Throughout Monday, Downing Street insisted it was business as usual as Boris Johnson remained under observation in St Thomas’ Hospital on the south bank of the Thames facing the Houses of Parliament.
The UK prime minister had “persistent” coronavirus symptoms, but Number 10 said he remained in good spirits.
The government’s stance changed soon after 8pm. Downing Street announced that Mr Johnson’s condition had worsened during the day and he had been moved to an intensive care unit an hour earlier. Although Mr Johnson remained conscious on Monday evening, he was moved in preparation for possible ventilation in the future.
Before moving to intensive care, Mr Johnson formally asked his de facto deputy Dominic Raab to deputise “where necessary” during his recovery. The UK government does not have a formal chain of command for such circumstances, but Mr Raab is now effectively leading the UK government and heading its response to the coronavirus crisis.
The dramatic development was a marked change from the government’s position earlier in the day — that Mr Johnson was fully in charge from afar. His spokesperson had insisted he was in contact with Number 10 officials and ministers; still had his ministerial red box; and still had official paperwork.
At the daily Downing Street press conference on Monday, Mr Raab said the Johnson government was operating at “full throttle” despite the prime minister’s absence, with ministers and officials fulfilling his directions.
“He will continue to take doctor’s advice on what to do next and we have a team which, in the way I described, is full throttle, making sure his directions and his instructions are being implemented and followed through,” Mr Raab said.
Yet there were signs that Mr Johnson was more ill than Number 10 had publicly suggested. Mr Raab later added that he had not spoken to Mr Johnson since Saturday. Senior Downing Street officials indicated that the prime minister’s workload had already been reduced since he began self-isolating over a week ago.
Instead of being fully engaged with government and making decisions, Mr Johnson was primarily being updated on events. “He’s not been worked to the bone, people aren’t expecting him to be overloaded with work,” said one Number 10 insider. “He’s been kept updated over the last 24 hours. It’s very much him being given information right now. He won’t be doing a huge amount as the priority is for him to recover.”
While the prime minister remains in intensive care, Mr Raab will chair the key daily coronavirus planning meeting — known informally in government as the “war cabinet”. He is also expected to continue to lead some of the daily press conferences.
The acting prime minister said that he would continue on the trajectory set by Mr Johnson: “There’s an incredibly strong team spirit behind the prime minister, and making sure that we get all of the plans the prime minister’s instructed us to deliver to get them implemented as soon as possible.”
A full cabinet meeting is not due to take place this week, as parliament is in recess. The coronavirus war cabinet — which includes chancellor Rishi Sunak, health secretary Matt Hancock and Cabinet Office minister Michael Gove — will take its place.
Government insiders said that this trio of ministers, along with Mr Raab, are expected to lead the government’s efforts to combat coronavirus and interact with the public while Mr Johnson is focusing on his health.
“Rishi, Gove, Matt and Raab will keep driving it,” said one official. “The PM provides the overarching strategic view, but we can operate for a few days without kicking big questions back to Number 10. We know the direction, the departments can deliver.”
Whitehall departments are continuing to operate on the policies and strategy set by the prime minister. One official said the approach is currently to “take every day as it comes”.
But the question facing ministers is what the government should do if Mr Johnson is forced to spend further time in hospital just as the pandemic is expected to reach its peak in the UK, placing the country’s health services under intense pressure.
This coming weekend may be when the country reaches the peak of its coronavirus outbreak. Mr Hancock, who has overseen the NHS preparedness for the crisis, will continue to be in charge of ensuring hospitals and healthcare staff are as prepared as they can be.
But next week, the Cabinet faces a significant decision when the first three weeks of the UK’s lockdown is due to be reviewed. There is a widespread agreement across government that it will need to be renewed for at least another three weeks.
Concerns are growing within government about what the exit strategy from the lockdown will be, and whether the UK economy will remain shut down for weeks or months. So far the government’s stringent social-distancing measures have been broadly adhered to. Yet ministers are aware that Britons may soon start becoming exasperated.