SAGEGATE: Part Three Cummings & Johnson Defied Scientific Advisors By Lifting Restrictions Without Robust Track and Trace
The third part of Nafeez Ahmed’s investigation shows how public health was sacrificed to ideology as the lockdown was eased
Less than two weeks after social distancing restrictions were finally brought to help tackle the Coronavirus crisis, Boris Johnson’s Government tasked its Scientific Advisory Group on Emergencies (SAGE) to figure out how rapidly they could be lifted.
The SAGE documents I have delved into confirm that the Government was warned by SAGE in no uncertain terms that, if lockdown restrictions were eased too early without a robust ‘Test, Trace and Isolate’ system in place, this would lead to a resurgence of the virus, with a high risk of new deaths.
Throughout May, SAGE was preoccupied almost entirely by the Government’s goal of lifting restrictions. Doing so was described as “desirable” from both a behavioural and “economic” perspective.
On 1 May, SAGE called for the establishment of a national test and trace programme, and urged the Government to benchmark it against “best international experience”, citing South Korea and Germany as prime examples.
But, those countries’ test and trace programmes had been established months earlier – as early as late January. The SAGE minutes confirm that it had taken the UK Government nearly five months to decide that it needed to adopt such a scheme, during which it had actually abandoned contact tracing even as others were increasing its use.
“The ability to test and release contacts is desirable from a behavioural (and economic) perspective,” the minutes read. “However, there is currently insufficient evidence as to how this could be done effectively.”
Wilful Blindness Over Track and Trace
In reality, there was no lack of evidence on testing and tracing. Plenty of it had long been available from other countries’ best practice strategies – the Government had simply failed to ask SAGE to obtain it.
The documents shows that the Foreign Office and Cabinet Office were only requested at this meeting to compare “international test and trace strategies” and that a paper would be produced for SAGE’s consideration by the end of the week.
The fact that this knowledge was not already available to the Government is astonishing. Nearly half a year into the pandemic, the Government had neglected the only approach with the potential to suppress the Coronavirus.
SAGE insisted that the Government should wait to allow infections to get to their lowest possible point before lifting restrictions – which it did not do.
SAGE’s new emphasis on testing was put to the Government repeatedly with vigour and urgency. The idea of “app-based tracing” was also touted and it is clear from the minutes that SAGE was being asked to take into account “modelling” to explore how a contact tracing app might work alongside manual tracing.
Notably, both the Prime Minister’s chief advisor Dominic Cummings and Cummings’ advisor Ben Warner were present at this meeting.
This is significant as the latter is the brother of Marc Warner, co-founding chief executive of Faculty AI. The previous month, Faculty had been contracted to build the Python interface for the Oxford University model that would underpin the design of the NHSX contact tracing app.
For the rest of the month, SAGE kept warning the Government that the drive to rapidly ease restrictions was fraught which tremendous risks that, if done without a proper national test and trace programme, would inevitably see a resurgence in the virus and new waves of death.
Despite this, the test and trace system the Government went on to establish was simply not fit for purpose – and restrictions were lifted anyway.
As early as 5 May, SAGE warned that a “more extensive relaxing of measures across a range of areas” is “highly likely to push R above one (high confidence)”. R is the ‘reproduction number’ and designates the number of people each newly infected individual is likely to infect in turn. SAGE also noted that “effective monitoring” at the “local level” is needed to “identify and respond to any outbreaks”.
Yet, as the June-July COVID-19 outbreak and lockdown in Leicester demonstrated, the Government has failed to build local guidelines, capacity and legislative authority for monitoring and rapid response at the local level.
SAGE Insists on Contact Tracing
Government officials who became regular fixtures at the SAGE discussions from 5 May onwards included Ben Warner and the Treasury’s Deputy Chief Economic Advisor Vanessa MacDougall.
MacDougall’s primary function is to advise the Government on how to improve economic growth and productivity. Her attendance at all the ensuing SAGE meetings about easing restrictions directly suggests that the Government’s lockdown exit strategy was driven by economic considerations, rather than public health concerns.
Perhaps that is why the Government appears to have ultimately ignored SAGE’s consistent advice.
On 7 May, SAGE provided its initial assessment of the Government’s ‘bubbles’ strategy – the idea that households could begin tentatively meeting other households.
The plan would be to allow more complex and different types of ‘bubbles’ as a way of easing restrictions. But SAGE was sceptical. “Introducing bubbles alongside other changes could reconstruct extensive networks, particularly when combined with an increase in contacts in other settings,” it said. “These networks could enable transmission through the population.”
In future meetings, SAGE continued to underscore the necessity of a robust test and trace programme before easing restrictions, including the capability for “extensive and rapid testing”, particularly for those “at highest risk” of infection and transmitting the virus to others.
During this period, the Government established a new agency, the Joint Biosecurity Centre (JBC), to support local monitoring and rapid response. While SAGE welcomed the development, it noted that it “remains concerned about the lack of a monitoring and test, trace, and isolate system in place”.
By mid-May, SAGE’s advice to the Government on the lifting of lockdown restrictions was unequivocal: restrictions should not be eased without a proper test and trace system in place that would enable rapid, targeted, local responses to potential outbreaks.
“Active contact tracing should be a pre-condition of introducing bubbling,” it warned. Social bubbles can “create significant unwanted effects”, particularly in the short-term. Further easing of restrictions should not be done without “effective outbreak surveillance and test and trace systems”.
These systems were supposed to be supported by the JBC, but it lacked capacity and expertise on “how to identify local outbreaks, the required pace of testing, what NPIs [non-pharmaceutical interventions] could be implemented in response (and how quickly), public messaging, the potential for outbreaks undefinable by local geography… and variation in regional capacity”. To help with this, SAGE was ready to offer “ongoing rapid support and advice to JBC”.
It is not at all clear whether the JBC ever acquired these desired capabilities in any meaningful way.
Getting the Right Answer
By 19 May, SAGE had doubled-down on its call for better systems to be in place before lockdown restrictions were eased.
It noted that “an effective Test, Trace, and Isolate system will be necessary (but not sufficient on its own) to allow further substantive adjustments to distancing measures without pushing R above one”. Other measures needed would include hand hygiene, hand sanitising points, face coverings, alongside other “supporting systems and infrastructure”.
SAGE also set out its reasonable worst-case scenario for lifting the lockdown: easing restrictions from 1 June would push R to 1.7 for four weeks. The reversal of this easing would bring down R to 0.7, before it “returns to 1 for the rest of 2020”. The scenario was based on assuming that multiple systems would fail, such as the “failure to quickly identify increasing incidence and failure to respond in a timely manner”.
Today, compelling evidence shows that the Government’s test and trace system is a shambles.
The Independent SAGE group led by former government Chief Scientific Advisor Sir David King has said that the current system fails to detect as much as 80% of contacts of an infected individual because it uses a top-down “centralised” system rather than a “local-first” approach.
The Cabinet Office was clearly not happy with SAGE’s worst-case scenario. SAGE had been asked by the Government to review it ‘again’.
The Government has also refused to invest in building local public health infrastructure and decentralised capacity to support a viable national test, trace and isolate system. Instead, it has opted to dish out contracts to giant conglomerates with no relevant track record, such as Deloitte – with disastrous public health consequences. Under Deloitte’s Government contract, for instance, the company is not even required to report positive test data to Public Health England or local authorities. What, then, is the point?
But the Government has always known that a viable test and trace programme would have to be based on local capacity. On 21 May, SAGE issued its most serious and prescient warning about the Government’s approach to lifting restrictions.
Due to the challenge of scaling-up local capacity, SAGE again urged the Government not to rush into easing restrictions: “If the test, trace and isolate (TTI) system begins operating when there is a relatively high level of incidence and prevalence of COVID-19 in the population, the system could very rapidly become overwhelmed.”
The Cabinet Office was clearly not happy with SAGE’s worst-case scenario. SAGE had been asked by the Government to review it “again”, but came back reiterating that the model “predicts a rise in R to 1.7 due to a lack of rapid detection of increased incidence in the population”.
SAGE called for “flexible localised capacity planning” within the NHS to enable public health responses to a rise in R and then warned that, without that capacity in place, “other scenarios, such as a rise in R to 1.2, could be more difficult to detect and, over time, lead to a gradual increase in hospitalisations and deaths”.
The group went on to make clear that opening schools would also increase the risk of driving up the epidemic: “Either social bubbling or opening both primary and secondary schools had the potential to recreate significant transmission networks, which would have a large effect on the epidemic.”
Similarly, opening up retail would require significant environmental changes such as distancing, hygiene measures, ventilation, along with strong “enforcement mechanisms” to ensure compliance.
SAGE also anticipated that botched messaging around lifting restrictions would signal to the public that social distancing was no longer important.
Without appropriate messaging, “multiple, simultaneous changes to current restrictions” could lead people to stop adhering to remaining measures, which would have “large, unintended, negative consequences”.
Finally, SAGE insisted that the Government should wait to allow infections to get to their lowest possible point before lifting restrictions – which it did not do: “The lower the number of infections at the point when measures are lifted, the better this would be in terms of managing the epidemic.” This would create a situation of “fewer people being infected, becoming ill and dying”. If, however, the contact testing and tracing system is overwhelmed this would require “re-imposition of significant NPIs” to regain control of the epidemic.
Fools Rush In
In its rush to reopen the economy, the Government ignored precise and urgent warnings from its own scientific advisors.
This included ditching the two metre distancing recommendation, despite SAGE’s advice in early June to uphold “at least 2m separation where possible… Current evidence suggests that 1m separation carries 2-10 times the risk of 2m separation”.
The SAGE minutes suggest that the continued inadequacy of the test and trace infrastructure may end up locking Britain into an approach that oscillates between the new ‘reasonable worst-case scenario’ – R remaining at or shortly above one for the rest of the year and dipping just below one.
As analyst Mark Thomas of The 99% Organisation has argued from preliminary modelling of these scenarios, they would mean that COVID-19 deaths continue well into 2021 amidst periodic but belated local lockdowns with a fatality rate between 110,000 and 250,000 people over a longer duration.
This will mean the country never really emerges out of lockdown, businesses continue to suffer, and the Coronavirus continues to run through the population and kill people – all because the Government refuses to attempt to decisively stamp it out.
Sacrificed on the Altar of Ideology
This investigation has brought some clarity to our understanding of how the Government has presided over the worst British public health catastrophe since the 1918-20 flu pandemic.
The Government delayed social distancing for as long as possible, then lifted restrictions as soon as it could – all without ever intending to try to eradicate the virus.
This dovetailed consistently with economic modelling commissioned by the Government external to SAGE, but which clearly played an instrumental role in its COVID-19 strategy.
The Government failed to properly research and model the details of social distancing as well as the panoply of test, trace systems until months into the pandemic. One of the reasons it did so, it seems, is because of a macabre fascination on the part of some officials and advisors with the notion of ‘herd immunity’, despite a complete lack of scientific evidence on its viability.
The Government rode roughshod over scientific advice warning ad nauseum that lifting restrictions too early, too quickly, and without locally-rooted national test and trace capabilities in place, would restart transmission of the Coronavirus and sleepwalk the country into a renewed slow-burn public health disaster.
Instead, the Government has continued to privilege centralised cronyism and excessive privatisation, whilst refusing to invest in the decentralised local capacity that has been proven to work in best-case examples such as South Korea and Germany.
At key points in these processes, particular individuals stand out for their involvement in SAGE meetings at which some of the most pivotal decisions were discussed: Dominic Cummings, Ben Warner and Vanessa MacDougall.
This has all been justified by the Government by its claim that it simply ‘followed the science’. In reality, the Government was cherry-picking and manipulating the science to pursue an incoherent chopping and changing of strategies, with no real scientific foundation at all – beyond the overriding assumption that protecting the economy would require sacrificing public health, or vice versa.
The irony lost on the Prime Minister’s A-team of herd immunity fantasists is that it is their own abject incompetence that has sacrificed both the economy and public health on the altar of laissez-faire ideology.
Parts One and Two of this investigation can be read here:
what the papers don’t say
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