This is a really interesting read & quite revealing.
It would be interesting to know what SAGE members themselves would NOW consider to have been better strategies.
The reliance on evidence based decisions seems to have overtaken the need to press the pause button whilst unsure
It would be interesting to know what SAGE members themselves would NOW consider to have been better strategies.
The reliance on evidence based decisions seems to have overtaken the need to press the pause button whilst unsure
A series of question are listed to help shape what we can extrapolate from the SAGE documents released so far.
What barriers were there to safe decision making and to what extent were there tensions between risk takers and those who are risk averse?
Was there “group think”?
What barriers were there to safe decision making and to what extent were there tensions between risk takers and those who are risk averse?
Was there “group think”?
Fear of a large second epidemic especially in a community without immunity was clearly a driving force behind suppression decisions.
On 13 March (post Cheltenham) there was unanimity on complete suppression being a bad thing, leaving the population vulnerable.
On 13 March (post Cheltenham) there was unanimity on complete suppression being a bad thing, leaving the population vulnerable.
By 16 March, however, simple mediation measures were not seen as providing enough reduction to prevent the NHS being overwhelmed.
The focus of success seems to be preventing the NHS being overwhelmed rather than saving lives by preventing people getting there in the first place.
The focus of success seems to be preventing the NHS being overwhelmed rather than saving lives by preventing people getting there in the first place.
22/3/20 wide scale Isolation elsewhere had not lead to major public unrest. But even if lockeded down special attention needed for the population most at risk.
But what sort of attention?
But what sort of attention?
As for travel bans. It looks as if it was thought that only draconian travel bans would have the effect of buying significant time (15 days-1 month)
The internal spread of COVID was thought to be so significant by 23rd March that shutting airports unlikely to have much impact.
The internal spread of COVID was thought to be so significant by 23rd March that shutting airports unlikely to have much impact.
What is striking to me is there seems to have been little attention given to what could be achieved to shore up internal weakness in capacity and preparation IF 15 days - 1 month had been “bought”.
Who determined that test and trace could not be scaled up and isolation facilities prepared in that time.
We saw what could be done in building the Nightingales.
We saw what could be done in building the Nightingales.
What if this was delivered, but, rather than ICUs but as isolation centres for people who could not successfully self isolate/ needed light nursing?
What if equipment/ PPE/test/trace capacity had been expanded with a real will whilst keeping infections much much lower?
What if equipment/ PPE/test/trace capacity had been expanded with a real will whilst keeping infections much much lower?
What if the time was used to get much deeper understanding of where the fires were springing up and how the virus was transmitting?
After all it is novel.
It is as if there was no will to do that at all and I don’t understand the drivers for that
After all it is novel.
It is as if there was no will to do that at all and I don’t understand the drivers for that
I wonder to what extent the mistaken belief that asymptomatic transmission was low risk set in motion a whole chain of poor decision making.
It was mid Feb before that asymptomatic seen as a likely driver..and by that time the lack of travel bans had done their job.
It was mid Feb before that asymptomatic seen as a likely driver..and by that time the lack of travel bans had done their job.
More puzzling was why key figures in PHE did not see this as a high risk factor in care homes for months, not even weeks.
Mass events. This suggests that the facts of how specific mass event worked was poorly understood.
That they pour over into pubs and restaurants and homes
Mass events. This suggests that the facts of how specific mass event worked was poorly understood.
That they pour over into pubs and restaurants and homes
Cheltenham Race week is a case in point.
But public attitudes in response to actions seen elsewhere was seen to be an issue.
Not a poor grasp of what happens AROUND mass events. Public transport heaves. Town facilities stretch. Loos become very busy.
Door handles touched.
But public attitudes in response to actions seen elsewhere was seen to be an issue.
Not a poor grasp of what happens AROUND mass events. Public transport heaves. Town facilities stretch. Loos become very busy.
Door handles touched.
Yes. They HAVE drinking and eating venues at mass events too.
Ah. Care Homes. The first mention is 3rd March. That seems to be extraordinary...but the need for special measures was noted.
What special measures?
10/3:-Hospitals ALREADY identified as experiencing COVID sprad
Ah. Care Homes. The first mention is 3rd March. That seems to be extraordinary...but the need for special measures was noted.
What special measures?
10/3:-Hospitals ALREADY identified as experiencing COVID sprad
The minutes indicate an increasing concern building up through March and April, as well as a lack of data (Ha! Test and trace!).
Clear concern of the spread of COVID within hospitals putting patients at risk but a belief that deaths in the community relatively small
Clear concern of the spread of COVID within hospitals putting patients at risk but a belief that deaths in the community relatively small
We now know that the proportion of deaths in care homes was anything but small, even in April. But, hey, if you limit testing, how would you know? If GPs are willing to write other causes on the death certificate without a test, how can you be sure of the risks?
Lack of resources, uncertainty about the accuracy of swabbing seems to have built a rather hopeless attitude towards making this a kingpin around virus detection. Whilst there was talk of expansion it was far too slow especially without preemptive isolation and tracing (Vietnam)
And why so little tracing.
OK. I took in a sharp breath when I read PHE only had capacity for 5 cases a week because tracing lead to the isolation of 800 of EACH CASE, and could only be expanded to cope with 50 cases a week (8K contact isolations). @SamuelHorti
OK. I took in a sharp breath when I read PHE only had capacity for 5 cases a week because tracing lead to the isolation of 800 of EACH CASE, and could only be expanded to cope with 50 cases a week (8K contact isolations). @SamuelHorti
That is a completely decimated service from 10 years ago.
Was no thought given to turning to Local Government and environmental health for help? We need to understand because it was as if it was met with a collective shrug: “What can we do?”
Was no thought given to turning to Local Government and environmental health for help? We need to understand because it was as if it was met with a collective shrug: “What can we do?”
What commitment did the gov make or refuse to make?
WHY did the Committee think it was so hopeless so very early on?
What did the Government/Cummings offer?
What did the scientists and PH ask for and when?
The precautionary principle went out the window.
WHY did the Committee think it was so hopeless so very early on?
What did the Government/Cummings offer?
What did the scientists and PH ask for and when?
The precautionary principle went out the window.
We KNOW PPE shortage, specifically face masks and face shields/goggles had been raised with respective Governments over the years and as recently as 2019.
Of course the focus on flu and lock of knowledge about COVID19 transmission may have had an effect.
Why did nothing happen?
Of course the focus on flu and lock of knowledge about COVID19 transmission may have had an effect.
Why did nothing happen?
I cannot believe it was not discussed.
Does whoever draft the minutes of it stuff that might embarrass the Government?
I wonder if there were redactions?
How does this work?
Does whoever draft the minutes of it stuff that might embarrass the Government?
I wonder if there were redactions?
How does this work?
In April the use of masks by the general public was not seen as particularly efficacious by NERVTAG.
But what if transmission was pre-symptomatic or asymptomatic.
Why was that seen as a “what if” by April 7th given other countries had already flagged such transmission?
But what if transmission was pre-symptomatic or asymptomatic.
Why was that seen as a “what if” by April 7th given other countries had already flagged such transmission?
The greatest concern was that supplies to essential front line staff would be threatened.
Reconsideration when social distancing relaxed especially in enclosed spaces.
Reconsideration when social distancing relaxed especially in enclosed spaces.
Interestingly, even, home made cloth ones “should only be worn for short periods”. No explanation.
Nor anything much on sun bathing.
Nor anything much on sun bathing.
Herd Immunity...This makes interesting reading.
Quite significant repression methods were clearly discussed, from school closures, household and home isolation, working from home, protective isolation of at risk groups, but only in a limited way.
Disagreement within the group.
Quite significant repression methods were clearly discussed, from school closures, household and home isolation, working from home, protective isolation of at risk groups, but only in a limited way.
Disagreement within the group.
Building some level of herd immunity in the groups perceived to be least at risk.
And being careful how this is messaged to the public if the U.K. was to be seen as going it’s own way compared to its neighbours.
I’m not seeing the risks being highlighted much in Early march
And being careful how this is messaged to the public if the U.K. was to be seen as going it’s own way compared to its neighbours.
I’m not seeing the risks being highlighted much in Early march
More risks to the NHS capacity.
This is odd because we now know that Prof Ferguson had done a report by 2nd March spelling out the potential for a very high death risk (250k) with just mitigation.
SURELY this was discussed vigorously and at length.
Are the minutes doctored?
This is odd because we now know that Prof Ferguson had done a report by 2nd March spelling out the potential for a very high death risk (250k) with just mitigation.
SURELY this was discussed vigorously and at length.
Are the minutes doctored?
SURELY there were vigorous discussions about the HOW of discharge to care homes? Testing? Especially as it was realised early that there was spread of the virus within hospitals.
Did it not get discussed at all as a priority? And care home workers?
Did it not get discussed at all as a priority? And care home workers?
Not to mention access to oxygen and palliation and the lack of access to GPs?
I cannot believe this was not discussed at length.
Were GPs even represented on the Committee at all?
I cannot believe this was not discussed at length.
Were GPs even represented on the Committee at all?
Late lockdown. Suppression was seen only to delay the inevitable.
Focus on not overwhelming the NHS not saving life.
No sense of stalling as long as possible to try and develop treatments and vaccines. A sort of hopeless inevitability of the spread of the disease.
Focus on not overwhelming the NHS not saving life.
No sense of stalling as long as possible to try and develop treatments and vaccines. A sort of hopeless inevitability of the spread of the disease.
12th March (so just after the Cheltenham races) the idea from Imperial of “toggling” between suppression and relaxation was discussed and the likely need to keep it going for at least a years.
Is that the current plan? If so it certainly isn’t being discussed and explained.
Is that the current plan? If so it certainly isn’t being discussed and explained.
Where was the precautionary principle as a foundation stone of decision making discussed?
When was buying time to put preventative building blocks like extensive testing/ tracing/ effective isolation/ building knowledge about the virus/ development of anti virals/ vaccines?
When was buying time to put preventative building blocks like extensive testing/ tracing/ effective isolation/ building knowledge about the virus/ development of anti virals/ vaccines?
Where were the ethics of making one decision over another discussed?
I can’t help but feel there is much missing from these minutes.
But also missing is a sense of courageous ethical leadership centred around citizen well being.
I can’t help but feel there is much missing from these minutes.
But also missing is a sense of courageous ethical leadership centred around citizen well being.
