“The scale of death was truly astounding”

In his testimony to the UK Covid inquiry this week, Kevin Fong finally laid to rest the myth that the NHS “coped” during the pandemic. But in some quarters the message has yet to land.

Lady Hallett, the chair of the UK’s Covid inquiry, has been quietly gathering evidence at a nondescript office building in west London for over two years now but, except when a prominent politician or senior government advisor testifies, the hearings rarely make the news.

However, since the latest module looking at the impact of Covid-19 on the health systems in Britain’s four nations opened three weeks ago, the hearings have come alive – and nowhere more so than on Thursday when Kevin Fong, a former clinical adviser in emergency preparedness, took the stand.

Best known as a presenter on Channel’s 4 Superhuman and for his BBC documentary on the final mission of the Space Shuttle, Fong wore a sharply tailored black suit for his appearance and delivered his testimony with the clarity you would expect from a seasoned broadcaster.

But unlike others who have testified before Hallett, there was nothing performative about what Fong had to say: this was raw and from the gut. More importantly, it was the first time we had heard in detail from a senior clinician who had been on the front line and could describe what it had been like to serve on an intensive care ward at the height of the pandemic.

Fong began slowly and calmly but by the end he was close to tears and, cumulatively, the effect of his testimony was devastating.

Remember, at the beginning of the pandemic journalists were barred from hospitals and, because of the fear of cross-infection, few relatives were permitted onto critical care wards to comfort their loved ones. Not so Fong, whose position as the national clinical advisor for NHS England’s Emergency Preparedness Resilience and Response (EPRR), gave him privileged access to the worst-affected hospitals in some of the most deprived areas of southern England. Fong’s testimony has been widely reported but it’s worth recalling some of the highlights.

Describing his visit to a large district hospital in April 2020, Fong said: “I was greeted at the entrance by one of the intensive care registrars. I asked him immediately what things had been like. I’ll never forget … He replied: ‘It’s been like a terrorist attack every day since this started and we don’t know when the attacks are going to stop.’

“The scale of death was truly, truly astounding,” Fong continued. “We had nurses talking about patients ‘raining from the sky’, where one of the nurses told me they got tired of putting people in body bags.”

Having worked shifts during both the 1999 Soho bombings and the London terrorist attacks in 2005, Fong thought he knew what it was like to serve during a disaster but Covid was “just like nothing I had ever seen.”

Usually, there would be one specialist nurse for every ICU patient or, at worst, a ratio of 1:2, but at one hospital Fong was astounded to see nurses treating between four to six patients. At another unit, Fong described how staff ran out of PPE and and had to wrap corpses in plastic body bags using cable ties. “These people are used to seeing death but not on that scale and not like that,” he said.

As he recalled what he had experienced, Fong found it difficult to contain his emotions. Using his position as EPPR national clinical lead, Fong tried to relieve the pressure on smaller hospitals by transferring critically ill patients to units with more capacity. But only the stronger patients could be safely transferred, leaving those who were weak and in most need of critical care on over-stretched wards. Following the onset of the second wave in January 2021, the situation soon became catastrophic. As one consultant at a small unit with capacity for nine critical care beds, confided in Fong in June 2021 at the end of that wave:

“We are broken; we are worse than broken. We can’t look after nine patients, we can’t surge to any more than that. And that consultant said … ‘look, we have run out of equipment, we have run out of drugs, we ran out of nurses, we ran out of goodwill.’ That is what this thing did to those people and those units.”

Listening to Fong’s testimony, one could sense his frustration. After one particularly harrowing shift, Fong had called his friend Jeremy Farrar, the then director of the Wellcome Trust and, at the time, a prominent member of SAGE, “to rant about how bad things were and how close to the edge I felt it all was.”

Farrar suggested Fong relay his concerns direct to Sir Patrick Vallance. “For me, it was all about the flow of information… trying to get the right information to the right people,” Fong explained. But, he admitted, “we sometimes couldn’t land that narrative.”

Throughout his testimony, Fong was keen to draw a distinction between data and information. “Data is not information or insight,” he told Hallett. “Not everything that counts can be counted”.

That is why he felt it was so important to visit the worst-affected units and relay what he was seeing on the ground to those, like Vallance and Whitty, who were in a position to take on board the information and act on it. Sitting in the headquarters of NHS England, Fong said it was“easy to convince ourselves that we knew what was happening but you don’t know”.

You don’t know unless you are the people going into that shop floor… You don’t know if you are not the people who held onto iPads while relatives are screaming down the phone…. You don’t know if you haven’t sat in a transfer vehicles next to a patient who is dying of Covid wondering if your PPE is buttoned up well enough that you might not do the same.

Listening to Fong’s testimony, it was hard not to conclude that, despite repeated assurances to the contrary, the NHS had been “overwhelmed” – if not during the first wave, then certainly during the second. However, that was not the view of the next witness: Chris Whitty.

This was not Whitty’s first turn on the witness stand – he has previously testified in modules one and two – and, though, compared to Fong, he cut a wan, almost passionless figure, as usual he came well-prepared.

Had anyone, at any point, thought to define what it might mean for the system to be “overwhelmed”, wondered Jacqueline Carey, the lead counsel to the inquiry? “Not really,” responded Whitty. “I think it [overwhelmed] has become, unfortunately, quite a loaded term.”

Yes, at times the NHS had been under intense pressure but the system never shut down and never stopped treating patients in need of urgent care. The result was that country avoided what could have been “an absolutely catastrophic situation”, said Whitty.

Pushed by Carey to explain then why 58 percent of healthcare professionals felt they lacked the resources to escalate patients to appropriate levels of care, Whitty replied that the problem was not unique to Covid. During bad winters prior to the pandemic, the NHS had also struggled, he said, before adding: “Pretty unsurprisingly for the biggest pandemic in 100 years, the system was unable to escalate things in the way it normally would.” The fact that the UK had a very low ICU capacity compared to other high-income countries, was “a political choice”, he insisted.

Whitty’s meaning could not have been clearer: don’t blame the medical profession for the parlous state the NHS found itself in at the beginning of the pandemic – that was down to politicians.

But these were not the comments that right-wing outlets chose to highlight. Instead, both The Telegraph and The Sun focussed on Whitty’s comments about whether he, and other experts, had been guilty of overstating the danger of Covid at the start of the pandemic – or, as Whitty put it, “over-pitching something… where in fact, the actuarial risk was low.”

“I think the balance is really hard, and arguably, some people would say, we, if anything, overdid it.”

It was left to Covid-19 Bereaved Families for Justice to spell out that the fears were real and not merely “acturial” and that the hellish scenes described by Fong “were not inevitable, can never be considered acceptable, and must never be repeated.”

That is a message, I fear, that has yet to “land” with the public. It will take many more moments like Thursday’s ­– and further testimonies from doctors and nurses who witnessed the devastation at close quarters – to remind people what really happened and counter the myth that the NHS somehow “coped”.