How Sage’s meetings revealed the best – and worst – of Whitehall
The minutes of the Sage meetings published on Friday provide the first detailed insight into the early days of Britain’s response to the pandemic.
Spanning five months and covering 34 sessions of the Scientific Advisory Group for Emergencies, the nation’s top scientists and health officials, they reveal the best and worst of Whitehall.
The body, roughly 50/50 in government and independent experts, was hobbled early by incorrect assessments of Britain’s testing surveillance capacity, poor intelligence from overseas and an outdated pandemic strategy.
Caution, perhaps borne of a perceived overreaction to Swine Flu in 2009, may also have caused Sage to place too much emphasis on hard evidence over action. On the upside, the documents show Sage moved rapidly to catch up. Crucially, it was able to change tack and assert the case for lockdown in the face of
Jan 22: First “precautionary” meeting Sage convenes 22 days after news of the Wuhan outbreak was first reported by China. The Department of Health and Social Care provides an update on China, warning “diagnostic testing capacity in Wuhan is overwhelmed”. There is evidence of human-to-human transmission but it is not known if it is sustainable. The meeting considers the UK’s readiness for a pandemic and is told: “The UK currently has good centralised diagnostic capacity – and is days away from a specific test, which is scalable across the UK in a few weeks.” February 2020: The build up
If the first meeting was calm, the rest were not. From the second meeting, Jan 28, the group is on a war footing. The DHSC notes half of all new cases in China are occurring outside Wuhan and there is evidence of “sustained human-to-human” transmission. Control in UK “healthcare settings”, “rapid detection of cases” and “selfisolation” will be required, says Sage.
But the UK’s testing capacity is still not ready: A “specific test should be ready by the end of the week, with the capacity to run 400 to 500 tests a day”, the minutes note. Sage adopts a “reasonable worst case scenario”. This is taken from the existing UK Pandemic Influenza Strategy, which says that 600,000 would die.
The next meeting, Feb 3, focuses on possible travel restrictions. Modelling shows only by restricting 95 per cent of flights can the epidemic be delayed by a month. But “a month of additional preparation time for the NHS would be meaningful”, it notes.
The next day the group meets again and is frustrated with the lack of data from China and Asia. “Greater sharing of data is essential”, it says. The Foreign Office is asked to work with DHSC to “ensure the message from the UK is coordinated. This is only mention of the Foreign Office – a future inquiry will almost certainly consider if the UK’s overseas intelligence gathering could have been better.
Feb 25: First mention of lockdown Modelling by the London School and mounting evidence from overseas appear to have convinced Sage that radical intervention measures are needed. Here it seems to break with the gentle “mitigation” approach of the old pandemic influenza strategy and embrace Asian-style lockdown tactics.
Sage discussed non-pharmaceutical interventions for university and school closures; home isolation; household quarantine; and social distancing.
“All require implementation for a significant duration to be effective.” Evidence indicates these measures “can reduce Covid-19 reproduction number to approximately one”. Reduced spread in the UK through a combination of these measures was assessed to be realistic, it says.
March 2020: The March crisis
It would be another month before Britain tuned in to watch Boris
Johnson’s address to the nation to announce lockdown as the only means of dealing with the “invisible killer”.
But in a sure sign No10 was waking up to the threat posed by Covid-19 and the lockdown proposals of Sage, Dominic Cummings attended his first meeting on March 5. Minutes suggest the scientists were cautious about repercussions of a lockdown strategy, fearing it could create a second wave and cause indirect harms.
But time was running out. PHE’s surveillance had not worked. By March 10, the committee noted there were 5,000-10,000 cases already in the UK. Yet at a time most countries worldwide were locking down – Italy was already
closed and Spain would follow a few days later – the UK was stalling.
Discussion shifted to the idea of locking down or “shielding” only the most vulnerable – a compromise.
A document from Sage’s behavioural science committee suggests one way to sugar coat this for the vulnerable was to suggest the rest of the population would be acquiring “herd immunity” to protect them. This is not mentioned in the minutes of the main Sage body, and the Government insists it was never official policy, but it became front page news. It was briefed, perhaps with No10’s consent, to the media on March 11, the day before the next and crucial Cobra meeting.
By March 16, the tone on Sage had changed dramatically. There were now as many as 10,000 new infections every day, and it was doubling every five or six days. Herd immunity coverage was generating anger and panic in the population. At the meeting Sage agreed to go public. “It is important to demonstrate the uncertainties scientists have faced… and the science behind the advice at each stage,” the minutes note. Later Prof Ferguson’s team published a report suggesting 500,000 could die without interventions.
Though the Government continued to grapple with a final decision on lockdown for another week, the public reaction to the Imperial paper was overwhelming and ultimately forced Mr Johnson’s hand.