The cost of Covid-19 in the UK, in 45,000 lives lost and considerably more if “excess” deaths are included, in long term illness for tens of thousands, in damage to our prosperity, is changing everything.
But did the shock have to be so great? Could the government have done more to protect us?
Among the questions that will be examined by Boris Johnson’s promised public inquiry is why vulnerable residents in care homes were put at serious risk, why health care workers struggled for months to obtain vital protective equipment, whether travellers from the viral hotspots of Italy, Spain and France should have been quarantined, whether the full lockdown could and should have been implemented a week or more earlier, and why the UK did not increase virus testing capacity much earlier.
There is one question that overarches all the rest, and it is why ministers and officials allowed the risk to build and build and build, during February and early March. The policy, as recorded in the minutes of a meeting of the government’s Scientific Advisory Group for Emergencies on 25 February, was that “interventions should seek to contain, delay and reduce the peak incidence of cases, in that order”.
There was seemingly no consideration given, till the illness was spreading virulently, to the Chinese, Korean, Taiwanese and Singaporean strategies of attempting to eliminate the virus altogether through mass testing in the community and isolation of infected and potentially infected individuals. To the contrary, most of the early debate was about when to suspend test and trace in the population as a whole, not how to expand it.
So what went wrong?
There is no defence for the government in ignorance of the risks.
I have trawled the minutes of the nine meetings in February of the Scientific Advisory Group for Emergencies (SAGE), the committee of scientists, doctors and experts that has been shaping the government’s response to the crisis, and reviewed notes of my own contemporaneous meetings with ministers and officials. This is what they show:
1) The government knew, from 11 February, that unchecked, Coronavirus could cause the deaths of more than 500,000 people. A senior minister that evening told me “the risk is 60% of the population getting it; with a mortality rate of perhaps just over 1%, we are looking at not far off 500,000 deaths”. Despite this desperately worrying risk, that was communicated to ministers by SAGE members, and notably the chief medical officer Chris Whitty, SAGE that same day decided that “it is not possible for the UK to accelerate diagnostic capability to include Covid-19 alongside regular flu testing in time for the onset of winter flu season 2020-21”.
2) From 13 February, there was an assumption that China would be unable to contain the virus. “SAGE and wider HMG should continue to work on the assumption that China will be unable to contain the epidemic”, the minutes say. In other words, SAGE knew that it was highly unlikely that the UK could insulate itself from Covid-19.
3) Also on 13 February, SAGE said that “the most effective way to limit spread in prisons at this stage would be by reducing transfer of individuals between prisons”. But what now seems extraordinary and reckless is there was no similar recommendation to prevent care workers moving between care homes, where residents were much more vulnerable than prisoners, or to deter older people going to care homes from hospitals without first being tested for the virus.
4) On 18 February, SAGE identified that Public Health England did not have the capacity to carry out contact tracing – finding those possibly infected – for a case load of infected people greater than 50 new cases a week. It tried to make a virtue of this weakness by deciding it would no longer “be useful” to continuing the tracing of infected people “when there is sustained transmission in the UK”. In the event, and disastrously some would say, testing of infected people in the community and tracing those to whom they may have passed the virus was formally abandoned on 12 March.
5) On 20 February, SAGE approved Public Health England’s strategy of discontinuing contract tracing when cases of Coronavirus in the UK could no longer be directly linked to infection abroad.
6) That same SAGE meeting said there was “evidence of local transmission unlinked to individuals who have travelled from China in Japan, Republic of Korea and Iran”. In other words, China had failed to contain the virus.
7) The official policy, by 25 February, was one of relative fatalism, in that SAGE concluded that “interventions should seek to contain, delay and reduce the peak incidence of cases, in that order”. There was NO consideration given to the Chinese, Korean, Taiwanese and Singaporean strategies of attempting to eliminate the virus altogether through mass testing and isolation of infected and potentially infected individuals. The view of SAGE, and of the chief medical officer, Chris Witty, and chief scientific adviser, Sir Patrick Vallance, quite explicitly, was that the virus would have to work its way through the population, one way or another.
8) By 27 February, “the reasonable worst case scenario” was 80% of the UK population become infected and 1% dying – and although this would equate to more than 500,000 deaths, it was described in SAGE’s minutes as representing “a reduction in the number of excess deaths relative to previous planning assumptions”. On 26 February, the SAGE secretariat produced a briefing note for SAGE members saying there were no clinical countermeasures available for Covid-19 and no vaccine “was likely to be available in a UK epidemic”.
9) That same SAGE secretariat briefing note says “asymptomatic transmission cannot be ruled out and transmission from mildly symptomatic people is likely”. This is highly significant, in view of the PM’s statement on 8 July at Prime Minister’s Questions that more measures to protect vulnerable residents in care homes had not been taken because “the one thing nobody knew early on during this pandemic was that the virus was being passed asymptomatically from person to person in the way that it is”.
What emerges from the SAGE minutes of those February meetings is that almost none of the havoc subsequently wreaked by Coronavirus should have come as a surprise to its members, or the Whitehall ministers and officials it advises. What they also show is that many weeks before the virus was present in the UK in any scale, it was baked into official thinking that large scale testing would not be part of the solution.
But those minutes leave unanswered a number of profoundly important questions. They include:
a) Why was no consideration ever seemingly given to rapidly expanding testing capacity, so as to adopt the strategy so successful in Asia, and latterly in Germany, of testing infected people and rapidly tracing and isolating their contacts – which eventually became British policy, but too late to dampen the initial infection rate and death toll?
b) Why was there never a single SAGE discussion in February of whether there was enough PPE protective clothing or equipment for healthcare workers and others at greatest risk of becoming infected or infecting the vulnerable?
c) Was the cabinet secretary Sir Mark Sedwill aware in February of the magnitude of the threat posed to the UK by the virus and did he become engaged in assessing whether enough was being done to protect the UK?
d) Why was the health secretary Matt Hancock, rather than the prime minister, leading the political and government response to the virus, until the beginning of March?
e) Why – and this is the biggest question of all – had Whitehall and ministers not learned the most important lesson from the banking crisis of 2007-8, which is that when there is a reasonable prospect of catastrophe, it is far better to intervene early and with devastating force, than do the minimum and hope for the best.
The problem for ministers, Whitehall officials and scientists is that it is not hindsight that condemns them. The SAGE minutes from February are explicit that they had all the information they needed to protect the UK. But for reasons they are yet to adequately explain, they were never confident they could do more than “reduce the peak incidence of cases”.