"21,460 people have been tested in the UK, of which 21,254 were confirmed negative and 206 were confirmed as positive," the UK Department of Health and Social Care said, adding that two coronavirus patients have died so far.
The British government's confirmation came shortly after an update from the Scottish health authorities, who announced that they have identified five new cases of coronavirus over the last 24 hours, bringing the total in the region to 16.
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 what the president and his allies call the “deep state.” In Britain, Mr. Johnson’s scruffy, iconoclastic adviser Dominic Cummings plays 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.”
His family said they had lost a "truly loving person" and were unable to arrange a funeral for him because they were self-isolating.
It comes as the UK cases rose to 206.
The man, who had underlying health problems, had been admitted to Milton Keynes Hospital for another reason and spent two days in a ward before being isolated and tested for coronavirus, the hospital said.
In a statement, his family said: "We as a family have lost a truly loving and wonderful person and are trying to come to terms with this.
"He was 83 years old and a wonderful husband, dad, grandad and great-grandad who would go to any lengths to support and protect his family."
The family said they had been unable to grieve for him as they would have wanted.
"This whole nightmare is not something that we or our loved one asked for.
"As we are in isolation currently, we cannot arrange for him to be put to rest, and with all the activity that is going around with regards to everyone's concerns, we cannot grieve him as we would wish to."
The family said the cause of death had not been confirmed.
They also said they had not spoken to any media outlets before releasing their statement, "contrary to what has been reported".
"People should perhaps put themselves in our shoes and think how would they feel with some of the hurtful comments that are being made. We would not wish this experience on anyone and we would ask that you have respect for us and allow us to grieve."
The man had been travelling but had at first showed no symptoms of coronavirus, the hospital said.
Its chief executive, Prof Joe Harrison, said: "After two days in the hospital they started showing signs of deterioration and at that point we decided to isolate the patient and test them for coronavirus and unfortunately that came back as positive.
"What we were doing was looking after that patient in a bay on one of our wards and subsequent to that we have ensured all of those patients have been followed up, as have the staff, to ensure that they are tested and appropriately isolated."
He said five patients had been isolated and were awaiting coronavirus test results, while nine staff had been asked to self isolate.
The hospital said it had already carried out a review of the patient's care but determined he had been treated appropriately.
The UK's first death - a woman in her 70s who also had underlying health conditions - was confirmed on Thursday. A British man also died last month in Japan after contracting the virus on board the Diamond Princess cruise ship.
As of Saturday morning, 21,460 had been tested for the virus, the Department of Health and Social Care said.
Jenny Harries told the BBC a decision about the next phase of delaying the spread of the virus would depend on how fast the number of cases rose.
But she said the UK was "teetering on the edge" of sustained transmission.
The UK's strategy on responding to the virus has three phases - containment, delay, and mitigation - alongside ongoing research.
Up until now, the containment phase has involved catching cases early and tracing all close contacts to halt the spread of the disease for as long as possible,
Moving into the delay phase could see the introduction of "social distancing" measures, such as closing schools and urging people to work from home.
Dr Harries said a decision on formally moving to the next phase would depend on how quickly the number of cases rises.
"We are, if you like, teetering on the edge, but not there just yet," she said. "We have surveillance systems in place and we're watching that on a daily basis."
The delay phase would focus on trying to prevent cases from rising too sharply, pushing the peak of the epidemic out of the winter period and helping health and social care services manage the flow of patients, she said.
Scientific advisers are due to review the evidence next week on measures such as restricting large gatherings, she said.
Dr Harries said they needed to "balance the benefits" with minimising disruption to people's lives and the economy, as well as ensuring that they are implemented at the time when they will have the most impact.
In other developments:
The updated figures come as US authorities prepare to respond to a coronavirus-hit cruise ship carrying British passengers off the Californian coast, after 21 people on board tested positive for the illness.
US Vice-President Mike Pence said on Friday that the Grand Princess, carrying more than 3,500 people on board, including 140 Britons, had been directed to a non-commercial port for testing.
Jackie Bissell, from Dartford in Kent, said passengers have had little information about what would happen to them since a note was pushed through their door two days earlier saying the virus may be on the ship.
"You can't go out. You can just go out in the hall if somebody taps your door. They put your food outside, drop your menus inside and that's about it," the 70-year-old said.
Dr Harries said she has a "great deal of trust" in the US public health system and said the Foreign Office was "extremely active" in looking after UK citizens abroad.
Globally, the number of coronavirus cases has now passed 100,000, with 3,400 deaths.
The government has updated its advice for travellers from Italy - the country in Europe that has been worst-affected by the virus with more than 4,600 cases.
It now says people 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.
The Foreign Office is also warning travellers to Moscow in Russia that they may be told to self-isolate for 14 days on arrival from the UK, as part of measures to control the virus.
It says in a small number of cases, foreign visitors have been placed in enforced quarantine if they have not complied.
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:
On Saturday, the hospital confirmed the patient, who was admitted for a separate issue, had spent two days in a ward before being isolated and tested for coronavirus.
The man, who had been travelling, had at first showed no symptoms of coronavirus, the hospital said.
Prof Joe Harrison, chief executive of the hospital trust, said: "After two days in the hospital they started showing signs of deterioration and at that point we decided to isolate the patient and test them for coronavirus and unfortunately that came back as positive.
"What we were doing was looking after that patient in a bay on one of our wards and subsequent to that we have ensured all of those patients have been followed up, as have the staff, to ensure that they are tested and appropriately isolated.
"We currently have five patients who are isolated and have been tested and we are awaiting results of those to come back and we have asked nine staff to self isolate."
The hospital said it had already carried out a review of the patient's care but determined he had been treated appropriately.
The UK's first death - a woman in her 70s who also had underlying health conditions - was confirmed on Thursday. A British man also died last month in Japan after contracting the virus on board the Diamond Princess cruise ship.
The UK's strategy on responding to the virus has three phases - containment, delay, and mitigation - alongside ongoing research.
Up until now, the containment phase has involved catching cases early and tracing all close contacts to halt the spread of the disease for as long as possible,
Moving into the delay phase could see the introduction of "social distancing" measures, such as closing schools and urging people to work from home.
Dr Harries said a decision on formally moving to the next phase would depend on how quickly the number of cases rises.
"We are, if you like, teetering on the edge, but not there just yet," she said. "We have surveillance systems in place and we're watching that on a daily basis."
The delay phase would focus on trying to prevent cases from rising too sharply, pushing the peak of the epidemic out of the winter period and helping health and social care services manage the flow of patients, she said.
Scientific advisers are due to review the evidence next week on measures such as restricting large gatherings, she said.
Dr Harries said they needed to "balance the benefits" with minimising disruption to people's lives and the economy, as well as ensuring that they are implemented at the time when they will have the most impact.
In other developments:
The updated figures come as US authorities prepare to respond to a coronavirus-hit cruise ship carrying British passengers off the Californian coast, after 21 people on board tested positive for the illness.
US Vice-President Mike Pence said on Friday that the Grand Princess, carrying more than 3,500 people on board, including 140 Britons, had been directed to a non-commercial port for testing.
Jackie Bissell, from Dartford in Kent, said passengers have had little information about what would happen to them since a note was pushed through their door two days earlier saying the virus may be on the ship.
"You can't go out. You can just go out in the hall if somebody taps your door. They put your food outside, drop your menus inside and that's about it," the 70-year-old said.
Dr Harries said she has a "great deal of trust" in the US public health system and said the Foreign Office was "extremely active" in looking after UK citizens abroad.
Globally, the number of coronavirus cases has now passed 100,000, with 3,400 deaths.
The government has updated its advice for travellers from Italy - the country in Europe that has been worst-affected by the virus with more than 4,600 cases.
It now says people 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.
The Foreign Office is also warning travellers to Moscow in Russia that they may be told to self-isolate for 14 days on arrival from the UK, as part of measures to control the virus.
It says in a small number of cases, foreign visitors have been placed in enforced quarantine if they have not complied.
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:
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.”
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.
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.”
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.
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