Vallance and Whitty had doubts about effectiveness of shielding policy
Boris Johnson wondered out loud if the Government should simply trust people to make decisions for themselves
THE Government’s most senior scientific advisers told the prime minister that the implementation of shielding measures was not “very effective” – but ministers still asked 2.2 million people to follow them for months, The Daily Telegraph can disclose.
At the height of the Covid pandemic, people who were clinically extremely vulnerable were advised to shield themselves from the virus by largely avoiding contact with other people, meaning many grandparents could not hug their grandchildren and had to wave at close family through closed windows.
In a Whatsapp conversation with his most senior scientific advisers, Boris Johnson raised the question of giving them “a choice” between shielding or taking what he hoped would be an “ever-diminishing risk” of living a more normal life.
The then prime minister compared pensioners’ risk of dying from Covid with that of “falling down stairs”, adding: “And we don’t stop older people from using stairs.”
Sir Patrick Vallance, the Chief Scientific Adviser, said in a Whatsapp conversation in August 2020 that the implementation of shielding had not been “easy or very effective”.
Prof Sir Chris Whitty, the Chief Medical Officer, added that he would personally “think twice” about following shielding guidelines himself, unless it was to protect the NHS – which was not their principal aim.
But, despite reservations, the Government still reintroduced shielding during subsequent national lockdowns, meaning many effectively shielded for most of the pandemic.
For some, it had a grim effect on mental health – with more than a third of people who were shielding reporting a decline, according to research by the Office for National Statistics (ONS).
But as these messages show, even those who were involved in devising the measures seemed unsure whether their implementation was “effective”.
Mr Johnson wondered out loud if the Government should simply trust people to make decisions for themselves.
The discussion between Mr Johnson and his advisers came on Aug 9, 2020, just over a week after the Government lifted national shielding guidance for the first time.
The prime minister had spotted an article in The Spectator suggesting that the way forward might be to “protect the elderly and other high-risk groups until they are protected by herd immunity, while the younger generations keep society afloat”.
Mr Johnson asked a Whatsapp group of senior officials – which also included Matt Hancock, the then health secretary; Simon Case, the Cabinet Secretary, and Dominic Cummings, his chief adviser – whether there was “any merit” in offering everyone over the age of 65 a choice about whether to shield.
Boris Johnson
Thanks Chris! I have a feeling you have made these points before and I apologise. But is there any merit in this idea of offering over 65s a CHOICE Ie if you are over a certain age and have certain vulnerabilities then you can choose to live one of two lives You can either shelter or at least avoid all potentially infectious environments and socialise on a strictly limited basis Or else you can take what we hope – especially with mass salivary testing –will be an ever diminishing risk. If you are over 65 your risk of dying from Covid is probably as big as your risk of falling down stairs And we don’t stop older people from using stairs. What do you think ? [09/08/2020, 19:05:54]
Chris Whitty
Agree this is entirely reasonable at an individual level. Probably one of the problems with shielding Mark 1 was that some (maybe many) people thought they were shielding to protect the NHS and others when, other than at the peak of the first wave, they were mainly doing it to protect themselves. So outside a situation where the NHS risks being overwhelmed it has to be a personal choice. People can rationally make an informed choice they would rather take a small increased risk of dying and hug their grandchildren / go clubbing. Personally I would think twice before shielding unless it threatened the NHS. At a population level the problem is that once R goes above 1 the deaths will start to rise exponentially unless we can entirely isolate the at risk population. Most of those who die in that situation will not have chosen to take the risk. So I agree that where we can offer choice we should. That is like saying to someone that an unpleasant operation or chemo is optional; they may choose to live a potentially shorter but happier life without. It does not however deal with the inexorable mathematics of exponentially increasing cases. Hope this makes sense
[09/08/2020, 19:22:49]
Boris Johnson
Yes I agree with all this but wonder why we should not be able to do better at shielding those vulnerable groups even in the context of a rising R
[09/08/2020, 21:06:34]
Patrick Vallance
It is a theoretically attractive idea but in reality we haven’t found shielding easy or very effective first time round and I don’t think anyone else has either. It is a particular problem with multigenerational households and will be even more difficult amongst some parts of society. So the challenge is how you could make all this work in practice if the disease is spreading widely amongst the younger population. And how you could be sure you could make it work [09/08/2020, 21:14:41]
Boris Johnson
Yes I see the point about multigenerational households. Many thanks [09/08/2020, 21:17:30]
When the guidance was first introduced in March 2020, it told “extremely vulnerable” people that they should not leave the house at all other than for medical appointments.
The guidance was designed to protect people who were most at risk from contracting the virus.
Those affected were advised to socially distance from other members of their households. In its strictest iteration, the guidance advised vulnerable people not to use the kitchen at the same time as others, to sleep separately if possible, and to ensure shared bathrooms were cleaned after every use.
The Whatsapp conversation involving Mr Johnson, Sir Chris and Sir Patrick suggested that the difficulty lay in implementing shielding in practice, rather than concerns with the policy and objective itself.
More than two weeks later, Mr Johnson again brought up the topic, this time after reading an article in the
Financial Times.
The article suggested that the mortality rate from Covid had recently fallen and the elderly were no longer the main drivers of the virus.
Troubled by the ailing economy, he asked how they could “justify the continuing paralysis”.
The prime minister initially misread the figures and thought that only one in every 2,000 people who caught Covid was dying. It transpired through the course of the conversation that he mistakenly thought a figure of 0.04 in the
FT article was a percentage, meaning that by his calculation the UK had already exceeded the number of people who could have been expected to have died from the virus – and he was baffled by this.
In fact, the 0.04 figure was not a percentage but a probability figure, which Sir Patrick said equated to 4 per cent.
But even when his advisers tried to correct his misunderstanding, he pushed the idea that they should simply give people the choice to take a calculated risk.
“If I were an 80-year-old and I was told that the choice was between destroying the economy and risking my exposure to a disease that I had a 94 per cent chance of surviving I know what I would prefer,” he said.
Boris Johnson
What is the mortality rate of covid ? I have just read sonewhere that it has fallen to 0.04 per cent from 0.1 per cent So by my maths that is down from one in a thousand to about one in two thousand (And I seem to remember that when the plague began we thought the fatality rate was one in a hundred) So if all 66m people in uk were to be infected we could expect 33000 deaths. And we have already had 41k. Is that why the death rate is going down ? Is it possible that covid is starting to run out of potential victims ? How can we possibly justify the continuing paralysis to control a disease that has a death rate of one in 2000?
[26/08/2020, 06:29:33]
Chris Whitty
It’s somewhere between 0.4% and 1% depending how you calculate it. But in practice it’s a lot lower than this if you are young (esp children) and significantly higher if you are old or have multiple other medical conditions
[26/08/2020, 06:56:53]
Chris Whitty
It has probably gone down a bit due to better medical management but there is still appreciable mortality in older people [26/08/2020, 06:58:12]
Patrick Vallance
Mortality on older age group can still be as high as 6%. Overall as Chris says it is between
Mr Johnson compared pensioners’ risk of dying from Covid with that of ‘falling down stairs’, adding: ‘And we don’t stop older people from using stairs’
0.4 to 1, and in the under 45 health it is very low. Some evidence that people may be getting infected with lower amounts of virus but that is not clear yet
[26/08/2020, 07:03:59]
Boris Johnson
Here is the Financial Times The global “case fatality rate” — total deaths as a proportion of confirmed cases — has fallen by half over the past three months to below 0.04 as of Monday
[26/08/2020, 08:08:44]
Boris Johnson
Is this a misprint?
[26/08/2020, 08:10:28]
Boris Johnson
Or is the British case fatality rate for some reason much higher than the global rate and if so why?
[26/08/2020, 08:16:05]
Simon Case
Have just read FT article. No sources for their global stats quoted
[26/08/2020, 08:28:21]
Dominic Cummings
Could be FT is cos of mix up due to definition : IFR [infection fatality rate] vs CFR [case fatality rate]
[26/08/2020, 09:00:27]
Dominic Cummings
My understanding is CFR is more robust but is determined by testing rates to detect cases ?
[26/08/2020, 09:01:12]
Patrick Vallance
The IFR calculation is highly dependent on ability to measure deaths accurately and get total infection numbers. The numbers we quote are not UK numbers they are estimates of overall (although I am worried that our CFR maybe higher than it should be for some reason). Recently the infections have been in younger age groups and so the more the disease is in the young the lower the overall estimate appears. I will ask the epidemiologist to produce a 1 pager on this
[26/08/2020, 09:02:27]
Dominic Cummings
[attached: 00000200-PH Oto-2020-08-26-09-20-12.jpg] [Screenshot of bar chart based on Spi-m data, showing the Covid mortality rate for different age groups]
[26/08/2020, 09:20:12]
Matt Hancock
We have a new data tool that Jenny Harries has been developing to define your risk should you be exposed to Covid. Age is the biggest determinant, then sex followed by other conditions inc obesity. What this means is that the overall mortality is pretty meaningless – because the mortality of high risk groups is still v high, but of low risk groups is v low
[26/08/2020, 09:28:22]
Boris Johnson
Matt as I read this chart an 80 yr old covid patient has a SIX per cent chance of dying and if you are under 35 your chances are negligible
[26/08/2020, 09:46:06]
Boris Johnson
If I were an 80 year old and I was told that the choice was between destroying the economy and risking my exposure to a disease that I had a 94 per cent chance of surviving I know what I would prefer
[26/08/2020, 09:48:15]
Matt Hancock
Chances of dying as an under 35 is negligible - but you still transmit. So it’s important to let people know their risk – the big challenge is whether it’s possible to segment those with the higher risk
[26/08/2020, 10:04:12]
Patrick Vallance
It seems that the FT figure is 0.04 (ie 4% not 0.04%) and is the case fatality rate not the infection fatality rate (which would be 0.4-1% overall)
[26/08/2020, 10:54:22]
Dominic Cummings
Yup. Bad explaining from ft
[26/08/2020, 10:55:18]
Boris Johnson
– Old Number: Eh
[26/08/2020, 11:06:33]
Boris Johnson
– Old Number: ?
[26/08/2020, 11:06:37]
Boris Johnson
– Old Number: So what is 0.04 if it is not a percentage ? (Five marks; show working)
[26/08/2020, 11:07:45]
Dominic Cummings
0.04 as a probability means 4%
[26/08/2020, 11:08:07]
Dominic Cummings
0 = 0%. 1=100% 0.04 = 4%
[26/08/2020, 11:08:57]
Dominic Cummings
It’s just confusion of using probability figure or % figure. They aren’t clear. This is a common confusion!
[26/08/2020, 11:09:37]
Dominic Cummings
We’ll get a proper note explaining it all later today
[26/08/2020, 11:10:28]
Three months later, the Government wrote to vulnerable people once again advising them to stay at home “as much as possible, except to go outdoors for exercise or to attend essential health appointments. People can exercise with those they live with or in their support bubble.”
In a letter signed by Mr Hancock and Robert Jenrick, at the time the secretary of state for housing, communities and local government, they were told: “We know that this is a difficult time and many people are making significant sacrifices. Thank you for your efforts to keep yourself and others safe.”
Strict social-distancing measures for vulnerable people stayed in place locally in the worst-affected areas once the second lockdown was lifted.
Shielding came into force nationally again in early January 2021. While lockdown pressed pause on most people’ lives, those who were clinically “extremely vulnerable” were much more severely isolated – and for longer.
Although the measures were loosened as time wore on, the isolation affected people’s psychological wellbeing. In June 2020, a poll by the ONS found 35 per cent of those shielding said their mental health had deteriorated during the pandemic. Among those under 60, nearly half said this was the case. Doctors also acknowledged that social isolation could increase the risk of malnutrition and dehydration, while other studies suggested worries about obtaining food and other essential items were twice as common among those who were shielding during the first wave of Covid-19.
A parliamentary report stated that 60 per cent of those who were disabled had trouble accessing food, medicine and other necessities during the first months of the pandemic.
Separately, the Social Science in Humanitarian Action Platform warned in a report: “It is important to plan for socioeconomic impacts on the shielded, including psychosocial well-being, income generation, food access and health service access... If a high-risk individual loses access to critical health treatment because of shielding, the risk of shielding may outweigh the benefit.”
A global study from BBC Radio 4’s All in the Mind and the Wellcome Collection suggested human touch was linked with greater well-being and lower levels of loneliness. A lack of exercise and vitamin D that shielders suffered from only added to the risks inherent in the policy. Shielding in England eventually ended for good on March 31, 2021.
Boris Johnson
But is there any merit in this idea of offering over 65s a CHOICE le if you are over a certain age and have certain vulnerabilities then you can choose to live one of two lives
09/08/2020 19:05
Boris Johnson
You can either shelter or at least avoid all potentially infectious environments and socialise on a strictly limited basis
09/08/2020 19:05
Prof Sir Chris Whitty
Agree this is entirely reasonable at an individual level.
09/08/2020 19:22
Boris Johnson
Or else you can take what we hope - especially with mass salivary testing - will be an ever
09/08/2020 19:05
Boris Johnson diminishing risk.
09/08/2020 19:05
Boris Johnson
If you are over 65 your risk of dying from covid is probably as big as your risk of falling down stairs
09/08/2020 19:05
Boris Johnson
And we don’t stop older people from using stairs.
09/08/2020 19:05
Chris Whitty
Probably one of the problems with shielding Mark 1 was that some (maybe many) people thought they were shielding to protect the NHS and others when, other than at the peak of the first wave, they were mainly doing it to protect themselves. So outside a situation where the NHS risks being overwhelmed it has to be a personal choice.
People can rationally make an informed choice they would rather take a small increased risk of dying and hug their grandchildren / go clubbing. Personally I would think twice before shielding unless it threatened the NHS. 09/08/2020 19:22
Boris Johnson What do you think ?
09/08/2020 19:05
Chris Whitty
So I agree that where we can offer choice we should. That is like saying to someone that an unpleasant operation or chemo is optional; they may choose to live a potentially shorter but happier life without. It does not however deal with the inexorable mathematics of exponentially increasing cases. Hope this makes sense.
09/08/2020 19:22
Boris Johnson
Yes I agree with all this but wonder why we should not be able to do better at shielding those vulnerable groups even in the context of a rising R
09/08/2020 21:06
Sir Patrick Vallance we haven’t found shielding easy or very effective first time round and I don’t think anyone else has either. It is a particular problem with multigenerational households and will be even more
09/08/2020 21:14
Patrick Vallance difficult amongst some parts of society. So the challenge is how you could make all this work in practice if the disease is spreading widely amongst the younger population. And how you could be sure you could make it work.
09/08/2020 21:14