Those close to the PM feared he might die; others fought over who was running the country. Photo / AP
Ever since his near-deadly bout of coronavirus last year, debate has raged about the extent to which the experience changed Boris Johnson's approach to tackling the pandemic.
His most loyal aides have always insisted it did not change him at all, but some allies now privately concede that he did emerge from his hospital stay a different man.
"That whole near-death experience made him look at this through a different lens," said one. "After he came out of hospital... he started talking about how we could lose more people to Covid than we lost in the Second World War."
Irrespective of the effect his illness had on him, Johnson's stay in intensive care was almost certainly the closest Britain has come to losing a prime minister in office since Lord Palmerston in 1865.
Now, for the first time, some of those who were closest to the centre of power while Johnson's life hung in the balance have spoken about the moment they feared they might lose him, and the Cabinet infighting his absence prompted.
Johnson was taken into hospital on Sunday April 5 last year, and while he fought for his life, another battle was going on at the heart of government.
"It became a bit of a power struggle between different ministers," said one well-placed source. "We were trying to keep team spirit together but Michael [Gove] and Dom Raab were taking chunks out of each other, it was just awful.
"There was a lot of talk of how Dom was trying to consolidate power, Michael was trying to muscle in on various committees and there was just lots of this noise going on.
"The PM was the final decision-maker, meaning that while he was in hospital it all went to Raab, but Gove didn't like that at all." Another senior source said: "There was an element of Gove and Hancock auditioning to be PM. But Raab did an excellent job, he earned everyone's respect by standing in but not trying to be PM."
Others disagree. "We all know that Gove can be like that, but during that period he categorically wasn't," said one, before adding: "Admittedly, I can't say it was all peace and harmony... There was a bit of unease from the usual suspects and Cabinet colleagues had conversations with members who were being a little bit snippy."
It was on the evening of Thursday March 26 that Johnson tested positive for the virus, telling the nation he had "mild symptoms" but was continuing to lead the Government while self-isolating.
"He was working from Rishi Sunak's office because it is below the flat in No 11 where he and Carrie live," recalled one member of his team, "and the only people allowed to see him face to face were Martin Reynolds, his principal private secretary, and Lee Cain, his director of communications.
"There is a study and a private office with a door in between, and Martin and Lee would go into the other room and speak to him through the open door."
Carrie Symonds, his fiancée, was living elsewhere as a precaution because she was heavily pregnant. But as his mandatory one-week self-isolation period neared its end, he was getting worse, not better.
"It was obvious he was getting more ill," said a source close to the Prime Minister. "He was doing video messages for Twitter but he was taking five or six goes to get it right, where he is normally a one-take guy.
"Whenever people told him to take it easy he kept saying, 'Strong like bull, strong like bull.' Except he wasn't. One time he said that and he beat his chest, which triggered an uncontrollable coughing fit."
Last night, on the advice of my doctor, I went into hospital for some routine tests as I’m still experiencing coronavirus symptoms. I’m in good spirits and keeping in touch with my team, as we work together to fight this virus and keep everyone safe.
— Boris Johnson (@BorisJohnson) April 6, 2020
Johnson was having to manage without Dominic Cummings, his most senior adviser, who had driven from London to Durham with his family on March 27, the day after Johnson tested positive, and remained there until April 13 after suffering with Covid-like symptoms.
By the evening of Friday April 3, staff were so concerned about Johnson that a doctor was called, and on the Sunday that followed he called his key staff to tell them he was going into hospital.
At the time Downing Street said it was a "precautionary measure", but behind the scenes it was a different story.
"There was such a change in him," said one member of his team. "He wasn't fully engaging in conversations and he was detached."
Officials checked with him that he wanted Dominic Raab, the Foreign Secretary, to take over if he became incapacitated, and he confirmed Raab was "100 per cent" his choice.
The Prime Minister's blood oxygen levels had fallen dangerously low, and by the next day, Monday April 6, "the doctors were telling us it was looking pretty grisly", one source said.
Nominally at least, the Prime Minister remained in charge of the country, but at around 5.30pm, while Raab was taking a turn to host the daily Downing Street press conference, the phone on the desk of Cabinet Secretary Sir Mark [now Lord] Sedwill rang.
Sir Mark, who had been watching the press conference with his deputy Helen MacNamara, James Slack, the Prime Minister's official spokesman, and Martin Reynolds, answered the call, which was from St Thomas' Hospital.
"It was one of the two Nicks that rang," said a senior source [Dr Nick Price and Prof Nick Hart were in charge of his care]. "They said they were going to move him to intensive care."
They said it was a ghastly situation because it was 50-50 whether he would need to go on to a ventilator, and if he did go on to a ventilator it was 50-50 whether he would survive." In fact, the survival odds for Covid patients who were intubated were even lower than that at the time.
Another source said: "Undoubtedly that Monday evening was the lowest point. Going to bed that night was a scary time because you didn't know what you were going to wake up to the next day."
After the phone call from the hospital "things moved incredibly quickly", one insider recalled. After Raab finished his press conference he was called into Sir Mark Sedwill's office and told he was going to have to take over.
Cain had finished his own period of self-isolation that afternoon and drove to Downing Street, where he became "the Prime Minister's mouth in absentia", as one official described it. "There was a fear that the PM could die and everybody was determined to keep the ship moving on."
A Cabinet call was hastily arranged to update ministers, some of whom feared they were about to be told the Prime Minister had died. One person who was in No 10 at the time said: "It was surreal when we found out. It hit us like a freight train. There weren't many of us in Downing Street that day because a lot of people were working from home, so there wasn't much time to process it. We just had to get on with the job in hand."
Raab was sent on to the airwaves to reassure the nation that the Prime Minister was "in safe hands". At St Thomas', opposite Parliament on the other side of the Thames, Johnson was being given "litres and litres of oxygen", as he later said himself.
Johnson recalled in an interview last May that "the bloody indicators kept going in the wrong direction" and that "the doctors had all sorts of arrangements for what to do if things went badly wrong. They had a strategy to deal with a 'death of Stalin' type scenario. I was not in particularly brilliant shape and I was aware there were contingency plans in place".
At Conservative Party headquarters, staff held top-secret discussions about how to appoint a new leader without the need for an internal election, believing a contest would be unseemly after a prime minister's death. Back in Downing Street, staff avoided talking about what would happen if Johnson died.
"They were pretty tough days," said one insider. "We were trying to source PPE every morning, meanwhile the PM was getting a lot of oxygen and it was very scary for him. It wasn't until the Thursday that the messages from the hospital started to get more positive."
Along with Raab, Chancellor of the Duchy of Lancaster Gove, Health Secretary Matt Hancock and Chancellor Rishi Sunak were the ministers at the forefront of running the country while Johnson was in hospital.
One source said the balance between saving lives and saving the economy shifted when Johnson was off sick. "The debate started when the PM was in hospital," said one source. "Sedwill was pro-opening up. The two big political operators are the PM and the Chancellor and when the PM is away the officials gravitate towards the big beast who is left, who was the Chancellor."
Raab was helped in Downing Street by Reynolds, Cain, Slack and Isaac Levido, a pollster who had previously worked on the general election campaign and who had been drafted in from the private sector to help out in the crisis.
Cain, a former tabloid journalist whose previous jobs famously included dressing in a chicken costume to taunt David Cameron during the 2010 election campaign, effectively stood in for Johnson in key meetings by telling Raab what the Prime Minister's thinking was on any given subject.
"Lee was sighted on the papers that were being sent to Raab," said one source. "He got every box that went to Raab, and in the same way that he would challenge things before they got to the PM, Lee did that for Raab. He was the intermediary."
Another source said: "Lee was basically running the joint. Raab stepped in but Lee was very much running the No 10 operation. He was in all of the key meetings with Raab, as the PM's right-hand man in the room, saying what the PM would have done. I can't recall anything on which he and Raab disagreed."
Johnson was discharged from hospital on April 12, a week after he had been admitted, and went to Chequers to recuperate. Although no one knew it at the time, it was the same day as Cummings was making his infamous trip to Barnard Castle to "test his eyesight" before returning to London the next day.
At Chequers, Johnson was soon resuming work calls with, among others, the Queen and then-president Donald Trump. Trump said at the time: "He sounded incredible. He was ready to go - It's like the old Boris, tremendous energy, tremendous drive."
Cummings, meanwhile, was becoming ever more evangelical about the benefits of lockdown.
"He had always been in favour of lockdown, and argued for doing it earlier than we did," said one former colleague. "While he was off sick, he read loads of stuff about pandemics and came back telling everyone that the countries that did best were the ones that locked down early and didn't unlock too soon. He said those countries lost fewer people and took a smaller hit to their economies."
Johnson returned to Downing Street on April 27, "probably a week too early", one aide now admits, and told the nation there were "real signs now that we are passing through the peak" of the virus. Two days later, his son Wilfred was born.
So what effect did the Prime Minister's darkest hour have on him?
"I do think it changed him," said one friend of the Prime Minister. "He had been very hesitant about putting the country into lockdown, but after he came out of hospital, it's all been about protecting lives.
"He started talking about how we could lose more people to Covid than we lost in the Second World War."
Britain has already lost more people to Covid than died in the Blitz, but the war cost 450,000 British lives in total, or 0.94 per cent of the population, including 383,000 in the Armed Forces.
To date, Covid has taken 125,000 lives, or around 0.2 per cent of the population.
Those most loyal to Johnson continue to hold to the official line that the events of last April made no difference to his policies.
"He was pretty determined before he went into hospital, and he was pretty determined when he came out," said one. "The one obvious change was that he started talking a lot about how we were too fat as a country and people needed to lose some weight, including himself."
Another Johnson loyalist said: "It didn't change him at all. Both before and after he went into hospital he kept saying it was important the cure wasn't worse than the virus."
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