For those who believe that the government are simply reacting to an emergency they couldn’t have foreseen.
Exercise Cygnus uncovered: the pandemic warnings buried by the government
Exercise Cygnus dramatically exposed the gaps in Britain’s pandemic response but its ‘terrifying’ findings have yet to be published
By
Paul Nuki,
GLOBAL HEALTH SECURITY EDITOR, LONDON and
Bill Gardner
28 March 2020 • 9:00pm
A woman makes PPE
In the test run, there was not enough personal protective equipment (PPE) for the nation's doctors and nurses CREDIT: Paul Faith / AFP
Ministers from across government were seated, ashen faced, in the Cabinet Office Briefing Room (COBR). On a large flat screen, epidemiologists from Imperial College London were showing a slide which detailed the scale of the epidemic that was enveloping Britain.
The first cases of the virus had been confirmed in south east Asia two months previously. Britain reported its first cases, imported from returning travellers, a month later. Now there was widespread and sustained domestic transmission and the World Health Organization (WHO) had declared a global pandemic.
But it was not the pandemic itself that was causing those gathered in Whitehall to grimace but the nation’s woeful preparation. The peak of the epidemic had not yet arrived but local resilience forums, hospitals and mortuaries across the country were already being overwhelmed.
There was not enough personal protective equipment (PPE) for the nation's doctors and nurses. The NHS was about to “fall over” due to a shortage of ventilators and critical care beds. Morgues were set to overflow, and it had become terrifyingly evident that the government’s emergency messaging was not getting traction with the public.
This was a drill. Code-named Exercise Cygnus, it took place in October 2016 and involved all major government departments, the NHS and local authorities across Britain. The modelling for the outbreak was prepared by the same team that is tracking the all-too-real Covid-19 pandemic now. And as the Sunday Telegraph reveals, it showed gaping holes in Britain’s Emergency Preparedness, Resilience and Response (EPRR) plan.
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The only significant difference between the test drill and the pandemic we now face is that Cygnus was assumed to be the H2N2 influenza virus, while Covid-19 is a coronavirus. Both spread rapidly and kill by causing acute respiratory illness.
There is one other difference. While the real Covid-19 epidemic is being played out in public, the report detailing the findings of Exercise Cygnus have never seen the light of day. A senior former government source with direct involvement in the exercise said they were deemed “too terrifying” to be revealed. Others involved cited “national security” concerns.
“There has been a reluctance to put Cygnus out in the public domain because frankly it would terrify people,” said the former senior government source yesterday.
“It’s right to say that the NHS was stretched beyond breaking point [by Cygnus]. People might say we have blood on our hands but the fact is that it’s always easier to manage the last outbreak than the one coming down the track. Hindsight is a beautiful thing.”
Others are more critical. A senior academic directly involved in Cygnus and the current pandemic said: “These exercises are supposed to prepare government for something like this - but it appears they were aware of the problem but didn’t do much about it.
“We’ve been quite surprised at the lack of coherent planning for a pandemic on this scale. It’s basically a lack of attention to what would be needed to prevent a disease like this from overwhelming the system. All the flexibility has been pared away so it’s difficult to react quickly. Nothing is ready to go.”
Reasons for the report not being published are likely to go beyond Whitehall’s paternal view and a desire not to frighten the public. The Telegraph has talked to multiple sources with first hand knowledge of Cygnus and all say the exercise revealed significant caps in the NHS’s “surge capacity”.
These gaps, which included a shortage of ICU beds and PPE, were revealed at a time of austerity. Jeremy Hunt, the then health secretary, and Simon Stevens, chief executive of NHS England, were cutting NHS bed numbers at the time rather than adding capacity. Dame Sally Davies, then chief medical officer, faced similar financial constraints.
There was also cynicism across Whitehall about the epidemiological modeling. The previous chief medical officer, Sir Liam Donaldson, ended his term under something of a cloud when the 2009 H1N1 (Swine Flu) pandemic proved a damp squib relative to the initial modelling.
The same view was taken of forecasting of the 2013–2016 west african Ebola outbreak.
Whatever the reasons, the final report on Exercise Cygnus was buried and its prophetic findings hidden from public view.
At meeting of the Public Health England (PHE) advisory board on 26 April 2017, Paul Cosford, the quango’s director for health protection, said a report “setting out the learning and recommendations” from Cygnus “was in the process of being finalised” but it never saw the light of day.
Tellingly perhaps, NHS England, the body which oversees the running of the NHS and was found most wanting by the report, has no mention of the exercise on its website. It’s high fidelity, government-operated search engine returns nothing for the phrase “Cygnus” despite a board paper on the exercise being unearthed by the Telegraph.
“Our preparations for pandemic influenza were exercised in October 2016 with NHS England participating in Exercise Cygnus. The exercise was set seven weeks into a severe pandemic outbreak and challenged the NHS to review its response to an overwhelmed service with reduced staff availability,” says the paper which was drafted for “clearance” by Matthew Swindells, the then national director of operations and information.
A video (below at 7 minutes 14 seconds) of the meeting shows the NHS England Board considering the paper for just a few moments, with no serious questions being raised. This is despite the document making clear, albeit in the obtuse language of Whitehall, that the NHS had been found wanting by the exercise.
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The NHS’s emergency plans were to be “revised to incorporate the learning from this exercise and ensure our continued preparedness for future pandemic influenza outbreaks”, said Mr Swindells’ paper. “We are also continuing the challenging work around the management of surge and escalation decision making processes”.
The NHS board was then asked to “receive assurance that NHS England and the NHS in England are prepared to respond to an emergency”, which it duly accepted without further action.
Pressure is already mounting on the NHS leadership. Yesterday the editor of the Lancet, Richard Horton, called on the NHS board to “resign in their entirety” once the current crisis is over. Others said this was not the time for such attacks, justified or otherwise. “It’s a bit like calling for heads to roll over D-day just as the boats are arriving on the beaches,” said one veteran NHS observer.
Nevertheless, the revelation the government and the NHS leadership knew of the gaps in Britain’s surge capacity ahead of the current outbreak will not go ignored.
It was the lack of “surge capacity” within the NHS, combined with fresh data from Italy, that the modellers at Imperial cited only last week as the reason for Britain having to pivot from a strategy of mitigation to total lockdown six days ago.
In their defence, insiders say that while the Cygnus findings have not been published they were acted on in part at least. Projected shortages of PPE and ICU beds were not filled with bulk purchase because of cash constraints and worries they would become outdated or obsolete if left in storage. Instead work was done on securing reliable supply chains - something they say we will see evidence of this coming week in terms of PPE.
“Throwing money at the problem was not necessarily the solution. The NHS eats up money. It’s a bottomless pit,” said a senior former government source. “We were in a time of austerity and it wasn’t easy.”
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Findings from Exercise Cygnus were cascaded down to at least some local organisations.
Croydon Council’s latest Pandemic Response Plan, dated March 2020, makes mention of Cygnus, for instance. A key lesson from the exercise, it notes, is the need for “a better understanding of the likely public reaction” to a pandemic in order to “help the development of a robust communications strategy to assist the response”.
The importance of this will not be lost on Number 10 communication chiefs who have faced criticism in recent weeks for their failure to communicate clearly and effectively with the public.
Rotherham’s Health Protection Annual Report 2016 also mentions Cygnus. Locally agreed objectives to be tested included: “assessing the co-ordination of public messages, strategic decision making, managing surges in health and social care activity and the wider consequence management (including dealing with excess deaths)”. Key “learning points” in the wake of the exercise included:
A better and wider understanding of the pressures within the social care setting and how these can be jointly managed
Ensuring the supply and proper use of PPE
Jointly reviewing, with partner agencies, the processes for managing excess deaths in a community setting
Northamptonshire Health and Wellbeing Board was also involved. On 15 March 2018 its annual report noted: “A recent national exercise (Exercise Cygnus) highlighted in particular the need for further work to be done to improve local arrangements around anti-viral distribution, community level protection measures, personal protective equipment [PPE] and mass vaccination programmes.”
The government also shared at least some of the findings of Exercise Cygnus with the Red Cross.
A report on an “NGO-Military Contact Group Conference” dated 17 July 2018, noted of Cygnus: “Lessons included the need … to drill down into the exact actions that the military, police, fire service, local authorities, and the voluntary sector could take to keep systems running and to keep as many people alive as possible.”
In a paragraph that foreshadows the army being called in last week to distribute PPE to hospitals after the NHS’s own logistics system failed, it adds: “Military actions included [the need for] command-and-control components to co-ordinate the healthcare system if the NHS senior management were unable to work.”
A former senior government minister with knowledge of Cygnus yesterday played down the significance of the exercise, saying it was designed, not to see if the NHS would be overwhelmed, but what would happen if it was.
“We knew there weren’t enough intensive care beds, and we wanted to know what would happen in a pandemic of that scale.
“There’s no health system in the world that could cope with that level of outbreak. When you have pressure of that severity it will overwhelm everything.
“There was no recommendation that we need more ventilators. We were modelling what would happen if we ran out of ventilators.
“We were trying to model a situation where the whole system was overwhelmed. We could have had another 10,000 ventilators and it wouldn’t have been nearly enough”.
Critics may counter that this was the problem. Exercise Cygnus starkly revealed what a worst case pandemic scenario would do to Britain but ministers did not respond by building capacity enough to cover it.
A Department of Health spokesperson said: “The coronavirus outbreak calls for decisive action, at home and abroad, and the World Health Organisation recognises that the UK is one of the most prepared countries in the world for pandemic flu.
“As the public would expect, we regularly test our pandemic plans and the learnings from previous exercises have helped allow us to rapidly respond to COVID-19. We are committed to be as transparent as possible, and in publishing the SAGE evidence the public are aware of the science behind the government’s response.”
https://www.telegraph.co.uk/news/2020/03/28/exercise-cygnus-uncovered-pandemic-warnings-buried-government/
