It was pretty inevitable that the first period I would look at in the SAGE minutes was all around the crucial weeks in March. I wont attempt to discuss everything properly in one go, I will just start by zooming in on my favourite subject of the botched timing, the orthodox approach, and the '4 weeks behind Italy' crap.
Well from what I've read so far, a lot of the stuff that came out of Vallances mouth, especially in and around the March 9th and March 12th press conferences was a reasonable representation of quite large chunks of the SAFE stuff that ended up recorded in the minutes. Unfortunately for all concerned, this involved some of the most obviously wrong stuff that contributed to the failures in the response of this country to the pandemic.
For example the '4 weeks behind Italy' stuff Vallance drove me crazy by going on about, was actually even worse:
March 10th:
https://assets.publishing.service.g..._meeting_on_Wuhan_Coronavirus__Covid-19__.pdf
The UK is considered to be 4-5 weeks behind Italy but on a similar curve (6-8 weeks behind if interventions are applied).
There are plenty of other signs of atrocious timing and being too late with things, but I'm not trying to do a thorough job on this right now. So I'll just give one example that may relate to some of the reasons why they botched the 'how far behind Italy' estimate by a baffling degree.
It was agreed that PHE and SPI-M should discuss how to make surveillance data more useful for modelling purposes (e.g. providing case location data).
And this table provides some indications about the limitations of their ambitions and the sense of timing they were still going with on March 10th, before the u-turn.
Anyway we already know this position didnt last much longer. Lets have a quick look at how their sense of timing was doing just 3 days later at their next meeting.
S0383_Fifteenth_SAGE_meeting_on_Wuhan_Coronavirus__Covid-19__.pdf
There are probably more cases in the UK than SAGE previously expected at this point, and we may be further ahead on the epidemic curve, but the UK remains on broadly the same epidemic trajectory. The change in numbers is due to the 5-7 day lag phase in data availability for modelling.
These particular minutes also cover another topic that I know is generating interest:
SAGE was unanimous that measures seeking to completely suppress spread of Covid- 19 will cause a second peak. SAGE advises that it is a near certainty that countries such as China, where heavy suppression is underway, will experience a second peak once measures are relaxed.
I tend to fit this into my old theory about the orthodox approach dying during that week, and some lag in the realisation that actually various previously unthinkable things now looked like the only option and experts invovled needed to shake up some of their ideas.
Even by March 16th when everything is actually in u-turn, there are still some areas where they are plodding along and getting it wrong. eg the doubling rate:
- London has the greatest proportion of the UK outbreak. It is possible that London has both community and nosocomial transmission (i.e. in hospitals).
- It is possible that there are 5,000-10,000 new cases per day in the UK (great uncertainty around this estimate).
- UK cases may be doubling in number every 5-6 days.
Elsewhere in that document there are some clues that suggest that just like it looked to the public on this week, the government were still pissing around wondering if they could delay school closures or tie them in to easter holidays in some way. SAGE had been pretty full on anti-school closures up to this stage but were now being asked to explore various things on that front.
In other regards the obvious u-turn and realisation that the original plans timing was also totally unsuitable were on full display:
- On the basis of accumulating data, including on NHS critical care capacity, the advice from SAGE has changed regarding the speed of implementation of additional interventions.
- SAGE advises that there is clear evidence to support additional social distancing measures be introduced as soon as possible.
- These additional measures will need to be accompanied by a significant increase in testing and the availability of near real-time data flows to understand their impacts.
- SAGE will further review at its next meeting whether, in the light of new data, school closures may also be required to prevent NHS capacity being exceeded.
On March 18th comes a modification to the 'how many weeks behind Italy' stuff, and their old stance on schools is also history:
Seventeenth SAGE meeting on COVID-19 - 18 March 2020
- Based on limited available evidence, SAGE considers that the UK is 2 to 4 weeks behind Italy in terms of the epidemic curve. The consensus is that growth of the UK epidemic is tracking at the same rate as in other countries.
- SAGE advises that available evidence now supports implementing school closures on a national level as soon as practicable to prevent NHS intensive care capacity being exceeded.
- There are 1,950 cases in the UK (17/03 at 14:00), with 87 intensive care cases, of which 62 are in London. Testing capacity has reached 6,084 daily, with a goal to reach 25,000 tests as soon as possible.
- The UK is following broadly the same exponential growth rate of cases as Italy, and there is consistency with patterns in other countries.
- There is uncertainty on our exact position, but the consensus view is that we are 2-4 weeks behind the epidemic curve in Italy.
- Assuming a doubling time of around 5-7 days continues to be reasonable, but this is before any of the measures brought in have had an effect; these measures are likely to slow the doubling time even if there is still an exponential curve.
- Modelling suggests that, without mitigation, London could reach Covid-19-related intensive care capacity by early April.
By March 23rd more corrections to their earlier estimates can be seen:
8. The accumulation of cases over the previous two weeks suggests the reproduction number is slightly higher than previously reported. The science suggests this is now around 2.6-2.8. The doubling time for ICU patients is estimated to be 3-4 days.
By March 26th they said this about the doubling time:
SAGE 19 minutes: Coronavirus (COVID-19) response, 26 March 2020
12. The data suggest a 3.3 day doubling time in hospitals.
And there were finally signs by then that they were actually getting a clue about the timing of some things to expect in future:
32. Assuming good compliance, the epidemic peak in the UK can be expected in April - around 2 weeks after all interventions came into effect.