UK Covid-19 Inquiry, Modules 2, 2A, 2B, 2C: Core decision-making and political governance, Volume I · 2025
The initial plan for the response
The initial plan for the response
¶3.35. Having been agreed by COBR the previous day, the Coronavirus: Action Plan was published on 3 March 2020.94 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); INQ000106107; Matt Hancock 30 November 2023 111/17-18 It set out in extremely high-level terms the plan that the four nations of the UK intended to follow in their responses to the virus, including the following phases:
¶" Contain: detect early cases, follow up close contacts, and prevent the disease taking hold in this country for as long as is reasonably possible
¶Delay: slow the spread in this country, if it does take hold, lowering the peak impact and pushing it away from the winter season
¶Research: better understand the virus and the actions that will lessen its effect on the UK population; innovate responses including diagnostics, drugs and vaccines; use the evidence to inform the development of the most effective models of care
¶Mitigate: provide the best care possible for people who become ill, support hospitals to maintain essential services and ensure ongoing support for people ill in the community to minimise the overall impact of the disease on society, public services and on the economy."95 Coronavirus: Action Plan: A Guide to What You Can Expect Across the UK, Department of Health and Social Care, 3 March 2020, p10, para 3.9 (https://assets.publishing.service.gov.uk/media/5e5e2e91e90e071110454391/Coronavirus_action_plan_-_a_guide_to_ what_you_can_expect_across_the_UK.pdf; INQ000182380)
¶This reflected the "contain, delay, research and mitigate" framework that began to be identified in late January 2020, as discussed in Chapter 2: The emergence of Covid-19, in this volume, although Mr Johnson believed that the first time he saw this sequence was in a briefing presented on 28 February 2020.96 INQ000251645_0077-0078 para 7.43; Christopher Whitty 21 November 2023 124/5-7; INQ000255836_0024 para 104; INQ000146569
105Contain phase: Stopping the spread of the virus through test and trace
¶3.37. This was an entirely sensible approach to take. However, containment of any virus is heavily reliant upon the ability to test and to detect cases and trace close contacts, as well as on the generation time of the virus being long enough for contact tracing efforts to keep pace. Two diseases with the same reproduction number (R) can spread at different speeds, depending on the generation time. As explained by Professor John Edmunds (Professor of Infectious Disease Modelling at the London School of Hygiene & Tropical Medicine), viruses with a short generation time, such as pandemic influenza, move so fast that "it's really impossible to keep up with it with contact tracing" (identifying the source and contacts linked to a confirmed case of an infectious disease).98 John Edmunds 19 October 2023 46/23-47/8
Three available options, should containment fail
¶3.38. In the event that test and trace capacity was outpaced by the spread of the virus and its spread could therefore no longer be prevented through that means, the contain phase would be over.
¶3.39. At that point there were, on the Inquiry's analysis, three distinct options available to the four governments for the next immediate phase of their response:
-
¶
- Option 1: No restrictions and allow the virus to spread at its natural pace;
- Option 2: Some restrictions to slow the spread of the virus; or
- Option 3: Stringent restrictions to stop the spread of the virus.
Option 1: No restrictions and allow the virus to spread at its natural pace
¶3.40. Governments could choose to put no restrictions in place and allow the virus to spread through the population (sometimes known as 'unmitigated spread'). In this approach, R would not be affected and the virus would therefore spread exponentially through the population over a relatively short period of time.
106¶3.41. The perceived benefit of this approach is that the population would become infected with the virus and most would recover over a relatively short period of time. A potential consequence of this is that it may create a degree of immunity in the population among people who have been infected with the virus (known as population immunity or 'herd immunity') relatively quickly. Population immunity is a complex scientific concept.99 For a detailed explanation of the scientific concept of population immunity, see INQ000252450_0016-0018 paras 2.33-2.38; INQ000238826_0073 para 233; INQ000251645_0106-0108 paras 7.144-7.149. In general terms, it refers to the point where there is a large number of people in the population who have some immunity to the virus (either through infection or vaccination), there are fewer people able to be infected and, as a result, the amount of the virus in circulation begins to decline until it dies out and the pandemic comes to an end.
¶3.42. Any such immunity would reduce the risk of the population being severely impacted by a second wave of infections. However, this consequence is not guaranteed, as some viruses do not lead to population immunity through infection. This can be the case if reinfection is possible because individual immunity is not particularly high or does not last a long time. In those circumstances, as Professor Whitty explained, population immunity "will fail to control the virus, which will continue to spread in the community".100 INQ000251645_0108 para 7.148 It was not known in March 2020 whether population immunity through infection was in fact possible in relation to Covid-19.
¶3.43. The obvious downside of this approach is that large numbers of people may die and become ill with the virus. Additionally, this is likely to happen over a short period of time, therefore creating a severe strain on health services as well as other public services and the economy, as large numbers of people become too ill to work.
Option 2: Some restrictions to slow the spread of the virus (a mitigation strategy)
¶3.44. Governments could put in place some restrictions to slow down the spread of the virus among the population (known as a mitigation strategy). Examples of relevant restrictions include advising people with virus symptoms to self-isolate and advising everyone to limit their social contacts.
¶3.45. The effect of these restrictions is that R is reduced, but it would remain above 1. The epidemic would continue to grow, but not as quickly as it otherwise would have.
¶3.46. The benefit of implementing restrictions to slow the spread of the virus is that it prevents as many people becoming infected with the virus at the same time as would have been the case in the absence of restrictions. This creates some time for effective treatments to be developed and reduces the strain on the health service as a result of an infection over a longer period of time. The downside of the approach of slowing the spread is that it still allows the number of infections to grow and therefore a significant number of people will still become infected with the virus.
107¶3.47. As explained above, a possible consequence of this may be that, when the restrictions are lifted, there is a degree of population immunity, thereby reducing the population's vulnerability to any future waves of the virus. However, this is far from guaranteed, since infection may not lead to immunity. Further, even if immunity through infection were possible, there is a possibility that the public would voluntarily start to reduce its social contact out of fear of the virus, thereby reducing the possibility of population immunity being achieved through this approach.
Option 3: Stringent restrictions to stop the spread of the virus (a suppression strategy)
¶3.48. The final option would be to put in place stringent restrictions – such as a mandatory 'stay at home' order or 'lockdown' – to stop the spread of the virus (known as a suppression strategy).
¶3.49. The effect of these stringent restrictions is that R is reduced below 1, so that the number of people infected with the virus begins to decline. The benefit of this approach is that there will be fewer infections and deaths than under either of the other approaches. However, the downside is that stringent restrictions come with significant social and economic impacts. This is particularly so if the restrictions remain in place for a prolonged period of time. A suppression strategy is also not a solution in itself. The number of infections will quickly start to grow again once restrictions are lifted, as the population will not have any immunity to the virus (known as an 'exit wave').
¶3.50. An exit strategy from the stringent restrictions therefore needs to be put in place to prevent or reduce the impact of this exit wave of infections. The exit strategy could involve the development of effective treatments or a vaccine, or driving down infections to a level that can be contained within test and trace capacity. However, this may take considerable time and, as a result, restrictions may need to be periodically reintroduced until effective countermeasures are available.
Delay phase: Slowing the spread of the virus through restrictions
¶3.51. On the Inquiry's analysis, the three options above were available to the four governments for the next phase of their response after the contain phase was over. They pursued a mitigation strategy of imposing some restrictions to slow the spread of the virus (Option 2). This was known as the delay phase.
108¶"flattening the curve", "a one peak strategy" and "squashing the sombrero".102 INQ000238826_0073, 0079 paras 233, 244; 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/live/cAE8-e5_EKY; INQ000231053_0004-0005, 0008); INQ000056221_0005 para 2; INQ000056217_0005 para 2; INQ000255836_0040 para 168; INQ000252711_0006 para 25; INQ000215035_0011 para 43
¶Mr Johnson told the Inquiry that this approach was based on Professor Whitty's advice that:
" [A]t a certain number of cases, the NHS becomes overwhelmed and collapses. The consequences would be catastrophic and therefore, as the curve increases, we have to flatten it."103 INQ000255836_0039 para 165
¶3.53. It is clear from statements made by Professors Whitty and Vallance in mid-March 2020 that the intended purpose of the delay phase was to slow the spread of the virus in order to reduce the number of cases at any one time, rather than to stop its spread entirely. Professor Whitty told COBR on 9 March that the delay response was intended to change "the shape of the virus curve, as opposed to suppressing it".104 INQ000056219_0007 para 8; see also INQ000056221_0005 para 2 Similarly, at a COBR meeting on 12 March, Professor Vallance explained that the aim of implementing the interventions under consideration "was not to completely suppress the spread of the disease".105 INQ000056221_0005 para 2 He explained:
"[N]ot only was this not possible, but it would likely lead to a larger second peak later in the year when the NHS may be under increased pressure."106 INQ000056221_0005 para 2
¶3.54. Even if it was practically possible, it was probably politically impossible for the UK government and devolved administrations to choose to do nothing in response to the virus (Option 1). On 5 March 2020, during a TV interview, Mr Johnson stated:
" [P]erhaps you could take it on the chin, take it all in one go and allow the disease, as it were, to move through the population, without taking as many draconian measures."107 INQ000548398
¶3.55. Media reporting of Mr Johnson's comments gave rise to public concern that this was the intention.108 'The government's herd immunity plan is callous and dangerous', The Guardian, 15 March 2020 (https://www.theguardian.com/ world/2020/mar/15/the-governments-herd-immunity-plan-is-callous-and-dangerous; INQ000625218) However, Mr Johnson clarified during the interview that the plan for the UK government's response was to "take all the measures that we can now to stop the peak of the disease being as difficult for the NHS as it might be".109 INQ000548398 Indeed, the Inquiry heard from a number of witnesses that it was never the UK government's plan to take no action at all and to allow the virus to spread through the population unchecked.110 INQ000255836_0040 para 170; INQ000232194_0089 para 370; INQ000251645_0083, 0104 paras 7.63, 7.135; INQ000238826_0048, 0062 paras 144, 193
109¶3.56. There was, however, a discussion at a meeting chaired by Mr Johnson on 12 March 2020 about whether it was possible to shield older people and the vulnerable while allowing the virus to spread among the rest of the population. At this meeting, Sir Mark Sedwill (later Lord Sedwill), Cabinet Secretary and Head of the Civil Service from October 2018 to September 2020, suggested that members of the public could be told it was better for them to catch the virus and get it over with, using an analogy of 'chickenpox parties' to spread the virus.111 Dominic Cummings 31 October 2023 192/11-193/3; INQ000237819_0008-0009 para 21; INQ000269182_0030 para 103; see also INQ000279901 Lord Sedwill told the Inquiry that he was seeking to explore whether there was a way of managing it spreading through those people:
" for whom the disease was likely to be unpleasant rather than dangerous, and that we could quarantine and shield those for whom it would be dangerous".112 Mark Sedwill 8 November 2023 76/14-19. This is akin to population segmentation strategies subsequently proposed by some scientists, for example in the Great Barrington Declaration published in October 2020. This is discussed further in Chapter 6: The second wave, in this volume.
¶Mr Johnson confirmed that this formed part of:
" a free-flowing discussion … to assess whether it might be sensible to allow the vast majority of younger people to get the disease (and therefore become immune) while protecting the elderly".113 INQ000255836_0043 para 178
¶But Mr Johnson said that the idea was "immediately dispensed with".114 INQ000255836_0043 para 178 Lord Sedwill explained that he dropped the 'chickenpox parties' analogy because he realised that it was causing confusion as to whether he had misunderstood the seriousness of Covid-19.115 Mark Sedwill 8 November 2023 75/16-24 In any event, it ultimately became clear that the capabilities were not in place to make this approach a viable option in March 2020.116 Mark Sedwill 8 November 2023 81/12-17
¶3.57. However, the Inquiry heard that no proper debate took place prior to the publication of the Coronavirus: Action Plan about whether it was appropriate to attempt to stop the spread entirely rather than simply slow it (Option 3). Dr Ben Warner, Special Adviser to the Prime Minister from December 2019 to May 2021, said that he was:
" not aware of any meeting where the Prime Minister was asked to choose between a mitigation or suppression strategy".117 INQ000269182_0029 para 99
¶Imran Shafi, Private Secretary to the Prime Minister for public services from March 2018 to March 2021, told the Inquiry:
110" I don't think there was a proper discussion in February about suppress [stopping the spread] or mitigate [slowing the spread]."118 Imran Shafi 30 October 2023 143/8-15, 144/8-10
¶3.58. The approach of slowing, rather than stopping, the spread of the virus pursued in the first half of March 2020 (Option 2) had its origins in the UK Influenza Pandemic Preparedness Strategy 2011. This was intended to be adaptable to another type of virus.119 UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011, para 2.21 (https://assets.publishing.service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708) It stated:
" [I]t almost certainly will not be possible to contain or eradicate a new virus in its country of origin or on arrival in the UK. The expectation must be that the virus will inevitably spread and that any local measures taken to disrupt or reduce the spread are likely to have very limited or partial success at a national level and cannot be relied on as a way to 'buy time'."120 UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011, para 2.12 (https://assets. publishing.service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708); see also 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)
¶It explained that to attempt to stop the spread of a new pandemic influenza virus
¶"would be a waste of public health resources and capacity".121 UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011, p28 (https://assets.publishing.service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708) Instead, it suggested that the spread should be slowed through limited measures, such as advising those infected with the virus to stay at home, minimising close contacts and adopting hygiene practices.122 UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011, pp36-37 (https://assets.publishing.service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708)
¶3.59. The approach to a response to a pandemic therefore long anticipated that – in the absence of scaled-up test, trace and isolate capacity – the spread of a virus would have to be managed, as any measures intended to stop the spread would not be successful.
¶3.60. Sir Christopher Wormald (Permanent Secretary to the Department of Health and Social Care from May 2016 to December 2024) told the Inquiry that, in the Department of Health and Social Care, "the presumption was that we would be following, basically, the flu plan".123 Christopher Wormald 2 November 2023 108/10-11 Similarly, Mr Shafi explained:
" I think the system, Number 10 [Downing Street] included, defaulted into accepting that the pandemic flu … approach, which is more of a mitigate approach [slowing the spread] rather than a suppress [stopping the spread] approach, was the right way forward."124 Imran Shafi 30 October 2023 143/8-15, 144/8-10
¶3.61. Mr Hancock understood that the UK government's approach, as set out in the Coronavirus: Action Plan, was "predicated, explicitly, on the inevitability of global spread".125 INQ000048399_0005 Lord Sedwill explained that "the scientific advice was … not that the virus could be stopped, but that its spread and serious incidence could only be managed".126 Mark Sedwill 8 November 2023 55/18-21 Mr Cain said:
111" [I]t was felt that a widespread Covid-19 infection could not realistically be stopped so government planning needed to focus on how it could be managed."127 INQ000252711_0006 para 26
" [I]t may be that widespread exposure in the UK is inevitable; but slowing it down would still nonetheless be beneficial."128 Coronavirus: Action Plan: A Guide to What You Can Expect Across the UK, Department of Health and Social Care, 3 March 2020, p18, para 4.42 (https://assets.publishing.service.gov.uk/media/5e5e2e91e90e071110454391/Coronavirus_action_plan_-_a_guide_to_ what_you_can_expect_across_the_UK.pdf; INQ000182380)
¶3.63. There was also a widely held view that putting in stringent restrictions to stop the spread of the virus would only lead to a wave of infections later in the year when the restrictions were lifted. This was articulated in a SPI-M-O consensus statement of 2 March 2020, a London School of Hygiene & Tropical Medicine paper of 3 March, a Civil Contingencies Secretariat paper of 6 March, by Professor Vallance at COBR on 12 March, on the BBC Radio 4 Today programme on 13 March, by SAGE on 13 March and in a WhatsApp message to Mr Johnson on 14 March.129 INQ000119430_0001 para 9; 'The effect of social distance measures on deaths and peak demand for hospital services in England', London School of Hygiene & Tropical Medicine, 12 June 2020 [considered at SAGE 3 March 2020], p2 (https://www.gov.uk/ government/publications/the-effect-of-social-distance-measures-on-deaths-and-peak-demand-for-hospital-services-in-england-3- march-2020; INQ000212223_0002); INQ000151558_0003; INQ000056221_0005 para 2; INQ000064580_0002-0003; INQ000048399_0003; INQ000236391_0002 para 24
¶3.64. Professor Whitty explained this concern to the Inquiry:
" If you go for a suppression strategy [of stopping the spread], for however long you do it … at a certain point you will have to release it, and then the pandemic is still with you and then you will have what is called in epidemiology an exit wave … So essentially the wave comes at the point you choose to release the measures … So this is trying to make clear to people: if you go for suppression, don't think that that's your problem done, you just have to suppress for a bit and you're done. At some point you're going to have to face this, and the question is: at what point do you want to? … But the idea that you can, absent an extremely effective vaccine, suppress and then not have an exit wave, is not realistic."130 Christopher Whitty 21 November 2023 212/10-25, 213/1-3, 214/21-25
¶3.65. A severe exit wave could only be avoided if stringent restrictions were maintained until an effective vaccine or treatment was widely available. This was not considered to be a realistic prospect because of concerns that the public might not be able to comply with stringent restrictions for a long time. Mr Cain told the Inquiry that the UK government had been advised that "a suppression strategy wouldn't work, people could only sort of undergo … 12 weeks of this kind of … hard measures".131 Lee Cain 31 October 2023 23/3-6; see also INQ000273872_0034
112¶3.66. It was also likely to be politically unpalatable to have stringent restrictions in place for such a long time, given their social and economic downsides. It was therefore understood that, as Professor Vallance advised COBR on 12 March 2020, attempting to stop the spread of Covid-19 in the initial months of 2020 would simply postpone a wave of infections, potentially to a time when the NHS was already under strain from seasonal illnesses like influenza.132 INQ000056221_0005 para 2
¶3.67. The possibility of population immunity arising as a result of slowing rather than stopping the spread was seen as a welcome potential by-product of this approach.133 INQ000238826_0074 para 236; INQ000280628_0053 para 99; Boris Johnson 6 December 2023 110/15-20; INQ000048399_0003; INQ000102697_0019-0020 At the COBR meeting on 12 March 2020, Professor Vallance described:
" a good outcome being that by September 2020 herd [population] immunity would be established".134 INQ000056221_0005 para 2
¶3.68. At a 10 Downing Street press conference the same day, Professor Vallance explained that, in the context of the response during the delay phase:
" It's not possible to stop everybody getting it. And it's also actually not desirable because you want some immunity in the population. We need to have immunity to protect ourselves from this in the future."135 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/ live/cAE8-e5_EKY; INQ000231053_0002)
¶Professor Vallance made similar comments in the media on 13 March 2020 and estimated that 60% of the population would need to have some immunity to Covid-19 for population immunity to be achieved.136 INQ000064580_0003; INQ000231021_0002 He told the Inquiry that he had been trying to explain that "an increased level of immunity in the population was a by-product of the policy of 'flattening the curve'".137 INQ000238826_0074 para 236
¶3.69. It was not known in early 2020 whether a vaccine could be developed. The plan to slow the spread of the virus was premised on an assumption that imposing some restrictions to keep the spread of Covid-19 more manageable would offer the most likely exit strategy from the pandemic in the absence of effective treatments, a vaccine or scaled-up test and trace. It was thought that it would enable population immunity through natural infection to be built up and therefore reduce the risk of waves of infection occurring later in the year when the NHS might be under more strain from seasonal influenza. However, this was not guaranteed, since it was not known in March 2020 whether people could be infected more than once. The risk of reinfection and the mutation of the virus into new variants could have meant population immunity would not be achieved through infection.
113¶3.70. The intention for the response to Covid-19 during the delay phase was therefore to slow the spread of the virus, based on an assumption that population immunity was an important potential, if not guaranteed, consequence of adopting this approach.
¶3.71. However, some in the UK government did not appreciate that being infected with Covid-19 would not necessarily give rise to immunity from the virus subsequently.138 INQ000273841_0031 para 59; Edward Udny-Lister 7 November 2023 160/25-161/1-2; INQ000251645_0110 para 7.159 Professor Whitty told the Inquiry that, while population immunity was discussed by some at the centre of the UK government, he was "not certain that they had always fully understood it".139 INQ000251645_0110 para 7.159 For example, Ms MacNamara explained:
" [I]n March 2020 our working assumption was that getting immunity was a once‑and-done event, at least for the foreseeable future. There was no discussion I remember about the risk of being re-infected or that the virus might mutate so rapidly."140 INQ000273841_0031 para 59
¶Similarly, Lord Udny-Lister said there was a belief in the UK government that "the quicker we actually all caught it, the quicker we would have immunity from it".141 Edward Udny-Lister 7 November 2023 160/25-161/1-2
Objectives of the delay phase
¶3.72. The delay phase had two high-level objectives, which were implied in the Coronavirus: Action Plan:
-
¶
- Reduce pressure on the NHS by reducing the number of people infected with the virus at any one time and, therefore, the number of severe cases requiring hospital treatment. The approach sought to lower and delay the onset of the peak until the summer months, when it was assumed that the NHS would be less busy and under less pressure from seasonal illnesses such as influenza.142 Coronavirus: Action Plan: A Guide to What You Can Expect Across the UK, Department of Health and Social Care, 3 March 2020, pp10, 15, 18, paras 3.9, 4.26, 4.42 (https://assets.publishing.service.gov.uk/media/5e5e2e91e90e071110454391/Coronavirus_action_ plan_-_a_guide_to_what_you_can_expect_across_the_UK.pdf; INQ000182380); INQ000056221_0005 para 2; Boris Johnson 6 December 2023 110/13-15; 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/live/cAE8-e5_EKY; INQ000231053_0003); INQ000232901_0004 para 16
- Protect those who would be at most risk from serious illness and death, such as older people and people with certain pre-existing medical conditions, by shielding as the virus circulated among the wider population.143 Coronavirus: Action Plan: A Guide to What You Can Expect Across the UK, Department of Health and Social Care, 3 March 2020, p18, para 4.46 (https://assets.publishing.service.gov.uk/media/5e5e2e91e90e071110454391/Coronavirus_action_plan_-_a_guide_to_ what_you_can_expect_across_the_UK.pdf; INQ000182380); INQ000056221_0005 para 2; 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/live/cAE8-e5_EKY; INQ000231053_0002)
Restrictions to be implemented during the delay phase to achieve objectives
" population distancing strategies (such as school closures, encouraging greater home working, reducing the number of large scale gatherings)".146 Coronavirus: Action Plan: A Guide to What You Can Expect Across the UK, Department of Health and Social Care, 3 March 2020, p18, para 4.45 (https://assets.publishing.service.gov.uk/media/5e5e2e91e90e071110454391/Coronavirus_action_plan_-_a_guide_to_ what_you_can_expect_across_the_UK.pdf; INQ000182380)
¶3.75. Given the plan was only to slow the spread of the virus rather than to stop it, no mention was made in the Coronavirus: Action Plan of more stringent restrictions, such as a stay at home order or other forms of lockdown. However, it stated:
" [O]ur experts are considering what other actions will be most effective in slowing the spread of the virus in the UK, as more information about it emerges."147 Coronavirus: Action Plan: A Guide to What You Can Expect Across the UK, Department of Health and Social Care, 3 March 2020, pp14, 18, paras 4.25, 4.45 (https://assets.publishing.service.gov.uk/media/5e5e2e91e90e071110454391/Coronavirus_action_plan_- _a_guide_to_what_you_can_expect_across_the_UK.pdf; INQ000182380)
¶3.76. Indeed, the day before its publication, Professor Whitty had advised COBR that SAGE was preparing advice on options for social distancing.148 INQ000056217_0005 para 3 The plan for the response during the delay phase was therefore far from fully formed when the Coronavirus: Action Plan was published. Mr Hancock told the Inquiry that, on reflection, there were "not nearly as much" action points in the Coronavirus: Action Plan as he wished there had been.149 Matt Hancock 30 November 2023 138/1-2
The timing of implementation of restrictions during the delay phase
115¶3.78. However, prior to mid-March 2020, scientific advice was provided on the timing of the implementation of the restrictions during the delay phase. Professors Whitty and Vallance advised that the implementation of restrictions should be delayed so that they were in place during the peak of infections and for the shortest time necessary to reduce the strain on the NHS. For example, on 2 March 2020, Professor Whitty advised COBR: "The interventions to delay the spread of the virus must not be implemented too early in order to ensure maximum effectiveness."151 INQ000056217_0005 para 3
¶3.79. In March 2020, a number of UK government scientific advisers privately and publicly explained that restrictions should not be implemented too early in order to limit the period of time during which they were in place.152 Christopher Whitty 22 November 2023 26/20-23; INQ000255836_0022 paras 88-89; INQ000056219_0005 para 6; 'Watch again: Boris Johnson says government is moving towards "delay phase" of coronavirus', YouTube, 9 March 2020 (https://www.youtube.com/watch?v=Yc1alOEjDVA; INQ000223088_0004-0005); INQ000273807_0057-0058 para 7.65; 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/live/cAE8-e5_EKY; INQ000231053_0002-0004) It was critical to have high compliance with the restrictions over the peak, and scientific advisers made clear on a number of occasions that restrictions should not therefore be implemented too soon, due to the perceived risk of 'behavioural fatigue'.153 INQ000056219_0005 para 6; 'Watch again: Boris Johnson says government is moving towards "delay phase" of coronavirus', YouTube, 9 March 2020 (https://www.youtube.com/watch?v=Yc1alOEjDVA; INQ000223088_0004-0005); INQ000273807_0057- 0058 para 7.65 This was most clearly put by Professor Whitty at a 10 Downing Street conference on 12 March, when he said:
" [I]f people go too early, they become very fatigued. This is going to be a long haul. It is very important we do not start things in advance of need … an important part of the science on this is actually the behavioural science. What that shows is probably common sense to everybody … which is that people start off with the best of intentions, but enthusiasm at a certain point starts to flag … So we do need to do it at the last point which is reasonable so that people maintain their energy and enthusiasm to get through what will be quite difficult things to do."154 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/live/cAE8-e5_EKY; INQ000231053_0003-0004)
¶The impact of the notion of behavioural fatigue on the timing of the implementation of restrictions in the initial months of 2020 is discussed in detail in Chapter 4: Realisation and lockdown, in this volume.
¶3.80. At the time these comments were made, it was already clear from NHS modelling that, if the reasonable worst-case scenario did materialise, the NHS in England would be overwhelmed, even if the restrictions of self-isolation, household isolation and shielding were implemented.155 INQ000146571_0001
116¶3.81. On 13 March 2020, in light of comments made concerning the risk of behavioural fatigue, SAGE felt it necessary to assert that this notion was not an appropriate basis on which to delay the intervention of restrictions:
" There is no strong evidence for public compliance rates during a major emergency … Difficulty maintaining behaviours … should not be taken as a reason to delay implementation where that is indicated epidemiologically."156 INQ000236391_0003 paras 29-30; INQ000146572_0001
The trigger for moving from 'contain' to 'delay'
" The decision to step up the response from Contain to Delay and then Mitigate will be taken on advice from the UK's [Chief Medical Officers], taking into account the degree of sustained transmission and evident failure of measures in other countries to reduce spread."157 Coronavirus: Action Plan: A Guide to What You Can Expect Across the UK, Department of Health and Social Care, 3 March 2020, p17, para 4.36 (https://assets.publishing.service.gov.uk/media/5e5e2e91e90e071110454391/Coronavirus_action_plan_-_a_guide_to_ what_you_can_expect_across_the_UK.pdf; INQ000182380)
¶The UK Influenza Pandemic Preparedness Strategy 2011 contained a similar trigger of "evidence of sustained community transmission of the virus" for moving on from its initial response stage of 'detection'.158 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)
The Coronavirus: Action Plan
¶3.84. As outlined in Chapter 2: The emergence of Covid-19, in this volume, the Coronavirus: Action Plan was commissioned by Mr Hancock on 10 February 2020 as "a coronavirus version" of the UK Influenza Pandemic Preparedness Strategy 2011.159 INQ000106107; Matt Hancock 30 November 2023 111/17-18
117¶Professor Whitty described it as "the best account of policy planning undertaken in
¶February 2020".160 INQ000251645_0083 para 7.62
" At the time the Plan was written it seemed to me to be an accurate reflection of the assessments made by the people best placed to understand the data and respond to it."165 INQ000273747_0009 para 27
¶The Scottish Government anticipated that there might be a need for a "differential
¶Scottish approach", reflecting "potential differences" between Scotland and the rest of the UK, including "distinctive features" (such as its remote, rural and island communities), but ministers also recognised that "a consistent, simple message covering all of the UK would be preferable".166 INQ000238822_0002-0004 paras 12-15
¶3.86. It took more than three weeks to draft and publish the Coronavirus: Action Plan.167 Coronavirus: Action Plan: A Guide to What You Can Expect Across the UK, Department of Health and Social Care, 3 March 2020, p11, para 4.5 (https://assets.publishing.service.gov.uk/media/5e5e2e91e90e071110454391/Coronavirus_action_plan_-_a_guide_to_ what_you_can_expect_across_the_UK.pdf; INQ000182380) This was despite it being thought that the UK Influenza Pandemic Preparedness Strategy 2011 was sufficiently adaptable to deal with other respiratory diseases. As discussed in the Inquiry's Module 1 Report, its approach was described as "ready for flu, ready for anything".168 UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011, p15 (https://assets.publishing. service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708); see also 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)
¶3.87. Having taken too long to produce, the Coronavirus: Action Plan came too late and failed to reflect the spread of Covid-19 as known at the time of publication. When it was published, the UK was said still to be in the contain phase, but containment had effectively been lost. Professor Whitty told the Inquiry that "the contain stage of things was near or at its end pretty well at the point that this document hit the printing presses".169 Christopher Whitty 21 November 2023 198/20-23; see also Frank Atherton 4 March 2024 35/24-25; Vaughan Gething 11 March 2024 77/12-17 As was subsequently understood, there had also been "a huge influx from Spain, France and Italy over half term and beyond", which Professor
118¶Vallance acknowledged "meant that we probably had lost control".170 Patrick Vallance 20 November 2023 52/14-16 A study subsequently published on 11 June 2020 by the COVID-19 Genomics UK Consortium
¶(a UK-wide collaborative network for Covid-19 genomics research and training) showed that the introduction of Covid-19 to the UK following the end of the February school half-term holidays was highly significant.171 Report 8: 11th June 2020 – COVID-19 Genomics UK (COG-UK) Consortium, COVID-19 Genomics UK (COG-UK) Consortium, 12 June 2020 (https://webarchive.nationalarchives.gov.uk/ukgwa/20201203114610/https://www.cogconsortium.uk/news_item/ report-8-11th-june-2020-covid-19-genomics-uk-cog-uk-consortium; INQ000230987); INQ000238826_0195 para 594
¶3.88. Mr Cain told the Inquiry that the Coronavirus: Action Plan "had little detail and was clearly only useful as a communications device", commenting that it was a "strange document for people to be referring to as an actual government plan".172 INQ000252711_0007 para 30; Lee Cain 31 October 2023 16/10-12 Dr Warner also described it at the time as a "comms [communications] plan".173 INQ000269182_0018 para 62 He told the Inquiry that he had assumed there would be "a much more detailed internal document that addressed the complexity of the problem".174 INQ000269182_0018 para 62; INQ000195879 Ms MacNamara described the Coronavirus: Action Plan as:
119" an extraordinary document, given that so many of the assertions about how well prepared we were would turn out to be wrong only weeks later … much of what was in the document had not been adequately tested or just was not true for the circumstances we were in".175 INQ000273841_0016 para 30