Richard Horton is editor-in-chief of The Lancet

Richard Horton is editor-in-chief of The Lancet

Douglas Fry for Piranah Photography

Richard Horton is editor-in-chief of The Lancet, one of the world’s most influential medical journals. In his new book, The Covid-19 Catastrophe: What’s gone wrong and how to stop it happening again, Horton condemns most countries’ responses to coronavirus. He spoke to New Scientist about how the crisis has been mishandled around the world.

How do you rate the UK’s coronavirus response?

We were too late with everything. In The Lancet, we published five papers in the last week of January that told the entire story: a new virus, rapidly killing people, human-to-human transmission. We could have mobilised more quickly.

Didn’t you also underestimate the risks? You tweeted on 24 January that the virus had low pathogenicity?

On 24 January, there were newspaper headlines that were in danger of fostering a panic: things like “Killer virus”. Panic isn’t a very good public health response.

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How should the UK have reacted?

The World Health Organization (WHO) called a public health emergency of international concern on 30 January, and then [in the UK] in the next six weeks, the government took its eye off the ball.

Is that with the benefit of hindsight?

Nobody can say we didn’t know this was coming. Pandemics are number one on our national risk register. Don’t you think there is an obligation to be prepared for that? We know that the conditions for pandemics have been increasing – to such an extent that there was Exercise Cygnus in October 2016, when we [simulated] an influenza pandemic that killed hundreds of thousands.

The message from that was that the country wasn’t prepared. There needed to be a pretty dramatic scaling-up of intensive care facilities, and so on. And ministers didn’t pick up on how important that was. Yet we had chief medical officers standing up saying that we were well-prepared for this pandemic. Although individually they were excellent scientists, the system in which they worked failed. We are talking about tens of thousands of deaths that were preventable.

What do you think of lockdown being eased in the UK?

We are playing roulette. You shouldn’t be releasing lockdown until you have got test, trace and isolate 100 per cent secure. We have an R value that is very close to one. I understand why we are doing it, because of the economic pressure, but it is a gamble and if that goes wrong, people will have died unnecessarily. What I am really frightened of is if we get a flare-up like the first wave again, it is going to be another 10 weeks of lockdown.

Why do you accuse US president Donald Trump of a crime against humanity for defunding the WHO?

The US government is the largest single funder of the WHO. That means it is damaging an organisation whose primary duty is to protect the health and well-being of the world’s most vulnerable populations.

Aren’t there valid criticisms of the WHO?

Yes. I think the WHO performed superbly during January. But after it declared a public health emergency of international concern on 30 January, it should have called an emergency [session of the] World Health Assembly and worked out a global strategy. You have every country in the world struggling to work out its own strategy. Some have acted superbly, like New Zealand and Germany, and some countries acted appallingly, like the US, UK and Brazil.

Would an assembly have made much difference?

Yes, we know the people in China who were leading the fight against the disease. You invite them to present on what is taking place. If they had stood up in the first week of February at an emergency meeting, our [science advisors] looking at the evidence from China would have come back to London and said “this is serious”.

How do you rate China’s actions?

Chinese health workers and scientists did an incredible job to stem the epidemic and to tell the world about its seriousness. But there are questions about the political response. The first patients admitted to hospitals in Wuhan were in the first week of December and the WHO wasn’t informed until 31 December. Those were four crucial weeks.

The WHO has praised China’s response. Do you think it is hamstrung by trying to keep on good terms with countries’ leaders, as it was accused of with Ebola in 2014?

Dr Tedros [Adhanom Ghebreyesus, the current head of the WHO] is a very fine public health leader, [but] I think the WHO is afraid to hold member states accountable and that is one of its critical weaknesses.

What should be done about that?

The WHO needs to call it as it is. So if countries have made mistakes or acted inappropriately, the head of WHO needs to say so. There needs to be an international inquiry into how this pandemic has been handled.

Hasn’t The Lancet also made some mistakes, like accepting a now retracted paper on using hydroxychloroquine to treat covid-19?

I don’t think we were at fault for accepting it. The paper passed through peer review. We took the paper, as did our reviewers, as being an accurate description of a piece of science. What peer review isn’t is a way to validate a piece of science. The only way you can validate a piece of science is by repeating the experiment.

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