The move from 'contain' to 'delay' and self-isolation advice

¶3.154. On the morning of 12 March 2020, Mr Cummings messaged Mr Johnson, warning him:

" We got big problems coming. CABOFF [Cabinet Office] is terrifyingly shit, no plans, totally behind the pace … We must announce TODAY – not next week – 'if feel ill with cold/flu stay home' … overwhelming danger here is being late and the nhs implodes … not being a week early."³³⁶³³⁶ INQ000048313_0022-0023

¶3.155. On 12 March 2020, SPI-B produced a consensus statement that expressed concern about displacement activities if mass gatherings were cancelled.³³⁷³³⁷ INQ000214048_0002 However, it highlighted that the public expected mass gatherings to be banned in the UK – as they had been in other countries – and therefore advised that failing to ban them could risk the public viewing the government's actions:

" as incompetent or not in the public's best interests. It may also be taken as signifying that the situation is not expected to be severe for the UK. This could have knock-on implications for public attitudes to other recommendations made by Government."³³⁸³³⁸ INQ000214048_0001

¶3.156. That same day, the UK Chief Medical Officers raised the risk level to the UK from 'moderate' to 'high'.³³⁹³³⁹ 'COVID-19: Government announces moving out of contain phase and into delay', Department of Health and Social Care, 12 March 2020 (https://www.gov.uk/government/news/covid-19-government-announces-moving-out-of-contain-phase-and-into-delay; INQ000052485_0002) Professor Whitty explained that this was in response to the clear increase in transmission.³⁴⁰³⁴⁰ INQ000251645_0091 para 7.94

¶3.157. By 12 March 2020, containment had already failed.³⁴¹³⁴¹ INQ000061522_0003 para 5 The Chief Medical Officers, along with SAGE, should have advised that the four governments move to the delay phase much earlier – around the time the Coronavirus: Action Plan was published at the latest. The evidence indicates that a move was not advised earlier because scientific advisers were unaware of how widely seeded the virus was in the UK and how short the doubling time had become. However, there was also evidence that Professor Whitty did not wish the UK to be the first country to abandon containment and felt it was best to wait until the World Health Organization had accepted that Covid-19 was a pandemic and, therefore, there was an international consensus that containment was not achievable.³⁴²³⁴² Christopher Whitty 21 November 2023 207/4-208/4; INQ000236382_0002; Neil Ferguson 17 October 2023 158/6-160/1 This was the wrong approach, given the extent of the spread of the virus within the UK before the World Health Organization declared Covid-19 to be a pandemic on 11 March.

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¶3.158. A COBR meeting was convened on the afternoon of 12 March 2020.³⁴³³⁴³ INQ000056221 It was chaired by Mr Johnson and attended by Ms Foster and Ms O'Neill, Ms Sturgeon and Mr Drakeford, as well as their health ministers and Chief Medical Officers. Professor Vallance explained that there were an estimated 5,000 to 10,000 cases in the UK and that the UK was approximately four weeks behind Italy.³⁴⁴³⁴⁴ INQ000056221_0005 para 1 A paper prepared for the meeting explained that SAGE had considered a number of "possible social and behavioural interventions to delay the outbreak" (see Table 2).³⁴⁵³⁴⁵ INQ000056209_0001 Professor Vallance told COBR that the aim of implementing these interventions:

" was not to completely suppress the spread of the disease, not 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. Instead, Government interventions should seek to change the shape of the epicurve, ideally delaying the peak until summer when transmission may be lower (although they noted the scientific basis for this is uncertain) and flattening the peak so as not to completely swamp NHS resources."³⁴⁶³⁴⁶ INQ000056221_0005 para 2

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¶Table 2: Interventions considered by SAGE (presented by the Cabinet Secretariat to COBR on 12 March 2020)

Potential effectiveness in reducing total Degree of Potential Potential number of cases

¶Measure confidence Primary effectiveness effectiveness and deaths and/or in the objective in delaying in reducing (excluding excess combination effectiveness of the the peak of an the peak of an deaths caused by lack of measures SAGE advice of the measure measure outbreak outbreak of NHS capacity)

¶(1) Home Advised for Low Delay 2–3 weeks' Reduction in Modest impact (<5%) isolation of consideration confidence delay to peak peak symptomatic now incidence of cases maybe 20% (individuals (uncertainty stay at home) range at least

¶15–25%)

¶(2) Whole- Advised for Medium Delay 2–3 weeks' Reduction in Modest impact (<10%) household consideration confidence delay to peak peak isolation now incidence of (household maybe 25% stays at (uncertainty

home) range at least 20–30%)

¶(3) Most Advised for vulnerable consideration Currently being modelled by SAGE stay at home now

¶(effect of peak including incidence, those with reduction of chronic health c.20–35% in conditions deaths and being peak hospital modelled by bed demand

¶SAGE) (5) Closing May be High Delay No more than c.10–20% Modest (<5%) schools appropriate at confidence 3 weeks' delay reduction in

a later stage to peak and peak hospital possibly much demand with less closures of 8–13 weeks (if children have similar role in transmission as in pan flu)

in some up to 50–60% circumstances

¶(7) Stopping Not advised Very low Very little on Very little on Very little on its own large events confidence its own its own

¶Source: Based on INQ000056209_0003

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¶3.159. The Cabinet Secretariat recommended that COBR agree:

" to implement intervention 1 ([symptomatic] individuals staying at home) now; and interventions 3 and 4 (protection for the most vulnerable groups; and social distancing for the over 70s and those with chronic conditions) in 1–3 weeks' time".³⁴⁷³⁴⁷ INQ000056209_0002

¶However, even with self-isolation and household isolation being implemented, it was anticipated that, at the peak of the epidemic, demand for NHS beds would outstrip supply by 328,000 beds in England, 37,000 in Scotland and 24,000 in Wales.³⁴⁸³⁴⁸ INQ000056209_0006. No figures were provided for Northern Ireland.

¶3.160. Professor Vallance advised COBR that self-isolation for symptomatic people should be implemented and potentially household isolation.³⁴⁹³⁴⁹ INQ000056221_0005 para 3 He also said that SAGE felt there was a strong argument not to begin household isolation or shielding of vulnerable or elderly people immediately, as:

" [T]here was a risk of starting too early in the epicurve, with people's resilience subsequently flagging during the peak weeks when it is most important for them to isolate."³⁵⁰³⁵⁰ INQ000056221_0005 para 4

¶Professor Vallance also described "a good outcome being that by September 2020 herd immunity would be established".³⁵¹³⁵¹ INQ000056221_0005 para 2; see also INQ000273747_0014 para 37; INQ000280628_0053 para 99

¶3.161. A debate took place at COBR over the timing of interventions. Mr Hancock suggested that the implementation of self-isolation should be delayed until 16 March 2020, due to challenges in providing operational support for NHS 111, the non‑emergency NHS helpline.³⁵²³⁵² INQ000056221_0007 para 10

¶3.162. Mr Johnson echoed Professor Vallance's advice and stated that the timing of the implementation of the restrictions was critical, since:

" [T]here were downsides to implementing the interventions too early, but if applied too late the most vulnerable may be exposed to the virus during the peak. The timing of the interventions was therefore key to minimising the number of deaths and it was very important to communicate this to the public. Another objective of the interventions would be to minimise the gap in NHS capacity to respond to the outbreak during the peak weeks."³⁵³³⁵³ INQ000056221_0007 para 8

¶3.163. COBR decided that an announcement would be made that day (12 March 2020) advising those with mild Covid-19 symptoms to stay at home for seven days from 13 March, reflecting scientific advice about the duration.³⁵⁴³⁵⁴ INQ000056221_0008 para 14 This was to be advisory rather than legally enforceable since, as Mr Johnson explained, it was thought that advice would be enough and "it would have taken longer to enact the legislation".³⁵⁵³⁵⁵ INQ000255836_0036 para 149 It was agreed that COBR would revisit whether and when to implement household isolation the following week and that no school closures would be implemented.³⁵⁶³⁵⁶ INQ000056221_0010 paras 3, 6 Household isolation and shielding were to be communicated to the public shortly, with an indication that these policies would come in the next few weeks.³⁵⁷³⁵⁷ INQ000056221_0008 para 15; INQ000255836_0037 para 154; INQ000412903_0026 para 67

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¶3.164. Professor Vallance told COBR that it was still thought possible that delaying the peak would avoid swamping the NHS.³⁵⁸³⁵⁸ INQ000056221_0005 para 2 However, as discussed above, Professors Vallance and Whitty, the Department of Health and Social Care, and 10 Downing Street advisers were aware by this time that NHS modelling indicated a level of deaths and hospitalisations that would, in the absence of stringent interventions, be likely to overwhelm the NHS before the peak was reached in the reasonable worst-case scenario. This was not reflected in the COBR minutes, which stated only that:

" the NHS would not find this crisis easy to deal with and that there was still significant work to be done to increase its capacity to respond".³⁵⁹³⁵⁹ INQ000056221_0006

¶3.165. Mr Johnson told the Inquiry that, with hindsight, it was clear from the graphs in the paper presented to COBR that:

" [ W]e were at risk of some incoherence. The measures envisaged did not seem to lower the epicurve enough to stop the NHS from being overwhelmed."³⁶⁰³⁶⁰ INQ000255836_0036 para 150

¶3.166. The decision to advise people with mild Covid-19 symptoms to self-isolate was the first intervention to be implemented as part of the delay phase of the Coronavirus: Action Plan. In the Inquiry's view, this intervention was too little, too late.

¶3.167. COBR also discussed the issue of mass gatherings and decided to keep its policy regarding mass gatherings under review.³⁶¹³⁶¹ INQ000056221_0010 The Scottish Government explained that it was minded to advise against gatherings of more than 500 people to ensure emergency workers could prioritise the Covid-19 response.³⁶²³⁶² INQ000056221_0006 Following the COBR meeting, Ms Sturgeon publicly announced that all gatherings over 500 people in Scotland would be cancelled from 16 March 2020.³⁶³³⁶³ 'First Minister announces large events to be cancelled', Scottish Government, 12 March 2020 (https://www.gov.scot/news/first-minister-announces-large-events-to-be-cancelled; INQ000249326)

¶3.168. Mr Johnson told the Inquiry that the move from 'contain' to 'delay' was agreed at this COBR meeting by all four nations.³⁶⁴³⁶⁴ INQ000255836_0037 para 154; INQ000056221; INQ000421704_0040 para 94; INQ000391237_0048-0049 para 196; INQ000339033_0070 para 188 While this was not explicitly recorded in the minutes of the meeting, it was implicit in the decision taken by the UK government and devolved administrations to start implementing restrictions to slow the spread of the virus – beginning with self-isolation advice.³⁶⁵³⁶⁵ 'COVID-19: Government announces moving out of contain phase and into delay', Department of Health and Social Care, 12 March 2020 (https://www.gov.uk/government/news/covid-19-government-announces-moving-out-of-contain-phase-and-into-delay; INQ000052485) A Northern Ireland Office Situation Report (SitRep) produced on the evening of 12 March 2020 stated that "COBR (M) today took the decision to move from Contain to Delay" and a UK government press release indicated that the decision had been taken that day.³⁶⁶³⁶⁶ INQ000083097_0002; 'COVID-19: Government announces moving out of contain phase and into delay', Department of Health and Social Care, 12 March 2020 (https://www.gov.uk/government/news/covid-19-government-announces-moving-out-of-contain- phase-and-into-delay; INQ000052485)

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¶3.169. After the COBR meeting, Mr Johnson and Mr Hancock met with Sir Simon Stevens to discuss "how the NHS would best manage in this situation".³⁶⁷³⁶⁷ INQ000215035_0014 para 56; INQ000146636_0054 Sir Simon Stevens explained that NHS England planned to "free up 30k beds" by "stopping non-urgent operations" and "being more assertive on long stays".³⁶⁸³⁶⁸ INQ000146639_0001 NHS England slides were presented to Mr Johnson outlining the potential impact of Covid-19 on the NHS. Mr Shafi explained that these slides demonstrated:

" [I]n a reasonable worst-case scenario with over 80% infected and if no restrictions, with no mitigation, we would need 800,000 beds versus total capacity of 100,000 and the ability to free up 30,000. Even if … measures … were introduced, 200,000 beds would be required … in a more benign scenario with only 20% of the country infected, implementing all the measures … would still lead to a total demand of 100,000 beds at peak."³⁶⁹³⁶⁹ INQ000215035_0014 para 56

¶Mr Shafi told the Inquiry that the discussion between Mr Johnson and Sir Simon Stevens focused on how the NHS would best manage this situation and "the conversation did not turn to what the implication of this analysis was" for the government's plan of slowing the spread.³⁷⁰³⁷⁰ INQ000215035_0014 para 56

¶3.170. The self-isolation advice that COBR had agreed to implement was announced on the evening of 12 March 2020 by the UK government at a 10 Downing Street press conference.³⁷¹³⁷¹ 'COVID-19: Government announces moving out of contain phase and into delay', Department of Health and Social Care, 12 March 2020 (https://www.gov.uk/government/news/covid-19-government-announces-moving-out-of-contain-phase-and-into-delay; INQ000052485); INQ000255836_0038 para 159; 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/live/cAE8-e5_EKY; INQ000231053_0001)Show full note Mr Johnson explained that delaying the implementation of further restrictions was thought to be necessary: "We have to deploy these at the right time to maximise their effect."³⁷²³⁷² 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/live/cAE8-e5_EKY; INQ000231053_0001)

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¶3.171. Mr Johnson informed the public that the delay phase would now commence and that, from 13 March 2020, people with coronavirus symptoms would be advised to self-isolate at home for at least seven days.³⁷³³⁷³ 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/ live/cAE8-e5_EKY; INQ000231053_0001); 'Prime Minister's statement on coronavirus (COVID-19): 12 March 2020', Prime Minister's Office and Boris Johnson, 12 March 2020 (https://www.gov.uk/government/speeches/pm-statement-on-coronavirus-12-march-2020; INQ000086751_0002-0003); INQ000255836_0038 para 159Show full note He explained:

" [ W]e have a clear plan that we are now working through. We're now getting on to the next phase in that plan because this is now not just an attempt to contain the disease as far as possible, but to delay its spread and thereby minimise the suffering … From tomorrow, if you have coronavirus symptoms, however mild, either a new continuous cough or a high temperature, then you should stay at home for at least seven days to protect others and help slow the spread of the disease."³⁷⁴³⁷⁴ 'Prime Minister's statement on coronavirus (COVID-19): 12 March 2020', Prime Minister's Office and Boris Johnson, 12 March 2020 (https://www.gov.uk/government/speeches/pm-statement-on-coronavirus-12-march-2020; INQ000086751_0002-0003)

¶Mr Johnson explained that it was likely in the coming weeks that it would be necessary to go further and implement household isolation, so that "if someone in a household has those symptoms, we will be asking everyone in that household to stay at home".³⁷⁵³⁷⁵ 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/live/cAE8-e5_EKY; INQ000231053_0001) Household isolation was ultimately introduced on 16 March 2020.

¶3.172. Professor David Halpern, Chief Executive of the Behavioural Insights Team (formerly known as the 'Nudge Unit') from 2014, sent an email to Mr Hancock, Sir Christopher Wormald, Professors Vallance and Whitty, and others, expressing his concern at the limitations of SAGE modelling.³⁷⁶³⁷⁶ INQ000129046 He recommended that there should be concrete advice on general social distancing. Professor Halpern told the Inquiry that he was "puzzled as to why SAGE was not recommending stronger action".³⁷⁷³⁷⁷ INQ000188738_0015 para 70

¶3.173. Professor Edmunds was also alarmed by the lack of urgency. On 12 March 2020, Sir Jeremy Farrar, Director of the Wellcome Trust from October 2013 to February 2023, asked Professors Edmunds and Ferguson whether they were "comfortable with the plans UKG [UK government] have got in place, the pace of actions and the changes they are making".³⁷⁸³⁷⁸ INQ000212037_0002 Professor Edmunds said that he was not:

" 1. The data are crap and hopelessly out of date, so we have little situational awareness. The daily figures are a joke and the guestimate of 5–10,000 cases is probably too low.

The measures just announced will do very little. Not quite sure just how

¶many cases will escape, but I suspect a fair few.

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We will have to do a lot more to manage this epidemic. The current plans

¶will overwhelm the NHS almost straight away. We need much more stringent control measures if we want to slow it down. Not necessarily now, but soon. Very soon.

There is an obsession with not getting an autumn / winter epidemic later

¶this year. This seems to be the tail wagging the dog. We are going to get a massive epidemic in the summer with hundreds of thousands of deaths."³⁷⁹³⁷⁹ INQ000212037_0001