The news that Boris Johnson had been moved into an intensive care unit on Monday night came as a shock in Westminster and Whitehall, after Downing Street had said a few hours earlier that he was still in hospital under observation after tests.
The prime minister’s coronavirus symptoms, described last week as mild, were now persistent but he was still receiving his official red boxes in hospital.
Dominic Raab, his de facto deputy, said Johnson was in good spirits and remained in control of the government as he continued to stay in touch with Downing Street colleagues.
But towards end of the press briefing Raab admitted that he had not spoken to the prime minister since Saturday, a day before Johnson was admitted to hospital with persistent symptoms of the coronavirus.
This raised the question of who was really in charge while the prime minister was in hospital and that of how, if he was ill enough to occupy a hospital bed, was he well enough to carry on working?
And if he was still running the government, why did he not feel it necessary to speak to the man who is representing him at key meetings about the coronavirus?
Raab’s title of first secretary of state has no constitutional status but he is the highest-ranking minister in the government after Johnson.
Since the coronavirus epidemic began, Downing Street has also made clear that, if the prime minister became unable to carry out his duties, Raab was the “designated survivor”. The term, which has been the favoured shorthand around Whitehall and Westminster in recent weeks, comes from American politics and gave its name to a television series.
It refers to someone usually far down the line of succession to the president who remains behind at the White House during the State of the Union address, when everyone senior is at the Capitol and could theoretically all be wiped out together. Last year, for example, it was energy secretary and former Texas governor Rick Perry – a figure few would hope to see in control of the levers of power in Washington.
Likewise Raab, whose chief attributes for Johnson and the Vote Leave veterans in charge in Downing Street are his perceived loyalty and his ideological purity on Brexit.
The coronavirus crisis has highlighted the weakness of a cabinet dominated by ideologues and placemen but the dangerous state of the prime minister’s health has brought it into grim, urgent focus.