6 2GM Wednesday April 8 2020 | the times
News
Moments before eight o’clock last
Thursday night Boris Johnson emerged
onto his doorstep in Downing Street
and stood for just over a minute
applauding NHS staff in the frontline
fight against coronavirus.
It was the first time he had been seen
in public since he had entered self-
isolation six days earlier.
He was clearly suffering. The prime
minister knew how closely the footage
would be scrutinised but his fixed smile
was more of a grimace. There was none
of the usual Johnson exuberance — he
looked like someone just trying to get
through the moment.
Mr Johnson was well aware by then
that his symptoms were no longer
“mild”. If they had been, he would have
returned to work the following day in
accordance with the government’s
seven-day isolation rules.
Instead, it looked as though he was at
risk of falling into the category of those
whose condition worsens about a week
after they develop symptoms. Those
around the prime minister continued to
insist that all was well and his self-isola-
tion was continuing only because his
symptoms had not gone away.
However, The Times was told on
Wednesday last week that Mr Johnson
was “really rather ill”, and ministers
said he had looked very unwell during a
cabinet meeting held over Zoom, the
video conferencing app. There were
reports on Thursday that a bed had
been prepared for him at St Thomas’
Hospital.
These reports were all denied by
government spokesmen, but they had
not seen him either — and by the week-
end rumours about the prime minister’s
deteriorating health were spreading.
By Sunday the line could no longer
hold. Mr Johnson spoke to his doctors
in a video call and they became so
concerned that they advised him that
he needed to be in hospital. He agreed.
And so the prime minister joined nearly
20,000 of his fellow citizens who have
so far needed hospital treatment for
Covid-19.
Yet even on Monday No 10 was deter-
mined to project a sense of normality,
saying that the prime minister was
receiving red boxes in hospital. But as
that afternoon’s press briefing went on
Sir Mark Sedwill, the cabinet secretary,
was told that Mr Johnson’s condition
had significantly worsened.
A senior official said: “It was shock-
ing, really shocking, how fast things
moved.”
Sir Mark and Helen MacNamara, the
head of ethics who has become a key
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Coronavirus
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Days of whispers and worrying
News Coronavirus
official in Mr Johnson’s administration,
started to ready the machine for the
news that the prime minister was being
moved into intensive care.
Sir Mark briefed the cabinet via
videolink, and shortly after 8pm a
public statement was released.
In some ways the story of Mr John-
son’s illness, and those of many others
in Downing Street, are an apt illustra-
tion of how quickly Covid-19 spreads.
Two weeks earlier, in the days before
the lockdown, people in Downing
Street were not following any kind of
social distancing rules. Every senior
minister, official and health adviser
responsible for developing the UK’s
strategy spent hours in close quarters as
plans were drawn up and signed off.
One witness described a meeting at
which dozens of people, including the
prime minister, spent more than an
hour in a closed room. Some were
openly coughing, they said, and it was
all but inevitable that people were
going to be ill.
And they did. The first to go down,
about three days before Mr Johnson,
was a senior official who had been
briefing him. Then Matt Hancock, the
health secretary, developed symptoms,
followed by Mr Johnson and a few
hours later Chris Whitty, the chief med-
ical officer for England.
Behind the scenes the toll was even
more extensive. Dominic Cummings,
Mr Johnson’s chief adviser, became ill,
as did a significant number of more
junior officials and advisers.
Downing Street was transformed
from a hive of activity to being run by a
skeleton staff. Mr Johnson was rattling
around in No 11 when his partner,
Carrie Symonds, left to isolate in the
couple’s south London flat.
Martin Reynolds, his principal pri-
vate secretary, continued to fill his red
boxes as Mr Johnson filmed short
videos on his phone in an effort to show
the public he was still in charge. Some
thought he should have tried to rest
completely. Cabinet ministers told The
Times they had concerns that he was
being overworked.
One said: “Boris was doing worse
than people thought. There’s a real
question of who was looking after him.
The only person in that building that
really cared for his welfare was Carrie,
and she had to leave.”
Another cabinet minister said: “Boris
doesn’t like to admit to illness. His
instinct if asked how he is is to say he’s
doing brilliantly.”
However, Downing Street insiders
insisted that the prime minister’s
workload had been reduced. No one
can know if that made any difference.
But it was clear when Mr Hancock
re-emerged on Thursday and Professor
Whitty went back to work on Friday,
and Mr Johnson remained in isolation,
that the signs were not good.
Mr Johnson’s absence has left a
power vacuum that has led to sniping
between ministers and officials. Some
senior aides in Downing Street have
accused Sir Mark of not having a grip
on the crisis. There have also been
reports of tensions between Michael
Gove, the Cabinet Office minister, and
Mr Hancock, and of disagreements
between the Treasury and the health
department over preparations for the
eventual easing of the lockdown.
Oddly, Mr Johnson’s hospitalisation
may improve the situation. Dominic
Raab now has full authority to grip the
government’s response, so there will be
no political vacuum. Still Mr Johnson,
and his personal fight against Covid-19,
are at the front of everyone’s mind. As
Mr Raab said: “He is not just the prime
minister. For all of us in cabinet, he is
not just our boss. He is also a colleague
and he is also our friend.”Oliver Wright Policy Editor
Steven Swinford Deputy Political Editor
Francis Elliott Political Editor
Next fortnight
will be crucial
in his battle
for survival
Analysis
I
t was not, we can be fairly
certain, the hospital
handshakes that did it (Tom
Whipple writes).
At the beginning of March —
a month ago and a world away —
Boris Johnson was criticised after
saying that he had been going
around hospitals greeting patients
and, in defiance of the coronavirus,
shaking them by the hand.
Today Mr Johnson is back in
hospital for very different reasons,
and there is neither defiance nor
glad-handing.
As foolish as the handshakes
may have been, it seems far more
likely that his infection can be
traced to a fortnight later and
what could be called the “Cobra
cluster”. On the day when Britain
went into lockdown Neil Ferguson,the government’s leading adviser on
disease modelling, was in Downing
Street.
It turned out that he was also
providing a less than theoretical
lesson in disease spread — the next
day he would announce that he had
coronavirus. We will never know
for certain if he was “patient zero”
for the cabinet. We do know that in
the days that followed Matt
Hancock, the health secretary,
Chris Whitty, the chief medical
officer, and Dominic Cummings,
Mr Johnson’s chief adviser, all went
down with symptoms. And so, on
March 26, did Mr Johnson.
We understand enough about
the virus’s trajectory to know that
most people who get over it easily
do so in the first week in which
their symptoms appear. As Mr
Johnson compared notes with Mr
Hancock, who was diagnosed on
the same day, they would have not,
initially, felt that dissimilar. Inside
their bodies — most likely confined
largely to their noses and throats —
the coronavirus was reproducing,
multiplying, and recreating the
symptoms of a bad cold.
While Mr Hancock’s immune
system was already containing and
controlling the coronavirus, in
Mr Johnson, for whatever reason,
the infection was probably spreading
to his lungs. And, about ten days
after his symptoms began, theinfection had worsened to such an
extent that he had to go to hospital.
From the intensive care unit
there are two routes out: death or
discharge. According to very early
data, both are equally likely. That
bald statistic ignores both Mr
Johnson’s circumstances, however
— he is five years younger than the
average British coronavirus patient
in ICU — and the fact that the
present statistics are based on only
a fraction of cases. Most Britons
who have gone into ICU with this
virus are still there.
What we do know from
experiences abroad is that the next
fortnight is crucial. As more of
Mr Johnson’s cells die they will
be sloughed into his lungs,
clogging them with fluid and
debris. At the same time, doctors
now believe, he will be in danger of
a “cytokine storm”, in which the
immune system overreacts, rushing
in defensive cells and opening up
blood vessels — causing damage
and leading to yet more fluid on
the lungs.
If he can battle that and come out
the other side then, on average, we
would expect to see Mr Johnson
give a wave — albeit a feeble one —
from the steps of St Thomas’ about
18 days after symptoms began, the
weekend after next.
Patients who do not survive leave,
on average, four days after that.March 27
Boris Johnson announces that he has
tested positive for coronavirusMarch 28
The prime minister chairs a meeting on the
pandemic via videolink in Downing StreetMarch 29
He looks fatigued as he gives
an update while in self-isolationApril 1
Mr Johnson is described as being “really
rather ill”, despite releasing a video onlineApril 2
He appears on the doorstep at Downing
Street to applaud NHS workersApril 3
He continues to self-isolate due
to “persistent symptoms”