Transcript of Module 2 Public Hearing on 19 October 2023

(10.00 am)

Lady Hallett: Ms Cecil.

Ms Cecil: Thank you, my Lady. Indeed. May I call Professor Catherine Noakes.

1. Professor Catherine Noakes

PROFESSOR CATHERINE NOAKES (affirmed).

Questions From Counsel to the Inquiry

Ms Cecil: Thank you, Professor Noakes.

As you will see, we’ve got a stenographer in the hearing room, and so if we can keep our answers at a reasonable pace, and if we’re going too fast it will be my fault, and I’ll ask you just to slow down, and if you can keep your voice up so that everybody can hear.

Professor Noakes, you very helpfully prepared a witness statement for the Inquiry. That’s dated 20 July of 2023, and it’s just been brought up at INQ000236261. It runs from page 1 through to page 89. It’s a substantial piece of work, and it’s accompanied by a declaration of truth. Is that right?

Professor Catherine Noakes: That’s correct.

Counsel Inquiry: You will appreciate that we have a limited amount of time, sadly, to go through some of your evidence. As we do with all witnesses, we simply won’t be able to go through every aspect of your witness statement but what I do hope to do today is to pull out the most pertinent aspects as we see them within Module 2.

So what I propose to do is to take you through your involvement in both SAGE, some of the working groups that were set up, and then specifically to deal with your expertise in the areas of transmission in terms of the virus.

If I can just set the background for that, you are a professor of environmental engineering in the School of Civil Engineering at the University of Leeds?

Professor Catherine Noakes: Yes, I’m actually environmental engineering for buildings.

Counsel Inquiry: For buildings, thank you.

Your background is as a chartered mechanical engineer; is that right?

Professor Catherine Noakes: That’s correct.

Counsel Inquiry: In fluid dynamics –

Professor Catherine Noakes: Yes.

Counsel Inquiry: – as a specialism.

You were a participant in SAGE, but your involvement went much further than that, and you were subsequently made the co-chair of a newly-formed group; is that right?

Professor Catherine Noakes: Yes, that’s correct.

Counsel Inquiry: I just want to go through how that came about, very briefly.

So on 7 April of 2020, you were contacted by SAGE; is that right?

Professor Catherine Noakes: That’s correct, yes.

Counsel Inquiry: What were you asked to do?

Professor Catherine Noakes: So I was asked initially to provide a paper that gave some information on the environmental routes of transmission and the current knowledge at that time, and then I was also – it was indicated to me at that time that they were interested in setting up a subgroup and I might be asked to lead that subgroup.

Counsel Inquiry: Indeed. So you prepared that paper with the assistance of your colleagues at that point, because of the urgency and the proximity –

Professor Catherine Noakes: Yes, that’s correct.

Counsel Inquiry: – of the next SAGE meeting, where it was to be presented, and indeed you attended that subsequent SAGE meeting on 14 April –

Professor Catherine Noakes: Yes.

Counsel Inquiry: – 2020? It was at that point that you were asked to set up what subsequently became the Environment Modelling Group; is that right?

Professor Catherine Noakes: That’s correct, yes.

Counsel Inquiry: That’s typically known by an acronym, we have many acronyms here, but EMG?

Professor Catherine Noakes: EMG, that’s correct.

Counsel Inquiry: With regard to SAGE, you continued to attend meetings, and I think you attended a total of 71 –

Professor Catherine Noakes: Yes, I did.

Counsel Inquiry: – meetings in the period that you were a member, and indeed, as we’ve already alluded to, you became the chair of EMG?

Professor Catherine Noakes: Yes.

Counsel Inquiry: Now, just dealing with the remit of EMG, in a nutshell, how would you describe it?

Professor Catherine Noakes: So I would describe it as we focused on how the virus transmits from person to person and the role that the environment plays in that, and then we also focused on the mitigations we could apply. But we focused more on the local mitigations, things like face masks, distancing, ventilation, hand hygiene, rather than the big ticket items like lockdowns or work from home.

Counsel Inquiry: Indeed. I’m going to come on and ask you about those, firstly about methods of transmission and then secondly about mitigations and how they interrelate, but before I do that, very briefly, EMG was a new group?

Professor Catherine Noakes: Yes, it was.

Counsel Inquiry: So it didn’t exist pre-pandemic and indeed it no longer exists; is that right?

Professor Catherine Noakes: That’s correct, yes. So we were asked to form this group and had to find a bunch of experts to create that group in under a week.

Counsel Inquiry: Indeed, and you set out in detail within your statement – I’m not going to take you there or go through it now – the challenges that you faced in setting up a group and the implications that had for diversity, and those mirror themes that we have already heard from other witnesses and that’s why I won’t go through those in detail now.

Professor Catherine Noakes: Yes.

Counsel Inquiry: Dealing with the demand for your group’s expertise, that was predominantly, it’s fair to say, at the outset of the pandemic and through to the end of 2020; is that right?

Professor Catherine Noakes: That’s correct, yes.

Counsel Inquiry: What was the position in 2021? How did that differ?

Professor Catherine Noakes: So by 2021 I think we had a lot more of the baseline knowledge around transmission and it was therefore much more around application, and I think some of the work we did in 2021 sort of fed in to the ways in which we could release from the winter lockdown and to safely manage that. We did also consider, when new variants came along, what the implications of that might be for whether routes of transmission changed or became more prominent.

Counsel Inquiry: Indeed, thank you. I think you describe it in your statement, it’s at paragraph 5.43 for those following, as a “limbo” period, in short, 2021, before then coming back in to looking at the roadmap out of lockdown?

Professor Catherine Noakes: Yes, I would agree with that. There was a period where we weren’t – we still had a few commissions but it was much slower and we were not quite sure how much longer we would remain as a group.

Counsel Inquiry: Thank you. I want to just touch upon one challenge that you faced within the EMG in relation to commissioning, and a very specific point, if I may.

In the earlier stages of the pandemic, you received a question about the application of triethylene glycol, I hope I pronounced that correctly, as a method of mitigating airborne transmission. How did that come about?

Professor Catherine Noakes: Yeah, so that particular one came about not as a commission to EMG but actually as a question from an adviser in Number 10, I believe that’s correct, and it therefore came as an email, and one of the challenges with that one was that that came with some external people tagged in to that email who then said, “Well, we have this technology, would you like to sign a non-disclosure agreement”, to which I said no.

Counsel Inquiry: Why was that in relation to a non-disclosure agreement?

Professor Catherine Noakes: Because I felt, as a co-chair of EMG, that we should focus on evidence on peer-reviewed scientific evidence, you know, the scientific evidence that was in preprints, and information from reputable laboratories, national laboratories, et cetera, rather than companies who were trying to sell products.

Counsel Inquiry: The difficulty there was, of course, they had been copied in to the email chain, and so that took up some of your time, it’s fair to say, in dealing with those requests and continued requests?

Professor Catherine Noakes: It did indeed, and it meant we had to put information into a paper that we wouldn’t ordinarily have done so, and respond to those requests. And I think it’s worth saying that triethylene glycol was never really going to be considered as a viable option, because the idea of putting something into the air to try to clean the air but you’re putting a chemical into the air, you’re just creating a new contaminant.

Counsel Inquiry: Thank you.

Now, as the pandemic progressed, a number of subgroups were set up under the auspices of both EMG, and indeed you participated in a broader range of subgroups in relation to other SAGE mechanisms; is that right?

Professor Catherine Noakes: Yes, that’s correct.

Counsel Inquiry: I’ll just run through those very quickly with you: the Hospital Onset Covid Working Group, Social Care Working Group, a number of task and finish groups, you were also spent at some SPI-B meetings, and indeed also GO-Science and co-ordination meetings; is that right?

Professor Catherine Noakes: Yes, that’s correct, and I went to the majority of those because I had very specific expertise around transmission and the engineering knowledge that was perhaps not present in those other groups.

Counsel Inquiry: We also see within EMG quite a broad range of other individuals from different SAGE groups and, indeed, non-SAGE groups such as NERVTAG, in attendance?

Professor Catherine Noakes: Yes, and when we set it up we deliberately co-opted people from those other subgroups so we could retain – make sure we kept those connections across the different subgroups.

Counsel Inquiry: Indeed, thank you.

What I want to go to next, if I may, is the issue of transmission and how the scientific evidence and understanding evolved over the period of the pandemic. To do so, may I just firstly deal with the various routes of transmission. We see that there is fomite transmission, airborne transmission, sometimes known as aerosol transmission, and droplet transmission.

Now, for the assistance of all of us, if I can just run you through what each of those actually means. So fomite?

Professor Catherine Noakes: Okay, so fomite transmission refers to – a fomite is an object, so it refers to transmission that would happen if, say, a surface or an object was contaminated, somebody touched that object with their hand and then they subsequently touched their mucus membrane, so their eyes, nose or mouth.

Counsel Inquiry: Okay. And airborne?

Professor Catherine Noakes: So airborne transmission, or, as you said, aerosol, refers to when there are very small particles containing the virus, these get emitted when we – through our respiratory activities, and these are the particles that can remain in the air and travel over some distance.

Often “airborne” is used to describe longer-range transmission, so to the other side of a room, but actually it also happens when you’re close to somebody, because those small aerosols are also present at close range, they don’t just sort of magically get to the far distance.

Counsel Inquiry: So effectively small droplets don’t – things don’t get smaller as they go further away, necessarily –

Professor Catherine Noakes: They do a little bit but that – they evaporate. But that evaporation happens really very quickly, happens in less than a second.

Counsel Inquiry: Thank you.

Then droplet?

Professor Catherine Noakes: So droplet transmission is – this is a slightly more tricky one, because it tends – most people think of it as it refers to large droplets, almost like the spit droplets, that then behave like a ball, ballistically, and deposit out on surfaces very close by. Now, in traditional sort of infection control in healthcare, droplets are defined as particles that are above 5 microns in diameter, and that’s not correct, because a 5-micron diameter – well, a 10-micron diameter particle can stay in the air and go to the other side of the room. So there are actually some incorrect definitions used to define the difference between droplets and aerosols that are used very commonly in infection control literature.

Counsel Inquiry: So it’s not an easy distinction, necessarily, to make, owing to those differences in interpretation?

Professor Catherine Noakes: Correct, it’s not an easy distinction to make, and there’s no sort of single cut-off between a droplet and an aerosol, we actually all breathe out all of the different sizes of particles. It’s not a sort of – there’s no single – not a cut-off you can put in there.

Lady Hallett: Does it make a difference – do you need to distinguish between them? Or if you’re trying to combat them, supposing you have aerosol transmission, does it make a difference if you’re trying to combat droplet transmission?

Professor Catherine Noakes: So in some senses perhaps you don’t, but actually where it becomes an issue is the sizes of these particles, because if you believe everything that happens when you’re close to somebody is droplets, then, for example, you won’t take precautions that require masks that will filter out the aerosols. So if people are just wearing a simple face mask or a face shield, which may deal with splashes and very large droplets, those won’t filter out the small aerosols that are quite likely to also be present at close range.

Lady Hallett: I follow, thank you.

Ms Cecil: So the implications essentially for infection control therefore go to barriers or things that you can put in place to mitigate aerosols alongside droplets?

Professor Catherine Noakes: Yes, so you need to think about both of them, at both short distance and longer distances.

Counsel Inquiry: Okay. In terms of understanding the transmission of Covid-19, what was the initial understanding at the outset of the pandemic in relation to the nature of the transmission?

Professor Catherine Noakes: So I think as a new disease it’s quite hard to – it was quite hard to have any good evidence. We were very much reliant on very early information coming out and papers that were starting to come out from – initially from China and then from other countries as that data grew. It was fairly clear from early stages that there was – it was transmitted through a respiratory route, but an awful lot of the focus to start with was on droplets and washing your hands and surfaces, the fomites, rather than aerosols.

Counsel Inquiry: Thank you.

Were you concerned that the airborne transmission routes in terms of aerosols were being overlooked to some extent?

Professor Catherine Noakes: Yes, I was.

Counsel Inquiry: How did knowledge develop in the initial period of the pandemic, from April, in your involvement onwards?

Professor Catherine Noakes: So in the initial period of the pandemic, we drew on evidence from previous respiratory diseases, including influenza, and other coronaviruses, things like SARS. We drew on our understanding of the basic physics of how aerosols behave and our understanding of how viruses can be carried in those, so there is some science in there.

Then, as the evidence progressed, we – we could see signals in epidemiological data that allowed sort of more understanding of transmission. So we started to see really quite early on that the vast majority of transmission happened indoors rather than outdoors, which starts to give you an indication that the environment matters and that how people interact together matters.

You also, I think –

Lady Hallett: You couldn’t just slow down, could you?

Professor Catherine Noakes: Apologies.

Lady Hallett: I’m conscious there is – it’s not me, I can keep up, but I’m not making a full note, unlike our stenographer.

Professor Catherine Noakes: Apologies. I think that –

Lady Hallett: Sorry, I interrupted you.

Professor Catherine Noakes: It’s also –

Lady Hallett: Environment matters and how people interact together matters.

Professor Catherine Noakes: Yes. It was also apparent that a lot of transmission happened when people were in fairly close proximity. The other thing that we started to see in perhaps February and into March 2020 was there were what we might term “superspreading events”, so where you have a large number of people infected in a short period of time, associated with a single event, and that perhaps is a bit of a red flag for airborne transmission.

Ms Cecil: Thank you.

Just in terms of those superspreader events, can you give any examples of those?

Professor Catherine Noakes: So there was – there were a number that were reported in the – early on, but there was a restaurant in Guangzhou in China where there were people who were infected who were more than 2 metres apart. There was a – quite a famous one called the Skajit Chorale Society, which was a choir in America, and again it was a very high number of people, I think it was 87% of the people there were infected in a single two-hour activity.

Counsel Inquiry: Thank you. And as you say, that causes a number of red flags to go up in terms of looking at transmission routes, but can I just ask you a little bit about the more global picture and the understanding by other organisations.

On 29 March of 2020 the World Health Organisation published a tweet stating that Covid-19 was not airborne. Did that cause concern?

Professor Catherine Noakes: I think it did. I was concerned by it, and I’m aware that other people were concerned by that as well.

Counsel Inquiry: Indeed, in your statement, you explain that that prompted the formation of a group that came to be known as Group 36, and that’s 36 experts in transmission, essentially?

Professor Catherine Noakes: Yes, so these were 36 scientists from all around the world who had expertise and had worked in this area prior to the pandemic.

Counsel Inquiry: Indeed, you and those individuals signed a petition that was then sent to the World Health Organisation very quickly thereafter, on 2 April –

Professor Catherine Noakes: Yes.

Counsel Inquiry: – 2020. If you forgive me just for summarising, you followed that up with a letter when it was – effectively fell on deaf ears, initially; is that right?

Professor Catherine Noakes: Yes, that’s correct.

Counsel Inquiry: And, following on from that, articles. And as you explain at paragraph 10.8, that prompted both media attention and started to change the discussion that took place around airborne transmission; is that right?

Professor Catherine Noakes: Yes, that’s correct.

Counsel Inquiry: Why do you think there was a reluctance to acknowledge the potential for airborne transmission?

Professor Catherine Noakes: So it is hard to be sure, but my personal opinions are there may be a number of reasons. So I think it’s – there’s something about changing an accepted paradigm, if – you know, traditionally respiratory diseases have often been categorised as droplet, and to change what people’s accepted views are is – can be difficult, especially if they feel that that challenge is coming from a different – different field, a different area, aspect of it.

I think mitigating airborne transmission is more challenging, because it involves dealing with the environment, every environment’s different, and it’s not as easy to put a simple rule like washing your hands.

It also takes the responsibility from the individual to the organisation, because it’s the organisation that tends to deal with the environment whereas it’s the individual who perhaps washes their hands.

And I think I note in my statement as well that it’s possible there may be a fear aspect to it, and you can see this in movies and things where it goes airborne, it promotes a fear. Now, I don’t know whether that really was the case, did happen, but I think that may possibly play into it as well.

Counsel Inquiry: You also touch upon implications for hospital infection control. What implications would those be?

Professor Catherine Noakes: Yes, so in hospital infection control, you know – which is a very good field and there are a lot of really expert people who do hospital infection control, but conventionally if something is deemed droplet transmission, then you have relatively simple precautions: you perhaps put somebody in a side room, you maintain a distance, and you would wear relatively straightforward PPE, a simple surgical mask, maybe a visor.

If something is deemed airborne, then, providing you’ve got the capacity to do it, ideally you put that person into a negative pressure isolation room and you wear full respiratory protective equipment to manage that person.

Counsel Inquiry: Certainly at the very outset of the pandemic, we’ll all recall those images of people in –

Professor Catherine Noakes: Yeah.

Counsel Inquiry: – those sorts of mitigating outfits and so on.

In terms of EMG, it was obviously not established until April 2020, but in your view, was there an evidence base sufficient to operate on the precautionary principle through January through to March of 2020?

Professor Catherine Noakes: I think there was, and I believe that, prior to my involvement in SAGE, that NERVTAG had indicated the potential for airborne transmission.

Counsel Inquiry: To your knowledge were there any reasons not to take steps to guard against airborne transmission?

Professor Catherine Noakes: I don’t see that there were, no. I think there was – although the evidence at the outset was weak, in truth it was weak for all transmission routes. I think there was just a tendency to assume the other transmission routes, and then require the evidence for airborne transmission. So I think from a precautionary basis, it would have been appropriate to indicate that aspects like ventilation mattered, early on, and as that evidence base built, it was important that that – those mitigations were more readily applied and people became more – should have been made more aware of them.

Counsel Inquiry: If I may move now through spring/summer of 2020, in short there were a number of papers that were published and you were still gathering the evidence; is that a fair summary?

Professor Catherine Noakes: That’s a fair summary, and an awful lot of research happened during the pandemic which – you know, we spent a lot of time sifting that information to put together.

Counsel Inquiry: Now, come autumn 2020, did you still have concerns in terms of airborne transmission being taken seriously, or did you consider that enough was being done?

Professor Catherine Noakes: Yes, I did, and one of the concerns which I think you will have identified that I raised in my statement was that the publicly available information that’s on the websites of the Public Health England, as it was then, and the NHS, for members of the public who maybe are trying to find information about how to manage the illness if, you know, they have a case in their home, that all still focused on droplets and surfaces and didn’t mention airborne. So I emailed Patrick Vallance and Chris Whitty in September to say: I’m concerned that this information, that we – you know, the evidence base that we’ve been collecting and discussing and agreeing is not feeding in to this guidelines.

Counsel Inquiry: Did you get a positive response?

Professor Catherine Noakes: So in one sense, yes: I believe Chris Whitty sent the emails on to Public Health England, they actually responded very quickly, they changed the information on their website, and indeed they – in the process of doing that, they shared it with me, and we – I helped them put some forms of words together to describe what we knew about transmission.

The NHS, on the other hand, nothing changed, and I believe I raised it in February, and then again at a SAGE meeting in June 2021, and finally, a few weeks after that, their webpages were changed.

Counsel Inquiry: So quite some time later?

Professor Catherine Noakes: Quite some time later, yes.

Counsel Inquiry: Now, you describe that period of autumn of 2020 as being the most frustrating period and – for you, during the pandemic. Why was that?

Professor Catherine Noakes: I think it was because we could see cases were rising. We could see there was a desire to try to get back to normal, which is understandable, we can’t stay in a lockdown forever, and that’s totally inappropriate. But I think it was that – seeing cases rising and not very much being really done to try to mitigate them, even when people were interacting together.

Counsel Inquiry: Now, your frustrations were such that you spoke to the press, is that right?

Professor Catherine Noakes: Yes. So I spoke to the press on many occasions through the pandemic, almost all of them were to talk about the science of transmission. On that one occasion I expressed a frustration with feeling that the mitigations that were being put in place, I think it was a curfew at 10 o’clock in a pub, that it was not going to make any difference.

Counsel Inquiry: Indeed. And that was an article in the – there was an article in The Financial Times in that respect –

Professor Catherine Noakes: That’s correct, yes.

Counsel Inquiry: – 23 September. Then subsequently you posted a tweet in October of 2020. I’m just going to ask for that to be pulled up, if I may.

It’s INQ000192075.

We see that here, it’s dated 13 October 2020, it’s 1.56 pm, so the afternoon, it’s a cartoon. If we just run through that. It’s a cartoon. We see the first – it goes from left to right, obviously – the first cartoon:

“Here’s the situation …”

We see a graph.

“This line is here.”

“But it’s going up towards here.”

Effectively pointing towards bad, going from good to bad.

And then a conversation between three individuals:

“So things will be bad?”

“Unless someone does something to stop it.”

“Will anyone do that?”

“We don’t know.”

“That’s why we’re showing you this.”

Ie the graph.

“So you don’t know, and the graph says things are not bad.”

Response:

“But if no one acts, they’ll become bad.”

“Well, please let me know if that happens!”

And as we see:

“Based on this conversation, it already has.”

So why did you send that tweet?

Professor Catherine Noakes: So I don’t recall my exact feelings at the time but I think it was very much that frustration that we could see almost a repeat of what was – what had happened the previous winter, that cases were rising and it was almost a case of we had to wait for something really bad to happen before something did about it. I think it’s also fair to say maybe I felt this applied to other things as well, such as climate change.

Counsel Inquiry: When you refer to the previous winter, that’s the January to March period –

Professor Catherine Noakes: Yes.

Counsel Inquiry: – of 2020?

Professor Catherine Noakes: Yes.

Counsel Inquiry: Thank you.

Then if I can just take you briefly through winter 2020 to 2021, that was when we saw the emergence of the Alpha variant –

Professor Catherine Noakes: Yes.

Counsel Inquiry: – and cases rising; is that right?

Professor Catherine Noakes: Yes, that’s correct.

Counsel Inquiry: Now, what implications did the Alpha variant have in terms of transmissibility?

Professor Catherine Noakes: So the initial indications, which proved to be correct, were that the Alpha variant was more transmissible, so – and when something is more transmissible, that means that the risk from any of your transmission routes increases. Our one concern there was that potentially the airborne route could become more significant.

So if you imagine at close range you might have already crossed a threshold whereby transmission happens, so if it’s more transmissible it doesn’t make that much more difference, but if before you’d not crossed that threshold for airborne transmission to happen but now perhaps you needed to breathe in slightly less of it or perhaps more virus was being emitted, it could become a more important route of transmission.

Counsel Inquiry: Thank you.

I just want to deal now, if I may, with the implications for physical distancing and the 1 to 2-metre rule specifically. With regard to that, can you help us with the evidence behind what was the 1 to 2-metre rule?

Professor Catherine Noakes: So I don’t know the evidence that was behind its original design, that was before I’d been involved in SAGE. It was one of the very first things EMG were asked to look at, and we looked at where there might be epidemiological evidence, there is very little of that, and then we looked at where there are – there was evidence from the understanding of the physics of how particles behave and different sizes of particles over distances, and we drew together from what limited evidence there was to indicate that actually, yes, this sort of 1.5 to 2 metres is where things are – I’m not sure I’d even now go as far as to say safe, but where the risk starts to drop off.

Counsel Inquiry: Thank you.

Now, during spring of 2020, there was a lot of focus on the 2-metre rule, and it caused a lot of controversy, there was a lot of pressure to reduce that, and in terms of your work, do you recall a situation where a line from one of your reports was relied upon in furtherance of promoting a reduction from that 2-metre rule?

Professor Catherine Noakes: Yes. So in May 2020 I was asked to give evidence to a select committee –

Counsel Inquiry: I’m not going to ask you about your evidence or anything in relation to the select committee –

Professor Catherine Noakes: Okay.

Counsel Inquiry: I’m not allowed to do that. What I am interested is in –

Professor Catherine Noakes: Yes.

Counsel Inquiry: – that following on from that –

Professor Catherine Noakes: Following on, yes.

Counsel Inquiry: – a letter was sent by Greg Clark MP, the chair of that committee, referencing your work and pulling out a line from one of your reports.

Was that an appropriate use of that line from your report?

Professor Catherine Noakes: No, it wasn’t, because he had taken the line from the report, it’s actually the paper from 28 April, and it’s paragraph 44 in that paper, and he had taken one line from it, the second sentence said “however”, and described the fact that actually this model that we’d referred to had quite significant limitations. So essentially it was using one part of a paragraph but not the rest of that paragraph.

Lady Hallett: Sounds like a West End review.

Ms Cecil: So that was on 29 May 2020. In June and July of 2020, with regard to decision-making and the response in terms of mitigations, there was quite significant movement in relation to social distancing, the opening up of restaurants and so on and so forth. Was that in accordance with the scientific principles that you’ve considered and looked at and the evidence base in relation to distancing?

Professor Catherine Noakes: A lot of it was, because that 2-metre rule did remain. And I think it’s worth saying the 2-metre rule doesn’t just describe about your distance from somebody, it actually sets the principles of how many people can go into a different – in a particular setting. So the more people there are in a setting, the higher those risks go.

Counsel Inquiry: If I can just ask you specifically about the Eat Out to Help Out scheme. How does that fit with your understanding of transmission at that time?

Professor Catherine Noakes: So just to clarify, EMG were not asked to consider it. Had we been asked, I think we would have had a concern that encouraging people to get together indoors, and only on perhaps three days of the week, which perhaps encourages crowding, was not necessarily a well designed approach.

Counsel Inquiry: Just to round off the 2-metre rule, you’ve already explained why it’s not a hard and fast rule, lots of variables apply to that, but it’s still your view that that was not over-precautionary at the time?

Professor Catherine Noakes: That’s correct, and indeed many other countries who did have shorter distances had implemented other measures to allow them to go shorter distances, particularly face coverings. which we didn’t have at the time in the UK.

Counsel Inquiry: Thank you.

Face masks have already been dealt with by Professor Horby, so I’m not going to ask you to deal with that today, but if I can just ask you very briefly to touch upon fomite transmission and the mitigations there. You’ve already referenced the hand washing campaigns that we’re all so familiar with, with the happy birthday and various other things, in that respect.

But in terms of broader challenges in relation to surfaces, what were those?

Professor Catherine Noakes: So there was – I mean, I guess any surfaces which are contaminated, there’s a potential risk there, so we’re thinking around cleaning of those surfaces. But I think, although that was a key focus early on in the pandemic, really the evidence base to show that hand hygiene and cleaning surfaces reduces transmission for Covid-19 has not grown. I have yet to see evidence that suggests that it plays a major role. At the same time, I don’t believe we can dismiss it, and I think we should have a certain amount of precaution there.

Counsel Inquiry: Thank you.

Then the final topic, please, from me today, and that is the role of socioeconomic inequalities. If I can just touch upon some of the work that was undertaken by you and ask you just to expand on that a little bit.

You explained in one of your papers from the EMG that previous research from the swine flu pandemic, so really contextualising this for a moment, demonstrated that social distancing was effective in reducing infections, but it was most pronounced in households with greater socioeconomic advantage, and you explain that similar findings were emerging for Covid-19.

Why is that? What implications does socioeconomic situation have on the ability to practice social distancing?

Professor Catherine Noakes: So this was something that was increasingly discussed in the papers that we produced, because we became more and more aware of those inequalities, and in the example you gave there around housing, obviously those who perhaps are more wealthy are more likely to have larger houses, they’re more likely to be able to have a spare bedroom for somebody to isolate in, and they tend to be slightly smaller households. If you have people who are living in multigenerational households, they are more crowded, it’s very hard, if somebody’s sick, to isolate, or, for example, if somebody is working in a higher risk occupation and doesn’t want to put their household members at risk, it’s much more challenging.

Counsel Inquiry: Indeed. You also refer to other aspects such as occupation, transport to and from work –

Professor Catherine Noakes: Yes.

Ms Cecil: – those sorts of issues as well.

Thank you very much, Professor Noakes, but if you just pause there, there are some questions.

Questions From the Chair

Lady Hallett: Just before we move to, I think it’s Ms Shepherd who is going to be asking questions, can I ask you about mass gatherings, Professor Noakes?

Professor Catherine Noakes: Yes.

Lady Hallett: Given what you’ve said, where do you stand on – I think I have heard evidence that suggested mass gatherings don’t of themselves create a greater risk because you’re only going to infect the people around you. How does that fit with your –

Professor Catherine Noakes: Yes, so that’s true, so actually a mass gathering – let’s say you go to a football match, it’s unlikely that you’re going to have transmission from somebody who is sat at the other side of the pitch to you, it’s more likely to happen very close to you. I think where mass gatherings perhaps do pose a risk is that people travel to them, so they will travel in coaches or all together, so there’s risks in there. They will perhaps stay overnight in places. They will perhaps, as part of that, go and visit pubs and restaurants. So it’s likely to be the activities alongside the mass gathering that pose more risk than the mass gathering.

Perhaps the only slightly differently one there is something like a wedding, which is a smaller gathering, but they were – weddings and parties were associated with quite high transmission, and I think because there lots of people mingle with lots of other people.

Lady Hallett: Thank you.

Yes, Ms Shepherd.

Questions From Ms Shepherd

Ms Shepherd: Good morning, Professor Noakes, I appear on behalf of Covid-19 Bereaved Families for Justice Cymru, and my questions will focus on the devolved administration angle.

So firstly, did you and your colleagues on the Environmental Modelling Group feel that you had an understanding of how your advice would be used by the devolved administrations?

Professor Catherine Noakes: So we didn’t have a full understanding because, as I say, we were producing advice papers for SAGE and therefore the routes for them to actually get to devolved nations were largely via SAGE. However, I think it’s worth noting that on our group we had representation, active representation from NHS Scotland and Public Health Scotland on the group. We did also have observers, as did many of the subgroups, from the devolved nations, so they would hear the discussions that we were having.

Ms Shepherd: Did you receive any data from the devolved administrations?

Professor Catherine Noakes: I don’t recall, but as a group, we didn’t deal with significant amounts of data, it was many of the other subgroups who dealt with – particularly SPI-M, who dealt with data more than us.

Ms Shepherd: Did you and your colleagues consider that you had a clear understanding of where the dividing line was in terms of your responsibility to provide advice to the whole of the UK, and the responsibility of the scientific advisers to the devolved administrations to provide advice which concerned their nation specifically?

Professor Catherine Noakes: I think we … most of the advice we gave was, I guess, agnostic to a particular nation, so we were giving advice around things like, you know, ventilation or distancing, and therefore really how that advice is acted on is the – is up to the policymakers in those nations to take on and use.

Ms Shepherd: Thank you, Professor Noakes, and thank you, my Lady.

Lady Hallett: Thank you, Ms Shepherd.

That I think completes the questions for you, Professor Noakes. Thank you very much indeed. Until I started this Inquiry, I confess I didn’t realise the extent to which your kind of expertise and skills were required and utilised during the pandemic response, and I should have known, and I’m really grateful to you, obviously unsung heroines and heroes. Thank you.

The Witness: Thank you.

(The witness withdrew)

Mr Keith: My Lady, the next witness is Professor John Edmunds.