The situation at the end of January 2020

¶2.66. By the end of January 2020, it was clear that a fatal respiratory disease – more severe and lethal than H1N1 influenza ('swine flu') – was spreading across the world, transmitted person to person and possibly asymptomatically. It had reached the UK. There was, as yet, no drug to alleviate the disease and no vaccine to prevent it.

¶2.67. Although the existing procedures for the identification and testing of high consequence infectious diseases had revealed the first two confirmed cases of Covid-19, test and trace capacity was still limited throughout the UK.¹⁷²¹⁷² INQ000061510_0003 para 8 Professor Whitty acknowledged:

¶" Scale-up was our great weakness in our response at the start of the pandemic;

we had significant scientific capability, but little scale-up capacity to meet the needs of an exponentially rising epidemic."¹⁷³¹⁷³ INQ000251645_0231 para 16.26

¶It is difficult to see, therefore, how the UK would be able to identify or contain a rapidly spreading disease.

¶2.68. The limited testing capacity, combined with a lack of adequate surveillance mechanisms, also meant that decision-makers did not appreciate the extent to which the virus was capable of spreading – and was indeed spreading – undetected.

¶2.69. This was compounded by uncertainty that lingered over the degree of asymptomatic transmission.¹⁷⁴¹⁷⁴ INQ000057492_0002 para 16; INQ000047820_0002-0004 paras 2.4-2.13 As Mr Johnson said, this uncertainty:

¶" bedevilled our handling of the virus, certainly in the early weeks, and probably caused us to underestimate the speed with which it was seeding in the UK".¹⁷⁵¹⁷⁵ INQ000255836_0011 para 30

¶His approach at this point was recorded in the Cabinet meeting minutes on 31 January 2020:

¶" [T]he tone of the Government should be reassurance, given the low mortality rate. People should not panic."¹⁷⁶¹⁷⁶ INQ000056125_0011

¶Mr Johnson further explained:

¶" Initially, we completely misunderstood asymptomatic transmission and,

as a result, it did not impact our decision making in relation to NPIs [non-pharmaceutical interventions]. However, by early April 2020 we did understand that Covid could be transmitted in the early stages of contracting the virus and we took that into account thereafter."¹⁷⁷¹⁷⁷ INQ000255836_0194 para 667

¶2.70. Mr Hancock told the Inquiry:

" [T]he scientific consensus, reflected in the global scientific advice from the WHO until April 2020, was that there was no asymptomatic transmission … despite anecdotal feedback from January 2020 that the virus could pass from people who showed no symptoms."¹⁷⁸¹⁷⁸ INQ000232194_0009-0010 para 37

¶Mr Hancock said that he "challenged the scientific advice on a number of occasions" but that he "could not simply over-rule this global scientific consensus on a lack of asymptomatic transmission".¹⁷⁹¹⁷⁹ INQ000232194_0010 paras 37, 39 With hindsight, he regretted not acting on the basis of asymptomatic transmission prior to April 2020.¹⁸⁰¹⁸⁰ INQ000273833_0008 para 32

¶2.71. Ms Sturgeon also said that there was a "significant degree of uncertainty in the advice being provided" in this period about the likely severity of the situation in the UK and the key characteristics of the virus.¹⁸¹¹⁸¹ INQ000339033_0056 para 149 She noted that the understanding about asymptomatic transmission – although reflective of scientific consensus – turned out to be "wrong".¹⁸²¹⁸² INQ000339033_0058 para 150 Professor McBride suggested that, in the absence of evidence, it would have been "premature" to assume that there was asymptomatic transmission.¹⁸³¹⁸³ Michael McBride 10 May 2024 69/9-10 He said:

" [A]t this stage, there was a high level of uncertainty, and I think it would have been not appropriate to proceed on the basis of what we think … And at this point in time, NERVTAG, SAGE were not saying that there is asymptomatic transmission. But we were alert to the fact that we needed to keep this under review to see if there was or there wasn't."¹⁸⁴¹⁸⁴ Michael McBride 10 May 2024 70/17-71/1

¶2.72. According to Mr Drakeford, "during January and February there was some limited and preliminary evidence which suggested the possibility of asymptomatic spread", but it was not "well-understood" until late April 2020.¹⁸⁵¹⁸⁵ INQ000371209_0027 para 83 Mr Swann told the Inquiry that "acceptance of asymptomatic transmission came about May of 2020".¹⁸⁶¹⁸⁶ Robin Swann 13 May 2024 179/20-21

¶2.73. However, as set out above, there were clear signs by late January 2020 that suggested asymptomatic transmission was taking place.¹⁸⁷¹⁸⁷ INQ000233747_0002; INQ000282744 Mr Hancock had been informed by a number of advisers, including the Chief Medical Officer for England, that there were indications that asymptomatic transmission was occurring in Europe. He himself opened a meeting on 27 January:

" by outlining his concern upon hearing the update from the Chinese government that the virus is transmissible when patients are asymptomatic".¹⁸⁸¹⁸⁸ INQ000106067_0001

¶On 28 January, Mr Hancock was further informed of:

" now credible evidence of asymptomatic transmission within Germany (resulting from the timings of the transmission)".¹⁸⁹¹⁸⁹ INQ000233747_0002

¶2.74. This, coupled with the discussion on the same date between the four Chief Medical Officers of the UK, in which it was noted that they should "assume it may be happening", ought to have led the four governments to adopt the default assumption that asymptomatic transmission was occurring and was a potentially significant factor in how the virus was spreading.¹⁹⁰¹⁹⁰ INQ000282744_0002-0003

¶2.75. Although there were difficulties caused by the lack of data and more precise knowledge of the characteristics of the disease, the absence of accurate data was not sufficient justification for the failures to prepare for a potentially significant health emergency. There was significant geographical spread beyond China, which gave a strong indication of sustained person-to-person transmission – one of Professor Whitty's three triggers. There was emerging evidence that asymptomatic transmission could be taking place. In the absence of scaled-up test and trace capacity, there were no practical means available in the UK to prevent the spread of the virus. The virus therefore posed a serious and immediate threat.

¶2.76. UK government scientific advisory bodies had been convened in good time. Professors Whitty and Vallance also took appropriate steps to warn the UK government that, if Covid-19 turned into a pandemic, there was likely to be very significant loss of life in the UK. Some officials in the UK government and devolved administrations had been warned that, if the reasonable worst-case scenario materialised, there was likely to be very significant loss of life, but action was limited. At meetings on 28 January and 4 February 2020, UK ministers were told – and clearly understood in some cases – that the UK was "looking at the risk of an epidemiological human catastrophe on a scale not seen in the UK for a century".¹⁹¹¹⁹¹ INQ000232194_0034-0035 para 142 However, the chances of that risk materialising were not sufficiently appreciated.

¶2.77. Mr Hancock said that he called Mr Johnson directly on at least four occasions during January 2020 to warn him of the risk and "to try and impress upon him my concerns as to the potential impact from the virus".¹⁹²¹⁹² INQ000232194_0027 para 107 He also said he was astonished that others did not seem interested.¹⁹³¹⁹³ Matt Hancock 30 November 2023 86/22-87/13 For his part, Mr Johnson stated that he "did not minimise the possibility that this virus could be dangerous" and asked Mr Hancock to keep him updated.¹⁹⁴¹⁹⁴ INQ000255836_0010 para 22 The emergence of a novel coronavirus was only "one of many issues crossing the Prime Minister's desk" in January 2020.¹⁹⁵¹⁹⁵ INQ000302484_0018 para 64 Lee Cain, Director of Communications at 10 Downing Street from July 2019 to November 2020, told the Inquiry that Covid-19:

¶" was a low priority at this time due to the uncertain nature of the threat combined

with reassurance from the Cabinet Office and Department for Health that 'pandemic planning' was robust if required … While Covid was monitored in Downing Street in January 2020 it was not considered as the most pressing issue … or even in the top five."¹⁹⁶¹⁹⁶ INQ000252711_0004 paras 16, 18

¶2.78. For their part, the devolved administrations failed to escalate consideration of the emerging crisis to their highest levels of government (Cabinets in Scotland and Wales and the Northern Ireland Executive Committee) with sufficient speed. It was only on 28 January 2020 that Humza Yousaf MSP, Cabinet Secretary for Justice in the Scottish Government from June 2018 to May 2021, suggested "significant alarm was raised in relation to the potential effect Covid-19 would have".¹⁹⁷¹⁹⁷ INQ000273956_0029 para 136; INQ000238707_0004-0005 Neither the Welsh Cabinet nor the recently reconstituted Northern Ireland Executive addressed Covid-19 during January 2020.¹⁹⁸¹⁹⁸ INQ000129852; INQ000371209_0025 para 77; INQ000255838_0005 para 17 Instead, in Wales, the Cabinet focus was primarily on arrangements for the UK's exit from the EU, budget concerns and adverse weather, with no Covid-19 cases reported in Wales. Mr Drakeford told the Inquiry that "at that point it is happening elsewhere".¹⁹⁹¹⁹⁹ Mark Drakeford 13 March 2024 46/19-24 However, given the warning sounded by Dr Atherton on 24 January 2020 and the clear signs of the virus's growing threat, the Welsh Government should have recognised the potential danger in late January 2020.

¶2.79. Although it was understandable that directing the response to the outbreak was not yet the absolute priority of the leaders of the four nations, there was insufficient attention paid to the emerging crisis at the highest levels of the government machinery. The multitude of meetings and papers failed to translate into immediate action.

¶2.80. It should also have been more quickly appreciated by all four governments – in light of the emerging knowledge about the virus's reproduction number, incubation period, severity and ability to transmit asymptomatically – that an approach based on the UK Influenza Pandemic Preparedness Strategy 2011 was flawed and reliance upon it was misplaced.²⁰⁰²⁰⁰ UK Influenza Pandemic Preparedness Strategy 2011, Department of Health, 10 November 2011 (https://assets.publishing.service.gov.uk/media/5a7c4767e5274a2041cf2ee3/dh_131040.pdf; INQ000022708) It was clear by the end of January 2020 that the UK was facing a virus with different characteristics from the one for which it had planned. The knowledge about the precise degree of difference might still have been evolving, but enough was known to indicate that plans would have to be revised, with a proper consideration of a centrally led, cross-government strategy and response, including the identification of potential interventions.