Boris Johnson Launches War on U.K.’s Own Deep State - The New York Times

LONDON — She is accused of flinging a folder at an aide, hitting the staffer in the head. She reportedly told another offending underling to “get out of my face” and castigated her staff as “useless,” adding an f-bomb for good measure.

The allegations of abusive behavior by Home Secretary Priti Patel — all of which she denies — have made her a lightning rod in Prime Minister Boris Johnson’s new cabinet, a ready-made villain for critics who accuse this hard-line Brexit government of running roughshod over British customs and institutions.

But when a respected career civil servant resigned last week because of what he claimed was a “vicious and orchestrated” campaign against him by Ms. Patel, what began as a juicy boss-from-hell story turned into a metaphor for Mr. Johnson’s broader tensions with Britain’s much vaunted civil service.

The feud between a populist leader and an entrenched bureaucracy carries echoes of the Trump administration’s war on the so-called “deep state,” with Mr. Johnson’s scruffy, iconoclastic adviser Dominic Cummings playing the role of Stephen K. Bannon, Mr. Trump’s one-time in-house provocateur.

In this case, the civil servant, Philip Rutnam, who served as the permanent secretary in the Home Office, said Ms. Patel’s behavior was part of a pattern of bullying civil servants that needed to be called out. His mutiny came as Mr. Cummings is moving aggressively to shake up the bureaucracy, seeking to inject new people — especially ones with the math and science skills he considers lacking in senior civil servants — and rooting out those he deems hostile to Brexit.

“Civil servants are under a lot of pressure,” said Bronwen Maddox, director of the Institute for Government, a think tank in London. “There is an intolerant tone in this government of, ‘You’re on our side or you’re not.’ The impartiality of the civil service is under question in a way that it hasn’t been.”

With Mr. Rutnam’s bitter public exit, which he promised to follow with a lawsuit against the Home Office, a feud that had been brewing behind closed doors spilled into the open. It was a startling break with decorum for the civil service, in which disputes are worked out privately and officials like Mr. Rutnam shun the limelight.

So far, Mr. Johnson has backed up Ms. Patel, who is a loyal political ally and a full-throated advocate for his project of leaving the European Union. As home secretary, her mandate includes overhauling Britain’s immigration system to implement a points-based system for admitting foreigners.

Among Mr. Rutnam’s offenses, people with knowledge of the situation said, was warning Ms. Patel how unrealistic it was to set up such a system in less than 10 months. While Ms. Patel has few defenders outside Mr. Johnson’s party — and faces a government investigation of her conduct — even her critics said they understood the pressures she faced, as the leader of a front-line ministry in a government that is carrying out radical changes in the name of getting Brexit done.

Philip Rutman speaking before the Home Affairs Committee in Parliament last month.Credit...Parliamentary Recording Unit

Moreover, Mr. Johnson’s aides are probably not wrong to suspect that on balance, most civil servants would have preferred that Britain never left the European Union. Many are weary after serving Mr. Johnson’s predecessor, Theresa May, who promised to deliver Brexit but went about it in a chaotic and contradictory way that sowed confusion in the bureaucracy.

“Cummings is right to think it’s a problem,” said Jonathan Powell, who served as chief of staff to Prime Minister Tony Blair. “But if he was going to get rid of them, he would have to sack the entire civil service, because in their hearts, they believe that leaving the European Union was a bad idea.”

New prime ministers, Mr. Powell said, typically come into office determined to overhaul the civil service — and they typically fail.

In 1997, Mr. Blair and his aides were convinced that after 18 years of Conservative Party rule, the civil service would be implacably hostile to his Labour Party agenda. In 1999, he complained about the “scars on my back” from two years of battling with Britain’s public sector, a broader category that includes teachers, doctors and other public employees.

But Mr. Powell said that to his surprise, the civil service showed an almost preternatural capacity to fall in behind its new masters.

“We thought they would be Tories,” he said. “In fact, they bent over backward to carry out our manifesto.”

Such a lack of partisanship is one of the defining characteristics of Britain’s civil service, which encompasses roughly 450,000 people who work in the upper and middle levels of government agencies from the Treasury to the Ministry of Defense.

Chosen through a competitive exam process, civil servants pride themselves on their skill in pulling the levers of government and in offering unvarnished advice to a changing cast of politically appointed ministers.

That is a notable difference from the United States, where political appointees fill out the top ranks of most agencies. President Trump famously distrusted appointees who were held over from the Obama administration as well as high-level civil servants and moved to get rid of them.

The political agnosticism of British civil servants is so celebrated that in the popular comic TV series, “Yes, Minister,” about a permanent secretary and his minister, the government’s party affiliation is never even mentioned.

The show, which starred Nigel Hawthorne as the civil servant Sir Humphrey Appleby, mined comic gold out of his masterful handling of his boss, portraying him as wily, quick-witted and cheerfully Machiavellian as he blocked ill-conceived projects.

“Ministers,” Sir Humphrey cracked at one point, “are like small children. They act on impulse.”

But even advocates for the civil service acknowledge its shortcomings. Along with being nonpartisan, civil servants are, by tradition, not held accountable for the performance of their departments or agencies. That can complicate their relationship with hard-driving ministers like Ms. Patel.

Defenders of Mr. Rutnam, the permanent secretary who clashed with her, said he was unflappable, honest and diligent. But others pointed to problems during his tenure at the Home Office, which became embroiled in a scandal over the wrongful deportation of Caribbean immigrants, and in his previous post in the Department for Transport, which has struggled to coordinate Britain’s semiprivatized rail industry.

Educated at Cambridge and Harvard, but virtually invisible until he went before cameras last week to deliver his emotional resignation, Mr. Rutnam was a civil servant out of central casting.

To Mr. Cummings, that is the problem. In a blog post in January, he complained that the civil service had too many “Oxbridge English graduates who chat about Lacan at dinner parties with TV producers and spread fake news about fake news.” (Never mind that Mr. Cummings studied ancient and modern history at Oxford.)

Emboldened after the Conservative Party’s thumping victory in the general election last December, Mr. Cummings has said he wants a broader overhaul of the civil service. He posted a recruiting call for data analysts, software developers, economists, and the like, to work as political advisers and “maybe as officials.”

Mr. Cummings also sought out “weirdos and misfits” — an invitation that boomeranged when one of his hires, Andrew Sabisky, was forced to resign after the disclosure that he said black people have a lower IQ than whites, and that enforced contraception could prevent “creating a permanent underclass.”

Experts said there was merit to Mr. Cummings’s drive for what he calls “genuine cognitive diversity.” Martin Stanley, a former civil servant who has written extensively on the subject and started a website devoted to it, said that while it had greatly improved its gender and ethnic diversity, it remained “too much of a club,” an institution where you could identify, from the first day, the people who would rise to the top.

Still, for all the furor over Ms. Patel’s clash with Mr. Rutnam, Mr. Stanley said the bigger danger was the tendency of civil servants to function as “courtiers,” appeasing their ministers rather than challenging them. That is a difficult characteristic to root out, he said, since ministers tend to like courtiers.

Critics of Mr. Cummings said his campaign was less about encouraging intellectual ferment than enforcing doctrinal orthodoxy. Mr. Johnson triggered the resignation of his top finance minister, Sajid Javid, last month after insisting that he get rid of advisers whom he and Mr. Cummings distrusted.

The Treasury, traditionally a power center in British government, is now being largely subjugated to Mr. Johnson’s office. There are no members of Mr. Johnson’s cabinet who are not dedicated Brexiteers.

“By U.K. standards,” Mr. Stanley said, “we have an increasingly presidential setup bent on centralized command and control.”

Anna Joyce contributed reporting

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2020-03-07 11:48:06Z
CAIiEG2yRRCcG40UKnpVNZFSfzkqFwgEKg8IACoHCAowjuuKAzCWrzww5oEY

Doctors Say U.K. Is Ill Prepared for Coronavirus - The New York Times

LONDON — Ventilators in short supply. Intensive care beds already overflowing. Some health workers buying their own face masks or hoods. And if cases of the deadly coronavirus surge in anything like the numbers some experts have predicted, doctors say they would have to consider denying lifesaving care to the frailest patients to prioritize those with better chances of surviving.

“If we haven’t got ventilatory support to offer them, it’s going to end in death,” said Dr. George Priestley, an intensive care doctor and anesthesiologist in Yorkshire in northern England. “I don’t want to be alarmist. I just want someone to pay attention.”

With the number of coronavirus cases in Britain climbing to 115 this week, and on Thursday the first fatality, Prime Minister Boris Johnson offered the first hints of how a health system sapped by years of austerity-driven reductions in budget growth would try to cope.

But for doctors already dealing with overflowing wintertime wards, there was little faith that even the most ambitious plans could keep the National Health Service from being deluged by a crisis that strikes where it is weakest — a severe shortage of beds for critically ill patients, which puts it behind much of Europe and has alarmed doctors for years.

“The N.H.S. has never been in a worse state going into something like this,” said Dr. Dominic Pimenta, a cardiologist and author in London. “The dominoes have been stacked for 10 years. It wouldn’t have taken much to tip them over.”

In many ways, Britain’s response to the coronavirus highlights the advantages of free health care in a crisis, analysts said. Roughly 18,000 Britons have received free testing so far. A national helpline has kept less serious cases away from hospitals. And doctors are counting on intensive care units coordinating closely as the crisis mounts to ensure the sickest patients have beds.

But in a dozen interviews with doctors and public health experts, the shortcomings of Britain’s efforts were laid bare, a lesson in the devastating consequences of a decade of trims to spending growth that have starved the health service of workers and beds at the very moment Britain most needs them.

“We’re already at maximum capacity and clearing out beds as best we can,” said Dr. Nick Scriven, a specialist in urgent conditions in Halifax, a town in northern England, and the former president of The Society for Acute Medicine.

Britain has shed roughly 160,000 hospital beds since the late 1980s as doctors shortened recovery times and tried to reduce reliance on hospital care, mirroring efforts across Europe. But Britain now has the second-fewest hospital beds per capita in Europe, according to the European Union. And a 2011 study suggested that it had one-seventh the number of intensive care beds per person that the United States did.

Admitting one patient now almost inevitably means finding a way to discharge another. The occupancy rate for intensive care beds regularly exceeds 90 percent, about 20 percentage points higher than intensive care specialists consider safe.

Get an informed guide to the global outbreak with our daily coronavirus newsletter.

For severely ill coronavirus patients, that could spell trouble.

By Dr. Priestley’s estimate, hundreds of people out of a population of several hundred thousand in his area could require respiratory support as the coronavirus spreads. But his unit has only 17 intensive care beds. Doctors could make use of another 18 or so ventilators stationed in operating rooms, but beyond that, he said, “We’re talking about people squeezing bags.”

“If we get those kinds of numbers, nobody knows how we’d possibly cope,” Dr. Priestley said. “We’d have to do a very robust triage where only those with a high chance of getting better would get near a ventilator.”

Intensive care doctors cautioned that Britain was still some ways from having to make decisions like that. Even so, doctors said, it has been difficult getting the ear of hospital administrators.

At some hospitals, administrators have only recently started asking about supplies of ventilators and oxygen. Doctors are still doing their normal jobs — and sometimes picking up extra shifts — as they try to prepare their wards.

In some cases, they find parts of hospitals lacking even basic training and supplies to tackle the virus.

Doctors at an emergency room in south London, for example, were faced last week with a coughing, gasping patient who had recently traveled to a high-risk country in Asia. They considered whether to insert a breathing tube.

But there was a problem: The doctors who were supposed to administer an anesthetic had none of the right protective gear. Many had not been fitted for face masks at all, a major liability, said one of the doctors who handled the case.

So instead of being rushed to a hospital ward, the patient had to remain in the emergency department.

Before 2009, when the swine flu arrived in Britain near the end of a period of larger spending growth for the health service, hospital administrators had expressed concern about preparing for a pandemic, doctors said.

But administrators dismissed some proposals to increase bed or ventilator supplies as too costly, they said, and after withstanding the swine flu outbreak, never dealt with the underlying shortage of beds.

Protective gear has grown even more scarce since then at some hospitals. Dr. Scriven said every doctor where he worked had his or her own heavy-duty face mask during the swine flu. Now they need to be shared, though Dr. Scriven said a quick scrub between uses was enough to remove traces of the coronavirus.

Dr. Ganesh Suntharalingam, the president of the Intensive Care Society, said, “We do have the advantage of a unified health care system, but we’re also starting from further behind the start block than other countries because we historically have fewer intensive care beds per population, and they tend to be more full.”

Chris Whitty, Britain’s chief medical officer, has acknowledged that a large outbreak “will put very high pressure on the N.H.S..” But he added that the government would try to delay any explosion of cases until the warmer months, and that in any case the N.H.S. would be up to the task.

“The N.H.S. will always cope because the N.H.S. is an emergency service that is very good at adapting to what it finds itself with,” he said this week.

The government has promised 40 million pounds, or about $52 million, for vaccine research, and said it would fund whatever urgent building work the health service needed to combat the coronavirus, like more isolation areas in hospitals.

It has also floated some bold ideas to deal with the bed shortage, like creating an extra 5,000 intensive care beds or treating people with at-home ventilators. It has even said it may be necessary to recruit retired doctors to help. But doctors were baffled by some of the proposals and unconvinced by others.

Dr. John Puntis, a pediatrician, said he had been pulled back from retirement once before, and it took two months of police checks, document approvals and new registrations to get to work. Now retired a second time, Dr. Puntis said that he would consider returning if his skills were applicable, but that retirees were also aware that they matched “the demographic that’s most likely to die from coronavirus.”

Family doctors say they have largely been left out of the government’s planning.

Despite instructions to bypass local clinics and go elsewhere for tests, some worried patients have shown up at family clinics because they had returned from northern Italy before the government deemed travelers from there eligible for testing. Many practices stock only a small supply of masks. And as the virus spreads, more non-travelers could show up with mild symptoms, not realizing they have the coronavirus, too.

“From our point of view, it makes us like sitting ducks for catching coronavirus,” said Dr. Sean Morris, a family doctor in London.

Meanwhile, family doctors are still seeing the usual crush of wintertime cough and flu cases at clinics. It has gotten busy enough in recent months that clinics sometimes get messages from local hospitals not to send people because of overcrowding, said Louise Irvine, a family doctor in London.

Some practices, said Dr. Sebastian Kalwij, another family doctor, are now rolling out experiments with telephone appointments to reduce the risk of infection. Shutting down any family practices could leave thousands of patients having routine chest pains or other problems without any place to go.

For that reason, said Dr. Sam Wessely, another London family doctor, the government should offer semiregular testing to health care workers to ensure they are not spreading the virus.

“The government needs to think about what to do to protect its health care workers,” he said. “Without them, you’re lost.”

At the south London hospital where the patient with a severe cough showed up last week, doctors later discovered that tests had come back negative for coronavirus.

But that was little solace to emergency room workers who saw firsthand how leaving some doctors unprepared for the coronavirus could unleash a cascade of problems.

“That’s not the way it should be working,” said one doctor who handled the case, speaking on the condition of anonymity. “It feels like we’ve been slightly caught on the hop with this one.”

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2020-03-06 12:57:06Z
CAIiELMAeUyy9jAzTD65bZS8xzwqFwgEKg8IACoHCAowjuuKAzCWrzww5oEY

Coronavirus: UK cases rise to 163, government confirms - BBC News

The number of coronavirus cases in the UK has now reached 163, the government has confirmed.

It is a jump of 48 cases since Thursday - the biggest increase in one day. More than 20,000 people have been tested.

Meanwhile, samples taken from an elderly man who died at Milton Keynes Hospital are currently being investigated for coronavirus.

The BBC understands the man, in his 80s, had underlying health issues but more tests for the virus are ongoing.

The UK's first death linked to the virus came on Thursday, after a woman with underlying health conditions in her 70s died in hospital in Reading.

As well as her death in the UK, a British man also died from the virus last month after being infected on the Diamond Princess cruise ship off the coast of Japan.

The Department of Health said as of 9:00 GMT on Friday, 20,338 people had been tested.

The latest number of confirmed cases comprises 147 cases in England, 11 in Scotland, three in Northern Ireland and two in Wales.

Of the cases in England there are:

• 29 in London
• 24 in the South East
• 22 in the South West
• 21 in the North West
• 13 in the North East and Yorkshire
• 12 in the Midlands
• 11 in the East of England
• 15 not yet confirmed

In Scotland, there are three cases in Grampian, two in Fife, two in Forth Valley and one each in Lothian, Tayside, Ayrshire & Arran and Greater Glasgow & Clyde.

About 45 of the confirmed cases have been self-isolating at home, while 18 people have recovered.

Earlier, the UK government pledged to spend £46m on urgent work to tackle the coronavirus - including more money to develop a vaccine and cash to help some of the most vulnerable countries prepare for an outbreak.

The money will fund work on eight possible vaccines which are already in development as well as a lab in Bedford to try to create a test that could provide results within 20 minutes.

Currently, tests take a couple of days to provide results.

In other developments:

• Facebook is closing its London office for the weekend after it was discovered that a Singapore-based employee who visited last week has been diagnosed with the virus. Staff members have been told to work from home until Monday
• British Airways said two members of their staff at Heathrow Airport - believed to be from the baggage team - had tested positive for the virus, which causes the disease Covid-19. The two employees are now self-isolating at home
• More than 140 British nationals - including 21 crew members - are stranded on a cruise ship which has been prevented from docking in San Francisco while tests are carried out
• Visitors to a hospital in Northampton have been stealing hand sanitising gel daily, with bottles taken from patients' beds and dispensers from walls
• Delivery company Hermes announced £1m to help support their self-employed couriers if they need to self-isolate. The move has been praised by the GMB Union
• A church in Devon has been closed for a deep clean after a parishioner tested positive and a Hare Krishna temple near Watford has also closed because of a coronavirus case among its congregation
• The latest drive-through coronavirus test centre has opened, this time in north-east Wales, where people do not need to leave their cars to be tested
• Starbucks branches and train operator LNER have temporarily banned reusable cups in response to the outbreak

On Thursday, Health Secretary Matt Hancock told a BBC Question Time audience he was "absolutely confident" food supplies would not run out, amid concerns some people were stockpiling.

But a supermarket executive told the BBC sales of cupboard basics had "gone through the roof" and he was not sure the government could guarantee food supply in all instances.

Meanwhile, the prime minister's official spokesman previously said it was "highly likely the virus is going to spread in a significant way".

The government said the UK was still in the first phase of its four-part plan to tackle the virus outbreak, which is made up of: contain, delay, research and mitigate.

But officials were ramping up work to prepare for the next phase, the PM's spokesman added.

The government is still deciding what measures will be taken in the delay phase, but has previously said this could include banning big events, closing schools, encouraging people to work from home and discouraging the use of public transport.

Earlier this week, the country's chief medical adviser Prof Whitty said half of all coronavirus cases in the UK are most likely to occur in just a three-week period, with 95% of them over a nine-week period.

Globally, the number of coronavirus cases has now passed 100,000, with 3,400 deaths.

The government has updated its advice for Italy - the country in Europe that has been hit worst by the virus, with more than 3,000 cases.

Travellers who develop symptoms after returning from any part of Italy - not just the north of the country - should self-isolate, while those returning from quarantined areas should self-isolate even without symptoms.

---

Have you or anyone else you know been affected by the coronavirus? You can tell us your story by emailing haveyoursay@bbc.co.uk.

Please include a contact number if you are willing to speak to a BBC journalist. You can also contact us in the following ways:

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2020-03-06 14:44:58Z
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‘It’s Going to End in Death’: Doctors Say U.K. Is Ill Prepared for Coronavirus - The New York Times

LONDON — Ventilators in short supply. Intensive care beds already overflowing. Some health workers buying their own face masks or hoods. And if cases of the deadly coronavirus surge in anything like the numbers some experts have predicted, doctors say they would have to consider denying lifesaving care to the frailest patients to prioritize those with better chances of surviving.

“If we haven’t got ventilatory support to offer them, it’s going to end in death,” said Dr. George Priestley, an intensive care doctor and anesthesiologist in Yorkshire in northern England. “I don’t want to be alarmist. I just want someone to pay attention.”

With the number of coronavirus cases in Britain climbing to 115 this week, and on Thursday the first fatality, Prime Minister Boris Johnson offered the first hints of how a health system sapped by years of austerity-driven reductions in budget growth would try to cope.

But for doctors already dealing with overflowing wintertime wards, there was little faith that even the most ambitious plans could keep the National Health Service from being deluged by a crisis that strikes where it is weakest — a severe shortage of beds for critically ill patients, which puts it behind much of Europe and has alarmed doctors for years.

“The N.H.S. has never been in a worse state going into something like this,” said Dr. Dominic Pimenta, a cardiologist and author in London. “The dominoes have been stacked for 10 years. It wouldn’t have taken much to tip them over.”

In many ways, Britain’s response to the coronavirus highlights the advantages of free health care in a crisis, analysts said. Roughly 18,000 Britons have received free testing so far. A national helpline has kept less serious cases away from hospitals. And doctors are counting on intensive care units coordinating closely as the crisis mounts to ensure the sickest patients have beds.

But in a dozen interviews with doctors and public health experts, the shortcomings of Britain’s efforts were laid bare, a lesson in the devastating consequences of a decade of trims to spending growth that have starved the health service of workers and beds at the very moment Britain most needs them.

“We’re already at maximum capacity and clearing out beds as best we can,” said Dr. Nick Scriven, a specialist in urgent conditions in Halifax, a town in northern England, and the former president of The Society for Acute Medicine.

Britain has shed roughly 160,000 hospital beds since the late 1980s as doctors shortened recovery times and tried to reduce reliance on hospital care, mirroring efforts across Europe. But Britain now has the second-fewest hospital beds per capita in Europe, according to the European Union. And a 2011 study suggested that it had one-seventh the number of intensive care beds per person that the United States did.

Admitting one patient now almost inevitably means finding a way to discharge another. The occupancy rate for intensive care beds regularly exceeds 90 percent, about 20 percentage points higher than intensive care specialists consider safe.

Get an informed guide to the global outbreak with our daily coronavirus newsletter.

For severely ill coronavirus patients, that could spell trouble.

By Dr. Priestley’s estimate, hundreds of people out of a population of several hundred thousand in his area could require respiratory support as the coronavirus spreads. But his unit has only 17 intensive care beds. Doctors could make use of another 18 or so ventilators stationed in operating rooms, but beyond that, he said, “We’re talking about people squeezing bags.”

“If we get those kinds of numbers, nobody knows how we’d possibly cope,” Dr. Priestley said. “We’d have to do a very robust triage where only those with a high chance of getting better would get near a ventilator.”

Intensive care doctors cautioned that Britain was still some ways from having to make decisions like that. Even so, doctors said, it has been difficult getting the ear of hospital administrators.

At some hospitals, administrators have only recently started asking about supplies of ventilators and oxygen. Doctors are still doing their normal jobs — and sometimes picking up extra shifts — as they try to prepare their wards.

In some cases, they find parts of hospitals lacking even basic training and supplies to tackle the virus.

Doctors at an emergency room in south London, for example, were faced last week with a coughing, gasping patient who had recently traveled to a high-risk country in Asia. They considered whether to insert a breathing tube.

But there was a problem: The doctors who were supposed to administer an anesthetic had none of the right protective gear. Many had not been fitted for face masks at all, a major liability, said one of the doctors who handled the case.

So instead of being rushed to a hospital ward, the patient had to remain in the emergency department.

Before 2009, when the swine flu arrived in Britain near the end of a period of larger spending growth for the health service, hospital administrators had expressed concern about preparing for a pandemic, doctors said.

But administrators dismissed some proposals to increase bed or ventilator supplies as too costly, they said, and after withstanding the swine flu outbreak, never dealt with the underlying shortage of beds.

Protective gear has grown even more scarce since then at some hospitals. Dr. Scriven said every doctor where he worked had his or her own heavy-duty face mask during the swine flu. Now they need to be shared, though Dr. Scriven said a quick scrub between uses was enough to remove traces of the coronavirus.

Dr. Ganesh Suntharalingam, the president of the Intensive Care Society, said, “We do have the advantage of a unified health care system, but we’re also starting from further behind the start block than other countries because we historically have fewer intensive care beds per population, and they tend to be more full.”

Chris Whitty, Britain’s chief medical officer, has acknowledged that a large outbreak “will put very high pressure on the N.H.S..” But he added that the government would try to delay any explosion of cases until the warmer months, and that in any case the N.H.S. would be up to the task.

“The N.H.S. will always cope because the N.H.S. is an emergency service that is very good at adapting to what it finds itself with,” he said this week.

The government has promised 40 million pounds, or about $52 million, for vaccine research, and said it would fund whatever urgent building work the health service needed to combat the coronavirus, like more isolation areas in hospitals.

It has also floated some bold ideas to deal with the bed shortage, like creating an extra 5,000 intensive care beds or treating people with at-home ventilators. It has even said it may be necessary to recruit retired doctors to help. But doctors were baffled by some of the proposals and unconvinced by others.

Dr. John Puntis, a pediatrician, said he had been pulled back from retirement once before, and it took two months of police checks, document approvals and new registrations to get to work. Now retired a second time, Dr. Puntis said that he would consider returning if his skills were applicable, but that retirees were also aware that they matched “the demographic that’s most likely to die from coronavirus.”

Family doctors say they have largely been left out of the government’s planning.

Despite instructions to bypass local clinics and go elsewhere for tests, some worried patients have shown up at family clinics because they had returned from northern Italy before the government deemed travelers from there eligible for testing. Many practices stock only a small supply of masks. And as the virus spreads, more non-travelers could show up with mild symptoms, not realizing they have the coronavirus, too.

“From our point of view, it makes us like sitting ducks for catching coronavirus,” said Dr. Sean Morris, a family doctor in London.

Meanwhile, family doctors are still seeing the usual crush of wintertime cough and flu cases at clinics. It has gotten busy enough in recent months that clinics sometimes get messages from local hospitals not to send people because of overcrowding, said Louise Irvine, a family doctor in London.

Some practices, said Dr. Sebastian Kalwij, another family doctor, are now rolling out experiments with telephone appointments to reduce the risk of infection. Shutting down any family practices could leave thousands of patients having routine chest pains or other problems without any place to go.

For that reason, said Dr. Sam Wessely, another London family doctor, the government should offer semiregular testing to health care workers to ensure they are not spreading the virus.

“The government needs to think about what to do to protect its health care workers,” he said. “Without them, you’re lost.”

At the south London hospital where the patient with a severe cough showed up last week, doctors later discovered that tests had come back negative for coronavirus.

But that was little solace to emergency room workers who saw firsthand how leaving some doctors unprepared for the coronavirus could unleash a cascade of problems.

“That’s not the way it should be working,” said one doctor who handled the case, speaking on the condition of anonymity. “It feels like we’ve been slightly caught on the hop with this one.”

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2020-03-06 09:55:00Z
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‘It’s Going to End in Death’: Doctors Say U.K. Is Ill Prepared for Coronavirus - The New York Times

LONDON — Ventilators in short supply. Intensive care beds already overflowing. Some health workers buying their own face masks or hoods. And if cases of the deadly coronavirus surge in anything like the numbers some experts have predicted, doctors say they would have to consider denying lifesaving care to the frailest patients to prioritize those with better chances of surviving.

“If we haven’t got ventilatory support to offer them, it’s going to end in death,” said Dr. George Priestley, an intensive care doctor and anesthesiologist in Yorkshire in northern England. “I don’t want to be alarmist. I just want someone to pay attention.”

With the number of coronavirus cases in Britain climbing to 115 this week, and on Thursday the first fatality, Prime Minister Boris Johnson offered the first hints of how a health system sapped by years of austerity-driven reductions in budget growth would try to cope.

But for doctors already dealing with overflowing wintertime wards, there was little faith that even the most ambitious plans could keep the National Health Service from being deluged by a crisis that strikes where it is weakest — a severe shortage of beds for critically ill patients, which puts it behind much of Europe and has alarmed doctors for years.

“The N.H.S. has never been in a worse state going into something like this,” said Dr. Dominic Pimenta, a cardiologist and author in London. “The dominoes have been stacked for 10 years. It wouldn’t have taken much to tip them over.”

In many ways, Britain’s response to the coronavirus highlights the advantages of free health care in a crisis, analysts said. Roughly 18,000 Britons have received free testing so far. A national helpline has kept less serious cases away from hospitals. And doctors are counting on intensive care units coordinating closely as the crisis mounts to ensure the sickest patients have beds.

But in a dozen interviews with doctors and public health experts, the shortcomings of Britain’s efforts were laid bare, a lesson in the devastating consequences of a decade of trims to spending growth that have starved the health service of workers and beds at the very moment Britain most needs them.

“We’re already at maximum capacity and clearing out beds as best we can,” said Dr. Nick Scriven, a specialist in urgent conditions in Halifax, a town in northern England, and the former president of The Society for Acute Medicine.

Britain has shed roughly 160,000 hospital beds since the late 1980s as doctors shortened recovery times and tried to reduce reliance on hospital care, mirroring efforts across Europe. But Britain now has the second-fewest hospital beds per capita in Europe, according to the European Union. And a 2011 study suggested that it had one-seventh the number of intensive care beds per person that the United States did.

Admitting one patient now almost inevitably means finding a way to discharge another. The occupancy rate for intensive care beds regularly exceeds 90 percent, about 20 percentage points higher than intensive care specialists consider safe.

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For severely ill coronavirus patients, that could spell trouble.

By Dr. Priestley’s estimate, hundreds of people out of a population of several hundred thousand in his area could require respiratory support as the coronavirus spreads. But his unit has only 17 intensive care beds. Doctors could make use of another 18 or so ventilators stationed in operating rooms, but beyond that, he said, “We’re talking about people squeezing bags.”

“If we get those kinds of numbers, nobody knows how we’d possibly cope,” Dr. Priestley said. “We’d have to do a very robust triage where only those with a high chance of getting better would get near a ventilator.”

Intensive care doctors cautioned that Britain was still some ways from having to make decisions like that. Even so, doctors said, it has been difficult getting the ear of hospital administrators.

At some hospitals, administrators have only recently started asking about supplies of ventilators and oxygen. Doctors are still doing their normal jobs — and sometimes picking up extra shifts — as they try to prepare their wards.

In some cases, they find parts of hospitals lacking even basic training and supplies to tackle the virus.

Doctors at an emergency room in south London, for example, were faced last week with a coughing, gasping patient who had recently traveled to a high-risk country in Asia. They considered whether to insert a breathing tube.

But there was a problem: The doctors who were supposed to administer an anesthetic had none of the right protective gear. Many had not been fitted for face masks at all, a major liability, said one of the doctors who handled the case.

So instead of being rushed to a hospital ward, the patient had to remain in the emergency department.

Before 2009, when the swine flu arrived in Britain near the end of a period of larger spending growth for the health service, hospital administrators had expressed concern about preparing for a pandemic, doctors said.

But administrators dismissed some proposals to increase bed or ventilator supplies as too costly, they said, and after withstanding the swine flu outbreak, never dealt with the underlying shortage of beds.

Protective gear has grown even more scarce since then at some hospitals. Dr. Scriven said every doctor where he worked had his or her own heavy-duty face mask during the swine flu. Now they need to be shared, though Dr. Scriven said a quick scrub between uses was enough to remove traces of the coronavirus.

Dr. Ganesh Suntharalingam, the president of the Intensive Care Society, said, “We do have the advantage of a unified health care system, but we’re also starting from further behind the start block than other countries because we historically have fewer intensive care beds per population, and they tend to be more full.”

Chris Whitty, Britain’s chief medical officer, has acknowledged that a large outbreak “will put very high pressure on the N.H.S..” But he added that the government would try to delay any explosion of cases until the warmer months, and that in any case the N.H.S. would be up to the task.

“The N.H.S. will always cope because the N.H.S. is an emergency service that is very good at adapting to what it finds itself with,” he said this week.

The government has also floated some bold ideas, like creating an extra 5,000 intensive care beds or treating people with at-home ventilators. It has even said it may be necessary to recruit retired doctors to help. But doctors were baffled by some of the proposals and unconvinced by others.

Dr. John Puntis, a pediatrician, said he had been pulled back from retirement once before, and it took two months of police checks, document approvals and new registrations to get to work. Now retired a second time, Dr. Puntis said that he would consider returning if his skills were applicable, but that retirees were also aware that they matched “the demographic that’s most likely to die from coronavirus.”

Family doctors say they have largely been left out of the government’s planning.

Despite instructions to bypass local clinics and go elsewhere for tests, some worried patients have shown up at family clinics because they had returned from northern Italy before the government deemed travelers from there eligible for testing. Many practices stock only a small supply of masks. And as the virus spreads, more non-travelers could show up with mild symptoms, not realizing they have the coronavirus, too.

“From our point of view, it makes us like sitting ducks for catching coronavirus,” said Dr. Sean Morris, a family doctor in London.

Meanwhile, family doctors are still seeing the usual crush of wintertime cough and flu cases at clinics. It has gotten busy enough in recent months that clinics sometimes get messages from local hospitals not to send people because of overcrowding, said Louise Irvine, a family doctor in London.

Some practices, said Dr. Sebastian Kalwij, another family doctor, are now rolling out experiments with telephone appointments to reduce the risk of infection. Shutting down any family practices could leave thousands of patients having routine chest pains or other problems without any place to go.

For that reason, said Dr. Sam Wessely, another London family doctor, the government should offer semiregular testing to health care workers to ensure they are not spreading the virus.

“The government needs to think about what to do to protect its health care workers,” he said. “Without them, you’re lost.”

At the south London hospital where the patient with a severe cough showed up last week, doctors later discovered that tests had come back negative for coronavirus.

But that was little solace to emergency room workers who saw firsthand how leaving some doctors unprepared for the coronavirus could unleash a cascade of problems.

“That’s not the way it should be working,” said one doctor who handled the case, speaking on the condition of anonymity. “It feels like we’ve been slightly caught on the hop with this one.”

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2020-03-06 08:35:00Z
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Passengers left scrambling as British airline Flybe collapses amid coronavirus travel fears - USA TODAY

David Oliver USA TODAY

Published 11:28 AM EST Mar 5, 2020

British airline Flybe abruptly shut down Thursday, causing chaos for passengers who were slated to travel on the airline and leading the U.K.'s Civil Aviation Authority as well as train and bus services to step in to try to mitigate the upheaval. 

Flybe collapsed Thursday amid drops in demand caused by the new coronavirus.

Northern Ireland resident Xenia Pestova Bennett, 40, was briefly stranded in Bournemouth, England, after a concert. Bennett was about to check out of her hotel room and head to the airport when she received a text telling her not to bother.

The U.K. Civil Aviation Authority said in a statement Thursday that "All Flybe flights are cancelled. Please do not go to the airport as your Flybe flight will not be operating.”

"FlyBe are not giving us money back or rebooking us, and I have about 10 flights booked with them for the rest of the spring, which will now be lost," she told USA TODAY. "That’s thousands of pounds gone."

Lekan Ojookiji Abasi, who was due to catch a flight from Belfast to Manchester en route to visit his mother in Nigeria, turned up at the airport — only to learn the bad news.

"I arrived here at about 4.25 a.m. and the whole place was empty," he said. "I couldn’t believe it."

In response to the shutdown, the Civil Aviation Authority is offering free travel to Flybe staff and customers over the next week, as are Britain's train operators. Bennett ultimately managed to get to London, though she will need to get home from there.

Other airlines and operators are offering help for customers in need, including Megabus and British Airways.

But passengers who were booked on the airline expressed confusion and concern as they tried to sort through their options.

"Currently stranded in Amsterdam courtesy of @flybe going into administration," Twitter user @AndyWalker251 wrote. "Trying to figure out how to get back to Exeter airport."

"Currently stranded in channel islands. Thanks flybe," user @MartinW58 wrote.

Other Twitter users have shown grace and offered assistance to those stranded.

@officialkappa99 wrote to Flybe's crew specifically: "I know this won't get you to where you want to be, but if you end up stranded and it gets you closer, I am driving from Glasgow to Leeds tomorrow around 12 noon tomorrow. I will be driving from Leeds back to Glasgow on Friday, again around noon. Space for 3."

Flybe’s fall highlights the damage that the virus outbreak has had on the airline industry, which has cut back on flights around the world as people avoid flying out of precaution.

Airlines have struggled after a spike in new coronavirus cases were reported in Italy, South Korea and Iran, spooking vacationers and sparking the cancellation of business trips.

The International Air Transport Association said January saw the slowest monthly year-over-year growth since April 2010 – and that was before the main impact of the virus outbreak. United Airlines said it will freeze hiring and ask employees to volunteer for unpaid leave as it struggles with weak demand. Finnair is enforcing temporary layoffs for some 6,000 staff.

The disruption is having the biggest effect on companies that were perceived as already weak financially. Norwegian Air Shuttle, which has struggled to maintain the costs of operating a low-budget business model on long-haul transatlantic flights, has seen its shares slide 55% since the start of the virus outbreak, including a 12% drop Thursday.

Flybe’s network included more than half of British domestic flights outside of London. Europe’s largest regional carrier, Flybe had a major presence at airports such as Aberdeen, Belfast City, Manchester and Southampton, and flew some 9 million passengers a year.

Its links to some difficult-to-reach spots in the U.K. were a strong selling point for the government. But the government’s efforts were dogged by allegations from competitors that it had provided state aid to Flybe.

“This is a sad day for UK aviation and we know that Flybe’s decision to stop trading will be very distressing for all of its employees and customers,” the chief executive of the UK Civil Aviation Authority, Richard Moriarty, said.

A consortium of Virgin Atlantic, Stobart Group and Cyrus Capital bought Flybe in February 2019. Known as Connect Airways, it paid just 2.2 million pounds for Flybe’s assets but pledged to inject cash into the airline to turn it around.

Flybe has struggled with a series of issues, including the weakening of the pound in light of Britain’s pending departure from the European Union. The weaker pound hurts airlines like Flybe that have significant costs in dollars but take in revenue in pounds.

The airline also was struggling to pay its airline passenger duty, a tax on flights that many airline groups have long complained restricts growth.

It is the second U.K.-based airline in six months to fail after Thomas Cook went bust in September.

Contributing: The Associated Press

'Memorable for the wrong reasons': Stranded travelers sound off after Thomas Cook collapse

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2020-03-05 16:18:45Z
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Coronavirus: UK moving towards 'delay' phase of virus plan as cases hit 115 - BBC News

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UK health officials are moving towards the second phase of their response to the coronavirus outbreak.

It comes as the number of UK people diagnosed with virus reached 115, a rise of 30 since Wednesday.

The latest government figures released on Thursday showed that of the total number of cases, 25 are in London.

Earlier, the country's chief medical adviser Prof Chris Whitty said the next phase - "delay" - will see more action to slow the spread of the virus.

He told MPs it was "highly likely" some people now being infected in the UK have no connection to overseas cases.

According to the latest figures, Prof Chris Whitty, said 25 of the newly diagnosed patients are from England.

Of the cases in England, there are 17 cases in the north-west, 17 in the south-east, 15 in the south-west, 10 in the north-east and Yorkshire, nine in the Midlands and eight in the east.

On Thursday, three new cases were confirmed in Scotland as well as one in Wales.

Speaking to MPs on the health and social care committee, Prof Whitty said the country was now "mainly" in the delay phase of the government's four-part plan to tackle the virus, but was still following aspects of the first phase.

Downing Street said it would formally announce when it switches from the contain to delay stage of taking on the virus - and that this has not yet happened.

The government is still deciding what measures will be taken in the delay phase, but has previously said they could include banning big events, closing schools, encouraging people to work from home and discouraging the use of public transport.

But Prime Minister Boris Johnson said the government's scientific advisory group for emergencies (Sage) had told him that closing schools and stopping big gatherings "don't work as well perhaps as people think in stopping the spread".

He told ITV's This Morning programme: "One of the theories is perhaps you could take it on the chin, take it all in one go and allow the disease to move through the population without really taking as many draconian measures. I think we need to strike a balance."

Mr Johnson said it would be "business as usual" for the "overwhelming majority" of people in the UK.

Prof Whitty also said there was "no need" for members of the public to stockpile food or medicine, adding that the outbreak would be a "marathon not a sprint".

"There is nothing in the current environment that would rationally lead someone to want to go out and stock up on stuff," he added.

The government has said it has a stockpile of important medicines and protective equipment, to counter any impact to global supply chains.

What do I need to know about the coronavirus?

Prof Whitty said benefits of the delay phase included:

• Pushing the peak of cases "further away from the winter pressures on the NHS" so that there was "more capacity to respond"
• Buying time to allow the UK to improve its response or develop counter measures such as drugs, vaccines and diagnostics
• There may be a seasonal element of the virus - so if the peak was delayed to spring or summer, the "natural rate" of transmission could be lower

Prof Whitty said the early stages of the delay phase were similar to the contain phase, and involved identifying cases of the virus, isolating patients, and tracing anyone who had been in contact with them.

"As time moves by, we then may start to move into the more socially determined actions... the kind of measures we can do to delay things which involve changes to society," he said.

He said it was likely that later in the response, elderly people and those with pre-existing health conditions would be advised to "have some degree of isolation from more public environments" and may be told, for example, to "avoid crowded areas".

On Wednesday the highest day-on-day rise in cases in the UK was reported, when the number of cases jumped from 51 to 87.

The UK's early response to the virus, which causes Covid-19, was based on the spread being controlled in China, with some minor outbreaks in other countries, Prof Whitty said.

But he added: "The chances of that happening are now very slim. Slim to zero."

Prof Whitty said in the worst case scenario of an epidemic in the UK, critical care beds would be "under pressure at quite an early stage".

In other recent developments:

• Bank HSBC says an employee at its Canary Wharf offices in London has been diagnosed and it is "deep-cleaning the floor where our colleague worked and shared areas of the building"
• UK airline Flybe has gone into administration and says coronavirus is partly to blame
• The competition watchdog has warned retailers and traders they could be prosecuted for trying to "exploit" the coronavirus outbreak by selling protective products at inflated prices
• England's Six Nations games against Italy in Rome on 14 and 15 March are expected to be postponed - rather than taking place behind closed doors - as a response to the outbreak
• Iran will close schools and universities until 20 March in an attempt to curb the spread
• Switzerland has reported its first death from the virus - a 74-year-old woman who died in hospital in Lausanne
• California has declared a state of emergency after announcing its first coronavirus death, bringing the US death toll from the disease to 11
• And the world's biggest dog show, Crufts, has begun in Birmingham, despite two major sponsors pulling out of the event amid fears over the virus

Elsewhere, the prime minister's official spokesman told a briefing in Westminster that the spread of the virus would cause "no change" to the end date of the Brexit transition period on 31 December.

About 90,000 people have been infected globally since the outbreak of coronavirus in Hubei province, China, in December, with cases in more than 50 countries and more than 3,000 deaths.

Last week, a British man who was infected on the Diamond Princess cruise ship quarantined in Japan became the first UK citizen to die from the virus.

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2020-03-05 16:16:21Z
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