Scathing COVID-19 book from Lancet editor — rushed but useful

Richard Horton skewers leaders in two of the richest, most powerful and scientifically advanced countries for getting it so wrong.
Stephen Buranyi is a writer specializing in science and the environment, based in London.

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The UK daily coronavirus briefing, led by Prime Minister Boris Johnson

UK Prime Minister Boris Johnson (centre), with chief medical and scientific advisers at the daily press conference on COVID-19 in early March.Credit: Leon Neal/Bloomberg via Getty

The COVID-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again Richard Horton Polity (2020)

Since the coronavirus crisis began, Richard Horton, editor-in-chief of leading medical journal The Lancet, has been tearing across the British public sphere. Here he is on the BBC, the national broadcaster, there in the pages of The Guardian newspaper — taking the government to task for failures that have left the United Kingdom with the world’s second-highest per capita COVID-19 death toll so far (Belgium is top). Horton has never shied away from controversy (his journal published the retracted, fraudulent paper by Andrew Wakefield that alleged a non-existent link between vaccines with autism) or crusades (against the Iraq war and for political action on climate change). In coronavirus, he has found a cause that matches his energy: the Lancet journals are pumping out both the latest research and his pointed critiques of government policy; and last month, he reviewed a new book by the Slovenian Marxist philosopher Slavoj Žižek that imagines economic and social worlds after COVID-19.

Now Horton has a book of his own. The COVID-19 Catastrophe is a sort of history, diagnosis and prescription, in real time. It is wide ranging, querying the changing role of international cooperation and the fallout of austerity economics, and taking a deeper dive into China’s scientific and political response to the crisis than most Western media have offered. But the book returns again and again to the catastrophe in both the United Kingdom and the United States. It is haunted by the question: how did two of the richest, most powerful and most scientifically advanced countries in the world get it so wrong, and cause such ongoing pain for their citizens?

The easy answer is in their leadership. Horton levels the accusation that US President Donald Trump is committing a “crime against humanity” for defunding the very World Health Organization that is trying to help the United States and others. UK Prime Minister Boris Johnson, in Horton’s view, either lied or committed misconduct in telling the public that the government was well prepared for the pandemic. In fact, the UK government abandoned the world-standard advice to test, trace and isolate in March, with no explanation, then scrambled to ramp up testing in April, but repeatedly failed to meet its own targets, lagging weeks behind the rest of the world. A BBC investigation in April showed that the UK government failed to stockpile neccessary personal protective equipment for years before the crisis, and should have been aware that the National Health Service wasn’t adequately prepared.

Politicians are easy targets, though. Horton goes further, to suggest that although scientists in general have performed admirably, many of those advising the government directly contributed to what he calls “the greatest science policy failure for a generation”.

Again using the United Kingdom as an example, he suggests that researchers were insufficiently informed or understanding of the crisis unfolding in China, and were too insular to speak to Chinese scientists directly. The model for action at times seemed to be influenza, a drastic underestimation of the true threat of the new coronavirus. Worse, as the UK government’s response went off the rails in March, ostensibly independent scientists would “speak with one voice in support of government policy”, keeping up the facade that the country was doing well. In Horton’s view, this is a corruption of science policymaking at every level. Individuals failed in their responsibility to procure the best scientific advice, he contends; and the advisory regime was too close to — and in sync with — the political actors who were making decisions. “Advisors became the public relations wing of a government that had failed its people,” he concludes.

Two Walk-In Sample Kiosks in Kerala, India, test for coronavirus

A ‘walk-in sample kiosk’ in Kerala, India, to test for SARS-CoV-2.Credit: Arun Chandrabose/AFP via Getty

The situation deteriorated to the point that former UK chief government scientific adviser David King set up an alternative scientific-advice committee on 3 May to both be more transparent to the public and exercise the independence of mind and tongue that he felt the official committees had ceded. It is a move Horton approves. It’s not clear that the group has swayed government policy, but it has given the public and the media a stable and open source of scientific information.

Elsewhere, the book discusses places with less-egregious failures, such as Spain and France, and the rare successes, such as New Zealand, and Kerala in India. Horton is fond of a tight timeline, and after experiencing the past six months through the fragmented lenses of social media and short news reports, it is a minor, but not insignificant, relief just to have all these events collected in one place, in order.

Such synthesis is a bulwark, too, against the blizzard of misinformation — the ‘infodemic’ — that has blanketed the crisis. Horton rightly points out that it isn’t just quacks and conspiracy theorists promulgating false information. There is a chilling effort by governments as well. Examples include the United Kingdom’s bizarre recent assertions that it never pursued a ‘herd immunity’ strategy, despite both the prime minister and a scientific adviser discussing it in public, and the Chinese authorities’ gagging of physician Li Wenliang, who tried to raise the alarm at the very beginning of the coronavirus outbreak in Wuhan.

The book is weakest where it discusses the future. This is unsurprising — no one knows how this calamity will end. Horton is of the camp that believes there is unlikely to be a return to normality. “Perhaps Covid-19 represents an impermeable boundary between one moment of our lives and another. We can never go back,” he writes. His recommendations for the future are largely admirable — a more-connected and conscientious public, a more-communitarian government, a more self-critical scientific elite. But there is little structure or path for getting there. I, too, want the United States to be a better global citizen, without a president such as Donald Trump. Sadly, I struggle to imagine how it will happen.

Like much of the scientific work produced during the pandemic, this book is a rushed product — not subject to the exacting standards of more normal times. But like the scientific work, it is vital and up to the minute. Early on, Horton paraphrases the mathematician and writer Adam Kucharski, saying “if you’ve seen one pandemic, you’ve seen … one pandemic.” What is imparted now won’t necessarily help us next time, and we’re still in the swell of this one. The events the book recounts are barely cold, and the powerful whom it critiques are still in power. It has lessons that are useful right now.

Nature 582, 478-479 (2020)

doi: 10.1038/d41586-020-01839-y

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