A must-read thread by Professor Anthony Costello on mistakes in coronavirus response. Why Deloitte was brought in to help. How Public Health England – despite not having enough testing labs – wanted to keep control of the overall testing, forbidding outsiders to do testing until the end of March.

First published in May 2020.

Overcentralisation vs Self-organising.

The UK always had testing capacity.

Like Korea we developed a WHO approved test on January 10. But Korea immediately approached their pharmaceutical companies to help expand testing. We didn’t.

On January 28 the first SAGE meeting said we (Public Health England?) didn’t have testing capacity so it was ignored by modellers. But the UK has 44 molecular virology labs to do tests. Public Health England has only a handful but wanted to keep control.

The molecular virology labs were actually forbidden to do testing by Public Health England up until the end of March. And we have always had huge research capacity to do tests that wasn’t tapped.


On March 12 we stopped all community testing at a time when there were less than 10 deaths and only 500 confirmed cases countrywide. Most local authorities had tiny numbers of cases. Before we stopped we were only doing 1,500 tests per day. This should not have happened.

And contact tracing could have easily continued with local authority public health teams, GPs, environmental health officers and trained volunteers. Except maybe in London and the West Midlands. This would have reduced spread +++.

On March 13 the World Health Organisation pointedly reminded us that containment (test, trace, isolate) should NOT be stopped. Dr Tedros, Director General of the WHO, said “The idea that countries should shift from containment to mitigation is wrong and dangerous.”

We stopped containment.

On March 13 many, many of us tweeted and argued for a national lockdown. The government didn’t do it. On March 19 Sir Mark Walport, CEO of UK Research and Innovation and member of SAGE, told Robert Peston that I and others were “utterly wrong” and modelling would lead us.

Once the government got serious about testing, and appointed John Newton to lead it in April, we quickly scaled up our capacity, within 3 weeks. At their peak Korea only tested 18,000 tests per day for a population of 51 millions.

Republic of Korea test status. / Korean CDC Data

So why in May 2020 have we again ignored our local and molecular virology capacity for testing, and recruited new people and new labs through Deloitte for a centralised testing system? Is this sustainable and joined up with local authority and GPs needs?

And why have we gone to Serco to organise call centre contact tracing? Is this joined up with 111, or local public health outbreak management teams and GPs who provide 80-90% of all care and support?

And why invent a new complicated national app, that Dr Hannah Fry has serious doubts about, and needs piloting in the Isle of Wight?


South Korea set up a simple app in two weeks which was used just to allow people to report symptoms and local health workers to monitor quarantine.

The government has overcentralised and made poor decisions throughout. They ignore the ‘self-organising principle’: “structures where some form of overall order or coordination arises out of the local interactions between smaller component parts of an initially disordered system”.

Tweets posted on 6 May 2020 by @globalhlthtwit.

[This piece was first published as a Twitter thread and turned into the above article on 6 May 2020 with the purpose of reaching a larger audience. It has been minorly edited and corrected. | The author of the tweets writes in a personal capacity.]

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