even bigger one to come.” I wake up and think I’ve got to
make the most of every day, because I don’t know how many I will have Rosa brings
a coffee cupcake, but we have moved on to talking about Horton’s cancer and it
seems disrespectful to eat it. It was his 19-year-old daughter Isobel, from
Horton’s marriage to paediatrician Ingrid Wolfe, who urged her father to get a
mole on his right temple checked out. Since his diagnosis, Horton has undergone
surgery three times and is left with scars and an uncertain prognosis. He is
now on immunotherapy. Every day is “the toss of a coin”. Therapy soothed his
darkest moments: “I thought I didn’t have very long to live, maybe weeks or
months . . . It was extraordinarily helpful to be able to sit in a room with
someone who is on your side and be able to say anything.” Solace now comes in
the form of books — currently The Birth of Biopolitics by Michel Foucault, on
how governments exercise power over the lives of their citizens — and a nightly
glass of Lagavulin whisky. He is still nervous about touching his face because
he fears to find cancer has returned.
But for now he feels — and looks —
strong: “I wake up and think I’ve got to make the most of every day, because I
don’t know how many I will have.” He will push for a public inquiry into the
coronavirus pandemic, and for the WHO to be strengthened, not weakened. The
inaction that followed the WHO’s emergency declaration, he clarifies, was down
to member states and not to China, to whom he says the world should be grateful
to for its warnings and containment efforts. That attitude might surprise those
in the medical profession who criticised China’s initial response to the
outbreak.
But the idea that China should pay
reparations for the resulting economic losses is, he says, ridiculous, and he
calls Donald Trump’s decision to suspend WHO funding a “crime against
humanity”. He is now writing a book about why, despite the warning signs, the
Covid-19 pandemic caught the world by surprise. Meanwhile, that formidable
to-do list leaves no time to answer his critics: “You said earlier that people
think I’m a pariah. Maybe in previous years that might have upset me. But now?
I really don’t care what people think of me. If I’m not here in six months or a
year . . . f*** them. Seriously.” Anjana Ahuja is an FT science commentator
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