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Nafeez Ahmed reveals how minutes from the NERVTAG estimated up to of 1.3 million fatalities from the Coronavirus as far back as 21 February.
Figures from the Government’s New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) reveal that, in late February, Government figures suggested that up to 1.3 million people could die in a “reasonable worst-case” scenario from the COVID-19 pandemic – yet no lockdown was declared until three weeks later.
NERVTAG is an expert committee of the Department of Health and Social Care (DHSC), which advises the Chief Medical Officer (CMO) and, through the CMO, ministers, DHSC and other Government departments. It is also part of the Government’s Scientific Advisory Group on Emergencies (SAGE).
On 16 March, ministers received advice from Imperial College modellers led by NERVTAG member Professor Neil Ferguson, who found that the Government’s stated approach at the time of simply ‘slowing’ the virus could result in as many as 250,000 deaths. The Imperial College paper had further warned that, in the absence of any control measures, an unmitigated epidemic in the UK would lead to 510,000 deaths in Britain.
It is widely believed that the formulation of these figures was the first time the Government had visibility of the catastrophic loss of life that could result from its own previous strategy. However, NERVTAG minutes dated 21 February reveal that, according to working assumptions at the time about the rate and deadliness of transmission provided to Government by its scientific advisors, anywhere between 833,313 and 1,333,330 Britons would potentially die.
Despite this, the Government did not pursue major social distancing actions for several weeks, allowing the Coronavirus to become endemic in the UK in that period. The NERVTAG minutes indicate that no advice had been sought from the scientific group on social distancing in that period up to the end of February.
I cross-checked these figures with Dr Deepti Gurdasani, a clinical epidemiologist and statistical geneticist at Barts and The London School of Medicine and Dentistry’s William Harvey Research Institute, Queen Mary University, and formerly a senior staff-scientist at the Wellcome Sanger Institute.
Dr Gurdasani, co-author of a new paper in The Lancet Global Health on how contact tracing could have suppressed the virus, told me that those large figures are “correct, based on their [NERVTAG’s] assumptions” at the time.
The NERVTAG minutes indicate that, in the Government’s reasonable worst-case scenario, some 80% of Britons would be infected with the virus. Of these, 50% would display illness, leaving 30% of the population asymptomatic – which accords to 37% of those infected.
At this time, NERVTAG’s estimation of the case fatality rate was 2.5-4% of people who become infected with COVID-19 and display symptoms. Applying that rate to NERVTAG’s figures indicates that, on 21 February, the Government’s scientific advisors’ own working assumptions suggested that between 833,313 and 1,333,330 could die in a reasonable worst-case scenario in the absence of action. These were the figures that NERVTAG had endorsed “for modelling purposes”.
‘Almost Certain there will be Sustained Transmission’
Despite this, there is no evidence from the NERVTAG minutes available up to the end of February that the group was ever asked about social distancing.
In fact, the only reference to social distancing was made on 3 February, when the meeting minutes indicate that NERVTAG is not “expected to comment” on the matter until possibly a later time: “JR [James Rubin] asked if there is a point about not attending school or work when ill? It was clarified that NERVTAG is not currently expected to comment on the question of social distancing at this time but could be asked this by DHSC at a later date”.
Yet the working assumptions about the virus discussed on 21 February did not prompt DHSC to ask the group about social distancing.
By 2 March, the Scientific Pandemic Influenza Group on Modelling (SPI-M) produced a consensus document describing estimates of transmission and fatality rates for the virus. The document shows that, at this time, the Government was told that the ‘Infection Fatality Rate’ – the number of people infected by COVID-19 who die – “is in the range of 0.5% to 1%, ranging from 0.01% in the under 20s to 8% in the over 80s”.
Applying the overall infection fatality rate to the expected 80% of people anticipated by NERVTAG to become infected, implied between 266,600 and 533,200 deaths. Those estimates are startlingly similar to the upper and lower bounds of the Imperial College model produced by Neil Ferguson and his team on 16 March – more than two weeks after this SPI-M analysis.
The SPI-M document also suggested a slightly revised case fatality rate (which would apply only to the number of symptomatic cases) of between 0.25 and 4%. As NERVTAG estimated some 50% of the population to become symptomatically infected, that put the lowest possible number of deaths at around 83,312, and the highest at 1.3 million, with considerable uncertainty – the final outcome likely depending on a range of other variables including healthcare facilities, intensive care unit (ICU) availability and so on.
The document also put forward a mortality rate of some 12% of those who are hospitalised. Once again, as NERVTAG was assuming that well over 4% of symptomatic cases (50% of the population) would result in hospitalisation, this indicated potentially more than 1.3 million people requiring hospital treatment. By SPI-M’s estimated 12% hospitalisation mortality rate, out of these, some 159,960 people would die.
The NERVTAG and SPI-M documents reveal that, based on their own working assumptions at the time, the Government and its scientific advisors were well aware of the risk of hundreds of thousands of deaths in the absence of a meaningful social distancing strategy, long before Imperial College publicly released its own modelling to this effect. This evidence was available to the Government as early as 21 February, some three weeks before a lockdown was finally declared, and became more refined by 2 March.
On that date, SPI-M’s consensus document warned: “It is highly likely that there is sustained transmission of COVID-19 in the UK at present. It is almost certain that there will be sustained transmission in the UK in the coming weeks.”
The question, then, is why did the Government refuse to introduce stronger social distancing measures until weeks later?
‘Feasibility of Effectiveness’
One answer might be provided by an earlier SPI-M document discussing behavioural interventions, dated 26 February – just five days after NERVTAG’s reasonable worst-case scenario indicated potentially 1.3 million deaths in the UK.
The document said: “It is a political decision to consider whether it is preferable to enact stricter measures at first, lifting them gradually as required, or to start with fewer measures and add further measures if required. Surveillance data streams will allow real-time monitoring of epidemic growth rates and thus allow approximate evaluation of the impact of whatever package of interventions is implemented. It will likely not be feasible to provide estimates of the effectiveness of individual control measures, just the overall effectiveness of them all.
“An additional strategy would be to apply more intense measures on those age or risk groups at most risk of experiencing severe disease (e.g. household isolation of those over 65, special measures around care homes). The majority of the population would the