The situation at the end of July 2021

The situation at the end of July 2021

¶8.57. By the end of July, an estimated 1 in 75 people in England had Covid-19. In Scotland, this figure stood at 1 in 120, in Wales it was 1 in 230, and in Northern Ireland it was 1 in 55.¹⁶¹¹⁶¹ Coronavirus (COVID-19) Infection Survey (Positivity Estimates): 25 to 31 July 2021, Welsh Government, 6 August 2021 (https://www.gov.wales/coronavirus-covid-19-infection-survey-positivity-estimates-25-31-july-2021-html; INQ000548011) By the start of August 2021, 72% of adults aged 18 and over had received two doses of the vaccine in England, Scotland and Northern Ireland.¹⁶²¹⁶² INQ000330424; INQ000065597_0011-0012 para 35 By 7 August, in Wales, 81% of people aged 16 and over were fully vaccinated.¹⁶³¹⁶³ INQ000066234

¶8.58. There was an openness across the four governments throughout this time to accept greater risk and manage the consequent increase in cases through less stringent restrictions. This high-prevalence strategy brought with it enhanced risks of variants that escaped natural or vaccine immunity and increased infections, hospitalisations and deaths, albeit tempered by the vaccine's impact on severity. The Inquiry saw no evidence to suggest that any of the governments had explicitly agreed a tolerable level of infection and deaths, but such calculations are inherent to the pursuit of a high-prevalence strategy.

¶8.59. However, by this time, the public across the UK had been under some form of restrictions for over a year. The UK government and devolved administrations were attempting to balance the risk of emerging variants with the desire to return 'normal' life to the public and the substantial economic and social harms caused by the restrictions.

¶8.60. The emergence of the Delta variant, with increased transmissibility, was a significant public health threat and necessitated a reappraisal of the timetable for relaxing restrictions during the summer of 2021. To allow for further vaccine uptake and consequent protection from serious illness or death, the UK government and devolved administrations made changes to their initial plans by delaying the relaxation of measures. The scientific advice on the benefits of such a delay was clear and the governments sensibly heeded that advice. This was appropriate – the risks were not worth taking for the sake of a few weeks. It inevitably prevented some deaths.

¶8.61. However, while the UK government heeded the advice to delay the relaxation of measures, it chose not to follow the additional scientific advice with regard to maintaining baseline measures. This included even those measures that were relatively modest. Instead, it relied on communications. Throughout this period, Professors Whitty and Vallance:

" had to make the point repeatedly that 'we were not there yet', and that the prospect of future population immunity did not mean that all of the brakes could be rapidly released".¹⁶⁴¹⁶⁴ INQ000238826_0144-0145 para 438

¶8.62. The tensions for the UK government were acute. However, the consequence of these decisions meant that the autumn and winter challenges, including any resurgence, would be set against a starting point of high levels of infections and hospitalisations. Ministers were advised that a very rapid return to normal behaviour could lead to a peak in hospitalisations similar to, or possibly higher than, previous peaks. This was a known risk and, by its decisions, one that the UK government was willing to take. It was a reasonable approach in light of the competing economic and social concerns and the comparatively low number of deaths.

¶8.63. There was, however, limited long-term planning, with no overarching strategic plan, aims or objectives, or proper consideration as to the potential impact of this approach. A plan for the autumn and winter of 2021 was not prepared by the UK government until September 2021. Had an active decision been taken on the tolerable level of infections and deaths, or a broad aim identified, it would have been significantly easier to make contingency plans.

¶8.64. Professors McBride and Young had advised the Northern Ireland Executive of the need for an incremental approach to the relaxation of restrictions and of significant uncertainties inherent in modelling.¹⁶⁵¹⁶⁵ INQ000207216_0004 para 13 The Executive Committee had also been advised that sufficient data and analysis would not be available until the end of July 2021.¹⁶⁶¹⁶⁶ INQ000065680_0002 para 5 Nevertheless, on a number of occasions between May and July 2021, the Executive Committee decided to relax restrictions despite contrary advice from the Department of Health (Northern Ireland).¹⁶⁷¹⁶⁷ INQ000207218_0009; INQ000357301_0005; INQ000048534_0002; INQ000212984_0002 para 5; INQ000048536; INQ000357302_0001; INQ000065680_0002, 0005; INQ000236737; INQ000065584_0002 para 4 While, of course, it was appropriate for the Executive Committee to take into account a wider set of considerations, such as economic and social impacts, it was clear from the advice it had been given that the relaxation of restrictions – in the absence of sufficient data to permit analysis of the direct health impacts – was fraught with risk.

¶8.65. On 1 May 2021, Scotland had only 3 cases per 100,000 of the population, which was fewer than both England and Northern Ireland.¹⁶⁸¹⁶⁸ INQ000591920 However, between 14 May and 9 July, Scotland had the highest incidence of Covid-19 in the UK, peaking at 61 cases per 100,000 of the population on 3 July. Around this time, World Health Organization figures placed Scotland as one of the top Covid-19 hotspots in Europe.¹⁶⁹¹⁶⁹ 'Covid: Scotland tops Europe hotspot chart', BBC News, 5 July 2021 (https://www.bbc.co.uk/news/uk-scotland-57712737; INQ000357759) By 31 July, the number of cases had decreased to 21 cases per 100,000 of the population, which was comparable with Wales and significantly lower than England and Northern Ireland. The number of deaths in Scotland remained stable until around 15 July, at which point the daily deaths from Covid-19 doubled to around seven or eight each day.¹⁷⁰¹⁷⁰ INQ000624817 Professor Jason Leitch, National Clinical Director and Co-Director of the Directorate for Healthcare Quality and Improvement in the Scottish Government from January 2015, attributed this spike in positive cases in Scotland to a lack of "natural immunity" (immunity through prior infection) in the population.¹⁷¹¹⁷¹ 'Covid: Scotland tops Europe hotspot chart', BBC News, 5 July 2021 (https://www.bbc.co.uk/news/uk-scotland-57712737; INQ000357759_0003) Similarly, at its meeting on 13 July, the Scottish Cabinet noted that relatively high figures for Scotland compared with the rest of the UK were thought to reflect that Scotland had been "behind and below" infection levels during the previous two waves but now appeared to be "above and ahead" of the rest of the UK in terms of the spread of the far more transmissible Delta variant.¹⁷²¹⁷² INQ000214642_0003 para 11

¶8.66. Despite the significant increase of cases in Scotland from the middle of May 2021, the Scottish Government continued with the planned relaxation of restrictions, but with some modifications. The Scottish Government's approach, based on advice, was to ease restrictions "at a careful and gradual pace, in order to minimise demands on the NHS – both now and in expectation of autumn/winter pressures".¹⁷³¹⁷³ INQ000214642_0003 para 14 The Scottish Government was less cautious at this time because of a desire "to move away from Government direction to a point where people make decisions themselves" and concerns about "losing the dressing room" if stricter measures were imposed.¹⁷⁴¹⁷⁴ INQ000233258_0005; INQ000334792_0006 Such an approach was reasonable in light of the need to balance the other economic and societal harms caused by the restrictions and the fact that prevalence of the virus was higher among younger people. This meant that deaths remained relatively low, despite the increasing cases.

¶8.67. The Welsh Government agreed indicative dates to remove restrictions, but at various points it paused to await further information about the new variant and to allow greater vaccine uptake before further easing restrictions, including delaying the full move to Alert Level 1. This was also a reasonable approach in light of uncertainty and, at this stage in the pandemic, each government was entitled to weigh up the competing harms within its own nation. Wales did not see a sharp increase in death rates throughout July 2021. Pressures on the NHS and death rates remained significantly lower than in previous waves. In those circumstances, by 7 August 2021, it was reasonable for the Welsh Government to conclude that a move to Alert Level 0 was appropriate, having received advice that direct harm from infections was beginning to be outweighed by the other harms caused by restrictions and that vaccines had weakened the link between infection and severe illness.