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What This Chart Actually Means for COVID-19

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Britain's approach

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It was on Wednesday March 11 - 10 days ago - that some of the experts on the government's Scientific Advisory Group for Emergencies began to realise that the coronavirus was spreading through the UK too fast for the NHS to cope.

Over the next few days, Britain's leading epidemiologists were embroiled in a series of extremely tense - and until now private - discussions among themselves, with the UK's chief scientific advisor Patrick Vallance, and Boris Johnson's government over what to do.

There was no consensus. Several of the scientists frantically argued that the UK must immediately introduce social distancing to halt the spread of the virus. Some pleaded with the government to change tack or face dire consequences.

But others continued to believe that introducing social distancing now would be unsustainable for a long period and would lead to a more disastrous second wave of infection.

The days-long debate between the experts themselves and with the government was "heated" and "extremely difficult", multiple sources familiar with the discussions told BuzzFeed News. Vallance admitted as much at a health select committee hearing this week: "If you think SAGE is a cosy consensus of agreeing, you're very wrong indeed".

The extent of the disagreement between the nation's top scientists and the government can be revealed at the end of one of the most extraordinary weeks in modern British history.

As chancellor Rishi Sunak unveiled an unprecedented package of state intervention in the economy, and Johnson enforced the closure of pubs, restaurants, theatres and gyms, it also emerged that: Ministers have criticised the prime minister's senior aides for "outsourcing" leadership on coronavirus to a small group of experts; Downing Street is still considering a partial lockdown of London in the coming weeks; and cabinet secretary Mark Sedwill introduced a series of new Whitehall structures after concerns that the government was acting too slowly on both its health advice and its economic response.

While the scientific debate was raging last week between experts, officials and ministers in face-to-face meetings and over emails and text messages, Johnson's government was publicly insisting that the scientific advice showed the UK did not yet have to bring in more stringent measures to fight the virus.

Political aides tacitly criticised other countries who had taken more dramatic steps, claiming Britain was being "guided by the science" rather than politics.

Towards the end of last week, some ministers and political aides at the top of the government were still arguing that the original strategy of home isolation of suspect cases - but no real restrictions on wider society - was correct, despite almost every other European country taking a much tougher approach, and increasing alarm among SAGE experts.

The thought of months or even a year of social distancing was simply not feasible, some in Johnson's team still thought at that point. They continued to privately defend the controversial "herd immunity" approach outlined to the media by Vallance, even as other aides scrambled to claim the UK had never considered it to be policy.

And there was fury behind the scenes among members of Johnson's team at the likes of Rory Stewart and Jeremy Hunt, who had been publicly saying the government had got it wrong.

But data from Italy - presented to the government before it was published by experts at Imperial College on Monday - changed all that. Their report confirmed the earlier fears of the epidemiologists who had been calling for more drastic action.

It showed that the NHS would indeed soon be overwhelmed if the UK's "mitigation" strategy continued. The country had to move right away to a "suppression" approach with much more social distancing and restrictions on normal life, Imperial concluded.

Vallance and Johnson accepted the chilling findings and the prime minister finally advised social distancing on Monday. The experts who had been demanding this for days wondered what the lost time would mean in terms of deaths.

They also raised concerns that the government must be completely transparent with the public, questioning why Vallance later chose to describe the difference between the mitigation and suppression strategies as "semantics". "This will all come out in the mother of public inquiries," a source said.

"If you want to know how much we underestimated this, last Wednesday Rishi's budget gave a £30 billion stimulus for the economy, six days later he had to spend another £330 billion," said a Whitehall official.

Allies of Johnson strongly defended his performance over the last two weeks to BuzzFeed News. They said no British government since the Second World War had been forced to deal with a crisis on this scale, and stressed that both the volume of decisions that had to be taken and the enormity of those decisions meant that they could not get everything right straight away.

Johnson's own personal views on the role of the state have also been a major factor, according to those familiar with his thinking. The prime minister has held deep ideological reservations about turning Britain into an effective police state, as some other countries have done. On Wednesday, Johnson told a press conference that the UK was a "land of liberty", but warned he would take further measures to enforce social distancing if necessary.

A lockdown at least in part reminiscent of what has happened in Italy and France is still being considered at the top of government if the situation worsens in the weeks ahead, despite Downing Street denying that it would happen. "This will be the hardest decision he will ever make," a source said of the PM.

While the crisis that Johnson faces is undoubtedly unprecedented, there is significant criticism of Number 10's handling of the situation across the government and the Conservative Party.

Chief among them is the view - expressed by several ministers and Tory MPs to BuzzFeed News over the last few days - that Johnson and his chief aide Dominic Cummings have effectively "outsourced" the government's decision-making process to Vallance, the chief medical officer Chris Whitty, and a small team of scientific advisers.

While Downing Street's deference to the experts won plaudits early on, this approach has turned out to be lacking, the ministers and MPs said, because the scientists themselves disagreed on what to do. One minister said that it was then the political responsibility of Johnson and Number 10 to decide which scientists to back, but described a "vacuum of leadership" among aides.

The minister told BuzzFeed News that Cummings and Vallance were "close allies" and claimed the government had "bet" the future of the UK on advice from a very small group of scientists that for a long time differed from the wider international consensus, and other members of SAGE.

They said they had been reassured that Sedwill had taken on a greater role in setting up new structures to manage the crisis over the last few days.

On Tuesday, the cabinet secretary established four implementation committees - chaired by Sunak, health secretary Matt Hancock, foreign secretary Dominic Raab, and Michael Gove - to form a "war cabinet" that is providing greater political and civil service support to the experts and Number 10. Senior officials from across Whitehall have been drafted in by Sedwill to head up work on coronavirus.

The new structures have begun to improve the government's response, insiders said, but there is a general belief that this should have happened days or even weeks earlier - and if it had, Johnson and Sunak would have been able to announce this week's health and economic measures sooner and in a more joined-up way.

One cabinet minister said that the culture instilled by Johnson's Downing Street operation had not helped in terms of quickly and smoothly implementing radical policy changes, suggesting that the personal style of some aides had made it harder for issues to be raised internally.

Widespread disquiet at the slow pace of the government's response to coronavirus blew into the open on Thursday, as Tory MP after Tory MP stood up in the House of Commons to lambast the Treasury for taking too long to announce safeguards for workers, businesses and those on benefits.

While French president Emmanuel Macron announced a full package to safeguard his economy largely in one go, it took Sunak five days to come up with Britain's own response.

The government's failure to announce a full suite of economic measures simultaneously to Johnson's statement on social distancing on Monday, coupled with Sunak's statement on Tuesday missing out measures on wages, as well as the further delay on that announcement to Friday, had likely led to thousands of layoffs across the country, the cabinet minister said.

Even the massive economic package for workers and businesses eventually delivered by Sunak on Friday is not complete. There is a growing Tory backbench rebellion on the lack of measures aimed at self-employed people. MPs expect Sunak to have to "go further" once again next week to protect the self-employed.

Despite the prime minister's praise for Londoners, there is increasing concern in Downing Street the public is so far not heeding his advice to avoid unnecessary social gatherings.

It is believed that in particular, millennial men have been the worst offenders at failing to reduce their contact with other people, continuing to visit pubs, travel widely and take part in other social events, despite being told that doing so risks the lives of the elderly and vulnerable.

On Wednesday, health minister and recent coronavirus sufferer Nadine Dorries blasted the "selfishness" of Londoners who have been failing to follow social distancing advice.

But there is also criticism within government of Downing Street's messaging. While France and Italy used the law to enforce social distancing, and Australian prime minister Scott Morrison gave an impassioned speech telling people to stop hoarding, Johnson gave a press conference on Thursday where the cut-through message was one of optimism that coronavirus can be defeated, rather than a stern order about the nation's behaviour.

The length of time to announce measures has also inevitably resulted in widespread speculation about what is coming next, which in turn has led to increased panic-buying from some sections of the public.

Some ministers want Johnson to deliver a starker warning to the country about how difficult life is about to become in the UK over the next few weeks.

"This is going to get much, much worse, very quickly, both in terms of deaths and the economy," the cabinet minister said. "It will not be long before we are getting numbers like Italy. I don't think people realise that yet."

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10 Days That Changed Britain: "Heated" Debate Between Scientists Forced Boris Johnson To Act On Coronavirus

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"This is going to get much, much worse, very quickly, both in terms of deaths and the economy," a cabinet minister told BuzzFeed News. "It will not be long before we are getting numbers like Italy. I don't think people realise that yet."

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The coronavirus has infected far more people in the United States than testing has shown so far, and stringent measures to limit social contact in parts of the country not yet seeing many cases are needed to significantly stem the tide of illness and death in the coming months.

Those are the conclusions of Columbia University researchers who used a New York Times database of known cases and Census Bureau transportation data to model how the outbreak could evolve based on what is known about the virus. The estimates are inherently uncertain, and they could change as America adopts unprecedented measures to control the outbreak.

But they offer a stark warning: Even if the country cut its rate of transmission in half - a tall order - some 650,000 people might become infected in the next two months.

The growth is driven by Americans with mild symptoms who are carrying and spreading the virus without being aware that they have it, the researchers say. The number of undetected cases - 11 times more than has been officially reported, they estimate - reflects how far behind the United States has fallen in testing for the virus.

New York City, Seattle, Boston and parts of California already have such large outbreaks that they will probably see significant growth even after taking extraordinary measures over the past week, the researchers say. New York City's outbreak, the nation's largest, grew to more than 4,000 known cases on Friday and is likely to increase many times over even in a favorable scenario.

On the other hand, parts of the country without large clusters of cases could still avoid the worst of the outbreak - if they impose measures like closing schools, banning mass gatherings and testing and quarantining sick people and their contacts. The epidemic would then spread inland at a much slower pace and strike with less severity, the estimates say.

But controls would need to be put in place immediately, and everywhere.

"We're looking at something that's catastrophic on a level that we have not seen for an infectious disease since 1918," said Jeffrey Shaman, a professor of environmental health sciences at Columbia and the leader of the research team, referring to the Spanish flu. "And it's requiring sacrifices we haven't seen since World War II. There are going to be enormous disruptions. There's no easy way out."

Controls in many places have already changed the fabric of American life. Restaurants and schools have closed, people are working from home and travelers have put off trips - all changes that should reduce the rate of infection. In California, New York and Illinois, officials have announced more stringent directives aimed at stopping the spread. That means that at least 1 in 5 Americans will be under orders to stay home in the coming days, and more states are expected to follow suit.

But other places have resisted. Bars and restaurants remain open in Wichita, Kan., in a county that reported its first case on Thursday night, and in Knoxville, Tenn., where reports of the virus have been scarce. Some malls remain open in Chicago, recreational marijuana shops in Oregon, and some retail chains nationwide. Many businesses are still requiring workers to come into the office.

"I'm not really supportive yet of restricting things further or closing down," said Pete Meitzner, head of the Board of County Commissioners in Sedgwick County, which includes Wichita, a city of about 400,000. Mr. Meitzner said he was growing increasingly anxious at the possibility that people who do not know they are ill might spread the virus, but that he also needed to consider the fate of workers as the community decided whether to close buildings.

"Some of our public offices and buildings are, but I do feel horrible for our restaurant workers and our hospitality workers at our hotels," he said. "They are really suffering."

Of the area's relative dearth of cases, Mr. Meitzner added, "We don't know for sure if we're lucky or what."

The scenarios do not estimate what effect individual local actions will have on the outbreak. But if the country as a whole does not take collective action, they suggest that Sedgwick County could see a significant proportion of its population - hundreds of thousands of people - infected with the virus in the next two months. If the country, as a whole, can reduce rates of transmission by 50 percent, Sedgwick County could instead see fewer than 1,000 cases in that time.

Several researchers not involved in the Columbia University analysis who reviewed the findings said they made sense and broadly agreed with their own thinking. Even in places that now appear to have few cases, they said, officials should act sooner rather than later.

"You have to think of this as an insurance for the future: The earlier you do it, the greater effect you have on the virus," said Alessandro Vespignani, director of the Network Science Institute at Northeastern University, who said the estimates were in line with his own projections. "It's better to take excessive precautions than not."

The economic challenges of that loom.

"We're staying open until someone forces us to shut down," Beau McKee, the general manager at Not Watson's Kitchen and Bar in Knoxville, said in a telephone interview, as dishes clattered in the background. "I feel like those people that are vulnerable know who they are and they should be careful, and we should continue testing. But small businesses are getting crushed."

Mr. McKee said he has grown increasingly worried about how the virus could affect his own father, in his 70s, but that there were other worries too. "At least we can offer a handful of people good-paying jobs and when we get out of this and we're on the other side, we'll hopefully have gained more clientele by doing so because we kind of stuck it out and didn't wave the white flag," he said.

The Columbia researchers' model works by observing the behavior of the outbreak in the United States up until March 13, based on case records compiled by The New York Times, commuting patterns and other data.

The researchers use those observations to infer key features of the outbreak. One is how many people each infected person has tended to infect so far, about 2.2. Another is how many people may pass on the virus without knowing that they have it. The disease is spreading far too fast to be explained by known cases alone, and only about 1 in 11 infections have been reported, they found.

Those factors allow the researchers to simulate the spread of a virus in the future. They adjust those simulations under different scenarios in which the nation imposes a range of control measures to stop the spread.

The estimates are imperfect, but they are consistent with the available data. It is impossible to know the exact number of cases a week ago or to predict the future. It is also impossible to model the precise impact of unprecedented measures that America has already put in place to control the outbreak.

But the research estimates that if measures to slow the disease are not effective, the virus could sicken millions of people or more, losing steam on the coasts in May before spreading to the rest of the country over the summer.

A worst-case scenario is unlikely to play out. A handful of countries, including China and South Korea, have managed to slow down their own fast-moving outbreaks through tracking and isolating sick people and reducing social contact. It is not known if measures imposed in the last week have started slowing the outbreak in the United States.

But the researchers' estimates show the enormity of the task. As in China, most of those who have been infected but not tested are likely to have mild symptoms, or none at all, the researchers say. That means they can spread the virus without being aware they are infected.

Several researchers said that the slow pace of testing in the United States is one major reason the proportion of unreported infections is so high here. Despite a ramping up of testing in recent days, the United States still lags both Italy and South Korea in the total number of people tested and in testing per-capita, figures show.

This map shows how many people the model estimates could get the virus in each county in the United States by two months from now.

One scenario - which is unlikely - simulates what could happen without any intervention. A second scenario envisions what would happen with some control measures, such as partial adherance to social distancing guidlines and a patchwork of government-imposed restrictions on work, travel, and dining out. A third envisions severe control measures: strict adherance across the country to social distancing, working remotely, closing schools and restaurants and banning large gatherings.

New York City, the model indicates, could count tens of thousands of new cases every day by late spring or early summer. But if the city remains vigilant about maintaining the stringent measures recently put in place, the peak could be delayed by weeks or longer and be significantly lower, the model suggests. Dr. Shaman cautioned that the model is designed to capture national trends, and local projections should be viewed as broad estimates.

"This is serious and this is real. We have to act now and act aggressive," Dr. Vespignani said. "We have to mobilize all the resources that we have. None of us has a single solution. But we have to try all of them."

In the days since New York's first recorded case, on March 1, the state has declared a state of emergency and deployed the National Guard to New Rochelle, an early focal point of the outbreak; New York City has closed schools and barred dining in at restaurants and watching Broadway shows.

But in places like Wichita, some parts of life have yet to change. In that city, bars and restaurants are allowed to operate freely as long as they keep crowds to fewer than 50 people.

Still, Beverly Salas, an owner of Egg Cetera, a downtown restaurant that serves brunch and late-night bites for the bar crowd, said she chose to close the restaurant anyway. "It was a hard decision, honestly, because we have no more income coming in," Ms. Salas, 24, said. But her customers include nurses from a nearby hospital and many people who are in their 60s or older, she said, and the thought that someone might somehow contract the illness at her small restaurant was too much for her to bear.

"I'm looking at other places like Italy and trying to avoid going through that," she said. "Why are we not taking it as seriously as New York, Chicago, or even Kansas City? I know we're a smaller town, but there are cases all over the country."

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Coronavirus Could Overwhelm U.S. Without Urgent Action, Estimates Say

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The coronavirus has infected far more people in the United States than testing has shown so far, and stringent measures to limit social contact in parts of the country not yet seeing many cases are needed to significantly stem the tide of illness and death in the coming months.