Senior health officials who war-gamed the impact of a coronavirus hitting the UK, warned four years before the onset of Covid-19 of the need for stockpiles of PPE, a computerised contact tracing system and screening for foreign travellers, the Guardian can reveal. The calls to step up preparations in areas already identified as shortcomings in the government’s response to Covid, emerged from a previously unpublished report of a health planning exercise in February 2016 that imagined a coronavirus outbreak. It was commissioned by Dame Sally Davies, then chief medical officer, who attended alongside officials from NHS England, the Department of Health, Public Health England, and observers from the devolved administrations. The participants imagined cases of Middle East respiratory syndrome (MERS-CoV) arriving in London and Birmingham and spreading rapidly resulting in “a large scale outbreak”. Like Covid, MERS causes potentially fatal respiratory illness and can spread asymptomatically; there were no known treatments or vaccines. Government ministers have previously stressed that pandemic planning focused more on flu so did not prepare the UK for the demands a coronavirus placed on PPE, hospitals and care homes. The disclosure of the 23-page report on Exercise Alice is set to trigger fresh scrutiny of the adequacy of UK preparations. In August the government refused to release the file saying it could “lead to loss of public confidence in the government’s and the NHS’ Covid-19 response … based on misinterpretation of the report.” However, the file was released on Thursday under freedom of information laws to Dr Moosa Qureshi, a clinician campaigning for greater transparency around the government’s preparedness for the pandemic, which has claimed more than 137,417 lives so far, according to the government’s own figures. Qureshi is posting official documents about pandemic preparation exercises he has obtained so far online.
Some of the key issues raised in the report became problems in the early weeks of the Covid pandemic. In March 2020 nurses and care workers reported chronic shortages of PPE leading to fears they were spreading the virus more than was necessary. This led to a scramble for the right equipment as deaths and cases increased. The UK government also continued to allow people to enter the country unscreened from Covid hotspots, such as China and Italy, despite the recommendations in Exercise Alice. Health officials involved in the 2016 coronavirus exercise believed levels of PPE were “of crucial importance for frontline staff” and “pandemic stockpiles were suggested as a means to ensure sufficient quantities were available”. They also explicitly called for consideration of “port of entry screening” to restrict the spread of the virus from abroad, and for health officials to “produce an options plan using extant evidence and cost benefits for quarantine versus self-isolation for a range of contact types, including symptomatic, asymptomatic and high risk groups.” The exercise also raised concerns that the UK needed better systems ready to trace the contacts of people who had the virus. They suggested “a web-based tool … a live database of contacts with classifications, current state and other data germane to the situation”. In the event the UK government launched its NHS test-and-trace service on 28 May 2020 more than two months after the first lockdown and long after the 1,000-a-day peak of the first wave of fatalities. Even by the summer of 2020 Test and Trace was failing to contact thousands of people in areas with the highest infection rates in England, with the proportion of close contacts of infected people being reached far below the 80% level considered necessary for such a system to be effective. Qureshi said: “Disgracefully, the government covered up Exercise Alice – a coronavirus exercise which predicted the importance of isolating patients, contact tracing, PPE provision, trained personnel and adequate NHS beds. “The fact that Covid-19 is a novel type of coronavirus is irrelevant, every pandemic is different. But the lessons of Exercise Alice were generally applicable to coronaviruses including Covid-19, they were agreed by general consensus, and both political leaders and NHS England executives failed to implement that consensus.” The report also called for the government to enter into “sleeping contracts” to allow rapid trials of vaccines and therapies and guidelines for how clinicians should prioritise specialist treatments, for example oxygenation. Tessa Gregory, partner at Leigh Day, the law firm which has represented Qureshi, said the government must now disclose “what follow up action was taken … and why matters such as a proper working contact tracing system had not already been set up”. Pandemic planning exercises which have previously emerged have dealt with preparations for other kinds of infections. A report into the three-day Exercise Cygnus, in 2016, which was leaked to the Guardian in May 2020, revealed problems with preparations for a flu pandemic rather than coronavirus infection. Lord Bethell, then health minister, told parliament at the time: “It was a trial run for a flu pandemic, not of the kind that Covid produced, and the demands on PPE, the health sector and the care sector were more profound than the flu pandemic trials prepared us for.” Yet Exercise Alice had already concluded: “There was a general consensus on the need to identify capacity and capability of assets within the health system. Assets in this context would be all resources that would be required to effectively respond to a MERS-CoV outbreak such as trained personnel, appropriate PPE in sufficient quantities and the requisite beds with suitable clinical equipment.” In 2019, a separate confidential Cabinet Office briefing warned ministers of the potentially catastrophic consequences of a pandemic, and included analysis of a viral flu. Exercise Alice, focusing specifically on a coronavirus, adds to the weight of evidence that Covid was not a bolt from the blue. In May, after months of defying calls from campaigners, the government finally agreed to convene a statutory public inquiry into its handling of the pandemic, saying it would begin in spring 2022. A spokesperson for the Department of Health and Social Care stressed MERS differed from SARS-CoV-2, which causes Covid-19, and said Exercise Alice “was not a coronavirus pandemic preparedness exercise”. “MERS-CoV does not transmit as easily as SARS-CoV-2 between people, outbreak sizes are comparatively small and the risk to individuals in the UK remains very low,” they said. “The results of Exercise Alice have been incorporated into ongoing planning work conducted by DHSC, UKHSA and the NHS to respond to potential outbreaks of high consequence infectious diseases like MERS-CoV.” They added: “We have always been clear that there will be opportunities to look back, analyse and reflect on all aspects of Covid-19, and a full statutory independent inquiry is due to begin in spring 2022.”