After 10 days of persistent symptoms, Boris Johnson is the first leader of a major country to be hospitalized with COVID-19. There’s never a good time to be sick, but there could hardly be a worse moment for a prime minister who has become such a towering figure in his party and the UK, and who has enjoyed strong ratings during the crisis. Even if Johnson’s absence is brief, it will only complicate a national response to the coronavirus that has prompted a long list of questions over its effectiveness. Communities Secretary Robert Jenrick told BBC radio Monday morning that Johnson’s admission was “routine,” taken as a precautionary measure. Whether his true condition hadn’t been disclosed, or his health deteriorated in the ensuing hours, is not clear, but by Monday evening the prime minister had been placed in an intensive care unit. As doctors have been saying for weeks now, there’s no certainty with this virus. Covid-19 impacts individuals differently; symptoms that persist beyond a week can also worsen rapidly, interfering with lung capacity and requiring medical intervention such as oxygen, or in severe cases the support of a respirator. He will hopefully make a full recovery soon. But for all the force of his personality and apparent vigor, Johnson will surely have to step back for some time. That raises two questions: Who will run the government, and how will the crisis be handled? Neither answer is straightforward. While the US constitution provides for the vice president to take over if the president becomes incapacitated (nine American “veeps” have succeeded mid-term presidents), Britain’s government has no such constitutional set-up. Not since Nick Clegg was given the unusual role of deputy prime minister in the 2010 Conservative-Liberal Democrat coalition has the UK even had an official number two. The very idea of “cabinet government” establishes the prime minister as first among equals, and Johnson — often via his most senior adviser Dominic Cummings — has extended this principle much further than others as he’s centralized control of his administration. But as the Queen’s most senior government adviser, he serves only so long as his cabinet supports him, one reason for the constant rumors of plotting during his predecessor Theresa May’s unsteady time. Different cabinet officials stand in for the prime minister during weekly parliamentary questions if he’s unavailable; during this crisis, several including Cabinet Office minister Michael Gove and Health Secretary Matt Hancock have done the daily press briefings. For all the constitutional uncertainty, Johnson acted with some foresight in designating Foreign Secretary Dominic Raab as First Secretary of State to chair the crisis response in the prime minister’s absence. It’s just not clear whether Raab, who has not been on the front lines of the Covid-19 action in the way some other cabinet members have, would continue in that role if Johnson’s absence dragged on, or how long he would have the support of his colleagues. Raab hasn’t always been the surest footed of political performers, especially during a previous cabinet stint as Brexit Secretary. All of this comes as the government faces mounting criticism over its delayed response to the crisis, its failure to ramp up testing and persistent shortages of personal protection equipment (PPE) for health care workers, as well as questions over how long a costly national lockdown can continue. There are already signs of cabinet infighting, blame-shifting and questions over strategy. In the debate over when the lockdowns can be lifted, solving the problem of testing is seen as key since more diagnostic data would mean a better picture of the general spread of the disease and levels of immunity. Last week, Hancock promised 100,000 Brits would be tested daily, but only about one-tenth of that level is taking place currently. The government claims the problem is a shortage of swabs and reagents. Meanwhile, Germany is conducting about 50,000 tests a day. That isn’t the only serious problem. The UK still is experiencing worrying PPE supply shortages at many hospitals and medical centers, and strengthened guidance was only issued late last week after complaints from doctors and surgeons about unsafe working conditions. Lack of PPE has been linked clearly to infection and death among medical workers in Italy and elsewhere. As the crisis drags on, there’s also the key question of an exit strategy. The economic cost of lockdown is estimated at 2.4 billion pounds ($2.73 billion) a day. While Chancellor of the Exchequer Rishi Sunak has won plaudits for responding with massive programs of public spending and relief, the Treasury is said to be growing uncomfortable at the prospect of a prolonged freeze on the economy. Meanwhile, it was the 93-year-old Queen Elizabeth II who steadied the nation on Sunday night, with a rare public address, recalling World War II memories of separation and struggle, and echoing the words of Vera Lynn’s wartime song, “We’ll meet again.” We’ve got this, was the message that the Queen’s steady presence and tone communicated. “We’ll see,” is the less solid impression given by her government, as it struggles to find its crisis footing and hopes for the return to health of its leader. Bloomberg