5. Submission by Mr Metzer

Mr Metzer: My Lady, I appear on behalf of the Long Covid groups, together with my learned friends Ms Sivakumaran and Ms Iengar. We are instructed by Bhatt Murphy Solicitors, as you are aware.

We were grateful to Mr Keith KC and his team for the clear indications in respect of the timetable and the plan for the way forward for Module 2 set out in his notes and oral submissions today. The assistance provided by Mr Keith KC and his team have obviated the need for detailed submissions from Long Covid groups today, and I have therefore focused only on a few matters of detail.

Long Covid and their interest in Module 2. Before turning to our submissions on procedural matters, we have two preliminary observations. Considering first the history of advocacy for recognition for Long Covid, you will recall at the first preliminary hearing the submissions advanced on behalf of the Long Covid groups setting out their concerns about being overlooked by Government decision makers and their formation to advocate for those with Long Covid. You will also recall that I addressed you on these issues yesterday as they related to the healthcare consequences of how the government and the public responded to the pandemic.

As I also mentioned yesterday, it has been suggested that “Long Covid is the first illness to be made through patients finding one another on Twitter and other social media”. The etymology of the term “Long Covid” can be traced to social media posts in May and June 2020. Patient advocacy has played an integral part in the recognition of and response to Long Covid.

You will be aware of the Long Covid groups’ advocacy for better recognition for and understanding of Long Covid, as set out in their responses to the Rule 9 questionnaires, and there is evidence and examples in our written note. Their interest in participating in this module is derived from their experience and concerns that the administrative and Government decision makers failed to have regard to Long Covid when making decisions in relation to the Covid-19 pandemic.

Long-term sequelae from Coronavirus infections and other infectious decisions were not unknown before Covid-19, and yet there was neither urgency in planning to respond to long-term sequelae for Covid-19 nor in responding to reports of Long Covid when they arose in summer 2020. It was left to people with Long Covid to advocate on their own behalf. The experience of those living with Long Covid and advocating for its recognition was a crucial element to the narrative of the administration and Government decision making on Covid-19.

There is a novel and important opportunity for the Inquiry and the wider community to learn from the experiences of patient advocacy groups in a pandemic in relation to the long-term sequelae of infectious diseases. The lessons to be learned from the Long Covid’s groups’ experiences during the Covid-19 pandemic will have relevance to any Government decision making in response to a future epidemic or pandemic.

Secondly, we endorse the calls from other Core Participants to the Inquiry to consider structural discrimination and racism across all modules of the Inquiry, including Module 2. As Mr Keith highlighted this morning, Covid-19 has had a disproportionate impact on different ethnic groups and disabled people. The statistics speak for themselves. We welcome the Inquiry’s commitment to investigate inequalities as set out by Mr Keith this morning. However, inequalities cannot be fully understood without fully considering structural and systemic factors driving those inequalities. To put it in common parlance, there is a risk of not seeing the wood from the trees. We do not seek to repeat submissions which have already been made on this matter but would strongly encourage the Inquiry to consider this issue with an open mind.

With these provisional observations in mind, I wish to briefly address some of the procedural matters. We have made detailed submissions in our written notes and I do not intend to repeat those submissions now unless there are any matters on which you would require further submission.

Witness list timetable and Rule 9 process. The Long Covid groups have raised the Rule 9 process with the issues of witness lists and timetabling, as they are interlinked. The Long Covid group support Mr Keith’s helpful commitment to providing a list of issues in April 2023 and to sharing a provisional list of witnesses shortly thereafter, in recognition that Core Participants’ early observations will assist the chair and her team.

In relation to timetabling, we note Mr Keith’s proposal for a further preliminary hearing to be held before September 2023 and possibly in July, following submissions from other Core Participants. We strongly support the suggestion that the preliminary hearing be scheduled considerably earlier and no later than the summer break, in order to iron out any outstanding issues and ensure the revised start date of October is wholly achievable.

In respect of the Rule 9 process, the Long Covid groups have sought greater clarity about the Rule 9 process in order to ensure effective assistance to the Inquiry. We are grateful for the indication from Mr Keith that the Inquiry is considering the Long Covid groups’ responses to questionnaires and whether to send a further request for a witness statement. We would be assisted if the Inquiry was able to provide an earlier indication as to whether Long Covid groups are likely to receive a further request for substantive witness statements.

The Long Covid groups note the Inquiry’s approach to evidence gathering through initial questionnaires issued pursuant to Rule 9, and welcome the indication from Mr Keith that relevant witnesses are now being asked about whether they took into account the risk of Long Covid when considering NPIs.

Although we are concerned that this was not considered earlier, the early disclosure of the list of issues will help identify if there are any other key areas related to Long Covid that the Inquiry has overlooked. We underscore that the Government and administrative decision maker’s perspective provides only one facet of the context in which decisions were made. The experiences of those living with Long Covid and advocating for its recognition provides a crucial element to the narrative of administrative and Government decision-making on Covid-19. They respectfully suggest and urge that it is necessary to hear further evidence from Long Covid groups to provide a complete picture of events from Module 2.

The Long Covid groups make these early observations in advance of any draft witness list in order that they can fully understand the Inquiry’s approach to evidence gathering whilst there is an opportunity to substantively assist the Inquiry. As Mr Keith observed, the Inquiry is moving at great pace, and they would welcome an early opportunity to assist the Inquiry with a provision of further evidence.

Experts. In relation to experts, the Long Covid groups have three core observations. First, the Long Covid groups welcome the indication that draft reports for the four experts in Module 2 will be shared in March 2023. They appreciate that the Inquiry team has been working at pace and that this early disclosure of reports is evidence of considerable effort on the part of the Inquiry to be prepared for the Module 2 hearings. The Long Covid groups also anticipate contributing a limited number of observations to the draft reports when they are disclosed.

Secondly, the Long Covid groups will be assisted by the early formal disclosure of Module 1 reports which relate to Module 2. We welcome those parts of the reports of the experts related to health inequalities in Module 1, Professor Marmot and Professor Bambra being considered for disclosure in this module. It is necessary for Core Participants who are not in Module 1, including our clients, to understand the opinions of the experts opining on preparedness and on what should have been in place at the time of the pandemic to understand the quality of the decisions then subject to review in Module 2.

It is respectfully requested that all the Module 1 expert reports be disclosed to Core Participants in Module 2 in full and at an early stage. While the reports will, as Mr Keith reminded us this morning, be published at the time of the Module 1 hearing, given the pace the Inquiry is progressing at, Core Participants in Module 2 would be considerably assisted by understanding the expert views in relation to Module 1 as they pertain to Module 2 in good time to advance preparation for Module 2.

Finally, the Long Covid groups recognise Mr Keith’s recognition that multiple epidemiologists will called in Module 2. However, we respectfully suggest that they will be witnesses of fact and do not replace the need for expert evidence. It will be of assistance to the Inquiry, in our submission, to seek expert reports from public health experts and epidemiologists on their opinions on the development of the pandemic and advice on responding to the different stages of the pandemic.

Whilst recognising that the focus of this module is on administrative and Government decision making, those decisions can only be properly understood in the context of what advice was being given and the appropriateness of following that advice. In our submission, this is no different from the approach to Module 1 where expert reports have been obtained to explain, for example, matters of resilience and risk management and the suitability of those structures. Currently the expert advice that has been sought is the exclusive preserve of political scientists and, while important in its own right, we consider it would not be of assistance in understanding whether the advice given to administrative and political decision makers was appropriate.

The Long Covid groups appreciate that the leading epidemiologists in the UK will be giving evidence as witnesses of fact in Module 2 in respect of advice that they gave to the Government during the pandemic. Their witness statements will not be sufficient, in our submission, to address this gap in evidence in Module 2, as first they will be motivated to defend the advice without recognising any oversights or mistakes in approach. And secondly, they do not have the same duties to the court.

In addition, an expert report will provide a framework explanation of approaches to pandemics which will provide the context necessary to understand the evidence of individual experts on the advice given in SAGE and other relevant forums. From the perspective of Long Covid groups specifically, the Inquiry may well be assisted by an expert who specialises in the study of long-term sequelae, their characterisation in a pandemic context, and developing research methods and responses to them.

The Long Covid groups are currently considering a number of individuals to propose in this regard and will follow up with the Inquiry by correspondence in the spirit of assisting the Inquiry.

Parliamentary privilege. The Long Covid groups have noted the observations made in respect to parliamentary privileges in CTI’s note in advance of the second preliminary hearing and my Lady’s ruling of 17 February 2023 following the second Module 1 preliminary hearing. The Long Covid groups do not, therefore, seek to make any observations at this stage, and reserve the right to make submissions on the application of parliamentary privilege at a later date.

Rule 10, the Long Covid groups welcome CTI’s proposal of a staged process to afford Core Participants “a meaningful opportunity to engage in the process” of gathering evidence from witnesses. We endorse and support the submissions made by the bereaved families of Core Participants to be permitted to ask their own questions of witnesses and submit that this can be managed in a proportionate way.

The only additional observation that the Long Covid groups make is that the Inquiry consider reasonable adjustment for Long Covid groups when setting deadlines for responses. I will not repeat the general submission on reasonable adjustments raised yesterday at the preliminary hearing for Module 3. I rely on those submissions and, in the same vein, invite the Inquiry to provide Core Participants with at least 14 days to respond to the evidence proposals.

Relativity. During the second preliminary hearing for the Module 1 hearing, Mr Keith indicated that the Core Participants “persuaded the Inquiry team to alter the field tagging system so that documents can be marked with additional fields”. The Long Covid Groups apply for similar permission to be granted to them on their Relativity workspace so that they can have a coding panel installed. This will facilitate the team’s review of what is anticipated to be a significant volume of disclosure. We appreciate from Mr Keith’s comments this morning that this permission may be forthcoming in any event.

Commemorations and listening exercise in Covid-19 safety measures. I have addressed you already in relation to the listening exercise and commemoration and the Covid-19 safety measures at the preliminary hearing for Module 3 yesterday and therefore do not need to repeat those submissions today.

In conclusion, the Long Covid groups remain willing to assist the Inquiry with their investigations at all stages.

That is all I wish to say, unless there is any matter I can assist my Lady with. Thank you.

Baroness Hallett: Thank you very much, Mr Metzer, and I’m very grateful and welcome the offers of assistance. As ever, your remarks were well made and I will bear them very much in mind. I know that the Inquiry team will as well. Thank you.

Next I think we have Mr Friedman.