The Challenge of Controlling COVID-19. Lewis, Jane
control] was highly unusual’ compared to other countries, but the advice from scientists at this stage did not support firm action. However, the Home Affairs Select Committee reported that it asked to see the advice underpinning the Government’s decision to impose quarantining for an expanding number of countries up to 12 March and then for abandoning all such measures, but, receiving no answer, suggested that it was reasonable to conclude that such advice did not exist. The Home Office News Team (5 August 2020) denied that this was the case.
SAGE became more explicitly careful about offering advice on policy as a result of its findings as time went on. But politicians wanted it to be thought that they were acting on scientific advice. Thus, when he introduced the Coronavirus Action Plan the Prime Minister said: ‘the plan does not set out what the government will do, it sets out the steps we could take at the right time on the basis of the scientific advice’ (Johnson, 3 March 2020). However, the tensions between political imperatives and scientific understandings (there was never only one) became sharper over time.
SAGE’s main focus was modelling the course of the pandemic and the findings on this seem to have had a major influence on politicians in mid-March, especially in respect of changing the Government’s belief in a pandemic with moderate effects, to the possibility that it could result in high mortality. There is also evidence to suggest that some toyed with the possibility of achieving herd immunity by allowing a large proportion of the population to become infected, even if this was not a position taken by the vast majority of people in the Group. Building on the experience of controlling influenza may have played a part in any such thinking. On 13 March, the CSO had told an interviewer on BBC Radio 4’s Today programme that the Government’s strategy had in part been ‘to build up some herd immunity’. However, the next day the Secretary of State, Matt Hancock, denied that herd immunity was ever considered as a practical possibility (Hancock, 14 March 2020). In fact, a policy to allow the virus to spread among younger people while attempting to shield the vulnerable6 was not only likely to fail, but also to result in the NHS becoming ‘overwhelmed’ and, as Professor Devi Sridhar (24 December 2020) has commented, neglected to take account of possible mutations in the virus. In addition, as Mark Carney (2020), former Governor of the Bank of England and the BBC’s Reith lecturer has remarked, ‘the pathway to herd immunity runs directly through the inequalities in our society’. For as Marmot et al (2020) have documented, inequalities have increased both in terms of extent and depth. People in low-wage, precarious employment, people in poverty, people in overcrowded accommodation and black and minority ethnic people have all suffered disproportionately high death rates (see also Bambra et al, 2020; Tinson and Clair, 2020).
One of the main problems with the confidence engendered by building on the way in which the 2009 influenza outbreak had been tackled was the extent to which the COVID-19 virus behaved in a very different way. What turned out to have been important at the beginning of the pandemic was the speed of transmission; however, the number of tests carried out was too small to be a useful tool in analysing its spread. SAGE signalled the need for an early warning surveillance system in mid-February (Meeting 8, Minutes 18 February 2020), but the Office for National Statistics (ONS) was not asked by the Government to provide this until mid-April. Data problems may also have affected the early advice SAGE gave on crucial issues such as closing borders.
In the event, the ‘containment’ phase of the pandemic proved relatively short. The main catalyst for the Government’s startling u-turn on 12 March, which signalled a move to the ‘delay’ phase and with it lockdown, seems to have been the findings by the modelling group at Imperial College under the direction of Professor Neil Ferguson which were submitted to SAGE in early March, warning that up to 250,000 people might die without drastic action and that with no action the death toll could be twice that (Imperial College Response Team, 16 March 2020). However, the 27 February Minutes of SAGE (Meeting 11) show that the Group had already warned that the UK could face an 80 per cent infection rate and a 1 per cent mortality rate (and, importantly, also warned that only a proportion of those infected would manifest symptoms), although the CMO seemed to suggest at the Downing Street Briefing of 3 March that moving to lockdown too early would risk ‘fatigue’ on the part of the public. It is impossible to know at this point whether the Government, the PM included, ignored SAGE’s warnings in late February and during the first two weeks of March, whether SAGE chose not to draw attention to them, or whether the views of SAGE were accurately relayed to ministers. On 16 March, SAGE advised that additional interventions, such as school closures were needed, because the number of cases was thought to be doubling every five to six days (Meeting 16, Minutes 16 March 2020). It was finally decided that doing little or nothing would exact too heavy a price in terms of mortality and, given the extensive spread of the virus in the UK, the only option was complete ‘lockdown’. This was announced a week later on 23 March in the hope of stopping the NHS from being overwhelmed. This was a risk that had been intensified by the way in which austerity had affected hospitals after 2010; for example, occupancy rates for intensive care beds were already running at or just above recognised safe levels before the pandemic started.
The UK was the last country to enter lockdown in Europe; Italy also locked down late on 10 March, but nevertheless had fewer confirmed cases when it did so. As a comparative Imperial College-led study has shown, the timing of lockdown in relation to when initial infections occurred affected the peak number of people infected, which drives both the number of COVID-19 deaths and the pressure on the healthcare system, which in turn limits the capacity of the NHS to treat other diseases (Kontis et al, 2020). Peak infection actually occurred in England before lockdown. The delay in locking down, even as little as the week between SAGE’s recommendation for additional measures and the Government announcement on 23 March, resulted in an increased number of deaths and had an adverse effect on the efforts to suppress the virus (Colbourne, 2020), which had become particularly widespread geographically in England compared to other Western European countries (Spiegelhalter, 2 August 2020). The reasons for the delay were possibly related to the Government’s lack of urgency and over-confidence, but its relationship with its scientific advisory body was also difficult. The modelling done by SAGE required good data (and sound assumptions). Its recommendations regarding the effectiveness of possible measures to control the virus demanded high standards of evidence – higher than were often available – and its conclusions were thus often equivocal. Above all, the Government was looking for policy solutions which the mathematical modellers who dominated SAGE did not have, and in any case regarded as strictly political territory, while public health practitioners, who might have made a valuable contribution – particularly on operational issues at the local level – were not consulted. Nor was there any forum in which a balance sheet of the possible impacts on the population in terms of health, but also economic performance, could be drawn up. The Government stressed throughout that it had ‘followed the science’ (although by the end of April, as tensions grew, the phrase was changed to being ‘guided by the science’ [Torjesen, 17 July 2020]), alongside an insistence that decisions had been taken at ‘the right time’.
By May, tensions between SAGE and the politicians were being referred to openly. Jeremy Hunt, Chair of the Select Committee on Health and Social Care (and Conservative Secretary of State for Health from 2012 until 2018), blamed the Group for lack of attention to what had happened in other countries, describing their efforts in terms that echoed those of Richard Horton (2020, p 41), editor of The Lancet, as ‘one of the biggest failures of scientific advice to Ministers in our lifetimes’ (HoC Debates, 11 May 2020, vol 676, col 59), albeit that Horton blamed scientists for colluding with Government rather than misleading it. On 19 May, Therese Coffey, Secretary of State for Work and Pensions, told Sky News that ‘if the science was wrong, advice at the time was wrong, I am not surprised people think we made the wrong decisions’. This prompted Venki Ramakrishnan, then President of the Royal Society, to comment that:
…it is not possible for scientists to give frank advice if they feel that they will be made the scapegoats for difficult policy decisions … Governments not only have to contend with the uncertainty of the science but a host of other practical considerations, including feasibility. In all this they want certainty from scientists – and feel or claim that they are “following the science” – but wishing something does not make it so (Ramakrishan, 24 May