Coronavirus simulation report Exercise Alice among seven released after campaign by NHS doctor Moosa Qureshi

Exercise Alice was carried out in 2016 and identified 12 specific actions and four key themes that Public Health England should address to make the NHS ready to cope with Middle East Respiratory Syndrome Coronavirus (MERS-CoV): quarantine versus self-isolation, levels of PPE, community sampling planning and effective and consistent public messaging.

Dr Moosa Qureshi, whose Freedom of Information requests and complaints to the Information Commissioner’s Office (ICO) secured the release of the reports, says the conclusions of Exercise Alice beg the question why Public Health England modelled its response to the COVID-19 pandemic on an influenza outbreak and not on lessons learned during Exercise Alice. The 2016 report identified key issues which needed to be looked at more closely such as quarantine and self-isolation requirements, the level of PPE and the setting up of a proper contact tracing system, yet when the Covid 19 pandemic broke in 2020 the Government discharged positive covid cases into care homes and did not have a contact tracing system which could be brought immediately into action.

A key paragraph is this, says Dr Qureshi, pictured:

"There was a general consensus on the need to identify capacity and capability of assets within the health system. Assets in this context would be all resources that would be required to effectively respond to a MERS-CoV outbreak such as trained personnel, appropriate PPE in sufficient quantities and the requisite beds with suitable clinical equipment."

The Exercise Alice report was released this week after Dr Qureshi told PHE that he would complain to the ICO over a lack of progress with his FoI request. PHE had resisted the release on the basis that it “could precipitate an unnecessary heightened public concern that could lead to loss of public confidence in the Government’s and the NHS’s COVID-19 response”. PHE said the report was covered by the exemption of Section 36 of the Freedom of Information Act: prejudice to the effective conduct of public affairs.

Following an intervention by the ICO Dr Qureshi has also secured the release of the report into Exercise Typhon, which PHE had been withholding on national security grounds. The ICO told PHE that it had failed to demonstrate that Section 24 of the Freedom of Information Act exempted it from releasing the material.

In February 2017 Exercise Typhon tested NHS capacity to cope with Lassa, viral haemorrhagic fever, which Dr Qureshi argued was in the public interest as a model of preparedness for similar emerging diseases.
Exercise Typhon identified lessons to be learned in leadership and communication.

Dr Qureshi secured the names of 11 reports into pandemic preparedness in June 2021 and following further Freedom of Information requests, PHE disclosed the contents of reports into Exercise Broad Street, Exercise Cerberus, Exercise Northern Light, Exercise Pica, and the Ebola Preparedness Surge Capacity Exercise in August.

Of those, most significant are the findings of Exercise Broad Street and Exercise Pica.

Exercise Broad Street, a 2018 testing of the UK’s readiness to deal with a high consequence infectious disease, revealed concerns about surge planning for airborne pathogens.

Exercise Pica, a 2018 report on how primary care would deal with a severe pandemic influenza for which there was no vaccine and no immunity, “was reassuring” said PHE. It was based on the premise that there were national stockpiles of PPE in place for healthcare workers to treat half the population and anticipated an upsurge in mental health care demand. It highlighted the need for “co-ordinated communications”, remote working by primary care staff and the possibility of fuel and staff shortages.

Dr Qureshi has been represented by law firm Leigh Day throughout his legal campaign for transparency into how well the government had prepared the NHS for the eventuality of a pandemic. His persistence, including an application for judicial review, finally led to the publication of the report into Exercise Cygnus in October 2020.

Dr Moosa Qureshi said:

“The Department of Health argued that Exercise Cygnus was not relevant for COVID-19 because it modelled an influenza pandemic, not a coronavirus. In fact, the disclosure of these seven reports shows a range of pandemics were modelled in the five years leading up to COVID-19. Disgracefully, the Government covered up Exercise Alice – a coronavirus exercise which predicted the importance of isolating patients, contact tracing, PPE provision, trained personnel and adequate NHS beds. The fact that COVID-19 is a novel type of coronavirus is irrelevant – every pandemic is different, but the lessons of Exercise Alice were generally applicable to coronaviruses including COVID-19, they were agreed by general consensus, and both political leaders and NHS England executives failed to implement that consensus. They failed to maintain contact tracing capacity and isolate patients, they failed to provide adequate PPE, and they cut NHS beds. Going forward, future pandemics remain at the top of our national risk register, and we will continue our legal campaign to establish a new paradigm of transparency and accountability for pandemic preparedness."

Leigh Day partner Tessa Gregory said:

“The case for transparency on the Government’s pandemic preparedness has always been overwhelming. Our client should not have had to repeatedly involve the Information Commissioner to secure the publication of these important reports. It is time for Public Health England and the Department of Health to disclose all the information they have in their possession including what follow up action was taken after Exercise Alice in 2016 and why matters such as a proper working contact tracing system had not already been set up. The public have a right to know about the steps the Government took and didn’t take to prepare for pandemics and full disclosure is essential in order to manage COVID-19 and future pandemics effectively.”

Dr Qureshi is crowdfunding his legal campaign and the seven documents are available to download here.