UK Inquiry Module 2: Decision-making & political governance

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Pages 115-116:

Q: Can we then go back to page 2 in this document, which gives us age-standardised mortality rates of deaths involving Covid-19 for those aged 10 to 100 years by ethnic group and sex.
Does this show that once you apply the age-standardised approach, therefore taking account of the absolute numbers in the population of persons defined by ethnic group, the age-standardised mortality rate was significantly higher for, firstly, all non-white groups than the white British group, and secondly, it was highest overall for those of Bangladeshi ethnicity?
A: I would just qualify that briefly, if I may.
You're absolutely right, but in the first wave the highest group was actually for people from black African and black Caribbean backgrounds, and I would argue that some of that explanation could be due to the geography of the first and second wave. The second wave was much more in the northwest and north of England, and less so, initially, in London.

Q: It shows, of course, therefore, also the very distinct differences between the impact of the waves. So
A: -- Yes.
Q: -- for those of Bangladeshi ethnicity, there is a very stark difference between the first and second wave, and then the Alpha wave, and similarly in relation to those of Pakistani ethnicity, and then also you can see the very distinct difference between male and female?
A: I completely agree.

Pages 116-118:

Q: Was the ONS able to draw any general conclusions, therefore, as to the link between ethnicity and socio-economic conditions? So, when you put it another way, that the mortality rate was, therefore, affected not simply by the fact of ethnicity, but by the socio-economic conditions, deprivation, housing or poverty, experienced by members of that particular ethnic group?
A: The socio-economic conditions, the lower dis -- the lower levels of advantage. Also, as I indicated, for those who were of working age, the higher likelihood to be in public-facing occupations.
In addition, we showed that for women of some ethnic heritages, living in a multi-occupied household had a real impact. And then the other point we note as we move into the later waves was differences in vaccine uptake played a real role in the probability of mortality.

Q: Did you in fact produce data showing mortality rate, therefore, by deprivation?
A: Yes.
Q: And the greater degree of deprivation, the greater the mortality rate?
A: These -- what we do is we use a number of indicators, which we add together for small geographic areas, and then we link the death registration to the geographic area, and as you indicated we've got the address that we can get from the death registration, and what that shows is a very straight gradient between people in the most deprived areas having the highest levels of mortality and people in the least deprived areas having the lowest. And as you rightly say, these are standardised so that we control for differences in the age distribution which may occur between those areas.

 

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Pages 118-120:

Q: You will recall that you referred earlier to protective service occupations and other operatives, transport and mobile machine drivers and operatives. Applying the age-standardised mortality rate approach, were there some occupations which had a markedly higher mortality rate and therefore, by implication, a higher risk of death?
A; Yes, there were, and these tended to be public-facing type jobs, so, for example, when we talk about transport, we're talking about taxi drivers and bus drivers --
Q: Could we go forward one page, please, and we will see transport and mobile machine drivers and operatives at 82.
A: And when we talk about protective services, that's largely the police and security and things like that.
Q: So -- thank you for highlighting 82 -- the highest standardised rate was for transport and mobile machine drivers and operatives, at 78.7.
By contrast, if you go back one page, health professionals, health and social care associate professionals, had lower rates of mortality, 22.2 and 32.6.
Why do you think that they had an age-standardised lower mortality rate even though they were in the health and care sectors?

A: What we show is that they had a relatively high rate of contracting Covid in other data, but that the relatively lower levels of mortality, at this stage -- I mean, I'm
a statistician, so I apologise if my knowledge of epidemiology is not brilliant, but much -- in many ways, better protection, much higher levels of vaccine uptake would be a really -- and early vaccine uptake -- would be important factors.
Q: What about barrier care, so the more prevalent use of PPE and so on?
That's certainly an impact, but as I indicated there were relatively high levels of Covid [sic: he means vaccines] uptake amongst some health professionals.

Pages 121-122, Levelling up!:

The other point I think it is important to refer to on international comparisons, which we report in a number of publications, is that the UK, and particularly England, was one of the very few countries in the first wave to have a national epidemic. So if we were, for example, to look at Italy, Italy had much higher levels of mortality than we did around Bergamo, in northern Italy, for example, but almost none at all in the south of Italy. The same in France, where we show that the French first wave epidemic was largely around Paris and Strasbourg, whereas in England the epidemic came right the way through the country.

Pages 124-125:

A: ...the first wave very much, you know, right across but in London in particular, the second wave, in that autumn of 2020, you may recall the outbreak in Leicester, you may recall some of the outbreaks across the northwest, very sadly, and indeed that crescent, which more or less starts in Liverpool, goes through the north and then down to Leicester, was very much where that second wave came, and that is reflected by London having a relatively lower level there.
Q: That wave or crescent of mortality sweeping through that part of England, is that in any way redolent of past infections or disease --
A: If you were to look at --
Q: -- rates in the united Kingdom?
A: I mean, look, if you were to look at a map, if you were to make a map of the geography, shall we say, of infant mortality in the 19th century, it would not look unlike that, I would have to say. So it is -- we have parts of our country that have long-lasting levels of ill health and the -- and everything around ill health.

There were then some questions from the bereaved families legal representative about an issue that was raised in a letter to Hancock about the misrepresentation of data to the public about the number of tests being carried out, but its not in a format that would allow me to present it sensibly via limited quotes.

There was also a question about lack of death certificate data about ethnicity - the system is flawed in this respect for various reasons including the fact that the person best placed to answer that question has died. There are proposals to fix this by embedding such things in NHS data during a persons lifetime that can then be linked to death certificates when someone dies.

 

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The final witness yesterday was a data expert witness who specialises in data policy, research and advocacy, and a focus on digital government.

Much of the evidence is dull, when I get round to quoting from this witness session later, I shall probably focus on the latter part where they deal with what a shitty mess the governments own crucial pandemic data was in when the first wave arrived.

 

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Pages 164-168:

Q: Are you familiar with what a CRIP is, Mr Freeguard?
A: Yes.
Q: What does it stand for?
A: Commonly Recognised Information Picture.

Q: But it's a term of art, is it not, in sort of contingency planning, and CRIPS are intended to be a sort of regular daily bringing together of the critical information that decision-makers need in order to make the decisions that fall for them?
A: Yes, and I think an attempt to create a single source of truth so that all of those decision-makers are at least starting in the same place.

Q: This, we note, is a CRIP dated Wednesday 18 March. As we will -- as we've already heard, but we will certainly come to hear in more detail, that was a critical moment in the early stages of the pandemic. We will hear evidence about the SAGE meeting on Friday the 13th, a few days before, where the true scale of the decisions facing the country perhaps became apparent; crisis meetings over the weekend, we're in the last few days before the decision to implement the first national lockdown were made early the next week, so it's really a sort of crisis moment.
We can also see, of course, it's CRIP number 28, so this CRIP system has been in play for a little while by that stage.

Q: If we just look at the next page, please, we see a situation update. I just want to draw your attention to, I think it's the fifth bullet point down at the top. There is an estimated population infected figure there of 5,000 to 10,000. Of course we know, looking back, that that was a gross underestimate, but that isn't really the point I want to make.
If we bear that figure in mind, 5,000 to 10,000, if we can just go on to the next page, we see in the third box down exactly the same variable, "Estimated population infected", but instead of 5,000 to 10,000, it's 30,000 to 40,000.

Q: So it would seem that whoever was typing in the numbers into the box, or perhaps it was more than one person, perhaps from a different source, we've ended up with a short document with two very different figures for the same variable. One might have thought one of, if not the most important variable in the document: how many people do you think in this country have got Covid at the moment? You look at one page, it says 5,000 to 10,000; the next page, well, it could be 30,000 to 40,000, this being the document that the Prime Minister is looking at in order to make his decisions.

Q: If we could go on to page 5 of the document, please, again one might have thought a rather important page for the key decision-making that was going on, trying to understand what the health and social care situation is in the country.
It's quite striking that, of the columns which are actually completed, in other words data is available, one of them is for the percentage of NHS 111 calls answered within 60 seconds. Not, one might have thought, the most important data on which to decide whether to, for example, lock down the country or not.

Q: Moving along, we also see full data for the number of urgent operations that have been cancelled. But between those two columns, the area on the sheet for the number of ICU beds occupied, the percentage of ICU beds occupied by Covid-19 patients -- and bearing in mind that one of the priorities, if not the priority, that had been identified by the government at that point was protecting the NHS from collapse because of being overwhelmed by Covid patients -- no data seems to have been provided?
A: Indeed, and I think some of the data that you would need to work out the percentages there would actually just be things like the overall number of beds in the system. Even data like that, which should have been easier to come by, was also missing at the start.

 

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The expert report from that data witness is here: INQ000260629 - Expert report by Gavin Freeguard for the UK Covid-19 Public Inquiry, titled 'Module 2: Political and administrative decision making in relation to the Covid-19 pandemic, dated 26/09/2023

Finishing off my extracts of the shit data situation, they then quoted from some Cummings email and a reply he had.

Some relevant parts of his email from https://covid19.public-inquiry.uk/wp-content/uploads/2023/10/10174450/INQ000174715.pdf


and

 

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The reply (inquiry think reference to MH might be Matt Hancock): https://covid19.public-inquiry.uk/wp-content/uploads/2023/10/10174446/INQ000048313_0031.pdf

 

[two sheds]

OK to put this here elbows? Says released during the enquiry:

Revealed: Boris Johnson and Dominic Cummings’s secret Covid WhatsApp messages

In a WhatsApp message to Boris Johnson, Dominic Cummings described the Cabinet Office as ‘terrifyingly s***’

www.independent.co.uk

 

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Sure, anyone should feel free to put press reporting in here, doesnt matter if it overlaps with what I already posted as my posts are a bit dense (understatement).

In this case the report covers some devolved stuff I sadly didnt have time to cover properly, and the WhatsApp message I posted in #56

 

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Plus I spend so much time on the daily evidence sessions that I dont have much time left to find press reports, and it would be useful to have the regular opportunity to have a quick look at how they are framing things.

 

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Although given how often they will focus on the big headline grabbing political/government stuff, consider putting them in the UK politics current events etc thread too: The Covid Inquiry

 

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Another press article on the devolved administrations side of things which I only touched on briefly a few times myself.

Covid: Boris Johnson refused talks with Drakeford and Sturgeon

Former prime minister tells Covid inquiry he was worried UK could look like a mini-EU.

www.bbc.co.uk

 

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It will probably take me some dfays to catch up with Wednesday-Fridays evidence sessions but in the meantime a report on what a witness said today:

February warning Covid could swamp NHS, inquiry told

Prof Graham Medley said that civil servants would have been aware of those concerns at the time.

www.bbc.co.uk

Prof Medley, professor of infectious disease modelling at the London School of Hygiene and Tropical Medicine, was a member of the Scientific Advisory Group for Emergencies (Sage) and co-chaired the influential SPI-M-O subgroup which calculated and modelled the spread of the virus during the pandemic.

Giving evidence, he said it was "no secret" by the end of February 2020 that the NHS would be overwhelmed by Covid cases.
"The extent of the epidemic became very clear during February. By that point we had established the infection fatality rate, that's the proportion of people dying following infection, at around 1%," he said.

"If 80% of the population were infected in a single wave, then we could calculate the numbers who would die."

Prof Medley was then asked why the formal minutes of the Sage group of advisers did not record a high level of concern about the impact on the NHS over that period.

He said civil servants responsible for the minutes would have "completely understood" the views of scientists on Sage.

He recalled an account named "Dominic Cummings iPhone X" also dialled into remote meetings of the SPI-M-O subgroup at the time.

"Even if it is not in the paperwork, it was known," he said.

 

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Also from that one:

The inquiry was also shown WhatsApp messages exchanged between Mr Johnson, Mr Hancock and Sir Patrick Vallance in June 2020.

Mr Johnson wrote: "These Sage geezers now saying we should have gone into lockdown earlier. Can we gently ask them why they didn't make their anxieties public at the time???"

Sir Patrick, the government's chief scientific adviser from 2018 to 2023, replied: "I think there's too much enthusiasm for the camera at the moment and will speak to them again.

"All the minutes of Sage are published and so data recommendations are clear."

Mr Hancock then replied to the messages saying it was "exceptionally unhelpful having individual members of Sage making comments like this, it undermines us all".

 

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Despite not getting a chance to put these latest 3 days of evidence in some detail in this thread, in the meantime I did get drawn into responding to someones question about some evidence yesterday involving a SAGE modelling heads claims about it being clear in Feb 2020 that the NHS would be overwhelmed. And then the visual evidence of Johnson calling Long Covid bollocks, in the UK forum thread about the inquiry:

The Covid Inquiry and the subsequent few posts.

 

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BBC etc have picked up on a load of stuff about Carrie that I've quoted in the other thread, and in regards autumn 2020:

Mr Case goes on to say: "This government doesn't have the credibility needed to be imposing stuff within only days of deciding not too [sic]. We look like a terrible, tragic joke.

"If we were going hard, that decision was needed weeks ago. I cannot cope with this."

Covid inquiry texts show No 10 staff complaining about Carrie Johnson

The Covid inquiry releases messages between civil servant Simon Case and No 10 adviser Dominic Cummings.

www.bbc.co.uk

 

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Not sure how well I am going to be able to encapsulate the science from this weeks witnesses, and theres much more of that next week too.

eg can I really go through all the stuff about masks and the importance and timing of lockdowns etc that came up this week? Will I be able to deal with a couple of witnesses next week that I had reasons to go mad about during the pandemic (eg Carl Heneghan) ?

I expect I will still do some but I'm not going to pretend it will be anything like complete.

 

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Here for example are references in this forum to Heneghan during the pandemic, I was far from the only one complaining about his shit: Search results for query: heneghan

He is up last next week.

Mark Woolhouse is up first. He has already been quoted a number of times in the first few weeks of this module, and when it comes to him I'd say he is more of a mixed bag. In that I agree with some of the things its been revealed he said, but at the time of the pandemic I was focussed on the other side to him which I dont agree with, and things like him fucking off to his holiday home in Scotland, double-standards that betrayed his real sense of personal risk in contrast to his preferred public health response that the masses would have to suffer if he got his way. Whether his actual private opinions about his preferred policies actually match my impression of his stance at the time, I cannot say quite yet.

Search results for query: woolhouse

www.urban75.net

My existing opinion was that these were experts in certain areas who had a grip on some aspects of pandemic reality but didnt come to terms with the strength of measures ultimately undertaken compared to the orthodox approach they were more comfortable with. Even I can sympathise with aspects of where they were coming from in terms of the negative consequences of lockdowns etc, but in my book they failed to get the balance right and Heneghan especially came out with various forms of deadly bullshit at critical moments as a result.

I'm getting this out of the way now so that if I do quote from their evidence sessions, I wont feel the need to start ranting quite so much, got some of the background out of the way in advance.

Anthony Costello, Neil Ferguson and John Edmunds are some of the other names up next week.

 

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Extract from an undated draft report by Helen MacNamara on the theme of how No 10 and the cabinet office can better support the PM in the next phase:

INQ000136755_ 0001- Extract of draft report from Helen MacNamara titled "How can No 10 and the CO better support the PM in the next phase", undated UK Covid-19 Inquiry Archives

Extract of draft report from Helen MacNamara titled "How can No 10 and the CO better support the PM in the next phase", undated.

covid19.public-inquiry.uk

This is the source of the 'superhero bunfight' remark and other comments.

 

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ANd more Cummings-supplied evidence that I've also stuck in the UK forum thread about the inquiry:

INQ000048313_0007, 0022, 0054, 0056, 0057 - Extracts from the letter from Dominic Cummings to the Inquiry titled 'Evidence of Dominic Cummings', dated 11/11/2022 UK Covid-19 Inquiry Archives



And:

 

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I managed to watch todays proceedings, and will try to catch up with the 3 days last week that I have only posted a few snippets of evidence from So far.

So, last Wednesdays session, transcript here: https://covid19.public-inquiry.uk/w...2039/2023-10-11-Module-2-Day-7-Transcript.pdf

First witness specialised in all sorts of stuff including diabetes, various forms of health research, including ethnic health research, disparities, long covid. Participated in SAGE later on, including chairing a SAGE subgroup on ethnicity that was setup in August 2020.

Earely on he noticed signals other saw in regards ethnic minorities being admitted to ICU at higher rates. Raised it with WHitty, Whitty responded by activating research on this subject.

It was mentioned that a lack of theoretically framework as to the meaning of ethnicity had hampered pre-pandemic health research.

Figures such as these are mentioned on page 7:

this showed for the first time that there were about 30% to 35% of people being admitted into the intensive care unit who were from ethnic minority backgrounds. The population statistics suggest it's about 16%, so it's double the number of people who were being admitted to intensive care unit.

On page 9 some discussion of early signs about conditions that increased risk:

"In particular recent systemic review data show that the multimorbidities with the worst outcomes seem to be cardiovascular disease, diabetes and hypertension and surprisingly not COPD."
Q: What's COPD?
A: Chronic obstructive pulmonary disease, so it's a chronic lung condition.
Q: Why was that a surprise?
A: Because when the virus first came round we thought it was a respiratory virus, like the flu virus, it affects more people who have respiratory diseases, asthma, COPD. It did affect people with COPD, but we were surprised that a lot more people with diabetes and cardiovascular disease were affected with this.
Q: As we've heard and indeed we'll deal with slightly later, those diseases are particularly prevalent or disproportionately so in certain ethnic minority
populations?
A: That's correct, yes.

And on page 11 something we've heard about from other evidence:

Q:You particularly flagged concerns being raised because the first ten doctors in the UK to die from Covid-19 were from ethnic minorities; is that right?
A: That's correct. That did raise eyebrows when we saw that in the news on a regular basis, yes.

Then some discussion about early findings via a May 2020 ONS report, pages 12 to 13:

Q: In relation to that article and the statistics that were produced, the provisional analysis showed the risk of death involving Covid-19 among some ethnic groups was significantly higher than that within the white ethnicity population?
A: That's correct.
Q: When taking into account age in that analysis -- so this is right at the beginning of the pandemic, what was known as at May of 2020 -- black males were 4.2 times more likely to die from a Covid-19-related death and black females 4.3 times more likely than white ethnicity males and females?
A: That's correct, yes.

And page 13-14:

Q: That reduced, then, to males and females of black ethnicity being 1.9 times more likely than those of white ethnicity and Bangladeshi and Pakistani ethnic minority men being 1.8 times more likely to have a Covid-19-related death.
So at this point in terms of the ONS statistics, is it right to say that it was already flagging up issues in relation to comorbidities that existed within ethnic minority populations and geographic issues, but that the disparity simply could not be explained by those?
A: That's right. So basically it was 4 times the risk, and once you take into account the deprivation, the previous health, comorbidities, it reduces risk by 50%. So 50% was accounted for by those factors.

Then there was a discussion about a PHE report that seemed like it had some bits left out, causing controversy, and a subsequent version of the report that was then issued. And then looking at some themes on pages 15-16:

Q: In relation to that, were issues flagged in relation to structural racism and discrimination?
A: That's right.
Q: As a link?
A: That's correct, yes.
Q: And socioeconomic circumstance?
A: That's correct, yes.

Q: Now, given the link between or potential link between structural racism and discrimination and those poor health outcomes, as noted in that PHE report, are you aware of any other work that looked at those issues?
A: There's been a number of studies. The issue with structural discrimination and discrimination is how you measure it. It's very, very difficult to measure. So qualitative interviews where people are asked about it will -- you can get a lot of information from.
There's a systemic review that's been done about the disproportionate outcomes in people from ethnic minority backgrounds, and that identified I think just a few papers that had talked about discrimination, and again they highlight that it's very difficult to measure.
But from the qualitative evidence we have from the British Medical Association, from the nurses associations, there may have been some elements of structural discrimination, for example getting PPE given to -- from the -- healthcare workers particularly from ethnic minorities.
Q: And we've heard earlier evidence that ethnic minorities are overrepresented within the healthcare workforce?
A: That's right, about 20% of the healthcare workforce, or 1.2 to 1.5 million people within the National Health Service, are from ethnic minority backgrounds, yes

And then in terms of report recommendations and missed opportunities, on page 17:

The reason we thought it was a missed opportunity, because they did have I think six recommendations, is that they didn't have the recommendations, although they'd identified them, of the wider source of determinants.
So, first of all, how to protect these populations, and the wider social determinants of how to ensure that housing is adequate, it's not overcrowded housing, the occupations that people were at higher risk, they weren't protected, the educational elements, communication, how it was to be done, who was going to do it. All of that wasn't there in huge detail.
Although they'd identified all the drivers, the recommendations or drivers -- the detailed recommendations on drivers were missing.

 

[elbows]

Then they discussed how those things were mentioned in SAGE, SAGE setting up the subgroup.

Then a discussion about a Badenoch group that produced four quarterly reports to the PM, no real interesting detail in this bit though.

Risk factors such as housing density and multigenerational households, occupation and existing poor health come up. As well as access to healthcare. These themes carry on and then on pages 28-31:

A: And I think we must have had -- we had the best data in the world, and we had five database studies that all concurred to the same conclusion, that multigenerational households, people with three or more occupants, was associated with worse infection, worse disease and worse mortality.
Q: Perhaps if I can just pick up on that, then, in relation to the first wave and the second wave. In the first wave all ethnic minority groups were at that elevated risk, particularly acute within back populations; is that right?
A: That's right, yes.
Q: But that changed when it came to the second wave, where one saw a decrease in relation to mortality, deaths, for black ethnic minority populations but a greater disproportionate effect in relation to Bangladeshi and Pakistani, South Asian groups; is that right?

A: That's correct. So overall, once -- so basically it showed that lockdown worked. For nearly -- most of the ethnic groups, including the white group, you sawa reduction in infection and mortality. But there was a higher risk in Bangladeshis and Pakistanis, and we looked at what the drivers were -- and this is using the ONS data -- and the drivers were likely to be what we've already said, the occupations that ethnic minorities are in, the housing density --
Q: If I can pause you for one moment, when you say occupations, what types of work?
A: So occupation is people-facing roles, taxi drivers, restaurants, healthcare workers, et cetera. And people who were on zero-hours contracts, so they weren't able to get time out, and so potentially they weren't reporting their symptoms.
Q: Just picking up on the people with zero-hours contracts, in terms of financial stability, did you see that as having any role?
A: That was one of the reasons that we put forward, that that would have definitely been one of the reasons, and some of the qualitative interviews have previously shown that as well.

Q: I think one of the recommendations that you made at that point was for the provision of proper statutory pay for --
A: Absolutely, yes.
Q: Sick pay?
A: And similarly we made recommendations on housing, that if people are in multigenerational housing there should be provision made of housing given for isolation if one member of the house was infected.

Q: Then just to pick up on one final aspect in relation to the drivers, can I just be clear with you in relation to genetic considerations. Do you consider it likely that genetics play a role?
A: Well, most of the data shows that there are some, what we call SNPs, genetic signals, but there is no conclusive evidence to show that this is driven by genetics. It does seem to be driven mainly by the social determinants.
And we've done some additional work subsequently showing that if we take 25% of the most deprived populations out of deprivation, we halve the risk of Covid infections and mortality. If we take 50% of the most deprived population out of deprivation, including ethnic minorities, we near enough eliminate the risk that we've seen. So a lot of this we feel is due to the social determinants.

 

[elbows]

Half an hour of towards proceedings involved legal submissions in regards how much of Vallances evening notes ('diaries') are shown on the screen and released:

Sir Patrick Vallance says release of full diary entries would breach human rights

Ex-chief scientist says only extracts of his evening notes should be released to the Covid inquiry.

www.bbc.co.uk

 

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Pages 32-34 of last Wednesdays transcript included the following, and I think the 'four quarter reports' are from the Badenoch group that was mentioned earlier but didnt contain useful detail on those prior pages I was previously describing:

So the four quarter reports mention a number of areas that the government addressed the disparities, this is the Race Disparity Unit four quarterly reports. There are a number of things that could be done. In terms of the detail, again, in some of them is lacking. There's data on pilot areas that were funded to do evaluations of what worked, what didn't work. Mention about communications on -- for ethnic minority populations. And again they mention a number of things that were done.
But to me there were other ways that this could have been done. We have the best data systems in the world, and we're the envy of the world with the data we have. What we needed was real-time data, real-time data on people being affected in different areas, because we always say local is best, we could have acted on this locally. Leicester local public health did a tremendous effort but they were lacking in data. So if we had data given to us in real time about where the highest risks are, we could have worked with our community champions within those areas, our community leaders in those areas, the pharmacists, the GPs, as we did in Leicester, to reduce that risk.

Similarly, the test, trace, isolation programme, again we didn't have any data coming to us to say where is -- are the bottlenecks, which areas are working well, which are not working well. And again, if this data came on a regular basis, in real time, the local public health messaging could have been done.

In the reports, you know, there are mentions about the culturally-adapted information that was given out there. Now, giving out a culturally-adapted leaflet doesn't mean that that's going to have a major effect. You need to do a lot more than that. You need to work with that community. And there are discussions about the community champions programmes that were funded, but again we're not sure how these were funded, which areas were funded.

And the key one is the evaluations. You know, 40 million, over £40 million was given out. These are the kinds of things that we should be evaluating robustly, because we have the data. If you put an intervention in Leicester and don't put it in Blackburn, I can tell within a short period of time with the data that we have whether that intervention's worked or not.

Q: So is that one of your primary concerns, is working out what happened, effectively, with those community champions, grants and research projects and that data?
A: There are soft evaluations that have been done for one of them, but others we're not aware of what the findings are and how we can implement them. For example, we should be implementing them now. Covid is still here, we're seeing an increased risk, but we're not hearing anything about those messages.
And when I say regarding the communication and language, Leicester has over 80 languages, London has over 300 languages, what we need to do is the local people will know the best about what their needs are, and it really needs to be localised in terms of the response.

Then there was a discussion about culturally tailored messaging that I cannot do proper justice to via quotes, but there was a specific point later on in that disucsiion:

Pages 39-40:

A: If you pick on one minority ethnic group and -- whether it's culturally tailored or not, they will be singled out as a high risk, and that will marginalise them, that will stigmatise them, that will create distrust in that population. So it's how that's been done. And what we were saying is: this message is for everyone. The messaging during the pandemic should have gone to everyone at the same time. But then, in a nuanced way, made it appropriate for that population.

A: I mean, we had an example of that in Leicester. We had a bus in an area where we had high vaccination rates and this bus turned up with a billboard about vaccinations and it was totally inappropriate to have a billboard there when we already had high vaccination rates there.
LADY HALLETT: So what was the impact of that?
A: Well, the local communities felt stigmatised. They were: why are we -- you know, we've worked very hard -- the GPs said: we've worked very hard to get the patients vaccinated, but the people who are -- why are the billboards still coming? Because the vaccination rates are already high in that area, because the local community worked really, really hard, and they thought that enough possibly wasn't being done by that community.

 

[elbows]

Then there is a brief discussion about the fact he was in Independent SAGE for a while too.

Then they move onto his work with the Long Covid Research Working Group. Including:

Page 44:

Q: Did you have the -- were you under the impression that you reported to the CMO, to Professor Sir Chris Whitty?
A: He'd asked us to set this group up, so whether it's reporting or -- he certainly was interested in what was going on, and he wanted to know what was going on on a regular basis. So I think we initially said it was reporting but it was really what we were doing is sharing what we were doing with Professor Sir Chris Whitty on a regular basis. Initially it was two-weekly, now it's four-weekly.

Then there is some tedious discussion about whether it was appropriate to put Whittys name on some stuff that was published, or whether the idea that they were 'reporting to the CMO' was overstating things. Then a discussion about how in April 2021 plenty of studies were just getting started to it was too soon to report to SAGE.

Then some other stuff to do with definitions and data and how much could actually be done about Long Covid. And then stuff relating to difficulties with coding it in data:

eg on page 54:

Q: ...you tweeted that: "Longcovid is poorly coded in primary care records but there are other ways."
Again, in relation to collation of data.
What other ways do you see?
A: So the coding structures came very quickly, I think there were 18 codes that were set up for Long Covid within the GP systems. The tweet was in relation to a paper that was published a month before from OpenSAFELY, that's in the British Journal of
General Practice, that showed that only 0.04% of practices at population level had a code for Long Covid.
By that time we'd had a number of people with Long Covid, but only 0.04% were shown on the GP computer systems, and it was variable, 25% of practices did not have a code at all. So it showed that there is an issue with coding of Long Covid.
The other areas are that if patients are going to Long Covid clinics, for example, if they came back to the practice, that's one way of putting Long Covid codes in. Otherwise we have to do them prospectively.
I think because the diagnosis is so difficult of Long Covid -- unless you're a researcher, we're doing that on a regular basis -- in clinical practice Long Covid is a difficult diagnosis for a busy general practitioner. There are training elements already inputting for that though.

 

[elbows]

Some other stuff is then discussed to do with the difficulties in establishing thether Long Covid was having a disproportionate effect on ethnic minorities.

Skipping ahead a bit, there are then various questions from other legal representatives. I'll just highlight one or two from pages 61-64:

Q: First of all, I'm going to cite, I'm not going to go to the INQ number, but it's INQ000280061, which is part of Sir Patrick Vallance's dairies.
At page 205, Professor Khunti, he recorded an entry, on 6 October 2020, listing the reasons why the Great Barrington proposal, namely herd immunity and let it rip, as you will be aware, is wrong. Number 4 on that list is Long Covid.
First of all, do you agree with Patrick Vallance's view that Long Covid was one of the reasons why letting the virus spread unchecked was wrong?
A: Absolutely. I agree with that. As I mentioned earlier, at the moment the way to reduce the risk of Long Covid is through reducing the risk of people getting Covid. And this is through, as we said, all the NPIs. And now we have the vaccines that can drive the risk. Vaccines drive the risk -- reduces the risk, and there's good evidence now that if people are vaccinated they're less likely to get Long Covid. If they have Long Covid and they're vaccinated, there's also data to suggest that they get less Long Covid.

Q: Thank you.
Since you've said yes, can you answer this subsidiary question: should Long Covid be one of the factors to take into account in assessing the need for non-pharmaceutical interventions to limit transmission?
A: Yes, absolutely. As I've said, that's one of the ways, and one of the major ways, of reducing the risk of getting Covid in the first place, and we know -- also know that if you have had Covid and you have Long Covid and you have Covid again, your risks are worse. So definitely, yes.

Q: Would SAGE be responsible for informing government decision-makers about the nature of risk of Long Covid, as with other factors on Patrick Vallance's list, such as how long immunity lasts?
A: I think that was already in many of the SAGE papers.
The SPI-M modelling had looked at how long the immunity lasts, after an infection or vaccinations, and these were all taken into account when the modelling was done.

Q: You said at paragraph 3.5 of page 13 of your report, you said:
"By August 2020, understanding was sufficient for guidance on management of 'post-acute Covid' (as the longer-term effects of Covid-19 were then termed) to be published in the British Medical Journal."
Is it right that SAGE did not provide advice on Long Covid to government decision-makers by October 2020 when Sir Patrick Vallance made this note in his diary?
A: As I mentioned earlier on, there weren't any interventions for people with Long Covid. Indeed, you'll hear on Friday we don't have any interventions at the moment. Really, we're at its infancy in terms of knowing much about Long Covid. So at that stage we did not have any interventions to put into place to help people with Long Covid except to reduce the risk of Long Covid with the interventions I've mentioned, the NPIs and the vaccination programmes.

They also asked a question about children and Long Covid but it wasnt a speciality of his so he couldnt really help.

 

[elbows]

The next witness was professor Thomas Hale who worked on the Oxford Covid-19 government response tracker, which recorded what measures different governemnts took around the world (185 countries), and when.

I cannot really cover their findings properly via quotes, so I'm just going to pick a few of the most obvious ones to highlight. And I may already have linked to their report, Iw ill check later.

Pages 78-79 of Wednesdays transcript:

Q: ...are there a number of general findings that you draw from your review of these thousands of studies reporting on the data which you've collated? So, in essence, what everybody did.
Firstly: "Speed matters."
And we're going to come and look at these in turn.
Secondly: "Strength matters."
Those two observations I think are self-evident, that their meaning is clear.
Third: "Effective use of test, trace, and isolate measures limits both health impacts and the need for restrictive policies."
By "restrictive policies", do you mean more stringent policies?
A: Correct.

Q: Stringent measures.
Fourthly: "Economic support bolsters compliance."
By that, do you mean the provision of economic support by government, for example by way of support for those who are self-isolating, tends to improve the ability or the degree to which a population will
comply with a particular measure?
A: Yes.
Q: Fifthly: "Prolonged restrictions can have costs."
What sort of costs, in very broad terms, did you have in mind by that phrase?
A: There are many potential costs. The ones we focused on, because they were a source of great interest in the literature, were around mental health impacts, around domestic violence, around learning outcomes for
children, and of course for the economy. Of course there are many others as well to consider.

A subsequent discussion about speed included, on page 80:

And, for example, one of the studies we looked at show that a single day of delaying a mass gathering ban, so something like concerts or sporting events, a single day of delay had an impact of perhaps a 7% increase in the cumulative death toll during that wave. So one day, 7% increase, quite a significant importance for speed.

And on pages 81-82:

Q: But on account of the way in which a viral outbreak or a virus disease will spread, what is the particular significance, what is the particular need for acting fast?
A: It's precisely to stop before it starts. Once it's become so widespread that you are inevitably going to have some degree of non-compliance leading to further spread, it's too late for those measures to have the kind of clampdown effect they would have had if it were just a few people. So it's a simple kind of fact, mathematical logic of exponential growth, that once you have passed the point of a certain threshold of spread, it's not going to be feasible to bring that down without a very prolonged and intense level of restriction.

 

[elbows]

Pages 84-85:

Q: I've already asked you about the generic difficulties of trying to apply a counterfactual position and of trying to drill down into the impact of specific measures. Is it for those reasons that you can't express a view, for example, as to what the specific impact might have been in the United Kingdom of banning mass gatherings earlier? For example, you're aware of the Six Nations matches which were held in February and March, a football match between Atlético Madrid and Liverpool and so on, and a racing festival at Cheltenham. Does the data and the literature provide you with any answer as to what might have been the impact had those large mass gatherings not taken place?

A: A study could be done, a modelling study, which would have tried to use mathematics and statistics to create a counterfactual for comparison, but no, we can't look back in an observational way and say: had this been done earlier, definitely this would be the impact. Rather we can say is: let's look at all of the countries in the world, see which ones imposed this kinds of mass gathering bans, what the impact was on their disease situations and then try to interpolate that to the UK. That's the level of evidence that we can provide.

When it came to strength, I'm not finding it so wasy to quote, but there was a bit that used quarantines in hotels as an example, and stay at home orders as another example.

On test, trace and isolate, they mention that the evidence base is a bit harder due to some data limitations with how well different countries did at things like the percentage of contacts traced each time. But also that, on pages 89-90:

...the studies that have been done nonetheless very clearly show that effective test, trace, isolate and support measures were very helpful.

and:

We have summarised a study by Panovska-Griffiths et al 2020 which was, as I said before, a modelling study, so using hypothetical parameters to estimate the effect of a counterfactual, and in that case they did show that TTI strategies could have been successful in particular in the second wave of Covid-19 in the UK if they had been more effective at capturing a wider range of contacts and more quickly.

On pages 90-91 in regards economic support:

So there are two categories of studies that are particularly relevant here: first, a number that show that existing levels of economic deprivation or short-term economic shocks reduced compliance; and secondly, and relatedly, when there's economic support that's provided, either through governmental programmes such as the furlough scheme here in the UK or, as was the case in many countries, through social organisations, for example in India an extensive social provision of food to vulnerable households, this was very helpful in ensuring greater compliance with NPIs.

And on pages 91-92, some of the downsides:

Q: The costs of prolonged restrictions is your next theme. Again self-evidently perhaps, the evidence which you looked at strongly suggests that strict and prolonged non-pharmaceutical interventions will have negative impact on mental health, educational prospects, particularly deleterious effects on older adults, and also the increased prevalence in domestic violence?
A: Correct.
Q: Were there a number of studies which showed that in relation to that latter issue, that of domestic violence, there were substantial increases in domestic violence as a result of the prolonged use of some NPIs, and that was in countries in Europe and in America, across the world?
A: Indeed. And it's striking to see such consistency in the findings across very different contexts. Indeed, in countries where the previous levels of domestic violence were also quite different, all showed a similar
increase.

Q: Again, we've heard evidence on this from a number of sources, the application of more stringent non-pharmaceutical interventions also had disproportionate impact on various sectors of the populations in each of the countries, on ethnic minorities, members of ethnic minorities, ethnic groups, women, the elderly, those living alone, and those suffering from comorbidities as well as those who were otherwise economically disadvantaged?
A: That's correct, and it truly is one of the cruellest injustices of this pandemic that often similar people, similar groups of people who were both vulnerable to Covid were also vulnerable to the effects of actions against Covid.

 

[elbows]

Page 94:

Q: And in general terms, do you conclude or does the literature show that for the majority of these NPIs, England, Scotland, Wales and Northern Ireland delayed -- or there was a greater elapse of time before the imposition of these NPIs than really the majority of all other countries?
A: That's correct.

This is then discussed in much greater detail that I cannot do proper justice to. This includes detail about how they represented the timing in terms of delay between getting 100 cases in a particular area and bringing in measures. WIth associated detail about how this meant the delay was worse for parts of the UK that were already further ahead in the epidemic than other parts, when they all brought in measures ont he same date.

Then they discuss strength of measures, and how in some ways the UK ended up having more severe restrictions, including with regards to schools. Including on page 100:

Q: What that shows, does it not, is that there was a degree of rollercoaster element in the United Kingdom's response? By comparison, I emphasise, to other countries, we went right up the scale and reacted, some would say overreacted, at the first wave, then underreacted between waves, and then rocketed right back up again at the time of the second wave?
A: There's certainly, in the United Kingdom's response, as in many other countries, I should add, an element of ramping up, ramping down, ramping up, ramping down, and so the metaphor of a rollercoaster does come to mind.

And on pages 101-102:

Q: Are you able to reach a view as to whether, in general terms, the United Kingdom applied non-pharmaceutical measures only when it became apparent that they were unavoidable, because they were delayed and at the time at which they were then imposed we know in the United Kingdom the NHS was believed to be likely to collapse, and then when they're lifted there is then a long period of delay before consideration appears to
be given to their reintroduction, and then when they are reintroduced, again, because of the passage of time and the lateness, there is a requirement for those restrictions to be ever more stringently reimposed?
A: Correct. So we see this rollercoaster tendency where restrictions are put into place only after it becomes apparent there will be a very severe threat to the health system. That's after a large amount of community spread has begun. Because it's so prevalent at that moment, the restrictions need to be more stringent and to be in place for a longer period of time than might have been the case otherwise, but precisely because sustaining high stringency for a long period comes with costs, there's huge pressure to roll them back sooner rather than later and that leaves, inevitably, some residual virus circulating in the population, which lays the seeds for the next wave to emerge. So this kind of tendency to act too late in the first instance and to take measures away too soon in the second instance does tend to lead to the peaks and troughs that these graphs show.

Then they discussed countries that were able to avoid that rollercoaster via effecticve test & trace and keeping levels of the virus down in the population. This carries into the next theme on page 103:

Q: Did you also find a link between those countries which had that testing capacity and which were able to avoid relatively stringent NPIs and those countries which suffered the most in terms of excess number of deaths, economic performance, and general health impact?
A: Correct. So the countries that were riding the rollercoaster were referring from a trifecta of large health impacts, high, long periods of stringency, and negative economic consequences, and those that were able to maintain a low level of spread, perhaps through effective TTI measures, were able to have a better outcome on all three of those measures.

Skipping ahead to the final remark on page 104-105:

LADY HALLETT: Thank you very much indeed, Professor Hale.
An extraordinary project.
I had no idea projects like that were going on, and I think one of my previous witnesses asked for global comparisons, so extremely helpful, thank you.

 

[elbows]

This is that last witnesses expert report: INQ000257925 Report by Professor Thomas Hale, titled 'Expert Report for the UK Covid-19 Public Inquiry - Module 2:Oxford COVID-19 Government Response Tracker Evidence for UK Covid-19 Inquiry', dated 22 August 2023

This is a Royal Society report on a somewhat similar theme, which was referred to during the session: INQ000250983 - Report titled Covid-19: examining the effectiveness of non-pharmaceutical interventions from the Royal Society, dated 24 August 2023

 

[elbows]

The final witness last Wednesday was Mark Walport, who used to be government chief scientific advisor some years prior (the Vallance role) and has had a bunch of other roles including head of the UK Research and Innovation (it replaced the research councils in 2018) and he attended 54 SAGE meetings. Also part of the Royal Society so the second aforementioned report is linked to him.

What NPIs are is discussed, and then we have stuff like this on page 112-113 of Wednesdays transcript:

Q: Once it became apparent that this was a virus capable of causing death in large numbers as well as severe injury, all governments faced a terrible balance or dichotomy, which was the absence of the imposition of non-pharmaceutical interventions would likely lead to unconscionable numbers of deaths, but the imposition of non-pharmaceutical interventions against that background of ignorance, through no fault of government, would likely lead to terrible cost and damage?
A: That is absolutely correct, and so a very strong incentive for policymakers to slow the spread of infection. And of course the other thing at the beginning of this pandemic was that it was not known whether it would be possible to make a vaccine or what medical countermeasures might become available. But there's not only the direct consequences of the virus in terms of causing illness, but also the indirect consequences in terms of health systems becoming overwhelmed, the danger of the breakdown of other aspects of national infrastructure. And so every incentive to take quite a strong precautionary principle and do the very best possible to slow or, if possible, to stop the spread of infection. And some countries did take a zero Covid approach from very early on. In other words they tried to eliminate the spread.

Page 114:

Q: At the time of the commencement of the pandemic, was there much by way -- or any objective analytical information or research available to governments as to the likely effects or impacts of this broad range of non-pharmaceutical interventions?
A: Well, once it became clear, which it did fairly rapidly, that it was transmitted by a respiratory route, then there was a lot of evidence that if you could keep infected people away from uninfected people, that would reduce the transmission. So every reason to think that non-pharmaceutical interventions would be effective, but how effective was unknown.
Q: Was there a large or any body of randomised controlled trial work or analysis from empirical data as to how in practice any of these NPIs would work?
A: No. Minimal information, because so much depends on the transmissibility of the virus, and the details of the route of the transmission. So there was very, very little prior evidence.

Then they discuss the difficulties in obvtaining empirical evidence when first bringing in measures, and the Royal Society report doing a systematic review of the evidence later. And of note on page 117:

So we did the work in two parts, really, which was to try to work out as much as we could about each of the individual non-pharmaceutical interventions, but we also did a number of country case studies, because that gives you a different observational approach to what happens when things are done in combination. You can learn quite a lot from those.
Q: Were those three case studies in fact studies drawn from Hong Kong, New Zealand and South Korea?
A: That's correct.

Cherrypicking just a short partt of the comments on masks, page 120-121:

So there were 35 studies in community settings. Three of them were in fact randomised controlled trials, and there were 32 observational studies, and then were a further 40 studies in healthcare settings, one of which was a randomised control trial, and 39 observations.
The majority of those studies, the large majority, showed that the masks were effective. And importantly there was a gradient. In other words, respirator masks were more effective than surgical masks, and mask wearing in the context of a mandate, in other words an instruction with more or less legal force behind it to wear masks, was also more effective.
So, if you like, the plausibility of the results was emphasised by that gradient of effect. In other words, you might expect that a very -- you know, the sort of masks that you'd wear in a -- if you're exposed to
a dangerous toxin is much more likely to be effective than a loosely fitting mask.
I should qualify it by saying that there was information about mask wearing in other infections, and in fact there were evidence syntheses, and we've learned about flu as well. So it's not that there was no
evidence, but there was no evidence in relation to masks in coronavirus.