Artillery Row

Would the UK have half the Covid deaths if Boris had “followed the science”?

“Professor Lockdown” argued against the one measure that really might have helped

Yesterday, Professor Neil Ferguson told the Science and Technology Select Committee in the House of Commons that if the Government had locked down a week earlier, the death toll would be less than half what it is now:

“The epidemic was doubling every three to four days before lockdown interventions were introduced.

So, had we introduced lockdown measures a week earlier, we would have reduced the final death toll by at least a half.”

But where’s the evidence that the number of people becoming infected was “doubling every three to four days” in the week running up to lockdown?

Numerous analyses – the latest by Simon Wood, a Professor at Bristol University, entitled “Did COVID-19 infections decline before UK lockdown?” – suggest the R number was <1 before the lockdown was imposed. Here’s one of Professor Wood’s graphs, showing the daily infection rate in the lead up to and immediately after lockdown (the red line).

Inferred daily infection rate for England and Wales. Light grey and dark grey regions show 95% and 68% confidence regions, respectively.

You can read more about Professor Wood’s paper in this blog post in the Spectator by Fraser Nelson.

The same conclusion was reached by Carl Heneghan, Professor of Evidence-Based Medicine at Oxford, who has long maintained that infections peaked shortly after the Government introduced a raft of social distancing measures on 16 March and were declining by the time the lockdown was imposed on 23 March. He told the Mail:

“The peak of deaths occurred on April 8th, and if you understand that then you work backwards to find the peak of infections.

That would be 21 days before then, right before the point of lockdown.”

Far from imposing the lockdown a week earlier, these data suggest it wasn’t necessary to impose it at all. Infections were falling before it was introduced and would have continued to fall, just as they did after peaking in those countries that didn’t impose a lockdown – like Sweden and Belarus – as well as those US states that avoided locking down. As numerous analysts have pointed out, the trajectory of the pandemic has followed almost exactly the same pattern in every country it’s afflicted, regardless of whether or not that country locked down, when it locked down or the severity of the lockdown it imposed.

Graph showing that the rise and fall of deaths in England and Sweden followed exactly the same pattern if you adjust for population size

The reason the media has seized on Neil Ferguson’s statement is because it fits the narrative that the UK’s high Covid death toll is due to Boris Johnson’s “dither and delay” at the beginning of the crisis. This was the narrative set in stone by a Sunday Times article on 23 May entitled: “22 days of dither and delay on coronavirus that cost thousands of British lives.” A key plank of that case is that the scientists advising the Government were urging the Prime Minister to impose a lockdown long before he did and if only he’d listened to them – to epidemiologists like Professor Ferguson – many unnecessary deaths could have been prevented.

But if you go through the minutes of the SAGE meetings immediately preceding the lockdown decision, there isn’t any evidence that the scientific attendees were urging the Government to impose more severe social distancing measures.

The former barrister Paul Chaplin has analysed these minutes in a lengthy blog post and concluded that placing the entire country under virtual house arrest was a political decision and not “based on the science”. His analysis is compelling.

Chaplin finds plenty of evidence in the minutes that various different containment measures were discussed by SAGE, but at no point before 23 March did the group recommend the quarantining of the whole population. The measures SAGE considered were home isolation of symptomatic individuals, the isolation of everyone in a symptomatic individual’s household for 14 days and the cocooning of those over 70 and those with underlying health conditions – the three measures introduced by the Government on 16 March.

At no point did SAGE discuss anything resembling a full lockdown. Indeed, SAGE noted at a meeting on 10 March that banning public gatherings would have little effect since most viral transmission occurred in confined spaces, such as within households.

The last SAGE meeting before the lockdown was on 18 March where it was noted that the impact of the social distancing measures introduced thus far would not be known for two or three weeks. The attendees did not at that stage know whether those measures would be sufficient to prevent the NHS’s critical care capacity being overwhelmed and in the absence of more data could not offer any advice on whether additional measures – such as closing bars, restaurants and entertainment centres, and limiting use of indoor workplaces – would be necessary.

The only further measure SAGE recommended at that meeting was closing schools.

“SAGE advises that the measures already announced should have a significant effect, provided compliance rates are good and in line with the assumptions. Additional measures will be needed if compliance rates are low.” – Minutes of the 17th SAGE meeting on COVID-19, 18 March 2020

The attendees discussed locking down London but no conclusion was reached. However, they did say that if additional measures were going to be necessary, it would be better to bring them in sooner rather than later. According to the minutes: “If the interventions are required, it would be better to act early.”

In other words, Boris Johnson and his Cabinet were not following “the science” when they took the decision to lock down the country on 23 March – they weren’t acting on any specific recommendations by SAGE – any more than they were ignoring the science by not locking down earlier. Nor can the Government claim this is one of the options that was discussed at SAGE meetings and it was basing its decision, in part, on SAGE’s analysis of the impact of a full lockdown. That option was not discussed at any of the meetings before 23 March.

This dovetails with Christopher Snowdon’s analysis of the decision-making in the period leading up to 23 March published in the Critic on 28 May, although Snowdon only had access to the broad summaries of the SAGE meetings that the Government has released at that point, not the more detailed minutes that were released on 28 May as a result of Simon Dolan’s lawsuit.

Snowdon concluded that the Government’s scientific advisors never explicitly recommended a lockdown; on the contrary, at various stages they recommended against it.

Snowdon says that even Neil Ferguson’s 16 March paper, predicting 510,000 Covid deaths if the Government took no measures to stop the spread of the virus and 250,000 if it stuck with its “mitigation” strategy, stopped short of recommending a full lockdown:

“Contrary to popular belief, the infamous study did not call for a full lockdown, nor did it model the effects of a full lockdown. It looked at school closures, social distancing and household quarantine for suspected cases and those living with them. It concluded that the greatest benefit would come from a combination of social distancing and household quarantine, with further benefits likely to come from closing schools, although it conceded that school closures would prevent many people from working.

There is no doubt that Ferguson’s model was impactful. It suggested that hundreds of thousands of people would die from COVID-19 if the Government continued to pursue a policy of mitigation. This put containment back on the table and gave legitimacy to more coercive action from Government, but the measures it recommended did not amount to a full lockdown. Its social distancing recommendations were far from trivial and yet they seem modest after nine weeks of genuine lockdown (the authors anticipated most people still going to work, for example). The only time Ferguson and colleagues use the word “lockdown” in the text is when they are making a distinction between their proposals and an actual lockdown. They implicitly dismiss a lockdown as being too extreme for the UK, saying that their favoured policies are “predicted to have the largest impact, short of a complete lockdown which additionally prevents people going to work.”

Snowdon’s conclusion is remarkably similar to Chaplin’s:

The founding myth of the lockdown is almost the opposite of the truth. Science did not triumph over politics on 23 March. It would be more accurate to say that the strategy which preceded the lockdown, unpopular though it now is, was based on science whereas the decision to go into lockdown was political.

I emailed Christopher Snowdon to see if he’d had a chance to look at the SAGE minutes and he said he had and they did indeed corroborate his analysis:

“The minutes fully support what I wrote in The Critic. The social distancing measures discussed by SAGE – and modelled separately by Neil Ferguson et al. and John Edmunds et al. – are not well described in the documents, but it is clear that they are more moderate than the lockdown that was introduced on March 23rd. Even at the late stage of mid-March, SAGE was never seriously entertaining a full lockdown, nor did the attendees expect their more modest measures to be in place for more than 12 weeks. To claim otherwise is to rewrite history.”

A reader of my website, LockdownSceptics.org, challenged this analysis, claiming that if you look at the minutes from SAGE 18, the meeting which took place on 23 March, the same day the full lockdown was imposed, it’s clear that the Government was “following the science” when it made that decision.

I took a look and don’t agree. As with the meeting of 18 March, there’s more stuff about not yet being able to assess the impact of the social distancing measures announced on 16 March, not much about them being insufficient: “SAGE noted that social distancing behaviours have been adopted by many but there is uncertainty whether they are being observed at the level required to bring the epidemic within NHS capacity.” However, there is some talk of the effectiveness of those measures: “Footfall in London transport hubs reduced by 80-90% over the weekend, but in retail and food outlets has decreased by a smaller margin.”

There is some other interesting stuff in there, however. For one thing, the attendees seem quite worried about the negative impact on public health of the measures already introduced. “Actuarial analysis is required to estimate deaths caused indirectly by COVID-19, including those caused by the social interventions,” says one of the minutes (is this the ONS data that was released on 5 June analysing excess deaths not involving coronavirus?). Another says: “Given the clear links between poverty and long-term ill health, health impacts associated with the economic consequences of interventions also need to be investigated.” And, “In due course, analysis of the effects of the interventions on other causes of death should be undertaken.”

There’s also some evidence that it was beginning to dawn on SAGE that COVID-19 is a predominantly nosocomial disease. There’s a reference to “nosocomial hospital clusters” and one of the action points is “NERVTAG and DSTL to investigate spread of COVID-19 in hospitals”.

Interestingly, the minutes also say that any restrictions on travel into the country “would have a negligible effect on spread”.

And that last minute points to one of the major shortcomings of the scientific advice the Government has received during this crisis. That is, at no point during the beginning of the pandemic did any of the members of the official scientific committees recommend that Britain introduce port-of-entry screening, when it could have actually been effective (unlike now).

The Newly Emerging Respiratory Virus Advisory Group (NERVTAG) considered screening passengers arriving from Wuhan at a meeting on 13 January chaired by Peter Horby, an Oxford professor with links to the World Health Organisation. This is the same Peter Horby who has criticised the Government for easing the lockdown too soon. At this point, seven other countries had introduced temperature screening at airports for visitors from Wuhan. However, the NERVTAG recommendation was that there would be no point in doing this if exit screening at Wuhan airports was already taking place, although they had no evidence it was.

The one intervention the Government could have made that really might have saved lives would have been to introduce port-of-entry screening in January. That’s something Neil Ferguson explicitly warned against

At the next NERVTAG meeting on 21 January, this one attended by Chris Witty and his deputy Jonathan Van-Tam, as well as Professor Neil Ferguson, the boffins were asked to reconsider the question. But again they passed the buck to the Chinese authorities. By now, human-to-human transmission had been confirmed. Nonetheless, NERVTAG’s response was the same.

“Neil Ferguson noted that from the modelling perspective, with exit screening in place in China, effectiveness of port-of-entry screening in the UK would be low and potentially only detect those who were not sick before boarding but became sick during the flight. NERVTAG felt there was a lack of clarity on the exit screening process in Wuhan, although it was thought that this process would be robust, and statements had been released by Chinese authorities about stopping febrile passengers from travelling. However, as noted, there were no data on the implementation of this programme.” – Minutes of the NERVTAG Wuhan Novel Coronavirus Second Meeting: January 21st 2020

So rather than recommend port-of-entry screening, the assembled brains at NERVTAG decided to trust to the Chinese authorities to screen people leaving the country.

That may count as one of the biggest blunders the British Government and its scientific advisers – notably Professor Ferguson – made. It’s a shame that none of the MPs questioning the Imperial Professor yesterday appeared to be aware of any of this. If they were, they could have pointed out that he was present at the meetings in January when a Government intervention really could have saved lives and recommended against it. Those countries that started screening airline passengers arriving from Wuhan in early January have some of the lowest Covid death tolls of anywhere in the world – Hong Kong (four deaths), Taiwan (7), Singapore (25), Malaysia (118), Thailand (58) and Vietnam (0).

Yesterday, Channel 4 News added its 10 cents to the case against Boris, bringing us what its Health and Social Care Correspondent, Victoria Macdonald, called an “exclusive”. This was the revelation that a member of the Scientific Pandemic Influenza Group on Modelling (SPI-M), Professor Steve Riley, produced a paper on 9 March saying that unless the Government imposed a full lockdown 1.7 million Britons would die over the next 18 months.

Macdonald acknowledged that she didn’t know if this paper had been circulated to SAGE, let alone shown to anyone in the Government, so it’s hardly a smoking gun.

But if it was circulated, the Government would have been right to dismiss it.

I haven’t seen Professor Riley’s paper, but assuming he was estimating that 80% of the country would be infected over an 18-month period, that means 53,600,000 would become infected. For that to result in 1.7 million deaths – the headline figure in the Channel 4 News report – the virus would have to have an infection fatality rate of >3.2% – higher, even, than the WHO’s initial estimate. If we assume the IFR Professor Riley was working with was 3.25%, that’s nearly 13 times the CDC’s current best estimate of the IFR, which is ~0.26%.

I’m amazed Professor Riley is sharing this forecast with Channel 4 News – if, indeed, that’s how Macdonald got her hands on it. If I was the author of that paper, I’d bury it in a nuclear waste facility at the bottom of the North Sea.

So to summarise:

  • Had Boris imposed the lockdown a week earlier it wouldn’t have made any difference to the subsequent Covid death toll since the R number was already falling by the time the lockdown was imposed. Neil Ferguson’s claim that infections were doubling every three or four days in the week leading up to the lockdown is evidence-free political point-scoring.
  • Nearly every robust comparative analysis of the rise and fall of the disease in different countries across the world has come to the same conclusion: the pattern is unaffected by whether or not a country imposed a full lockdown, when it imposed it, or how severe it was.
  • There is no evidence that the Government’s scientific advisors, acting in their official capacity as members of SAGE and its subgroups, advised the Government to impose a full lockdown before 23 March.
  • The one intervention the Government could have made that really might have saved lives would have been to introduce port-of-entry screening in January. That’s something Neil Ferguson explicitly warned against, preferring to rely on a Communist dictatorship to ensure the safety of the British people.

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