UK: Exercise Cygnus leak confirms Tory government’s criminal inaction over pandemic threat

“Exercise Cygnus,” held over three days in October 2016, modelled the national and local responses to a serious influenza pandemic and identified critical failings leading to the overwhelming of the National Health Service (NHS). A government report on Cygnus produced in 2017 concluded, “Pandemic influenza is one of the most severe natural phenomena to affect the UK and the most severe civil emergency risk.”

The Conservative government did nothing in response and refused to publish the report on Exercise Cygnus. When questioned, Health Secretary Matt Hancock claimed officials had said “everything recommended was done.”

Anger at such brazen lies was such that Dr. Moosa Qureshi tried to bring judicial review proceedings against the government’s refusal to publish the findings of the Cygnus Exercise. Last Thursday, a version of the report was leaked to the Guardian which placed it online, confirming that the Johnson government is desperate to conceal its criminal lack of preparation for the outbreak of a pandemic.

Under the heading “Key Learning,” the report concludes, “[T]he UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nation-wide impact across all sectors.”

Running to 57 pages, the report reveals the Tory government has been aware of the dangers millions in Britain would confront when faced with the outbreak of a deadly viral infection. The scenario which Exercise Cygnus imagined was based on the emergence of a virus in Thailand in June 2016, subsequently identified by the World Health Organisation as a Public Health Emergency of International Concern (PHEIC).

“During the exercise, participants considered their capacity and capability to operate at the peak of a pandemic affecting up to 50 percent of the UK’s population and which could cause between 200-400,000 excess deaths in the UK.”

This figure of “excess deaths,” i.e., the number of fatalities above the average for the same time of year, clearly underestimates the real level of mortality, given other assumptions made in the exercise. The Case Fatality Rate (CFR) of 1.5 percent was “adjusted from the worst-case scenario planning figure of 2.5 percent, to take account of the effect of antivirals,” the report states.

However, Exercise Cygnus was based on the disease being responsive to existing treatments such as oseltamivir (Tamiflu®) and zanamivir (Relenza®) and not on a novel virus like COVID-19, for which there is not yet any effective medication or vaccine.

One of the “scenario assumptions” was that most schools would remain open, envisaging that just 250 schools (1 percent) across England would decide to close. When it came to COVID-19, this supposition ran far of the reality, with most schools closed by the end of March because of public outrage over the Johnson government’s “herd immunity” policy of letting the virus run unchecked through the population. Now, the government is pressing for schools to begin reopening as part of its “back to work” agenda, despite the fears of parents and teachers about an eruption of COVID-19 cases incubated among school children and passed on to staff and parents.

Another critical area identified in the report is that of prisons. While praising the “excellent” relationship between Public Health England (PHE) and the National Offender Management Service (NOMS), “Exercise Cygnus did not test the tactical and operational responses to outbreaks in prisons,” which “should be considered as an area for development.”

No plan was developed about how to deal with the threat posed by a pandemic to those incarcerated. So far, 19 prisoners have died of COVID-19, with 362 prisoners testing positive in 74 prisons in England and Wales. Over 400 prison staff, employed at 67 prisons, were confirmed as having the virus last week.

The procurement and supply of personal protective equipment (PPE) was not examined comprehensively in the exercise. But the report recommended “opening up more distribution points” for PPE, and that consideration be given to developing “a whole system approach to the distribution of PPE to health and care staff.”

Clear guidance was needed to “define and communicate who will receive PPE from national stockpiles and which parts of the private and voluntary sectors are expected to make their own arrangements to safeguard their workers.”

Health and Safety issues “around an employer’s duty of care to staff in specific sectors (e.g., health care, prisons, poultry workers),” needed to be examined, “including provision of appropriate PPE where relevant.”

What has been exposed by the COVID-19 pandemic is that rather than building up supplies of such vital safety equipment, national stockpiles were run down and allowed to go out of date.

A BBC Panorama investigation showed that the government had failed to buy crucial protective equipment to cope with a pandemic, such that “there were no gowns, visors, swabs or body bags in the government’s pandemic stockpile when COVID-19 reached the UK.”

An issue that was completely absent in Exercise Cygnus was any examination of the role of testing in containing and eliminating new infections, since the scenario assumed the emergence of an influenza strain that could respond to treatment using existing medications. The lack of adequate testing and tracing procedures in the UK, and the application of the “herd immunity” policy for weeks, has meant the virus has been able to run rife.

A major assumption in Exercise Cygnus was that vital health resources would rapidly become overwhelmed, and that the euphemistically entitled “surge plan” would call for “an alternative model of care (population-based triage) to manage capacity and respond to the excessive demand for hospital places.”

The use of a triage approach means doctors being forced to decide which patients will and will not receive possibly life-saving treatment, with the report recognising this might well need to be extended “to services beyond critical care.”

The exercise also considered how to manage public reaction to the use of body bags and mass burials. Such “ethical dimensions surrounding a pandemic of this severity deserve further consideration,” is the report’s anodyne conclusion.

A critical area identified by Exercise Cygnus is that of social care, which the report correctly identifies as “currently under significant pressure during business as usual.” Additional pressure on the social care sector, “especially with a 20–40 percent absenteeism rate and with illness among vulnerable sections of society,” could be “very challenging.”

Following decades of privatisation and outsourcing in the care sector, it was “not possible to collate an accurate picture of social care capacity because much of that capacity lies with private providers,” the report found.

It is under such circumstances that government plans proposed to implement “reverse triage,” whereby sick individuals are released from hospital and sent back into the social care sector. The report notes that local responders “raised concerns about the expectation that the social care system would be able to provide the level of support needed” were the NHS to follow such a protocol.

Much worse has happened in the present COVID-19 pandemic and to devastating effect. With COVID-19 infected patients being sent out of hospitals to care homes, the disease has run rampant.

The Office for National Statistics now admits that deaths in care homes made up 10,000 of an overall UK death toll of 40,000. But this only counts those tested for the virus when this was not standard practice. The Financial Times estimates over 60,000 deaths and the Times 61,000—of which the FT says 19,900 are “excess deaths” in care homes.

Responding to the leak, Dr. Qureshi stated his belief that the full extent of the government’s cover-up is still not known. Qureshi wrote for example, “I welcome the Guardian’s investigation which has uncovered a version of the Cygnus Report. However, many questions remain unanswered about Exercise Cygnus.” He asked, “What precisely were the Report’s findings with regard to PPE and ventilator capacity, and how were these acted on? Why did the Government ignore clear early warning signs about care homes? How has implementation of the report’s recommendations been audited? Are there other similar classified reports for other public health threats?”