APPENDIX 2

COBRA, SAGE, NERVTAG and other committees, advisory bodies and organisations

 

COBRA

The purpose of a COBRA meeting is to discuss high-level co-ordination and decision-making in the face of a crisis, according to the Institute for Government (see below).

The crisis could be a range of things, including natural disasters, terrorist attacks, major industrial accidents and, as coronavirus has demonstrated, threats to public health.

The Institute for Government says that COBRA’s purpose is to “keep ministers appraised of the situation, to ensure that the wider response of the government is co-ordinated, to record and disseminate key decisions and updates to all relevant ministers and officials, and to provide ministers and the prime minister with up to date information on the situation for any decisions that they may need to make”.

COBRA is an acronym (sort of) for a series of rooms in the Cabinet Office in 70 Whitehall and is sometimes referred to as COBR, which stands for: Cabinet Office Briefing Room. The A is believed to stand for briefing room A, although room F was the one most commonly used when the first meetings were held.

While COBRA refers to that set of rooms in the Cabinet Office, the term actually refers to the “Civil Contingencies Committee”, which is the group of people who meet inside the rooms to discuss various issues.

Thus, the expression “COBRA is meeting” really means “members of the Civil Contingencies Committee are convening in the Cabinet Office”. The term was born when an emergency situation centre was developed for the government to review its response to the 1972 miners’ strike.

There is no fixed register for who should attend a COBRA meeting; attendance depends on the issue to be discussed and is usually made up of officials and agency personnel, alongside ministers from relevant departments and agencies.

Meetings are normally chaired by the most senior and/or most relevant minister in the room, plus the prime minister.

The Prime Minister, Boris Johnson, attended the COBRA meeting on 9th March, the first he had attended on the coronavirus (missing five earlier meetings), when confirmed cases of COVID-19 had gone past 300 and known deaths were four. England’s chief medical officer, Professor Chris Whitty, and the government’s chief scientific adviser, Sir Patrick Vallance, were also there.

It was announced after the 9th March meeting that the UK remained in the “containment phase” of the outbreak, which would be followed by the “delay phase” when the aim was to slow the spread of the virus, reducing the impact and pushing it away from the winter season.

 

The Institute for Government

The Institute for Government is a think tank (in its own words, the leading think tank) working to make government more effective.

It says: “We provide rigorous research and analysis, topical commentary and public events to explore the key challenges facing government. We offer a space for discussion and fresh thinking to help senior politicians and civil servants think differently and bring about change.

The institute is a company limited by guarantee and a registered charity in England and Wales with cross-party governance. The main funder is the Gatsby Charitable Foundation, one of the Sainsbury Family Charitable Trusts, which contributed initial funding of £15 million in 2008.

The charitable objectives of the Institute are:

• The advancement of education in the art and science of government in the UK for the benefit of the public and on a non-party political basis;

• The promotion of efficient public administration of government and public service in the UK by providing programmes of education, training, research and study for the public benefit and on a non-party political basis.

“Our research,” it says, “focuses on the big governance challenges of the day and on finding new ways to help government improve, rethink and sometimes see things differently.

“Our inspirational learning and development programme provides a range of opportunities to help ministers, senior civil servants and their teams to govern and lead more effectively; and to help ministers, special advisers and top officials to develop further the skills and behaviours required to govern effectively, and to help opposition parties to become better prepared for political transitions and government.”

The institute is led by a board comprising (in July 2020): Lord David Sainsbury of Turville (chairman), Baroness Valerie Amos, Sir Andrew Cahn, Sir Ian Cheshire, Miranda Curtis, Lord Simon of Highbury, Baroness Susan Kramer, Sir Richard Lambert, Sir David Lidington, Jonathan Slater and Sir Paul Tucker. Then comes a group of directors, led by Bronwen Maddox and including Dr Hannah White (deputy), Emma Norris (research), Nick Davies (programme director), Gavin Freeguard (head of data and transparency and programme director), Alex Thomas (programme director), Dr Gemma Tetlow (chief economist), Pauline Joy (finance and resources), and Sam Macrory (communications and marketing).

Income in the year ended 31st Match 2019 was £4.75 million, the bulk from the Gatsby Charitable Foundation, and it spent £4.87 million, staff costs accounting for £2.82 million of that.

 

SAGE

SAGE is the Scientific Advisory Group for Emergencies which “provides scientific and technical advice to support government decision makers during emergencies”. SAGE also uses advice generated by the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), a group that “advises the government on the threat posed by new and emerging respiratory viruses”.

After accusations of secrecy and a lack of transparency, the Government Office for Science eventually published – on 29th May – the minutes from SAGE meetings 1 to 34, from January to the beginning of May. The minutes, which for the early meetings referred to the “Wuhan Virus”, outlined the scientific and health issues discussed and actions and advice agreed during each meeting, which were held regularly, and usually twice a week, since 22nd January.

Eighteen “scientific experts” attended the first meeting, along with five “observers and government officials”, plus members of the group’s secretariat.

This meeting discussed the outbreak in Wuhan and considered conclusions from NERVTAG (see below).

These were noted as: NERVTAG does not advise port of entry screening, irrespective of the current limited understanding of the epidemiology; it does not advise use of screening questionnaires, pilot declarations or requiring confirmation of exit screening at Wuhan; it supports public health information efforts via leaflets, posters and broadcast messengers to passengers.

SAGE said it supported NERVTAG's position both on the value of port screening and on monitoring measures and would review its position on port screening only if a simple, specific and rapid test was available and was deployable at scale across the UK. Temperature and other forms of screening were unlikely to be of value and had high false positive and false negative rates, it said. The 13th meeting, which took place on 5th March, some weeks after the publication of a series of papers in The Lancet, including a comprehensive statement from the WHO Scientific and Technical Advisory Group, had just 14 “scientific experts” in attendance, along with Dominic Cummings and Ben Warner from 10 Downing Street and two civil servants.

This meeting concluded that the UK “remains in the containment phase of the epidemic”, and stated that the government should plan for the introduction of behavioural and social interventions within 1-2 weeks to contain and delay spread; precise timings depending on progress of the epidemic.

It advised that the science supported a combination of case isolation and whole family isolation; along with “a third intervention” with epidemiological advantages, to socially isolate those in vulnerable groups (the elderly and those with underlying conditions) approximately two weeks after these initial interventions.

The minutes of the meeting note: “If implemented in combination as modelled, this set of measures is understood to most effectively delay and modify the epidemic peak, and reduce mortality”; and: “To be most effective, these measures should be implemented early in the epidemic and publicly adhered to throughout the peak period of infection.”

Paragraphs 14 to 16 state: SAGE agreed there is no evidence to suggest that banning very large gatherings would reduce transmission. Preventing all social interaction in public spaces, including restaurants and bars, would have an effect, but would be very difficult to implement. SAGE agreed that school closures would have smaller effects on the epidemic curve than other options.

The group also noted the importance of clear and sufficiently detailed public communication in advance of their implementation.

An “action” agreed was for “Imperial group [Imperial College London] to model and compare triggers and timings for national-level and regional-level behavioural and social interventions”. Their findings were to be shared by 6th March (i.e. the following day).

The Imperial group rose to fame during the foot-and-mouth epizootic in 2001, foot-and-mouth being an infectious and sometimes fatal viral disease that affects cloven-hoofed animals. The government of the day sidelined “experts” such as veterinary surgeons, including veterinary virologists and epidemiologists, and put the Imperial group, which had very little experience on animal diseases, in charge of managing the problem. Having developed its epidemiological models, it introduced what it called the contiguous cull, whereby not only were all animals on affected farms slaughtered, but all animals on farms adjacent to infected ones were also culled. This led to the slaughter of more than 6 million animals, mainly cattle and sheep but a number of pigs as well, resulting from a total of 2,026 cases.

This slaughter, which cost more than £3 billion, appalled farmers and public alike, as well as many members of the veterinary profession. One senior veterinary professor, who became president of the Royal College of Veterinary Surgeons, observed that the only thing that could be said of epidemiological models is that they were always wrong.

It is likely that the Imperial group was advised that it would be politically inappropriate for them to advocate a cull, much less a contiguous one, in the human pandemic, but they did, as expected, come up with some terrifying figures.

On 18th March the group published what it said would be a weekly report on its analyses, stating that unless drastic measures were taken immediately to combat the spread of the COVID-19 virus, deaths from the virus could reach 510,000 in the UK (and 2.2 million in the United States).

“More ambitious measures could cut both numbers in half,” the group said, “but the crisis will not be resolved completely until a vaccine is available – a process that could easily take 18 months or more.”

Back to SAGE and its “scientific” recommendations that it said should be implemented within 1-2 weeks of that 5th March meeting. That would have meant 19th March at the latest but it was 23rd March before the Prime minister announced that the UK would go into lockdown. The aim (or hope) was to severely limit the scale of physical and social interaction, and thus slow the spread of the virus so that the growth in cases did not overwhelm the NHS and lead to mass deaths. As Mr Johnson put it: “Without a huge national effort to halt the growth of this virus, there will come a moment when no health service in the world could possibly cope.” If only the measures had been put in place earlier.

In fact, the minutes of the early SAGE meetings, coupled with reports from NERVTAG and others, suggests there was little sense of urgency, little attention paid to what the World Health Organization had been saying and a quite remarkable complacency that the outbreak could be contained without too much effort. The forecast by the Imperial group on 18th March certainly began to change the thinking but it was still several days – and much too long – before any firm action was taken.

Perhaps the advisory groups had looked at past experiences with diseases such as SARS*, MERS**, Swine Flu*** and others, and been lulled into a false sense of security.

Those “health scares”, notably bird flu along with SARS, MERS and Swine Flu, turned out to be much less deadly than had been anticipated and this, as suggested earlier, may have been a factor in the lack of action in the UK over COVID-19. The esteemed committees may have felt the WHO was crying wolf once again and little action would be necessary to keep the UK safe. How wrong could they be!

The government woke up on 23rd March and announced the first serious measures to restrict the spread of the virus. “When we reduce our day-to-day contact with other people, we will reduce the spread of the infection,” the government said, as it proclaimed that people should stay at home, except for very limited purposes; certain businesses and venues would be closed; and all public gatherings should be limited to two people.

“Every person in the UK must comply with these new measures,” the government said, as it announced that “the relevant authorities, including the police, have been given the powers to enforce them – including through fines and dispersing gatherings.”

The government said it would look again at these measures after three weeks, and relax them if the evidence showed this was possible.

The wording of the statement and the graphics used in relation to this were intriguing for the fact that they appeared to regard “protecting the NHS” as more important than “saving lives”. As it turned out, that was very much the government’s intention, as it began clearing older patients, particularly “bedblockers”, out of hospitals and into care homes. It mattered not if they were infected with COVID-19 and asymptomatic transmission was certainly not taken into account. This set the stage for what the Imperial group would likely have regarded as a cull – and by putting infected people among healthy ones, effectively a contiguous cull – and more than 25,000 people in care homes died from the disease.

 

* The outbreak in 2002 of SARS (severe acute respiratory syndrome), a coronavirus first identified in China in November of that year, was widely expected to wreak havoc across the world. Nearly three months passed before the Chinese authorities informed the World Health Organisation and the infection spread to nearly 30 countries. However, only around 8,000 people were infected and 774 died. The major part of the outbreak lasted eight months but the last cases were reported in May 2004. The virus was named SARS-CoV-2 and was a strain of coronavirus closely linked to COVID-19.

** In 2012, another coronavirus-related disease appeared: Middle East Respiratory Syndrome (MERS). Most MERS patients developed severe respiratory illness with symptoms of fever, cough and shortness of breath. About three or four out of every 10 patients reported with MERS died. The first known case was in Jordan in April 2012 and further cases were reported in Saudi Arabia in September that year. The only cases outside the Middle East occurred in South Korea and were linked to a traveller returning from Saudi Arabia. The disease spread from infected people to others through close contact, such as caring for or living with an infected person, and patients ranged from under one-year-old to 99 years old. Guidance published to help reduce the spread of MERS (or other respiratory illnesses) included: (1) Wash your hands often with soap and water for at least 20 seconds, and help young children do the same – if soap and water are not available, use an alcohol-based hand sanitizer; (2) Cover your nose and mouth with a tissue when you cough or sneeze, then throw the tissue in the trash; (3) Avoid touching your eyes, nose, and mouth with unwashed hands; (4) Avoid personal contact, such as kissing, or sharing cups or eating utensils, with sick people; (5) Clean and disinfect frequently touched surfaces and objects, such as doorknobs. This guidance, published by the Centers for Disease Control and Prevention in the US, was issued well before COVID-19 made an appearance and much of the early guidance on the new coronavirus was simply a cut-and-paste job from this.

*** In 2009-10, a pandemic was declared for a global flu outbreak. This was first identified in Mexico in April 2009 and became known as swine flu (H1N1) because of its similarity to flu viruses that affect pigs. Early predictions suggested as many as 1.4 billion people (about a fifth of the world’s population at the time) could be affected but although it spread rapidly from country to country it turned out to be much less serious. The number of deaths globally was around 284,000; the WHO estimates that 250,000 to 500,000 people die each year of seasonal flu. Cases did occur in the UK: most were fairly mild but a relatively small number led to serious illness and death in children and young adults, particularly those with underlying health problems, and pregnant women. The World Health Organization declared the pandemic officially over in August 2010.

 

The 5th March meeting of SAGE

Participants in the SAGE meeting on 5th March, listed as “scientific experts”, were:

• Sir Patrick Vallance, government chief scientific adviser and head of the Government Science and Engineering (GSE) profession – a physician, scientist and clinical pharmacologist, his personal research was in the area of diseases of blood vessels and endothelial biology;

• Professor Chris Whitty, chief medical officer (CMO) for England, the UK government’s chief medical adviser and head of the public health profession, chief scientific adviser for the Department of Health and Social Care (DHSC), with overall responsibility for the department’s research and development, including the National Institute for Health Research (NIHR) – a physician and epidemiologist, he is also a practising NHS Consultant Physician at University College London Hospitals (UCLH) and the Hospital for Tropical Diseases, and Gresham Professor of Physic at Gresham College;

• Professor Jonathan Van-Tam, deputy chief medical officer for England – specialist in influenza, including its epidemiology, transmission, vaccinology, antiviral drugs and pandemic preparedness;

• Professor Stephen Powis, the national medical director of NHS England and professor of renal medicine at University College London;

• Professor Dame Angela McLean, chief scientific officer at the Ministry of Defence, professor of mathematical biology in the Department of Zoology at Oxford University and director of The Institute for Emerging Infections of Humans, with research interests in the use of mathematical models to aid the understanding of the evolution and spread of infectious agents;

• Professor John Aston, chief scientific adviser at the Home Office, professor of statistics in the Statistical Laboratory at the University of Cambridge, who specialises in applied statistics;

• Dr Rob Orford, chief scientific adviser for health and the professional lead for healthcare scientists in NHS Wales, as well as head of Health Science and Allied Health Professions Division at the Welsh Government who advises the government and ministers on matters relating to health science;

• Professor Sharon Peacock, National Infection Service interim director of Public Health England and professor of public health and microbiology at the University of Cambridge, who trained in clinical microbiology and virology;

• Graham Medley, professor of infectious disease modelling at the London School of Hygiene & Tropical Medicine (LSHTM) and the director of the Centre for the Mathematical Modelling of Infectious Diseases there;

• Professor Neil Ferguson, an epidemiologist specialising in the patterns of spread of infectious disease in humans and animals, who is professor of mathematical biology, director of the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), director of the MRC Centre for Global Infectious Disease Analysis, head of the Department of Infectious Disease Epidemiology in the School of Public Health and vice-dean for Academic Development in the Faculty of Medicine at Imperial College London, and part of the Imperial College COVID-19 Response Team

• Dr David Halpern, chief executive of the Behavioural Insights Team in the Cabinet Office since 2010 and previously the first research director of the Institute for Government and between 2001 and 2007 the chief analyst at the Prime Minister’s Strategy Unit;

• Andrew Rambaut, professor of molecular evolution at the University of Edinburgh with research interests in the evolution of emerging human viral pathogens: in particular, fast evolving RNA viruses;

• Professor Maria Zambon, a virologist who is director of reference microbiology at Public Health England and independent adviser to the WHO, ECDC (European Centre for Disease Prevention and Control), the EU, Gates Foundation, the World Bank and other international agencies;

• Brooke Rogers, professor of behavioural science and security at King’s College London – a social psychologist who studies risk and threat, in 2014 she was asked to chair the Cabinet Office Behavioural Science Expert Group (BSEG) and in 2019 was appointed to chair the Home Office Science Advisory Council (HOSAC).

Without doubt, that’s a bright group of people, covering the more important aspects of dealing with the novel coronavirus – and including an adviser to the WHO.

But: had any of the professors involved – those with teaching posts – asked their second- or third-year students to prepare a one-page summary of actions to be taken at this stage of the pandemic in the UK, they would most likely have come up with something rather better than the one-page summary of the minutes of this “thirteenth meeting on Wuhan Coronavirus”. Indeed, had those same students been asked to make an assessment of the SAGE page, it is unlikely that any would have rated it better than C-.

Take paragraph 8, for example: “SAGE advised that the science supports a combination of case isolation and whole family isolation.” Wow. Yes, this was eight days before the WHO declared the disease to be a pandemic but there was considerable evidence that COVID-19 was both highly contagious and infectious, with a rapid spread from country to country, and a higher mortality rate than most viral diseases of the last 20 years. Perhaps it was necessary to state the bleedin’ obvious for government ministers, but all that the combined brainpower of these “experts” could come up was to tell the government that standard medical practice should be adhered to.

Reading the rest of the “summary”, “situation update” (which noted that “sustained community transmission is underway in the UK”) and “behavioural and social interventions”, gives the impression that the members of the committee were not taking the situation particularly seriously. Although there were some sensible suggestions, there wasn’t much for the government to work with, though ministers kept stating that they were following the science or, as the PM said on 24th July, had stuck to it “like glue”.

The students would have been told to pay attention to papers published in The Lancet and elsewhere and to take special note of what the WHO had published and recommended. They would certainly have given full consideration to modes of transmission and proposed: (1) as the virus is known to be passed on via body fluids such as saliva and as, therefore, aerosol transmission is highly likely, then the wearing of face masks in all situations where people are in close proximity to one another would be advisable; (2) as physical contact is well-known as a means of transmission of this type of virus, this should be limited as much as possible [the only clear recommendation made by SAGE in the early stages]; and (3) as asymptomatic transmission is unproven but highly likely, it would be wise to err on the side of caution and ensure that all patients in vulnerable situations should be tested and, if shown to be infected, to be isolated.

Hardly rocket-science, but science nevertheless with a big dose of common sense (what Boris Johnson said on 11th May would get the country through the crisis). But SAGE simply failed to give adequate – and clear – advice. It seemed that unless something had been proven, it would not be considered. Much of scientific discovery is not founded on certainty but based on the balance of probabilities, as the students would have known. They would also have known of the expression, “Coughs and sneezes spread diseases”, first used during the 1918 influenza pandemic and used subsequently by the UK and other governments to encourage good public hygiene and prevent the spread of the common cold, influenza and other respiratory illnesses. It has been known for many decades that airborne droplets disseminate respiratory pathogens, including viruses and bacteria. A cough can produce about 3,000 droplets and a sneeze releases an estimated 40,000.

At the very least, SAGE could, and should, have said, well before the end of February, that in the light of published information and the guidance and recommendations from WHO, it would be prudent to take action to minimise the effects of the virus in the UK – and provided sensible guidance for the government, particularly the Department of Health and Social Care, to follow.

For those of us who thought the government was not paying sufficient attention to the science, a reading of the SAGE meetings’ minutes reveals why things were going so badly wrong. SAGE was not giving the government much to work with and much of what the committee did produce was inconclusive and muddle-headed. C- is probably too generous a mark. SAGE’s efforts merited no more than a D and it is difficult to escape the conclusion that the SAGE committee failed the nation in its hour of need. No wonder there was considerable reluctance for the minutes of its meetings, particularly the earlier ones, to be published.

 

Research Professional News highlights SAGE’s lack of urgency and obsession with flu

After the government published, on 29th May, minutes of SAGE meetings up to that point, on 1st June Research Professional News (researchprofessionalnews.com, publishing as Ex Libris, focused on enabling the research community to obtain timely and trusted information surrounding COVID-19) published an assessment of them.

This reported that SAGE’s initial discussions appeared largely academic, with little sense of urgency over putting in place measures to prepare for a UK outbreak. “Throughout the early weeks, SAGE talks about delaying rather than stopping a UK epidemic, using ‘worst case scenario’ planning borrowed from flu and seemingly without an urgent ramp of capacities to deal with the coronavirus. Eight meetings in, on 18th February, it still talks about a UK outbreak in hypotheticals: ‘should there be an outbreak of COVID-19 in the UK’, it says.

“It’s not until early- to mid-March that minutes get longer, attendance higher and a keen sense of urgency on multiple fronts is apparent. Attendance goes from as few as eight scientists at a meeting in February to as many as 50 in April and May, and minutes go from as little as a single page to four pages long.”

Further on, the review states: “On the day chief scientific adviser Patrick Vallance controversially floated the idea of herd immunity in media interviews, 13th March – only for the idea soon to be dismissed by ministers – the 15th meeting notes SAGE’s “near certainty” that not letting the virus take hold in the population would only lead to a second peak. Avoiding this scenario is the basis of the herd immunity idea.

“The minutes say: ‘SAGE was unanimous that measures seeking to completely suppress spread of COVID-19 will cause a second peak. SAGE advises that it is a near certainty that countries such as China, where heavy suppression is underway, will experience a second peak once measures are relaxed.’

“Again, the minutes seem to raise more questions over whether SAGE did indeed advise the government not to fully suppress the spread of COVID-19 and to follow herd immunity. The actual advice provided by SAGE has still not been released publicly.”

Further on Research Professional News states: “From the start, SAGE appears to be focusing on delaying the epidemic, rather than stopping it in its track. Its second meeting, on 28th January, tasks its influenza modelling group SPI-M ‘to advise on actions the UK could take to slow down the spread of the outbreak domestically’. The next meeting talks about pushing the outbreak out of winter months.

“Its ninth meeting, on 20th February, discussed a Public Health England paper on monitoring and contact tracing, the purpose of which is detection and containment ‘to delay spread’ of COVID-19 rather than to stop it taking hold. ‘Mitigations can be expected to change the shape of the epidemic curve or the timing of a first or second peak, but are not likely to reduce the overall number of total infections,’ notes the 11th meeting on 27th February.

“SAGE appears to have concentrated on what it knew – influenza. Unlike some Asian countries that seem to have learnt the lessons from SARS outbreaks and were better prepared, from the outset SAGE used flu plans to frame responses to COVID-19. Its second meeting agreed ‘that pandemic influenza infection control guidance should be used as a base case and adapted’ and this was stuck to for some weeks to come.

“Even where the evidence pointed at possible differences, for example around children and transmission in schools, SAGE still stuck to assumptions based on flu.”

 

Shadow equivalent of SAGE

A former government chief scientific adviser, Sir David King, decided at the beginning of May to convene a separate 12-member “independent” panel of experts, a shadow version of the SAGE, which would take evidence from “global experts”.

This group, he said, which had been created “in response to concerns over the lack of transparency” from SAGE, would look at how the UK could work its way out of the coronavirus lockdown.

The intention was to focus on seven key points including how testing and tracing could work, and the future of social distancing.

Sir David told The Sunday Times of his plans, stating that he was not at all critical of the scientists who were putting advice before the government, “but because there is no transparency, the government can say they are following scientific advice but we don’t know that they are.”

Criticising Mr Cummings’s attendance at the SAGE meetings, he said: “Cummings is an adviser to the Prime Minister and the chief scientific adviser is an adviser to the Prime Minister. So there are two voices from the scientific advisory group and I think that’s very dangerous because only one of the two understands the science.”

The Guardian had earlier reported that one attendee of SAGE had said that Cummings’s interventions had sometimes inappropriately influenced the impartial scientific process of the committee. Another told the newspaper they were shocked at the adviser’s appearance because they believed the committee should be providing “unadulterated scientific advice”.

Members of the Independent Sage committee are (were):

Sir David Anthony King (who chairs the group); Professor Gabriel Scally (president of Epidemiology & Public Health section, Royal Society of Medicine and visiting professor of public health at both the University of the West of England and the University of Bristol); Dr Tolullah Oni (public health physician, scientist and urban epidemiologist, and a clinical senior research fellow with the University of Cambridge’s Global Public Health Research programme); Professor Anthony Costello (professor of global health and sustainable development at University College London and a former director at WHO); Professor Karl Friston (computational modeller and neuroscientist at UCL in charge of developing a generative SEIR COVID-19 model); Professor Susan Michie (professor of health psychology and director of the Centre for Behaviour Change at University College London, as well as a member of SPI(B), SAGE sub-committee); Professor Deenan Pillay (professor of virology at UCL and a former SAGE member); Professor Kamlesh Khunti (professor of primary care & diabetes at the University of Leicester); Professor Christina Pagel (mathematician and professor of operational research at UCL); Dr Zubaida Haque (director of the Runnymede Trust, a race equality think tank); Professor Martin McKee (professor of European public health at the London School of Hygiene & Tropical Medicine); Professor Stephen Reicher (professor of social psychology at the University of St Andrews); and Professor Alysson Pollock (director of the Newcastle University Centre for Excellence in Regulatory Science). Another pretty impressive list.

Also formed was an Independent SAGE Behavioural Advisory Group, which aimed to help in the development of constructive proposals and policies that would help the government to lead the country out of the public health crisis.

The members: Imran Awan (professor of criminology and an expert on tackling victimisation against BAME communities and the effects of violent crime in society); Val Curtis (professor of hygiene and director of the Environmental Health Group at the London School of Hygiene& Tropical Medicine, an evolutionary anthropologist specialising in hygiene behaviour globally); John Drury (professor of social psychology at the University of Sussex specialising in research on collective behaviour including behaviour in emergencies); Susan Michie (professor of health psychology and director of the Centre for Behaviour Change at University College London, and an adviser to the WHO on behavioural science in relation to Covid-19); Ann Phoenix (professor of psychosocial studies at the Thomas Coram Research Unit, UCL Institute of Education); Stephen Reicher (professor of psychology at the University of St Andrews); Elizabeth Stokoe (professor of social interaction at Loughborough University, an expert in conversation analysis); Robert West (emeritus professor of health psychology at University College London, editor-in-chief of the journal Addiction and an adviser to Public Health England on tobacco control and behaviour change); and Laura Bear (professor of anthropology at the London School of Economics, whose current research focuses on the impact of COVID-19 on vulnerable communities).

In one of its public statements, Independent SAGE said it saw little in Britain’s response that was evidence-based, especially after an upturn in new cases forced a delay in lifting more lockdown restrictions.

“There is no long-term strategy, as far as we can see,” said Professor Pillay, who advised the government during the 2009-10 swine flu pandemic.

The group issued detailed reports on almost every major issue tackled: including contact tracing, reopening schools, restaurants and pubs, and relaxing social distancing. In most cases, they highlighted what they considered mistakes in the government’s approach.

Mark Walport, a SAGE member and former chief government scientific adviser, said the rival group risked confusing the public with its assessments and that scientists should not be making policy decisions.

 

All the SAGE members

Membership of SAGE was kept under wraps for many months but eventually the members – well over 80 of them (though usually only about 20 attend a meeting) – were named as (in alphabetical order, after the first two):

Sir Patrick Vallance and Professor Chris Whitty; Professor Rebecca Allen (University of Oxford); Professor John Aston (chief scientific adviser at the Home Office); Professor Charles Bangham and Professor Wendy Barclay (Imperial College London); Professor Jonathan Benger (UWE Bristol); Fliss Bennee (Welsh Government); Allan Bennett (Public Health England); Professor Phil Blythe (chief scientific adviser at the Department for Transport); Professor Chris Bonnell (London School of Hygiene & Tropical Medicine); Professor Sir Ian Boyd (University of St Andrews); Professor Peter Bruce (University of Oxford); Caroline Cake (HDR-UK, described as an innovation gateway); Professor Andrew Curran (chief scientific adviser to the Health and Safety Executive); Professor Paul Cosford and Dr Gavin Dabrera (Public Health England); Professor Sir Ian Diamond (national statistician at the Office for National Statistics); Professor Yvonne Doyle (medical director at Public Health England); Professor Deborah Dunn-Walters (University of Surrey); Professor John Edmunds (London School of Hygiene & Tropical Medicine); Professor Sir Jeremy Farrar  (Director of the Wellcome Trust); Professor Michael Ferguson (University of Dundee); Professor Neil Ferguson (Imperial College London); Professor Kevin Fenton (Public Health England); Dr Aidan Fowler (national director of Patient Safety in England and a deputy chief medical officer at the Department of Health and Social Care who in March was seconded to the office of Professor Whitty); Professor Julia Gog (University of Cambridge); Professor Robin Grimes (chief scientific adviser at the Ministry of Defence); Dr Ian Hall (University of Manchester); Dr David Halpern (behavioural insights team at the Cabinet Office); Baroness Dido Harding (NHS Improvement); Dr Jenny Harries (a deputy chief medical officer for England); Dr Demis Hassabis (a data scientist on SAGE in a personal capacity); Professor Andrew Hayward (University College London); Professor Gideon Henderson (chief scientific adviser at DEFRA); Professor Peter Horby (University of Oxford); Professor Anne Johnson (University College London); Dr Indra Joshi (NHSx – a joint unit with teams from the Department of Health and Social Care, NHS England and NHS Improvement “to drive the digital transformation of care”); Dr Vittal Katikireddi (University of Glasgow); Dr Ben Killingley (University College London Hospitals); Professor David Lalloo (London School of Hygiene & Tropical Medicine); Professor Janet Lord (University of Birmingham); Professor Dame Theresa Marteau (University of Cambridge); Professor Dame Angela McLean (chief scientific adviser at the Ministry of Defence); Dr Jim McMenamin (Health Protection Scotland); Professor Graham Medley (London School of Hygiene & Tropical Medicine); Dr Laura Merson (University of Oxford); Professor Susan Michie (University College London); Professor Christine Middlemiss (chief veterinary officer at DEFRA); Professor Andrew Morris (University of Edinburgh); Professor Paul Moss (University of Birmingham); Professor Carole Mundell (chief scientific adviser at the Foreign and Commonwealth Office); Professor Cath Noakes (University of Leeds); Dr Rob Orford (Welsh Government); Professor Michael Parker (University of Oxford); Professor Sharon Peacock (Public Health England); Professor Alan Penn (chief scientific adviser at the Ministry of Housing, Communities and Local Government); Dr Pasi Penttinen (European Centre for Disease Prevention and Control); Professor Guy Poppy (chief scientific adviser at the Food Standards Agency); Professor Steve Powis and Dr Mike Prentice (National Health Service England); Osama Rahman (chief scientific adviser at the Department for Education); Professor Venki Ramakrishnan (ex officio as chair of DELVE – Data Evaluation and Learning for Viral Epidemics, a multi-disciplinary group convened by the Royal Society); Professor Andrew Rambaut (University of Edinburgh); Professor Tom Rodden (chief scientific adviser at the Department for Digital, Culture, Media and Sport); Professor Brooke Rogers (King’s College London); Dr Cathy Roth (Department for International Development); David Seymour (HDR-UK); Professor Sheila Rowan (chief scientific adviser for Scotland); Alaster Smith (Department for Education); Professor Iyiola Solanke (University of Leeds); Dr Nicola Steedman (Scottish Government); Dr James Rubin (King’s College London); Professor Calum Semple (University of Liverpool); Dr Mike Short (chief scientific adviser at the Department for International Trade); Dr Gregor Smith (chief medical officer for the Scottish Government); Professor Sir David Spiegelhalter (University of Cambridge); Professor Jonathan Van Tam (a deputy chief medical officer for England); Professor Russell Viner (University College London); Professor Charlotte Watts (chief scientific adviser at the Department for International Development); Dr Rhoswyn Walker (HDR-UK); Professor Sir Mark Walport (UK Research and Innovation, the government’s national funding agency which invests in science and research in the UK); Professor Mark Wilcox (University of Leeds); Professor Lucy Yardley (University of Bristol and University of Southampton); Professor Ian Young (Northern Ireland Executive); Professor Maria Zambon (Public Health England).

 

NERVTAG

NERVTAG is described as “an expert committee” of the Department of Health and advises the chief medical officer and, through the CMO, to ministers, the Department of Health and other government departments.

It provides scientific risk assessment and mitigation advice on the threat posed by new and emerging respiratory virus threats and on options for their management.

Members (in July 2020) were/are: Professor Peter Horby (chair, University of Oxford), Professor Wendy Barclay (Imperial College London), Professor John Edmunds (London School of Hygiene & Tropical Medicine), Professor Neil Ferguson (Medical Research Council, Imperial College London), Professor Andrew Hayward (University College London), Dr Benjamin Killingley (University College London Hospital NHS Trust), Professor Wei Shen Lim (Nottingham University Hospitals NHS Trust), Dr Jim McMenamin (Health Protection Scotland), Professor Peter Openshaw (Imperial College London), Professor Malcolm Semple (University of Liverpool), Professor Robert Dingwall (Dingwall Enterprises Ltd and Nottingham Trent University), Dr James Rubin (Kings College London), Dr Cariad Evans (Sheffield Teaching Hospitals NHS Foundation Trust), Dr Chloe Sellwood (co-opted member, NHS England), and Professor Ian Brown (co-opted member, Animal and Plant Health Agency).

 

Behavioural advisory group

There is also the Scientific Pandemic Influenza Group on Behaviours (SPI-B) which provides advice “aimed at anticipating and helping people adhere to interventions that are recommended by medical or epidemiological experts”. This has 40 members, including representatives of the behavioural insights team (also known as the nudge team, which is described as a “social purpose company independent of the government, but is partly owned by the Cabinet Office and NESTA – National Endowment for Science, Technology and the Arts, which is a registered charity described as “an innovation foundation”, as well as by some its employees). The British Psychological Society is well represented and so also is Devon and Cornwall Police, along with Public Health England, the Office for National Statistics, various universities and government departments and, of course, the London School of Hygiene & Tropical Medicine. Four people on this group did not wish to be named – and who could blame them.

In the meeting of 5th March, under “behavioural and social interventions”, it was noted that modelling had shown there might only be 50% compliance for household quarantine. Another example of “modelling” being way off beam.

 

COVID-Operations committee

The government set up a COVID-Operations Committee in Downing Street. This comprised relevant secretaries of state, the chief medical officer and senior civil servants as needed.

Its remit was to give cross-government consideration of situation and actions required in the extreme cases where local lockdown was a consideration.

 

New group formed to tackle virus

The COVID-19 Genomics UK (COG-UK) Consortium was created “to deliver large-scale and rapid whole-genome virus sequencing to local NHS centres and the UK government”.

COG-UK was made up of a partnership of NHS organisations, the four Public Health Agencies of the UK, the Wellcome Sanger Institute and more than 12 academic partners providing sequencing and analysis capacity.

The work was supported by £20 million funding from the Department of Health and Social Care (DHSC), UK Research and Innovation (UKRI) and the Wellcome Sanger Institute, administered by UK Research and Innovation.

The consortium’s website states: “The virus genome data is combined with clinical and epidemiological datasets in order to help to guide UK public health interventions and policies. The subsequent analysis will permit evaluation of the effectiveness of novel treatments and non-pharmacological interventions on SARS-CoV-2 populations and spread.

“It will provide information on whether or not outbreaks are due to introductions from outside or ongoing transmission within the community. The data will also enable researchers to identify and understand genetic changes that affect how easily the virus is passed on and the severity of the symptoms it causes. Finally, the information helps us target the development of treatments and vaccines and monitor their impact as they are introduced.”

On 25th March, the consortium said that virus genome sequencing was a vital and rapidly-developing tool in the diagnosis of COVID-19 and in understanding the spread and control of the new coronavirus.

It continued: “A genome – an organism’s genetic material – is essentially its instruction manual, which contains all the information needed to make and maintain it. Human genomes are made of double-stranded DNA and are written in its special code of four nucleotide base ‘letters’. Human genomes are over 3 billion base letters long. In contrast, a virus genome can either be made of DNA or of its close cousin RNA and is tiny. Coronaviruses are RNA viruses and the newly-discovered virus SARS-CoV-2 [COVID-19] has a single short RNA strand that is just 30,000 letters long. These letters can be ‘read’ one by one, using a technique called sequencing.

“If the new coronavirus’s sequence is found in a sample (usually taken from the nose or mouth) it will confirm the likelihood that a patient’s symptoms are those of COVID-19.

“Virus genomes constantly alter (mutate), changing a few letters at a time as they divide and spread by infecting more people. These changes can be exploited to track the spread of the virus by sequencing, recording and analysing genomes.

“If virus genome sequencing is undertaken rapidly and on a large-scale then it can assist epidemiologists and public health authorities in understanding how the virus is spreading and in evaluating how effective their interventions have been. It can also help to establish whether new variants are associated with particular patterns of symptoms or severity of disease. In the longer term, tracking new variants is likely to be extremely important to ensure that vaccines, when these are developed, can be kept ‘up to date’ with the strains of virus that are currently circulating.

“In the initial stages of the epidemic, sequencing can be used to find out how many new cases of disease are imported or come from local transmission. Global databases of virus genomes enable researchers to compare genomes so that an accurate assessment of local transmission in each country can be made.

“Mathematical models of how viruses evolve during an epidemic – developed from extensive analysis of past outbreaks – allow epidemic growth rates and other measurements of transmission and infection to be estimated from virus genome sequences. Compared to estimates from other sources of data, insights from virus genetics are most useful for the prediction of longer-term, larger-scale trends. Importantly, they provide independent validation of estimates of the size and growth rate of an epidemic. This is useful especially when cases are under-reported, for instance because many people who are infected do not have symptoms.

“Widespread sampling and genome sequencing of the new coronavirus allows the reconstruction of virus spread in different places or groups of people. This provides information about what is driving the spread of the virus both locally and nationally. This work can be made more precise if virus genomes are combined with information about where, how and when people travel locally and internationally.

“Virus genome sequences can also identify unique genetic changes shared by all those infected in a single virus transmission chain. This can be used to distinguish whether two clusters of cases in the same area have arisen because one started infection in the other, or because there were two distinct and independent chains of transmission with separate, earlier origins. Virus genomes can therefore add to the information provided by patient contact tracing, which is important for tracking outbreaks in communities, hospitals and other care settings.

“Many genetic changes that occur in the genome of the virus will have no significant effect on the course of infection or disease, or the impact of control measures. However, a few of the changes might be important. These need to be identified and tracked through time. In viruses such as influenza, we know that genetic changes can alter how the immune system recognises viruses, resistance to antiviral drugs, and the severity of disease. These discoveries have yet to be made for the new coronavirus.

“Rapid, large-scale virus genome sequencing is a new stream of information that can contribute to the tracking of epidemics and the development of new methods of control. Its application to the new coronavirus is only just beginning.”

A statement released on 10th June was headed: “COG-UK preliminary analysis reveals the frequency and source of virus introductions into the UK”.

This read: “The latest analysis of the COVID-19 epidemic in the UK combines large-scale data and genomic sequencing to provide a detailed picture of the number and sources of SARS-CoV-2 introductions into the UK. The study by researchers at the University of Oxford, University of Edinburgh, and the COVID-19 Genomics UK Consortium (COG-UK), shows how and when the SARS-CoV-2 virus entered the UK, mostly from European countries during March. The rate of virus importation peaked around 15th March.

“The study found that the UK epidemic was composed of a very large number of transmission lineages. Each lineage was founded by a separate introduction event from inbound international travel, then grew through local transmission within the UK. The study detected 1,356 independent transmission lineages, based on analysis of genome and travel data up to 22nd May. However, this is likely to be an underestimate of the actual number of virus introduction events that have resulted in onwards transmission, because we have generated virus genome sequences for only a small fraction of UK infections.

“An estimate of the daily intensity of SARS-CoV-2 importation into the UK indicated that importation intensity to the UK rose rapidly in early March, peaked around 15th March, then quickly declined to a low level in April. This pattern is driven by the interplay between two trends throughout March: a substantial fall in the number of inbound travellers and a rapid growth in the number of infections in many European countries.

“The study found that early importations from Italy were, by early March, surpassed in number by importations from inbound travellers from Spain and France. The diversity of source locations also increased in March, with importations attributed to a growing range of countries. The contribution of China and other Asian countries to the number of importations was very small.

“Many UK transmission chains are no longer detected by genome sequencing and have likely been extinguished. In early March the epidemic mostly comprised chains that had been newly detected for the first time, whilst by late April most transmission chains had not been detected by genomic sampling for more than a week. This trend reflects the declining number of SARS-CoV-2 cases in the UK during April.”

The statement finished: “Work on these data is ongoing and findings may therefore change in the future. The analysis does not attempt to model or evaluate the effectiveness of public health interventions or travel restrictions.”

 

International emerging infection consortium

ISARIC, the International Severe Acute Respiratory and Emerging Infection Consortium, is a global federation of clinical research networks, which aims to provide a proficient, co-ordinated, and agile research response to outbreak-prone infectious diseases. Its mission is to generate and disseminate clinical research evidence for outbreak-prone infectious diseases, whenever and wherever they occur.

On 31st January, it activated its Clinical Characterisation Protocol (CCP) for emerging infections in England and Scotland.

The CCP was prepared for such an emergency and “provides an ethically-approved framework for enrolling patients to a clinical study which will offer new insights into this emerging global threat”.

The CCP facilitates the collection of standardised clinical data and samples on patients hospitalised with suspected or confirmed infection with COVID-19 to inform the outbreak response and patient care, not just in the UK but internationally.

The chief investigator for the UK CCP is Professor Calum Semple at the University of Liverpool. The development of the CCP was led by Dr Kenneth Baillie at the University of Edinburgh. The CCP study is sponsored by the University of Oxford and ISARIC’s Global Support Centre is hosted by the University of Oxford. ISARIC’s members have developed the CCP over a number of years.

The CCP is supported by the National Institute for Health Research (NIHR) and is now open to enrolment in NHS Trusts, including the network of high-containment clinical facilities where patients with the coronavirus will be admitted in the early stages of the disease in the UK.

On 15th July ISARIC published a paper entitled Plug COVID-19 research gaps in detection, prevention and care. This noted that in the absence of a vaccine and community-based treatment, we are reliant on public health measures to stop this pandemic. From how to implement social distancing in urban informal settlements to how to gain trust and mitigate myths within communities, there is a clear and urgent need to further understand COVID-19.

The Global Health Network (TGHN), the African Academy of Sciences (AAS) and UK Collaborative on Development Research (UKCDR) published findings of a global study to establish what are the remaining research priorities for COVID-19 and whether they are the same across the globe. A peer-reviewed paper reporting these data was accepted for publication by BMJ Global, with a global perspective on this also being reported in Nature.

There is a finite window to undertake research within an outbreak, said ISARIC. Scientists and researchers around the world have worked rapidly to increase understanding of COVID-19 but there are still many unknowns as the pandemic accelerates and spreads into new areas. Different studies are needed across the globe and the evidence must be tailored for different settings with the benefits from the research being equitable and widely accessible.

The World Health Organisation produced a “roadmap” that set out the research priorities following a meeting in February, just before COVID-19 was declared a pandemic. Now, at this point [mid July] in the evolution of this novel disease across the world, it is important to assess whether these priorities are still current and whether they are the same for all types of communities and health care settings

GHN, AAS and UKCDR undertook an online survey and held a series of workshops, where researchers representing all WHO regions were able to rank research questions, and identify new ones that need to be tackled within their health care setting and communities, mitigating this and future pandemics.

With contributions from over 3,000 healthcare workers and researchers, the results show that the global research community supports the existing WHO roadmap, but strongly calls out areas where more focus is needed and where new priorities have emerged, particularly from low-resourced settings.

The results demonstrate there is a need for evidence on the relative effectiveness and optimal implementation of public health interventions in varied global settings. Study participants explained how they need data to show when and how best to implement social distancing, for example, in urban informal settlements where families are sharing limited sanitation facilities.

Another clear priority is to understand better how to gain community trust and mitigate myths, to understand the impact on already present diseases within communities and to explore the ethics of research during a pandemic.

 

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