Chapter 2: The emergence of Covid-19 (January and February 2020)

Introduction

¶2.1. As Covid-19 emerged in early 2020, the UK government and devolved administrations were facing a number of pressing matters. These included: the setting up of a new administration under Boris Johnson MP (Prime Minister from July 2019 to September 2022) following the December 2019 General Election; the resumption of power-sharing in Northern Ireland on 11 January 2020 after a prolonged period of suspension; the departure of the UK from the European Union (EU) on 31 January 2020; widespread flooding in Wales in February 2020; and preparations for the UK government budget in March 2020.

¶2.2. This chapter examines how, against this backdrop, the systems and personnel within the UK government and devolved administrations responded to the developing crisis in the first two months of 2020. The decisions that were made during this early and fast-moving phase of the Covid-19 pandemic had a significant impact on the effectiveness of the UK's response. The chapter considers whether the scientific, administrative and political arms of government properly understood the threat and reacted appropriately and with sufficient speed on learning of the emergence of the virus.

January 2020: Emerging understanding

¶2.3. When Covid-19 first emerged, there was a great deal that was unknown, including some of the key characteristics of the virus, as set out in Chapter 1: The context for pandemic decision-making, in this volume. In particular, the nature and extent of its transmission were not understood, including the degree to which it could be transmitted through contact or respiratory routes.¹¹ Technical Report on the Covid-19 Pandemic in the UK, Department of Health and Social Care, 1 December 2022, p55, para 10 (https://www.gov.uk/government/publications/technical-report-on-the-covid-19-pandemic-in-the-uk; INQ000101642)

Initial awareness

¶2.4. On 2 January 2020, Professor (later Sir) Jonathan Van-Tam, Deputy Chief Medical Officer for England from October 2017 to March 2022, received an email notification from a publicly available system reporting infectious disease outbreaks. It referred to a "mystery viral pneumonia outbreak" in the city of Wuhan, China, which had led to the hospitalisation of 27 people – the majority of whom were stallholders at a live animal 'wet market'.²² INQ000151286_0002 Professor Van-Tam forwarded the email to colleagues in the Department of Health and Social Care, including Professor (later Sir) Christopher Whitty, Chief Medical Officer for England from October 2019. He commented that the outbreak was "one we should watch (no more than that)".³³ INQ000151286_0001 Over the next few days, he sought to obtain further information from multiple sources, including Professor (later Sir) Peter Horby (Professor of Emerging Infectious Diseases and Global Health at the University of Oxford), the World Health Organization and the US Centers for Disease Control and Prevention.⁴⁴ INQ000151286_0001; INQ000151289_0001; INQ000151291_0001 On 3 January 2020, Professor Sir Patrick Vallance (later Lord Vallance of Balham), Government Chief Scientific Adviser from April 2018 to March 2023, activated the internal Scientific Advisory Group for Emergencies (SAGE) team to monitor the outbreak.⁵⁵ INQ000238826_0024 para 63

¶2.5. On 5 January 2020, Professor Whitty identified three "triggers" which, if met, would "mean we should start taking a close interest and considering risk to the UK".⁶⁶ INQ000047484_0001 These triggers were:

healthcare workers dying ("often the early warning that a new infection is both severe and transmissible");
evidence of person-to-person (or human-to-human) transmission; and
geographical spread.⁷⁷ INQ000047484_0001

¶Professor Whitty said that "much of the next 2 weeks were spent trying to ascertain if the triggers were met".⁸⁸ INQ000251645_0071 para 7.10

¶2.6. Professors Whitty and Vallance met on 7 January 2020 and discussed the outbreak in Wuhan. At this stage, their view aligned with that of Professor Van-Tam and:

¶" would have been that this was something to keep a close eye on rather than something which was definitely going to turn into a pandemic".⁹⁹ INQ000251645_0071 para 7.12

¶2.7. On 8 January 2020, Professor Van-Tam advised the Department of Health and Social Care that there remained "no known [person-to-person] transmission" in relation to the new emerging virus.¹⁰¹⁰ INQ000151293_0001

¶2.8. Public health agencies across the UK shared information. On 7 January 2020, Public Health England provided a briefing note on the known cases in Wuhan, along with clinical advice and advice on implications and recommendations for onward distribution to the NHS, private health providers and the devolved administrations.¹¹¹¹ INQ000147248 Each devolved administration subsequently produced its own briefing.¹²¹² INQ000235212_0024-0025 paras 81-82; INQ000147237; INQ000188992_0001; INQ000147248; INQ000425573 Public Health England also began work on adapting its First Few Hundred Protocol, which functioned as both a scientific study (to gather and publish data on all early UK cases of a new outbreak) and a relatively small-scale test and contact tracing system for initial cases.¹³¹³ INQ000251906_0149 paras 656-667. The protocol was published later in January 2020 (INQ000061497) with analyses being reported in daily Situation Reports (SitReps) from 13 February; see for example INQ000223365.

¶2.9. On 9 January 2020, Public Health England assessed that the current threat level to the UK population was "Very Low".¹⁴¹⁴ INQ000119453_0003. This was endorsed by NERVTAG on 13 January 2020 (INQ000023107_0006). However, the purpose of this and other risk assessments was:

¶" not to assess the risk at some theoretical future point but rather the risk at that point in time [ie on that day]".¹⁵¹⁵ INQ000251645_0075 para 7.33

¶Professor Whitty told the Inquiry that, with China having "reported 41 cases and the first case outside of China had just been reported", in the circumstances as they then stood, the 'very low' threat was "a rational assessment".¹⁶¹⁶ INQ000251645_0075 para 7.33

¶2.10. Professor Van-Tam also emailed Professor Whitty, noting that there had been no reported deaths to date but that the reported severity of the disease and hospitalisation rates were such that, in his view:

¶" established person-to-person transmission would cause serious hospital surge pressures on a par with a severe panflu virus".¹⁷¹⁷ INQ000151296_0002

¶2.11. Also on 9 January 2020, Matt Hancock MP, Secretary of State for Health and Social Care from July 2018 to June 2021, received his first written briefing by email from the Department of Health and Social Care, which stated:

¶" [T]he assessed risk to people in Wuhan is low to moderate, and the risk to the

¶UK is low. There is no evidence of human to human transmission."¹⁸¹⁸ INQ000233737_0001; see also INQ000232194_0024-0025 paras 92-97

¶Mr Hancock informed Mr Johnson of the outbreak.¹⁹¹⁹ INQ000232194_0025 para 98; INQ000255836_0010 para 20 Recalling their exchange, Mr Johnson told the Inquiry that he:

¶" could tell he was serious. I said that I understood his concern but could see no

reason to panic. I felt that I was familiar with zoonotic diseases and the public health scares they can cause."²⁰²⁰ INQ000255836_0010 para 20. Zoonotic diseases are those caused by pathogens that originated from animals other than humans.

¶Those "scares" included "things like SARS [severe acute respiratory syndrome] and MERS [Middle East respiratory syndrome] and swine flu [the 2009 to 2010 H1N1 influenza pandemic]", which had had an impact in Asia in particular, but, as Mr Johnson observed, "ultimately were relatively, if not wholly benign in the UK".²¹²¹ Boris Johnson 6 December 2023 51/1-7

¶2.12. On the same day, the World Health Organization reported that Chinese authorities had stated that the coronavirus did "not transmit readily between people".²²²² 'WHO statement regarding cluster of pneumonia cases in Wuhan, China', World Health Organization, 9 January 2020, p1 (https://www.who.int/hongkongchina/news/detail/09-01-2020-who-statement-regarding-cluster-of-pneumonia-cases-in-wuhan-china; INQ000236523); see also INQ000183385 It made no recommendations for any specific measures for travellers and advised against the application of any travel or trade restrictions with China.

¶2.13. On 13 January 2020, Thailand reported the first case imported from Wuhan.²³²³ INQ000023107_0005 para 3.7 The National Incident Management Team of Health Protection Scotland (which facilitated the flow of advice and information to the Scottish Government) also met for the first time.²⁴²⁴ INQ000360968_0006 para 2.6; INQ000339576_0010 para 1.4.4

¶2.14. Similarly, that day, the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) met formally for the first time to consider the outbreak.²⁵²⁵ NERVTAG is an expert committee with a specific focus on novel respiratory illnesses and its members have a variety of expertise, including clinical, epidemiology, virology and behavioural sciences (INQ000248853_0053 para 5.164). It noted:

¶" [I]t has been stated that there has been no 'significant' human to human

transmission, which implies there may be some evidence of limited human to human transmission which has not yet been made available. Given that the onset dates are over a period of almost one month, and now the case in Thailand, we should be cautious at this point in making conclusions about the absence [of] human to human transmission."²⁶²⁶ INQ000023107_0003 para 3.2. It also stated that "[w]ith the evidence that is currently available, the novel virus does not look to be very transmissible" (INQ000023107_0003 para 3.3).

¶2.15. Professor Van-Tam attended the meeting and reported to the Civil Contingencies Secretariat in the Cabinet Office that NERVTAG was:

¶" watching closely; remain cautious that it is too early to rule out all person to person [transmission] but it so far looks very low or absent".²⁷²⁷ INQ000269203_0032-0033 para 6.18

¶" Although such transmission cannot yet be ruled out there does not appear to be

a significant risk of human to human transmission at this time."²⁸²⁸ INQ000047493_0002; see also INQ000269203_0034-0035 para 6.22 (emphasis in original)

¶2.16. On 14 January 2020, the World Health Organization announced:

¶" Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission."²⁹²⁹ INQ000236435

¶However, it informed the media that:

¶" [f]rom the information that we have it is possible that there is limited human-to-human transmission, potentially among families, but it is very clear right now that we have no sustained human-to-human transmission".³⁰³⁰ INQ000151316_0002-0003

¶2.17. Professor Van-Tam emailed Professor Whitty on 16 January 2020, after identification of a confirmed case in Japan, stating:

¶" [T]his does give me increased worry that the footprint of infections in Wuhan is far larger and more dispersed than we are being told and no longer market focused. And to note the interval between symptom onset and hospitalisation (assumed on clinical grounds) is 10 days – quite long. It does also reinforce that there is some form of P2P [person-to-person] transmission even if relatively inefficient. Do you agree?"³¹³¹ INQ000047501_0001

¶Professor Whitty agreed.³²³² INQ000047501_0001

¶2.18. That day, Professors Whitty, Vallance and Van-Tam received an email attaching a report from Professor Neil Ferguson, Mathematical Epidemiologist at Imperial College London. Professor Ferguson estimated that:

¶" between 189 and 3500 cases have occurred by 6th January, with a central estimate of 1149. Our analysis does not directly address transmission routes, but past experience with SARS and MERS-CoV [Middle East respiratory syndrome coronavirus] outbreaks of similar scale suggests currently self-sustaining human-to-human transmission should not be ruled out."³³³³ INQ000151324_0002; INQ000183386_0002

¶This was significantly higher than the official figure of 41 confirmed cases in Wuhan. The full report, published the following day, stated:

¶" It is likely that the Wuhan outbreak of a novel coronavirus has caused substantially more cases of moderate or severe respiratory illness than currently reported … past experience with SARS and MERS-CoV outbreaks of similar scale suggests currently self-sustaining human-to-human transmission should not be ruled out."³⁴³⁴ INQ000183386_0002; INQ000151324_0002

¶2.19. Professor Van-Tam said that, by 16 January 2020, it was:

¶" fairly clear that human to human transmission was occurring, and my view was that this would be a significant pandemic".³⁵³⁵ INQ000269203_0076 para 6.109

¶He recalled articulating his view to colleagues and ministers shortly after this, and that Professor Whitty agreed that "the situation may well escalate but for now we needed to wait and monitor developments closely".³⁶³⁶ INQ000269203_0042 para 6.34; see also Jonathan Van-Tam 22 November 2023 178/8-10

¶2.20. By mid-January 2020, Oxford University scientists had heeded the warnings and adapted a MERS-CoV vaccine research programme into a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes Covid-19) research programme.³⁷³⁷ INQ000474401_0015 para 5.1 A number of other countries and territories had also introduced entry screening at airports of arrivals from China.³⁸³⁸ INQ000119453 However, in Europe, as noted in a permanent secretary meeting on 20 January 2020, attended by Professors Whitty and Van-Tam, both Italy and France had received direct flights from Wuhan and their governments had "currently not instigated port of entry screening".³⁹³⁹ INQ000106057_0002

¶2.21. In a briefing provided on 17 January 2020 to the Scottish Government, NHS boards and others, Health Protection Scotland stated that there had been no confirmed cases outside China, Thailand and Japan but advised that the possibility of person-to-person transmission could not be excluded.⁴⁰⁴⁰ INQ000291499_0002-0003 This was the first briefing sent to Nicola Sturgeon MSP, First Minister of Scotland from November 2014 to March 2023. Although it was "an issue that was increasingly central to our thinking" by the end of January, Ms Sturgeon said that it was only one of a number of issues before her.⁴¹⁴¹ INQ000339033_0061 para 158 There was also a lack of scientific consensus as to the significance of the virus at that stage.

¶2.22. However, there was growing awareness of the possibility of asymptomatic transmission. Sir Jeremy Farrar, Director of the Wellcome Trust from October 2013 to February 2023, alerted Professor Whitty on 19 January 2020 to an unpublished scientific paper that, in his view, suggested "transmission in absence of material symptoms".⁴²⁴² INQ000047509_0002 Professor Whitty considered that it would be "actively unhelpful" to "do anything at a government level".⁴³⁴³ INQ000047509_0002 In forwarding this to Professor Van-Tam, Professor Whitty agreed that "it provides reasonable additional evidence of onward transmission", although he was:

" less convinced it shows people who are asymptomatic are infectious (which would be a major issue, so important not to jump the gun)".⁴⁴⁴⁴ INQ000047509_0002

¶Professor Van-Tam's view was that the data showed "a possibility of asymptomatic transmission".⁴⁵⁴⁵ INQ000269203_0041 para 6.32

An increasing threat

¶2.23. On 20 January 2020, in London, the first Wuhan Novel Coronavirus Officials' meeting took place.⁴⁶⁴⁶ INQ000269203_0042 para 6.36 It was chaired by Sir Christopher Wormald (Permanent Secretary to the Department of Health and Social Care from May 2016 to December 2024) and attended by Professors Whitty and Van-Tam.⁴⁷⁴⁷ INQ000106057_0001 Sir Christopher Wormald stated that his personal involvement in the response "escalated" from this point.⁴⁸⁴⁸ INQ000280628_0035 para 69

¶2.24. By this time, both Professors Whitty and Van-Tam were "increasingly concerned", although Professor Whitty stated that he:

" did not at this stage think it necessarily would become a significant threat to the UK, but thought the potential was increasing. The tempo of our response therefore increased from 20 January 2020 onwards."⁴⁹⁴⁹ INQ000251645_0072 para 7.17

¶Mr Hancock said that, by 20 January 2020, Professor Whitty had advised him that there was "a 50/50 chance of the virus going global and becoming a pandemic".⁵⁰⁵⁰ INQ000232194_0005 para 16

¶2.25. On 21 January 2020, Professor Vallance raised the emerging novel virus with Sir Mark Sedwill (later Lord Sedwill), Cabinet Secretary and Head of the Civil Service from October 2018 to September 2020.⁵¹⁵¹ INQ000250229_0021 para 78; INQ000182321_0002 That same day, NERVTAG concluded that it was clear that at least some person-to-person transmission was occurring, but that "the extent of transmissibility between people is not clear".⁵²⁵² INQ000023119_0003 para 2.5 It remained unknown whether sustained transmission in the community was taking place in Wuhan.⁵³⁵³ INQ000023119_0003 para 2.5

¶2.26. On 21 January 2020, at a meeting of the NHS Wales Executive Board (which brought together the Chief Executives of NHS Wales), Dr (later Sir) Frank Atherton (Chief Medical Officer for Wales from August 2016) stated:

" [C]olleagues need to think about their plans for isolation and ambulances if it does come to the UK … This area would become of increasing importance."⁵⁴⁵⁴ INQ000262076_0003

¶However, 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) confirmed that work was not initiated at this stage, although Dr Atherton's comments raised "awareness" of the problem that might come.⁵⁵⁵⁵ Andrew Goodall 5 March 2024 47/5-13

¶2.27. Professor Mark Woolhouse (Professor of Infectious Disease Epidemiology at the University of Edinburgh) also emailed Dr Catherine Calderwood (Chief Medical Officer for Scotland from April 2015 to April 2020) on 21 January 2020. Professor Woolhouse set out his concerns that Scotland was not preparing for a pandemic that reflected the World Health Organization's latest estimates and currently available evidence.⁵⁶⁵⁶ INQ000103352_0005-0006. Dr Calderwood did not give evidence on these issues due to having been excused on medical grounds. He noted that there were some instructive parallels with H1N1 influenza, with "a widespread epidemic fuelled by mild cases but with mortality among vulnerable patients".⁵⁷⁵⁷ INQ000103352_0005 He warned that such an epidemic would be "difficult to track" and that the Scottish Government needed to put in place an "integrated surveillance set up that combines clinical surveillance, genomic surveillance, and serological surveillance [the study of bodily fluids as part of the monitoring and analysis of public health]" (noting that the latter required an appropriate test) in advance of the arrival of the virus.⁵⁸⁵⁸ INQ000103352_0006 He cautioned that, in relation to H1N1 influenza, "we were slow off the mark", and hoped that "history won't repeat itself" here.⁵⁹⁵⁹ INQ000103352_0006 Later that same day, Dr Calderwood replied to Professor Woolhouse. She noted his "fears that this might develop into a potential pandemic" and reassured him that "response plans are in place".⁶⁰⁶⁰ INQ000103352_0005-0006

¶2.28. Professor Whitty requested that SAGE meet, on a precautionary basis, to discuss the Covid-19 outbreak.⁶¹⁶¹ INQ000047510; see also Chapter 9: Scientific and technical advice, in Volume II That meeting took place on 22 January 2020. SAGE recorded:

¶" 7. There is evidence of person-to-person transmission. It is unknown whether transmission is sustainable.

¶…

There is no evidence yet on whether individuals are infectious prior to showing symptoms.

There is no evidence that individuals are more infectious when symptoms are more severe, but that is likely."⁶²⁶² INQ000061509_0003 paras 7-13

¶It also noted that the incubation period "appears to be within 5 to 10 days".⁶³⁶³ INQ000061509_0003 para 8 By 3 February 2020, the Scientific Pandemic Infections Group on Modelling, Operational sub-group (SPI-M-O) estimated it to be an average of 5 days (with a range of 1 to 11 days), which was "approximately twice as long as for influenza".⁶⁴⁶⁴ INQ000074895_0002 para 15

¶2.29. In its Report 2: Estimating the Potential Total Number of Novel Coronavirus (2019‑nCoV) Cases in Wuhan City, China, published on 22 January 2020, Imperial College London estimated that there were 4,000 cases in Wuhan by 18 January 2020. It concluded it was likely that the outbreak had "caused substantially more cases of moderate or severe respiratory illness than have currently been detected and reported".⁶⁵⁶⁵ Report 2: Estimating the Potential Total Number of Novel Coronavirus (2019-nCoV) Cases in Wuhan City, China, Imperial College London, 22 January 2020, pp2-4 (https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/disease-areas/covid-19/ report-2-update-case-estimates-covid-19; INQ000236275) That same day, Public Health England raised the current threat level to the UK population (ie the risk on that day, not future risk) from 'very low' to 'low' on the basis of "the emerging evidence regarding case numbers, potential sources and human to human transmission".⁶⁶⁶⁶ INQ000223314_0003; 'DHSC and PHE statement on coronavirus', Department of Health and Social Care and Public Health England, 22 January 2020 (https://www.gov.uk/government/news/dhsc-and-phe-statement-on-coronavirus; INQ000051719_0002) It was recorded that two of Professor Whitty's triggers had been met:

¶"• Some healthcare workers are infected

Sustained human-to-human transmission (i.e. long chains of transmission within a community) may be occurring."⁶⁷⁶⁷ INQ000056148_0006

¶2.30. At this point, the UK had "good centralised diagnostic capacity" and was days away from developing a scalable test for deployment across the UK in weeks, having successfully developed an initial diagnostic test within three days of China publishing the genetic code.⁶⁸⁶⁸ INQ000061509_0004 para 23 Although a test was developed, scaling up the ability to test was to prove challenging because of inadequate infrastructure and testing capacity (discussed further below). As noted in the Inquiry's Module 1 Report, one of the recommendations from Exercise Alice (a February 2016 exercise to assess the challenges of a large-scale outbreak of MERS-CoV in England) was the development of a diagnostic test procedure, including a plan to scale up capacity – but it, like others, was not implemented.⁶⁹⁶⁹ Module 1: The resilience and preparedness of the United Kingdom, UK Covid-19 Inquiry, July 2024, Chapter 5 (https://covid19.public-inquiry.uk/documents/module-1-full-report); see also INQ000238826_0031-0032, 0047 paras 89-90, 140 The UK government and devolved administrations could and should have invested in this infrastructure in advance of the Covid-19 pandemic, but had not done so.⁷⁰⁷⁰ See Module 1: The resilience and preparedness of the United Kingdom, UK Covid-19 Inquiry, July 2024, Chapter 5 (https://covid19.public-inquiry.uk/documents/module-1-full-report) It is unsurprising therefore that testing remained a problem for a prolonged period, as is being examined in Module 7: Test, trace and isolate.

¶2.31. Criteria for testing and advice for healthcare workers on testing were being developed, along with plans for both isolation of the infected and contact tracing. Public Health England announced that health officials at Heathrow Airport would meet people returning on direct flights from Wuhan to ask "if they were feeling OK and handing out advice leaflets".⁷¹⁷¹ INQ000232194_0029 para 117 Mr Hancock was "concerned that this was too little but accepted the expert advice".⁷²⁷² INQ000232194_0029 para 117 Both Public Health England and NERVTAG, as well as officials at the Department of Health and Social Care, considered that port-of-entry screening was neither efficient nor effective.⁷³⁷³ INQ000106057_0002; INQ000023107_0008 para 5.8; INQ000051708_0005 This reflected the "relatively long" incubation period, which increased the risk of a passenger infected with Covid-19 showing no symptoms.⁷⁴⁷⁴ INQ000023107_0007-0008 para 5.6 It was also noted that screening passengers from Wuhan on arrival in the UK would detect relatively few people and potentially only detect those who became unwell during a flight. Providing information to passengers and screening travellers attending healthcare settings was considered likely to be a better option.⁷⁵⁷⁵ INQ000023119_0005 paras 4.4, 4.9; see also INQ000061509_0003-0004 paras 18-20, 25 Mr Hancock did, however, request expansion of the enhanced monitoring from Heathrow Airport to all airports with direct arrivals from China.⁷⁶⁷⁶ INQ000232194_0027, 0029 paras 105, 117

¶2.32. Also on 22 January 2020, a briefing was provided to Robin Swann MLA (Minister of Health for Northern Ireland from January 2020 to October 2022 and from February to May 2024) which explained that there was evidence to suggest that some limited person-to-person spread might be occurring.⁷⁷⁷⁷ INQ000103626_0002 para 5 Public Health Wales invoked its Emergency Response Plan at enhanced level and queried when the Welsh Government would stand up the Emergency Coordination Centre (Wales), responsible for:

" information gathering and keeping Welsh Ministers and the UK Government informed of the implications of emergencies in Wales".⁷⁸⁷⁸ INQ000267867_0006, 0014 paras 26, 56; INQ000107119_0016 para 3.1

¶The precautionary SAGE minutes were shared with Dr Rob Orford, Chief Scientific Adviser (Health) for Wales from January 2017, Dr Goodall and Sir Frank Atherton. This was the first time Dr Orford became aware of the virus through official government communications.⁷⁹⁷⁹ INQ000390618_0032 para 92; INQ000309705

¶2.33. In Northern Ireland, this period coincided with the re-establishment of power-sharing and there was little by way of government activity in relation to Covid-19. On 22 January 2020, it was noted that the Civil Contingencies Policy Branch of The Executive Office, which had responsibility for civil contingencies arrangements:

" was allocated responsibility for taking forward the sector resilience element of Pandemic flu preparations a few years ago … However, no work had commenced on it … This has resulted in Northern Ireland being more than 18 months behind the rest of the United Kingdom in terms of ensuring sector resilience to any Pandemic flu outbreak."⁸⁰⁸⁰ INQ000092712_0001-0002 para 3

¶A submission dated 23 January 2020, sent to Chris Stewart (Director at The Executive

¶Office of Northern Ireland with responsibilities for civil contingencies), stated that there was "a critical lack of resources" in the Civil Contingencies Policy Branch.⁸¹⁸¹ INQ000183632_0001 para 1 Silver

¶(Tactical) Command Structures involving the Public Health Agency, Health and Social

¶Care Board and Business Services Organisation, however, were instituted.⁸²⁸² INQ000411550 0033 para 83

¶2.34. On 23 January 2020, the World Health Organization's Situation Report confirmed that "there is now more evidence that [Covid-19] spreads from human-to-human and also across generations of cases".⁸³⁸³ INQ000573860_0001 A briefing note prepared by Public Health Wales for the Welsh Government confirmed that:

" Due to the enlarging geographic area affected, and evidence of human to human transmission, it is increasingly likely that suspected cases … will be identified in the UK, including Wales."⁸⁴⁸⁴ INQ000147265_0001

¶2.35. On the same day, Mr Hancock made the first statement to the UK Parliament about Covid-19.⁸⁵⁸⁵ INQ000232194_0030 para 122 At this point, public transport (including outbound trains and flights) was suspended in Wuhan.⁸⁶⁸⁶ INQ000279874_0002 However, a coach trip of tourists from Wuhan landed in England and drove unimpeded around the UK and into the Republic of Ireland. In Scotland, one of the party developed respiratory symptoms but tested negative for Covid-19. The tour group crossed over into Northern Ireland on about 25 January.⁸⁷⁸⁷ INQ000398416_0001 No steps were taken to prevent this group from entering Northern Ireland and travelling on to the Republic of Ireland.⁸⁸⁸⁸ Michael McBride 10 May 2024 55/20-56/16; INQ000398416_0001 A government official in Northern Ireland noted, at the time, that the "CMO [Chief Medical Officer] is not concerned".⁸⁹⁸⁹ Michael McBride 10 May 2024 55/11-13 Richard Pengelly, Permanent Secretary to the Department of Health (Northern Ireland) from July 2014 to April 2022, recorded that, as the individual tested negative for Covid-19 and other passengers were asymptomatic:

" NO action required. To do so would have been contrary to national and international protocols. We would have had no powers to insist."⁹⁰⁹⁰ INQ000398416_0001

¶2.36. Two days later, Dominic Cummings, Adviser to the Prime Minister from July 2019 to November 2020, asked Mr Hancock in a WhatsApp message, "To what extent have you investigated preparations for something terrible like Ebola or a flu pandemic?"⁹¹⁹¹ INQ000048313_0005 Mr Hancock responded that there were "full plans up to & including pandemic levels regularly prepped and refreshed" (see Figure 1).

¶Figure 1: Message from Mr Hancock to Mr Cummings, 25 January 2020 register and we had an SR bid even before this -

¶Source: Extract from INQ000129180_0001

¶2.37. Mr Hancock's reassurance was likely to be a reference to the UK Influenza Pandemic Preparedness Strategy 2011 because, as set out in the Inquiry's Module 1 Report, no UK-wide contingency plan for SARS, MERS or any other high consequence infectious disease was disclosed by the UK government.⁹²⁹² See UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011 (https://assets.publishing.service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708) The Inquiry is not therefore satisfied that such plans ever existed.⁹³⁹³ Module 1: The resilience and preparedness of the United Kingdom, UK Covid-19 Inquiry, July 2024, Chapter 3 (https://covid19.public-inquiry.uk/documents/module-1-full-report) Based on the UK Influenza Pandemic Preparedness Strategy 2011, the UK remained in the first 'detection' phase as there were no recognised cases in the UK. The second 'assessment' phase would occur when there were isolated cases and clusters, traceable with no "sustained community transmission" with an aim of containment.⁹⁴⁹⁴ UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011, p27, para 3.13 (https://assets.publishing.service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708) For both phases, the primary action was enhanced surveillance, undertaken as set out above by Public Health England. Other actions included intelligence gathering, development of new tests, public health guidance and communications.

¶2.38. On 24 January 2020, COBR met for the first time to discuss Covid-19.⁹⁵⁹⁵ INQ000056214; see also INQ000279876 This meeting was chaired by Mr Hancock (as the Secretary of State for the lead government department responsible for pandemic preparedness, response and recovery) and was attended by health ministers from the devolved administrations.⁹⁶⁹⁶ INQ000092893_0014 para 2.28; INQ000273841_0024-0025 para 43 Professor Whitty informed COBR that, in Wuhan, there were:

" around 850 confirmed cases and 25 confirmed deaths, however the true number was likely higher with modelling indicating between 1,000 – 10,000 cases. There was no clear evidence of sustained transmission (infectious spread across communities and not just within households) outside of Wuhan."⁹⁷⁹⁷ INQ000056214_0004 para 2

¶COBR was also informed that at least 2,500 people had travelled from Wuhan to the UK over the previous fortnight.⁹⁸⁹⁸ INQ000056214_0005 para 9 Professor Whitty relayed the SAGE advice that "an infected person was likely to be infectious before the onset of symptoms, and very infectious when seriously ill".⁹⁹⁹⁹ INQ000056214_0004 para 4 His advice was:

¶" that an individual case in the UK is likely at some point. The NHS is already well

prepared to identify and treat infectious disease cases such as WN-CoV. In the case of a sustained human to human transmissions, we would explore surge measures in healthcare and public containment steps."¹⁰⁰¹⁰⁰ INQ000279876_0001

¶2.39. The UK's four Chief Medical Officers also met on 24 January 2020. They agreed:

¶" [T]he risk to the UK public remains low, but there may well be cases in the UK at some stage."¹⁰¹¹⁰¹ INQ000237557_0002

¶2.40. Sir Frank Atherton recalled that it was "from around this time that Covid-19 was discussed as a real potential threat to the UK".¹⁰²¹⁰² INQ000391115_0011 para 41 Professor Sir Michael McBride (Chief Medical Officer for Northern Ireland from September 2006) reflected that, by this time, he too became:

¶" fully aware of the potential gravity of the outbreak of Covid-19 in China, although the degree of uncertainty around this still remained very high".¹⁰³¹⁰³ INQ000421704_0106 para 229

¶2.41. In Scotland, on 24 January 2020, Ms Sturgeon received a briefing from the Scottish Government's Health Protection Policy Team incorrectly stating: "We now know that people carrying the virus are only infectious to other people when experiencing symptoms."¹⁰⁴¹⁰⁴ INQ000339033_0055 para 147 Ms Sturgeon challenged the view that asymptomatic transmission was not possible.¹⁰⁵¹⁰⁵ INQ000339033_0056 para 149(b) The following day she received advice from Health Protection Scotland, which explained that "it is likely that person to person transmission, when it does occur, mostly involves transmission of virus from people with symptoms" and that:

¶" infected people with symptoms (e.g., someone who is coughing) are much more

likely to spread virus around than someone who is infected but free of symptoms".¹⁰⁶¹⁰⁶ INQ000292534_0001

¶2.42. In Wales, Mark Drakeford MS (First Minister of Wales from December 2018 to March 2024) was briefed about the COBR meeting. He recalled that Sir Frank Atherton told him on 24 January 2020 "that there was a significant risk the virus would arrive in Wales".¹⁰⁷¹⁰⁷ INQ000371209_0023-0024 paras 72, 74; Mark Drakeford 13 March 2024 52/16-54/21 The Welsh Government confirmed that it was:

¶" closely monitoring the emergence of a novel coronavirus originating in Wuhan,

China … We are treating this as an enhanced public health incident and we are working very closely with the other UK Nations."¹⁰⁸¹⁰⁸ INQ000227810_0001

¶2.43. Based on a study of the first 41 patients admitted to hospital in Wuhan, published in The Lancet on 24 January 2020, the percentage of people diagnosed with Covid-19 who died from it (the case fatality ratio) appeared to be close to 3%.¹⁰⁹¹⁰⁹ 'A novel coronavirus outbreak of global health concern', C. Wang, P.W. Horby, F.G. Hayden, G.F. Gao, The Lancet (2020), 395(10223), 470-473 (https://doi.org/10.1016/S0140-6736(20)30185-9; INQ000222003_0003) The article noted that 66% of those patients had been exposed to a wet market, that some healthcare workers had been infected and that several exported cases had been confirmed in other provinces in China and other countries.¹¹⁰¹¹⁰ 'Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China', C. Huang, Y. Wang, X. Li, L. Ren, J. Zhao, Y. Hu, et al., The Lancet (2020), 395(10223), 497-506 (https://www.doi.org/10.1016/S0140-6736(20)30183-5; INQ000408060_0001) An accompanying commentary piece, co-authored by Professor Horby (who was Chair of NERVTAG), warned there was:

" no room for complacency … the increasing number of cases and widening geographical spread of the disease raise grave concerns about the future trajectory of the outbreak … every effort should be given to understand and control the disease, and the time to act is now".¹¹¹¹¹¹ 'A novel coronavirus outbreak of global health concern', C. Wang, P.W. Horby, F.G. Hayden, G.F. Gao, The Lancet (2020), 395(10223), 470-473 (https://doi.org/10.1016/S0140-6736(20)30185-9; INQ000222003_0003-0005)

¶2.44. The following day Imperial College London published its third report, Transmissibility of 2019-nCoV. It stated that self-sustaining person-to-person transmission was "the only plausible explanation of the scale of the outbreak in Wuhan".¹¹²¹¹² Report 3: Transmissibility of 2019-nCoV, Imperial College London, 25 January 2020, p1 (https://www.imperial.ac.uk/mrc-global- infectious-disease-analysis/disease-areas/covid-19/report-3-transmissibility-of-covid-19; INQ000236276). This was published on 25 January 2020 but shared with the UK government and the World Health Organization two days earlier (INQ000249526_0039 para 122). It also concluded that R0 of the new virus (the basic reproduction number, based on the number of secondary infections generated from one initial case) was above 1 and most likely in the range of 2 to 3 (ie one person could infect two to three people).¹¹³¹¹³ INQ000249526_0039 para 122; Report 3: Transmissibility of 2019-nCoV, Imperial College London, 25 January 2020, p1 (https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/disease-areas/covid-19/report-3-transmissibility-of-covid-19; INQ000236276)

¶2.45. In emails with Professor Ferguson and Sir Jeremy Farrar that day, Professor Woolhouse noted:

" The 2 key numbers reported in the WHO [World Health Organization] statement on Thursday are R0=2 and case fatality rate = 4%. Plus we can estimate or make a reasonable guess at the generation time.

I f we take those numbers at face value we quickly get a ballpark estimate of almost half the people in the UK (and many other countries) getting this infection over a year or so, at least a doubling of the gross mortality rate (much more during epidemic peak), and a completely overwhelmed health system.

I know that, you both know that, anyone in the infectious disease modelling community knows that, PHE [Public Health England] must surely know that, and my undergraduate class could work it out with a pocket calculator."¹¹⁴¹¹⁴ INQ000103233_0002

¶Professor Ferguson agreed, noting that he and Sir Jeremy Farrar had said "the same to Patrick Vallance and Chris Whitty last night".¹¹⁵¹¹⁵ INQ000103233_0001

¶2.46. On 25 January 2020, Professor Woolhouse again contacted Dr Calderwood. He noted that Dr Calderwood's reply to his earlier email of 21 January 2020 "did not give any indication that here in Scotland we are preparing" for a pandemic at this scale, where over the course of a year:

¶" at least half the population will become infected, the gross mortality rate will

triple (more at the epidemic peak) and the health system will become completely overwhelmed".¹¹⁶¹¹⁶ INQ000103352_0004

¶Professor Woolhouse said it was now his hope rather than expectation that the outbreak could be contained.¹¹⁷¹¹⁷ INQ000103352_0004 Dr Calderwood subsequently shared this with the Chief Medical Officers for England, Wales and Northern Ireland and others.¹¹⁸¹¹⁸ INQ000047559_0002 Reflecting on his reaction to Professor Woolhouse's email of 25 January 2020 during his evidence to the Inquiry, Professor McBride said that this email "raised a level of concern". However, he also said:

¶" [A]t that time it had the potential not to be so significant, and I think that, you know, planning and preparing in uncertainty is extremely difficult."¹¹⁹¹¹⁹ Michael McBride 10 May 2024 54/1-8, 61/19

¶2.47. Professor Woolhouse also contacted Dr Calderwood the following day, reiterating the need for public health measures. He explained that case isolation, infection control and contact tracing would be "the mainstay of any control effort for this virus" and they became "more difficult to implement as the numbers of cases rise and resources are stretched".¹²⁰¹²⁰ INQ000103352_0003 He also emphasised the importance of public messaging and social distancing.¹²¹¹²¹ INQ000103352_0001-0002

¶2.48. That same day, Dr Atherton met with Public Health Wales to agree strategic aims and actions, including monitoring and assessing the risk to the public, facilitating detection, case management and isolation, developing a diagnostic pathway for the virus (a route from a person presenting symptoms to being diagnosed), developing guidance for health professionals and facilitating communication across different partners in Wales.¹²²¹²² INQ000267867_0007-0008 para 31 Regular meetings continued.¹²³¹²³ INQ000235212_0055-0056 para 181; Quentin Sandifer 6 March 2024 6/4-23

¶2.49. On 27 January 2020, the UK government advised that arrivals from Wuhan should self-isolate for 14 days.¹²⁴¹²⁴ 'Wuhan coronavirus: Health Secretary's statement to Parliament', Department of Health and Social Care and Matt Hancock, 27 January 2020 (https://www.gov.uk/government/speeches/wuhan-coronavirus-health-secretarys-statement-to-parliament; INQ000237587_0002) A few days later, the Welsh Government extended its self‑isolation guidance to arrivals from all of mainland China who developed flu-like symptoms.¹²⁵¹²⁵ 'Statement from the Chief Medical Officer for Wales about Coronavirus (2019-nCoV)', Welsh Government, 31 January 2020 (https://www.gov.wales/statement-chief-medical-officer-wales-about-coronavirus-2019-ncov; INQ000048722) Guidance was updated throughout January and February.¹²⁶¹²⁶ INQ000068530_0001; INQ000068531_0001; INQ000087249_0001; INQ000068537_0001

¶2.50. Health Protection Scotland initiated its Incident and Emergency Response Plan on 27 January 2020 as part of the planned response to an emergency where the scale of the actual or potential public health concern was deemed to be beyond normal response capabilities.¹²⁷¹²⁷ INQ000300280_0020 para 2.4 Similarly, the Department of Health (Northern Ireland) activated its Emergency Operations Centre, which managed the flow of information through the department as part of its Emergency Response Plan.¹²⁸¹²⁸ INQ000411550_0015, 0033 paras 29, 82

¶2.51. On 28 January 2020, Professor Whitty emailed William Warr, Special Adviser to the Prime Minister for Health, Social Care, Life Sciences and Technology, about the possible scenarios that might develop in terms of the impact on the UK.¹²⁹¹²⁹ INQ000146557_0001-0002 He explained that only two of four potential scenarios were "probably worth considering for planning at this point".¹³⁰¹³⁰ INQ000146557_0001 One was a major outbreak in China that was brought under control, with any cases seeded in other countries, including the UK, not leading to "sustained onward transmission".¹³¹¹³¹ INQ000146557_0001 The other "opposite end of the risk scale" was that the virus could, within the next few weeks, "become widespread and turn into a significant pandemic relatively quickly".¹³²¹³² INQ000146557_0002 He said that this was the "reasonable worst case scenario for which plans are also being developed", using the influenza pandemic plans as "a base case", without the benefit of a vaccine or antivirals.¹³³¹³³ INQ000146557_0001-0002 Professor Whitty noted:

" [T]he economic consequences of over-calling can be substantial, but the mortality and social consequences of under-calling are even more substantial."¹³⁴¹³⁴ INQ000146557_0002 para 3

¶Professor Vallance agreed.¹³⁵¹³⁵ INQ000146557_0001 Professor Whitty also explained:

" The main aim of current UK planning in public health terms is [to] ensure we do not have outbreaks from index travellers, so that if the epidemic is brought under control it has had minimal impact on the UK."¹³⁶¹³⁶ INQ000146557_0001 para 1

¶This reflected the approach set out in the UK Influenza Pandemic Preparedness Strategy 2011.¹³⁷¹³⁷ UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011 (https://assets.publishing.service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708)

¶2.52. At a meeting on 28 January 2020, SAGE set out its understanding of a number of important features of Covid-19, including:

"limited evidence of asymptomatic transmission, but early indications imply some is occurring";
the case fatality ratio was "estimated to be lower than SARS" (which was around 9.7%), although it was recognised that "many uncertainties remain"; and
R was estimated to be 2 to 3 and the doubling rate was estimated to be 3 to 4 days.¹³⁸¹³⁸ INQ000061510_0003 paras 10-12, 16; see also Module 1: The resilience and preparedness of the United Kingdom, UK Covid-19 Inquiry, July 2024, Chapter 1 (https://covid19.public-inquiry.uk/documents/module-1-full-report)

¶This meant that Covid-19 was likely to spread quickly. At the meeting, the Scientific Pandemic Influenza Group on Modelling (a pre-existing standing science advisory group convened by the Department of Health and Social Care) was formally redeployed as SPI-M-O (a sub-group of SAGE). SPI-M-O was asked by SAGE to "advise on actions the UK could take to slow down the spread of the outbreak domestically, even if widespread globally".¹³⁹¹³⁹ INQ000061510_0004 In the early stages of the pandemic, one of SAGE's main priorities was to establish the likely impact of Covid-19 if it arrived in the UK. The ability of the scientific advisory groups to do this was hampered by a lack of data at the time, which meant that a reasonable worst-case scenario could not easily be formulated. (As set out in Chapter 1: The context for pandemic decision-making, in this volume, a reasonable worst-case scenario is a tool used in risk assessment processes to prepare for "a challenging yet plausible manifestation of the risk".)¹⁴⁰¹⁴⁰ INQ000147775_0004 footnote 3; INQ000147768_0009; INQ000147770_0005 At the end of January 2020, SAGE agreed that the reasonable worst-case scenario for pandemic influenza where no vaccine or specific treatment is available – which anticipated 820,000 excess deaths – should be used for government planning purposes until sufficient data had emerged.¹⁴¹¹⁴¹ INQ000061510_0004 para 27

¶2.53. Professor Van-Tam described SAGE's decision to base the reasonable worst-case scenario on pandemic influenza planning as:

" a perfectly reasonable approach to adopt. There was no other respiratory virus that had hitherto caused a known human pandemic that could reasonably direct our response."¹⁴²¹⁴² INQ000269203_0074 para 6.105

¶2.54. SAGE considered that the triggers which would require a change in the UK government's approach were "sustained human-to-human transmission outside China and or a severe UK case".¹⁴³¹⁴³ INQ000061510_0004 para 28 It also advised that "[p]andemic influenza infection control guidance should be used as a base case and adapted".¹⁴⁴¹⁴⁴ INQ000061510_0003 para 20

¶2.55. Testing capacity across the UK was exceptionally limited in January and February 2020. For example, the SAGE minutes from 28 January recorded that there would only be capacity to "run 400 to 500 tests per day" by the end of the week in the UK.¹⁴⁵¹⁴⁵ INQ000061510_0003 para 8 SAGE described this capacity as "limited" and noted that it could not "be substantially increased during this winter influenza season".¹⁴⁶¹⁴⁶ INQ000051925_0003 para 26

¶2.56. Covid-19 was discussed by the Scottish Cabinet for the first time on 28 January 2020. It was noted that there was some evidence of pre-symptomatic transmission from China, which was considered "alarming".¹⁴⁷¹⁴⁷ INQ000238707_0005 para 17; INQ000273956_0029 para 136 The Scottish Government Resilience Room was activated on 29 January, following discussions between government officials and Jeane Freeman MSP (Cabinet Secretary for Health and Sport in the Scottish Government from June 2018 to May 2021) becoming aware that it was likely that the first positive case had reached the UK.¹⁴⁸¹⁴⁸ INQ000257364; INQ000339033_0061 para 160

¶2.57. On 28 January 2020, NERVTAG advised that there was "no evidence to support that the wearing of face masks by the general public reduces transmission", noting a risk that advising the public to do so "may add to fear and anxiety".¹⁴⁹¹⁴⁹ INQ000047820_0008 para 4.1

¶2.58. That same day, Professor McBride noted in a WhatsApp group including the Chief Medical Officers for England, Wales and Scotland and Professor Van-Tam that reports appeared "to be consistent with asymptomatic transmission during the incubation period".¹⁵⁰¹⁵⁰ INQ000282744_0002 Professor Whitty agreed that it was:

" [c]ompatible, probable but not conclusive … But we should now assume it may be happening."¹⁵¹¹⁵¹ INQ000282744_0002-0003 (Professor Whitty was listed as "the owner of the cell phone")

¶Professor Whitty advised Mr Hancock and officials from the Department of Health and Social Care that there was:

" now credible evidence of asymptomatic transmission within Germany (resulting from the timings of the transmission)".¹⁵²¹⁵² INQ000233747_0002

¶2.59. Mr Hancock told the Inquiry that, on 29 January 2020, Professor Whitty proposed four elements to the plan: contain outbreaks, delay spread, mitigate the effects on the population and, throughout, research treatments and a vaccine.¹⁵³¹⁵³ INQ000232194_0036 para 147; see also INQ000251645_0077-0078 para 7.43; Chapter 1: The context for pandemic decision- making, in this volume; Module 1: The resilience and preparedness of the United Kingdom, UK Covid-19 Inquiry, July 2024, Chapter 4 (https://covid19.public-inquiry.uk/documents/module-1-full-report) Professor

¶Whitty described this strategy, which began to be identified in late January 2020, as being based on a "contain, delay, research and mitigate" framework.¹⁵⁴¹⁵⁴ INQ000251645_0077-0078 para 7.43

¶2.60. At a COBR meeting on 29 January 2020, Professor Whitty stated:

" There were two scenarios to be considered. The first was that the spread was confined within China, the second was that the spread was not limited to China and there would be a pandemic like scenario, with the UK impacted. The second scenario was plausible but it may take weeks to months."¹⁵⁵¹⁵⁵ INQ000056226_0005 para 3

¶He described "a 10 per cent likelihood" (a 1 in 10 chance) of the reasonable worstcase scenario occurring, but stated that this had not been agreed by SAGE.¹⁵⁶¹⁵⁶ INQ000056226_0005 para 4

¶2.61. On the same day, an article was published by the Chinese 2019-nCoV Outbreak Joint Field Epidemiology Investigation Team. It estimated, based on research of the first 425 cases, that R0 was 2.2 (ie one person would infect, on average, 2.2 others) and stated that there was evidence that person-to-person transmission had occurred among close contacts since mid-December 2019.¹⁵⁷¹⁵⁷ 'Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia', Q. Li, X. Guan, P. Wu, X. Wang, L. Zhou, Y. Tong, et al., The New England Journal of Medicine (2020), 382(13), 1199-1207 (https://doi.org/10.1056/NEJMoa2001316; INQ000308705_0002) The article concluded:

" Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk."¹⁵⁸¹⁵⁸ 'Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia', Q. Li, X. Guan, P. Wu, X. Wang, L. Zhou, Y. Tong, et al., The New England Journal of Medicine (2020), 382(13), 1199-1207 (https://doi.org/10.1056/NEJMoa2001316; INQ000308705_0002)

¶2.62. On 30 January 2020, the World Health Organization declared a Public Health Emergency of International Concern – recognising Covid-19 as an extraordinary event that constituted a public health risk through the international spread of disease and could require immediate international action.¹⁵⁹¹⁵⁹ INQ000238826_0028-0029 para 80 That day, the UK risk level was raised from 'low' to 'moderate' by the UK's four Chief Medical Officers.¹⁶⁰¹⁶⁰ 'Statement from the 4 UK Chief Medical Officers on novel coronavirus', Department of Health and Social Care, 30 January 2020 (https://www.gov.uk/government/news/statement-from-the-four-uk-chief-medical-officers-on-novel-coronavirus; INQ000203938_0002) NHS England also declared a Level 4 Major Incident (the highest category of emergency under the NHS England Emergency Preparedness, Resilience and Response Framework), requiring NHS England National Command and Control to support the NHS response in England.¹⁶¹¹⁶¹ INQ000269892; INQ000269973; INQ000087445; INQ000116811_0005 para 11 As a result, NHS England was required to apprise the Department of Health and Social Care (as the lead government department) and ministers of progress and impact.¹⁶²¹⁶² INQ000116811_0031 para 110 The following day, the Department of Health and

¶2.63. Also on 30 January 2020, a briefing note to 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, and Michelle O'Neill MLA (deputy First Minister of Northern Ireland from January 2020 to February 2022) provided an update from COBR. It noted that the Department of Health (Northern Ireland), "as the lead government department", was closely monitoring the rapidly evolving situation.¹⁶⁴¹⁶⁴ INQ000391226_0003; Michelle O'Neill 14 May 2024 146/13-147/25 It also explained that the clinical effects of Covid-19 "range from asymptomatic to a relatively mild illness through to pneumonia" and that the elderly and those with existing health conditions would be disproportionately affected.¹⁶⁵¹⁶⁵ INQ000391226_0003; Michelle O'Neill 14 May 2024 146/13-147/25

¶2.64. On 31 January 2020, Covid-19 was discussed for the first time at a meeting of the UK Cabinet. The advance briefing for Mr Johnson advised that COBR had agreed to:

" use the reasonable worst case for pandemic flu to guide planning, and build on the existing work that is continuously underway for pandemic flu".¹⁶⁶¹⁶⁶ INQ000056142_0009

¶Mr Hancock indicated to the Cabinet that if China "did not grip the situation it could become global. That would be very serious, including for the UK."¹⁶⁷¹⁶⁷ INQ000056125_0011 Mr Hancock told the Inquiry that he had informed the Cabinet that as many as 820,000 people in the

¶UK might die in the reasonable worst-case scenario, although this was not recorded in the minutes.¹⁶⁸¹⁶⁸ INQ000056125; INQ000232194_0038 para 159

¶2.65. By the end of January 2020, in addition to the 9,826 cases reported around the world across 18 countries, the first case of Covid-19 had been confirmed in the UK – a 23-year-old Chinese student who had travelled to York from Hubei province in China.¹⁶⁹¹⁶⁹ INQ000223324_0018 On 31 January, it was announced that the student and his mother had tested positive for Covid-19.¹⁷⁰¹⁷⁰ INQ000237635_0002 There were also four cases in both France and Germany.¹⁷¹¹⁷¹ 'CMO confirms cases of coronavirus in England', Department of Health and Social Care, 31 January 2020 (https://www.gov.uk/ government/news/cmo-confirms-cases-of-coronavirus-in-england; INQ000056166_0002) That same day, China imposed regional lockdowns and travel restrictions.