If you read anything about the Covid Inquiry, let it be the opening statement by Mr Hugo Keith, King’s Counsel (KC). This is where the Inquiry sets out its current position. Based on the mass of evidence they have seen, they ask the question: where was the fault in the central decision-making?
Government ministers will say the fault lay with the Scientists. But judging by the KC’s opening statement that will not wash. Indeed, it seems likely Ministers will be named and shamed for avoidable deaths and the ongoing damage prolonged lockdowns and restrictions caused.
Here I will share the key parts of the KC’s opening statement:
The KC summarises where we were at the end of January 2020
The pandemic was inevitable and it would cause death and disruption. Were we world-leading, this is when we would have acted!
It’s a matter for you, and it will be a matter for you at the conclusion of all the evidence, but it may seem that by the end of January it was clear that a fatal respiratory disease was inevitably spreading across the world, transmitted person-to-person, possibly asymptomatically. The clinical consequences of that virus included, without any doubt, organ failure and death. There was and there didn’t remain for some time any antiviral drug to alleviate the disease, and there was, of course, no vaccine.
The KC goes through the timeline
The government’s Scientific Advisory Group for Emergencies (SAGE) is first under the spotlight.
“SAGE and wider [government] should continue to work on the assumption China will be unable to contain the epidemic … SAGE concluded that travel restrictions within the UK, unless draconian and fully adhered to, would not be effective in limiting transmission. They would also be ineffective if Covid-19 cases were already established in the UK … There is no current evidence to suggest prevention of mass gatherings is effective in limiting transmission. Public actions in the absence of a mass gathering could have comparable impacts (eg watching a football match in a pub instead of a stadium as [being equally] likely to spread the disease).”
And while the KC makes it clear through his opening statement that govt ministers and officials failed to follow SAGE advice on many occasions – often to catastrophic consequences -, here in Jan 2020, there seems a significant flaw in SAGE thinking.
Perhaps the thinking was too “scientific method”…
What I mean is, the lack of evidence was given too much weight and this meant basic common sense was often missing. Simply put, just because the effect of mass gatherings hasn’t been adequately studied does not equate to there being evidence that limiting mass gatherings doesn’t work. “There is no current evidence to suggest prevention of mass gatherings is effective in limiting transmission”…
Yet on a simple common sense basis, of course limiting mass gatherings would reduce transmission. And, of course, this was what our counterparts in Japan, Singapore, New Zealand, South Korea, and Taiwan were doing to suppress viral transmission.
Equally, there seemed a sense that, ‘well, we cannot stop the pandemic so what’s the point of doing x,y,z’ – often referred to as fatalistic thinking.
Why such thinking was the case may relate to the selection of the SAGE members (the purview of Prof Vallance): there were very few members with practical experience. Also, there was the very real issue of groupthink – the problem of not wanting to challenge current assumptions for fear of being excluded from the group.
On the same day, the Deputy Chief Medical Officer and others advised the Secretary of State for the Department for Culture, Media and Sport, that the epidemiological data did not support the cancellation of the Six Nations England and Italy game in Rome. COBR meets again on the 28th. The United Kingdom reports publicly its first case of confirmed community transmission.
And, in January, such thinking did lead to advice being given to Ministers that cancelling big events was not worthwhile (again, the ‘data did not support’).
KC questioning speed of UK’s action on basic protections
This becomes highly relevant. The KC asks: had the UK acted quicker with more basic protections – eg. travel restrictions, quarantine for high-risk travellers, limiting mass gatherings, proper test and trace, expanding healthcare capacity – would lockdowns have been necessary AT ALL?
So an issue for you to consider is what would have been the alternative impact if there had been an earlier suppression of the virus, rather than the suppression that took place in March, by stringent methods falling short of a lockdown? Would the virus have reemerged with less venom in the winter of 2020 or perhaps been kept under control without the need for a national lockdown at all?
The KC suggests it may relate to the initial strategy of natural herd immunity
Certainly, the KC talks as if there is little doubt the government strategy was Herd Immunity through mass infection (the evidence is overwhelming). Where such a strategy emanated from he does not, in his opening statement, explore further.
But generally speaking, the notion of herd immunity seems to viewed by the Inquiry as lazy, ill-conceived, and frankly dangerous…
However stringently a government intervenes, it is of course not possible to stop everyone getting infected. Some will inevitably be infected and thus be immune, but that is a long way from deliberately exposing them to a virus that might kill them. There are a number of extremely problematic issues surrounding this issue. What proportion of the population might be required to become infected and therefore immune to ensure the epidemic dies out? What if lots of people accidentally, coincidentally become sick and then die? What if not enough people get infected and immunised to mean the epidemic dies out alongside that appalling
vista. What if so many people fall ill and die regardless, that the health system becomes overwhelmed, or if the immunity they acquire doesn’t last?
Inability and lack of good intent from Cabinet Ministers
And really, it is this sense of chaos, disorganisation, and failure to grasp what was actually happening that predominates at the start of the pandemic. Why were we not doing much at all to contain the virus? In part, perhaps (initially) SAGE failed to convey the correct advice, but ultimately, it was the inability of Cabinet Ministers to grasp what was actually going on and, I think we will find, a lack of good intent of Cabinet Ministers, the lack of empathy or concern for the public that were the core reasons for the UK’s dismal response to the pandemic.
On 3 March, the report — the publication to which I’ve referred you — was published. An adviser in Number 10, Ben Warner, who was provided with a draft, asked:
“This is a comms plan, where is the real plan?”
A member of the DHSC press group sent a WhatsApp saying:
“What are we doing to contain, what are we doing to delay, what are we doing to research, what are we doing to mitigate?”
By the end of January, the KC doesn’t seem to discriminate between whether it was the ineffectualness of the govt that led to little being done or if it was the Herd Immunity strategy. Indeed, it seems quite possible that the Herd Immunity Strategy was chosen due in part to its simplicity – the option that permitted Johnson and his ineffectual team to do as little as possible while being able to convince themselves that this was in fact a strategy.
“The PM doesn’t think it’s a big deal; [he] doesn’t think anything can be done, and his focus is elsewhere; he thinks it will be like swine flu and thinks his main danger is taking the economy into a slump.”
Specific timeline: a forensically examined 11 days
The KC then drills down in detail on a very specific timeline, from March 12th to March 23rd. This will become a forensically examined 11 days. Much of what happened next – deaths and lockdowns – came from decisions made during this period.
On the 12th of March the World Health Organisation (WHO) announced a global pandemic. On the March 13th a “heated” SAGE meeting took place, whereby NHS representatives voiced concern as to whether the NHS could cope with the now expected volume of cases.
That evening, lockdown is mentioned as probably being required.
That evening a discussion takes place between a number of Number 10 officials and advisers. One of them, Ben Warner, argues that the strategy is required
to be changed from one of mitigation to one of suppression, because the modelling shows that, unless the Government changes course urgently, the NHS will be overwhelmed. On a whiteboard, the Prime Minister’s Chief Adviser, Mr Cummings, writes:“Must avoid NHS collapse. To stop NHS collapse, we will probably have to lock down.”
Then on 15th March, the PM meets with Chief Medical Officer Professor Chris Whitty and Chief Scientific Adviser Professor Sir Patrick Vallance. Johnson escalates to self-isolation and voluntary social distancing. Yes, the team is now talking lockdown and Johnson still thinks self-isolation is enough.
On Sunday, 15 March the Prime Minister discusses the matter with the Chief Medical Officer, the Chief Scientific Adviser and there is another wider ministerial meeting. He agrees that stricter measures should be taken to COBR the following day, including individual isolation and voluntary social distancing.
On Monday the 16th March, PM advises people to work from home and self-isolation for 14 days. The impression here is that he continues to resist formal restrictions and/or lockdown.
On the 18th of March, SAGE meets, and advises for school closures. Johnson does so, on the same day!
On Tuesday, there were national lockdowns announced in France and the Netherlands. In London, the Government advises against international travel. On Wednesday, 18 March, SAGE 17 convenes and there is a discussion over the locking down of London. SAGE advises immediate school closure. The PM announces an indefinite closure straightaway. On Thursday, 19 March, the NHSE/I publishes guidance for discharging patients from hospital, that is the discharge service requirements order.
The fact that the KC mentions this in his opening statement is likely important. SAGE advised and the PM followed. Without seeing a record of the conversations between Vallance, Whitty and Johnson it is difficult to understand what they were advising. This may become a critical line of questioning when Vallance, Whitty and Johnson are called to give evidence in this module. At what point did the CMO and CSO formally advise stricter restrictions? Albeit there is an argument that it was neither the CMO or CSO’s role to advise on the specific restrictions, merely the options. And a further argument is that with a more detail-orientated PM, merely knowing the numbers and the likely scenario would lead to the decision to suppress viral transmission more aggressively.
On the 20th March, pubs and restaurants were closed. Yes, it was seemed to the leadership that it was more important to keep pubs and restaurants open than schools!
On the 23rd March, lockdown began. KC highlights that on the day lockdown began, 100,000 new cases were likely to have occurred (in other words, very late in the course of the pandemic).
Chaotic leadership
I think it will be reasonably concluded that action should have been taken much sooner. The argument that taking proactive steps in January to suppress viral transmission (e.g. travel restrictions or tracing passengers from high-risk areas) should have been made. In reality, under the chaotic leadership of Johnson, the notion that such proactive steps would be taken seems like pie in the sky!
The Inquiry will then likely move to the latter half of February, suggesting that if the pandemic had been taken more seriously and proper suppression techniques had been deployed then we could have avoided lockdowns altogether.
With the state of the NHS and its critically low bed capacity, it seems unlikely lockdowns could have been “avoided”, but the Inquiry may well conclude that the length of the lockdowns would have been drastically shorter had the govt put mitigations in earlier.
Lockdown for months
We ended up in lockdown for months and almost certainly this could have been weeks.
And whose fault is that? I struggle to see how SAGE don’t take some of the blame here. What they were actually thinking during Jan and Feb will be interesting to hear. Let us hope for an honest and open critical appraisal of their own thought processes and where they got it wrong. But certainly, the clincher will be between March 12th and March 23rd. Johnson failed here.
And it was this failure that had the most devastating consequences. Up until 23rd of March Johnson conceded to token mitigations (still focused on herd immunity). It was only when the reality/optics of an actual collapse of health services hit that he was forced to act.
Johnson was not alone, though. Gavin Williamson and others made some spectacularly ignorant contributions…Expect them to get a roasting too.
As for Sunak, he may well avoid a proper embarrassment in relation to Eat Out to Help Out. Evidence linking a surge in cases with his policy is deemed too unclear.
Most importantly, perhaps, the Treasury argues that the scheme and the re-opening of the hospitality sector did not have any noticeable impact on the rates of infection. The evidence on this is not clear. Some other evidence suggests there was an increase. But the conflict may not be easier to resolve and we don’t invite you to do so. The lack of clear evidence one way or the other means that you’d only ever have quite a weak foundation from which to draw any conclusions and recommendations.
While the time leading up to the first lockdown was absolutely critical for how the UK (including the devolved nations) tackled the pandemic, the most damning point of failure will undoubtably be what happened around the second lockdown. This time round it is clear that SAGE were pushing for earlier action and Johnson wasn’t having any of it…delaying until it was simply too late!
Catastrophic Christmas
The catastrophic Christmas of 2020 showed clearly that Johnson had learned nothing…
Hospitalisations peaked in mid-January, though by this time roughly 70% of all ICU beds available in the NHS were taken up by Covid patients. Deaths increased from 82,000 or so by 11 December to 152,000-odd by 1 April. Roughly 70,000 people died in the wave despite the start of the vaccination programme and the imposition of severe restrictions.
And this was truly tragic! Weeks away from vaccinations being implemented, Johnson failed to act in a timely way, despite a chorus of calls to act. And yes, tens of thousands of people died that would not have died had he ‘followed the science’, or indeed, common sense. This was also likely a tipping point for the NHS – shortly after we saw record ambulance response times and A&E waits. The NHS became even more overwhelmed. If Johnson was looking for his Churchillian moment, this was it.
But, and a point that will be raised throughout this module of the Inquiry, it seems implausible that Johnson would have been able to resist common sense had those around him acted more boldly. He had enough ‘yes men’ within the scientific community and at government adviser levels to allow this to happen. Indeed, the KC draws attention to a specific meeting of advisers (but gives little else away – expect this to hold some stark revelations).
At an extraordinary meeting of NERVTAG and SPI-M-O on 21 December, the debate began as to whether or not a lockdown was required.
No doubt, Johnson wanted something. He wanted to power through. Even if that meant suffering for millions of people. But, he was empowered to do so by others; other ministers, advisers, scientists, media, and more.
There is a good chance we will gain some insight from the Inquiry into the points of the most significant failures, but will lessons be learned? I remain pessimistic that enough change will come from the Inquiry to avert another calamitous government response to a further pandemic.
Those that let the pandemic rip, occupy senior positions nowadays
In part, those who facilitated Johnson’s will of letting it rip have prospered and now occupy senior posts in important positions. They will be the people who determine how we respond next time. As yet, there is little contrition from them that they made critical mistakes, and the fallacy of the “yes man” remains the inability to challenge their bosses when it really matters.
The right strategy was maximal suppression until vaccines. This is now unequivocal. It is the strategy followed by countries like New Zealand and Japan, countries with a tenth of the deaths and significantly less time in lockdown than those countries that failed like the UK. The suppression until vaccine strategy was also better for the economy, both in the immediate short-term and for the long-term with fewer people off long-term sickness and fewer businesses having closed.
Those who supported the Johnson “let it rip” approach need to correct their thinking. We now know restrictions would have been much less harmful had they happened earlier. This was the international norm and WHO guidance. On what basis did they advise against what many see as the basic tenets of public health? And more importantly, would they act differently now?
I leave you with a single piece of evidence to highlight that we have not learned enough, and perhaps even unlearned some of the basic tenets of public health. This is from the NHS website, astonishingly still advising on how to manage breathlessness at home for Covid patients, still, in Oct 2023!
Here is the link to this unbelievable piece of advice on the NHS website
P.S. If you have Covid and you are breathless don’t stay at home…get urgent medical attention!
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