13 March 2020: New data and a dawning realisation

¶Figure 6: Daily confirmed cases from 7 February to 13 March 2020 across the UK

ry ry ry ry ch ch ua ua ua ua ar ar br br br br M M

Fe Fe Fe Fe 6 — 13
7 14 21 — 28

¶Source: UK Health Security Agency Covid-19 data dashboard archive (https://ukhsa-dashboard.data.gov.uk/covid-19-archive-data-download)

¶4.15. On 13 March 2020, the Scientific Advisory Group for Emergencies (SAGE) stated:

" Owing to a 5-7 day lag in data provision for modelling, SAGE now believes there are more cases in the UK than SAGE previously expected at this point."³⁴³⁴ INQ000109142_0002 para 1

¶4.16. Data on the spread of the virus had been commissioned in late February 2020.³⁵³⁵ INQ000273553_0045-0047 para 8.13. As noted in Chapter 2: The emergence of Covid-19, in this volume, in late February 2020, two surveillance systems were put in place to get an estimate of prevalence of infection. Firstly, people in intensive care units with pneumonia were tested. Secondly, the Royal College of General Practitioners tested a random sample of patients attending GP practices for Covid-19.Show full note By mid-March 2020, some of these data had become available but the data received were "very difficult to analyse".³⁶³⁶ INQ000273553_0045-0047 para 8.13 Professor John Edmunds, Professor of Infectious Disease Modelling at the London School of Hygiene & Tropical Medicine and a participant in the Scientific Pandemic Infections Group on Modelling (SPI-M), told the Inquiry:

" [T]he delays between onset in cases to confirmation and entry onto the database were long, at about 5-7 days, but with a very long tail so that some cases were taking up to 3 weeks to be recorded … new cases registered on a given day were actually reflecting infections that might have occurred two weeks earlier … we were estimating that there were hundreds or perhaps thousands of cases occurring every day."³⁷³⁷ INQ000273553_0045-0047 para 8.13

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¶Professor Edmunds explained:

¶" [The] data revealed that there were significant delays to confirmation and

reporting of cases and that the scale of the epidemic was far larger than was being reported. Both of these had serious implications for the accuracy of the information being portrayed to decision-makers and the public (and even other SAGE members)."³⁸³⁸ INQ000273553_0045-0047 para 8.13

¶4.17. The SAGE meeting of 13 March 2020 was "sometimes tense and heated", in part because "unease came to a head about the logistical, political and ethical feasibility of a mitigation strategy which would overwhelm NHS capacity".³⁹³⁹ INQ000249526_0066 para 211 Professor Ferguson asked NHS England representatives:

¶" whether there was any way the NHS could cope with the numbers of

hospitalisations being envisaged under any of the mitigation scenarios previously reviewed by SAGE, even allowing for surging general bed and ICU capacity. This question got a very clear 'No' in response, which was the first time NHSE [NHS England] had stated this at any SAGE meeting."⁴⁰⁴⁰ INQ000249526_0066 para 212

¶4.18. As Professor McBride explained, "We realised we were further into the pandemic than we knew … That caused significant concern."⁴¹⁴¹ Michael McBride 10 May 2024 148/12-15 Professor Vallance told the Inquiry that this information "unambiguously showed that the pandemic was far more widespread and far bigger and moving faster than we had anticipated", which was "extremely worrying". He explained that, in light of this, "it was my view that we were in a position now where we had to move quickly" and introduce "much more stringent measures".⁴²⁴² Patrick Vallance 20 November 2023 45/4-21

¶4.19. Professor Dame Angela McLean (Chief Scientific Adviser to the Ministry of Defence from 2019 to 2023 and Government Chief Scientific Adviser from April 2023) described the analysis which showed that "ICU capacity was way below that which would be required if there was a wave of infections" as a "real wake-up call".⁴³⁴³ INQ000309529_0034 para 114(b)

¶4.20. This realisation came too late. It was almost two months after Covid-19 had emerged, and 10 days after NHS England modelling had been presented to SAGE, which established that:

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" under a RWC [reasonable worst-case] scenario, the NHS would be unable to meet all demands placed on it, with demand on beds being likely to overtake supply well before the peak was reached".⁴⁴⁴⁴ INQ000116811_0047 para 169

¶4.21. In a discussion on what could be done to limit the spread, most likely in response to the comments that had been made in the preceding days by Professor (later Sir) Christopher Whitty (Chief Medical Officer for England from October 2019) and Professor Vallance about the risk of 'behavioural fatigue', SAGE emphasised:

" [D]ifficulty maintaining behaviours should not … be taken as a reason to delay implementation where that is indicated epidemiologically."⁴⁵⁴⁵ INQ000109142_0004 para 30

¶4.22. However, SAGE recorded that there was a real concern that the restrictions proposed – self-isolation, household isolation and social distancing – would not reduce NHS demand enough and that they might need to be coupled with more intensive actions to enable the NHS to cope.⁴⁶⁴⁶ INQ000109142_0003 para 19 It therefore requested that the Scientific Pandemic Infections Group on Modelling, Operational sub-group (SPI-M-O) "investigate what kinds of interventions might be sporadically or continuously implemented to enable the NHS to meet demand".⁴⁷⁴⁷ INQ000109142_0003 para 20 SAGE reiterated that measures that sought to completely suppress the spread of Covid-19 would cause a second peak.⁴⁸⁴⁸ INQ000109142_0003 para 24 On the morning of 13 March 2020, Professor Vallance had publicly voiced similar concerns about the use of stringent measures, explaining in a media interview:

" [I]f you suppress something very, very hard. When you release those measures, it bounces back and it bounces back at the wrong time."⁴⁹⁴⁹ INQ000064580_0002-0003

¶4.23. SAGE's advice on mass gatherings also began to shift at this meeting as organisers continued to take matters into their own hands and cancel events. It advised:

" Supporting social distancing measures that are taking place anyway (e.g. sporting events, working from home) may be useful and reinforce the notion that all measures the UK implements need to be taken seriously. Not doing so potentially undermines the other actions and trust."⁵⁰⁵⁰ INQ000109142_0004 para 26

¶4.24. During the SAGE meeting, Professor David Halpern, Chief Executive of the Behavioural Insights Team (formerly known as the 'Nudge Unit') from 2014, wrote in his notebook "WE ARE NOT READY". Dr Ben Warner, Special Adviser to the Prime Minister from December 2019 to May 2021, "leaned over, crossed out 'NOT READY' and wrote 'Fucked!'".⁵¹⁵¹ INQ000129100_0001; INQ000188738_0016 para 73; David Halpern 1 November 2023 177/5-21 Professor Halpern's impression, which he relayed to

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¶Mr Hancock later that day, was that "the penny had dropped at that meeting for several people in the room" and that "we really needed to do something about suppression and locking down".⁵²⁵² INQ000188738_0016 paras 74-75

¶4.25. Despite the 'penny dropping' and the 'wake-up call', SAGE concluded that "the UK remains on broadly the same epidemic trajectory and time to peak".⁵³⁵³ INQ000236391_0001 paras 1, 7 It stated in the first version of the minutes that "household isolation and social distancing of the elderly and vulnerable should be implemented soon".⁵⁴⁵⁴ INQ000109142_0002 para 2 On receipt of the minutes, Sir Jeremy Farrar (Director of the Wellcome Trust from October 2013 to February 2023 and a participant in SAGE) expressed concern that this language did not "convey the need for urgency that was palpable at the meeting".⁵⁵⁵⁵ INQ000236389_0001 An amended version of the minutes was subsequently produced on 16 March 2020, which advised that those measures should instead be implemented "as soon as practical (i.e. they can be done well and equitably)".⁵⁶⁵⁶ INQ000236391_0001 para 2; INQ000251645_0092-0093 para 7.97

¶4.26. Mr Hancock explained that, after the meeting, Professor Whitty informed him of SAGE's view that household isolation and shielding should "come in sooner rather than later" and that greater restrictions could be needed "to make sure case numbers stay within NHS capacity and they were examining options".⁵⁷⁵⁷ INQ000232194_0063 para 267

¶4.27. Mr Hancock told the Inquiry that he had spoken to Mr Johnson and reinforced his view that "we needed to lock down immediately".⁵⁸⁵⁸ INQ000232194_0063 para 267; Matt Hancock 30 November 2023 31/1-34/11 Mr Johnson said that he did not recall any such discussion.⁵⁹⁵⁹ Boris Johnson 6 December 2023 122/2-6 Mr Hancock, in the event, was unsure whether he had called or emailed Mr Johnson. The Inquiry was not provided with any contemporaneous material to demonstrate that Mr Hancock had communicated such concerns to Mr Johnson on that day. Given the extraordinary significance of a communication in which the Secretary of State for Health purportedly informed the Prime Minister that an immediate lockdown was required, the fact that lockdown was not yet widely being considered as an option and the absence of any corroborative confirmation, it is likely that Mr Hancock's recollection was mistaken.

¶4.28. Immediately after the SAGE meeting of 13 March 2020, Professor Ferguson spoke to Dr Warner and Imran Shafi (Private Secretary to the Prime Minister for public services from March 2018 to March 2021). Mr Shafi said that he had raised "concerns about our overall approach … arguing that we needed to go further with our measures".⁶⁰⁶⁰ INQ000215035_0015 para 59 Following the meeting, Professor Ferguson emailed Sir Jeremy Farrar and Professor Edmunds:

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" I think the message got across. I still think part of the issue is Chris [Whitty] hoping it won't be as bad as we say. I was amazed that Chris and Patrick [Vallance] haven't appeared to have previously asked the question … as to whether the NHS could cope with what the govt [government] policy would likely produce."⁶¹⁶¹ INQ000149061_0001

¶4.29. That evening, a number of advisers and officials from 10 Downing Street, led by Mr Cummings, gathered to discuss SAGE's findings.⁶²⁶² INQ000273872_0044 paras 25-27; INQ000269182_0034 para 115 Dr Warner used NHS modelling data and a paper from Professor Ferguson to support his conclusion that the UK "needed to change strategy from mitigation to suppression".⁶³⁶³ INQ000269182_0034 para 115; INQ000196056; INQ000149009 Dr Warner and Mr Cummings used a whiteboard to illustrate the problems with the current strategy and to explain the need for the UK government to implement stringent restrictions shortly.⁶⁴⁶⁴ INQ000273872_0044 paras 25-26 The whiteboard (see Figure 7) explained that the difference between the mitigation approach to the response currently being pursued by the UK government and that outlined on the whiteboard was that the new approach required "> [more] aggressive [action] next week".⁶⁵⁶⁵ INQ000273872_0044-0045 para 26 It further explained that "[we] [m]ust avoid NHS collapse … [t]o stop NHS collapse, we will probably have to 'lockdown'" and that this would mean that "e/o [everyone] stays home, pubs etc close".⁶⁶⁶⁶ INQ000273872_0044-0045 para 26

¶Figure 7: Notes on a whiteboard during the meeting at 10 Downing Street on 13 March 2020

¶Source: INQ000273872_0045

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¶4.30. Mr Cummings told the Inquiry that it was clear that if the UK government continued to pursue its initial mitigation plan:

¶" not only would there be thousands of deaths but NHS projections were clear that there would effectively be no NHS at all for anything for a period".⁶⁷⁶⁷ INQ000273872_0039

¶The advisers agreed that Mr Johnson must be advised to "change course and introduce a national lockdown as a matter of urgency".⁶⁸⁶⁸ INQ000252711_0008-0009 para 34

¶4.31. Helen MacNamara, Deputy Cabinet Secretary from January 2019 to February 2021, described a "sense of foreboding" in 10 Downing Street on 13 March 2020.⁶⁹⁶⁹ Helen MacNamara 1 November 2023 38/17-22 She had heard that the SAGE meeting had concluded that case numbers were rising faster than thought and was concerned that there was not sufficient urgency.⁷⁰⁷⁰ INQ000273841_0032-0033 para 61 She became aware – including through discussions with Mark Sweeney, Director General of Domestic and Economic Affairs in the Cabinet Secretariat from November 2019 to September 2022, who was coordinating with the Department of Health – that there were gaps in the policy for interventions. Mr Sweeney told Ms MacNamara:

¶" I have been told for years that there is a whole plan for this. There is no plan.

¶We are in huge trouble."⁷¹⁷¹ INQ000273841_0032-0033 paras 60-61

¶4.32. Ms MacNamara went into 10 Downing Street that evening and encountered Mr Cummings and others at their meeting. She gave a blunt assessment of the situation:

¶" We are absolutely fucked. I think this country is heading for a disaster."⁷²⁷² Helen MacNamara 1 November 2023 37/1-20; INQ000273841_0032 para 60; see also INQ000273872_0045 para 28

¶4.33. That evening, Mr Cummings sent a WhatsApp message to a group which included Mr Johnson, Mr Hancock, and Professors Whitty and Vallance, stating:

¶" [ W]e must talk on Monday through the full plan up to lockdown if necessary in

time to stop Italy style collapse. If we are 2-4 weeks behind Italy we may have to be more aggressive faster."⁷³⁷³ INQ000048399_0002

¶Professor Vallance replied: "Yes."⁷⁴⁷⁴ INQ000048399_0002

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¶4.34. Professor McBride told the Inquiry that, around 13 March 2020, it was "increasingly apparent" that there were:

" huge pressures on the health service, and particularly in London, and the health service and intensive care beds were about to be overwhelmed".⁷⁵⁷⁵ Michael McBride 10 May 2024 148/4-11

¶He explained that the Chief Medical Officers for the four nations of the UK met that day to discuss the SAGE update and that "[m]inisters were and should have been fully aware of the way in which things were ramping up".⁷⁶⁷⁶ INQ000421704_0152-0153 para 329

¶4.35. A briefing prepared by the Department of Health (Northern Ireland) on 13 March 2020, in advance of Northern Ireland Executive Committee and COBR meetings on 16 March, referred to the current high consequence infectious disease capacity in the UK having been exceeded. It noted the establishment of a planning sub-group to ensure an appropriate level of preparedness across the health and social care sector.⁷⁷⁷⁷ INQ000425611_0003-0004 paras 8, 11 The briefing did not provide any detail of the ability of health services in Northern Ireland to cope, nor any detail of concerns that those services could be overwhelmed.