Given allegations about early UK response to Covid-19 I’ve been looking at minutes of the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG). This to the main Scientific Advisory Group for Emergencies (SAGE). The minutes can be found here app.box.com/s/3lkcbxepqixk…
Its chaired by Peter Horby of Oxford University. Professor Neill Ferguson of Imperial among its members. Clearly not the only advisory group meeting and not where decisions are taken but it has a lot of academic firepower and addresses some big question for the government.2/n
Before this crisis its previous meeting had been in June 2019 when it discussed a variety of influenzas. It first met on this crisis on 13 January and has since met regularly. The last published minutes are of a sub-group that met on 4 March 3/n
For anyone who thinks it was all obvious in January and February reading these minutes is a sobering experience. What comes over is the real uncertainty about what could be foretold from the Chinese experience and the ease with which the disease could be transmitted.4/n
The 13 January meeting, called at the request of DHSC, discussed the ‘Wuhan Novel Coronavirus’. The latest information from China was of 41 cases and one death. 5/n
The World Health Organisation (WHO) had reported that there had been no new cases reported since 3 January. This illustrates the unfortunate role played by WHO at this time in passing on official Chinese complacency. 6/n
Though members were keen for more diagnostic information, NERVTAG concluded on available evidence that ‘the novel virus does not look to be very transmissible’. The risk level internationally was put as ‘low/moderate’. Travel advice was endorsed for people visiting Wuhan. 7/n
By 21 January there were now 279 cases in mainland China with another 4 outside the country. There had been six deaths. There was no doubt of human-to-human transmission. 8/n
The first modelling from the Imperial College team estimated that there had been up to 2,500 cases in Wuhan but they still new little about the role of animals in transmission, infectiousness in relation to symptom onset, and whether asymptomatic patients were infectious.9/n
Risk of disease having wide impact was raised to moderate although the risk to UK still assessed as low. Discussion was largely about flights from Wuhan and whether people should be screened when leaving or asked to confirm had no symptoms (they were screened on departure). 8/n
sorry that 10/n
The DHSC asked if the advice would change with multiple outbreaks in Chinese cities. The response was that in those circumstances ‘it was unlikely that transmission to the UK could be prevented’. At best it could be delayed. 11/n
Messages were to be sent out to raise awareness of the issue in the health service. 12/n
A week later, 28 January, the virus had spread through China, and the first case had reached Europe (Germany). 13/n
There was evidence of transmission by asymptomatic individuals and that the virus was not behaving the same way as SARS in 2003. The case numbers appeared to be doubling every three to four days.14/n
The issues now being discussed in addition to travel advice (direct flights from Wuhan had stopped five days earlier) were about face masks and PPE. 15/n
Two days later, 30 January, NERVTAG met again. They now agreed on a clinical definition (cough, fever and shortness of breath) and began to discuss possible treatments and tests. 16/n
On 3 February they approved formal recommendations on hygiene and face masks and noted that social distancing might need to be considered. 17/n
By 21 February (six weeks ago) the situation was recognised to be more serious. China had shifted from counting cases that had been laboratory confirmed as well as those clinically diagnosed. 18/n
The Chinese number now was 75,465 cases with 2,236 fatalities. There were now 1,259 cases outside China with 11 fatalities (of which2 had been on the cruise ship Diamond Princess). 19/n
DHSC asked for modelling of the Reasonable Worst Case – what population could be infected, what proportion would be symptomatic, how many would require hospital care and respiratory support. 20/n
The Imperial Group undertaking this were still hampered by limited information from China. If children contributed to transmission up to 80 % of population would get infected in absence of intervention. 21/n
Evidence that 40 % cases were asymptomatic, case fatality rate outside of mainland China was 2-4% though in China much higher, possibly because only severe cases detected, perhaps 5% of the total. Older people were more vulnerable: younger people could get infected. 22/n
Surprisingly the risk assessment for the UK population was still moderate, although there was now a push for it to be moved to high. 23/n
At this time there were nine cases in the UK with no deaths, with 12 cases in France, and one death, an 80-year-old Chinese tourist. In Italy, whose terrible experience would soon transform attitudes, there were then 21 cases with the first death that day. 24/n
This group was one of number feeding into policy-making. Looking at its deliberations provides a reminder of how the seriousness of this pandemic only gradually came to be appreciated and how the national effort was hampered by uncertainty about the information from China. 25/n
We may wish that they had known then what we know now but they didn’t. My main point is that where the evidence is available we should at least examine it before passing judgement on those who were grappling with this crisis in that faraway time, a few weeks ago. End
Sorry about link. This is NERVTAG site
gov.uk/government/gro…
gov.uk/government/gro…
