Exercise Cygnus
Exercise Cygnus was a three-day simulation exercise carried out by NHS England in October 2016 to estimate the impact of a hypothetical H2N2 influenza pandemic on the United Kingdom. It aimed to identify strengths and weaknesses within the United Kingdom health system and emergency response chain by putting it under significant strain, providing insight on the country's resilience and any future ameliorations required. It was conducted by Public Health England representing the Department of Health and Social Care, as part of a project led by the "Emergency Preparedness, Resilience and Response Partnership Group". Twelve government departments across Scotland, Wales and Northern Ireland, as well as local resilience forums (LRFs) participated. More than 950 workers from those organisations, prisons and local or central government were involved during the three-day simulation, and their ability to cope under situations of high medical stress was tested.

The exercise was named 'cygnus' as the theoretical H2N2 virus was nicknamed "swan flu" and said to originate from swans, the latin name for which is cygnus.

In the scenario, participants were placed in the seventh week of the pandemic – the peak of the crisis, when there is the greatest demand for healthcare. At this stage, an estimated 50% of the population had been infected, with close to 400,000 deaths. The hypothetical situation was that the vaccine had been made and purchased but not yet delivered to the United Kingdom. Hospital and social care officials were to come up with emergency plans managing resource strain, while government officials were exposed to situations requiring quick decision-making. To make the situation more realistic, COBRA meetings were held between ministers and officials. Simulated news outlets and social media such as "WNN" and "Twister" were also employed to give fictitious updates. A government disclaimer on the UK pandemic preparedness website stated that Exercise Cygnus was not intended to manage future pandemics of different nature, or to pinpoint what measures to adopt to avoid widespread transmission.

Results from the exercise identified four main learning points and 22 further recommendations. In general, it showed that the pandemic would cause the country's health system to collapse from a lack of resources, with Sally Davies, the Chief Medical Officer at the time, stating that a lack of medical ventilators and the logistics of disposal of dead bodies were serious issues. The full results of the exercise remained classified up till October 2016 following public inquiry and pressure. In November 2020, the United Kingdom government stated that all identified lessons have been discussed accordingly and appropriately taken into account for its pandemic preparedness plans.

"The Daily Telegraph" reported one government source as saying that the results of the simulation were "too terrifying" to be revealed. According to "The Telegraph", the exercise led to assumptions that a "herd immunity" approach would be the best response to a similar epidemic. The "New Statesman" had been first to report on the results of Cygnus two weeks earlier. A partial report of findings was later released by British newspaper "The Guardian", leading to public dissatisfaction on how it was managed. In May 2020, when interviewed by "The Guardian", Martin Green, chief executive of Care England, one of the United Kingdom's biggest private care home companies, said that the government did not previously alert private health sectors to the lack of capacity should a pandemic arise.

A number of news reports have criticised the government's handling of the COVID-19 pandemic in the light of the conclusions reached by Exercise Cygnus. There was criticism that no follow-up document was written detailing how to deal with an influenza pandemic after December 2016. In March 2020, the three government documents available for response to COVID-19 were those published in 2011 ("Influenza Pandemic Preparedness Strategy"), 2012 ("Health and Social Care Influenza Pandemic Preparedness and Response") and 2014 ("Pandemic Influenza Response Plan") respectively, with no revised report following Exercise Cygnus and no mention of ventilators.

Despite a lack of ventilators being previously identified in Exercise Cygnus, there was a shortage of them during COVID-19 with the government stockpiles proving to be insufficient. In March 2020, six weeks following the first case of coronavirus in the United Kingdom, Matt Hancock, acting Health Secretary of the United Kingdom, turned to a range of corporations such as JCB and Rolls-Royce, stating, "If you produce a ventilator, we will buy it. No number [you produce] is too high".
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