Transcript of Module 2 Public Hearing on 17 October 2023
(10.00 am)
Lady Hallett: Mr O’Connor.
Mr O’Connor: Good morning, my Lady. Our first witness this morning is Professor Steven Riley.
1. Professor Steven Riley
PROFESSOR STEVEN RILEY (sworn).
Questions From Counsel to the Inquiry
Mr O’Connor: Do take a seat, Professor. Could you give us your full name, please.
Professor Steven Riley: Steven Riley.
Counsel Inquiry: Professor, you have prepared a witness statement at our request. It’s on the screen now. I know that you’re familiar with the contents of that statement, and it is signed at the end of the statement with your name underneath a statement of truth saying that you believe the facts contained in the statement to be true. Is that right?
Professor Steven Riley: That is correct.
Counsel Inquiry: Thank you.
You are a professor of infectious disease dynamics at Imperial College London; is that right?
Professor Steven Riley: Yep.
Counsel Inquiry: Is that a post you’ve held for some time?
Professor Steven Riley: Yes, I think since 2016.
Counsel Inquiry: We’ve heard from other witnesses, and no doubt you’d agree, that Imperial is one of the main centres of infectious disease epidemiology in this country?
Professor Steven Riley: Yes, that’s correct.
Counsel Inquiry: Also on the staff at Imperial is Professor Neil Ferguson, from whom the Inquiry will be hearing later today.
Professor Steven Riley: Yes.
Counsel Inquiry: You give us some detail of your career in your witness statement, Professor, and we can see, amongst other things, that earlier in your career you worked on the SARS outbreak of 2003?
Professor Steven Riley: That’s correct.
Counsel Inquiry: And you explain that you conducted work at that stage assessing the transmissibility of that particular virus?
Professor Steven Riley: Yes, that’s correct.
Counsel Inquiry: Then subsequently, is this right, you worked for some years at the University of Hong Kong?
Professor Steven Riley: That’s correct, from 2004 to 2010.
Counsel Inquiry: And you explain, therefore, that you were in Hong Kong during the influenza pandemic or epidemic in Hong Kong of 2009?
Professor Steven Riley: That’s correct.
Counsel Inquiry: Subsequently, you have been back at Imperial College since 2010?
Professor Steven Riley: That’s right.
Counsel Inquiry: And you refer to something called the MRC Centre for Global Infectious Disease Analysis.
Professor Steven Riley: Yep.
Counsel Inquiry: Is that a research body entirely within Imperial College or not?
Professor Steven Riley: Yes, that’s entirely within Imperial College, almost entirely within the Department of Infectious Disease Epidemiology.
Counsel Inquiry: Professor Ferguson, is he the head of that centre?
Professor Steven Riley: He – not at the current time, but he was the head of the centre until recently.
Counsel Inquiry: And during the pandemic he was?
Professor Steven Riley: Yes, he was.
Counsel Inquiry: Yes. I’m going to ask you about the pandemic in a moment, but before 2020, I think it’s right that you were a member of SPI-M?
Professor Steven Riley: That’s correct.
Counsel Inquiry: Sometimes referred to as the peacetime modelling committee?
Professor Steven Riley: That’s right.
Counsel Inquiry: Then once the pandemic started, in early 2020, you became a member of SPI-M-O, the operationalised version of that committee, that we heard about from Professor Medley?
Professor Steven Riley: Yep, that’s right.
Counsel Inquiry: Also as the pandemic started, you refer to something called the Imperial College Covid-19 research team.
Professor Steven Riley: Response team.
Counsel Inquiry: Sorry, response team.
Professor Steven Riley: Yep.
Counsel Inquiry: In a few sentences, what was that?
Professor Steven Riley: So that was the group of individuals within Imperial College who started working almost entirely on the response to the pandemic, the scientific – doing scientific studies to support the response, that grew rapidly through the end of January, February and March to try to provide support.
Counsel Inquiry: We’ve heard that Imperial College was well represented on SPI-M-O. Was it that response team that was, as it were, driving the Imperial College efforts in that regard?
Professor Steven Riley: The response team did not only support the UK response and they did not only support SPI-M-O, but yes, lots of people within the team would have been contributing to material that went to SPI-M-O.
Counsel Inquiry: You say it didn’t only support the UK response; were you also involved with assisting other countries then?
Professor Steven Riley: That’s right. So there was work done directly to support WHO, to support US – the US response in some ways, and individual country support through existing bilateral relationships. There was a lot of – a lot of work was done going in many different directions globally.
Counsel Inquiry: Thank you.
Now, we’re now becoming increasingly familiar with the structure of scientific committees. At the time, of course, SPI-M-O reported to SAGE. You were not on SAGE; is that right?
Professor Steven Riley: That’s correct.
Counsel Inquiry: We’ll come to a more recent period where I think you did attend some SAGE meetings, but in your role as academic modeller in the early stage of the pandemic, you were simply attending SPI-M-O meetings?
Professor Steven Riley: That’s correct.
Counsel Inquiry: You also were lead investigator in the REACT programme. We’ve heard something about this programme already. In full, it was the Real-time Assessment of Community Transmission programme, and it went through various phases, but they were all, one way or another, designed to get a richer picture of the extent of transmission of the virus throughout the country?
Professor Steven Riley: That’s correct. So in collaboration with colleagues at Imperial, we had a number of different studies under the REACT umbrella, and I was most concerned with REACT-1.
Counsel Inquiry: And that was the element of REACT which was involved in sending PCR tests or obtaining PCR tests throughout the country, and through that means –
Professor Steven Riley: That’s right.
Counsel Inquiry: – an understanding of the rate of transmission?
Professor Steven Riley: Trying to have as least a biased sample as we could of how many people were positive for SARS-CoV-2 at any point in time.
Counsel Inquiry: Just give us an idea of the scale of that: how many thousands of tests were being done how frequently?
Professor Steven Riley: I think in the end we approached – I think we approached 16 million people and we received, I think, over 2.5 million testable swabs.
Counsel Inquiry: So a lot?
Professor Steven Riley: Yeah.
Counsel Inquiry: Then lastly, and I mentioned this, since October 2021, so some way into the pandemic, your role changed quite dramatically. Tell us about that.
Professor Steven Riley: Yeah, so since October 2021 I’ve been seconded at 90% to the UK Health Security Agency, where I’m part of the group that looks after data, analytics and surveillance.
Counsel Inquiry: So, to all intents and purposes that was your main job?
Professor Steven Riley: Yes, yes.
Counsel Inquiry: Did you continue to be a member of SPI-M-O from that time?
Professor Steven Riley: I did continue to attend SPI-M-O. So I think I did maintain membership. To be perfectly honest, it’s not 100% clear to me in the capacity, but I did contribute to meetings and do attend.
Counsel Inquiry: But presumably you didn’t have the time to be doing the research and the modelling work that you had done previously?
Professor Steven Riley: That’s correct, and I stepped back from the REACT Study when I joined UKHSA.
Counsel Inquiry: It’s in this capacity that there was that caveat about SAGE attendance, because you mention in your statement that later in the pandemic you did attend, I think you said, two SAGE meetings, as, as it were, a UKHSA representative?
Professor Steven Riley: That’s correct.
Counsel Inquiry: We’ve heard something, Professor, about the – I don’t know if “clash” is the right word, “tension” might be a better word, between those academic scientists, if you like, who were members of SPI-M-O, and other committees, on the one hand, and government scientists, government civil servants, who were also part of that system. First of all, do you recognise that description?
Professor Steven Riley: Yes. I think there are different roles. I think acting as an independent scientist providing advice to government is quite a well defined and different role from being – acting as an official for the government and working with those scientists, but also working – potentially working directly with ministers.
Counsel Inquiry: You have experience of, as it were, seeing the workings of these committees from both sides, having occupied both roles?
Professor Steven Riley: That’s correct.
Counsel Inquiry: We’ll come back to that in a little while when I ask you about some of the matters you’ve raised in your statement about the ways of working of those committees.
I want first now to turn to your involvement right at the start of the pandemic, and we heard from Professor Woolhouse yesterday, and indeed from Professor Costello, about their developing understanding of the virus early in those first few weeks, really, in January and early February of 2020.
In your statement at paragraphs 4.11 and 4.12, perhaps we can call them up, you’ve copied a couple of tweets that you sent, I think.
Professor Steven Riley: Yep.
Counsel Inquiry: Which, as it were, record your initial developing understanding of the pandemic.
Professor Steven Riley: Yes.
Counsel Inquiry: So on 9 January, you say:
“It’s better in many ways that this incarnation appears to be less severe once infected. However, our ability to control it is driven by our ability to find cases. If being ‘mild’ makes it harder to find, it _could_ pose a greater health threat.”
Then if we can just look at the other tweet, which is on the top of the next page, I think. So you’re referring to a further report, and you say the characteristics seem to be – presumably this is one of the cases:
“- did not visit the market
“ - returned on the 6th
“- already recovered”
And then you say:
“A version of SARS with a lower infection fatality rate _could_ be a much bigger public health problem.”
Could you describe, perhaps in lay terms, what the concerns you were expressing in those two tweets were, particularly with regard to the lower infection fatality rate?
Professor Steven Riley: Yeah. So thinking back to SARS-CoV-1, the virus that caused the 2003 outbreak, it had a very high infection fatality rate. It wasn’t evident at the time, but afterwards we became sure it really was very high, and it also became evident there was very little transmission from people who – prior to exhibiting symptoms or from that small proportion of people who didn’t actually have symptoms, and it was very small for SARS-1. So when we did a lot of that work, and we kind of did some wash-up work thinking about exactly why we’d been able to control SARS-1, we started to think about properties of similar viruses that would make them much more difficult to control. And I don’t have a really good published reference for this but, recalling those conversations, if it was a bit more mild, and because it’s more mild there’s less severe disease and possibly less disease at all, there’s asymptomatic transmission, that would make stopping it much more difficult. And it’s – the overall impact is about the number of people who were infected times the severity. So the overall impact could be much, much higher, even if it was less severe.
Counsel Inquiry: Exactly. So, I mean, one might have thought that a lower infection fatality rate would be a good thing, but what you’re pointing to is that the milder symptoms make it that much harder to stop –
Professor Steven Riley: That’s –
Counsel Inquiry: – and so even if there is a lower infection rate, it could still involve the deaths of a far larger number of people?
Professor Steven Riley: That’s right. So from the point of view of a virus, when you’re trying to optimise your success, having a very high fatality rate is not necessarily good, from the point of view of the virus.
Counsel Inquiry: Thank you.
Let’s move on. In your statement you make a couple of observations about the work of SPI-M-O during February 2020.
If we could go, first of all, please, to paragraph 2.9. Thank you. If we could enlarge that paragraph. Paragraph 2.9, that’s it.
So just picking it up in the second line you say:
“It is my view that during the early period of the response, some key commissions were too narrow. For example, during February 2020 we were asked for views on school closures and on the impact of other interventions in delaying the peak, and we were asked about reasonable worst-case scenarios. We were not asked about the likelihood that interventions could achieve ongoing containment, nor were we asked about most plausible scenarios.”
Just pausing there for a moment, the term “ongoing containment”, is that a term which also means suppression of the virus, keeping the R number below 1?
Professor Steven Riley: Yeah. I think as it developed later they’re essentially synonyms. At that stage I was preferring the phrase “ongoing containment”.
Counsel Inquiry: But when we see the term “suppression” used in other documents, that’s the same thing?
Professor Steven Riley: Yes.
Counsel Inquiry: If we can keep that in mind, and just go, please, to another paragraph, which is 2.5, on a similar theme, you say that:
“[You] do not believe that SAGE and its sub-groups took sufficient account of international experiences during the early stages of the pandemic. In particular the possibility of a national lockdown should have been actively considered from 23 January onwards.
So bringing those two paragraphs together, you appear to be saying that the thinking was not, perhaps, on a large enough scale, or that you weren’t addressing, in particular, the possibility of a lockdown early enough?
Professor Steven Riley: Yeah, I mean, it was my view then, and I think it’s kind of evident elsewhere in the evidence, that the Wuhan – on 23 January, that was when the public health officials in Wuhan decided to try to contain the virus there. We certainly did not know that that would work and we did not know that that would be a good policy in the end for China, not by any stretch of the imagination, but it was incredibly innovative, although crude, and with lots and lots of negative side effects. It was actually very innovative, because no one had really thought you would go for containment from that point.
So my main point here is not that it would be the right thing for us to do, but it should have been actively considered because the population with the greatest experience of the virus at that point had decided to try it.
Counsel Inquiry: Is that the point you make about international experiences, it’s the comparison with China that you’re talking about there?
Professor Steven Riley: Yeah, so I think that’s one example. I think, you know, somewhat later, you know, much later in this timeline, there were comparisons with Italy as well.
Counsel Inquiry: Yes.
Professor Steven Riley: But for me, because of – because Wuhan happened first, it’s perhaps the most important.
Counsel Inquiry: So that brings us back to what you said in that first paragraph we looked at, that on SPI-M-O you were being asked about modelling school closures and other, perhaps more micro, matters. You felt, did you, that there was a bigger picture that should have been considered even at that early stage?
Professor Steven Riley: Yeah. It’s not to say they weren’t also important questions, but I couldn’t think of elsewhere in the system where consideration was being given to some of those broader questions. So I was frustrated at the time at the narrowness of questions that we were being asked.
Counsel Inquiry: In his evidence yesterday to the Inquiry, Professor Woolhouse referred to February 2020 as a “lost month”, I think it was a quote he picked up from somewhere else. Is it a similar idea that you’re expressing here?
Professor Steven Riley: I think somewhat. I think – I did not know for sure that we wouldn’t consider stringent interventions until very – I became increasingly concerned we were not considering them at the end of February, into the beginning of March. So there was a huge amount of work going on, on lots of different issues, during February, and I didn’t realise that we weren’t actively considering some of these more severe interventions.
So in that respect, then yes, I’d agree, in not considering some things then it was a lost opportunity.
Counsel Inquiry: Moving on, you describe in your statement having conversations with Professor Ferguson during this period.
If we could look, please, at page 13, paragraph 4.21. If we could perhaps look at 4.21 and 4.22 together, that might make it slightly easier.
So first of all you say that you and he discussed the likely speed of the pandemic in the context of vaccine investment decisions. Tell us how those two go together.
Professor Steven Riley: Yeah – a quick comment, that just to say that with Professor Ferguson and many other members of the team, we agreed on many, many things, but that’s not the business of science; the business of – the practice of science is to talk about what you disagree with and trying to figure it out. And I’m emphasising for very deliberate reasons here some of the things that we didn’t agree on.
Counsel Inquiry: And you probably realise, Professor, that quite a few of my further questions will be about things that you and Professor Ferguson did not agree on, so we can – it’s an important point to start with, that there was an awful lot that we won’t be talking about where there was a consensus between you.
Professor Steven Riley: And a lot of that is extremely valuable.
Counsel Inquiry: Yes.
Professor Steven Riley: So, yes, so very early in the pandemic I was involved in some email discussions in very broad terms thinking about the global speed of the pandemic, and I took the view in those early discussions that we couldn’t assume that it would be very rapid in the same – without – and that there may be behaviour change whether mandated or otherwise. So I thought it could be slow enough that it was worth spending a lot of vaccines that might not be ready for nine, 12 months.
Counsel Inquiry: And this idea of yours, of behaviour change, is something that we’ll see that you came back to in a report in early March that we’ll look at.
Professor Steven Riley: Yep.
Counsel Inquiry: But when you say behaviour change, I think what you’re describing is people in society reacting to the pandemic for themselves, as opposed to being told to do things by the government?
Professor Steven Riley: Not quite. So I would – the – we should really talk about them separately.
We can measure pretty well how people are behaving with respect to the transmission of these pathogens, and that may or may not be influenced by government mandation or advice, but it’s kind of important to be clear: it doesn’t matter how the behaviour changes, if people observe the risk and make significant changes to the way that they’re behaving then the rate of transmission will go down regardless of how it happens.
Counsel Inquiry: So perhaps a better way of putting it, the point you were wanting to make, is that even if the government doesn’t, for example, impose a lockdown or other NPIs, it may well be that people will still change their behaviour in a similar way?
Professor Steven Riley: That’s also a point that I make in lots of places, yeah.
Counsel Inquiry: That relates, in terms of paragraph 4.21, to the speed of the pandemic because if people change their behaviour it will slow the pandemic down?
Professor Steven Riley: Yes.
Counsel Inquiry: Then on a related point, we see at paragraph 4.22 you and Professor Ferguson discussed whether that lockdown experiment in Wuhan would succeed or not?
Professor Steven Riley: Yes.
Counsel Inquiry: And what was your view?
Professor Steven Riley: I did not know that it would succeed, whatever a measure of success was, but I thought there was a reasonable chance and a … partly because I wouldn’t have expected them to try unless they thought they had a pretty good chance. So I thought there was a reasonable chance that it would.
Counsel Inquiry: These are discussions that you describe having with Professor Ferguson during late January and into February. It may be that they involved other colleagues at Imperial as well. But are these the types of debate that you’re saying perhaps ought to have been happening at SPI-M-O and SAGE but weren’t?
Professor Steven Riley: I think this was a crucial issue from the very beginning. And I don’t have a clear idea of what was discussed at SAGE. It could have been discussed more at SPI-M-O for sure.
Counsel Inquiry: Lastly on this part, I’d like to turn to page 6 and paragraph 2.12 of your statement, please. You were asked about an observation made in an Institute for Government report to the effect that in the initial months of the pandemic ministers put too much weight on SAGE, relying on it to fill the gap in government strategy and decision-making that was not its role to fill, and you indicate that you agree with that observation.
I think this is one of the aspects where your subsequent experience at UKHSA gives you an insight into the position earlier in the pandemic, before the capacity at UKHSA and other organisations had developed. So can you expand on why you agree with that observation, please.
Professor Steven Riley: Yeah. As you mentioned a few moments ago, I’ve had the opportunity to see the process as an independent scientist feeding in through SPI-M and then as a member of UKHSA, and when I arrived at UKHSA in October 2021 the resourcing around government in terms of supporting policy was probably at its maximum, and I could see the size of teams, the quality of work and the amount of work that was being produced in order to support decisions at that point. And as – you know, under simple assumptions of how much resource there would have been operating during the early phases, trying to support even more difficult decisions, then I think the Institute for Government’s statement is good.
Counsel Inquiry: What follows from that, if the point is that SAGE is doing work that it shouldn’t be doing, because it ought to be really being done by government, does it follow that SAGE either was or might have been actually involved in developing policies that weren’t part of its role, or are you really more talking about a sort of capability issue?
Professor Steven Riley: So I’d probably speak better to the capability issue, and I think there’s a difficult question here about how much standing capacity a government should maintain to provide this kind of support, because it’s – the level of resource in October 2021 was very high, and it’s probably not appropriate – it’s definitely not appropriate to maintain indefinitely. So I think the difficult question here is, and I’ll address the capability rather than necessarily policy, the difficult question is: what are the right mechanisms for the standing level of support and what is the right level of confidence in scalability of support in those early stages?
Counsel Inquiry: Thank you. We can take that down.
I’d like to move on with you, please, Professor, to address the period a few weeks later, in early March of 2020. Just by way of context and summary, we know, do we not, that the national lockdown was announced on 23 March, and that that represented a change in government policy from the mitigation strategy that it had pursued previously, flattening the peak, towards one of suppression or ongoing containment, depending on the terminology.
You were, as we shall see, centrally involved in the discussions at SPI-M-O that led towards that decision, and in fact again, as we shall see, you proposed the pivoting to a policy of suppression right at the beginning of March, and that is what we will look at now.
Can I start on this, please, by asking you to look at your statement. It’s paragraph 5.6 on page 23, starting three lines – actually on this copy it’s a few more than three lines, but five or six lines down, where it says:
“On 1 March 2020, [you] drafted and circulated a report …”
And you give its title, “The potential benefits of ongoing containment”, which we will remind ourselves means suppression.
You say you “hoped [that this report] could become an Imperial College Response team report”. We talked about that team at the beginning, and was it the case that the team generated reports which then went to SPI-M-O?
Professor Steven Riley: We – the team did generate reports that went directly to SPI-M-O. The type of report I’m talking about there is a public report.
Counsel Inquiry: Right.
Professor Steven Riley: So it’s worth a quick comment that, compared to prior outbreaks, the speed and transparency with which the evidence came from academic groups like Imperial was much, much better. So my primary concern was the – us publishing reports on the website because then they were – they could be available to SPI-M and to people all around the world as well.
Counsel Inquiry: Right. But in any event, it was like a badged product of the response team that you hoped this report would become?
Professor Steven Riley: Yes.
Counsel Inquiry: And you mention that it was an early version of a report which was in the end circulated a week or so later, and we will talk through the chronology of all of that.
Dropping down a few lines, the crux of it, you describe, is that you pointed out that a rapid wave, similar to the realistic worst-case scenario, could lead to 464,000 deaths. But by contrast, you were positing that if there was a successful policy of immediate suppression, that could reduce it vastly to only 148 deaths?
Professor Steven Riley: That’s right.
Counsel Inquiry: So was that your sort of core thinking at that stage, you were simply –
Professor Steven Riley: Yeah.
Counsel Inquiry: – positing those two alternatives?
Professor Steven Riley: And it – I mean, as you present those numbers, it looks strange, in – I mean, it felt strange to be writing that at the time, and it still looks a little bit strange to be reflecting on it.
I think on 28 February, WHO China delegation published their report and within that they state China’s policy is to maintain control and restart the economy, so on the 28th China had committed to going full bore for economic productivity and containment.
So, to me, that meant that we had to consider the possibility of ongoing containment without it being unachievable or without it being so bad that we would never want to do it. We had to consider that possibility at that point. And that justifies that very strange looking comparison of what we were apparently planning for versus what one could conceivably think might be an option for us. Might be. Not was, but might be.
Counsel Inquiry: Yes.
Now, you go on to describe, in summary, Professor Ferguson’s sort of negative reaction to this report, and you actually quote him, you say:
“Professor Ferguson’s view at the time was that ‘everyone in policy circles’ knew that R could be brought below 1 …”
Pausing there, do we mean they knew that this suppression policy was a possibility at the very least?
Professor Steven Riley: Yeah, so in the crudest level of success that you could – if your restrictions were severe enough, you could make the incidence start to decline.
Counsel Inquiry: Yes. And then reading on:
“… but that there was no appetite for the draconian measures that would be required.”
Presumably no appetite amongst those people in policy circles, that’s how we take it, is it?
Professor Steven Riley: You will be speaking to Professor Ferguson later today, so …
Counsel Inquiry: How did you take it at the time? Who was he describing, do you think?
Professor Steven Riley: I think I actually mention it just a few lines lower, I put “everyone in policy circles” in quotes, or yeah, I requote “everyone in policy circles” –
Counsel Inquiry: Let’s –
Professor Steven Riley: – because I don’t actually know what that means, and I’m highlighting that that’s kind of important.
Counsel Inquiry: Yes. Let’s drop down. I think the passage you’re referring to is at the bottom of the page, after the tirets. You say:
“Professor Ferguson also commented that we were currently driving UK preparedness and planning and that we were trusted by the government.”
So I think the “we” must mean the – Professor Ferguson and his science colleagues?
Professor Steven Riley: Again –
Counsel Inquiry: All right, we’ll ask him.
Professor Steven Riley: Yep.
Counsel Inquiry: But:
“He added that this was not the same as saying that we never disagreed with government policy or the CMO, but that we did so privately and constructively.”
He certainly seems to be stating there that “we” – take it that you can’t provide us with more precision as to what is meant, but it certainly doesn’t seem to be the government.
This group that he’s describing was in charge of pandemic policy at the time?
Professor Steven Riley: Could you repeat your question? I’m sorry.
Counsel Inquiry: The text says:
“… we were currently driving UK preparedness and planning and that we were trusted by the government.”
Professor Steven Riley: Yes.
Counsel Inquiry: So I appreciate that you don’t want to be drawn on stating what Professor Ferguson –
Professor Steven Riley: Okay.
Counsel Inquiry: – meant by that, but he appears to mean that a group other than the government is driving the policy.
Professor Steven Riley: Yeah. Yes, that is what it appears to be. There’s a lot of – there’s potential importance on the word “driving” and exactly who the “we” are. I agree that that’s – that’s how I would have understood it at the time, but I wouldn’t – as I say, the aspect of Professor Ferguson’s reply that kind of struck me was “everyone in policy circles”, which is why I repeated it back in quotes.
Counsel Inquiry: Yes.
Professor Steven Riley: I think my understanding is clear from how I’ve replied.
Counsel Inquiry: All right. Well, let’s just pick up another part of this, please. If we can go back in your statement to 5.6, here you’re commenting on another observation by the Institute for Government.
Thank you, that’s fine.
You say:
“I agree with the neutral Institute for Government that the desire of ministers to avoid a lockdown framed the advice commissioned from SAGE, and contributed to the delay in considering and implementing [suppression] measures.”
So again, is that something you picked up from Professor Ferguson, and maybe it’s linked to what we were talking about a moment ago, that there was no appetite for lockdown-type measures early in the pandemic?
Professor Steven Riley: Yeah, and I think it’s based on – I went back and – you know, when that opinion from the Institute for Government was put to me, I went back through the emails to see if I, you know, did have useful evidence, and I’ve put in that paragraph, you know, a specific example of how that statement does make sense.
Counsel Inquiry: So stepping back to your earlier observation that the February was a wasted month point –
Professor Steven Riley: Yep.
Counsel Inquiry: – that you weren’t looking at those larger issues of, might suppression work, you were looking at much more – the smaller but important issues, for example, about school closures and so on; is it possible that the reason SPI-M-O wasn’t being asked to consider those matters at that stage was this point you’re making here, which was that there was almost a deliberate decision being taken not to engage with those issues, or –
Professor Steven Riley: That is possible, yes. Yeah, and certainly the sentiment, yeah.
Counsel Inquiry: Moving on in the chronology, then, we were looking at that part of your statement where you describe drafting the note on 1 March, and Professor Ferguson’s reaction, not agreeing with it. I think it’s also right, I’m not going to take you to this part of your statement, but tell me if it’s right, that he indicated around that time that he didn’t want the report to become an official Imperial College response team report. Is that right?
Professor Steven Riley: Yeah. And can you check your dates for that one? But that’s certainly – that discussion did occur – it might be worth checking the dates.
Counsel Inquiry: I think what you say in your statement is that that occurred a few days later, around the 7th and 8th of March –
Professor Steven Riley: Yes.
Counsel Inquiry: – that you prepared a further draft and he said, “Well, I” – it was at that stage that he said he didn’t want it to be an official Imperial College report, and suggested that you publish it sort of separately in a scientific journal?
Professor Steven Riley: That’s correct.
Counsel Inquiry: But we will see that you did go on to provide your note, possibly slightly amended again, to SPI-M-O a few days later?
Professor Steven Riley: Yes, that’s correct.
Counsel Inquiry: So let’s move forward, if we can, to Monday 9 March, so a week or so after you had first drafted the note, and again you refer in your statement to hearing a radio report that morning about a COBR meeting which was due to take place and the suggestion that the Prime Minister would be considering imposing social distancing measures at that stage.
Professor Steven Riley: Yes.
Counsel Inquiry: If we can then, please, go to an email exchange, we see that that was the trigger.
Thank you.
So is it right, then, that having heard that radio exchange, or radio report, rather, that’s what prompted you to send this email that we’re looking at now?
Professor Steven Riley: Yes.
Counsel Inquiry: We can see from the start that it was sent, is this right, to the sort of SPI-M-O group email address and also to Graham Medley, who was one of its chairs?
Professor Steven Riley: No, I think it was sent to the SPI-M secretariat and to Graham. I don’t think this was sent to the full distribution list. I don’t think all my colleagues had the opportunity to comment.
Counsel Inquiry: Okay, that’s helpful, thank you.
If we look at the second paragraph down, we see you stating:
“It is my considered scientific opinion that we should implement school closures and working from home where possible and any other social distancing measure we can for the next three weeks. Starting as soon as possible.”
Professor Steven Riley: Yes.
Counsel Inquiry: You refer to school closures and working from home, but then you say – and everything else.
Professor Steven Riley: Yes.
Counsel Inquiry: Did you in fact mean a lockdown or something equivalent to that?
Professor Steven Riley: Yes. Well, the “any other … measures we can”. I wasn’t aware of what would be possible.
Counsel Inquiry: Well, we’ve heard that the word “lockdown”, which we’re now all so familiar with, wasn’t used at the outset of the pandemic, but I think it’s clear you are describing a broad set of NPIs?
Professor Steven Riley: Yeah. And I try to avoid using the word. I don’t – I don’t think it’s a good word, I think it’s – it sounds, it’s a lot more nuanced –
Counsel Inquiry: Right.
Professor Steven Riley: – than that word leads people to think of when they start discussing it.
Counsel Inquiry: But with that caveat, that’s what you’re suggesting?
Professor Steven Riley: Yeah, yeah yep.
Counsel Inquiry: In the next paragraph, you explain the basis for this suggestion, in effect what’s become described as NHS becoming overwhelmed.
Professor Steven Riley: Yes.
Counsel Inquiry: You say that:
“… business as usual [in other words, without those measures] will likely lead to the (at least partial) collapse of our health service within that time.”
And I think you mean three weeks, that’s the time period that you’re talking about in that context?
Professor Steven Riley: Yes.
Counsel Inquiry: Just looking at the next paragraph, as well as talking about – you’re talking about what should happen, first of all, within the three weeks of your proposed lockdown, and then what might happen afterwards?
Professor Steven Riley: Yes.
Counsel Inquiry: But in that context, you say:
“If you look back three weeks …”
So to, let’s say, mid-February –
Professor Steven Riley: Yep.
Counsel Inquiry: “… the world was a very different place.”
Professor Steven Riley: Yes.
Counsel Inquiry: I wanted to ask you whether what you’re saying there is that this issue about the likelihood of NHS collapse, if nothing changes, was different on 9 March when you sent this email as opposed to the middle of February, three weeks earlier, which here you’re saying was a very different place?
Professor Steven Riley: As a scientific point I don’t think the – there was no new understanding about what the demand would be on healthcare if behaviour did not change. I don’t – I think that’s established by the 1% infection fatality rate and the associated hospitalisation rate. So, as a scientific consensus, I don’t think that changed during that period.
What I’m referring to there, and I’m not being very specific about it, is our shared understanding of what this is going to mean, you know, in and around me and in our community in the UK and probably across Europe and elsewhere, has changed dramatically in the previous three weeks, and I would expect a similar change in understanding, possibly behaviour and attitude, in the following three weeks.
I think from recollection that’s kind of what I was trying to say, but I’m not very precise there.
Counsel Inquiry: Sure. We might come back to that point about the developing understanding of NHS collapse in due course.
Just finally on this email, I think, a rather more general point: you do refer in the third paragraph to numerous models as a basis for your understanding that you’re expressing in the email. But equally, in the final paragraph you make the point that this view you’re expressing is based on something rather broader than merely modelling, if I can put it that way.
Professor Steven Riley: Yeah.
Counsel Inquiry: Is that right? Can you explain what you’re trying to get at here?
Professor Steven Riley: Yeah, so I consider my scientific discipline to be the study of the transmission and control of infectious diseases. That involves properties of the virus –
Counsel Inquiry: Don’t go too quickly, Professor.
Professor Steven Riley: That involves properties of the virus, that involves the behaviour of people, it involves the design of interventions, their effectiveness, their cost effectiveness. It’s a very broad topic, and we use evidence from lots of different sources in order to generate a scientific view, and an evidence-based scientific view comes from lots of different types of evidence.
I think I mention – I do mention the committee being described as a modelling committee, and I’m highlighting there my frustration perhaps at the narrowness that we’ve discussed a moment ago, and I’m saying – I’m claiming a right, as a biological scientist, to give this opinion, somewhat regardless of any specific modelling output.
Counsel Inquiry: Yes. If we can just look, I just want to look briefly at the emails that followed this one. First of all, Professor Medley responded that same morning, did he not?
No, sorry, if we can go back to the document before, but just scroll up within it. That’s it.
At the bottom half of that page there is a response from Professor Medley, and if we can just look, there’s a paragraph starting:
“We have a choice now: Full or Partial.”
By which he means, to use the slang, full or partial lockdown, doesn’t he?
If we can see the two lines below that he’s talking about the full lockdown option, but he says:
“… we will have saved lives but at enormous cost (health, economic etc).”
This is one of the points which we will come on to see again and again, but the objection to a lockdown on the basis of economic impact, and with that in mind, if we can look up at the top of this page, and your response back to Professor Medley, there’s a paragraph starting “To be honest”, you say:
“To be honest, I have not seen any economic analysis of an …”
Then you describe I think an unsuppressed pandemic. But you say:
“… but it keeps being implied to me by Neil and others. I am happy to go sit in a room somewhere and review that evidence or to give an opinion on email. An awful lot of our decisions seem to rely on the idea that the above scenario has some kind of economic advantage over the alternatives.”
Are we seeing here, and I think we see it in other emails, Professor, a level of frustration on your part about assertions being made relating to economic impacts without any evidence being provided to support those assertions?
Professor Steven Riley: Yes, that’s correct.
Counsel Inquiry: Was that a problem which, in your view, continued?
Professor Steven Riley: Yes.
Counsel Inquiry: Thank you. As I say, we’ll come back to that.
So that was the exchange that you had with Professor Medley on that day, and we can see – if we can now go to the next document, please – the next day, so on 10 March, and this again was early in the morning, you sent an email to Sir Jeremy Farrar, who we heard something about yesterday. He was the director of the Wellcome Trust at the time. And we can see that you send him a draft of your paper; is that right?
Professor Steven Riley: That’s correct.
Counsel Inquiry: And essentially you’re asking him for his advice?
Professor Steven Riley: Correct.
Counsel Inquiry: Can you expand on what you were asking him and why?
Professor Steven Riley: So, it felt to me – it must have felt to me at the time that there was a reluctance to put some of these ideas on paper in a very formal way, and I – in the other evidence that I’ve submitted, you can see me having been frustrated with that over, like, the preceding period of time. So at this point I’m considering emailing my paper to the entire SPI-M, where I think it would attract a lot of attention. I didn’t know – I did not know for sure what the right policy was. I felt I should under – if we were doing something that I didn’t understand, that was important, not to – not to be too arrogant, I thought I should understand why we’re doing stuff, and if I don’t, then I was willing to push and push until I could understand why we were doing things. But if it turned out my view actually wasn’t that useful, I could see that this would massively disrupt – potentially disrupt the work of the committee, potentially need a whole load of people to divert and handle it, if you like, in some way, so I could see that this would potentially be a distraction for other people and – and it was a risk, so I was – I valued Jeremy’s opinion and I was asking him whether he thought I should do it.
Lady Hallett: Can I just intervene there? Sorry, Mr O’Connor.
You’re sitting as an independent scientist on a committee but you felt that you shouldn’t send what was a considered but different opinion to the committee? I’m not quite following why you thought you couldn’t.
Professor Steven Riley: Maybe I was wrong, maybe I was overthinking it. I hadn’t had a lot of sleep –
Lady Hallett: I can understand that.
Professor Steven Riley: – in the 48 hours prior to that. But there’s an awful lot of people doing a lot of work and I didn’t assume my view was the only view or completely correct or, in the fullness of time, would be judged as useful, I wasn’t sure that was the case. So I thought this would be disruptive. That was my sense, that it would be disruptive. And, you know, somewhat risky to me. I mean, honestly, in a slightly personal professional capacity, somewhat risky to me, and I was looking for a little bit of advice from someone I trusted.
Lady Hallett: Thank you.
Mr O’Connor: Thank you.
Also, let’s not forget, someone who was himself on SAGE?
Professor Steven Riley: Yes, absolutely, and that’s not incidental to me choosing Professor Farrar.
Counsel Inquiry: Now, we don’t have, as far as I know, an emailed written response from Jeremy Farrar to this email. Did he respond?
Professor Steven Riley: Yeah, I think he did. I then went to sleep for a couple of hours after this and then I decided to send it when I woke up anyway, and I think Jeremy did reply afterwards, but I’d already decided to send it in at that point. And I think in Jeremy’s book he does mention a positive response a little bit later.
Counsel Inquiry: It’s – we don’t need to worry about this, it’s cut off on the version on the screen, but this email to him was sent at 6 o’clock in the morning?
Professor Steven Riley: That’s right, that’s before I – yeah.
Counsel Inquiry: As you say, you did shortly after that then, an hour or two later, circulate the paper to the members of SPI-M-O?
Professor Steven Riley: Yes.
Counsel Inquiry: That then provoked an email discussion which I’m going to take you to. Before we do that, I’d like to take you to the paper itself briefly.
Professor Steven Riley: Yep.
Counsel Inquiry: So for those purposes can we go to –
Professor Steven Riley: Yep.
Counsel Inquiry: We’ve got it, thank you.
Professor, I don’t want to spend too much time going through the detail of the paper, but the passage in bold here is a summary, is it not?
Professor Steven Riley: Yes.
Counsel Inquiry: Is it right to say that in essential terms, like the email that you sent to Professor Medley, you are here calling for a switch from the mitigation strategy to a suppression strategy?
Professor Steven Riley: Yes, that’s correct.
Counsel Inquiry: What this paper does, which perhaps the email didn’t, is to add a level of sort of modelling support for that call?
Professor Steven Riley: It does two things. It certainly does add some illustrative modelling. I think I repeat in this paper in another paragraph that I didn’t believe that modelling was required for that switch, but I thought that it was useful nonetheless. And it also expands on the reasons that I held the views that I did on how behaviour may or may not change. So I – yeah.
Counsel Inquiry: If we just pick this up three lines down, you say:
“The primary benefit of mitigation is that the epidemic will be over more quickly than might otherwise be the case, with the population having acquired herd immunity and also having experienced a relatively low peak.”
What you’re describing there is what is the sort of perceived benefit of the mitigation strategy?
Professor Steven Riley: Yes.
Counsel Inquiry: Squash the peak?
Professor Steven Riley: Yep.
Counsel Inquiry: Get it over with still relatively quickly?
Professor Steven Riley: Yep.
Counsel Inquiry: And achieve herd immunity?
Professor Steven Riley: Yep.
Counsel Inquiry: And you, in this paper, challenge that thesis on two grounds. One is the argument which we were looking at a few minutes ago, which is that the NHS would collapse in the course of that wave; is that right?
Professor Steven Riley: The sheer number of deaths implied by the wave I think is the first point. So the implicit health impact if that wave were to happen is very, very large over such a short period of time.
Counsel Inquiry: Yes. There is a sentence about eight or nine lines down which says:
“We show [that’s presumably in this report] that critical care facilities in the UK would be saturated quickly.”
Professor Steven Riley: Yes.
Counsel Inquiry: Is that the point?
Professor Steven Riley: Yes.
Counsel Inquiry: But then there is a separate point which takes us back to those discussions you were having with Professor Ferguson in January –
Professor Steven Riley: Yes.
Counsel Inquiry: – that maybe the mitigation strategy wouldn’t quite work out as expected anyway?
Professor Steven Riley: That’s correct.
Counsel Inquiry: Can you expand on that?
Professor Steven Riley: Yes.
Counsel Inquiry: Or just explain it.
Professor Steven Riley: So, the benefit – and again, given the numbers in this paper, it’s strange to talk about benefits of strategies with those health impacts, and it felt strange at the time, and I would – you know, anyone watching this now who thinks that we were writing these numbers and not believing them to be strange and understand their implication, that was not the case. It’s just these – this – these were the apparent choices in front of the people looking at it.
So the benefit of a successful mitigation is that it’s over quickly, but the population would have to – could only change their behaviour somewhat in order to land just the right amount of immunity so the virus couldn’t come back. Forgetting about all the other issues about immunity and things. So if you got it just right, you’d have to somehow bring transmission down through changes in behaviour.
If the population responded by changing even more, even more than you wanted them to, they wouldn’t have to change that much more to go down to a threshold where the virus wouldn’t grow, to get R to 1. And that’s a break point analysis, it’s – in olden days of this kind of science, when we used differential equations and not simulations, this was quite a common way of looking at a problem to identify a key parameter and say: what’s the implications of that taking a different value? And at that point the rate at which you would accumulate herd immunity is very, very slow, and you’re operating within an entirely overwhelmed health service.
Counsel Inquiry: So is this right, another way of putting that same point is that if the government went down the mitigation strategy, the problem you’re identifying is that the population might almost lock themselves down, to use a very general term, or at the very least change their behaviour in a way that prevented the virus spreading amongst the community as rapidly as had been expected, which would have that effect that you’ve described?
Professor Steven Riley: That’s also a good summary, yes.
Counsel Inquiry: I just want to take you to two other parts in this report, if I may. First of all, if we can look at page 4, please, this is the final paragraph of the report.
You mentioned, Professor, in answer to one of my questions, that even in this paper, which was dealing with modelling, you made the point that there were other reasons to adopt this course beyond simply modelling. Is this the passage that you had in mind, where you talk about the example of other countries leading to that conclusion as well?
Professor Steven Riley: Yeah, and a very, you know, brief comment on the style. This is – it was drafted with the intent of being a published article that would have readership much broader than just the UK potentially. So that’s – the style then is to go to some very general points at the end. And yes, I think the point I wanted to make here is that even though there was useful evidence contained in the modelling in this report, I didn’t – my view was not that it was necessary, and that actually there were – other evidence was sufficient to arrive at a similar policy conclusion.
Counsel Inquiry: Thank you.
Then if we can just finally –
Lady Hallett: Before you do, could you just tell me what you meant by “fixed-term social distancing”? Sorry, could we highlight the passage again? The penultimate line:
“… [we should] adopt stringent fixed-term social distancing.”
Professor Steven Riley: So that’s – I’ve mentioned – I mentioned three weeks. I thought that there should be a time limit imposed on any stringent social distancing, not because we knew for sure what the impact would be by that time, but because earlier imposition had such high value that essentially the information that we would gain would put us in a different place at some known future time. Because …
Lady Hallett: And what measures exactly did you mean by stringent social distancing?
Professor Steven Riley: So I think I’d probably go back to the email that I’d sent the previous morning for the meaning, so it was school closures, work from home, and whatever else we had, and I didn’t really know what we might have at that point.
Lady Hallett: Okay, thank you.
Mr O’Connor: Professor, you don’t like using the word, but may we use the shorthand –
Lady Hallett: Lockdown.
Mr O’Connor: – lockdown?
Professor Steven Riley: You may.
Mr O’Connor: Could we then turn to page 6, please.
Now, could we get as close as we can to the graph on the right-hand side, please.
Professor, there is a reason we’ll come back to why this graph may be of some extra significance, but for the purposes of the report – well, perhaps you can tell us in summary what these different lines show?
Professor Steven Riley: Yeah, and this is obviously – this is intended for my scientific colleagues. I mean, it’s not the most accessible presentation, it’s on a log scale, so powers of 10 on the vertical axis rather than – rather than the linear scale. And the red line is showing some hypothetical completely unmitigated, no behaviour change, massively rapid epidemic, and it goes very high. The blue line is what I viewed as, again hypothetical, perfectly landed mitigation.
Counsel Inquiry: Just pausing there, that’s the sort of squashed peak aim that –
Professor Steven Riley: Yeah.
Counsel Inquiry: – at one stage the government was trying to achieve?
Professor Steven Riley: And it’s not that squashed. That’s – we’re looking at infectious disease incidence for a whole country on a log scale here. That’s a – you know, that’s – you don’t normally need to do that.
And then the cyan line there is the output from the model which shows if people’s behaviour was strictly triggered by ICU being saturated. And this is – this is a scenario. I didn’t think – it’s not a forecast. I didn’t think that that – those features of the line would play out exactly as are on there, but it’s a – I thought it was a very useful scenario.
Let’s say we were going to let the thing spread until we saturated ICU but then everyone is like, “I’m not going to carry on behaving the same because I’ve no longer got a ventilator available to me”, you’d get this kind of short cycle bouncing around at a very low level. So the key thing here is the height of the cyan line is quite low.
Counsel Inquiry: So that’s the turquoise line, and that’s the –
Professor Steven Riley: Sorry, turquoise, yeah.
Counsel Inquiry: – sort of unilateral decision within the population to dramatically reduce their movement that’s – the problem that you were identifying potentially?
Professor Steven Riley: Yeah, yeah. If every time the ICU was saturated we all changed and reduced and then we started back again, that’s what it would look like.
Then the green line is the scientifically kind of trivial – let’s say we managed to bring the R down and keep it down, then it’s the green line.
Counsel Inquiry: Thank you.
So that’s your report, and as I indicated, when you circulated, it generated a debate amongst the members of SPI-M-O, and particularly you and Professor Ferguson.
So we can turn to that now, please, and that is INQ000269369. Thank you.
So we’ve gone first to this page, where – do we see here, halfway down, Professor – so we’ll recall that it was 6 in the morning when you sent that email to Sir Jeremy Farrar, I think you said that you thought about it a bit, maybe had a cup of tea, and then two and a half hours later you are deciding “I’m going to send this to the whole committee”?
Professor Steven Riley: That’s correct, yep.
Counsel Inquiry: So that’s what you’ve done and that’s the report we’ve just looked at?
Professor Steven Riley: Yes, correct.
Counsel Inquiry: Then if we can go forward, please, or scroll up to the next page, within less than an hour, we see Professor Ferguson’s response, which is not a positive one, Professor. I wanted particularly to pick up on the third paragraph, where he says:
“I do feel strongly that we should focus on providing an evidence based assessment of what the policy choices are and their likely impacts, rather than advocate for a particular policy. At least in our role on SPI-M.”
Professor, this is a point that you expand on in your witness statement, the issue about scientific advocacy or scientific evidence. What was the difference of opinion here and what was your take on it?
Professor Steven Riley: So I think we should be very careful describing a view as advocacy and another view as evidence-informed scientific opinion, and I think – I don’t think I say so explicitly here or in the other evidence but I think I probably show, I felt that I had an evidence-based opinion that covered recommendations on interventions. As I’ve mentioned before, our scientific discipline includes the study of interventions and I had an evidence-informed opinion for one intervention over another.
I think here Professor Ferguson has chosen to describe my view as advocacy, and by implication the view of others as being more valid or more based in evidence. And I think that’s what – that’s my understanding of what Professor Ferguson is saying here.
Counsel Inquiry: Linked to that then is also the point which is debated in these emails about whether a proposal such as yours should be made without explaining exactly how it’s going to work?
Professor Steven Riley: Yeah, and that is a different – that’s a different point, but linked. We disagreed on that, and I don’t think that’s any more complicated than my view was, having studied interventions against respiratory viruses for many – my view was that other countries had decided to adopt this approach without necessarily knowing exactly how it was going to work, but acknowledging that the timing, the speed with which you adopt it is important. So there is a trade-off there between knowing exactly how it’s going to work out for you, but – or doing it quickly, and my view was it was justified to move quickly, even – and again, even if we didn’t really know exactly how it was going to work.
Counsel Inquiry: It might also be thought that the mitigation strategy that was in place, and which, as we will see, Professor Ferguson was defensive about, I mean, there were also some quite serious doubts about how that was going to work at the time?
Professor Steven Riley: Yeah, I think that’s true.
Counsel Inquiry: Let’s move on in the exchanges, if we can, which are all – in fact, if we can move to page 3, there is an exchange between the two of you about this point about the extent to which the workings of a policy need to be demonstrated.
Then I want to come to – thank you – this one, which – we can see we’re now on the next day, it’s 11 March now, and so the first paragraph is the continuing debate about exactly what your role is or the role of you and Professor Ferguson and SAGE and the government and so on. But I want to come particularly to the second and third paragraphs, where Professor Ferguson said:
“I would also note that there is now significant momentum behind the current strategy. A huge amount of effort is going into operational planning right now. Government is aware of the projected incidence, health system demand and mortality impact. Though I … would like to be reassured that the Cabinet is aware of what that will look like in reality.”
Then this:
“The current view is that – with difficulty – this can be handled. Policy will not change unless we can demonstrate convincingly (rather than rhetorically) that the strategy will fail, and/or propose a concrete ‘better’ alternative. There is limited appetite for intense social distancing policies – it has taken considerable work to move the government to the likely current strategy.”
The first point to be made is Professor Ferguson is not keen to move away from the mitigation policy. What did you understand by his language of, as it were, having in the first place moved the government to that strategy?
Professor Steven Riley: I honestly can’t remember focusing on that at the time. I understood – so, through February I didn’t know what the government would do when the virus arrived, and, you know, it wasn’t clear that they weren’t considering really stringent interventions. To me. So it was – during the very end of February and the beginning of March it became more clear that they were – that the government was focusing much more on mitigation. So I didn’t really know whether there had been a move or a change – or I didn’t – I didn’t know what had gone on at higher levels during February at all, and I didn’t – I didn’t notice that at the time.
So with all due respect, you can ask Professor Ferguson.
Counsel Inquiry: Yes. Just one other point on this, before we move on, the paragraph above. He says:
“Government is aware of the projected incidence …”
So that’s the anticipated mortality rate of the mitigation strategy.
And also “health system demand”. The inference there is that, on the one hand, you’re saying an awful lot of people are going to die and the health service is going to be saturated; Professor Ferguson seems to be saying the government know that but they want to do the strategy anyway?
Professor Steven Riley: That’s correct. What you’re saying is correct.
Counsel Inquiry: Yes.
Just one other point on this set of exchanges I’d like to ask you about, and for those purposes I think we need to go back to the first page of the document.
Yes, thank you. Sorry, let me just make sure I’ve got the right reference here.
(Pause)
Counsel Inquiry: Yes, thank you. So you say:
“I understand your view.”
This is – sorry, let’s just be clear about this, this is Professor Ferguson.
Professor Steven Riley: Yep.
Counsel Inquiry: He says:
“I understand your view. But just bear in mind the Treasury advice is that 6 months of intense social distancing – sufficient to achieve R<1, is predicted to drive deep recession and massive business failures and job losses.”
Then he refers to talking to someone from the US federal interest committee, and so on.
Do we see here again an example of the economic impact of lockdown being used to challenge that possibility?
Professor Steven Riley: Yes, we do, and can I comment on my –
Counsel Inquiry: Yes.
Professor Steven Riley: – response?
Counsel Inquiry: Yes.
Professor Steven Riley: People who were supportive of lockdown did not for one moment think that it wouldn’t have lots of massive negative consequences, but the point I make here in reply to Professor – to Neil is that we don’t have a counterfactual, we don’t – there seems to be an unstated implicit assumption that if we don’t do something we’re going to have a better economic outcome and a better outcome across all those other different dimensions, and I – I didn’t know why people assumed that.
Counsel Inquiry: So there are two points, perhaps. The first is the one you’ve made, which is that it’s all very well to say that a lockdown will be very costly, but how expensive will that turquoise unsuccessful mitigation policy – or even the successful mitigation policy be?
Professor Steven Riley: Yep.
Counsel Inquiry: But the second is: did you actually see these Treasury forecasts or Treasury modelling that you occasionally are being told about?
Professor Steven Riley: That’s correct, yeah, that’s another point, yes.
Counsel Inquiry: And in that regard, can I take you to a further document, please, INQ000103475.
So this is an email from several weeks later, the end of March, so we’re into lockdown by this stage, and you’re discussing, on this occasion with Professor Medley and Professor Woolhouse, some further aspects of social distancing policy.
In fact if we can go to the next page, please, it’s the paragraph starting “There are no easy choices here”, you say:
“There are no easy choices … While understanding that the stated government objective is to save as many lives as possible, economic impact is also important. But has any other branch of government done a detailed assessment of what the economy would look like with a prolonged period of virus circulation at or near maximum NHS capacity?”
So that’s the counterfactual point again. But you go on to ask:
“Is there a treasury team to whom we can send a plausible set of scenarios and ask directly how much better one scenario might be than another? We have a _little_ bit of time and this question has arisen many times.”
So did you get an answer to that question as to whether there was a Treasury team you could engage with?
Professor Steven Riley: I don’t think that I did. I think I may have put in my statement that I searched and was unable to find any answer. Or it may have been a slightly different email. But I don’t think – I don’t believe I did.
Counsel Inquiry: Moving away from this particular email, your general experience of that time when you were sitting on SPI-M-O as an academic scientist, did you ever find the answer to this question of: where was the economic modelling that you could look at to help understand your advice on policy change?
Professor Steven Riley: No, I did not.
Counsel Inquiry: Thank you.
My Lady, I see the time. I’ve got just a couple more quick topics to cover and then I might suggest we have a break in about five minutes’ time.
Just moving on with the chronology, Professor, the report was sent to SPI-M-O, and I think we know that it was discussed at a SAGE meeting, possibly on the same day.
Professor Steven Riley: That’s correct.
Counsel Inquiry: That then was 10 March. We will hear in due course plenty of evidence about what happened for the remainder of that week in Downing Street, and in particular a series of meetings that took place on Friday, 13 March, and then over the weekend that followed, which were all central in the decision that was in the end taken to lock down.
Dominic Cummings has provided evidence to this Inquiry about those discussions in Downing Street which have included a picture of a whiteboard that was used at those meetings, and it’s helpfully been brought up on the screen.
You comment in your statement you’ve seen this – this wasn’t the first time; I think it’s been in the public domain for some time – and you thought that you could see your own work reproduced on this whiteboard.
Professor Steven Riley: So I think there are some similarities. So in terms of some of the points that are noted, and it is difficult to read here, but they comment on an increasing fatality rate once hospitals are overwhelmed, which wasn’t a common feature of the models at the time.
Then the actual plots that are there, they have some – they have some similarities, some features that are quite similar to the way I presented my results.
On a log scale, the seeding – the way that you start the epidemic if you use a log scale means that you get a down and then an up on that left-hand side, so both of those curves are a down and up. And then actually on the mitigation, the second curve on the whiteboard there, you can see it’s two straight lines joined by a curve, which is – that’s what an epidemic on a log scale looks like. So there’s – and then I think in the bottom right that kind of looks like a discussion of how an epidemic is progressing up against some thresholds.
So – and I – and I do want to also add that during that week there were many voices within – I’m sure some within government and certainly many voices outside of government which were making very similar points, with excellent clarity. There was lots of input that week.
Counsel Inquiry: Yes. Yours wasn’t a lone voice, certainly, as that week developed.
The other part of the narrative that we should perhaps make clear is that Dominic Cummings was at that SAGE meeting where your paper was discussed a few days earlier.
Professor Steven Riley: I think I checked the minutes and a member of his team, Ben Warner, was at that meeting. I don’t know if Dominic Cummings –
Counsel Inquiry: Sorry, you’re right, that was it, it was Mr Warner.
Thank you, we can take that down.
Then lastly for the moment before we have a break, Professor, I want to ask you about a report that was published by the Imperial College response team the next week, so after your report was circulated, after Friday, the 13th, after that whiteboard, the next week there was a report published known as Report 9, and we can see from the top that Professor Ferguson’s name is the first name on the list of authors, and was he the principal author of this document?
Professor Steven Riley: Yes. Yes, he was.
Counsel Inquiry: We do see your name, the penultimate name on the list.
Professor Steven Riley: That’s right.
Counsel Inquiry: So you were also involved?
Professor Steven Riley: That’s right.
Counsel Inquiry: I’m not going to ask you about this document in any detail, Professor, because we will be dealing with it with Professor Ferguson, but I did just want to ask you about the last two or three perhaps.
So if we can go to page 16, please.
So just in summary, the penultimate paragraph, there is a striking sentence:
“We therefore conclude that epidemic suppression is the only viable strategy at the current time.”
So we saw those emails the week before where Professor Ferguson had been resisting your suggestion of a pivot towards suppression, but by the time of this report he has himself changed his mind and is advocating for that policy; is that right?
Professor Steven Riley: That’s correct.
Counsel Inquiry: In the paragraph that’s at the top of that section we can see why he is now saying that suppression is the right policy, and that is because of the NHS overwhelm problem –
Professor Steven Riley: Yes.
Counsel Inquiry: – in summary.
Then this, the paragraph between those two:
“In the UK, this conclusion has only been reached in the last few days, with the refinement of estimates of likely ICU demand due to COVID-19 …”
I want to ask your view about that paragraph. You of course, as we see in the report, had been saying from your email to Professor Medley, and then in the report, that NHS overwhelm was a reason for moving to suppression. You had been saying that for a couple of weeks. And indeed the Inquiry has heard Professor Woolhouse saying he was worried about the NHS being overwhelmed from the end of January, and Professor Medley saying that everyone became aware that the NHS would be overwhelmed during February at least. So is it right, in your view, that this conclusion was only drawn just a few days before this report?
Professor Steven Riley: No. And I have checked back through my files, I did comment kind of heavily on a version of this. The version I commented on didn’t contain this paragraph, but I did receive a copy prior to publication, so I did see this before it went out and, you know – so perhaps I missed this at the time, but I don’t agree with that characterisation of how the evidence changed.
Counsel Inquiry: In fact if we go to page 20 of your statement, paragraph 5.1, you expressed the view, perhaps unsurprisingly in light of the documents we’ve been looking at, that the first national period of – you’ve allowed yourself to use the word “lockdown” there, “should have been introduced on or around 9 March”. Is that still your view?
Professor Steven Riley: Yes. I felt – and I do remember having discussions at the time and certainly thinking this, that once we had lab-confirmed deaths in ICU with no travel history, no obvious connections to any out-of-country social networks, even a handful of those would indicate that we were – we would be rapidly progressing in our epidemic. I think – yeah.
Counsel Inquiry: Just to be clear, on the basis of the answer you’ve just given, and of course the documents, this view that you’re expressing here is one that you had at the time, not just with hindsight?
Professor Steven Riley: That’s correct. I mean, the – I think the introduction to the note circulated on the 10th kind of captures this, even if it’s not stated explicitly.
Counsel Inquiry: Yes.
Lastly, Professor, on this, your view, please: if a lockdown had been implemented two or so weeks earlier, what can you say about the different effect that might have taken place?
Professor Steven Riley: So we’ve got a lot of data about how social mixing changed over this period, and actually the – on or around 16 March seems to be when everybody did start to change their behaviour. So I think the best way to talk about this is to say: had we achieved that rapid reduction in mixing earlier than the 16th, then the peak height would have been lower and the area under the curve for the first wave would have been less, and potentially quite a bit less, and the area under the curve is proportional to the number of deaths, in a very kind of crude but useful way.
Mr O’Connor: Yes. Thank you.
My Lady, would that be a convenient moment?
Lady Hallett: Can you remind me of the date of the report that said “this conclusion has only just been reached in the last few days”?
Mr O’Connor: Yes, sorry, Report 9. Is it the 16th?
Lady Hallett: 16th, thank you.
Mr O’Connor: I suspect we’ll hear more about that report, my Lady.
Lady Hallett: I thought we might, but I just wanted to make a note there.
11.40, please.
(11.23 am)
(A short break)
(11.40 am)
Lady Hallett: Mr O’Connor.
Mr O’Connor: I’m grateful, my Lady.
Professor Riley, I’m going to move now away from the chronology of events during the pandemic and ask you finally a series of questions about the way in which the structure for providing scientific advice to government worked during the pandemic, and following up on some observations you’ve made in that regard in your statement.
I’d like to turn first to paragraph 2.4 of your statement, which is on page 4, and here you comment on that part of the system whereby the advice of the subcommittees or the evidence from the subcommittees is passed up to SAGE, SAGE is chaired by the Chief Medical Officer and the Government Chief Scientific Adviser, and then it’s they who act, to use a word you’ve used, as the bridge for providing that advice on to policymakers within government.
You say here that that aspect of the system had strengths and weaknesses. You emphasise that the two people who held those roles during the pandemic were highly effective in digesting and synthesising evidence, and therefore, as you say, the process by which they acted as a bridge was a strength, because they could ensure quality and coherence of the scientific evidence.
“However [you say], regardless of the capabilities of individuals, it is my view that they must also have acted as a slightly unrealistic bottleneck if their role was to be the primary arbiter of scientific opinion.”
What do you mean by “slightly unrealistic bottleneck”?
Professor Steven Riley: So my understanding of the process is that onwards from SAGE it is primarily the CMO and GCSA who take that forward. I think Stuart Wainwright described this in his testimony, there is written minuting of SAGE and then the oral communication of CMO and GCSA going forwards. So what I’m – my comment here is that, looking at the volume and complexity of the scientific information that was funneling into that SAGE process, I – the fact that it went forward through such a restricted mechanism to the most senior levels of decision-makers does seem like a bottleneck.
I acknowledge there will be working-level relationships all around SAGE as well, but I think the formal structure is also important in addition to those working level contacts that will also propagate information.
Counsel Inquiry: And do you – if you’re right, what you say has obvious sense about it, do you have any ideas as to how that bottleneck might be removed?
Professor Steven Riley: I think there are examples in other countries where they have broader panels meeting directly with ministers in a more formal way, and I would again emphasise there’s lots of informal communication that will be going on around this process, so at a very basic level something that has more people involved in the formal communication, because it just seems like two isn’t – it’s an enormous load on two individuals.
Counsel Inquiry: As you say, the system as it stands, you have the debate at SAGE amongst that broad group of people, fed into by the subcommittees, and debate above that at the policy level, but just those two people acting as the link between the two, and if one was to have some sort of larger organisation where policymakers and scientists, more than just those two, could communicate about the scientific advice, that might be a better approach?
Professor Steven Riley: I think it might be, yes.
Counsel Inquiry: Moving on, Professor, in fact on the same page of your statement, paragraph 2.6, you refer to a lack of diversity amongst SAGE and its subgroups, illustrated – sorry, during the early months of the pandemic, and you say that’s illustrated by the under-representation of women on SAGE and its subgroups during that period, although you go on to say that that was corrected as the pandemic progressed.
What about diversity in terms of representation of other ethnic groups?
Professor Steven Riley: So, just to comment, I’ve not reviewed data on this. This is a topic where, you know, looking at the number of people attending meetings and their diversity characteristics is a very valuable exercise. I have not done that, so I’m commenting from my impression, and that’s actually what I was doing here in the statement. And I’m suggesting that looking at gender was a – illustrated the overall lack of diversity, not – I’m not saying that’s the only important aspect of diversity.
Counsel Inquiry: No.
Professor Steven Riley: And from recollection, with – you know, in a seria – you know, I would – there is very little ethnic diversity that I’m aware of within the system. So yes, I’d imagine that is an issue that should be addressed as well.
Counsel Inquiry: Do you think that that lack of ethnic diversity within the SAGE and its subgroups, and I take it that it’s fair for you to say that that’s just a sort of observation, it’s nothing sort of scientific about that observation, but taking that as read, do you think that that may have had any actual substantive impact on the way in which scientific advice was provided, bearing in mind of course what turned out to be the disproportionate impact of the pandemic on certain ethnic groups in this country?
Professor Steven Riley: I think it’s entirely possible that it did have an impact, yes.
Counsel Inquiry: And that would obviously be another reason why that aspect needs to be looked at and corrected as soon as possible?
Professor Steven Riley: Yes. It’s a common theme across lots of technical disciplines, that historically there has not been sufficient diversity. It would apply to many organisations, certainly beyond SAGE. It’s a difficult problem to address but it is an important problem.
Counsel Inquiry: Just sticking with the question of diversity for a moment, if we could move to page 38 of your statement, paragraph 11.2, you pick up this theme again later in your statement, Professor.
We should bear in mind, of course, shouldn’t we, that you were not an attendee of SAGE other than those few occasions where you attended it after you joined the UKHSA, but with that in mind you say that you understand that SAGE is an ad hoc committee and is shaped to respond to specific outbreaks, but you say it can be so influential and therefore you float the idea of there being some kind of what I take it to mean a more formal recruitment process than exists at present; is that what you’re driving at?
Professor Steven Riley: Yes, I might contrast – so NERVTAG I believe has an open recruitment process. I think they advertise, people apply, and even though it’s only a proportion of time, I’m not sure it’s even remunerated, but there is a recruitment process that would be similar to any other position, whereas some other committees do not. And what I’m really saying here is, even if you’re not invited to every meeting, there may be benefits in considering that for SAGE. I can imagine there are some – you know, there may be drawbacks with that as well, but given the impact that the committee may have during key times, then that may be something to consider.
Counsel Inquiry: Yes, thank you.
Moving on to a different topic, this is at 5.3 of your statement, page 21. The issue here is what you refer to as groupthink, and you describe a particular moment during the pandemic, in fact during that period that we were talking about before the break, when you were trying to gain an audience for your paper, where you were taken aside and privately assured that you were being listened to, even if perhaps it didn’t feel like that. But you at that point describe raising the question of red teaming, perhaps a fairly well known phrase, whether there was a sort of challenge process built into the structure.
Tell us more about that issue.
Professor Steven Riley: Yeah, so it was at the end of the meeting on the 11th that I’d attended in person and in discussions afterwards I raised the possibility of groupthink, and then – and used the term “red team” to just ask whether anywhere else in government they had a bunch of people in a room trying to figure out if there was a better way to be doing – to be thinking about the stuff that we were doing.
And it was – I was very tired, I was quite frustrated, and I was kind of – I was flailing a little bit, but, you know, that was a thought that occurred to me then: given the stakes here, I hoped at that time that there might be people I didn’t – that we weren’t aware of who were actively considering the same issues.
Counsel Inquiry: We certainly haven’t seen any evidence of management consultants being brought in to SAGE during the pandemic. I take it that nothing came of your suggestion at the time?
Professor Steven Riley: I’m not aware of – no feedback was given to me, and, you know, I wouldn’t have expected it. This was an informal conversation after a long meeting.
Counsel Inquiry: But looking back on it now, and in particular with the extra perspective you’ve gained from UKHSA, do you think there is a weakness in the system here? Do you think that the system would benefit from having some form of formal internal challenge mechanism?
Professor Steven Riley: I think effectively that was addressed very quickly. I’m not sure it was ever – so, yeah, I’m not sure it was ever referred to as a red team existing that hadn’t existed before, but if you look at the structures across government that were – sprung up immediately following March, and certainly by the time I could observe them in October 2021, effectively there were numerous red teams that were capable of providing advice.
So I don’t feel that’s something that was overlooked, beyond that moment I mention there.
Counsel Inquiry: I’m going to move on, just two more topics left. The first is transparency and for these purposes if we look at paragraph 11.1 of your statement on page 38, please.
You here refer to the suggestion that the government, the UK Government, “did not see transparency of evidence as an integral part of managing the Covid-19” question, and you say that in your experience that was a fair criticism, at least in the early stages, but that, perhaps a little bit like the red teaming, the position improved later on in the pandemic.
Why do you say it was a fair criticism early in the pandemic?
Professor Steven Riley: So I think the details – you know, the details of the SAGE considerations weren’t made public initially. The membership was not kind of – I remember a lot of debate about the membership at SAGE. So issues like that I think reduce the transparency.
However, again, you know, my view, even when I was outside of government, is that the level of commitment and resource that was employed after this time was very, very high, and even compared to many other places around the world. So I think that – I think this was a – moving onwards from, you know, April 2020, this was an incredibly strong aspect of the UK response. And just to mention the REACT Study, that was – we were funded by government, worked closely with DHSC and Ipsos MORI, we’d had extreme – we’d had very, very good data, we wrote our reports, we published our reports. So I think that’s an example of something that was very transparent to the public.
Counsel Inquiry: So, so far you’ve described, if I can say, maybe the epidemiological, the infection side of the story, SAGE minutes and papers, not published to begin with but within a few months –
Professor Steven Riley: Yeah.
Counsel Inquiry: – that was all made very public.
Professor Steven Riley: Yep.
Counsel Inquiry: If we can go down, please, to paragraph 11.3, you refer there to Professor Edmunds, who is coming later in the week, stating:
“… that it was a ‘massive failure’ of the government not to share the economic evidence or to explain how this evidence informed its decision-making.”
And you say you agree with that agreement.
Is there a contrast to be drawn between the transparency which came to be adopted in regard to the sort of more infection-based materials on the one hand and the economic evidence on the other?
Professor Steven Riley: Yeah, I think there is an interesting contrast between those two areas of analysis.
Counsel Inquiry: Your view, you seem to agree with Professor –
Professor Steven Riley: Yes, so I think we mentioned it before, I – my view is that there was – I was – I never – there was insufficient public evidence about the potential economic trade-offs with some of the – with many of the policies that were considered.
Counsel Inquiry: On a similar theme, if we could look, please, at page 42, 12.14 of your statement, you again come back to the question of transparency and public scrutiny, here in the context of modelling, and I think what you’re saying here is that perhaps the whole – and this is a broad topic which we will have to cover very quickly, but the headline is that government could do more to explain or could explain better the whole modelling process and how that advice feeds into decision-making?
Professor Steven Riley: This – yeah. Briefly, this reflects perhaps my own kind of professional bias. I try to be very careful, using a phrase “the model says”. I would rather give my view, which is sometimes very heavily informed by a model, other times draws on lots of other evidence. But I think that phrase “What does the model say? The model says this” is sometimes not helpful.
Counsel Inquiry: Yes. Another lesson that could be learnt for the future.
Then just finally, Professor, I want to ask you a few questions about the need, from a scientific point of view, for defined policy objectives against which to set scientific advice. It’s a subject that some of the earlier witnesses have touched on already.
Could I ask you to look, please, at paragraph 11.5 of your statement on page 39. It’s another one of these parts of your statement where you have been asked to address an observation made by the Institute for Government, here about chaotic decision-making.
Picking it up about five lines down, you say you have no comment on whether lack of clarity delayed decisions or made it harder for scientific advisers to provide useful advice, but you go on:
“… on reflection and with hindsight, it may be possible to define objectives that would drive government strategies for some specific scenarios.”
Could you explain what you mean by that.
Professor Steven Riley: Yes, so – and here I am thinking about viral respiratory pandemics to some degree, that we should be able to decide in advance what those objectives would be. And, you know, a particular scenario is where there is a reasonable expectation of a vaccine, and where the way we behave, our social mixing, affects the speed of transmission. That’s a reasonable future scenario. And we – I think it would be good to try to agree collectively what the objectives should be.
Counsel Inquiry: That’s what you explain in the rest of this paragraph, and it’s striking, the objective that you propose, just as an example, to:
“… maximise the number of at-risk individuals who receive an effective vaccine prior to being infected naturally, while minimising any indirect harms of the interventions that [you] employ …”
It’s still at fairly high level, but you think that even that sort of policy objective would help as a structure for scientific advice?
Professor Steven Riley: Yes, yeah, I think that it would, and I think many of the other witnesses have commented on how difficult it was to scope the scientific advice in the absence of that kind of framework.
Counsel Inquiry: So without getting into specifics, even that type of high-level objective was missing in the early stages of the pandemic; is that a fair point to make?
Professor Steven Riley: Yes.
Counsel Inquiry: Then very lastly, Professor, and you’ve already mentioned that these objectives could be at least debated now, if we could go to paragraph 12.15 of your report, please, it’s actually the last paragraph, and you come back to the point about the economic trade-offs of these measures, and the need for co-working. But you say:
“At the very least, with the benefit of hindsight, it should be possible for different disciplines to agree on how they could have better assessed trade-offs between the economy and health at key moments of the acute phase of the … pandemic.”
And:
“If this work were public, it could inspire substantial progress in academic collaborations between health scientists and economists.”
At the beginning of the paragraph you make the point that there is no reason these steps shouldn’t be taken now?
Professor Steven Riley: That’s right.
Counsel Inquiry: Are they being taken?
Professor Steven Riley: There is – there are – I think as Professor Keeling commented on, there are a number of groups that are looking at exactly these economic questions, and there is – I think there is a lot of work going on in this area, some of which I may not be aware of. I’m still not aware of a kind of definitive description of what the appropriate counterfactuals could have been or should have been during kind of March 2020, but they may exist and I’m not aware of them.
Mr O’Connor: All right.
My Lady, those are all the questions.
Lady Hallett: Can I just ask about that?
I’m a simple soul at heart, Professor. Surely if I were a minister and I was asked to provide my objectives, I would say my objectives are: minimise deaths, minimise infections, because people have long-term sequelae, minimise the impact on the economy, minimise the impact on societal wellbeing, mental health, educational opportunities and the like. Wouldn’t I just give you a whole range of extraordinarily high-level objectives, and you might say, “But they’re not compatible, they don’t go together”? How would they help you?
Professor Steven Riley: So if you gave us a very long list of everything that you could be worried about, that probably wouldn’t help. I think even narrowing it down and saying, “I’m going to describe our objectives in one or two or three ways”, that would be a start. And then I think that if you – if from that there was a discussion and you start to put a little bit of qualitative trading off between those objectives, then that would help even further.
So you’re right, if you just list everything you’re worried about, that wouldn’t help, but being – picking two or three things and exactly how you express it, and then perhaps moving on from there, I think could be very helpful.
Lady Hallett: But if I excluded from the list I just gave you, for example, minimise the infection, then I’d be accused, as the minister, of not taking into account those who suffered Long Covid. If I didn’t include educational prospects, I would be accused of not taking into account children. So how do I address all those concerns when I’m making my decision or setting my objectives?
Professor Steven Riley: I mean, it’s really difficult, and I say in a number of places that ministers were presented with the most difficult possible decisions. But if ministers don’t choose a framework then they’re leaving it to everyone else to create their implicit separate frameworks, and we end up with over-emphasising deaths, which is, you know, one criticism of the response, or completely missing some aspects. So it’s – I’m not for a moment suggesting that it’s easy. I’m suggesting it’s a process that’s better gone through in advance for scenarios that you can reasonably expect to arise.
Lady Hallett: I’m glad I’m not the one having to set those objectives, Professor.
Thank you very much indeed, you’ve been extremely helpful. And I think looking back on it, you probably feel you were right to send your report. I don’t think you would have forgiven yourself if you hadn’t. So I appreciate it must have been a very stressful time for all of you, so thank you very much for your help and all you tried to do. Thank you.
Mr O’Connor: My Lady, I have finished, but in fact –
Lady Hallett: I’m so sorry.
Ms Morris, cutting you off, I’m so sorry.
Questions From Ms Morris KC
Ms Morris: Thank you, my Lady.
Good afternoon, Professor Riley. I ask questions on behalf of the Covid Bereaved Families for Justice, and I have just one topic, please, to ask you about, and that’s the use of face masks in the community, a question that’s not only important to the Inquiry but also to the bereaved families.
You mention it at paragraph 4.9 of your witness statement, it’s a side note, an illustration of a paper that you’ve written and a provision of advice that goes forward. I just want to ask you about the specifics, if I may.
I’m not going to ask you to look at the paper, hopefully you’ve got a good recollection of it.
Professor Steven Riley: I do.
Ms Morris KC: It’s dated 20 April 2020, it’s called “Potential impact of face covering on the transmissibility of SARS-CoV-2 in the UK”, and just for the transcript reference, it’s at INQ000236296.
Was this a report that was commissioned by SAGE?
Professor Steven Riley: Yes. So, Professor – the co-chairs of SPI-M-O asked me to write a report.
Ms Morris KC: Thank you. I think we can see from the minutes of SAGE on 21 April, that’s SAGE 27 – again, I’m not going to ask you to look at it, but it’s INQ000062295 – that they did in fact discuss the impact of face coverings. and Graham Medley from SPI-M-O was at that meeting.
Thank you.
So you’ve produced a paper in April 2020 on the use of face masks in the community for asymptomatic members of the public. Is it a fair summary to say that there was no obvious reason why surgical face masks couldn’t be used in closed community settings, for example buses, public transport and shops, based on the limitations you’d observed from the widespread use of face coverings in other countries which had been considered useful and successful in containing Covid-19?
Professor Steven Riley: So I just want to give what I perceive to be the key points of the report, because there was a reason I was asked to do that and it’s because I had looked at some of the evidence from influenza, studies of influenza.
Ms Morris KC: Yes. Pre-pandemic studies?
Professor Steven Riley: Yes, so I went back to look at those, and the key point that I thought I was making in the report was, even though those studies suggested quite low effectiveness of face masks for influenza, there were a number of issues around the design and interpretation of those that said maybe it could actually be better and we shouldn’t necessarily rely too heavily on those as negative results.
Ms Morris KC: That’s helpful, thank you.
Professor Steven Riley: Then if we just come to your question, you asked quite a specific list of things about use in other countries. I don’t know whether I commented on those in the report.
Ms Morris KC: At that time, had you looked at, for example, other East Asian countries and their use of face masks?
Professor Steven Riley: So I don’t recall commenting on that explicitly in the report, so I’m not sure that I did.
Ms Morris KC: Okay. You’ve just touched upon the literature review you did about the influenza use of face masks, so you’re doing this review in April 2020?
Professor Steven Riley: Yeah.
Ms Morris KC: Is it fair to say that if that review had been done in February 2020, of that pre-pandemic literature, the results would have been the same, had you done it in February?
Professor Steven Riley: I think they would have been quite similar. And I believe WHO have commissioned a relatively recent study of face masks for influenza that I think probably was quite similar.
Ms Morris KC: Okay, thank you.
So was it your conclusion that now would be quite a good time to gather more evidence about the efficacy of face masks?
Professor Steven Riley: Yes, I think that’s – yep.
Ms Morris KC: For example by combining it with digital contact tracing?
Professor Steven Riley: I believe I do mention that as an opportunity in the report, yes.
Ms Morris KC: Yes. So this is the advice you’re giving in April?
Professor Steven Riley: Yep.
Ms Morris KC: There may be utility to using surgical face masks in closed community settings?
Professor Steven Riley: Yes.
Ms Morris KC: Thank you.
How did you expect that paper to be used by policymakers? Was it just for SAGE or did you expect it to have any wider impact?
Professor Steven Riley: So it was commissioned as a rapid review over just one weekend, a rapid review to support the discussion at SAGE, and I could see from the SAGE minutes that there was an extensive discussion of face masks and there were clearly many other points raised – I was not there – there were clearly many other points raised in that meeting in addition to the material that I provided in that report.
Ms Morris KC: But from your report, was there any scientific, as opposed to resource, reason not to advise the public to use surgical face masks in closed community settings in April 2020?
Professor Steven Riley: I did not find a reason in the work that I did, no.
Ms Morris: I’m grateful, thank you very much indeed. Thank you, Professor.
Thank you, my Lady.
Lady Hallett: Thank you very much, Ms Morris.
Mr O’Connor: That does bring this witness’s evidence to a close.
Lady Hallett: Thank you, Mr O’Connor. Sorry, I’d missed the one sheet.
Thank you very much again, Professor, really grateful to you.
(The witness withdrew)
Mr O’Connor: My Lady, the next witness is Professor Ferguson.
Lady Hallett: Thank you.