Update
In the few months since Richard Horton wrote his book, the global death count from the pandemic has risen from 300,000 to well over a million as of 12 October. His concluding thoughts are more relevant than ever:

“COVID-19 has provided us with an opportunity to rethink the ethical basis of our society. The virus took so many lives. We can’t allow ourselves to return to our old worlds … To honour the lives lost we have to live differently. What we now face is not only a political predicament of enormous proportions. We also face a moral provocation.

“Capitalism has many virtues. But the intense version of capitalism that has emerged over the past forty years has weakened something essential in the social fabric of our societies … can we seize a moment to redefine our values and our goals together?”

Ending on a visionary note, he says: “The post-COVID-19 age will usher in a new era of social and political relations, one in which our liberties will be achieved…We are social beings. We are political beings. COVID-19 has taught us that we are mutual beings too.”

This little book about the pandemic carries a real punch and will be read with dismay in government circles. It denounces the actions of governments, particularly the US and UK ones, in stark terms: “Every death was evidence of systematic government misconduct – reckless acts of omission that constituted breaches in the duties of public office… Missed opportunities and appalling misjudgements were leading to the avoidable deaths of thousands of citizens”.

The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop it Happening Again is not any old book. It is by Richard Horton who has edited The Lancet for a quarter century. Founded by a surgeon in 1823, The Lancet has a global reputation for being honest and authoritative, prepared, when necessary, to admit mistakes and correct them in the pursuit of scientific truth.

Horton traces the spread of the disease from Wuhan in China to the rest of the world. He praises the Chinese scientists (though not the Chinese government which, he says, owes the world a more detailed explanation of what took place in Wuhan) for their attempts to warn the world and for their early intensive research into the characteristics of the virus – which they shared internationally. The scientists made it their duty to inform the World Health Organisation (WHO) as soon as the global implications had become clear. WHO, with the memory of the 2002-3 SARS outbreak still fresh in their minds, declared a Public Health Emergency of International Concern at the end of January. There is disagreement as to whether the WHO acted quickly enough with its emergency warning. Horton contends that it did.

So, what went wrong? The book argues that since the SARS disease outbreak (severe acute respiratory syndrome) as well as more recent forms of zoonotic diseases (infections transmitted from animals to humans), most Western countries had displayed a “disgraceful complacency” that amounted to a “miserable failure of government” in their response to the possibility of a pandemic.

The British government’s failure to heed the warning from Exercise Cygnus, which took place over three days at the end of 2016, that the UK was not sufficiently prepared to “cope with the extreme demands of a severe pandemic” is a case in point. And there are plenty of others. Austerity measures imposed by most European governments following the 2008 economic crash led to severe cuts in health services and the dismantling of the infrastructure of public health, nowhere more so than in Britain.

Horton describes President Trump’s decision to cut funding to WHO in the middle of the pandemic as a crime against humanity. “Is that an exaggeration?” he asks. “No… WHO exists to protect the health and wellbeing of the world’s peoples. A crime against humanity is a knowing and inhumane attack against a people”. Trump had met the criteria for an act of violence that is deemed a crime against humanity.

The US was spectacularly unprepared for the pandemic, largely owing to the huge cuts and under-funding of public health by the Trump administration. Horton also blames Trump for the debilitating dissemination of misinformation and conspiracy theories swirling around on the internet over the causes of the epidemic, how it is transmitted, quack cures and the planting of false beliefs.

Boris Johnson is not spared. It took his government seven weeks to recognise the seriousness of Covid-19, and it wasted the whole of February and March when it should have made the necessary preparations for the arrival of a deadly virus – and when it did arrive, the residents of the care homes were basically sacrificed to “save the NHS”.

Almost a month after WHO declared its global public health emergency, Johnson failed to mention the danger of coronavirus when speaking about the “changing nature of the threats we face”. It appeared he was still tied up with his integrated policy review arising from Brexit. When confronted with the growing numbers of cases, Johnson argued as late as March 3 that the UK was “extremely well-prepared”. The failure to spot what was coming and to escalate the risk assessment, led to catastrophic delays in preparing the NHS for the coming wave of infection. Of the hospital workers, the author writes: “Our government deserted the nation’s most precious line of human defence”.

Early on in the pandemic, the scientists advising the government seemed to believe the new virus could be treated like influenza. There was a paralysis in government. Johnson said on television: “Perhaps you could sort of take it on the chin, take it all in one go and allow the disease, as it were, to move through the population…”. And some advisers openly spoke about “herd immunity”. A few days later the UK abandoned its policy of test, trace and isolate, a big mistake in the opinion of most.

“Inexplicably”, Horton writes, “medical and scientific advisers to the UK government ignored the warnings coming from China”. He accuses the science policymaking regime of being both corrupted and collusive. In spite of the government having the services of some of the most talented researchers in the world, there was somehow a collective failure to recognise the signals from Chinese and Italian scientists. The fact that they apparently took no serious precautions constituted an “abuse of entrusted power”.

Government scientists and politicians, he says, agreed to act together to protect the government, giving the illusion that the UK was in control and making the right decisions based “on the science” of course. Horton criticises the official SAGE (Scientific Advisory Group for Emergencies) for its lack of transparency, deference to government, secrecy, and the fact that too many of its members were paid government employees. The Group had even allowed unelected advisor Dominic Cummings, the architect of Brexit, to participate in the meetings, and it had become impossibly compromised.

It was the Independent SAGE, a new body set up by former chief scientific adviser Sir David King, that flagged up issues the government hardly touched on, in particular how to support the most vulnerable groups in society, the poor, and the black and minority ethnic populations that had suffered the most. It called for the immediate strengthening of public health and primary care systems that had been so decimated over the previous 10 years, and for improved long-term planning to meet the needs of those most at risk. It warned also against a perception of a vaccine as a magic bullet.

Horton completed this book at the end of May. Had the incompetence of the government over its test, trace and isolate policies been more evident then, one can only imagine what he would have written. And the same can be said about the awarding of huge contracts to the private sector to carry out the test and trace operation, while leaving the public health and local authority teams largely out of the equation.

The book takes a look at how other countries have fared. In China, several Fangcang shelter hospitals were rapidly constructed to house people under quarantine and to remove them from spreading the infection in the communities. The government did not hesitate to impose strict lockdowns on towns and even regions to confine the virus. In Taiwan the government put the country on high alert as the first reports of Covid-19 began to emerge from the Chinese mainland. Those entering the country were screened for infection. Air travel to China was suspended. Personal protective equipment for hospital staff was secured, physical distancing and mask-wearing were mandated. Schools were closed and quarantine centres established. The number of cases remained very low. New Zealand was another country where quick reactions by the government – the complete opposite of what happened in the UK – proved decisive.

In concluding, Horton tries to go beyond the simple narration of the details of how and why the governments of Western democracies failed to protect their people, and to anticipate the arrival of the next pandemic. He discusses attitudes to risk and the dangers of security, of state intrusion into our lives. He asks whether we have to accept the “inevitability of a strengthened surveillance state and disciplinary society” to keep safe or whether we can create “a vigilant state and society, one in which government and the public work together to identify, monitor and respond to new and emerging risks, while ensuring protections for our most cherished political and social rights”. And he draws up a list, a Utopian list really, of what societies must do to prevent the most extreme depredations of the next pandemic.

He stops short however at seeing the pandemic as a product of a systemic social, economic and environmental breakdown; but more of a catastrophic failure of government and of medical policymaking. The book remains a devastating expose of government failure, ignorance and incompetence, especially in the UK and the US.

The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop it Happening Again, by Richard Horton. £9.99 in many outlets