Spursex
Alert Team
Part III
Symptomless transmission
The issue of asymptomatic transmission - and ministers’ lack of knowledge of it - has been cited by Mr Johnson almost every time he is asked about why Covid was able to spread in the UK.
It is a narrative that has gone largely unchallenged, yet some scientists on Sage did try to raise the alarm.
On Jan 28 Sage noted that “there is limited evidence of asymptomatic transmission, but early indications imply some is occurring”.
Then on Feb 21 last year the Italian village of Vo’Euganeo near Venice went into quarantine after the country’s first recorded death from Covid, and almost all of its residents were tested for the virus.
Around 40 per cent of those who tested positive were asymptomatic, strongly suggesting asymptomatic transmission was occurring.
Members of Sage were so struck by the findings that they raised them with the Chief Scientific Adviser, Sir Patrick Vallance, and with Prof Ferguson, only for their concerns to be dismissed.
One scientific adviser said: “Neil Ferguson’s response was that it doesn’t really make that much difference to the models, which seemed a bit strange, because it certainly made a bloody big difference.”
Tests on passengers on the Diamond Princess cruise ship in Japan, where hundreds of people became infected and were quarantined, including Britons as seen in the video below, also raised questions in February about whether the virus was being transmitted asymptomatically.
The European Centre for Disease Prevention and Control recommended that the new virus be treated like Middle East Respiratory Syndrome, telling health bodies such infections “may be asymptomatic” and should be diagnosed with polymerase chain reaction (PCR) tests.
The centre said the virus could potentially be transmitted through “aerosols” - in other words breath - and stressed the importance of contact tracing in order “to implement timely control measures like isolation or quarantine as appropriate”.
It turned out to be good advice, but at their Jan 28 meeting Sage decided to disregard the European centre's recommendation and instead said the Department of Health and Social Care should “use existing planning assumptions for an influenza pandemic to develop a reasonable worst case for [Covid-19] in the UK”.
It meant that government departments followed the pandemic response set out by Exercise Cygnus, effectively flicking a switch that turned on the policy of mitigation rather than prevention.
As one scientific adviser put it: “Flu becomes a metaphor for ‘it's an uncontrolled surge and you can't contain it any more’.”
Worst-case scenarios
By late February predictions of up to 500,000 deaths were making headlines, but even this was not the worst-case scenario presented to ministers.
“We were told early on, when we weren’t sure of the mortality rate, that there could be 830,000 deaths over a seven-week period,” said one Cabinet source.
“The normal death rate is 600,000 per year and we were having conversations about whether we were going to have to live with that figure going up to 700,000 deaths a year if this became endemic.”
Ministers could be forgiven for casting a sceptical eye over startling predictions; in 2005, for example, Prof Ferguson warned that bird flu could kill 200million people worldwide, when the true death toll turned out to be fewer than 300.
“In public Matt Hancock and others were saying we were well prepared because we had dealt with similar things before,” said one senior MP, “but privately they were saying they didn’t think it was going to come here in any major way.”
Another source said: “We were being told there could be 830,000 deaths and at the same time we were being told that if we locked down too tightly and too quickly we would push the second wave to Christmas where it would be even worse, so you can see how difficult the decisions were.”
Secrecy was also the order of the day in those first months. Mr Hunt said: “If Sage’s advice to ministers had been published contemporaneously it would have effectively been peer-reviewed straight away and we probably would have come to the conclusion we ultimately did come to much sooner.”
But outside Sage’s meetings, the wider scientific community had no idea of the course that was being followed. The idea of flu being the main pandemic threat is so ingrained in Government that the Sage sub-groups responsible for modelling and behaviour - SPI-M and SPI-B - contain the word influenza in their names, as Scientific Pandemic Influenza groups.
In mid-March, Sir Patrick spoke of the need “to build up some degree of herd immunity” which would mean that “probably 60 per cent” of the population would have to get the virus.
One health source said: “He was talking about herd immunity because that’s what you do with flu. What’s been forgotten in all of this is that herd immunity was what Sage wanted at the beginning.”
One senior MP said: “They definitely had a view early on that allowing it to spread to build up immunity was necessary. They were saying privately ‘this is going to be like chickenpox, we are probably all going to have to get this’.”
Sir Patrick later denied herd immunity had ever been the preferred policy of Sage, and it was never taken up by the Government.
The political dimension
What of the allegation that the Government was too distracted by politics to realise the danger of coronavirus?
Covid was initially seen as largely a matter for the Foreign Office and the Department of Health, with confirmed cases on British soil remaining in double figures throughout February, with no confirmed deaths.
Downing Street was fully focused on implementing the manifesto plans that had earned Boris Johnson an 80-seat majority less than a month earlier.
Brexit finally happened on Jan 31, and after that the talk was of levelling up. Mr Johnson was also plotting a reshuffle which was to take place on Feb 13, and included the unexpected resignation of Sajid Javid as chancellor.
One member of Mr Johnson’s team said: “Maybe with hindsight the Prime Minister and his team know they should have delved deeper into this at an earlier stage. But everyone can be a professor of hindsight and there was nothing in those early days to suggest where we were going to end up.”
Symptomless transmission
The issue of asymptomatic transmission - and ministers’ lack of knowledge of it - has been cited by Mr Johnson almost every time he is asked about why Covid was able to spread in the UK.
It is a narrative that has gone largely unchallenged, yet some scientists on Sage did try to raise the alarm.
On Jan 28 Sage noted that “there is limited evidence of asymptomatic transmission, but early indications imply some is occurring”.
Then on Feb 21 last year the Italian village of Vo’Euganeo near Venice went into quarantine after the country’s first recorded death from Covid, and almost all of its residents were tested for the virus.
Around 40 per cent of those who tested positive were asymptomatic, strongly suggesting asymptomatic transmission was occurring.
Members of Sage were so struck by the findings that they raised them with the Chief Scientific Adviser, Sir Patrick Vallance, and with Prof Ferguson, only for their concerns to be dismissed.
One scientific adviser said: “Neil Ferguson’s response was that it doesn’t really make that much difference to the models, which seemed a bit strange, because it certainly made a bloody big difference.”
Tests on passengers on the Diamond Princess cruise ship in Japan, where hundreds of people became infected and were quarantined, including Britons as seen in the video below, also raised questions in February about whether the virus was being transmitted asymptomatically.
The European Centre for Disease Prevention and Control recommended that the new virus be treated like Middle East Respiratory Syndrome, telling health bodies such infections “may be asymptomatic” and should be diagnosed with polymerase chain reaction (PCR) tests.
The centre said the virus could potentially be transmitted through “aerosols” - in other words breath - and stressed the importance of contact tracing in order “to implement timely control measures like isolation or quarantine as appropriate”.
It turned out to be good advice, but at their Jan 28 meeting Sage decided to disregard the European centre's recommendation and instead said the Department of Health and Social Care should “use existing planning assumptions for an influenza pandemic to develop a reasonable worst case for [Covid-19] in the UK”.
It meant that government departments followed the pandemic response set out by Exercise Cygnus, effectively flicking a switch that turned on the policy of mitigation rather than prevention.
As one scientific adviser put it: “Flu becomes a metaphor for ‘it's an uncontrolled surge and you can't contain it any more’.”
Worst-case scenarios
By late February predictions of up to 500,000 deaths were making headlines, but even this was not the worst-case scenario presented to ministers.
“We were told early on, when we weren’t sure of the mortality rate, that there could be 830,000 deaths over a seven-week period,” said one Cabinet source.
“The normal death rate is 600,000 per year and we were having conversations about whether we were going to have to live with that figure going up to 700,000 deaths a year if this became endemic.”
Ministers could be forgiven for casting a sceptical eye over startling predictions; in 2005, for example, Prof Ferguson warned that bird flu could kill 200million people worldwide, when the true death toll turned out to be fewer than 300.
“In public Matt Hancock and others were saying we were well prepared because we had dealt with similar things before,” said one senior MP, “but privately they were saying they didn’t think it was going to come here in any major way.”
Another source said: “We were being told there could be 830,000 deaths and at the same time we were being told that if we locked down too tightly and too quickly we would push the second wave to Christmas where it would be even worse, so you can see how difficult the decisions were.”
Secrecy was also the order of the day in those first months. Mr Hunt said: “If Sage’s advice to ministers had been published contemporaneously it would have effectively been peer-reviewed straight away and we probably would have come to the conclusion we ultimately did come to much sooner.”
But outside Sage’s meetings, the wider scientific community had no idea of the course that was being followed. The idea of flu being the main pandemic threat is so ingrained in Government that the Sage sub-groups responsible for modelling and behaviour - SPI-M and SPI-B - contain the word influenza in their names, as Scientific Pandemic Influenza groups.
In mid-March, Sir Patrick spoke of the need “to build up some degree of herd immunity” which would mean that “probably 60 per cent” of the population would have to get the virus.
One health source said: “He was talking about herd immunity because that’s what you do with flu. What’s been forgotten in all of this is that herd immunity was what Sage wanted at the beginning.”
One senior MP said: “They definitely had a view early on that allowing it to spread to build up immunity was necessary. They were saying privately ‘this is going to be like chickenpox, we are probably all going to have to get this’.”
Sir Patrick later denied herd immunity had ever been the preferred policy of Sage, and it was never taken up by the Government.
The political dimension
What of the allegation that the Government was too distracted by politics to realise the danger of coronavirus?
Covid was initially seen as largely a matter for the Foreign Office and the Department of Health, with confirmed cases on British soil remaining in double figures throughout February, with no confirmed deaths.
Downing Street was fully focused on implementing the manifesto plans that had earned Boris Johnson an 80-seat majority less than a month earlier.
Brexit finally happened on Jan 31, and after that the talk was of levelling up. Mr Johnson was also plotting a reshuffle which was to take place on Feb 13, and included the unexpected resignation of Sajid Javid as chancellor.
One member of Mr Johnson’s team said: “Maybe with hindsight the Prime Minister and his team know they should have delved deeper into this at an earlier stage. But everyone can be a professor of hindsight and there was nothing in those early days to suggest where we were going to end up.”