This article's lead section may be too long for the length of the article.(December 2020)
Exercise Cygnus was a three-day simulation exercise carried out by NHS England in October 2016 to estimate the impact of a hypothetical H2N2 influenza pandemic on the United Kingdom.It aimed to identify strengths and weaknesses within the United Kingdom health system and emergency response chain by putting it under significant strain, providing insight on the country's resilience and any future ameliorations required. It was conducted by Public Health England representing the Department of Health and Social Care, as part of a project led by the "Emergency Preparedness, Resilience and Response Partnership Group". Twelve government departments across Scotland, Wales and Northern Ireland, as well as local resilience forums (LRFs) participated. More than 950 workers from those organisations, prisons and local or central government were involved during the three-day simulation, and their ability to cope under situations of high medical stress was tested.
The exercise was named 'cygnus' as the theoretical H2N2 virus was nicknamed "swan flu" and said to originate from swans, the latin name for which is cygnus.
In the scenario, participants were placed in the seventh week of the pandemic – the peak of the crisis, when there is the greatest demand for healthcare. At this stage, an estimated 50% of the population had been infected, with close to 400,000 deaths.The hypothetical situation was that the vaccine had been made and purchased but not yet delivered to the United Kingdom. Hospital and social care officials were to come up with emergency plans managing resource strain, while government officials were exposed to situations requiring quick decision-making. To make the situation more realistic, COBRA meetings were held between ministers and officials. Simulated news outlets and social media such as "WNN" and "Twister" were also employed to give fictitious updates. A government disclaimer on the UK pandemic preparedness website stated that Exercise Cygnus was not intended to manage future pandemics of different nature, or to pinpoint what measures to adopt to avoid widespread transmission.
Results from the exercise identified four main learning points and 22 further recommendations. In general, it showed that the pandemic would cause the country's health system to collapse from a lack of resources, [ contradictory ] following public inquiry and pressure. In November 2020, the United Kingdom government stated that all identified lessons have been discussed accordingly and appropriately taken into account for its pandemic preparedness plans.with Sally Davies, the Chief Medical Officer at the time, stating that a lack of medical ventilators and the logistics of disposal of dead bodies were serious issues. The full results of the exercise remained classified up till October 2016
The Daily Telegraph reported one government source as saying that the results of the simulation were "too terrifying" to be revealed.According to The Telegraph, the exercise led to assumptions that a "herd immunity" approach would be the best response to a similar epidemic. The New Statesman had been first to report on the results of Cygnus two weeks earlier. A partial report of findings was later released by British newspaper The Guardian , leading to public dissatisfaction on how it was managed. In May 2020, when interviewed by The Guardian, Martin Green, chief executive of Care England, one of the United Kingdom's biggest private care home companies, said that the government did not previously alert private health sectors to the lack of capacity should a pandemic arise.
A number of news reports have criticised the government's handling of the COVID-19 pandemic in the light of the conclusions reached by Exercise Cygnus. [ by whom? ] that no follow-up document was written detailing how to deal with an influenza pandemic after December 2016. In March 2020, the three government documents available for response to COVID-19 were those published in 2011 ("Influenza Pandemic Preparedness Strategy"), 2012 ("Health and Social Care Influenza Pandemic Preparedness and Response") and 2014 ("Pandemic Influenza Response Plan") respectively, with no revised report following Exercise Cygnus and no mention of ventilators.There was criticism
Despite a lack of ventilators being previously identified in Exercise Cygnus, there was a shortage of them during COVID-19 with the government stockpiles proving to be insufficient.In March 2020, six weeks following the first case of coronavirus in the United Kingdom, Matt Hancock, acting Health Secretary of the United Kingdom, turned to a range of corporations such as JCB and Rolls-Royce, stating, "If you produce a ventilator, we will buy it. No number [you produce] is too high".
Results of Exercise Cygnus were leaked to The Guardian newspaper in May 2020.A complete version was later released in October 2020 by the Department of Health and Social Care. Four main areas of improvement as well as 22 other weaknesses were identified.
During Exercise Cygnus, the strategy used was a combination of Department of Health and Social Care's UK Influenza Pandemic Preparedness Strategy 2011, as well as eight or more other scientific documents gleaned from the H1N1 pandemic in 2009. However, the exercise revealed that there was no overview or central management to coordinate all participants. As of October 2016, feedback showed that organisations varied in preparedness, with some relying on corporate memory of the 2009 H1N1 response, and others depending on individual pandemic protocols which may be outdated, missing or incomplete.There was also demonstration of silo planning between and within some corporations, however organisations had different levels of detail and structure that could not correspond well when used simultaneously. It was understood that up to half the population will be implicated should there be insufficient understanding of the severity of a pandemic during the response.
Exercise Cygnus revealed the need to develop a "Pandemic Concept of Operations" to bridge communication between organisations.This aims to manage collective response strategically by delegating specific roles to each organisation and directing their interactions during a pandemic. NHS England recognises that a variety of sectors are implicated, hence a central administration and unified protocol to oversee the whole strategy is required for organisations to work synonymously.
Devolved administrations have separate contingency plans which were not investigated during Exercise Cygnus. In this segment, Wales was also excluded as it had previously investigated its response through "Exercise Cygnet" conducted in 2015.
The proposition to roll back on legislation and regulatory restrictions, particularly within the health sector, is considered.This would aid in managing essential services and operationalising increased health care demands with fewer obstacles. Greater flexibility is recommended especially in a pandemic when situations evolve quickly and decisions need to be made as soon as possible. Key suggestions were for rules to be more malleable and easily adapted to the circumstance at hand. The choices as to which legislation will be amended is determined by pandemic influenza planning assumptions. Previous findings from Department of Health and Social Care provide direction as to what type of corrections are appropriate for health legislation in the midst of a pandemic.
Devolved administrations were advised to adopt similar measures in fields of devolved competence. The need for future work to expand on the types of restrictions affected was noted.
Exercise Cygnus was centred around assumptions of public responses that have yet to be validated. Expectations of how the public will react was postulated based on the magnitude of "swan flu". This may not have been entirely representative of what would have happened in real life.For example, Exercise Cygnus did not involve live broadcasting or widespread coverage which typically characterises an actual pandemic. Hence, its reactions are based around theoretical public reaction. This was identified and understood as a possible limitation to Exercise Cygnus, and the role of public opinion on pandemic response still requires further investigation. It was stated that in reality, moral decisions, such as those involving mass burials or population triage, may differ in face of public reaction.
Further work is required to understand public reaction, so that it can be factored into significant decisions and communication strategies, particularly for ethically charged scenarios. Research into how public perception and response to a pandemic will further aid the trajectory of emergency strategies and how they can be communicated. In 2019, the Moral and Ethical Advisory Group (MEAG) was established to give unbiased guidance to government regarding controversial health issues.
A lack of resources and limited ability to increase supply in face of demand was identified in health disciplines.This affects how emergency plans can be operationalised at a local level, implicating the revision of the "Pandemic Concept of Operations".
Little tactical coordination was observed when the need for services outweighed the capacity of local responders, particularly in communities with excess death, social care facilities and amongst National Health Service staff.The need for more precise protocols was identified to guide health care providers at an operational level should there be a need to drastically step up local response. A suggestion was to implement planning at a regional level as opposed to through local resilience forums for crucial aspects of pandemic influenza response (e.g., excess death). This improves coordination across multiple agencies locally.
Logistically, more health workers and resources such as ventilators, personal protective equipment (PPE) and hospital beds are required to face a large pandemic. Investigation also showed that the reverse triage strategy proposed by the NHS, whereby patients are moved from hospitals to social care, may not be well supported by the current social care system.This requires a high level of teamwork across several corporations, which was detailed through a provided framework but may not be viable under the pressure and widespread impact of a pandemic.
Local resilience forums have announced that they depend on subject matter experts for more complicated aspects of pandemic response to implement responses.These professionals do not belong to LRF but give detailed technical support to enable colleagues to comprehend different elements of the response. The Strategic Coordinating Group (SRG) structure is used by experts for holistic contribution. Doubts were raised if this method was sustainable in the case of a fast-moving pandemic, since experts would have to aid more than one SRG.
The 22 further recommendations, listed as per the report, include:
Public Health England (PHE) is an executive agency within the Department of Health and Social Care whose goal is to "protect and improve the nation’s health and well-being, and reduce health inequalities".It has the autonomy to guide and help the United Kingdom government, authorities and NHS without their influence.
In Exercise Cygnus, the Emergency Response Department was specifically employed within PHE.Its specialists assist the health community by providing training and expert advice with regards to emergencies. It collaborates with several organisations such as the European Commission, European Centre for Disease Prevention and Control and World Health Organization.
Dame Sally Davies was Chief Medical Officer (United Kingdom) and Chief Medical Advisor to the United Kingdom government (March 2011 - September 2019) at the time of the exercise.Additionally, she was on the World Health Organization executive board then (2014 - 2016).
She previously raised concerns for the lack of medical resources, specifically ventilators and hospital beds.The Health Secretary, Jeremy Hunt, and NHS chief executive Simon Stevens, had reduced the budget for equipment. In 2016, she raised the need to adapt to an increasingly ageing population which will be more susceptible to disease and vulnerable to pandemics, and "welcomes" a larger budget on "public health and prevention fields". However, she understands "times of austerity" and the difficulties faced by the central government.
Matt Hancock was the Secretary of State for Health and Social Care of United Kingdom (2018–2021). On 28 April 2020, Hancock was questioned by British radio host Nick Ferrari regarding findings of Exercise Cygnus leaked to The Guardian.Responding, Hancock said officials informed him that "everything that was recommended has been done".
Moosa Qureshi is a National Health Service doctor campaigning for disclosure of the results of Exercise Cygnus following the 2020 COVID-19 outbreak.According to Dr Qureshi, who has experience treating leukemia patients severely impacted by COVID-19, healthcare should be built on transparency and collaborative peer review. In April 2020, he raised more than £46,000 through crowdjustice.com for this cause. Dr Qureshi, represented by UK solicitor Leigh Day, filed action against Matt Hancock for withholding the reports following Exercise Cygnus. In response to the UK government's refusal on the grounds of inciting public fear, Dr Qureshi pursued legal action under both the Freedom of Information Act and an application for Judicial Review. On 28 September 2020, the Information Commissioner's Office ordered the Department of Health and Social Care to respond to Dr Qureshi's Freedom of Information request, and Matt Hancock announced publication of "the report into Exercise Cygnus" on 20 October 2020. Following publication, and following the Department of Health's confirmation that it held no further reports evidencing the findings of Exercise Cygnus, Dr Qureshi withdrew his legal action for Judicial Review. However, questions were later raised about whether the Government had disclosed all relevant material, and Dr Qureshi argued that the Department of Health continued to withhold a plan for surge capacity and "refusing NHS care to large numbers of sick patients" in the event of an overwhelming pandemic.
This section needs to be updated.(November 2020)
In March 2020, according to The Sunday Times, Downing Street officials found follow-up planning from Exercise Cygnus lacking, with one stating that it "never went into the operational detail".
In late April 2020, The Observer reported that the government had been threatened with legal action over demands to publish the results of the study. 's sister paper The Guardian on 7 May 2020.A version of the report, classified as "Official – Sensitive", was leaked and published (with redaction of some contact details) in The Observer
As of October 2020 [update] , legal action is in progress to force the Department of Health and Social Care to publish the full report and other supporting documentation related to Exercise Cygnus.
In November 2020, Liberal Democrat MP Tim Farron submitted a written question to the Secretary of State for Health and Social Care asking whether the full findings of Exercise Cygnus will be published; no immediate answer was forthcoming.
Following the UK's response to COVID-19 in 2020, criticism arose questioning whether the findings of Exercise Cygnus have been implemented.In June 2020, an enquiry by the House of Lords was conducted to investigate if follow-up actions had been executed as suggested. Baron Bethell raised several concerns including persistent lack of medical equipment in United Kingdom during the COVID-19 pandemic, despite it being previously identified as a weakness through Exercise Cygnus. An explanation given was that Exercise Cygnus was based on a curable influenza, whereas treatment for COVID-19 is still unavailable. In November 2020, the Department of Health and Social Care website stated that findings from Exercise Cygnus, coupled with suggestions from scientific experts, have incorporated in the United Kingdom response to COVID-19.
In July 2020, a request under the Freedom of Information Act was filed by an anonymous citizen nicknamed "P Newton" to seek further transparency of Exercise Cygnus.His Freedom of Information request to Department of Health and Social Care was unanswered twice. It was subsequently rejected by the UK government under Section 35(1)(a) of the Freedom of Information Act on the basis that full disclosure of results would affect the ongoing progress of policy making by ministers.
In August 2020, Public Health England was placed under a new organisation, the National Institute for Health Protection.
Following Exercise Cygnus and COVID-19, several health professionals working on epidemics and primary care have provided suggestions to help the UK manage pandemics more effectively. Areas of improvement identified include bridging disease communication by focussing on specific vulnerable demographic groups and relaying layman instructions to control transmission.
Exercise Cygnus led to the development of a pandemic influenza draft legislation "Pandemic Influenza Draft Bill", a collaboration by Civil Contingencies Secretariat (CCS), Department of Health and Social Care and Devolved Administrations. This later formed the basis for further developed into the Coronavirus Act 2020.Legislation easements drawn from Exercise Cygnus include emergency recruitment and registration of retired healthcare professionals and protection against clinical negligence action for health workers.
The complete 57-page report was released by the Department of Health and Social Care on 23 October 2020.
The Telegraph raised doubts as to whether full implementation of improvements were conducted before COVID-19, as previously reassured. Six possible areas of contention were identified. Key complaints include: improper management of surge capacity, incomplete "silo planning between and within organisations", disorganised school closures, consistent lack of funding for care homes, inefficient public communication and lack of social distancing which were still unresolved during COVID-19.
In a 2020 policy paper titled "UK pandemic preparedness", the Department of Health and Social Care states that it will continue to incorporate lessons learnt from Exercise Cygnus (2016) into future pandemic control protocol, coupling it with insight from COVID-19 (2019) response. In March 2020, the coronavirus action planwas published by the UK government, adopting and tweaking recommendations from Exercise Cygnus to suit coronavirus rather than influenza virus.
The Strategic National Stockpile (SNS), originally called the National Pharmaceutical Stockpile (NPS), is the United States' national repository of antibiotics, vaccines, chemical antidotes, antitoxins, and other critical medical supplies. As its website states:
"The Strategic National Stockpile's role is to supplement state and local supplies during public health emergencies. Many states have products stockpiled, as well. The supplies, medicines, and devices for life-saving care contained in the stockpile can be used as a short-term stopgap buffer when the immediate supply of adequate amounts of these materials may not be immediately available."
Healthcare in Wales is mainly provided by the Welsh public health service, NHS Wales. NHS Wales provides healthcare to all permanent residents that is free at the point of need and paid for from general taxation. Health is a matter that is devolved, and considerable differences are now developing between the public healthcare systems in the different countries of the United Kingdom, collectively the National Health Service (NHS). Though the public system dominates healthcare provision, private health care and a wide variety of alternative and complementary treatments are available for those willing to pay.
The Biomedical Advanced Research and Development Authority(BARDA) is a U.S. Department of Health and Human Services (HHS) office responsible for the procurement and development of medical countermeasures, principally against bioterrorism, including chemical, biological, radiological and nuclear (CBRN) threats, as well as pandemic influenza and emerging diseases. BARDA was established in 2006 through the Pandemic and All-Hazards Preparedness Act (PAHPA) and reports to the Office of the Assistant Secretary for Preparedness and Response (ASPR). The office manages Project BioShield, which funds the research, development and stockpiling of vaccines and treatments that the government could use during public health emergencies such as chemical, biological, radiological or nuclear (CBRN) attacks.
Public Health England (PHE) was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as a result of the reorganisation of the National Health Service (NHS) in England outlined in the Health and Social Care Act 2012. It took on the role of the Health Protection Agency, the National Treatment Agency for Substance Misuse and a number of other health bodies. It was an executive agency of the Department of Health and Social Care, and a distinct delivery organisation with operational autonomy.
Simon Laurence Stevens, Baron Stevens of Birmingham, Kt is a British health manager and public policy analyst who served as the eighth Chief Executive of the National Health Service in England from 2014 to 2021.
Jennifer Margaret Harries is a British public health physician who has been the chief executive of the UK Health Security Agency and head of NHS Test and Trace since April 2021. She was previously a regional director at Public Health England, and then Deputy Chief Medical Officer for England from June 2019 to April 2021.
"Catch It, Bin It, Kill It" is a slogan used in several public health campaigns of the British government to promote good respiratory and hand hygiene by recommending carrying tissues, using them to catch a cough or sneeze, disposing of them immediately in a waste bin and then killing any remaining viruses by washing hands or using hand sanitiser. In 2007, following evidence that good respiratory and hand hygiene might reduce the spread of flu, the phrase appeared in a government campaign that publicised the directive "Catch it, Bin it, Kill it" throughout the NHS, on buses and trains and in libraries, shopping centres and police stations.
The COVID-19 pandemic was first confirmed to have spread to Scotland on 1 March 2020 with the positive COVID-19 test of a male Tayside resident who had recently travelled between Scotland and northern Italy. The first reported case of community transmission was on 11 March 2020 and the first reported coronavirus death in Scotland was on 13 March 2020.
Shortages of medical materials, manufacturing and consumer goods caused by the COVID-19 pandemic quickly became a major issue worldwide, as did interruptions to the global supply chain, which has challenged supply chain resilience across the globe. Shortages of personal protective equipment, such as medical masks and gloves, face shields, and sanitizing products, along with hospital beds, ICU beds, oxygen therapy equipment, ventilators, and ECMO devices were reported in most countries.
The COVID-19 pandemic was confirmed to have spread to Wales on 28 February 2020, with a case being reported in the Swansea area; this first known case was a person who had recently returned from Italy. The first known case of community transmission was reported on 11 March in the Caerphilly area.
In response to the COVID-19 pandemic in the United Kingdom, Her Majesty's Government have enacted various public health and economic responses to mitigate its impact. Devolution has meant that the four nations' administrative responses to the pandemic have differed; the Scottish Government, the Welsh Government, and the Northern Ireland Executive have produced different policies to those that apply in England. Numerous laws have been introduced throughout the crisis.
Planning and preparing for pandemics has happened in countries and international organizations. The World Health Organization writes recommendations and guidelines, though there is no sustained mechanism to review countries' preparedness for epidemics and their rapid response abilities. National action depends on national governments. In 2005–2006, prior to the 2009 swine flu pandemic and during the decade following it, the governments in the United States, France, UK, and others managed strategic health equipment stocks, but they often reduced stocks after the 2009 pandemic in order to reduce costs.
The following is a timeline of the COVID-19 pandemic in the United Kingdom from January 2020 to June 2020.
NHS COVID-19 is a voluntary contact tracing app for monitoring the spread of the COVID-19 pandemic in England and Wales. It has been available since 24 September 2020 for Android and iOS smartphones, and can be used by anyone aged 16 or over.
NHS Test and Trace is a government-funded service in England, established in 2020 to track and help prevent the spread of COVID-19. Despite its name, the programme is not in fact run by the NHS but is part of the UK Health Security Agency; the service and the agency are headed by Jenny Harries.
The following is a timeline of the COVID-19 pandemic in England from January 2020 to June 2020. There are significant differences in the legislation and the reporting between the countries of the UK: England, Scotland, Northern Ireland, and Wales.
In response to the COVID-19 pandemic in the United Kingdom, the British government decided in March 2020 to rapidly place contracts and recruit a number of individuals; shortages of personal protective equipment were a particular political issue for the second Johnson ministry. This led to a number of contracts being awarded without a competitive tendering process, and friends of political figures and people who had made political donations were fast-tracked into contracts. Accusations of cronyism or a "chumocracy" were made, with Transparency International UK finding that one-fifth of the contracts "raised red flags for possible corruption".
The COVID-19 vaccination programme in the United Kingdom is an ongoing mass immunisation campaign for coronavirus disease 2019 (COVID-19) during the COVID-19 pandemic in the United Kingdom. The UK's vaccination rollout was the world's first mass immunisation programme for the disease when it began on 8 December 2020 after Margaret Keenan received her first dose of two. As of 6 October 2021, 49,068,705 first doses and 45,078,529 second doses of a vaccine had been administered across the UK.
Exercise Alice was a British Middle East respiratory syndrome (MERS-CoV) pandemic modelling exercise from 2016 involving officials from Public Health England and the Department of Health and Social Care and led by the Chief Medical Officer. The details of the exercise was kept secret on grounds of national security until October 2021.
The United Kingdom's response to the COVID-19 pandemic with consists of various measures by the national health services community; the British and devolved governments; the military; and the research sector.