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UK Inquiry Module 1: Resilience and preparedness

elbows

Well-Known Member
This is a thread for any detail that comes up in this module of the UK inquiry that people want to cover.

I am watching todays opening statements and will try to talk about a few highly specific details each day rather than provide commentary on the whole thing.

This module covers stuff within the timescale of the previous 2009 pandemic and the very first Covid situation report that the World Health Organisation published on January 21st 2020.

(The WHO report that they've chosen as a timescale endpoint for this module is here: https://www.who.int/docs/default-so...ation-reports/20200121-sitrep-1-2019-ncov.pdf )
 
Details of Exercise Cygnus are going be interesting.

What I don't get is, Theresa May, with everything Brexit related she had to deal with, sanctioned the exercise in the first place
 
A chunk of this module will look at the various structures of emergency etc planning and response. I probably wont be getting into much of the detail about that very often in the coming 6 weeks, because there is a big web of structures and tedious bureaucratic stuff that stretches all over the place. They do seem to have already highlighted that the structures left gaps when it came to people in central government, as opposed to at the local level, actually having formal responsibilities and duties in relation to various aspects of emergency situation management, and I might dwell on those a bit when they come up in detail.

If anyone remembers my areas of special interest and rants early in the pandemic, you wont be surprised to know that I will be paying special attention to stuff involving the orthodox approach in this country, areas where unsafe claims are made about how much hindsight was required, and any excuses that are based on claims about the nature of influenza pandemics compared to other sorts of pandemics. Already I have found cause to moan about something Hugo Keith said about influenza in his opening statement today, but I will wait till I can quote the transcript before describing my complaint.

The question of whether Brexit preparations distracted from improvements to general pandemic preparedness is going to be discussed in this module.

There is going to be some focus on whether the UKs plans just dealt with the practicalities of responding to a reasonable worst case scenario, rather than proactively trying to make the pandemic less severe.

The Welsh bereaved families group are not happy with the quality of evidence submitted by the Welsh government and the likes of Drakeford for this module, especially given that Wales isnt getting its own inquiry.
 
Sections of the media are already showing interest in opening comments made today that the government didnt appear to have considered lockdowns and their consequences very much at all. But this fact should be no surprise - this module is looking specifically at the longer term planning before Jan 21st 2020 and its bloody obvious that lockdowns/strong social distancing were in no way part of the orthodox approach to pandemics in this country. Such measures were considered unthinkable by the establishment until shortly before they ended up doing them.

For example Hugh Pym of the BBC has today said:

And, intriguingly, the inquiry KC added that there seemed to have been very little thought about a national lockdown and a failure to think through the consequences for education and the economy.

It will be an interesting subject to explore, but it should not really be intriguing or surprising that the theme got a mention today. So watch out for media attempts to distort this theme to match their own agendas: For example this module is not dealing with how much thought the government may have given to the consequences of these measures once they were actually on the table, since that was only possible once the old orthodox approach collapsed, which didnt happen till mid March 2020, long after the scope of module 1 ends. Nor were todays opening statements only referring to the failure to consider the negative consequences lockdowns, they are also talking about the fact there was no consideration in the pandemic planning for lockdowns being an option full stop.
 
What I don't get is, Theresa May, with everything Brexit related she had to deal with, sanctioned the exercise in the first place

The bureaucratic system is quite capable of coming up with these things and a timetable for them without the PM having to come up with them on their own. There were other exercises in the same time period too.

What our system wasnt very good at was actually acting on the findings that these sorts of exercises produced. They were box ticking exercises, even when some of the boxes may as well have been labelled 'in deep shit if this stuff ever happens for real'.
 
The UK bereaved families representative, in their opening statement, noted that the UK national risk assessment managed to come up with assumptions that there could be 750,000 deaths in reasonable worst case planning for an influenza pandemic, but made use of much lower figures in the 100,000-200,000 deaths range for pandemics involving other unknown diseases. So some dodgy assumptions in this area of planning are going to get looked at.

The hideous effects of austerity is another theme thats come up today.

And judging by the BMA reps opening remarks, aspects of the disgraceful PPE situation will be another focus of this module. Including some 'convenient' but dodgy assumptions made in regards aerosol transmission, shit that allowed authorities to recommend a much lower standard of masks for certain scenarios. I do hope a broader picture of planning details being fudged via believing what it was convenient to believe is allowed to emerge during this and other modules.
 
The BBC went for the lockdown thing in its sensational headline, skewed towards the impact rather than the possibility of needing to plan to have one at all, but at least later on they did bother to quote the relevant part of the statement in full. So I can just quote their article rather than have to look at the transcript myself:


Mr Keith, counsel to the inquiry, said UK was "taken by surprise" over "significant aspects" of the pandemic, including lockdowns.

"Extraordinary though it may seem, given that it's a word that's forever seared in the nation's consciousness, there was very little debate pre-pandemic of whether a lockdown might prove to be necessary in the event of a runaway virus, let alone how a lockdown could be avoided.

"Very little thought was given to how, if it proved to be necessary, how something as complex, difficult and damaging as a national lockdown could be put in place at all.

"Equally, there appears to have been a failure to think through the potentially massive impact on education and on the economy."
 
The bureaucratic system is quite capable of coming up with these things and a timetable for them without the PM having to come up with them on their own. There were other exercises in the same time period too.

What our system wasnt very good at was actually acting on the findings that these sorts of exercises produced. They were box ticking exercises, even when some of the boxes may as well have been labelled 'in deep shit if this stuff ever happens for real'.
It would have been quite hard to act on cygnus from my understanding
 
The last of the core participants opening statements are currently taking place.

In SAGEs opening statement they were sure to point out that thewy werent the only source of science advice to UK government. That they werent in charge of policy. And that they received a lot of attention (in the media etc) because unlike some others, they made their stuff public. They also made reference to the need to have decent, timely data, which is not surprising given that some of their early mistakes, including when it came to pandemic timing assessments were due to poor or laggy data.
 
This was the thing about flu that the lead counsel for the inquiry said in his opening statement yesterday, that I mentioned I wasnt impressed by. I have no problem with the first sentence, and am including it only for context, since this context adds danger to the faulty assumptions about the extent to which influenza manifests in a symptomatic way.

So it's clear that the system had not adequately foreseen and prepared for the need for mass testing in the event of a non-influenza pandemic.

For a flu pandemic, of course, you're most likely to show symptoms. You know you have a bug. You go home, possibly to bed, and you try not to pass it on, and tests aren't needed.

Thats from the day 1 transcript, page 12:


Attitudes and faulty beliefs like that in regards flu are one of the reasons we didnt have a decent mass diagnostics testing system in this country in the first place, and the lack of that stuff is one of the problems this module is bound to highlight.

In fact if you search for asymptomatic influenza on google etc you will not find a shortage of sources that totally contradict the assumption of that statement. Just to offer one example:

But can the flu be asymptomatic? Research points to a resounding yes. Quite a large portion of people won’t experience any symptoms – one out of every three people could be asymptomatic. The lack of symptoms in certain people could be due to various reasons, such as pre-existing partial immunity. Some individuals might even have an immune system response that fights off the virus before symptoms even have a chance to show up.

In a study from The Lancet Respiratory Medicine, seasonal or pandemic influenza is asymptomatic in most people with confirmed infection. Roughly 20% of the people who hadn’t received a flu vaccine had evidence of influenza infection, but up to 75% of the infected were asymptomatic. The proportions did not vary significantly between seasonal and pandemic influenza.


We dont have a tidy scientific consensus about the role of asymptomatic flu cases in driving epidemics and pandemics, and other parts of that article make mention of that., but that does not excuse the tendency to make unsafe assumptions.

Going back a long way I have expressed the expectation that some fallacies about influenza would be used as excuses for why our planning and response to this covid pandemic was inadequate, why we needed the benefit of hindsight to properly deal with some aspects of covid, etc. So I am bound to be on the lookout for such things rearing their ugly head at this inquiry.
 
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The evidence has begun.

This included a slide the inquiry prepared itself about past pandemics and notable epidemics. Note the last column which rather blows any bullshit that seeks to downplay the possibility or expectations of asymptomatic infections in pandemics in general out of the water.

The lead counsel was occasionally sloppy with language when asking witnesses questions relating to this chart, eg describing some of these events that were not actually pandemics as pandemics rather than epidemics.

Screenshot 2023-06-14 at 12.30.17.jpg
 
Thank you elbows for this thread. You did sterling work during the pandemic, sure you'll do the same here. Can't help thinking it's a thread where Badgers input would have been really useful too tho

I think of him whenever there is a revelation of failure, since he was fond of throwing the phrase 'world beating' back in their face on those occasions. I'd be happy if others here took on that role.
 
The Welsh bereaved families group are not happy with the quality of evidence submitted by the Welsh government and the likes of Drakeford for this module, especially given that Wales isnt getting its own inquiry.

Yeah, the same Drakeford who either helped produce, or at the very least gave the nod to, the 'Back to school' 50 page document that gave less than one line to air conditioning 'open a window'. put mask wearing at the bottom of the list of priorities 'there's no evidence they work and staff arriving in masks must remove them before entering school grounds', but gave 3 pages to what was the correct mark to put into the register for kids who didn't come in because of Covid.
 
Yeah, the same Drakeford who either helped produce, or at the very least gave the nod to, the 'Back to school' 50 page document that gave less than one line to air conditioning 'open a window'. put mask wearing at the bottom of the list of priorities 'there's no evidence they work and staff arriving in masks must remove them before entering school grounds', but gave 3 pages to what was the correct mark to put into the register for kids who didn't come in because of Covid.

I will admit to a distinct concern that the DE's will - in the public/political sphere - get a free pass simply because they weren't Johnson and his band of Coke Fiends.
 
I became tired during this afternoons evidence session and the lead counsels inability to say the word surveillance really started to get on my nerves. He pretty much says surveyance every single time.

He also revisited the asymptomatic thing when questioning the first witnesses in a way that caused me to start shouting 'look at your own chart!' (the one I posted earlier). Thankfully the witnesses response at least corrected the faulty assertion:

MR KEITH: So flu, influenza, in the main is symptomatic, is it not? You know that you've got flu, and you therefore know that you might have to take a step to isolate yourself and go home or go to bed and stop it being passed on?

PROFESSOR WHITWORTH: Mostly. But as we've discussed, there was a swine flu epidemic where we had very large numbers of cases and there were many people who didn't know that they were infected.

MR KEITH: So in fact if you -- even if you were to focus on an influenza pandemic, to the exclusion of all other pandemics, you would necessarily have to prepare for both asymptomatic and symptomatic versions of that pandemic?

PROFESSOR WHITWORTH: Indeed, yes.

From pages 106 and 107 of todays transcript: https://covid19.public-inquiry.uk/w...44/C-19-Inquiry-14-June-23-Module-1-Day-2.pdf
 
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If I was able to be of some use to some people durting the early months of the pandemic, one of the reasons was that I was aware of the nature of our traditional pandemic plans, their limited ambitions, and how this made a mockery of certain assurances that people were being given, especially during February 2020.

So I was very pleased to see the following come up today when the representative of UK bereaved families had an opportunity to ask the witnesses some questions in the final part of todays evidence session:

MR WEATHERBY: Now, finally on this point, you mentioned the UK pandemic flu plan, which was based on the 2011 plan. Within that, there's an acceptance with flu that measures to stop the transmission of flu once the dangerous pathogen had emerged would almost certainly fail. So there was a fatalistic approach to flu. You've mentioned that having a plan is better than not having a plan for diseases such as Covid that emerge, unknown diseases that emerge. Isn't that a problem where the plan is based on not having an approach to slowing the transmission of it?

PROFESSOR WHITWORTH: I think it is, and I think that in future it would be good to have not just a pandemic flu plan but one that is more generic for respiratory infections that takes into account different incubation periods.

The reason why there is that fatalistic attitude towards influenza is that when you've got an incubation period of just one to three days, by the time you're aware that the disease is in your community, it's everywhere and it's too late to act. That isn't the case if you've got a longer incubation period, as we did with Covid, which meant that it is possible to implement more of a plan to control transmission.

MR WEATHERBY: So the plan going forward must have a recognition that you may be able to slow transmission?

PROFESSOR WHITWORTH: I think now we've had three experiences of Covid epidemics, we've got more information to develop a more generic Covid type of plan for the future. I think that was harder when we'd just
got the two rather divergent approaches.

MR WEATHERBY: Yes, although I think we'd agreed earlier that the Asian countries had kind of got the message about the transmission point.

From pages 173 and 174 and of todays transcript (already linked to in previous post)
 
This morning the other human coronaviruses have come up, the ones that cause 'common colds'. Concepts such as population immunity were discussed, whereby a disease that originally caused severe disease in humans would eventually have a much milder impact for most people via the populations immune systems learning to respond more effectively to infection from the virus. This population immunity was differentiated from herd immunity in that herd immunity was described as involving an even higher level of protection that could prevent transmission and thus get in the way of the virus achieving endemic status. It was pointed out that we dont have herd immunity to the current pandemic virus because neither the vaccines or prior infections have resulted in immune responses that thwart transmission.

OC43, which is thought to have come from cattle, is one of those. The hypothesis that the 1889-1890 pandemic may have been caused by this virus was discussed, along with the use of a molecular clock technique to estimate timing of the original emergence of this virus in humans. This is a subject that has been discussed a few times on this forum in the past. It was then mentioned that one study used molecular clock analysis on this pandemics coronavirus and they came up with October 2019 as a possible date of crossover from animals to humans.

The 2003 SARS outbreak was discussed, including a vector of transmission that is assumed to have occurred after the original transmission from animals to a limited number of humans, that of health workers to a wider population via infection of their families.

Reasons why the original SARS was contained rather than becoming a large pandemic were discussed, including it being harder to transmit due to being a deep lung infection, lack of early asymptomatic transmission, and the willingness of countries to limit travel to the locations of most severe outbreaks.
 
Other subjects that came up with this mornings witness (professor David Heymann) included:

The main two hypothesis in regards the origins of the virus - the witness sensibly takes the stance of not having enough evidence to judge which of them was the actual cause.

A main vector for MERS spread being nosocomial (in healthcare settings). South Koreas experience of a MERS outbreak that spread via hospital transmission due to inadequate infection control procedures and staff training. How that outbreak was subsequently brought under control, and subsequent lessons learnt as a result of that.

WHO not liking to take a precautionarty approach to things like mask wearing because they prefer to wait till an evidence base emerges (and otehr concers such as advising the public to wear masks having made mask supply shortages worse).

The fact that the last known infections of humans with the original SARS 1 virus (from the early 2000s) were caused by lab accidents in China.

The importance of surge capacity in health systems resilience (such themes also came up yesterday and will no doubt do so repeatedly)

Variations in case definitions, with an example of Chinas early case definition only including severely ill hospitalised people, causing milder cases to be missed.

Variations in global death figure estimates, including issues such as the use of death certificates where comorbidities may end up being listed as the main cause of death even if it would actually be fair to count it as a Covid death.

Some very interesting stuff about early successes in some countries that I will probably go into more detail about once todays transcript is available. edit - I have since quoted from that in this post: UK Inquiry Module 1: Resilience and preparedness

The next pair of witnesses are involved in broader civil contingencies and disaster planning stuff and I am less likely to describe the topics they are touching on because much of it is to do with governmental structures. THose with an interest in how brexdit preparations drew away certain resources will find some stuff of interest from those witnesses though.
 
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elbows. I haven't seen anything of the inquiry as I'm more time constrained now, but did they cover the possiblity of a lab originated virus for any pandemic plans?
Also, was there any discussion of how and why previous pandemics faded away?
 
elbows. I haven't seen anything of the inquiry as I'm more time constrained now, but did they cover the possiblity of a lab originated virus for any pandemic plans?
Also, was there any discussion of how and why previous pandemics faded away?

Its early days, there is 6 weeks of evidence for this first module and we are only on the 3rd day of that evidence.

The origins of the pandemic has come up a few times already, I dont know how much it will come up again. This inquiry is not likely to hear any evidence and opinion on that which goes beyond what we already hear in the news. Witnesses have also already pointed out that those questions about origin dont make any difference to our subsequent attempts to cope with the pandemic, though they do of course have implications in the area of trying to prevent the initial risky outbreaks with pandemic potential from happening in the first place.

There is already much orthodox understanding of why the effect on humans of pandemics changes over time, in a way that could be described as fading away. A pandemic is a pandemic because a virus that human populations have no prior protection against arrives, with dramatic implications due to that lack of prior immunity. Over time, as more and more members of the population either catch the virus or have their immune responses changed by other means such as vaccination, the impact of the virus on humanity changes, perceptions of risk change, people end up with a sense that the pandemic is over even though the virus has not gone away (and usually becomes endemic). This stuff has been briefly touched upon by witnesses so far, when talking about population immunity and herd immunity.
 
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My brain got worn out listening to the witnesses talking about the inadequacies of structure and planning in the UK system, which included all manner of aspects. These included some big holes at the regional level, and a lack of straightforward accountability at the top. ALso a lack of systems to actually test that both the individial parts and the overall system of dealing with emergencies was actually fit for purpose.
 
. Witnesses have also already pointed out that those questions about origin dont make any difference to our subsequent attempts to cope with the pandemic, though they do of course have implications in the area of trying to prevent the initial risky outbreaks with pandemic potential from happening in the first place.
I was wondering because if the virus isn't natural, trying to predict/model how it will behave becomes harder undermining any efforts to do so as you maybe can't use previous pandemics as a reference.

Over time, as more and more members of the population either catch the virus or have their immune responses changed by other means such as vaccination, the impact of the virus on humanity changes, perceptions of risk change, people end up with a sense that the pandemic is over even though the virus has not gone away (and usually becomes endemic).
Did you say a witness said something like this time natural or synthetic immunity wasn't working as hoped, but covid has 'faded' away to a point.
Sorry, I realize your not a witness but these are questions I can't ask them directly!
 
I was wondering because if the virus isn't natural, trying to predict/model how it will behave becomes harder undermining any efforts to do so as you maybe can't use previous pandemics as a reference.

THe question of a lab leak is not exactly the same question as whether the virus is 'natural' or modified in some way. For example, entirely natural viruses could be studied in labs that then have an accident.

In terms of modifications to viruses, various different sorts are possible, and different properties could be modified. Some of those would affect specific properties of the virus, but would not really be expected to eliminate the overall 'rules' for how coronaviruses behave. And even if they did, the dynamics of pandemic diseases in humans are inevitably tied to general concepts such as population immunity, and the evolution of the virus. I will continue this point when answering your other question:

Did you say a witness said something like this time natural or synthetic immunity wasn't working as hoped, but covid has 'faded' away to a point.
Sorry, I realize your not a witness but these are questions I can't ask them directly!

No, I did not say that. The pandemic is basically progressing as expected so far, and the only hopes that have not been realised are ones that were overly optimistic or based on false premises in the first place. Personally I have moaned about the premature presentation of such hopes at times in recent years, but this isnt something witnesses to the inquiry have mentioned so far.

The simplified version of what is expected is as follows:

The new disease has a field day to start with because the population has no immunity against it.
Over time population immunity starts to increase as a result of people getting infected and parts of their immune system learning to recognise the virus.
If vaccines are invented and deployed, that further adds to this phenomenon.
The virus becomes endemic and continues to circulate in humans, but it causes less hospitalisations and deaths than it did at the start because huge numbers of people are better able to fight the virus.

The overly optimistic version would go further than the above, by introducing the idea that the population gains the sort of immune response that can also knock transmission on the head. Under that scenario you could stand a chance of stopping the disease from remaining endemic. You could hope to ultimately eradicate it, although concerted action and a very prolonged effort would likely still be required to do so.

We would need to generate more transmission-stopping immune responses in order to get closer to that second scenario, eg by inventing and deploying vaccines that do a much better job of stopping transmission. Even under those conditions people would probably not dare to predict that the disease would be completely eradicated, but it would make a difference to size of future waves, ongoing healthcare pressures, ongoing death rate etc.

In addition to how the human immune picture evolves, the evolution of the virus can also make a difference to that picture. Predictions about what will happen with that dont stand a good chance of being correct, regardless of whether the vaccine was entirely natural or modified to start with.

A few examples of what happened to some previous pandemic viruses later on:

The descendants of the 1968 influenza virus are still with us, still cause epidemics some years, still kill plenty of people, often older people whose immune systems are less capable of fighting off the virus. Vaccines have reduced the deaths but are not perfect and deaths still occur, as they did here last winter.

If the 1890 pandemic was caused by the OC43 strain of a coronavirus, what was long ago capable of causing a nasty pandemic in the years when it first arrived, now tends to cause nothing more than a cold.

This is my own attempt to explain the basics. Only certain parts of this sort of picture have come up in evidence so far.
 
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Also note that even if we had more tools to eliminate huge amounts of transmission, total eradication would probably still not be considered a realistic aim. For all sorts of reasons I wont waffle on about too much, but including animal reservoirs of disease, and difficulties in reaching every human with the available tools.

It would still be considered to be a wonderful thing if we could use such things to keep the number of cases down, and protect the most vulnerable from bumping into the virus much in future.
 
It was pointed out yesterday that one of the criticisms when the establishment reviewed how the swine flu pandemic was handled was that there was no genuine, sincere containment phase in the plans (even if that label was used for one of the phase). And that this criticism was not acted upon subsequently. I remember going on about that a long time ago, probably quite repetitively, because some official statements to the public in Jan-Feb of 2020 led some here to believe there were sincere attempts at containment, and it wasnt really true.

From page 198 of yesterdays transcript:

MR WEATHERBY: The points that you make from that are that, despite the fact of the Hine review referring to a containment phase as being an important part of a whole-system plan, that didn't find its way into the 2011 plan.
MR MANN: That's correct.
MR WEATHERBY: And in the decade or almost decade until Covid struck, no change was made to the plan to include a containment plan.
MR MANN: That's correct too.

Theres plenty else I could quote from yesterday, but I'll just settle on this from page 196 of yesterdays transcript:

MR KEITH: Was preparedness for a novel infectious disease pandemic adequate or inadequate?
PROFESSOR ALEXANDER: Inadequate.
MR KEITH: Had the response strategy put in place by the United Kingdom Government been adequately tested in advance of Covid-19?
MR MANN: In detail, forensic detail, to make sure that the plans worked on the ground, no.
MR KEITH: Was it clear in fact that health and social care sectors were liable to be overwhelmed?
MR MANN: That was the clear advice, not only from the Hine review in 2010, it appears in the Cygnus report, the report of Exercise Cygnus, it appears in officials' advice to ministers, it's in Ms Hammond's statement that they would be overwhelmed, which has to raise serious questions about whether the plan would not -- would have worked.
MR KEITH: Is, therefore, now radical innovation and change required?
PROFESSOR ALEXANDER: Yes.

 
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