The SAGE files: Social distancing must stay until the virus is gone
The SAGE files: Local lockdowns may prompt attacks on the police, hairdressers could be Covid-19 hotspots and strict social distancing measures cannot go away until the coronavirus can be wiped out
- Only half of people acutally self-isolate if they have symptoms, scientists said
- Reopening pubs, restaurants and schools would speed up virus spread
- Lockdown rules should be stricter for people at high risk of dying of Covid-19
- Here’s how to help people impacted by Covid-19
Scientists have peppered the Government with warnings about lifting the coronavirus lockdown too soon, published secret advice papers have revealed.
A trove of around 50 scientific papers submitted to the Government were unveiled today laying bare the advice top researchers gave to ministers in April and May.
The Scientific Advisory Group for Emergencies (SAGE) has been warned that social distancing must be kept in place until the virus is gone and that returning to offices, hairdressers and nail bars could push the outbreak out of control again.
Papers warned that easing the lockdown region-by-region could lead to violent protests and tensions within the UK, but that different groups of people may face varying rules based on their risk of dying if they catch the disease.
The release of the documents – which SAGE committed to do for better transparency – comes as Prime Minister Boris Johnson this week announced the biggest lockdown changes so far.
Schools will start to reopen next week, along with some outdoor businesses, and people will be allowed to meet in groups of six outdoors.
But infection rates are still high in hospitals and care homes and SAGE papers suggest that up to 25 per cent of more patients are catching the virus inside hospitals.
Scientific advice put to the Government in SAGE papers revealed:
- Only around 50 per cent of people will actually self-isolate for a week if they have coronavirus symptoms;
- Regional lockdowns could increase tensions and risk violence, much of it directed at the police;
- Face masks are beneficial and scientists told officials two weeks before the public was given the advice;
- Test and trace will not be enough to stop the virus spreading – social distancing must carry on until the coronavirus can be eradicated;
- Up to 25 per cent of hospital patients diagnosed with the coronavirus caught it while they were being cared for;
- A policy of ‘social bubbles’ could have encouraged the spread of the virus by opening the door to ‘excessive’ social networking.
Lifting Britain’s lockdown in April would have led to more than double the number of deaths of lifting restrictions at the start of May, scientists predicted in the midst of the outbreak
Papers presented to SAGE suggest that it is possible for thousands of deaths per week to continue into and beyond August if the coronavirus situation is not handled well. In the past seven days 2,119 deaths have been declared by the Department of Health, putting Britain close to the worst case scenario on this graph
Regional lockdowns could trigger violence
Imposing lockdowns on a region-by-region basis wouldn’t work and could lead to a rise in attacks on the police, scientists warned.
Health Secretary Matt Hancock confirmed this week measures may be imposed on whole towns, if there are regional flare-ups of coronavirus cases.
But ministers were warned enforcing rules on certain regions ‘would not be suitable’ for the UK – despite its apparent success in China.
In one of the SAGE papers, two security experts said doing so may ‘undermine the consensus that has been built on the need for restrictive measures’.
Professor Clifford Stott, a social psychologist at Keele University, and another author whose name was redacted said enforcing lockdowns on a region-by-region basis may ‘lead to significant issue of disorder’.
Allowing sub-sets of the population to live normally ‘undermines’ the sense of ‘we are all in this together’ spirit, the pair said.
They added: ‘Geographical division of a large urban area in the UK will inevitably intersect with ethnic and socio-economic boundaries.
‘Those in lower socio-economic positions are more susceptible to the virus and therefore lockdown will be more likely in areas of poverty relative to wealth.
‘Anger arising from communities who perceive they have been locked down unfairly would be directed at police in the majority of cases.
This is particularly problematic in areas… whose populations traditionally have more difficult historical relations with police and could easily lead to escalations.’
Restrictions imposed in the UK so far have yet to lead to any conflict because they have been perceived as fair, the experts said.
They added: ‘Any sense of inequality… would likely lead to civil disorder and feed the propaganda of extremist groups and hostile states.
‘Households may also fear retaliation if cases within a neighbourhood prevent release and may conceal cases as a result.’
‘Not enough is being done’ to protect the vulnerable
Scientists raised concerns last month that not enough was being done to protect people most at risk of dying of Covid-19 and called for separate tiers of protections.
In a SAGE paper dated April 27, one of its sub-groups, SPI-M, raised concerns that the most at-risk groups of people were not being protected well enough.
It suggested that lockdown rules should not be loosened in a blanket fashion but should be designed to ‘de-couple’ outbreaks in the community and vulnerable places like care homes.
Experts in the group said: ‘SPI-M remains concerned that not enough is being done to protect those who are known to be at high risk of death if infected with COVID-19.’
The people at highest risk of dying if they catch Covid-19 are the very elderly and those with serious long-term health problems such as dementia, or people whose immune systems or lungs don’t function properly, such as cancer or transplant patients.
Those people are still being urged to ‘shield’ themselves by the Government – to avoid leaving home or having visitors – even as lockdown releases around them.
SPI-M’s paper suggested they may have to abide by social distancing rules for longer than other younger, lower risk sections of society, even if case numbers were low.
The statement added: ‘A low incidence scenario would still require risk-based variation in social distancing measures and careful shielding of parts of the population, although this would not need be as aggressive or have as high adherence rates necessary for a high incidence scenario.’
Hairdressers and nail bars are high risk
Hairdressers and nail bars could be coronavirus hot-spots, ministers were warned at the start of May.
Scientists feeding into SAGE claimed personal care businesses ‘could have levels of infection as high as those seen in social care’.
And the Scientific Pandemic Influenza Group on Modelling group warned it may lead to an increase in Covid-19 transmission in the community.
Mr Hancock yesterday said hairdressers will not reopen in the next fortnight, despite salons saying they are ready to open their doors in June.
The Health Secretary – who revealed his wife cuts his locks – would not commit to hairdressers being allowed to open their doors again on June 15.
In Europe salons are open already with everyone forced to wear masks, including customers, and dry cuts, magazines, hot drinks and even long chats banned.
Social distancing must stay until vaccine or cure is found
Social distancing cannot go away until the coronavirus can be wiped out, vaccinated against or cured, top scientists say.
Government advisers regularly remind the public social distancing is ‘here to stay’ but SAGE documents ram home how indispensable it is in the long term.
WHAT WAS DISCUSSED IN THE FIRST SAGE MEETING?
WHEN WAS IT HELD?
January 22 in Westminster – Britain recorded its first confirmed cases of coronavirus nine days later.
WHICH SCIENTISTS ATTENDED?
- Sir Patrick Vallance, Chief Scientific Adviser
- Professor Chris Whitty, Chief Medical Officer for England
- Charlotte Watts, Chief Scientific Adviser, Department for International Development
- Professor Jonathan Van Tam, Deputy Chief Medical Officer for England
- Carole Mundell, Chief Scientific Adviser, Foreign and Commenwealth Office
- Cathy Roth, Department for International Development
- Phil Blythe, Chief Scientific Adviser, Department for Transport
- Pasi Penttinen, European Centre for Disease Prevention and Control
- Maria Zambon, Public Health England
- Jim McMenamin, Health Protection Scotland
- Christine Middlemiss, Chief Veterinary Office, DEFRA
- Professor Neil Ferguson, Imperial
- Professor Peter Horby, Oxford
- Professor David Lalloo, LSHTM
- Sir Jeremy Farrar, Wellcome Trust
- Dr Ben Killingley, UCL
- Professor John Edmunds, LSTHM
- Dr James Rubin, King’s College
WHAT WAS THEIR UNDERSTANDING ABOUT THE VIRUS AT THE TIME?
There is evidence of person-to-person transmission.
The incubation period appears to be within five to 10 days.
It is ‘highly probable’ the reproductive number is currently above one.
The mortality rate for WN-CoV appears to be lower than for SARS.
No evidence to prove individuals are infectious prior to showing symptoms.
WHAT DID EXPERTS RECOMMEND AT THE TIME?
NERVTAG did not advise port of entry screening, despite not knowing much about the virus.
It also didn’t advise the use of screening questionnaires or requiring proof of exit screening at Wuhan.
SAGE said it would review its position on port screening only if a simple, specific and rapid test was available.
Temperature screening was unlikely to be of value and have high false positive and false negative rates, it said.
DID THEY DISCUSS GETTING A TEST READY?
The UK currently has good centralised testing capacity for Covid-19, which had yet to be named at the time, the experts claimed at the meeting.
And they claimed they were days away from having a specific test, which they said was scalable across the UK within weeks.
They warned of ‘conflicting reports’ of the accuracy of test samples taken from the upper respiratory tract, such as the nose and mouth.
SAGE agreed that only people who had symptoms and had returned from Wuhan in the past fortnight should be tested.
Even a highly effective test and trace system which has 100 per cent compliance from the public would not be enough to keep the R below 1 on its own, SAGE was warned.
The SPI-M group said that people must make long-term reductions to the number of people they meet up with outside of work and change how they do so.
In papers submitted in April and May the group warned: ‘Case isolation, household quarantine and app-based tracing, even with very high uptake levels, without some level of social distancing will not be sufficient to keep R below 1 on their own.’
It added: ‘Even with contact tracing in place, there will need to be sustained, deep reductions in contacts outside work and schools to keep the reproduction number below 1.’
Keeping the R below 1 is crucial for preventing a second wave.
The group said trying to restrict social distancing only to specific groups, such as the over-45s, would require ‘unrealistic’ proportions of people to agree to it. Applying it to everyone would see benefits with a lower level of compliance.
Rules expected to continue in the long-term could include keeping distance from other people (currently 2m/6’6′) and not having physical contact with people from outside your household.
The strictness of these would depend on the number of coronavirus cases being diagnosed in the population.
Herd immunity could develop in a year but thousands would die
One of the only ways to get rid of distancing measures without a vaccine or cure would be to try and develop herd immunity SAGE was told, but tens of thousands of people would die.
Herd immunity, in which so many people catch a virus that it struggles to spread any more, could work if it turns out people are unable to catch the illness twice.
For a brief period at the start of the outbreak the Government had considered trying to slow down the virus but let it keep going so that herd immunity would develop, but there was massive public backlash when it emerged thousands would die as a result.
In a paper submitted to SAGE in April, SPI-M said: ‘Maintaining a high incidence scenario [large number of infections] could allow measures to be progressively relaxed as population immunity developed.
‘It would, however, take around one year to allow all measures to be removed using such an approach, even if all infections resulted in an effective, long-lasting immune response.
‘Such a policy would result in tens of thousands of direct deaths from COVID-19 and it is unlikely that significant levels of population immunity could be achieved by autumn without ICU [intensive care units] being overwhelmed.’
Up to 25% of Covid-19 hospital patients catch virus during treatment
Up to a quarter of Covid-19 who need medical treatment caught the virus in hospital, government advisers warned.
And SPI-M told ministers the figure – compiled from ‘several sources’ – suggested this figure was ‘highly likely’ to be an under-estimate.
Scientists revealed their estimate, submitted on April 20, did not include people who acquire infection in hospital, leave and are then readmitted.
They called for an ‘urgent investigation’ into the true burden of healthcare-acquired infections.
And the experts suggested using some hospitals solely to treat Covid-19 patients, to reduce the rate of healthcare-acquired infections.
Their estimate took into account data from provided to the Department of Health on a weekly basis, as well as Public Health England figures.
It comes amid claims 40 per cent of staff at a Weston-super-Mare hospital that shut to new patients over a spike in Covid-19 have tested positive for the infection.
Separate studies have suggested up to three per cent of NHS medics on coronavirus front-line unknowingly had the virus in April.
It raised the possibility that NHS workers were spreading the disease to vulnerable patients without knowing, treating them while infectious.
Opening pubs, restaurants and schools would speed up viral spread
Scientists cannot say how lifting lockdown will affect the speed at which the virus is spreading but fear reopening pubs, restaurants and schools would allow it to spiral.
SPI-M warned in a paper on April 1 that the more time people spend indoors with one another, the more likely it is that a second wave of coronavirus would emerge.
The Government, as it releases lockdown restrictions, is desperate to keep the virus’s reproduction rate – the R – below 1, to make sure patients don’t infect any more than one other person each.
Lockdown has pushed the R to somewhere between 0.7 and 0.9 but releasing the rules too soon will allow it to spiral again.
SPI-M said: ‘Relaxing rules of the use of outdoor spaces, including working outdoors, is highly unlikely to make a significant direct difference to infection rates, as long as social distancing continues to be followed in this environment.
‘There is limited evidence on the effect of closing of non-essential retail, libraries, bars, restaurants, etc., but it is likely that R would return to above 1 and a subsequent exponential growth in cases.’
They said that allowing people outdoor exercise and supermarket shopping were likely to have little effect on the R rate.
And large gatherings are also unlikely to boost an outbreak because they account for so few of people’s personal contacts because they are attended infrequently.
But encouraging people to return to offices instead of working from home would likely have ‘the largest effect’ on the reproduction rate.
Fully reopening schools back to normal would also have a significant effect, the scientists said: ‘Lifting any of the other measures in place, including school closures are almost certain to return R to above 1’.
However, SPI-M admitted that it was difficult to assess the true impact of different lockdown measures on the speed the virus spreads.
The group added: ‘Measures have been introduced simultaneously or in quick succession, so their individual effects cannot be disentangled; self-imposed population behaviours may also complicate the picture.’
Terrorists could attack large gatherings while police short-staffed
Terrorists could carry out an attack on British soil while police forces are distracted by a lack of crime, experts warned.
In evidence submitted to ministers on May 4, behavioural scientists claimed it was ‘an opportunity’ for the UK to be rocked by an attack.
SPI-B claimed violent extremist organisations may launch an attack ‘as a means of signalling to the public that a group or issue has not gone away’.
The group also warned that permitting protests – currently restricted because of the Covid-19 crisis – could also be exploited by terrorists.
They said: ‘Lifting restrictions on assembly will permit protests against the economic effects of the lockdown, which will become more visible as time wears on.
‘It is at points such as this that one could expect exploitation by violent extremist organisations and intersection with protests in other countries as a result of emulation/common purpose or trans-European activism.’
In a separate paper, government advisers said data showed 999 calls for the police have dropped up to 75 per cent in some areas.
Experts said the trend suggests the lockdown has led to major reductions in crime across Britain, perhaps due to a ‘lack of opportunity’.
But they revealed there has been a spike in calls to the police for certain offences, such as domestic violence.
Social bubbles could lead to ‘excessive networks’ and risk spread
Allowing people to meet in bubbles could have enabled coronavirus to spread through the population, scientists suggested.
It was thought the roadmap to easing the lockdown contained the possibility one household could form a social ‘bubble’ with one other in a mutual group.
However as people are set to start meeting up outdoors in groups of up to six from Monday, there has been no mention of bubbles.
And Downing Street has warned the public that socially-distanced, six-people meet-ups remain prohibited in England until Monday.
Minutes from a SAGE meeting on May 7 disclosed what the experts had to say on the issue of bubbles.
They said that while the concepts of bubbles has potential benefits for wellbeing and mental health, there were also risks if they were to be introduced alongside other changes, or if there is poor adherence.
The minutes said: ‘The effects of bubbles are complex. Introducing bubbles alongside other changes could reconstruct excessive networks, particularly when combined with any increase in contacts in other settings.
‘These networks could enable transmission through the population. It will be difficult to assess the effects of individual policy changes on R if multiple changes are introduced together.’
SAGE added: ‘A safe approach to bubbles would need to include isolation of all members of a bubble in the case of one member showing symptoms.
‘This would lead to increased frequency of isolation for people, particularly in winter months.’
Face masks are protective when people can’t social distance
Scientists concluded there was enough evidence to recommend the use of face coverings weeks before ministers issued the advice.
Experts said on April 21 that the public should be advised to wear coverings when social distancing is not possible, but ministers in England did not issue the advice until May 11.
The SAGE panel, including chief scientific adviser Sir Patrick Vallance and chief medical officer for England, Professor Chris Whitty, discussed masks on April 21.
‘SAGE advises that, on balance, there is enough evidence to support recommendation of community use of cloth face masks, for short periods in enclosed spaces, where social distancing is not possible,’ they concluded.
Despite Scotland and Northern Ireland issuing the advice to wear coverings, ministers in England did not give the guidance until publishing the ‘plan to rebuild’ nearly three weeks later.
‘As more people return to work, there will be more movement outside people’s immediate household,’ they said.
‘This increased mobility means the Government is now advising that people should aim to wear a face-covering in enclosed spaces where social distancing is not always possible, and they come into contact with others that they do not normally meet, for example on public transport or in some shops.’
Only HALF of people with coronavirus symptoms self-isolate
Only about half of people with coronavirus symptoms self-isolate for an entire week, behavioural experts told SAGE.
The discovery raised concerns over whether future outbreaks can be prevented.
The disclosure of low compliance with a key rule in suppressing Covid-19 comes days before the lockdown is eased, with people being asked to isolate for 14 days even if they do not have symptoms.
Under the NHS test and trace programme, people in England will be told to quarantine themselves for two weeks if they come into contact with someone who has tested positive.
A document shows behavioural experts warning: ‘We strongly recommend monitoring and rapid research into adherence rates to all key behaviours and how to improve them, noting that based on DHSC tracker only around 50 per cent of people are currently reporting self-isolating for at least seven days when symptomatic with cough or fever.’
Their warning came on April 29 and an updated figure was not immediately available, but now people across the UK are beginning to be allowed to meet up outside, at a distance, and shops are starting to reopen.
Masks could make people ‘falsely reassured’ and ignorant of rules
Wearing a face mask could give someone a false sense of security that encourages them to flout other social distancing rules, SAGE was warned.
The Government declined for weeks to advise that people wear face masks, saying they were best reserved for medical workers.
But it now encourages people to use coverings – not medical grade masks – if they are in indoor spaces where social distancing is difficult, such as in busy shops or on public transport.
A document from SPI-B presented in April said: ‘There are a number of issues, risks and potentially harmful behaviours associated with recommending or mandating use of facemasks which could reduce their effectiveness.’
It said people might use them incorrectly or touch them, contaminating their hands, or make homemade masks that are ‘ineffective.
The group also warned: ‘People may feel falsely reassured by wearing facemasks and so pay less attention to other behaviours that reduce viral transmission e.g. wash their hands less, do not adhere to social distancing measures.’
90 per cent of care homes could experience outbreaks
Scientists said in April that ‘current trends’ suggested 90 per cent of all care homes could suffer from outbreaks of Covid-19.
The SPI-M group said in a statement on April 20: ‘There is evidence in continued growth in the number of care homes which have experienced cases of COVID-19.
‘Any estimates of the proportion of care homes which will eventually experience outbreaks is highly speculative at this stage, but a figure approaching 90 per cent cannot be ruled out if current trends are maintained.’
The statement came shortly the peak of the outbreak before a focus had really shifted on to care homes and testing was not widely available for staff or residents.
More than 11,000 people are now known to have died in care homes.
The proportion of homes that have had outbreaks is not clear, but bosses in the sector estimated it was around two thirds in April, while the Government’s estimate was considerably lower.
Russia ‘is watching and gathering intelligence’
SAGE was warned by SPI-B that Russia would be watching the attempts to set up a track and trace system and mobile app in a bid to find ways to gather data.
They said: ‘From an external security perspective, Russia will scrutinise all Western responses to Covid-19 as a significant intelligence gathering opportunity.
‘Responses to CV19 allow it to monitor different countries’ response measures, timings and effectiveness in a wartime-like scenario.
‘In particular they will examine planning and capabilities in response to a civil contingency/peacetime threat.
‘There will consequently be interest in how effectively the UK can mount a contact tracing campaign as well as attempts to exploit whatever deficiencies or public concerns there may be with it.’
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