February 2020: The spread of the virus

¶2.81. By 1 February 2020, about 12,000 cases of Covid-19 had been confirmed worldwide, 132 of which were in 23 countries outside China – 259 deaths had been reported.²⁰¹²⁰¹ 2019 Novel Coronavirus (2019‑nCoV): Strategic Preparedness and Response Plan, World Health Organization, 4 February 2020, p6 (https://www.who.int/publications/i/item/strategic-preparedness-and-response-plan-for-the-new-coronavirus; INQ000087457) Assessments of key features of the virus had also developed further. In an email to Professor Whitty on 2 February, Professor Ferguson gave a central estimate of the case fatality ratio as "1.5-1.8%".²⁰²²⁰² INQ000047653_0001 This would mean that, for every 100 diagnosed cases of a disease, 1.5 to 1.8 people would die. SAGE advised that "[s]ustained community transmission outside China should be expected", although there was not yet "definitive evidence of a sustained outbreak/epidemic elsewhere".²⁰³²⁰³ INQ000051883_0002 para 13; INQ000051925_0003 para 27

¶2.82. A UK-wide public information campaign was launched on 2 February 2020 by the Department of Health and Social Care, advising the population to adopt respiratory and hand-hygiene measures.²⁰⁴²⁰⁴ 'Coronavirus public information campaign launched across the UK', Department of Health and Social Care, 2 February 2020 (https://www.gov.uk/government/news/coronavirus-public-information-campaign-launched-across-the-uk; INQ000237306)

¶2.83. In early February 2020, travel restrictions were considered again by scientific advisers, but the consensus was that these would achieve only a limited delay.²⁰⁵²⁰⁵ INQ000212206_0001 SPI‑M-O concluded that "the average delay expected to result from a 90% reduction of travel from China may be up to two weeks".²⁰⁶²⁰⁶ INQ000051882_0001 SAGE noted that "draconian and coordinated measures" would be required to sufficiently reduce the number of imported infections and that "direct flights from China [were] not the only route for infected individuals to enter the UK".²⁰⁷²⁰⁷ INQ000061511_0003 para 3 Professor Whitty relayed this advice to COBR shortly afterwards.²⁰⁸²⁰⁸ INQ000056215_0005 para 6

¶2.84. On 3 February 2020, NERVTAG advised that people with Covid-19 symptoms should wear a face covering, but again stated that the precautionary use of face coverings by people without symptoms was not recommended.²⁰⁹²⁰⁹ INQ000119615_0009 paras 3.40-3.42 This was based on its view that the evidence for the use of face coverings by the general public was "near nil", that risk of exposure in the community was hard to predict and it was likely that compliance would be poor.²¹⁰²¹⁰ INQ000119615_0008-0009 paras 3.29, 3.37 The following day, SAGE considered NERVTAG's advice that there was "limited to no evidence of the benefits of the general public wearing facemasks as a preventative measure".²¹¹²¹¹ INQ000051925_0004 para 40 SAGE endorsed NERVTAG's advice that face coverings should only be worn by people with Covid-19 symptoms and by health and social care workers who were visiting people who might be infectious.²¹²²¹² INQ000051925_0004 paras 40-42 SAGE also provided advice on mass gatherings on 4 February.²¹³²¹³ INQ000061512_0003 para 5

¶It advised there was little evidence that cancelling or banning mass gatherings would have a significant effect in reducing transmission of the virus. It reiterated this advice on 13 and 27 February.²¹⁴²¹⁴ INQ000052045_0003 para 8; INQ000061519_0004 paras 14-15

¶2.85. In its Strategic Preparedness and Response Plan of 4 February 2020, the World Health Organization issued guidance recommending:

"[s]caling up country preparedness and response operations, including strengthening readiness to rapidly identify, diagnose and treat cases; identification and follow-up of contacts when feasible (with priority given to high‑risk settings such as healthcare facilities); infection prevention and control in healthcare settings; implementation of health measures for travelers; and awareness raising in the population though [sic] risk communication and community engagement".²¹⁵²¹⁵ 2019 Novel Coronavirus (2019‑nCoV): Strategic Preparedness and Response Plan, World Health Organization, 4 February 2020, p8 (https://www.who.int/publications/i/item/strategic-preparedness-and-response-plan-for-the-new-coronavirus; INQ000087457)

¶2.86. At a departmental performance meeting on 4 February 2020 between the Prime Minister and the Department of Health and Social Care, Professor Whitty briefed Mr Johnson on Covid-19 for the first time.²¹⁶²¹⁶ INQ000251645_0080 para 7.52 He informed Mr Johnson that a major pandemic with 100,000 to 300,000 deaths in the UK was possible.²¹⁷²¹⁷ INQ000251645_0011 para 2.10 Mr Johnson was "in listening mode", according to Sir Christopher Wormald.²¹⁸²¹⁸ INQ000280628_0040 para 80 Following a discussion over possible fatality numbers, Mr Johnson noted that high fatality figures had been given for bovine spongiform encephalopathy (BSE, often referred to as 'mad cow disease' and causing variant Creutzfeldt–Jakob disease in humans) and swine flu. His demeanour was described as "concern mixed with a level of scepticism".²¹⁹²¹⁹ INQ000280628_0040 para 80

¶2.87. According to Professor Whitty:

" My principal aim in this meeting was to ensure that the Prime Minister understood that if COVID-19 turned into a pandemic there was likely to be very significant loss of life in the UK. He heard the advice and in my view understood it; I have no way of telling whether he believed it. It was a relatively brief discussion."²²⁰²²⁰ INQ000251645_0080-0081 para 7.53

¶2.88. Mr Johnson accepted generally that he did not take warnings seriously enough:

" [ W]hen you read that an Asiatic pandemic is about to sweep the world … you think you've heard it before, and that was the problem."²²¹²²¹ Boris Johnson 6 December 2023 71/16-18

¶He explained that he had:

" a basic confidence that things would turn out all right, on the fallacious inductive logic that we'd had Asian zoonotic scares before, and they had turned out all right".²²²²²² INQ000255836_0020 para 80

¶Mr Johnson also acknowledged that he had been lulled into a false sense of security by his belief that earlier outbreaks had been "exaggerated":²²³²²³ INQ000255836_0010 para 22

" I think that in that period, January really to the end of February, towards the end of February, Covid was pretty much like a cloud on the horizon, no bigger than a man's hand, and you didn't know whether it was going to turn into a typhoon or not."²²⁴²²⁴ Boris Johnson 6 December 2023 45/24-46/3

¶2.89. On 4 February 2020, the Scottish Cabinet met in accordance with its usual schedule. Covid-19 received little attention at the meeting. It was noted that the virus had reached the UK, although no positive cases in Scotland had been identified. The Scottish Government Resilience Room continued to "monitor the situation" and preparations were said to be "in hand, based on a reasonable worst case scenario of a situation similar to an influenza pandemic".²²⁵²²⁵ INQ000238704_0004 para 19 An accompanying paper referred to directorates "planning, in the first instance, to stand up pandemic flu plans".²²⁶²²⁶ INQ000348708_0004

¶2.90. The following day, Professor Woolhouse sought the involvement of Professor Dame Sally Davies, Chief Medical Officer for England from June 2010 to October 2019, telling her to "get Catherine [Calderwood] to listen to me, because she's not listening".²²⁷²²⁷ Mark Woolhouse 24 January 2024 30/24-25; INQ000352401 Professor Davies then emailed Dr Calderwood to "introduce" Professor Woolhouse and suggested that Dr Calderwood might "benefit" from having a conversation with him, particularly in relation to Scotland's preparedness.²²⁸²²⁸ INQ000103215_0004 Although Dr Calderwood sought to reassure Professor Woolhouse that adequate steps were being taken, he was concerned by what he saw as her lack of engagement.²²⁹²²⁹ INQ000103352_0004-0005; INQ000352401_0001-0002

¶2.91. In Wales, Reg Kilpatrick, Director in the Welsh Government with responsibility for civil contingencies from 2013, convened a meeting of the Civil Contingencies Group (Wales) on 4 February 2020, in accordance with the Pan-Wales Response Plan, to allow officials to "begin to plan".²³⁰²³⁰ Reg Kilpatrick 6 March 2024 153/11-154/19; INQ000321239 He told the Inquiry that it:

" seemed to me at the end of January we were in the position where there was a potential for coronavirus to come to the UK and therefore to come to Wales".²³¹²³¹ Reg Kilpatrick 6 March 2024 151/12-22

¶However, there was some confusion even in the latter part of February about the extent of the operations of the Emergency Coordination Centre (Wales) and whether it "was ready to 'stand up' if and when required".²³²²³² INQ000321228_0003; INQ000129852_0006 para 5.4 While Dr Quentin Sandifer,

¶Executive Director for Public Health Services and Medical Director at Public Health

¶Wales from October 2012 to December 2020, was informed that the Emergency

¶Coordination Centre (Wales) had been stood up, he "didn't recognise its functions in terms of the Pan Wales Response plan".²³³²³³ INQ000267867_0036 para 148 Mr Kilpatrick accepted that "we should have been clearer".²³⁴²³⁴ Reg Kilpatrick 6 March 2024 158/21-159/1 The triggers for the establishment of the Emergency

¶Coordination Centre (Wales) must be reviewed – something which the Welsh

¶Government has acknowledged.²³⁵²³⁵ INQ000187578_0019; Reg Kilpatrick 6 March 2024 158/15-159/1

¶2.92. The Northern Ireland Executive Committee was first briefed by the Minister of Health "on protection measures against the Coronavirus" at its meeting of 3 February 2020, although its first substantive discussion did not take place until 2 March 2020.²³⁶²³⁶ INQ000048442_0004; INQ000048441_0002; Robin Swann 13 May 2024 104/24-105/13 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, attended a 'Wednesday Morning Colleagues' meeting in the Cabinet Office on 5 February, at which Professor Whitty gave an update on Covid-19. Sir David Sterling recalled Professor Whitty saying that "in his view the Chinese government had not got to grips with this and that it would almost certainly become a global pandemic".²³⁷²³⁷ INQ000449440_0037 para 115

¶2.93. On 5 February 2020, the daily commonly recognised information picture (CRIP, a summary of information from the Civil Contingencies Secretariat made available to COBR) stated that two of Professor Whitty's triggers had "been met, resulting in the increase in risk assessment on 21 January".²³⁸²³⁸ INQ000056148_0006

¶2.94. COBR met again on 5 February 2020.²³⁹²³⁹ INQ000056215 The health ministers and Chief Medical Officers for the devolved administrations were in attendance and were provided with the CRIP. COBR was informed that the case fatality ratio was estimated to be 2% to 3% and that the two most high-risk groups appeared to be the elderly and those with pre-existing illnesses.²⁴⁰²⁴⁰ INQ000056215_0005 para 2; INQ000056148 Mr Hancock also noted that "there were no legal powers in place to force nationals into isolation" and COBR decided not to close the borders for arrivals from China.²⁴¹²⁴¹ INQ000056215_0005 para 5 It also resolved to develop plans for an emergency bill to support the UK's pandemic response, with an action item for all departments and devolved administrations to finalise their policy inputs for the proposed legislation.²⁴²²⁴² INQ000056215_0008 para 9 The first coronavirus laws – the Health Protection (Coronavirus) Regulations 2020 – were introduced in the UK Parliament a few days later under the Public Health (Control of Disease) Act 1984.²⁴³²⁴³ The Health Protection (Coronavirus) Regulations 2020 (https://www.legislation.gov.uk/uksi/2020/129/contents); Public Health (Control of Disease) Act 1984 (https://www.legislation.gov.uk/ukpga/1984/22/contents) This enabled the Secretary of State to declare an emergency and activate emergency powers, which Mr Hancock did on 10 February.²⁴⁴²⁴⁴ The Health Protection (Coronavirus) Regulations 2020 (https://www.legislation.gov.uk/uksi/2020/129/contents). As discussed in Chapter 13: Legislation and enforcement, in Volume II, these regulations were subsequently revoked by the Coronavirus Act 2020, which largely replicated their provisions.

¶2.95. On 6 February 2020, SAGE advised of a third UK case of a person testing positive for Covid-19.²⁴⁵²⁴⁵ INQ000061513_0003 para 5 It stated that "[i]n light of new evidence of human-to-human transmission beyond China … the UK geographical case definition should be widened" to include individuals who were showing possible symptoms and had travelled from a number of other countries, including Thailand, Japan and the Republic of Korea.²⁴⁶²⁴⁶ INQ000061513_0002 paras 2-3 This evidence of transmission occurring outside China was the third of Professor Whitty's three triggers. That same day, Mr Cummings sent a message to a 10 Downing Street WhatsApp group saying that the "Chief Scientist" had told him that "it's prob out of control now and will sweep world".²⁴⁷²⁴⁷ INQ000236371_0037

¶2.96. At a Cabinet meeting on 6 February 2020, Mr Johnson observed:

¶" [C]onfidence was also contagious, and it was important that the Government

remain measured in its response … Often the significant economic damage of a crisis came from political overreaction rather than the problem itself. This had been true of Bovine spongiform encephalopathy (BSE)."²⁴⁸²⁴⁸ INQ000056137_0007

¶Mr Hancock was similarly reassuring, stating:

¶" Whilst the virus spread easily, it was better news that the mortality rate was only

around 2 per cent … The central point to make was that the Government had a plan to deal with this illness, and this was guided by science."²⁴⁹²⁴⁹ INQ000056137_0006

¶As set out above, the only 'plan' was the UK Influenza Pandemic Preparedness Strategy 2011, and it was inadequate to cope with the threat of the new virus.²⁵⁰²⁵⁰ UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011 (https://assets.publishing.service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708)

¶2.97. That same day, Liz Redmond, Director of Population Health, advised The Executive Office that it was not necessary to activate the contingency arrangements for civil emergencies (Northern Ireland Central Crisis Management Arrangements, known as NICCMA) "unless or until" Covid-19 appeared in Northern Ireland.²⁵¹²⁵¹ INQ000218470_0002 This was despite the NICCMA Protocol anticipating that, where there was a UK-wide risk and COBR was activated, Northern Ireland would convene an equivalent body.²⁵²²⁵² INQ000092739_0006-0007 para 13

¶2.98. Also on 6 February 2020, Professor McBride advised all Northern Ireland government departments and public authorities to ensure that staff were acquainted with contingency plans for responding to infectious diseases, but that otherwise no action was required at that stage.²⁵³²⁵³ INQ000254430_0003 paras 20-21 An aide-memoire prepared for Mr Pengelly set out:

" I do not consider it necessary to activate [NICCMA] at this time, however, this is an evolving situation and preparedness across NI [Northern Ireland] is critical."²⁵⁴²⁵⁴ INQ000185378_0003

¶As a result, the Department of Health (Northern Ireland) remained the lead government department for the response to the pandemic at this time.²⁵⁵²⁵⁵ INQ000469468; INQ000212916_0002 para 6

¶2.99. On 7 February 2020, Public Health England announced the rollout of Covid-19 testing to 12 laboratories across the country.²⁵⁶²⁵⁶ 'PHE novel coronavirus diagnostic test rolled out across UK', Public Health England, 7 February 2020 (https://www.gov.uk/ government/news/phe-novel-coronavirus-diagnostic-test-rolled-out-across-uk; INQ000582848) A joint letter from Public Health England, the National Medical Director, NHS England and Professor Whitty was also issued to NHS organisations implementing the earlier SAGE advice on travellers:

" [A]ll travellers who develop relevant symptoms, however mild, within 14 days of returning from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau should self-isolate at home immediately and call NHS 111 [the non-emergency NHS helpline]."²⁵⁷²⁵⁷ INQ000087249_0001

¶Similar advice was issued in Wales, Scotland and Northern Ireland.²⁵⁸²⁵⁸ INQ000048723; INQ000357279; INQ000254430

¶2.100. On 10 February 2020, Imperial College London published Report 4: Severity of 2019-Novel Coronavirus (nCoV), which gave an overall case fatality ratio for "all infections (asymptomatic or symptomatic) of approximately 1%".²⁵⁹²⁵⁹ Report 4: Severity of 2019-Novel Coronavirus (nCoV), Imperial College London, 10 February 2020, p1 (https://www.imperial.ac.uk/ media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-severity-10-02-2020.pdf; INQ000236277) A 1% case fatality ratio in all infections, as opposed to just in confirmed cases, represented a serious degree of lethality (the comparable rate for swine flu was approximately 0.01% to 0.02%).²⁶⁰²⁶⁰ INQ000207453_0001 That same day, SPI-M-O advised that it was a realistic probability that outbreaks outside China could not be contained by isolation and contact tracing. If a high proportion of asymptomatic cases were infectious, then, it stated, containment was unlikely to be achieved through those policies alone.²⁶¹²⁶¹ INQ000237386_0001-0002 para 7

¶2.101. That same day, following discussions with Mr Cummings, Professor Vallance met Mr Johnson for the specific purpose of briefing him on the pandemic and to ensure that Mr Johnson "understood how important and dangerous this was".²⁶²²⁶² INQ000238826_0039 para 113 Professor Vallance said:

¶" I think the Prime Minister expressed a view that he thought the problem would be contained but there was no doubt that Mr Cummings and the No. 10 team understood the level of concern."²⁶³²⁶³ INQ000238826_0039 para 114

¶2.102. Despite this, Mr Johnson told the Inquiry that, by mid-February:

¶" I think it would be fair to say that the scientific community within Whitehall at that stage was not telling us, I was not being informed, that this was something that was going to require urgent and immediate action."²⁶⁴²⁶⁴ Boris Johnson 6 December 2023 70/2-71/23

¶Mr Cain also said that Mr Johnson was:

¶" receiving assurances that … everything actually is being well prepared and we are in a good situation to handle things … nobody's sort of setting up the warning flares to him or to the core team".²⁶⁵²⁶⁵ Lee Cain 31 October 2023 11/16-21

¶Stuart Glassborow, Deputy Principal Private Secretary to the Prime Minister from May 2019 to May 2022, told the Inquiry:

¶" I do not believe the Prime Minister was advised at this early stage as to the likely scale of the impending challenge."²⁶⁶²⁶⁶ INQ000302484_0018-0019 para 65

¶If Professor Vallance did advise the Prime Minister of the danger facing the UK – as seems likely – not enough was done in response.

¶2.103. On 10 February 2020, Mr Hancock commissioned "a coronavirus version" of the UK Influenza Pandemic Preparedness Strategy 2011 to be prepared.²⁶⁷²⁶⁷ INQ000106107; Matt Hancock 30 November 2023 111/17-18; UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011 (https://assets.publishing.service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708)

¶2.104. By 11 February 2020, the UK had "8 confirmed cases, all of whom acquired the virus overseas".²⁶⁸²⁶⁸ INQ000075784_0002 para 5

¶2.105. An estimate provided by SPI-M-O to the meeting of SAGE on 11 February 2020 suggested that the number of confirmed cases in China was 10 times higher than the number currently confirmed. SPI-M-O reiterated its earlier advice and stated:

¶" It is a realistic probability that there is already sustained transmission in the UK, or that it will become established in the coming weeks."²⁶⁹²⁶⁹ INQ000237386_0001-0002 paras 1, 13

¶SAGE noted that it was "important to understand hospital bed requirements" and identified that SPI-M-O should:

¶" work with NHSE [NHS England] and others on modelling the impact of the

pandemic influenza reasonable worst case on the NHS, including the number of people requiring respiratory support".²⁷⁰²⁷⁰ INQ000075784_0004 para 33

¶SAGE advised that the UK government should continue to plan using the influenza pandemic assumptions, but again identified important differences between the viruses. In checking its understanding of Covid-19 against planning assumptions, it expressly compared characteristics of influenza viruses with those of Covid-19 in the form of a table. This table:

¶" was adapted and updated repeatedly in February and March, with the intention

of checking what was known about the virus against the planning assumptions that underlay the pandemic influenza [reasonable worst-case scenario], and hence assessing the extent to which planning for pandemic influenza served as a useful guide".²⁷¹²⁷¹ INQ000238826_0041 para 117; INQ000320718

¶SAGE confirmed that asymptomatic transmission "cannot be ruled out". Its working assumptions were that Covid-19 had a longer incubation period than pandemic influenza, a similar case fatality ratio, a longer duration of illness and potentially a longer average duration of infectivity to others (the length of time an infected individual remains able to transmit a virus).²⁷²²⁷² INQ000249526_0039 para 123; INQ000320718 A longer incubation period was potentially significant because it would increase the window of opportunity for tracing people who had been in close contact with infected individuals before they became infectious themselves.

¶2.106. Mr Kilpatrick forwarded the table to officials within the Welsh Government, noting:

¶" This material needs to be shared internally and rapidly … for information and to underline the potential seriousness of the issue."²⁷³²⁷³ INQ000320721_0001

¶2.107. On 12 February 2020, a ministerial table top exercise – Exercise Nimbus – was held. Representatives of the health departments in the devolved administrations also attended.²⁷⁴²⁷⁴ INQ000232194_0044-0045 para 187 It imagined a fictional COBR meeting taking place in April 2020 in order to test decision-making processes and strategies.²⁷⁵²⁷⁵ INQ000052022; INQ000273915 Ms Freeman (who did not attend the exercise herself) understood that the purpose of the exercise was to:

¶" update or double check planning against the flu pandemic … which had informed most of government planning prior to Covid-19".²⁷⁶²⁷⁶ Jeane Freeman 29 January 2024 168/5-9, 167/23

¶2.108. It is, however, unclear whether any practical benefits were achieved. Dr Ben Warner, Special Adviser to the Prime Minister from December 2019 to May 2021:

¶" did not think this exercise had stress tested the Government's overall pandemic response in any meaningful way".²⁷⁷²⁷⁷ INQ000269182_0012 para 38; see also Robin Swann 13 May 2024 91/6-17; Vaughan Gething 11 March 2024 61/4-62/11

¶In particular, reflecting the UK Influenza Pandemic Preparedness Strategy 2011, Exercise Nimbus focused on health impacts and managing the large numbers of deaths that 'occurred' under the assumed reasonable worst-case scenario, rather than on controlling the spread of the virus or preventing deaths.²⁷⁸²⁷⁸ INQ000052022; UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011 (https://assets.publishing.service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708)

¶2.109. Mr Swann, who attended Exercise Nimbus on behalf of Northern Ireland, had no memory of it, which he thought was because it had no impact.²⁷⁹²⁷⁹ Robin Swann 13 May 2024 90/19-91/17 Vaughan Gething MS, Minister for Health and Social Services in the Welsh Government from May 2016 to May 2021, said:

¶" We never got to the point that Operation Nimbus envisaged. So the choices that

ministers were being asked to envisage there, I think it was a[s] real as it could have been, to have been helpful."²⁸⁰²⁸⁰ Vaughan Gething 11 March 2024 61/4-62/11

¶Its utility was also limited by the absence of many relevant decision-makers. According to Mr Hancock, "most Government Departments had sent junior ministers, many of whom were about to be moved" in any event due to a reshuffle.²⁸¹²⁸¹ INQ000232194_0044-0045 para 187. The same was true of Scotland (INQ000320642_0002 paras 7-8).

¶2.110. SAGE met again on 13 February 2020, noting:

¶" SAGE and wider HMG [Her Majesty's Government] should continue to work on the assumption that China will be unable to contain the epidemic."²⁸²²⁸² INQ000106109_0002 para 5

¶2.111. The UK Cabinet met the following day, on 14 February 2020. Mr Johnson warned that "the government and the country needed to be ready for the coronavirus situation to get worse".²⁸³²⁸³ INQ000056138_0006 This was the first occasion on which Professor Whitty briefed the Cabinet directly on Covid-19. He told them:

" If the virus spread beyond China to its neighbours and across the world, then the UK would not be immune. Either the whole world would be affected, or the virus would be effectively restricted to China. There was no in-between scenario."²⁸⁴²⁸⁴ INQ000056138_0006; INQ000248853_0039 para 5.125

¶Professor Whitty also advised:

" [T]he spread of the virus would not be stopped by the suspension of flights from China. If the UK suspended flights, the modelling showed that it would only slow the spread of the virus by a maximum of five days. If the whole of the EU suspended flights from China then the virus may be slowed by two to four weeks."²⁸⁵²⁸⁵ INQ000056138_0008; INQ000106109_0002 para 1

¶This reflected the consistent advice given by scientists, that:

" completely closing borders would achieve very little in the way of epidemiological protection; it would only delay and there were other reasons why it did not seem advisable at the time, for example, making sure we had access to supplies from overseas and the need to repatriate UK nationals".²⁸⁶²⁸⁶ INQ000255836_0083-0084 para 315

¶Professor Whitty said that, if the virus became widespread in the UK, "[t]he plans that were already in place to tackle an influenza epidemic would be needed".²⁸⁷²⁸⁷ INQ000056138_0007 While it was possible that the virus would die out naturally as the seasons changed, if it did not, Professor Whitty expected up to 50% of the population to be affected with symptoms. Mr Hancock reiterated that "the Government had a plan, informed by science".²⁸⁸²⁸⁸ INQ000056138_0007

¶2.112. That same day, NHS Supply Chain (a body that procures healthcare products for NHS trusts and healthcare organisations) was provided with delegated authority to conduct significant spending on the open market for items of PPE that were of most concern. This followed earlier instructions by the Department of Health and Social Care to purchase additional volumes of PPE.²⁸⁹²⁸⁹ INQ000144792_0066 para 204. (The Inquiry is considering procurement of healthcare-related supplies in Module 5: Procurement.)

¶2.113. The World Health Organization published guidance on 14 February 2020, which stated:

" There is ample evidence that mass gatherings can amplify the spread of infectious diseases … Such infections can be transmitted during a mass gathering, during transit to and from the event, and in participants' home communities upon their return."²⁹⁰²⁹⁰ INQ000087520

¶However, no decision was yet taken on cancelling mass gatherings throughout the UK.

¶2.114. The UK Cabinet was not convened between 14 and 25 February 2020. There was also no COBR between 19 and 26 February 2020. It was school half-term holidays and parliamentary recess. Mr Johnson, staying at Chevening House (a country residence used by Foreign Secretaries), continued to receive box notes and sent three returns back to 10 Downing Street.²⁹¹²⁹¹ Boris Johnson 6 December 2023 81/20-82/13 It does not appear that he was briefed, at all or to any significant extent, on Covid-19 and he received no daily updates.²⁹²²⁹² Martin Reynolds 30 October 2023 71/18-72/2; INQ000273872_0030 para 149; INQ000226185_0038-0042

¶2.115. Mr Cummings observed that his general view of the Cabinet Office and the Department of Health and Social Care at this time was that they "weren't banging alarm bells at this point. Far from it, they were going skiing."²⁹³²⁹³ Dominic Cummings 31 October 2023 167/22-24

¶2.116. On 17 February 2020, SPI-M-O noted:

" There were differing views within the group about the likelihood of sustained transmission in the UK both currently and in the near future. Some believe it is a realistic possibility that sustained transmission in the UK will become established in the coming weeks while others believe this likelihood is higher and that there may already be sustained transmission."²⁹⁴²⁹⁴ INQ000310090_0002 para 16

¶2.117. John Swinney MSP, Deputy First Minister of Scotland from November 2014 to March 2023, chaired a Scottish Government Resilience Room meeting on 17 February 2020 to review the current situation.²⁹⁵²⁹⁵ INQ000233531 The Scottish Cabinet met the following day, noting that "extensive work" was under way to prepare for any outbreak in Scotland, including an assessment of the vulnerability of the social care sector.²⁹⁶²⁹⁶ INQ000238703_0004 para 16 Analysis prepared in advance of the Cabinet meeting included one scenario involving a 12 to 15-week pandemic, with a mortality rate of 2.5%, or 68,000 people.²⁹⁷²⁹⁷ INQ000362666_0003 The note of the Cabinet meeting does not record whether this potential scenario was specifically discussed, although Ms Sturgeon introduced the briefing paper (which covered a number of topics).²⁹⁸²⁹⁸ INQ000238703

¶2.118. At its eighth meeting, on 18 February 2020, SAGE noted that Public Health England could cope with only five new Covid-19 cases per week (requiring isolation of 800 contacts), although:

" Modelling suggests this capacity could be increased to 50 new cases a week (8,000 contact isolations) but this assumption needs to be stress tested with PHE operational colleagues."²⁹⁹²⁹⁹ INQ000052098_0002-0003 para 7

¶2.119. Professor Yvonne Doyle, Medical Director at Public Health England from June 2019 to October 2021, explained to the Inquiry that this was not correct. The five cases were references to new cases imported into the country with the capacity to trace the chain of transmission generated from these, amounting to about 2,000 onward contacts for each case imported into the UK. The underlying point was that this "would rapidly get out of control".³⁰⁰³⁰⁰ Yvonne Doyle 2 November 2023 200/2-202/22; INQ000273878_0010 para 28 It was correct that Public Health England had limited capacity – it was "not remitted to", nor was it:

" set up – in manpower capacity, workforce, facilities or funding – to address a pandemic of the scale of COVID-19 and mass population-level testing".³⁰¹³⁰¹ INQ000273878_0009-0010 paras 26-27

¶2.120. The London School of Hygiene & Tropical Medicine had concluded earlier in February 2020 that "60-80% of contacts must be traced (and transmission stopped) in order to achieve control in most scenarios, and more for some characteristics".³⁰²³⁰² 'Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts', J. Hellewell, S. Abbott, A. Gimma, N.I. Bosse, C.I. Jarvis, T.W. Russell, et al., The Lancet Global Health (2020), 8(4), E488-E496 (https://doi.org/10.1016/S2214-109X(20)30074-7; INQ000092645_0001) The UK did not have the ability to do so. Demand would rapidly outpace Public Health England's capacity. Nonetheless, Public Health England retained responsibility for testing and tracing until early April.

¶2.121. A meeting of COBR was also held on 18 February 2020 (chaired by Mr Hancock but attended for the first time by the leader of a devolved administration, Mr Drakeford). Professor Whitty stated:

" Both escalation to a global pandemic, and isolation of the majority of cases to China remained realistic possibilities."³⁰³³⁰³ INQ000056227_0005 para 2

¶A legislative policy paper presented to COBR confirmed that a "full response to an outbreak of Covid-19 in the UK will require additional UK legislation".³⁰⁴³⁰⁴ INQ000049396_0001 Mr Drakeford stated that his "very clear impression" was that the choice of legislation under which emergency powers would be exercised would be a decision for the UK government.³⁰⁵³⁰⁵ Mark Drakeford 13 March 2024 33/19-21 Ms Sturgeon agreed.³⁰⁶³⁰⁶ INQ000339033_0196 para 615 (This is considered further in Chapter 13:

¶Legislation and enforcement, in Volume II.) The Civil Contingencies Secretariat also provided an update on planning, noting:

" [T]here was work to be done to create a clear plan of activity (across the UK Government) from the moment of sustained transmission to its estimated peak, which was likely to be a period of three months."³⁰⁷³⁰⁷ INQ000056227_0007 para 17

¶2.122. At its meeting on 20 February 2020, SAGE noted that individual cases in England could already have been missed.³⁰⁸³⁰⁸ INQ000061517_0004 para 11 The minutes highlighted that, before consideration of measures to reduce the spread could be meaningfully undertaken by SAGE, it was essential to:

" understand the objectives behind seeking to manage the epidemiological curve (for example flattening the peak, spreading the duration, avoiding winter) informed by key challenges the NHS is seeking to mitigate. Once there is clarity on those issues, SAGE should review all potential methods to limit spread (schools, travel, large gatherings, home working), including their likely relative effectiveness."³⁰⁹³⁰⁹ INQ000061517_0003 paras 8-9

¶2.123. NHS England was also given the task of providing SPI-M-O with "a list of precise and essential criteria upon which NHS planning depends", for example "an estimate of the percentage of patients needing respiratory support, and for how long", in order for SPI-M-O to model these in different outbreak scenarios.³¹⁰³¹⁰ INQ000061517_0003 The UK government had not, by this point, communicated to SAGE in sufficient detail – if at all – the objectives of its plan for responding to the virus.

¶2.124. SAGE again discussed the need for a UK-wide surveillance study, proposals for which were to be drafted by Public Health England in conjunction with the devolved administrations.³¹¹³¹¹ INQ000061517; INQ000238826_0047 paras 139-140 Professor Vallance said that, by this point:

" [I]t had already become apparent to me and to others on SAGE that we were struggling, and would continue to struggle to collect, share, and analyse the data that we needed to inform our response to the pandemic. This was true for NHS data and for community infection data."³¹²³¹² INQ000238826_0047 paras 139-140

¶2.125. Nonetheless, no action was taken until April 2020, when a UK-wide surveillance programme led by the Office for National Statistics was introduced.³¹³³¹³ INQ000238826_0018 para 45b That became the Office for National Statistics-led Coronavirus (Covid-19) Infection Survey.

¶2.126. On 20 February 2020, for the first time, there was a meeting of the Civil Contingencies Group (Northern Ireland), which brought officials together.³¹⁴³¹⁴ INQ000023220 Dr Naresh Chada, Deputy Chief Medical Officer for Northern Ireland from 2019, advised:

" Departments should consider pandemic influenza planning as a starting point to rapidly advance planning for the reasonable worst case scenario for COVID-19. The elderly and those with existing health conditions will be disproportionately affected. These planning assumptions predict excess deaths, massive impacts across government, school closures, rail and road transport issues, and huge costs."³¹⁵³¹⁵ INQ000425536_0016 (emphasis in original)

¶There was discussion on, for example, the lack of isolation facilities in Northern

¶Ireland, the need to consider storage facilities in relation to excess deaths, and the need to review business continuity plans in light of reasonable worst-case scenario parameters.³¹⁶³¹⁶ INQ000023220 NICCMA had still not been instituted – an aide-memoire prepared for

¶Mr Pengelly on 21 February repeated that it was not necessary to do so at this time.³¹⁷³¹⁷ INQ000425535 NICCMA was not ultimately activated until mid-March 2020.³¹⁸³¹⁸ David Sterling 1 May 2024 180/15-20

¶2.127. At a NERVTAG meeting on 21 February 2020, it was noted that "the evidence suggests that 40% of virologically confirmed cases are asymptomatic".³¹⁹³¹⁹ INQ000119469_0006 para 3.4 This was an alarmingly high percentage and suggested that official case numbers in China (and likely internationally) were a significant underestimate of the true spread of the virus.

¶2.128. Professor John Edmunds, Professor of Infectious Disease Modelling at the London School of Hygiene & Tropical Medicine and a member of NERVTAG from 2014 to 2022, advocated for the risk level to be raised from 'moderate' to 'high' as there was evidence of ongoing transmission in China, Korea, Japan and Singapore. Unfortunately, NERVTAG did not support this view.³²⁰³²⁰ INQ000119469_0005 paras 2.4-2.5 At the time, Professor Edmunds felt:

" [S]tating that the risk was 'moderate' when all indications suggested that we were about to experience a very severe epidemic could be misconstrued and could lead to complacency amongst decision-makers."³²¹³²¹ INQ000273553_0053 para 8.26

¶2.129. Also on 21 February 2020, NHS England noted that it needed to raise with the Department of Health and Social Care that its initial modelling suggested:

" [E]ven with continued mitigation work, the NHS would be overwhelmed well before the peak without significant interventions to flatten the curve."³²²³²² INQ000116811_0042, 0226-0227 paras 6-9, 152

¶2.130. Later that day, a situation update noted a cluster of cases in northern Italy, with 7 out of 16 new cases in intensive care. None involved travel to China and the reports indicated that five were healthcare workers. Cases were also reported in Iran, Canada and Lebanon. Fatality and severity indicated that there were substantially more cases. Professor Ferguson told Professor Whitty:

" [T]he epidemiological data – while patchy – suggests that we should be acting on the assumption that sustained transmission is happening now in the UK."³²³³²³ INQ000148969_0003

¶Professor Ferguson also called for systematic surveillance to be established, with de‑escalation only if that demonstrated sustained transmission was not occurring.³²⁴³²⁴ INQ000148969_0003-0004

¶2.131. By 21 February 2020, Professor Ferguson said that he:

" felt it was a matter of when rather than if local community transmission would be discovered in the UK, and thus that the UK should move away from its stated 'containment' strategy (i.e. focussing on border measures, which in my view were ineffective) to an evidence-based mitigation strategy (i.e. targeted, layered use of NPIs to reduce transmission). Chris Whitty disagreed regarding the inevitability of local spread and felt it was premature to talk about ending containment. Overall, I felt there was insufficient urgency in government planning at that time, a view shared by John Edmunds and Jeremy Farrar."³²⁵³²⁵ INQ000249526_0055 para 175

¶2.132. Professor Ferguson sent a number of emails to Professors Whitty and Vallance and others in government, expressing his concerns and setting out his:

" initial analysis of the potential impact of a variety of non-pharmaceutical interventions (NPIs) on COVID-19 spread".³²⁶³²⁶ INQ000216096_0001

¶He emphasised the most important conclusion of the analysis, which was:

" [A] package combining multiple measures could likely have a major effect. Social distancing which reduces community contacts outside the household and school/workplace might have the single largest impact, if practical and affordable. Akin to the measures in operation in parts of China, Italy and South Korea now."³²⁷³²⁷ INQ000216096_0001

¶2.133. UK passengers from a cruise ship, the Diamond Princess, arrived back in the UK on 22 February 2020, having been quarantined by the Japanese government after a passenger tested positive for Covid-19. Of some 2,600 passengers and 1,000 crew, over 600 people became infected with Covid-19.³²⁸³²⁸ 'Estimating the infection and case fatality ratio for coronavirus disease (COVID-19) using age-adjusted data from the outbreak on the Diamond Princess cruise ship, February 2020', T.W. Russell, J. Hellewell, C.I. Jarvis, K. van Zandvoort, S. Abbott, R. Ratnayake, et al., Euro Surveillance (2020), 25(12), 2000256 (https://doi.org/10.2807/1560-7917.ES.2020.25.12.2000256; INQ000262586_0001) Early reports showed that about 50% of the people infected had no symptoms when they tested positive. Using data from passengers on board, Professor Edmunds and his team initially estimated the overall case fatality ratio and infection fatality ratio to be about 1.1% and 0.5% respectively.³²⁹³²⁹ 'Estimating the infection and case fatality ratio for coronavirus disease (COVID-19) using age-adjusted data from the outbreak on the Diamond Princess cruise ship, February 2020', T.W. Russell, J. Hellewell, C.I. Jarvis, K. van Zandvoort, S. Abbott, R. Ratnayake, et al., Euro Surveillance (2020), 25(12), 2000256 (https://doi.org/10.2807/1560-7917.ES.2020.25.12.2000256; INQ000262586_0001) The infection fatality ratio was estimated to be more than 7% in those over 70 years old.³³⁰³³⁰ INQ000273553_0048 para 8.17; 'Estimating the infection and case fatality ratio for coronavirus disease (COVID-19) using age-adjusted data from the outbreak on the Diamond Princess cruise ship, February 2020', T.W. Russell, J. Hellewell, C.I. Jarvis, K. van Zandvoort, S. Abbott, R. Ratnayake, et al., Euro Surveillance (2020), 25(12), 2000256 (https://doi.org/10.2807/1560-7917.ES.2020.25.12.2000256; INQ000262586_0003)Show full note These were significant levels of lethality for a virus that could infect up to 80% of the population.³³¹³³¹ INQ000310090_0001 para 6

¶2.135. That same day, the Italian government imposed a lockdown in 11 municipalities following outbreaks of Covid-19.³³³³³³ INQ000303288_0007 This followed the confirmation of the first two Covid-19 cases on 31 January (as in the UK) and subsequently the first death on 22 February, with a further six deaths by 24 February. It included strict containment measures: prohibition of leaving the area, closure of schools at all levels and suspension of all events, museums and public offices, commercial and work/business activities, with the exception of essential services. This was in response to the threat of hospitals being overwhelmed, with a shortage of beds, ventilators and health professionals.

¶2.136. On 24 February 2020, Imran Shafi, Private Secretary to the Prime Minister for public services from March 2018 to March 2021, emailed Professor Vallance, Ms Hammond and senior officials and key advisers to Mr Johnson. He stated:

" At some point soon, I'd like to start exposing the PM to the potential decisions he might have to take in short order on this – at the moment it's been fairly abstract with him I think."³³⁴³³⁴ INQ000136744_0001

¶2.137. On 24 February 2020, Scottish Government Resilience Room (Officials) met.³³⁵³³⁵ INQ000233292 Derek Grieve, Deputy Director to the Health Protection Division, recorded that the Chief Medical Officer gave "everyone both barrels on the impact of COVID19. Felt like a few were starting to appear interested."³³⁶³³⁶ INQ000346137_0013 This was one of many examples of Mr Grieve's growing frustration at the slow pace of the Scottish Government's response to the virus during this period. On 26 February 2020, he recorded in his notebook that he had attended a COBR meeting with Ms Freeman and that it was "clear all [departments] in UK Govt are fully engaged [and] mobilised in a way that the [Scottish Government] simply isn't".³³⁷³³⁷ INQ000346137_0014 On 27 February 2020, he recorded that he had attended a meeting of senior officials within the Scottish Government and there was "still no real engagement. They then spent 20 mins talking about internal SG [Scottish Government] comms. Completely amazed!"³³⁸³³⁸ INQ000346137_0014

¶2.138. The concern that departments were not engaged and mobilised also applied to Northern Ireland. The Executive Committee continued to be briefed on the pandemic but had yet to have a substantive discussion about it. At a meeting on 24 February 2020, Mr Swann "briefed the Executive on the COVID 19 (Coronavirus)" under "Any Other Business".³³⁹³³⁹ INQ000048445_0005; INQ000065693_0009-0010 Although the substance of this is unclear, a briefing note prepared for Mr Swann in advance of the meeting contained details of the Cabinet Office's reasonable worst-case scenario planning and advised that the working assumption at the time was:

¶" [T]he first wave of the pandemic will last approximately 15 weeks with over 50%

of the population falling ill and up to 20% off work during the peak weeks. This would lead to a huge surge in demand for health and social care services which would have a knock-on impact on current provision."³⁴⁰³⁴⁰ INQ000425518_0004 para 12

¶The note highlighted:

¶" Besides very severe levels of stress on [the health and social care system], the

level of excess deaths would stretch capacity within organisations involved in the management of deaths."³⁴¹³⁴¹ INQ000425518_0004 para 13

¶However, these planning assumptions do not appear to have been shared with the Executive Committee at this time. The speaking note provided to Mr Swann for the meeting made no reference to the reasonable worst-case scenario planning assumptions, nor were they recorded in the handwritten notes of the meeting.³⁴²³⁴² INQ000425518_0008-0012

¶2.139. At the weekly Scottish Cabinet on 25 February 2020, Ms Sturgeon stated that she would chair the Scottish Government Resilience Room meeting later that day, with a fuller discussion at the following week's Cabinet. A brief discussion of the virus took place under "Any Other Business".³⁴³³⁴³ INQ000238705_0009 para 44

¶2.140. At a meeting between Mr Johnson, Mr Hancock, Dominic Raab MP (Secretary of State for Foreign and Commonwealth Affairs and First Secretary of State from July 2019 to September 2021), Professors Vallance and Whitty, and others on 25 February 2020, Mr Cummings stated:

" No10 [10 Downing Street] should see all the plans for what the UK would do in a worst case scenario, including comms plans. The Health Secretary confirmed that there would be a discussion on this with No10 the following day, and that all these plans would be shared."³⁴⁴³⁴⁴ INQ000146565_0001

¶A note highlighting "the most significant choices should a pandemic occur in the UK" was to be shared by 28 February.³⁴⁵³⁴⁵ INQ000146565_0001

¶2.141. Covid-19 was not included on the formal agenda for the UK government Cabinet meeting on 25 February 2020. Mr Johnson acknowledged that its absence was "a measure of the focus we then had on other things".³⁴⁶³⁴⁶ INQ000255836_0019 para 70 Notwithstanding this, Covid-19 was raised during the meeting. Mr Hancock reported that case numbers had risen in northern Italy and that Professor Vallance had changed his advice, suggesting:

" [T]hose with symptoms returning from the region North of Pisa should self-isolate for 14 days. Those returning from areas now quarantined should self-isolate regardless of symptoms."³⁴⁷³⁴⁷ INQ000056140_0004

¶2.142. The Welsh Government did not discuss Covid-19 in the Welsh Cabinet until 25 February 2020.³⁴⁸³⁴⁸ INQ000129852_0006 Mr Drakeford told the Inquiry that the signal to start discussing matters in Cabinet was:

" the moment when chief medical officers advised that the risk level to the United Kingdom and to Wales has moved from low to moderate. Right until the point at which the Cabinet begins to discuss things, the advice from our chief medical officers is the risk to Wales is low, and when that is your primary signal it doesn't read to me like a signal that we need to start mobilising in that purposeful way."³⁴⁹³⁴⁹ Mark Drakeford 13 March 2024 50/1-9

¶As noted above, however, the Chief Medical Officers' assessment of risk had in fact changed from 'low' to 'moderate' on 30 January 2020.

¶2.143. Work had been ongoing in SAGE with regard to potential interventions. At its meeting on 27 February 2020, SAGE:

" reviewed a table summarising the impacts of non-pharmaceutical interventions – to be finalised at its next meeting".³⁵⁰³⁵⁰ INQ000106129_0003 para 10

¶SAGE discussed a report from Imperial College London regarding potential interventions, as well as modelling and examination of a 'flattening the peak' strategy. It also endorsed planning assumptions of an overall 1% infection fatality ratio and that 80% of the UK population could become infected.³⁵¹³⁵¹ INQ000106129_0002-0003 This reflected "deaths as a direct result of infection, not those related to NHS overload or other [secondary] effects".³⁵²³⁵² INQ000106129_0002 para 9 A report before SAGE confirmed that, without action, demand on NHS beds would overtake supply before the peak was reached.³⁵³³⁵³ INQ000409251_0078 para 321

¶2.144. Consequently, SAGE noted two action points in relation to NHS England. Firstly, it should confirm to SPI-M-O "the variables for which it needs numbers in order to model NHS demand".³⁵⁴³⁵⁴ INQ000106129_0002-0003 Secondly, UK academic modelling groups and NHS England planners should organise a working group to analyse key clinical variables for reasonable worst-case scenario planning for the NHS, which would then be reviewed by SPI-M-O and discussed at SAGE.³⁵⁵³⁵⁵ INQ000106129; INQ000116811_0045 para 163 This working group met on 1 March 2020 (see Chapter 3: The first 12 days of March 2020, in this volume).

¶2.145. The delay between Imperial College London making available the first estimate of the infection fatality ratio on 10 February 2020, its accepted use by SAGE at its 27 February 2020 meeting for planning purposes, and its eventual sign-off in early March was described by Professor Ferguson as "understandable given the magnitude of the decisions", but:

" frustrating for me at the time and clearly regrettable in retrospect. It is difficult for me to establish a clear cause, other than the caution felt by SAGE in accepting estimates with a high level of uncertainty until that uncertainty (slightly) declined. The further delay until broad government acceptance that the RWCS [reasonable worst-case scenario] was a likely rather than just a 'worst case' scenario was even more regrettable."³⁵⁶³⁵⁶ INQ000249526_0047 para 146

¶2.146. At COBR on 26 February 2020, Mr Hancock noted:

" [T]he reasonable worst case planning assumptions looked close to becoming the reasonable planning assumptions … [and] all departments should step up preparations."³⁵⁷³⁵⁷ INQ000056216_0006 para 11

¶2.147. Internationally, case numbers indicated sustained person-to-person transmission, including in Italy – which received a high number of travellers to and from the UK.³⁵⁸³⁵⁸ INQ000056216_0005 para 1 COBR also discussed the UK's legislative response. An emergency bill was deemed the appropriate legislative vehicle to address the pandemic.³⁵⁹³⁵⁹ INQ000056216_0006 para 11 However, Mr Drakeford's impression from this meeting was that the proposed emergency bill would largely mirror the framework of the Civil Contingencies Act 2004, with primary decision-making power remaining with the UK government and implemented by the devolved administrations.³⁶⁰³⁶⁰ Civil Contingencies Act 2004 (https://www.legislation.gov.uk/ukpga/2004/36/contents); INQ000273747_0008 para 23 This was not to be the case. Instead, as discussed in Chapter 13: Legislation and enforcement, in Volume II, public health legislation was used to enforce restrictions in each nation, enabling each government to make its own decisions about the appropriate response in its nation.

¶2.148. On 27 February 2020, Mr Johnson stated that he was "keen to really step up activity on Coronavirus".³⁶¹³⁶¹ INQ000136747_0002 That same day, Northern Ireland identified its first case of Covid‑19.³⁶²³⁶² INQ000411550_0046-0047 para 124

¶2.149. Following the meeting between Mr Johnson, Mr Hancock and others three days earlier, the Civil Contingencies Secretariat circulated 'Covid-19: The UK's preparedness' on 28 February 2020. This had been drafted in consultation with Mr Hancock and Professors Whitty and Vallance.³⁶³³⁶³ INQ000146569; INQ000221567_0017 para 52 A draft of what would become the Coronavirus: Action Plan, published on 3 March 2020, was also shared.³⁶⁴³⁶⁴ INQ000174667_0003; INQ000182332; Coronavirus: Action Plan: A Guide to What You Can Expect Across the UK, Department of Health and Social Care, 3 March 2020 (https://assets.publishing.service.gov.uk/media/5e5e2e91e90e071110454391/Coronavirus_ action_plan_-_a_guide_to_what_you_can_expect_across_the_UK.pdf; INQ000182380)

¶2.150. The paper acknowledged: "Covid-19 looks increasingly likely to become a global pandemic, although this is not yet certain."³⁶⁵³⁶⁵ INQ000146569_0001 para 1 It further stated:

" Based on existing assumptions for a severe pandemic flu outbreak, in a reasonable worst case scenario about half of the UK's population would become ill (many with mild symptoms), and up to 520,000 people could die as a direct result of Covid-19."³⁶⁶³⁶⁶ INQ000146569_0001 para 2

¶It went on to explain:

" [I]n the reasonable worst case scenario, the risk of Covid-19 to the UK is similar to that of a severe pandemic flu outbreak, although it may well be less severe than this."³⁶⁷³⁶⁷ INQ000146569_0002 para 6

¶2.151. The paper noted that the UK's tactical aims were to "contain the infection if possible, delay the peak if not" (emphasis in original).³⁶⁸³⁶⁸ INQ000146569_0002 para 8 It explained that the response would proceed through the phases if the outbreak escalated, and stated:

" The triggers for moving between phases will be provided by the Chief Medical Officers, informed by an assessment of the Scientific Advisory Group for Emergencies (SAGE) and the World Health Organization … we cannot wait until there is sustained transmission in the UK before taking steps to protect the UK. Once the outbreak spreads here we will not have time to both prepare and respond."³⁶⁹³⁶⁹ INQ000146569_0003, 0005 paras 11, 20

¶2.152. Mr Johnson believed that the first time he saw the "containment, delay, mitigation" sequence was in this paper (which is considered further in Chapter 3: The first 12 days of March 2020, in this volume).³⁷⁰³⁷⁰ INQ000255836_0024 para 104; INQ000146569 He also told the Inquiry that he was "puzzled" after reading the briefing:³⁷¹³⁷¹ INQ000255836_0024 para 102

" Which was it? Half a million deaths or a bad flu epidemic? I remember asking my team – and no one seemed to be sure."³⁷²³⁷² INQ000255836_0024 para 102

¶2.153. At a meeting between Mr Johnson, Mr Hancock, Mr Raab, Rishi Sunak MP (Chancellor of the Exchequer from February 2020 to July 2022), Professor Whitty and others to discuss the paper on 28 February 2020, it was concluded:

" We need a major ramp-up of OGD [other government department] activity on domestic preparedness – and we should use the COBR meeting on Monday to land this point with Secretaries of State."³⁷³³⁷³ INQ000136750_0002

¶However, Mr Shafi's notes recorded Mr Johnson as saying:

" What's the strategy. – When are we going to take big decisions, of what evidence. – biggest damage done by overreaction."³⁷⁴³⁷⁴ INQ000146636_0021

¶2.154. On the same day, Wales confirmed its first positive case of Covid-19 and the World Health Organization raised its alert to 'very high' (its highest level of alert).³⁷⁵³⁷⁵ INQ000371209_0025 para 79; 'Coronavirus: WHO issues "highest alert" over coronavirus', BBC News, 28 February 2020 (https://www.bbc.co.uk/news/live/world-51669434; INQ000573842)

¶2.155. Between the end of February and the beginning of March 2020, four cases had been detected through GP surveillance in the UK, one of which was in intensive care.³⁷⁶³⁷⁶ This was one of two surveillance systems launched in late February in an effort to understand the prevalence of Covid-19 infections (INQ000273553_0045 para 8.13). None were linked to foreign travel. Professor Ferguson viewed this as:

" the first definitive evidence indicating that community transmission was ongoing in the UK".³⁷⁷³⁷⁷ INQ000249526_0079 para 240