I’ve known Boris Johnson for 30 years. He is the most fiercely competitive of men. He plays tennis like a gorilla. Using a warped wooden racket, he leaps in the air with a fearsome grunt and smashes the ball past you. His alpha-male image helped him become British prime minister, a job he has sought all his life. He is something of a fitness fanatic and saw himself as invulnerable, even when he first contracted the coronavirus, three weeks ago.

The news on April 5, that Johnson had been taken into intensive care with severe symptoms of Covid-19 convulsed Britain and made headlines across the world. The shock was all the greater because for the previous 10 days, both Johnson and his Downing Street spin doctors had systematically downplayed his symptoms.

This pattern has been seen all over the world, from U.S. President Franklin D Roosevelt, who hid his partial paralysis from the American public, to President François Mitterrand of France, who went to great lengths to conceal his terminal cancer from the nation. It is also one I recognize well. In 2003, I made a BBC TV documentary titled “The Downing Street Patient,” which looked at the gulf between the image of robust fitness for office that U.K. prime ministers seek to project and their true state of health. 

Lord David Owen, a former cabinet minister and medical doctor who has written a book on this subject, told me, “Political leaders are usually, by nature of the office they hold and the greasy pole they have climbed to get there, exceptional people. They want to appear super-fit supermen or superwomen. So, when they get unhealthy, they want to give the impression that they’re still healthy.”

Boris Johnson didn’t believe in illness – he scoffed at those who took time off work, saying that being sick was for the weak. At his first Covid-19 press briefing before he contracted the virus, he declared he would not stop shaking hands with people. When he did succumb, a week later, he announced it in a typically upbeat March 27 Twitter video. Beginning, “Hi folks,” he went on to say that he had mild symptoms, was self-isolating and that, “thanks to the wizardry of modern technology,” would continue “to lead the national fightback against coronavirus.”

As Johnson worked from home inside Downing Street, his papers and meals being left outside the door, his advisers sought to convey that it was all business as usual. The PM released another video on April 3. Despite looking unwell and admitting that he still had symptoms, Johnson declared, “I’m feeling better.” Within 24 hours, he was being driven at speed to St Thomas’ hospital, Britain’s leading facility for viral and respiratory diseases. The official No. 10 line was that he had been admitted “for tests,” on the advice of his doctor.

The following day, the foreign secretary Dominic Raab told a No. 10 press briefing that red boxes of official papers were being sent to the PM in hospital. Just hours later, Downing Street released the news that Johnson had been moved into intensive care. These events clearly illustrate that when medical doctors and spin doctors come together, truth often takes a backseat to optics. 

Almost 70 years ago, Winston Churchill — Johnson’s great hero — was at the center of a classic cover-up. In 1951, the Grand Old Man had returned to power at the age of nearly 80, and continued to run the country on a diet of brandy, cigars and midnight oil that had seen him to victory in World War II. But two years later, during an official dinner at No. 10, he suffered a stroke — the second of his life. Officials managed to maneuver Churchill out of the room, but his condition was so severe that his doctor, Lord Moran, did not expect him to last the night. Yet, he did.

At that time, Fleet Street was largely run by newspaper proprietors who were personal friends of Churchill. They got together with Downing Street and published a No. 10 statement that the PM was “taking a complete rest.” According to Moran, “It was a medical communique that didn’t include any medical facts.” With Churchill out of action, his son in law, Christopher Soames, signed official documents with his own version of the PM’s signature. The public was none the wiser.

Churchill’s successor, Sir Anthony Eden, took office in 1955. When he launched the Suez invasion the following year, he was suffering from the after-effects of a botched operation on his gallbladder, which leaked bile into his system. He was also on very high doses of amphetamines, according to Lord Owen. “There was very little doubt that he was taking decisions at a time when he was not fully well. I’m not saying he was deranged — but he was right on the edge.” 

Eden resigned in 1957, citing poor health, and went on to live another 20 years.

The Labour party’s Harold Wilson became prime minister in 1964. At 48, he was the youngest PM of the century and sought to present himself as a British JFK. Joe Haines, Wilson’s press secretary, told me, “Harold would always brace himself and go up stairs two at a time in a public place, as if to say: ‘I’m on top of the job; I’m Superman.’”

Although it was unreported at the time, Wilson suffered serious heart palpitations in 1974, during an official visit to the French president Giscard d’Estaing. The prime minister’s travelling doctor ordered him to take to his bed.

“I told the press, who believed me when I said that Harold had the flu,” said Haines. “We had an economic crisis and we had a majority of just three in Parliament. If I had said, ‘He’s got a heart problem,’ then the cabinet would have been queueing up to take over from him and the Stock Exchange would have fallen through the floor. So, I didn’t have the slightest compunction about not telling the truth.”

Tony Blair was just 43 years old when he came to power in 1997. This made him the youngest PM since Lord Liverpool, nearly two centuries earlier. Projecting an image of health and youthful energy, he was the first prime minister to have a rowing machine installed at No. 10. “I do the gym three times a week,” said Blair. “It helps me deal with the stress of the job.”

But in 2003, after he had ordered British troops to support the U.S. invasion of Iraq, the pressures of the job began to show on this face. That autumn, I filmed Blair as he visited a new cardiac unit at a London hospital. He was clearly still in war-talk mode when he asked a doctor performing an ultrasound heart scan, “Does that mean when you open a patient up you can go straight to where you want to operate on the heart, without any collateral damage?”

The following month, Blair had to depend on cardiac technology himself. On October 19, he was rushed to hospital, with a seriously irregular heartbeat. The prime minister was anaesthetized and given electric shock treatment to restore its normal rhythm. 

That night, Downing Street put out a statement designed to reassure. It gave few details beyond saying that the PM had been “feeling under the weather,” had experienced an irregular heartbeat, and that a “cardioversion was administered to regulate it.” It was a common complaint that had been successfully treated.

Medicine, of course, like politics, is an inexact science. But Lewis Moonie, a former doctor and minister under Blair, had suffered the same condition. He told me, “Anaesthetizing somebody and giving their heart electric shocks is not something you just do in the routine run of medical practice. Anybody with the slightest knowledge of medical procedures knows it’s not nothing when that’s done.” 

Questioned by journalists the following day, Downing Street’s director of communications Alastair Campbell said that Blair’s heart scare was “just one of those things,” and that nothing similar had ever happened to the PM before. 

A week later, however, there were credibly sourced press reports that Blair had separately informed both the Queen and former U.S. president Bill Clinton that he had experienced the same problem previously. In response, Blair told reporters: “I have never had this condition before. It happened. It was over in a day and I was back at work.”  

Blair feared being seen as a lame duck prime minister. He knew from his own experience that ill health is the malign and unpredictable joker in the political pack. His predecessor as Labour leader John Smith’s sudden and unexpected death from a heart attack in 1994 had given Blair the chance to rise to the top.

Tony Blair was the last British prime minister to be rushed to hospital while in office — until Boris Johnson. The terrible irony about Johnson becoming the latest Downing Street patient is that, until he fell ill, he was determined to battle Covid-19 from the front. Then he became the embodiment of the power of a virus impervious to the dark arts of spin doctors. 

When Johnson was moved to intensive care, he was given less than a 50/50 chance of survival if he was put on a ventilator. Happily, that didn’t need to happen and he was brought back from the brink by the remarkable professional skills of the team at St Thomas’ hospital. “They saved my life — things could have gone either way,” said Johnson as he was discharged on Easter Sunday. His father rejoiced with the words, “He is risen.”