Immediately after Boris Johnson completed his evening news conference yesterday NZT, which saw a sombre Prime Minister encourage his fellow citizens to avoid "all nonessential contact with others," his aides hustled reporters into a second, off-camera briefing.
That session presented jaw-dropping numbers from some of Britain's top modellers of infectious disease, who predicted the deadly course of coronavirus could quickly kill hundreds of thousands in both the United Kingdom and the United States, as surges of sick and dying patients overwhelmed hospitals and critical care units.
The new forecasts, by Neil Ferguson and his colleagues at the Imperial College Covid-19 Response Team, were quickly endorsed by Johnson's Government to design new and more extreme measures to suppress the spread of the virus.
The report is also influencing planning by the Trump Administration. Deborah Birx, who serves as the coordinator of the White House coronavirus task force, cited the British analysis at a news conference yesterday, saying her response team was especially focused on the report's conclusion that an entire household should self-quarantine for 14 days if one of its members is stricken by the virus.
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The Imperial College group reported that if nothing was done by governments and individuals and the pandemic remained uncontrolled, then 510,000 would die in Britain and 2.2 million in the US over the course of the outbreak.
These kinds of numbers are deeply concerning for countries with top-drawer healthcare systems. They are terrifying for less-developed countries, global health experts say.
If Britain and the US pursued more ambitious measures to mitigate the spread of coronavirus, to slow but not necessarily stop epidemic over the coming few months, they could reduce mortality by half, to 260,000 people in the United Kingdom and 1.1 million in the US.
Finally, if the British Government quickly went all-out to suppress viral spread - aiming to reverse epidemic growth and reduce the case load to a low level - then the number of dead in the country could drop to below 20,000.
To do this, the researchers said, Britain would have to enforce social distancing for the entire population, isolate all cases, demand quarantines of entire households where anyone is sick, and close all schools and universities - and do this not for weeks but for 12 to 18 months, until a vaccine is available.
"We might be living in a very different world for a year or more," Ferguson told reporters.
The modellers did not give numbers for the US for the most intense suppression efforts.
The researchers reminded governments that these forecasts are based on current observed trends in China, South Korea, Britain and Italy but that much remains unknown about the virus.
The Imperial College report, which was shared with the British Government over the weekend ahead of its official release yesterday, was responsible in large part for Johnson's turnaround decision to begin rolling out what 10 Downing St described as life-altering, "drastic" measures to control the spread of the novel coronavirus, aides said.
Johnson said the virus "would overwhelm any health system in the world" if quarantines and limits on social contact are not taken. "Although the measures we have already announced are extreme, we may have to go further in the coming days," the Prime Minister said today.
If the US takes every possible mitigation effort to slow #COVID19 the impact will be tremendous -- fewer people hospitalized, far fewer deaths. But this calls for all-fronts-war on the virus.https://t.co/HxjLyp4LuA pic.twitter.com/jlW6NJV4HJ
— Laurie Garrett (@Laurie_Garrett) March 17, 2020
Johnson urged his fellow citizens to immediately start to avoid "all nonessential contact with others," work from home and self-isolate now if they are elderly or suffer from underlying medical conditions. The measures are still voluntary, but Johnson warned that his Government had the power to make them mandatory.
Johnson said that healthy and asymptomatic Britons should avoid pubs, clubs and theaters. In London, the bars were still open yesterday. Most schools, museums and restaurants were, too. But the Prime Minister said closing schools was "under consideration."
Roy Anderson, an infectious disease specialist at Imperial College London, who was not a part of this study, said Britain likely had much more to do. "I don't know if these measures are enough yet," he said. "And I wish we had done them last week."
If Britain had continued on the go-slow, step-by-step course that it set just days ago, the Imperial College modelling envisioned hundreds of thousands of deaths and a tidal wave of cases that would overwhelm the National Health Service and its hospitals. There are currently just 7000 ventilators available for all of England, the largest nation within the UK with a population of 56 million.
Imperial College estimates of severity of disease and #COVID19 fatality rates, by age group, is startling -- the range of CFR is enormous, hitting more than 9% of the >80 year olds. pic.twitter.com/dvLjrln6HP
— Laurie Garrett (@Laurie_Garrett) March 17, 2020
The British forecast also influenced thinking at the White House. Yesterday in Washington, US President Donald Trump said that Americans should avoid gathering in groups of more than 10 people, eating in restaurants or taking nonessential trips - his most significant push yet to combat a viral outbreak.
At a news conference, Birx said her group has been working with modellers around the globe, including in Britain.
"So, we had new information coming out from a model, and what had the biggest impact in the model is social distancing, small groups, not going in public in large groups. But the most important thing was if one person in the household became infected, the whole household self-quarantined for 14 days. Because that stops 100 per cent of the transmission outside of the household," she said.
To suppress spread in Britain, widespread school and university closings might also be necessary, though Ferguson worried about its impact on staffing at NHS hospitals, where as many as a third of nurses have school-age children, the Guardian newspaper reported.
What will go down as the biggest breakdown in the US response to #COVID19 is the lack of test kits. South Korea and the US had their 1st patients on Jan 20 and Jan 21, respectively. Look at the difference in daily testing. By March 4th, SK was ~18,000 per day. pic.twitter.com/466Du8Iq2V
— Eric Topol (@EricTopol) March 17, 2020
In their forecast, the modellers envision that strict measures over the coming months will occasionally be loosened, but as soon as they are, viral spread could come roaring back.
"The major challenge of suppression is that this type of intensive intervention package . . . will need to be maintained until a vaccine becomes available (potentially 18 months or more), given that we predict that transmission will quickly rebound if interventions are relaxed," the study concludes.
"Intermittent social distancing - triggered by trends in disease surveillance - may allow interventions to be relaxed temporarily in relatively short time windows, but measures will need to be reintroduced if or when case numbers rebound," the research team said.
"This is the calm before the storm. Before the surge. And when it comes, and it will come, never will so many ask so much of so few," Taoiseach Leo Varadkar says in address to Ireland.#StPatricksDay #coronavirus https://t.co/bfsSH7dccG
— Naomi O'Leary (@NaomiOhReally) March 17, 2020
The 'Dictator Approved' artwork shows a gold hand crushing the Statue of Liberty's crown.