Boris Johnson is getting better, but the nation he leads is not

When British Prime Minister Boris Johnson was released from hospital on Sunday, the country breathed a collective sigh of relief. And with good reason – despite officials’ daily insistence that Johnson was in “good spirits,” Johnson himself has since admitted that his life was in the balance.

Questions over whether Downing Street was fully transparent about the Prime Minister’s health will doubtless dominate the British media in the days to come. But while important, they risk overshadowing the true picture of the UK’s struggle against coronavirus.

Jeremy Farrar, a member of the Scientific Advisory Group for Emergencies (SAGE), put it starkly when he told the BBC’s Andrew Marr program on Sunday that the UK is “likely to be one of the worst, if not the worst, affected countries in Europe”.

LONDON, ENGLAND - MARCH 25: Prime Minister Boris Johnson leaves 10 Downing Street for PMQ's on March 25, 2020 in London, England. British parliament will be suspended tonight due to concerns about the spread of COVID-19. It had previously been scheduled to break for Easter on March 31; it will tentatively sit again on April 21. The Coronavirus (COVID-19) pandemic has spread to at least 182 countries, claiming over 18,000 lives and infecting hundreds of thousands more. (Photo by Peter Summers/Getty Images)

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Only a few weeks ago, Britons looked on at the unfolding horror in Italy and Spain. Now, as those two countries appear to be over the worst, the UK is on a similar, grim trajectory. The British government – led by Johnson’s designated deputy, Foreign Secretary Dominic Raab – is facing serious questions about why.

Some health experts are increasingly scathing about the government’s response to the crisis – driven largely by the advice of leading scientists from SAGE.

Gabriel Scally, president of epidemiology and public health at the Royal Society of Medicine, believes this has led to an abstract response – one based on numbers and scientific models – rather than traditional principles of public health.

“There has been this kind of scientism – an approach of academics gathering data and analyzing it then producing theories to be tested – at the heart of the government’s response,” he says. “In fact, what we needed was to follow good public health practice and listen to the advice from the World Health Organization.”

In the early stages of the pandemic, the UK was something of an outlier compared to its European counterparts, especially in the areas of testing and social distancing measures. Unlike some other states, the UK appeared slow to increase its testing capacity, and reluctant to impose the kind of social distancing measures that were swiftly put in place elsewhere. “I find it amazing that testing, contact tracing and isolation was not part of any of the scenarios that any of the expert advisers on this group discussed,” Scally says.

It has been barely a week since the UK announced plans to increase its testing capacity to 100,000 by the end of April, after even Johnson loyalists criticized the UK’s approach to testing compared to countries like Germany. As of Monday morning, the most recent number was 18,000 tests in a 24-hour period, according to the government.

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Updated 3:39 AM EDT, Tue April 14, 2020

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“I don’t see how we are going to reach 100,000 tests a day unless we dramatically increase testing capacity,” says Simon Clarke, associate professor in microbiology at the UK’s University of Reading. “It’s also worth noting that other countries will also want to increase their capacity, so this is going to place a massive burden on companies producing testing kits.”

Testing hasn’t been the only area in which the UK’s coronavirus strategy has been criticized.

For weeks, the government has insisted that its primary objective has been to minimize pressure on the National Health Service. That has meant encouraging people to go home and self-isolate if they show symptoms of coronavirus, and only seek medical care if those symptoms persist. It has also reluctantly introduced social distancing measures in order to spread the peak of the crisis over a longer period of time, meaning that hospitals are not overwhelmed at once.

There are signs that this approach has – albeit belatedly – begun to work.

While some claim that the government’s predictions for the peak dates of the outbreak have shifted in recent weeks, Clarke says that “the peak is not really a peak, the peak is a plateau and I don’t think it has actually shifted.”

This fits with Johnson’s previously stated aim to “squash the sombrero” of the outbreak, delaying hospital admissions over a longer period of time in order to manage the pressure on the health service. “The peak will last for at least a week, probably closer to two. That’s why it gives the appearance of being pushed back, but in reality it was always meant to start flattening now,” adds Clarke.

The government is keen to point out that it is running a surplus of intensive care beds and ventilators, meaning anyone who needs such treatment has access to it.

But inside the hospitals battling the outbreak, the picture isn’t so rosy.

LONDON, ENGLAND - MARCH 25: Prime Minister Boris Johnson leaves 10 Downing Street for PMQ's on March 25, 2020 in London, England. British parliament will be suspended tonight due to concerns about the spread of COVID-19. It had previously been scheduled to break for Easter on March 31; it will tentatively sit again on April 21. The Coronavirus (COVID-19) pandemic has spread to at least 182 countries, claiming over 18,000 lives and infecting hundreds of thousands more. (Photo by Peter Summers/Getty Images)

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Unions representing doctors, nurses and care workers complain that the level of personal protective equipment (PPE) they need is not hitting the frontline anywhere near fast enough.

On Monday, the Royal College of Nursing issued guidance that staff were entitled to refuse to work if they did not feel comfortable doing so. “If the employer does not provide appropriate PPE and a safe working environment, as an employee you can refuse to care for a patient.”

The government points to the fact that its testing of health workers and their families has increased dramatically over the past week or so. However, when Johnson returns to work, he might find that the public are less inclined to believe any government narrative.

It’s clear that the government was not entirely transparent about how unwell Johnson was. There will be lots of theories as to why this happened. The truth is that all stories as to precisely what treatment the PM received and when must be taken with a pinch of salt.

News reports quoting medical staff at the hospital where Johnson was treated should be read with a degree of skepticism. “Hospitals are always full of discussion debate and gossip between staff but a very high proportion of it is speculative because at the back of it, patient confidentiality matters a lot to all health professionals,” says Scally.

And getting too tangled up in exactly what happened could ultimately distract from the plain reality: The UK is about to enter its hardest phase of this crisis with no idea when its leader will return to work and growing uncertainty as to whether the approach his government has taken is doing the job.