Ian Sinclair and Rupert Read provide a comprehensive countdown to how Britain came to have one of the highest COVID-19 per capita death rates in the world.

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Speaking on the BBC’s Question Time on 26 March 2020, Richard Horton, the editor-in-chief of the Lancet medical journal, described the Government’s response to the Coronavirus pandemic as “a national scandal”. Here is a look through the key moments which explain why.

October 2016: Exercise Cygnus, a three-day training exercise on how to deal with a pandemic, is carried out, involving all major Government departments, the NHS and local authorities. “It showed gaping holes in Britain’s Emergency Preparedness, Resilience and Response plan.” A report on the exercise has never been published, with a senior former Government source with direct involvement saying that the findings were deemed “too terrifying” to be revealed. A senior academic directly involved in Exercise 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.” (Sunday Telegraph)

14 September 2017: A National Risk Register Of Civil Emergencies is published by the Cabinet Office. The report notes that “there is a high probability of a flu pandemic occurring” with “up to 50% of the UK population experiencing symptoms, potentially leading to between 20,000 and 750,000 fatalities and high levels of absence from work”. (Cabinet Office)

30 July 2018: A UK biological security strategy is published, addressing the threat of pandemics. It “was not properly implemented, according to a former Government chief scientific advisor… Prof Sir Ian Boyd, who advised the environment department for seven years until last August and was involved in writing the strategy, said a lack of resources was to blame”. (Guardian)

2 January 2020: “Chinese authorities have launched an investigation into a mysterious viral pneumonia which has infected dozens of people in the central city of Wuhan”. (BBC News)

Mid-January 2020: “From about mid-January onwards, it was absolutely obvious that this was serious, very serious”, notes John Edmunds, a professor of infectious disease modelling and a key advisor to the Government. (Reuters)

21 January 2020: “China’s health ministry has confirmed human-to-human transmission of a mysterious Sars-like virus that has spread across the country and fuelled anxiety about the prospect of a major outbreak as millions begin travelling for lunar new year celebrations”. (Guardian)

23 January 2020: China implements a lockdown in Wuhan province, the centre of the outbreak. All transport into and out of the city is stopped (with no exceptions even for personal and medical emergencies), shops, schools and universities are closed, public transport halted, and private vehicles barred from the roads without special permission. (Guardian)

24 January 2020: A group of Chinese doctors and scientists publish an article in the Lancet medical journal titled ‘Clinical Features of Patients Infected With 2019 Novel Coronavirus in Wuhan, China’ (Lancet). According to Devi Sridhar, chair of global public health at the University of Edinburgh, the study showed “that a third of patients require admission to intensive care, and 29% get so bad that they need ventilation”. (Guardian)

26 January 2020: Nassim Taleb and two colleagues publish a note with the New England Complex Systems Institute urging a robust precautionary response to the outbreak. “Policy- and decision-makers must act swiftly and avoid the fallacy that to have an appropriate respect for uncertainty in the face of possible irreversible catastrophe amounts to ‘paranoia’, or the converse a belief that nothing can be done,” they conclude. (New England Complex Systems Institute)

30 January 2020: The World Health Organisation (WHO) declares that the Coronavirus is a “public health emergency of international concern”. (Guardian)

31 January 2020: Professor Joseph Wu, of the School of Public Health at the University of Hong Kong, co-authors an article in the Lancet medical journal about the Coronavirus outbreak in China. The authors note that “independent self-sustaining outbreaks in major cities globally could become inevitable because of substantial exportation of presymptomatic cases and in the absence of large-scale public health interventions. Preparedness plans and mitigation interventions should be readied for quick deployment globally”. (Lancet). “British officials took part in four meetings where EU projects to bulk-buy medical kit were discussed – the earliest in January, according to official minutes… At this [31 January 2020] meeting, four EU member states said the virus could require increased stocks in Europe of personal protective equipment (PPE) such as gloves, masks and goggles, and the commission said it was ready to help if asked… the UK had decided not to participate in any of four EU procurement schemes to buy medical equipment in response to the Coronavirus crisis.” (Guardian)

13 February 2020: Between 13 February and 30 March the UK misses a total of eight conference calls or meetings about the Coronavirus between EU heads of state or health ministers. (Reuters)

24 February 2020: At a press conference in Beijing, the WHO-China Joint Mission on COVID-19 highlights how China “rolled out probably the most ambitious, and I would say, agile and aggressive disease containment effort in history” to fight the spread of Coronavirus (WHO). Rupert Read sends a briefing to a senior member of the Government, urging the adoption of the kind of strong precautionary measures laid out in Taleb et al’s 24 January note. The Government response to Read is non-committal.

26 February 2020: A memo from the Government’s National Security Communications Team warns that, in a worst-case-scenario, half a million Britons could die from the Coronavirus. (Mirror)

Late February 2020: According to a Sunday Times report, at a private event, the Prime Minister’s chief advisor Dominic Cummings, outlined the Government’s strategy at the time in a way that was summarised by someone present as “herd immunity, protect the economy, and if that means some pensioners die, too bad”. (Guardian)

29 February 2020: First recorded case of local transmission in the UK. (BBC News)

2 March 2020: The SPI-M committee, an official committee set up to model the spread of pandemic flu, publishes a report noting that up to four-fifths of the population could be infected and one in a 100 might die – “that was a prediction of over 500,000 deaths in this nation of nearly 70 million” (Reuters). After chairing his first emergency COBRA meeting (the Government’s emergency response committee) on the Coronavirus, Prime Minister Boris Johnson says that the country is “very, very well-prepared”. (Sky News)

3 March 2020: “Prime Minister Boris Johnson said… that Coronavirus would not stop him greeting people with a handshake, adding that he had shaken the hands of everyone at a hospital where infected patients were being treated” (Reuters). During a press conference, Johnson said that “our country remains extremely well prepared. We already have a fantastic NHS, fantastic testing systems and fantastic surveillance of the spread of disease”. However, “the upbeat tone of that briefing stood in sharp contrast with the growing unease of many of the Government’s scientific advisers behind the scenes. They were already convinced that Britain was on the brink of a disastrous outbreak”. (Reuters)

4 March 2020: “The Government has been accused of withholding information about the spread of Coronavirus after a 70% increase in confirmed cases prompted health officials to stop providing daily updates on the location of new infections.” (Guardian)

5 March 2020: The Prime Minister floats the idea of “herd immunity” on ITV’s This Morning, saying that “one of the theories is, that perhaps you could take it on the chin, take it all in one go and allow the disease, as it were, to move through the population, without taking as many draconian measures” (This Morning). Professor Chris Whitty, the Chief Medical Officer, tells the Commons Health Committee that “one of the things which is clear, if you model out the epidemic, is you will get 50% of all the cases over a three-week period and 95% of the cases over a nine-week period, if it follows the trajectory we think it’s likely to”. One scenario could involve a “huge number” of cases “overtopping the ability of the NHS realistically to put everybody in beds”. (Guardian)

7 March 2020: Rupert Read publishes a briefing setting out what a precautionary approach to the outbreak would look like, having sent it to a senior member of the Government on 24 February. The briefing urges the immediate implementation of measures such as the shutting down of most air travel, treating cold and flu symptoms presumptively as Coronavirus symptoms and shutting down places where the old or medically vulnerable are likely to exposed to the virus. (Rupert Read)

Early-mid March 2020: In the face of Government inaction, large numbers of institutions, organisations and individuals across the UK move to cancel or postpone public events, or hold them remotely, including the Six Nations Championship and the Premier League. (Independent)

9 March 2020: A report from the Government’s Scientific Advisory Group for Emergencies (SAGE) recommends, with no dissension recorded in its summary, that the UK reject a China-style lockdown. (Reuters)

10-13 March 2020: The Government allows the Cheltenham Festival to take place, with more than 60,000 people attending each day. Since then, a number of racegoers have been diagnosed with the Coronavirus. (Guardian)

10 March 2020: “The Government was accused of playing roulette with the public by the editor-in-chief of the Lancet medical journal. Dr Richard Horton called for the ‘urgent implementation of social distancing and closure policies’.” (Guardian)

11 March 2020: WHO declares a Coronavirus pandemic. The Government allows the UEFA Champions League football match between Liverpool and Atlético-Madrid to go ahead at Anfield stadium in Liverpool. 54,000 people attend the game, including 3,000 fans from Spain. Spain closed its schools on 10 March 2020 (Guardian). NHS England says that there are plans to increase Coronavirus testing to 10,000 a day (NHS England). Dr David Halpern, the head of the Number 10 ‘nudge unit’, tells the BBC that “there is going to be a point, assuming the epidemic flows and grows as we think it probably will do, where you’ll want to cocoon, you’ll want to protect those at-risk group so that they basically don’t catch the disease and by the time they come out of their cocooning herd immunity has been achieved in the rest of the population” (Guardian). “The [unpublished] modelling from Imperial College that underpinned the Government’s belief that the nation could ride out the epidemic by letting the infection sweep through, creating ‘herd immunity’ on the way, was… troubling”, the Guardian’s science editor noted. “The model, based on 13-year-old code for a long-feared influenza pandemic, assumed that the demand for intensive care units would be the same for both infections. Data from China soon showed this to be dangerously wrong, but the model was only updated when more data poured out of Italy, where intensive care was swiftly overwhelmed and deaths shot up”. (Guardian)

12 March 2020: Addressing the “question of banning major public events such as sporting fixtures” the Prime Minister says that “the scientific advice as we’ve said over the last couple of weeks is that banning such events will have little effect on the spread” (Prime Minister’s Office, 10 Downing Street). The Government announces it will “no longer try to ‘track and trace’ everyone suspected of having the virus. Instead, under plans outlined by the Prime Minister and his medical and scientific advisors, testing would be limited to patients in hospital with serious breathing problems” (Guardian). The WHO’s director-general makes his opening remarks at the mission briefing on COVID-19: “We are deeply concerned that some countries are not approaching this threat with the level of political commitment needed to control it. Let me be clear: describing this as a pandemic does not mean that countries should give up. The idea that countries should shift from containment to mitigation is wrong and dangerous” (WHO). The Guardian reports that, as of 12 March, “almost every country [in Europe] had deployed nationwide or regional school closures”. The UK’s schools remain open. (Guardian)

13 March 2020: “Mass gatherings are to be banned across the UK from next weekend the Government has announced after Boris Johnson’s cautious approach to the Coronavirus outbreak was overtaken by care homes, sporting bodies and even the Queen taking matters into their own hands” (Guardian). The Government’s Chief Scientific Advisor, Sir Patrick Vallance, tells BBC Radio 4’s Today programme that one of “the key things we need to do” is to “build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission” (Vox). Interviewing Sir Patrick on Sky News about the herd immunity strategy, presenter Stephen Dixon says that “even looking at the best case scenario… 0.5-1% fatality in something like this, that’s an awful lot of people dying in this country” (Sky News). Professor Graham Medley, who leads the Government’s disease modelling team, tells BBC Newsnight that “we are going to have to generate what is called herd immunity… and the only way of developing that in the absence of vaccination is for the majority of the population to become infected” (BBC Newsnight). The WHO’s director-general says that all possible action should be taken: “Not testing alone. Not contact tracing alone. Not quarantine alone. Not social distancing alone. Do it all” (Guardian). “Anthony Costello, a paediatrician and former World Health Organisation director, said that the UK Government was out of kilter with other countries in looking to herd immunity as the answer. It could conflict with WHO policy, he said in a series of Twitter posts, which is to contain the virus by tracking and tracing all cases” (Guardian). BBC News reports on a new study of more than 44,000 cases of COVID-19, based on data from the Chinese Centre for Disease Control and Prevention. The study puts “the overall death rate of the COVID-19 virus at 2.3%.” (BBC News)

14 March 2020: WHO spokeswoman Margaret Harris questions the UK Government’s decision to follow a herd immunity response to the outbreak, telling BBC Radio 4’s Today programme: “We don’t know enough about the science of this virus, it hasn’t been in our population for long enough for us to know what it does in immunological terms” (Guardian). More than 200 scientists sign an open letter to the Government urging it to introduce tougher measures to tackle the spread of COVID-19, noting that the UK’s current approach will put the NHS under additional stress and “risk many more lives than necessary” (BBC News). Six senior health experts, including Richard Horton, the editor-in-chief of the Lancet, and Devi Shridhar, professor of public health at the University of Edinburgh, publish a letter in the Times, noting that there is “no clear indication that the UK’s response is being informed by experiences of other countries”. The letter urges the Government to share the scientific evidence being used to inform policy, rather than acting on the basis of modelling that is being kept secret (Times). The British Society for Immunology publishes an open letter to the Government with “significant questions” about the herd immunity plan: “this strategy only works to reduce serious disease if, when building that immunity, vulnerable individuals are protected from becoming ill, for example through social distancing… we don’t yet know if this novel virus will induce long-term immunity in those affected as other related viruses do not”. (British Society for Immunology)

15 March 2020: “When I first heard about this, I could not believe it… my colleagues here in the US… assumed that reports of the UK policy were satire”, notes William Hanage, a professor of the evolution and epidemiology of infectious disease at Harvard University, writing in the Guardian about the UK Government’s herd immunity plan. “The UK should not be trying to create herd immunity, that will take care of itself. Policy should be directed at slowing the outbreak to a (more) manageable rate. What this looks like is strong social distancing… All this and more should have started weeks ago”. (Guardian)

Mid-March 2020: A Reuters investigation into the Government’s response to COVID-19 notes that “interviews and records published so far suggest that the scientific committees that advised [Prime Minister] Johnson didn’t study, until mid-March, the option of the kind of stringent lockdown adopted early on in China”. (Reuters)

16 March 2020: The Imperial College team advising the Government publishes a report that predicts “unconstrained, the virus could kill 510,000 people” and that “even the Government’s ‘mitigation’ approach could lead to 250,000 deaths and intensive care units being overwhelmed at least eight times over”, Reuters reports. “Imperial’s prediction of over half a million deaths was no different from the report by the Government’s own pandemic modelling committee two weeks earlier” (Reuters). The Prime Minister urges the public to avoid all unnecessary contact and travel and to not visit pubs and theatres, “following expert modelling which suggests that the approach could cut the estimated Coronavirus death toll from 260,000 to 20,000” (Guardian). The Guardian reports on the Government’s partial U-turn: “What changed was new data on the impact of Italy’s out-of-control epidemic on its health service. Basically, it is catastrophic, with 30% of hospitalised patients having to be admitted to intensive care” (Guardian). “We have a simple message for all countries: test, test, test. Test every suspected case” and “if they test positive, isolate them and find out who they have been in close contact with… and test those people too”, says the WHO director-general. (BBC News). “While the UK has carried out about 44,000 tests, South Korea had by Saturday tested more than 248,647 people – one in every 200 citizens – and Italy 86,011, including anyone who might have been exposed to the virus, as well as those with symptoms”. (Guardian)

17 March 2020: The Guardian reports that “only the UK and Belarus [in the whole of Europe] had held off implementing full or partial closures” of schools. The UK’s schools remain open (Guardian). An open letter organised by Rupert Read is published in the Daily Mail, co-signed by 26 people including former House of Commons Select Committee Chair Ian Gibson, George Monbiot, Chris Packham and Peter Tatchell, urging the Government forthwith to institute quarantining policies, compel most firms to ensure workers work from home, introduce physical distancing policies, roll out mass testing and give sick pay to those on zero hours contracts. (Daily Mail)

18 March 2020: “Dr Tedros Adhanom Ghebreyesus, the WHO’s director-general, has again called on every country to adopt its recommended strategy. The only way to slow the pandemic sufficiently to give time for treatments and a vaccine to become available is to test everyone who has symptoms and track and isolate their contacts, he said” (Guardian). “The UK’s best scientists have known since that first report from China that COVID-19 was a lethal illness. Yet they did too little, too late”, Richard Horton, editor-in-chief of the Lancet, writes in the Guardian. “Something has gone badly wrong in the way the UK has handled COVID-19… there was a collective failure among politicians and perhaps even Government experts to recognise the signals that Chinese and Italian scientists were sending” (Guardian). The Prime Minister announces the ambition of carrying out 25,000 tests per day. 5,779 tests are carried out on 18 March. (Guardian)

20 March 2020: All schools are closed by the Government (Guardian). The Prime Minister announces that all cafes, pubs, bars, clubs, restaurants, gyms, leisure centres, nightclubs, theatres and cinemas must close tonight (Guardian). Deputy Chief Medical Officer Jenny Harries says that “the country has a perfectly adequate supply of PPE [personal protective equipment]” and that supply pressures had now been “completely resolved”. (Pulse)

23 March 2020: The Prime Minister announces a strict national lockdown, with people ordered to stay at home, except for shopping for basic necessities, one form of exercise a day, medical need, to provide care, or travelling to and from work if it is absolutely necessary. (Guardian)

24 March 2020: BBC journalist Victoria Derbyshire speaks to the director of a UK company that makes protective equipment who says it is exporting all over the world but hasn’t had orders from the UK Government. “We actually offered our services [to the UK Government] when this first happened and unfortunately our services wasn’t taken up, but the rest of the world did take it up”, the director notes. (Stefan Simanowitz)

25 March 2020: BBC Newsnight interviews Andrew Raynor, CEO of a ventilator manufacturer. “You got in touch with the Government as soon as they put out the call for help a few weeks ago. What happened then?” asks journalist Emily Maitlis. “Nothing quite honestly”, the CEO replies (Stefan Simanowitz). The Prime Minister states that “we are going up from 5,000 to 10,000 tests per day, to 25,000, hopefully very soon up to 250,000 per day.” 6,583 tests are carried out on 25 March 2020. (Guardian)

26 March 2020: Speaking about why the Government has eased up on what initially seemed to be a concerted contact tracing and quarantining effort, Deputy Chief Medical Officer Jenny Harries tells reporters that “there comes a point in a pandemic where that is not an appropriate intervention” and that the testing focus would shift to patients and health workers (Financial Times). Responding to the WHO’s “message for all countries: test, test, test”, Harries says that “we need to realise the clue for WHO is in its title. It is a world health organisation. And it is addressing all countries across the world with entirely different health infrastructures, and particularly public health infrastructures. We have an extremely well-developed public health system… the point there is they are addressing every country, including low and middle income countries.” (BBC News)

1 April 2020: Speaking from isolation in 11 Downing Street, the Prime Minister says that “I want to say a special word about testing, because it is so important, and as I have said for weeks and weeks, this is the way through. This is how we will unlock the Coronavirus puzzle. This is how we will defeat it in the end” (BBC News). Interviewed on ITV News, Deputy Chief Medical Officer Professor Jonathan Van Tam says that testing “is a bit of a side issue to be truthful with you” (ITV News). The Government confirms that only 2,000 people out of 500,000 frontline NHS England workers have been tested for Coronavirus so far – 0.4%. 9,793 tests are carried out on 1 April 2020. (Guardian)

2 April 2020: “Dr Chaand Nagpaul, chair of council at the British Medical Association, said the doctors’ union had heard concerns from physicians in more than 30 hospital trusts about [personal protective equipment] shortages… Reports have been rife of shortages and large variations in the level of PPE available. Pictures of healthcare workers who have created their own makeshift protective equipment out of bin bags and other materials have proved embarrassing for the government and NHS leaders. Staff have also improvised masks out of snorkels, bought kit from hardware stores, and used school science goggles to protect themselves” (Guardian). Admitting that the Government has made mistakes on testing, Health Secretary Matt Hancock announces that it is aiming to carry out 100,000 Coronavirus tests a day in England by the end of April (BBC News). “It is good to finally hear the explanation from the minister of health about the difficulties in scaling up testing. This is down to a lack of preparedness in advance of a pandemic, which then impacts upon the ability to greatly and rapidly increase a national response”, notes Michael Head, a senior research fellow in global health at University of Southampton. (Guardian)

3 April 2020: “Hospitals could be left without enough medical ventilators at the height of the UK Coronavirus outbreak, with manufacturers struggling to build thousands of new machines in time for the likely mid-April peak in cases.” A source tells the Guardian that it was impossible to “produce into the peak… we should have started doing this weeks ago” (Guardian). In a joint press release from the British Medical Association, Royal College of Nursing (RCN), Unite and UNISON, the RCN chief executive and general secretary Dame Donna Kinnair notes that “weeks into this crisis, it is completely unacceptable that nursing staff, wherever they work, have not been provided with PPE. I am hearing from nurses who are treating patients in COVID-19 wards without any protection at all. This cannot continue.” (BMA)

5 April 2020: 13,069 tests are carried out in the UK, excluding Northern Ireland (Department of Health and Social Care). The UK has carried out 195,524 tests, in contrast to at least 918,000 completed a week earlier in Germany. (Reuters)

6 April 2020: “The Government has been accused of missing an opportunity after it failed to deploy 5,000 contact tracing experts employed by councils to help limit the spread of Coronavirus. Environmental health workers in local government have wide experience in contact tracing, a process used to prevent infections spreading and routinely carried out in outbreaks such as of norovirus, salmonella or legionnaires’ disease… Public Health England’s contact tracing response team was boosted to just under 300 staff, deemed adequate for the containment phase of handling the COVID-19 virus up to mid-March… tracing was scaled back when the UK moved to the delay phase of tackling Coronavirus in mid-March… in Germany, thousands of contact tracers are still working – with more being recruited”. (Guardian)

7 April 2020: “Lack of personal protective equipment continues to be a critical issue. It is heartbreaking to hear that some staff have been told to simply ‘hold their breath’ due to lack of masks”, says Dr Samantha Batt-Rawden, president of the Doctors’ Association UK (Guardian). “World-leading disease data analysts have projected that the UK will become the country worst hit by the Coronavirus pandemic in Europe, accounting for more than 40% of total deaths across the continent. The Institute for Health Metrics and Evaluation in Seattle predicts 66,000 UK deaths from COVID-19 by August, with a peak of nearly 3,000 a day, based on a steep climb in daily deaths early in the outbreak” (Guardian). “Leaked recordings of a Home Office conference… reveal that the Government has all but given up in its fight against the Coronavirus and is intent on simply finding ‘a method of managing it within the population’. The recordings reveal Home Office Deputy Science Advisor Rupert Shute stating repeatedly that the Government believes “we will all get” COVID-19 eventually. The call further implies that the Government now considers hundreds of thousands of deaths unavoidable over a long-term period consisting of multiple peaks of the disease.” (Byline Times)

8 April 2020: The UK reaches the highest number of recorded daily deaths from Coronavirus: 938 (Guardian). The Government’s published figures are certainly an underestimate, as they exclude those dying at home and in care homes (Times), as well as the likely large increase in indirect deaths (“excess mortality”) resulting from a significant drop in the number of people attending A&E (Independent) and the unavailability of doctors, beds and vital treatment for those suffering from other conditions besides the Coronavirus (Guardian). The UK media coverage of the crisis however is dominated by none of this, but rather by the Prime Minister’s own hospitalisation. (ITV News)

10 April 2020: The UK reaches a new record high of 980 recorded daily deaths from Coronavirus from those tested and dying in hospitals. This number is higher than any daily maximum recorded in Italy (or any other European country) during the entire pandemic to date and places the UK’s per capita death rate from the Coronavirus as probably the highest in the world (European CDC/Twitter). BBC News coverage leads with Boris Johnson sitting up in bed and taking short walks, and on the Government’s alleged “Herculean” efforts to secure enough PPE for NHS frontline staff who are becoming infected with COVID-19 in record numbers (BBC/Twitter).

This timeline will be updated periodically