4 to 12 March 2020

4 to 12 March 2020

¶3.90. On 4 March 2020, the UK government launched a public health information campaign that focused on the importance of handwashing.¹⁷⁷¹⁷⁷ 'Public information campaign focuses on handwashing', Department of Health and Social Care, 4 March 2020 (https://www.gov.uk/government/news/public-information-campaign-focuses-on-handwashing; INQ000618208)

¶3.91. On the same day, COBR met again. It was chaired by Mr Hancock and attended by health ministers from the devolved administrations.¹⁷⁸¹⁷⁸ INQ000056218_0001-0003

¶3.92. A SAGE paper prepared for the meeting stated: "In the event of a severe epidemic, the NHS will be unable to meet all demands placed on it."¹⁷⁹¹⁷⁹ INQ000056158_0003 para 3 It also outlined the scientific evidence for a number of proposed interventions (not including a stay at home order, since this was not in contemplation at this stage).¹⁸⁰¹⁸⁰ INQ000056158 As outlined above, it highlighted, even with these interventions:

" [ W]hatever the reduction in peak NHS bed demand achieved by these interventions, in the reasonable worst-case scenario demand will still greatly exceed supply."¹⁸¹¹⁸¹ INQ000056158_0003 para 14

¶However, the minutes of the COBR meeting do not contain any discussion of this.¹⁸²¹⁸² INQ000056218

¶3.93. The SAGE paper also explained that any interventions implemented would need to be government policy for a significant duration, since relaxing them too early could "result in further peaks and potentially extend transmission of the virus into Winter 2020".¹⁸³¹⁸³ INQ000056158_0001 para 6 It noted that, the following day, SAGE would consider the optimal combination of interventions, the optimal point at which they should be implemented and the duration for which they should be in place to delay the peak (mitigation) or to contain the outbreak (suppression).¹⁸⁴¹⁸⁴ INQ000056158_0001 para 7 Dr Stuart Wainwright, Director of the Government Office for Science from December 2019 to June 2023, informed COBR that combinations of the interventions in the SAGE paper had not yet been modelled and this would be done in the coming days.¹⁸⁵¹⁸⁵ INQ000056218_0008 para 17 Mr Hancock stated that "the science was guiding them towards self isolation".¹⁸⁶¹⁸⁶ INQ000056218_0009 para 19

¶3.94. COBR noted that analysis of the economic impact of the interventions had been completed, but analysis of the social impacts – noted by SAGE as potentially affecting society, individuals, the workforce and businesses, as well as the operation of government and public services – was still being undertaken.¹⁸⁷¹⁸⁷ INQ000056218_0008 para 18 The Cabinet Office was asked to ensure that analysis of social distancing measures took into account their social and economic impact.¹⁸⁸¹⁸⁸ INQ000056218_0011 para 10 UK government departments – and the devolved administrations – were asked to provide information on the impacts, challenges, cross-government interdependencies and societal impacts of various restrictions (giving the closure of schools as an example).¹⁸⁹¹⁸⁹ INQ000425601 This was work that the Cabinet Office regarded as likely to be already taking place in departments.

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¶3.95. The Welsh Government responded to the request on 7 March 2020 and subsequently discussed provision of further information, including comparative data on the "demographic differences between England and Wales".¹⁹⁰¹⁹⁰ INQ000352956_0001-0010; INQ000352955_0001-0013; INQ000352957_0001-0008 In Northern Ireland, Bernie Rooney, Deputy Director at The Executive Office from September 2019 to September 2020, contacted the Department of Health (Northern Ireland) but was told that it had not planned to reply.¹⁹¹¹⁹¹ INQ000258367_0002 Professor McBride said:

¶" [ W]e simply do not have the modelling capability to replicate and provide such

granularity and have not previously sought to provide same. Given the unrealistic time frames it is not possible to provide any meaningful analysis."¹⁹²¹⁹² INQ000309229_0003

¶Professor McBride considered that timeframes were being driven by the rapidly changing epidemic curve (or epicurve, a visual representation of the number of cases over time) and the need for imminent implementation of behaviour interventions in England. Notwithstanding evidence of community transmission in the Republic of Ireland, he thought Northern Ireland "was probably some few weeks behind".¹⁹³¹⁹³ INQ000309229_0003 The Inquiry saw no evidence that the Scottish Government responded to this request.

¶3.96. The Top Management Group within the Department of Health (Northern Ireland) had agreed to the full activation of the health Gold Command to provide strategic direction and advice (although only on 4 March 2020).¹⁹⁴¹⁹⁴ INQ000103631_0001 para 1; INQ000421704_0125 para 279 This was not a cross-government coordination body. Ms Rooney also advised Chris Stewart (Director at The Executive Office with responsibilities for civil contingencies) of "strong views" about the need for an "NI Hub [a coordination centre for Northern Ireland] to be established as a matter of priority", as well as a:

¶" [l]ack of structures and staff to respond to Cabinet Office requests – particularly the legislative requests for input to emergency Bill".¹⁹⁵¹⁹⁵ INQ000218494_0002

¶3.97. Derek Baker (Permanent Secretary to the Department of Education (Northern Ireland) from February 2017 to November 2020) enquired about 'standing up' the NI Hub but was advised by David Sterling (later Sir David Sterling), Head of the Northern Ireland Civil Service and Permanent Secretary to The Executive Office from June 2017 to August 2020, that, at that time, this "would be premature".¹⁹⁶¹⁹⁶ INQ000398439_0001 para 4

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¶3.98. The Welsh Cabinet met on 4 March 2020. It noted:

¶" [T]he Welsh Government and partners had plans in place to deal with pandemic flu, which would now be tested."¹⁹⁷¹⁹⁷ INQ000216456_0004 para 3.4

¶The Cabinet was briefed about a new operating model that "outlined cross-government activities and support for Ministers and Cabinet", including "specific issues, such as dealing with excess deaths, proposed emergency legislation and communications", and that it would take "around three to four weeks to build the necessary capacity to support the structure".¹⁹⁸¹⁹⁸ INQ000216456_0004 para 3.5 (See Chapter 11: Government decision-making, in Volume II, regarding the establishment of the Covid-19 Project Team.) The minutes of the meeting reflected the lack of urgency among ministers in the Welsh Government, stating that ministers would "have a further opportunity to discuss developments at its regular meeting the following Tuesday", which was six days later.¹⁹⁹¹⁹⁹ INQ000216456_0005 para 5.2

¶3.99. In contrast to their ministerial counterparts, following a meeting of officials within the Civil Contingencies Group (Wales), it was confirmed that:

¶" [ W]hat was clear to us all this morning is that our work on COVID-19 must now pick-up pace and intensity."²⁰⁰²⁰⁰ INQ000281647_0001

¶3.100. On 4 March 2020, in a message to Mr Cummings, Michael Gove MP (later Lord Gove), Chancellor of the Duchy of Lancaster from July 2019 to September 2021 and Minister for the Cabinet Office from February 2020 to September 2021, raised concerns about the Cabinet Office's ability to deliver on government priorities and to deal with Covid-19 (see Figure 4).

¶Figure 4: Exchange of messages between Mr Cummings and Mr Gove on 4 March 2020

¶Source: INQ000275436_0003

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¶3.101. On 5 March 2020, the first death of a patient with Covid-19 in England was reported.²⁰¹²⁰¹ 'CMO for England announces first death of patient with COVID-19', Department of Health and Social Care, 5 March 2020 (https://www.gov.uk/government/news/cmo-for-england-announces-first-death-of-patient-with-covid-19; INQ000237343) A further 25 cases in England were identified, bringing the total number of cases in the UK to 115.²⁰²²⁰² 'CMO for England announces 25 new cases of coronavirus (COVID-19): 5 March 2020', Department of Health and Social Care, 5 March 2020 (https://www.gov.uk/government/news/cmo-for-england-announces-25-new-cases-of-coronavirus-covid-19-5- march-2020; INQ000237341)

¶3.102. At a meeting of COBR COVID-19 (Officials) that day, chaired by Mr Johnson, Professor Whitty stated that:

" the prohibition of mass gatherings was not considered necessary from a scientific standpoint, and that widespread school closures were not yet necessary in the current phase of the outbreak".²⁰³²⁰³ INQ000183959_0003

¶Professor Whitty confirmed that the UK was "still in the containment phase but actively preparing for delay".²⁰⁴²⁰⁴ INQ000216492_0002 He also explained that there would be a "need to move to the Delay phase in the next seven to 14 days".²⁰⁵²⁰⁵ INQ000391237_0045 para 180

¶3.103. Also on 5 March 2020, SAGE recommended implementation of self-isolation and household isolation within one to two weeks, followed roughly two weeks later by shielding of those aged over 65 and those with underlying medical conditions.²⁰⁶²⁰⁶ INQ000106152_0002 paras 2-3 It reiterated that there was no evidence that banning very large gatherings would reduce transmission.²⁰⁷²⁰⁷ INQ000119719_0002 para 7; INQ000106152_0002 para 14

¶3.104. SAGE concluded that the UK remained in the containment phase, noting that "there are currently no scientific grounds to move away from containment efforts in the UK".²⁰⁸²⁰⁸ INQ000106152_0002 paras 1, 6 However, earlier on 5 March 2020, Professor Vallance had advised Mr Johnson that SAGE was close to advising a move from the contain phase to the delay phase.²⁰⁹²⁰⁹ INQ000047950_0001 As outlined above, this move was required even before the Coronavirus: Action Plan was published on 3 March. Professor Neil Ferguson, Mathematical Epidemiologist at Imperial College London, recalled:

" (quite possibly imperfectly) … that Chris Whitty was uncomfortable with the idea that the UK would be the first European country to abandon containment".²¹⁰²¹⁰ INQ000249526_0061-0062 para 200

¶3.105. On 6 March 2020, a Cabinet Secretariat briefing prepared for a later COBR meeting stated that the advice from SAGE was "that our response will soon need to move from contain to delay" and that containment was "now unlikely to be achievable".²¹¹²¹¹ INQ000056179_0001-0002

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¶It also advised on the possibility of an exit wave if stringent restrictions were implemented:

" [ V]ery stringent social and behavioural interventions (such as those in China) have the potential to prevent a major epidemic establishing but risks a large epidemic re-establishing when lifted."²¹²²¹² INQ000151558_0003

¶3.106. The same day, the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) discussed how to explain "why facemasks were acceptable for healthcare staff but not the general public".²¹³²¹³ INQ000087540_0004 para 2.6 It noted that members of the public were not trained to use face coverings and that it was the use of face coverings alongside other personal protective equipment (PPE) that made face coverings effective at preventing contamination in a healthcare setting.²¹⁴²¹⁴ INQ000087540_0004 paras 2.7-2.9

¶3.107. Also on 6 March 2020, Dr Rob Orford (Chief Scientific Adviser (Health) for Wales from January 2017) shared the eighth update from the Technical Advisory Cell with Dr (later Sir) Frank Atherton (Chief Medical Officer for Wales from August 2016) and Dr Andrew Goodall (Director General of Health and Social Services in the Welsh Government and Chief Executive of NHS Wales from June 2014 to November 2021), which attached simple modelling for the projected demands on health services in Wales.²¹⁵²¹⁵ INQ000252311; INQ000252096; INQ000252095. Dr Orford's updates to the Chief Medical Officer for Wales became labelled as Technical Advisory Cell updates from 2 March 2020. See INQ000390618_0032, 0039 paras 92, 115. The cell was established during the pandemic to provide coordination of scientific and technical advice to support Welsh Government decision-makers during emergencies – see Chapter 9: Scientific and technical advice, in Volume II.Show full note It projected that:

" Adjusting the model assumptions by simple scaling down [of the reasonable worst-case scenario] gives lower demand – but even with a 25% scaling, demand will exceed supply."²¹⁶²¹⁶ INQ000252311_0001 point 4

¶With interventions, the peak Covid-19 case load in Wales would still require almost

¶5,000 additional beds and over 1,400 additional intensive care beds.²¹⁷²¹⁷ INQ000252311_0008

¶3.108. In considering when it became clear that the NHS in Wales would be overwhelmed without taking action, Dr Goodall said that there was "definitely a switch from the last week of February into that first week of March".²¹⁸²¹⁸ Andrew Goodall 5 March 2024 57/13-21

¶3.109. On 9 March 2020, a protocol for the move from 'contain' to 'delay' was agreed across the four nations on a draft basis, although advice remained that there were no scientific grounds for moving away from containment.²¹⁹²¹⁹ INQ000255779; INQ000049539 It stated that the decision to move to the delay phase must be based on scientific advice and "jointly recommended" by the UK Chief Medical Officer (the Chief Medical Officer for England) and the Government Chief Scientific Adviser, "working in concert with the

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¶[Chief Medical Officers] of Scotland, Wales and Northern Ireland".²²⁰²²⁰ INQ000049539_0001 para 3.a

¶3.110. On 8 March 2020, a Six Nations rugby match between Scotland and France went ahead in Edinburgh. Dr Calderwood and Health Protection Scotland had recommended the match be allowed to proceed on the basis that "there is no clear scientific evidence that cancelling the event would lessen the risk of exposure to coronavirus".²²¹²²¹ INQ000292536_0002 para 14 The first recorded death of a person with Covid-19 in Scotland was a French national who had visited Scotland to watch the game.²²²²²² INQ000339033_0077 para 207 It was understood that he had contracted the virus prior to travelling to Scotland.²²³²²³ INQ000292579_0001-0002 When the Scottish Government announced this first death on 13 March, Dr Calderwood described the deceased as being an older person with underlying health conditions who was being treated by Lothian Health Board.²²⁴²²⁴ 'First death of patient from Coronavirus (COVID-19)', Scottish Government, 13 March 2020 (https://www.gov.scot/news/first-death-of-patient-from-coronavirus-covid-19; INQ000357783_0002) The Scottish Government did not disclose to the public at the time that he had attended the rugby match in Edinburgh.

¶3.111. On 8 March 2020, the Department of Health and Social Care reported that there had been more than 80,000 cases and more than 3,000 deaths in China and almost 6,000 cases and more than 200 deaths in Italy.²²⁵²²⁵ INQ000049540_0003 That same day, a number of northern provinces in Italy were placed into an effective lockdown – this was extended to the whole of the country on 9 March.²²⁶²²⁶ 'Coronavirus: Northern Italy quarantines 16 million people', BBC News, 8 March 2020 (https://www.bbc.co.uk/news/world-middle- east-51787238; INQ000591899); 'Coronavirus: Italy extends emergency measures nationwide', BBC News, 10 March 2020 (https://www.bbc.co.uk/news/world-europe-51810673; INQ000573840)

¶3.112. In the UK, the total number of Covid-19 cases had increased to 273, including 244 cases in England, 18 in Scotland, 4 in Wales and 7 in Northern Ireland. There had been two deaths.²²⁷²²⁷ INQ000049540_0008

¶3.113. Data from systematic NHS surveillance (initiated in late February 2020) became available around 8 March 2020.²²⁸²²⁸ INQ000273553_0045-0047 para 8.13. S-COVER was a respiratory intensive care network under which, from 29 February 2020, 11 pilot trusts were asked to submit samples from adult patients admitted to intensive care with an acute community-acquired respiratory infection (see INQ000251906_0168 para 724). (This was later replaced by the COVID-19 Hospitalisation in England Surveillance System, known as CHESS.) In addition, the Royal College of General Practitioners' sentinel surveillance system tested a random sample of patients attending GP practices for acute respiratory illness (see INQ000273553_0045-0047 para 8.13). This was added to Public Health England's First Few Hundred or FF100 datasets.Show full note Professor Edmunds told the Inquiry that positive cases were found through this surveillance "almost immediately".²²⁹²²⁹ INQ000273553_0045-0047 para 8.13 According to Professor Edmunds, given the sensitivity of those surveillance systems, the identification of any cases might "indicate a large underlying epidemic".²³⁰²³⁰ INQ000273553_0045-0047 para 8.13 Professor Edmunds explained that the data were, however, "very difficult to analyse" because there were delays of five to seven days between onset of cases and "confirmation and entry onto the database" – although "some cases were taking up to 3 weeks to be recorded".²³¹²³¹ INQ000273553_0045-0047 para 8.13 There were significant caveats to, and uncertainties in, the data available.

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¶3.114. Mr Cain raised concerns on 8 March 2020 that the Department of Health and Social Care appeared to be overwhelmed and unable – or unwilling – to support the Cabinet Office work on interventions and the coordination of the response.²³²²³² INQ000273841_0030 para 56; INQ000285993

¶3.115. Modelling from NHS England on 9 March 2020 indicated that:

" NHS demand will greatly exceed supply before the peak of the virus is reached in a Reasonable Worst Case scenario (RWCS), meaning the NHS will be unable to meet the demands placed on it."²³³²³³ INQ000146571_0001

¶It also noted that NHS beds and critical care capacity would still be overwhelmed in the reasonable worst-case scenario, even if self-isolation, household isolation and social distancing for over-65s were implemented.²³⁴²³⁴ INQ000146571_0001

¶3.116. The same day, Professor Steven Riley, Professor of Infectious Disease Dynamics at Imperial College London, sent a paper to Professor Medley. It advised that measures akin to lockdown should immediately be implemented to avoid the NHS being overwhelmed.²³⁵²³⁵ Steven Riley 17 October 2023 28/11-30/14; INQ000269365 In his reply, Professor Medley made the point that the present approach being pursued by the four governments was based on:

" the assumption that herd immunity will develop after one infection … if we need multiple infections to develop immunity … then we are really in trouble".²³⁶²³⁶ INQ000269365_0001

¶3.117. There was a growing recognition in the UK government and devolved administrations that the move from the contain phase to the delay phase was fast approaching. For example, at a COBR meeting for officials on 5 March 2020, chaired by Mr Johnson and attended by an official from the Welsh Government, Professor Whitty noted that the UK "will need to trigger Delay within the next week or fortnight".²³⁷²³⁷ This was not recorded in the minutes of the meeting (INQ000183959_0003), but was set out in a note taken by the Welsh Government at the meeting (INQ000216492_0001). Mr Gething told the Inquiry that he was informed of the discussion at the meeting and he therefore understood at this point that there would be a "need to move to the Delay phase in the next seven to 14 days".²³⁸²³⁸ INQ000391237_0045 para 180 On the same day, Professor Vallance advised Mr Johnson that SAGE was close to advising a move from contain to delay.²³⁹²³⁹ INQ000047950_0001 The Scottish Cabinet recognised on 3 March that it was likely that the response would move to the delay phase in the "near future".²⁴⁰²⁴⁰ INQ000232901_0004 para 15

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¶3.118. On the evening of 8 March 2020, Mr Stewart told colleagues at The Executive Office of Northern Ireland: "The UK is approaching (but has not yet reached) the transition point from 'contain' to 'delay'."²⁴¹²⁴¹ INQ000255049_0001 He explained that a COBR meeting the following day would:

¶" focus on those measures that will need to be adopted and maintained when that transition point is reached (soon)".²⁴²²⁴² INQ000255049_0001 (emphasis in original)

¶3.119. COBR met on 9 March 2020, again chaired by Mr Johnson. It was attended by the First Minister and deputy First Minister of Northern Ireland and the First Ministers of Scotland and Wales, as well as their health ministers and Chief Medical Officers.²⁴³²⁴³ INQ000056219 Sir Christopher Wormald explained that, by the time of this meeting, "it was widely expected … we would move from contain to delay".²⁴⁴²⁴⁴ INQ000280628_0049 para 92 The purpose of the meeting was therefore to agree which restrictions to slow the spread should remain in development and what the priority should be for work on them.²⁴⁵²⁴⁵ INQ000056190_0001 Mr Johnson was briefed that he should ask Professors Whitty and Vallance to confirm at the meeting that they still expected to advise on or around 11 March that the triggers for moving from 'contain' to 'delay' had been met.²⁴⁶²⁴⁶ INQ000056190_0003

¶3.120. A paper presented at the meeting stated "advice from SAGE is that our response will soon need to move from contain to delay".²⁴⁷²⁴⁷ INQ000056179_0001; INQ000056178_0002 It also explained that SAGE had considered the effectiveness of these interventions against different objectives, including containing the outbreak so that it did not become an epidemic and slowing the spread (mitigation).²⁴⁸²⁴⁸ INQ000056179_0002 The paper noted that containing the outbreak through the use of restrictions was "now unlikely to be achievable".²⁴⁹²⁴⁹ INQ000056179_0002 It is clear from the fact that SAGE was considering the effectiveness of potential restrictions to achieve different objectives that, even at this point, the UK government had still not made clear to SAGE its objectives for the response.

¶3.121. COBR considered "planned interventions to delay the virus' peak" in three stages:

¶" 1. Self isolation of symptomatic individuals.

2. Full house-hold isolation where one individual is symptomatic.

3. A series of currently undetermined measures to safeguard the elderly and

¶vulnerable individuals."²⁵⁰²⁵⁰ INQ000056219_0005 paras 4-5

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¶3.122. Professor Vallance explained that these interventions aimed to reduce "the peak of the virus to enable the NHS to cope with demand and to reduce the mortality rate".²⁵¹²⁵¹ INQ000056219_0005 para 4 SAGE had advised that both individual self-isolation (for those with "mild respiratory symptoms") and household isolation ("for all individuals living in the same household as someone who is 'symptomatic'") should be implemented by 13 March 2020 to maximise effectiveness, with a decision on these measures to be made by 11 March.²⁵²²⁵² INQ000056179_0001. This included high-level analysis of the likely societal and economic impacts of Covid-19 and interventions that had been collated by the Cabinet Office (as discussed above). COBR recognised that Scotland, Wales and Northern Ireland were not at the same stage as England and that the island of Ireland faced the additional challenge of having two separate jurisdictions with different public messaging.²⁵³²⁵³ INQ000056219_0005-0006 para 7

¶3.123. Professor Whitty advised COBR that the public should be reminded to self-isolate for serious, influenza-like symptoms and that this was not a change in medical advice. He confirmed that the next step would be for mildly symptomatic people to self-isolate and that this should be communicated within the next 10 days.²⁵⁴²⁵⁴ INQ000056219_0007 para 8 Professor Whitty also said that scientific advice supported early implementation of self-isolation, although household isolation and measures for vulnerable people and the elderly could be triggered later.²⁵⁵²⁵⁵ INQ000056219_0005-0006 paras 6, 8 He warned COBR that "the timing of implementation of measures was crucial" because measures might "be in place for months and public compliance or despondence was heavily dependent on timing".²⁵⁶²⁵⁶ INQ000056219_0005 para 6; see also INQ000056221_0005 para 4

¶3.124. No decision was made at the COBR meeting on 9 March 2020 about implementing the three restrictions of self-isolation, household isolation or shielding, although an action was raised for SAGE to "set out the thresholds for triggering each of the three interventions".²⁵⁷²⁵⁷ INQ000056219_0010 The delay phase was imminent. COBR should have asked SAGE to identify the trigger points for the implementation of restrictions during the delay phase long before this point.

¶3.125. COBR decided to "advise people with serious flu-like symptoms to stay at home today, in line with existing medical advice" and that it should consider at a meeting on 11 March 2020 whether to advise people with mild symptoms to do the same.²⁵⁸²⁵⁸ INQ000056219_0010; INQ000056179_0005; see also 'Watch again: Boris Johnson says government is moving towards "delay phase" of coronavirus', YouTube, 9 March 2020 (https://www.youtube.com/watch?v=Yc1alOEjDVA; INQ000223088_0014) Ms Sturgeon and Mr Drakeford had raised their concerns at the meeting that advising only people with serious influenza-like symptoms to self-isolate – and not those with mild symptoms – did not reflect the restriction outlined in SAGE's paper for their consideration.²⁵⁹²⁵⁹ INQ000216493; INQ000273747_0011-0012 para 33 Mr Johnson stated that the next COBR meeting would discuss self-isolation for people with mild symptoms, household isolation and shielding.²⁶⁰²⁶⁰ INQ000056219_0007 para 9 The issue of whether the implementation of restrictions was timely is analysed in detail in Chapter 4: Realisation and lockdown, in this volume.

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¶3.126. On 10 March 2020, Mr Drakeford updated the Welsh Cabinet about COBR discussions, stating that the timing of the implementation of restrictions was critical, since if they:

" were used prematurely it would likely lead to the population being less receptive to messages at a time when the spread of the virus was more virulent".²⁶¹²⁶¹ INQ000129909_0002 para 2.1

¶3.127. The Top Management Group within the Department of Health (Northern Ireland) met on 9 March 2020 but, even at this late stage, was only considering the possibility of invoking Northern Ireland Central Crisis Management Arrangements (known as NICCMA) to involve The Executive Office further. This was to be discussed further with the Chief Medical Officer.²⁶²²⁶² INQ000433481_0002 action 1 Further, the Department of Health (Northern Ireland) was still debating whether to advise that these civil contingency arrangements should be initiated in Northern Ireland.²⁶³²⁶³ Richard Pengelly 7 May 2024 55/5-60/5 While the Department of Health (Northern Ireland) did provide updates to officials in other departments, the Executive Committee (through the Minister of Health) and The Executive Office – and provided strategic public health advice – it fundamentally underestimated the scale of Covid-19 and the risk it presented in Northern Ireland and failed to appreciate the need for urgent, ministerially sponsored, whole-of-government action.

¶3.128. SAGE met again on 10 March 2020.²⁶⁴²⁶⁴ INQ000109125 By this date, there were 319 confirmed cases in the UK, but SAGE advised there were likely to be as many as 5,000 to 10,000 cases and transmission was "underway in community and nosocomial (i.e. hospital) settings".²⁶⁵²⁶⁵ INQ000109125_0002 paras 5-6; INQ000249526_0083 para 255 These estimates were based on approximations by Professors Medley and Ferguson, who had sought to gain an understanding of the degree to which cases in the UK had been underestimated. However, as Professor Ferguson told the Inquiry:

" [I]n retrospect that range was almost certainly a substantial underestimate, given [various data limitations and connected issues] … it is highly likely that many (if not most) COVID-related deaths were missed in the UK prior to 11th March 2020."²⁶⁶²⁶⁶ INQ000249526_0084-0085 para 262

¶3.129. Professor Ferguson told the Inquiry that, at this meeting, he asked the 10 Downing Street officials present "if they knew what an epidemic with 4000-6000 deaths per day would feel like".²⁶⁷²⁶⁷ INQ000249526_0063 para 206 He later emailed Dr Warner in 10 Downing Street, stating that he would like Mr Johnson to see graphs in an Imperial College London paper that indicated the NHS would be overwhelmed under the interventions being considered and deaths would still likely peak at 4,000 to 6,000 a day.²⁶⁸²⁶⁸ INQ000196055; INQ000149009 Professor Ferguson told Dr Warner:

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" While this got called the reasonable worst case until today, this is my Centre's best estimate of what might happen. Even allowing for uncertainty, we will still see at least half of those numbers …

So long as the PM and Cabinet accept and understand this is what is likely to happen and are still happy to proceed with current plans, then there is a rational basis to that decision which I would say the science supports …

But what would be the worst outcome – in my opinion – would be to go for mitigation (the policy package currently being discussed) and for the health, social and political cost to be judged later to be unacceptable – necessitating a policy pivot in the midst of what will already be a national crisis."²⁶⁹²⁶⁹ INQ000196055_0002

¶Professor Ferguson later told the Inquiry that he would not have sent these emails had he been satisfied that his views were being properly reflected in SAGE and communicated to the UK government through Professors Whitty and Vallance.²⁷⁰²⁷⁰ Neil Ferguson 17 October 2023 191/21-192/2

¶3.130. The Cheltenham Festival took place from 10 to 13 March 2020.²⁷¹²⁷¹ 'Cheltenham Festival 2020: Race schedule and BBC radio coverage times', BBC Sport, 4 March 2020 (https://www.bbc.co.uk/sport/horse-racing/51592290; INQ000591894) On 11 March, a Champions League football match took place in Liverpool.²⁷²²⁷² 'Champions League: Atletico score three as Liverpool knocked out – reaction', BBC Sport, 11 March 2020 (https://www.bbc.co.uk/sport/live/football/51468477; INQ000591893) SAGE had advised on 10 March that "public gatherings pose a relatively low but not zero public risk … But it acknowledged the importance of advice in this area and agreed to review it."²⁷³²⁷³ INQ000109125_0004 para 37 A paper was therefore provided by the London School of Hygiene & Tropical Medicine on 11 March, which concluded the following:

" Banning sporting events has a negligible impact on the epidemic. Reducing all leisure contact, which mainly occurs in pubs/bars, restaurants and cinemas would have a much larger (though still modest) impact on the epidemic."²⁷⁴²⁷⁴ INQ000151575_0003

¶3.131. On 10 March 2020, Mr Shafi suggested the NHS England modelling dated 9 March should be included in the papers for the COBR meeting on 12 March and stated that it was "frightening that even if we pull all levers we are still overwhelmed".²⁷⁵²⁷⁵ INQ000146572_0001 Even at this stage, decision-makers in the UK government had failed to understand that there was a real risk the reasonable worst-case scenario would materialise and, as a result, the NHS in England would be overwhelmed. This was despite, as outlined above, an NHS England modelling paper being provided to COBR on 4 March, which indicated that, in a severe epidemic where the reasonable worst-case scenario materialised, the NHS would be overwhelmed before the peak was reached, regardless of the interventions put in place.²⁷⁶²⁷⁶ INQ000056158

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¶3.132. Mr Johnson told the Inquiry that, following his review of the daily update contained in his ministerial red box on 10 March 2020, "the potential consequences were becoming ever clearer".²⁷⁷²⁷⁷ INQ000255836_0031 para 130 The update advised that 8% of those diagnosed with the virus in the Lombardy region of Italy had died, due to its older population.²⁷⁸²⁷⁸ INQ000183880_0002; INQ000255836_0029 para 129 Mr Johnson explained that this figure disturbed him, as Britain also had an elderly population.²⁷⁹²⁷⁹ INQ000255836_0031 para 130 There were others with concerns. Mr Gove asked Mr Hancock and Mr Cummings probing questions about aspects of the UK government's response, including about the provision of PPE, respirators and ventilators.²⁸⁰²⁸⁰ INQ000263380 As the Inquiry is examining in detail in Module 5: Procurement, the Department of Health and Social Care was working on the issue but, by this stage, it was known that procurement in a global pandemic would be a challenge.²⁸¹²⁸¹ INQ000536350_0014-0015 paras 65-70 Mr Gove told the Inquiry that he sent this email as he was concerned the UK government "needed more challenge" to its assessment.²⁸²²⁸² INQ000259848_0018-0019 para 31

¶3.133. On 10 March 2020, the Scottish Cabinet discussed Covid-19 at length. Its conclusions suggest that the matter was discussed in far greater detail than on previous occasions and the tone of the record suggests a broader recognition of the gravity of the situation.²⁸³²⁸³ INQ000238706_0003 para 10 The Cabinet was now considering the closure of schools and the cancellation of mass gatherings for behavioural reasons because it might:

" be a problem with the credibility of a public message advising significant restrictions of personal behaviour while allowing a 'business as usual' approach for large events".²⁸⁴²⁸⁴ INQ000238706_0003 para 10

¶It noted that the spread of the outbreak in Scotland was not out of proportion with that elsewhere in the UK and that:

" [T]here was no current reason to depart from a concerted, UK-wide approach, guided by the evidence provided by the Scientific Advisory Group for Emergencies [SAGE] … the only reason for a departure from a UK-wide approach would be if the evidence suggested that there would be an advantage for the Scottish population in following a different course from the rest of the UK."²⁸⁵²⁸⁵ INQ000238706_0003 para 9

¶Its conclusions record the need for a cross-government response.²⁸⁶²⁸⁶ INQ000238706_0004 para 15(a) The overall objective was said to be "to do everything possible to keep the number of severe cases to a minimum".²⁸⁷²⁸⁷ INQ000238706_0004 para 15(d)

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¶3.134. On 10 March 2020, the Northern Ireland Executive Committee was briefed that there was no government advice to cancel large events but that organisers had called off various large gatherings, including various St Patrick's Day parades.²⁸⁸²⁸⁸ INQ000425540_0004 By this point, there were 16 cases of Covid-19 in Northern Ireland and 21 cases in the Republic of Ireland.²⁸⁹²⁸⁹ INQ000065695_0001 In the meeting, Michelle O'Neill MLA, deputy First Minister of Northern Ireland from January 2020 to February 2022, said: "[Executive] approach needs to kick in – all need to contribute."²⁹⁰²⁹⁰ INQ000065695_0002 Arlene Foster MLA (later Baroness Foster of Aghadrumsee), First Minister of Northern Ireland from January 2016 to January 2017 and from January 2020 to June 2021, was noted to have asked: "Civil Contingencies – have we got plans to handle?"²⁹¹²⁹¹ INQ000065695_0002-0003 These comments capture the Executive Committee's belated realisation that responding to the pandemic would require a ministerially sponsored, cross-governmental response. Mr Swann agreed that, at that time, there was no real cross-departmental response to Covid-19 in Northern Ireland.²⁹²²⁹² Robin Swann 13 May 2024 121/2-24

¶3.135. In an exchange with Professor Whitty, Professor McBride noted that he needed "to secure an all Ireland approach aligned with the UK".²⁹³²⁹³ INQ000282777_0003 An all-Ireland approach was, within days, to prove unrealistic.

¶3.136. On 11 March 2020, with more than 118,000 cases in 114 countries and 4,291 deaths, the World Health Organization declared Covid-19 to be a pandemic.²⁹⁴²⁹⁴ 'WHO Director-General's opening remarks at the media briefing on COVID-19 – 16 March 2020', World Health Organization, 16 March 2020 (https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing- on-covid-19---16-march-2020; INQ000237407) It had deep concern over the "alarming levels of spread and severity, and by alarming levels of inaction". The World Health Organization further stated:

" [ W]e have called every day for countries to take urgent and aggressive action. We have rung the alarm bell loud and clear."²⁹⁵²⁹⁵ 'WHO Director-General's opening remarks at the media briefing on COVID-19 – 20 March 2020', World Health Organization, 20 March 2020 (https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media- briefing-on-covid-19---20-march-2020; INQ000052458_0001)

¶3.137. That morning, Professor Whitty sent an email to Professor David Hunter, Professor of Epidemiology and Medicine at the University of Oxford, concerning the timing of the implementation of restrictions. Professor Whitty explained that "my main concern at the moment is sustainability if we go too early".²⁹⁶²⁹⁶ INQ000048039_0001

¶3.138. On 11 March 2020, Mr Cummings sent a message to Mr Gove expressing his frustration that, contrary to assurances, the Cabinet Office did not have a plan for responding to Covid-19 (see Figure 5).

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¶Figure 5: Exchange of messages between Mr Cummings and Mr Gove on 11 March 2020

¶Source: Extract from INQ000275436_0003

¶3.139. Mr Cummings also sent a message to a WhatsApp group of 10 Downing Street and Department of Health and Social Care advisers and officials, Mr Hancock and Professors Vallance and Whitty. He stressed that it was necessary for senior people to understand and discuss with Mr Johnson that "all sensible people can see the trajectory and how social distancing will be needed to flatten curve".²⁹⁷²⁹⁷ INQ000102697_0017 Mr Cummings referred to the fact that some were saying the risks of implementing restrictions too late were higher than those of going too soon and that "extremely clear scientific justification" would be needed if the introduction of social distancing was to be delayed for a further week.²⁹⁸²⁹⁸ INQ000102697_0017

¶3.140. The UK Cabinet met on the morning of 11 March 2020. Mr Johnson explained that:

" [E]pidemiologists were clear that the timing of [the] introduction of [further interventions] was key to their effectiveness. Measures would be deployed only when the time was right."²⁹⁹²⁹⁹ INQ000056132_0006

¶Mr Hancock advised the UK Cabinet that:

" [T]he key symptoms were a dry cough and a temperature. Without these symptoms, it was highly unlikely that someone was suffering from coronavirus."³⁰⁰³⁰⁰ INQ000056132_0004

¶Mr Hancock's statement was incorrect. As outlined in Chapter 2: The emergence of Covid-19, in this volume, there was clear evidence (including reports from the Diamond Princess cruise ship) by February 2020 that someone could have Covid-19 and be asymptomatic.

¶3.141. The first case of community transmission of Covid-19 was reported in Wales on 11 March 2020.³⁰¹³⁰¹ INQ000273747_0013 para 35 That same day, Public Health Wales identified Covid-19 as a potential "major (health) incident".³⁰²³⁰² INQ000147246_0002 para 1; INQ000267867_0014 para 56 It noted that:

" Objectively the demographic characteristics of the Welsh population and specifically the age profile of the population over 65/75, health and economic status, and dependency responsibilities are such that Wales may experience disproportionate levels of impact from Covid-19."³⁰³³⁰³ INQ000147246_0005 para 2

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¶3.142. Public Health Wales recommended early implementation of home isolation, household quarantine and cocooning (or shielding) of vulnerable people, commending "urgent attention directed at the elderly population cared for in residential and nursing homes in Wales".³⁰⁴³⁰⁴ INQ000147246_0006 The Inquiry is considering the decisions affecting the adult social care sector in Module 6: Care sector.

¶3.143. Public Health England was also active at this time. It was still trying to develop an effective test and trace system, and it established the Covid-19 Hospitalisation in England Surveillance System (known as CHESS) to collect data relating to people hospitalised with the virus and provide real-time data on the utilisation of hospitals by these patients.³⁰⁵³⁰⁵ INQ000119666; INQ000251906_0169-0179 paras 727-730

¶3.144. SPI-M-O met on 11 March 2020. It discussed the paper dated 9 March from Professor Riley, which set out reasons for the UK not to delay closing schools, to move to working from home and to implement any other possible social distancing, with a suggested initial three-week duration of additional interventions.³⁰⁶³⁰⁶ INQ000269367; see also INQ000269365; INQ000233674_0001 para 5 He also suggested that the perceived benefits of slowing the spread of the virus might not be achieved if NHS critical care was overwhelmed and the public voluntarily began to socially distance as a result. He said there was:

" strong evidence with which to abandon mitigation strategies, justified in any way by the possibility of a short epidemic … we suggest that the first step is to adopt stringent fixed-term social distancing".³⁰⁷³⁰⁷ INQ000269367_0004

¶Professor Riley proposed an immediate switch to a suppression strategy of stopping the spread of the virus and discussed the possibility of using adaptive or repeated lockdown policies. It was agreed at the meeting that these scenarios should be modelled.³⁰⁸³⁰⁸ INQ000233674_0001 para 6 This would be the first time that a lockdown, as it became known, had been "seriously considered" as a possible intervention.³⁰⁹³⁰⁹ INQ000273553_0059 para 9.8

¶3.145. SPI-M-O also produced a consensus statement on the matter of mass gatherings on 11 March 2020. It advised that stopping mass gatherings would only have a low impact on the spread of Covid-19, noting that "the risk to an individual from attending large events is generally no higher than in smaller events".³¹⁰³¹⁰ INQ000195883_0001 Cancelling mass gatherings could either lead to more epidemiologically risky displacement activities or, by contrast, could send a message to people that would lead them to change their behaviour and potentially slow the spread of the virus. However, it noted that:

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" [I]t is not possible to quantify either of these effects. The impact of stopping all leisure activities, including public gatherings such as at bars and restaurants, would be expected to have a much larger effect on the population-level spread of the epidemic."³¹¹³¹¹ INQ000195883_0001

¶The following day, the Technical Advisory Cell advised that "only a modest reduction in the infection related deaths (2%) is predicted for restricting mass gatherings".³¹²³¹² INQ000271613_0002 However, a Welsh Covid-19 Core Group meeting the same day recorded that "it would be difficult to justify not cancelling events".³¹³³¹³ INQ000215171 para 9

¶3.146. On the afternoon of 11 March 2020, Mr Hancock chaired a COBR meeting, attended by the First Minister of Northern Ireland, the Deputy First Minister of Scotland and the Director of Local Government in the Welsh Government.³¹⁴³¹⁴ INQ000056220_0001-0003, 0007 para 12 The purpose of this meeting was to agree a coronavirus bill, as it was intended that the following day COBR would discuss the move from 'contain' to 'delay' and interventions to slow the spread (despite SAGE having previously advised that a decision on interventions was required by 11 March).³¹⁵³¹⁵ INQ000056192_0001, 0006

¶3.147. Professor Whitty advised COBR that cases in the UK were rising, with an estimated 5,000 to 10,000 cases present. If no significant actions were taken to mitigate the upward trajectory, the peak would arrive in 10 to 14 weeks, with cases increasing rapidly from 6 weeks. It was believed that the UK was 4 to 6 weeks behind Italy, which was still some weeks away from its peak.³¹⁶³¹⁶ INQ000056220_0005 para 1 Sir Simon Stevens (later Lord Stevens of Birmingham), Chief Executive of NHS England from April 2014 to July 2021, advised COBR that, in the reasonable worst-case scenario, NHS services would be under extreme pressure, but that:

" [I]n the event of a lower infection rate than in Lombardy, lower, but nonetheless high, pressure would still be experienced."³¹⁷³¹⁷ INQ000056220_0008 para 15

¶Sir Simon Stevens explained that elective surgery would need to be postponed to release 30,000 beds.³¹⁸³¹⁸ INQ000056220_0008 para 15 COBR agreed that NHS England should liaise with its counterparts in the devolved administrations on decisions that might be required to surge health and care facilities, including cancellation of elective treatments.³¹⁹³¹⁹ INQ000056220_0009 para 10

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¶3.148. The content of the emergency coronavirus bill was also agreed by COBR.³²⁰³²⁰ INQ000056220_0007 para 12 The bill was based on the Pandemic Influenza (Emergency) Bill, which had been prepared in collaboration with the devolved administrations and finalised in 2019.³²¹³²¹ INQ000263372_0015 para 44 Its development had been led by the Department of Health and Social Care, with input from the UK government and devolved administrations at both official and ministerial levels.³²²³²² INQ000056208_0001-0002 para 6; INQ000056180_0003 It contained measures for use in the delay phase, to manage the peak of the outbreak, and created public health powers for the Scottish Government and Northern Ireland Executive to implement restrictions (such powers were already available to the UK and Welsh governments under the Public Health (Control of Disease) Act 1984).³²³³²³ INQ000056208_0003-0004 para 17; see Coronavirus Act 2020, sections 48, 49 and Schedules 18, 19 (https://www.legislation.gov.uk/ukpga/2020/7/contents); Public Health (Control of Disease) Act 1984, section 45C (https://www.legislation.gov.uk/ukpga/1984/22/contents) Mr Drakeford told the Inquiry that it was not until 20 March 2020 that there was a "looming reality" that public health powers would be used to respond to the pandemic.³²⁴³²⁴ Mark Drakeford 13 March 2024 38/20-40/20

¶3.149. On 11 March 2020, Professor (later Dame) Jenny Harries (Deputy Chief Medical Officer for England from July 2019 to March 2021) publicly stated that it would be detrimental for people without Covid-19 symptoms to wear a face covering:

" If a healthcare professional hasn't advised you to wear a face mask, it's usually quite a bad idea. People tend to leave them on, they contaminate the face mask and then wipe it over something. So it's really not a good idea and doesn't help."³²⁵³²⁵ 'PM and Deputy CMO on Coronavirus', Facebook, 11 March 2020 (https://www.facebook.com/borisjohnson/videos/pm-and- deputy-cmo-on-coronavirus/227850301597915; INQ000548399)

¶3.150. The Irish government followed the example of other countries such as Italy by announcing a package of measures that were to take effect from 18:00 on 12 March 2020 and remain in place until 29 March. These included the closure of schools, colleges and childcare facilities, the cancellation of all indoor mass gatherings of 100 people and outdoor gatherings of over 500 people, the closure of cultural institutions and the implementation of social distancing in restaurants and cafes. People were also advised to continue to work if they could, but to work from home where possible.³²⁶³²⁶ INQ000083097_0002 This took ministers in Northern Ireland by surprise and showed Professor McBride's hope of securing an all-Ireland approach that aligned with the UK to be unrealistic. Ms O'Neill said that the Irish government:

" took that decision and didn't tell us. That wasn't good enough, because that actually led and fed into that confusion and put us all in a very difficult spot."³²⁷³²⁷ Michelle O'Neill 14 May 2024 90/8-11

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¶3.151. On 12 March 2020, Ms Foster and Ms O'Neill met with Mr Sterling, who advised that there was "no medical/scientific evidence" to support the measures announced by the Irish government.³²⁸³²⁸ INQ000232525_0001 A note of the meeting records that Ms O'Neill referred to "one island and two approaches – need to identify which approach is right and which isn't".³²⁹³²⁹ INQ000232525_0002

¶3.152. The same day, at a further meeting attended by all Northern Ireland Executive ministers and permanent secretaries in Northern Ireland, Ms Foster explained:

" [T]he urgency of this meeting was driven by the statement this morning by the Taoiseach. DFM [deputy First Minister] referred to public confusion. While we continue to follow the science and medical advice, we are now in a difficult position given RoI [Republic of Ireland] approach."³³⁰³³⁰ INQ000289859_0001

¶Professor McBride advised that there was a risk in creating a peak too early and then inviting an additional peak. Conor Murphy MLA, Minister of Finance from January 2020 to October 2022, pointed to a need to understand why the advice in the Republic of Ireland was different. Ms Foster and Ms O'Neill subsequently took different positions publicly on the issue of school closures.³³¹³³¹ INQ000083098_0002 The Northern Ireland Office noted that "cracks" were beginning to emerge in the Northern Ireland Executive, with Sinn Féin "wanting to follow Irish government particularly re school closures".³³²³³² INQ000083098_0003 The impact of this is explored in greater detail in Chapter 11: Government decision-making, in Volume II.

¶3.153. On the morning of 12 March 2020, Ms Sturgeon decided that mass gatherings of more than 500 people should be cancelled from 16 March 2020.³³³³³³ INQ000339033_0010 para 23 Although Dr Calderwood's view was that cancelling mass gatherings, particularly those outdoors, would not have a significant impact on transmission, Ms Sturgeon made the decision for three reasons: (i) mass gatherings carried a risk of potential outbreaks that would be better avoided at this time; (ii) the impact of mass gatherings on the resources of the emergency services; and (iii) the risk that negative public perceptions about mass gatherings continuing might undermine the general public health advice.³³⁴³³⁴ INQ000339033_0072-0074 paras 194-197 Ms Sturgeon told the Scottish Parliament at noon that day that she was minded to cancel mass gatherings in Scotland, subject to the views of the other three governments at the COBR meeting that afternoon.³³⁵³³⁵ INQ000339033_0010 para 23

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