Transcript of Module 2 Public Hearing on 23 November 2023
(9.30 am)
Lady Hallett: Ms Cecil.
Ms Cecil: Indeed, good morning, my Lady, may I call Professor Dame Angela McLean, please.
1. Professor Dame McLean
PROFESSOR DAME ANGELA McLEAN (affirmed).
Questions From Counsel to the Inquiry
Ms Cecil: Indeed, Professor, thank you for your assistance this morning, and indeed you have provided a witness statement to the Inquiry as well. That’s dated 19 October 2023, so earlier this year. It runs to some 51 pages, at the conclusion of which is there’s a statement of truth and your signature. Can I just ask you to confirm that the contents are true?
Professor Dame McLean: Yes, the contents are true.
Counsel Inquiry: Now, if you can keep your voice up, not least because we have a transcript being made at the same time, and so it may be that at points we need to take things more slowly, so we will try to maintain a reasonable speed and pace. If I ask you to slow down it will be my fault. Similarly we’ll take a break at some point this morning.
So, Professor McLean, you are currently the UK’s Government Chief Scientific Adviser; is that right?
Professor Dame McLean: Yes.
Counsel Inquiry: That’s a position you have held since 3 April of this year; you succeeded Professor Sir Patrick Vallance?
Professor Dame McLean: Yes.
Counsel Inquiry: Previously you’ve occupied a number of roles both within government but also within academia?
Professor Dame McLean: Yes.
Counsel Inquiry: You were formerly the Chief Scientific Adviser for the Ministry of Defence?
Professor Dame McLean: Yes.
Counsel Inquiry: And indeed you were at the time and the period with which the Inquiry is concerned with regard to the Covid-19 response?
Professor Dame McLean: Yes, that’s right.
Counsel Inquiry: At that point you also acted as a Deputy Chief Scientific Adviser from spring of 2020?
Professor Dame McLean: That’s correct, yes.
Counsel Inquiry: Thank you.
In terms of your professional background, you were also a professor of mathematical biology and that’s where your expertise lies; is that right?
Professor Dame McLean: Yes.
Counsel Inquiry: At Oxford University, and you hold a number of fellowships in that regard?
Professor Dame McLean: Yes.
Counsel Inquiry: If I may now turn to the pandemic response itself and your involvement in the various scientific advisory bodies at that stage, you were a participant in SAGE?
Professor Dame McLean: I was.
Counsel Inquiry: That run from 11 February 2020 all the way through to 10 February 2022?
Professor Dame McLean: Yes.
Counsel Inquiry: In conjunction with that, were you also the co-chair of SPI-M-O?
Professor Dame McLean: That’s right, I was the co-chair from 27 March 2020.
Counsel Inquiry: And that, again, ran throughout that period until the conclusion of the committee in spring of 2022?
Professor Dame McLean: Yes.
Counsel Inquiry: You were also involved in some task and finish groups. Can you just give a very brief outline as to what those were?
Professor Dame McLean: Yes, there were three of those. So the first one was on mass testing, we did that in August of 2020. The second one we always called the “four nations task and finish group”; that was looking at what happened before and after the tiers were put in. And then there was one on – about the science of vaccination, although of course most of the advice, the great majority of the advice about vaccination was handled separately by JCVI.
Counsel Inquiry: Indeed, and we will return to the second of those, the impact of interventions, the four nations –
Professor Dame McLean: Yeah.
Counsel Inquiry: – task and finish group in due course, but you cover the other two within your statement so I don’t propose to take you to those today.
With regard to providing scientific advice to government, did you at any point attend COBR, Cabinet, Covid-O or Covid-S?
Professor Dame McLean: I think I went to a small number of Covid-O meetings, none of the others.
Counsel Inquiry: With regard to the later stages of the pandemic, was your involvement with the Covid-19 Taskforce?
Professor Dame McLean: So later on in the pandemic, towards the end of that first year, Covid-19 Taskforce Analytics became a really important part of our lives as advisers, because it formed a really fantastic sort of network for collaborators. So that was headed up by a man called Rob Harrison, and so I think sort of from about December, maybe, 2020, I started going to their morning meeting every day.
Counsel Inquiry: Again, we will turn to that in a little more detail when we come to discuss the roadmap out of lockdown in 2021.
So just very briefly with respect to SAGE, you attended a significant number, some 89 of those SAGE meetings, throughout that period. Initially that was as the chief scientific adviser for the Ministry of Defence but subsequently as a consequence of your role as co-chair, is that right, of SPI-M-O?
Professor Dame McLean: That’s correct.
Counsel Inquiry: What was your role within SAGE at that time?
Professor Dame McLean: So my role in SAGE at that time was like other people, it was to listen to other people’s evidence, so evidence that was being brought to SAGE by attendees that day, and challenge it like any scientist would challenge other scientists. Once I was the co-chair of SPI-M-O, it was also to support my co-chair, Graham Medley; sometimes if he wasn’t there I would present the SPI-M-O consensus. And then an important part of the work would be to listen very carefully because straight after SAGE we co-chairs and the SPI-M-O secretariat would sit down and think through: right, what’s the new commissions that come out of that? What questions arose in SAGE this week that we think SPI-M-O should be – start working on and thinking about?
Counsel Inquiry: Do you consider that to be a strength of the SAGE system, that the co-chairs of the various committees sat on it and then had these follow-up sessions?
Professor Dame McLean: I would say that was a strength, yes.
Counsel Inquiry: In terms of SPI-M-O, again a large number of meetings, 81 during that period as the co-chair, alongside Professor Graham Medley, who we’ve also heard from, as you will know, earlier in the Inquiry.
What was your – as co-chair of SPI-M-O, what was your role as distinct from that of Professor Medley?
Professor Dame McLean: So I think my main role was really to be the go-between. I was the person who was at SPI-M-O meetings, very involved in the work they had done and were going to do, but also with lots of access to the relevant civil servants, so particularly in CCS – what does CCS stand for? – Civil Contingencies Secretariat to start with, and then later on in Covid-19 Taskforce and then particularly in Covid-19 Taskforce Analytics. So lots of that. But then also supporting Graham in devising workflow, like I just described. I was often there – well, I was always there, when I was available, for the main meeting – so SPI-M-O had a main meeting, ended up being on a Wednesday – to support Graham to be listening very carefully to make sure our consensus statement did reflect the discussion.
Yeah, quite often I would be the one who said, “Listen guys, you think that’s interesting but I can tell you that is not interesting with respect to this particular policy question”. They’re academics, my – I mean, friends of mine, they would get very interested in some particular detail and I would sometimes say, “Sorry, but move on”. And on the other side quite often they would say “Oh, but that’s obvious” about something that they felt was very obvious, just from what they knew about epidemiology, and I would have to say, “Well, that’s obvious to you but actually it’s not obvious to lots of extremely well-important – well-informed people who are absolutely involved in managing this pandemic”.
Counsel Inquiry: With regard – sorry, if I may just pause you there, just to pick up on that – with regard to your input from that perspective, was that very much based upon your role and interaction within government as a chief scientific adviser?
Professor Dame McLean: Very much. Very much so. I mean, I’d been in the civil service since that September, but I had also done quite a lot of work over the years as an academic advising into government, because there are lots of mechanisms where government reaches out for academic advice, so it wasn’t just those six months, I had also done quite a lot of advisory work beforehand. So I think I probably had more experience, particularly perhaps with civil servants who weren’t completely steeped in public health, than some of my colleagues on SPI-M-O did.
Counsel Inquiry: And with that role in terms of policy development and having that understanding, did you find that you were predominantly therefore involved in commissioning exercises and being that bridge between government and SPI-M-O?
Professor Dame McLean: I did have a lot to do with commissioning exercises, particularly early on. I mean, I think – well, actually, I thought Graham put it very well when he said that I was able to talk about things that modelling could do and things that modelling could not do. So quite – I remember many discussions where I said, “That’s just not a good question to bring to SPI-M-O, don’t ask them that”. And then quite often – you can imagine we would have a conversation where I would say, “Well, why are you asking that question? What is the policy decision you’ve got to make here? Is there another way we can frame that question into something that epidemiology analysis and modelling can help with?”
Counsel Inquiry: Can I ask you just to slow down slightly –
Professor Dame McLean: Yes.
Counsel Inquiry: – Professor McLean.
Lady Hallett: I think we had three minds all the same.
Ms Cecil: Indeed. Just because, as I say, there is a note being taken and, as I say, it will be my fault rather than yours.
So just picking up on that, what were the initial problems that you saw with commissioning?
Professor Dame McLean: So early on with commissioning, so remember this would be – when I say early on, this is from 27 March onwards, so actually after the first lockdown was in place, commissions arrived from all over the place. So particularly we would get commissions from Civil Contingencies Secretariat and Number 10 and we didn’t know how – and we wouldn’t know how to prioritise those. And sometimes we would get commissions that would string several sort of, “Please tell us about option A and/or option B, that’s three possibilities, and then string those together for sort of three or four different things”, and quite soon we’d get to sort of 100 or so possibilities. And it was my job to say, “I’m really sorry, but in a week we can’t do that. What do you really care about? How will you prioritise these questions? Let’s turn this into something where we can actually help you.”
Counsel Inquiry: Did that process, firstly, improve as the pandemic progressed?
Professor Dame McLean: It got much better. So SAGE secretariat basically built a commissioning system, which – one of the things it did was to stop just sort of commissions just arriving just sort of from left field, from department X or ministry Y, so they really helped us a lot by effectively making some rules of the road about how commissioning would work. And then, yes, I think – well, I felt that my growing relationship with CCS meant that we got better at shared language and me understanding more why they were asking their questions, them understanding more what kind of thing we in SPI-M-O could and could not do.
Counsel Inquiry: Thank you. If I may just pick up, then, in terms of those difficulties that were initially experienced with a lack of understanding, you undertook a number of initiatives, would that be fair to say, to try to assist civil servants and policy-makers and indeed decision-makers in their understanding of both scientific consents but also the outputs of SPI-M-O and SAGE?
Professor Dame McLean: Yes, we put lots of work into that.
Counsel Inquiry: Just to give a few examples of those very briefly, you were responsible for producing explainer documents?
Professor Dame McLean: We did.
Counsel Inquiry: Very short, pithy documents explaining things such as the reproduction number, the R, the R number as it’s been referred to, general principles and assumptions on transmission, introduction to epidemiological modelling, which we’ve all had sight of, and indeed an FAQ on epi modelling to try to imbue some further understanding effectively within the civil service and indeed those decision-makers?
Professor Dame McLean: That’s right.
Counsel Inquiry: Did you see the fruit of that effectively?
Professor Dame McLean: I think we did, yes, I think the discourse became much better informed on both sides.
Counsel Inquiry: In addition to that, and I appreciate some of us are not so familiar with graphs and graphical representations, but one of the other main developments throughout that period, in terms of communications of the scientific advice and the outputs of SAGE and SPI-M-O, was the production of something that became known as “ready reckoners”?
Professor Dame McLean: (Witness nods)
Counsel Inquiry: Again, that was something initially pulled together by a Professor Brooks-Pollock –
Professor Dame McLean: That’s right.
Counsel Inquiry: – within SPI-M-O –
Professor Dame McLean: Yes.
Counsel Inquiry: – and taken forward by you, as co-chair?
Professor Dame McLean: Yes, I mean, I think that’s a good shorthand way of putting it. I think generally in SPI-M-O and then in SAGE it was felt, yes, this is a useful way of making lots of comparisons all on one page without having to draw thousands of squiggly lines.
Counsel Inquiry: Indeed. And perhaps we could have a very quick look at perhaps one of the earliest iterations of that, and that’s INQ000216286.
If we can go over the page, please, what we see here are a sequence of graphs that deal with issues in terms of schools and the mixing outside of home, degrees of school opening, the efficacy or otherwise of contact tracing, and then NPIs that are in place.
Perhaps if you could, just because – very quickly or very gen – I say in high level through the first of those graphs.
Professor Dame McLean: So, my Lady, I’ve heard you don’t like graphs, but this is a beautiful –
Lady Hallett: Well, it depends on the graph.
Professor Dame McLean: A very beautiful graph.
I think the way to look at this graph is to think about what can this remind us about how things felt on three different dates.
So before, let’s say, mid-March, in 2020, we would have been on the right-hand end of – I’m looking at the left-hand graph, okay? So the bottom axis says how much active work and leisure contact are people having. So 100 is normal everyday life and the Y axis, the up-down axis, is – what is this – here is our R number, and we would like –
Ms Cecil: If I could just pause you just very briefly with the R number for the moment.
Professor Dame McLean: Yes. Yes.
Counsel Inquiry: Based on the R number, was that because decision-makers had become familiar with that concept?
Professor Dame McLean: Yes. Yes.
Counsel Inquiry: It was a shorthand, effectively?
Professor Dame McLean: Exactly, it had turned into a shorthand for: have we got this infection under control, is R at 1 or below 1? Or have we not got this infection under control? Which was the case when R was above 1.
So when R is a long way above 1, you really are in trouble.
Counsel Inquiry: And that’s why we have the R number along the one axis –
Professor Dame McLean: That’s right.
Counsel Inquiry: – and the active work and leisure contacts on the other.
Professor Dame McLean: That’s right.
Counsel Inquiry: And I interrupted you, so please go ahead.
Professor Dame McLean: Fine, thank you.
So remember this is very early on, nobody vaccinated, the entire population susceptible to infection with bad consequences, particularly for elderly people and also for lots of other people too.
So, there we are, living our normal lives in late February, early March 2020, so we’re at – we’re far over on the right-hand side of the X axis, all the schools are open, so the R number is somewhere between 2.5 and 3, we’re in the middle of that – we’re somewhere in that red band up there on the right-hand side. And that was what was driving the rapid exponential growth that we eventually saw in the very rapid rise in hospitalisations that we saw a few weeks later.
I’m going to come on later – I hope we’ll come later to where were we in the middle of the week just after the Prime Minister stood up on 16 March and said “Please stay home”.
Counsel Inquiry: We will be dealing with that in due course.
Professor Dame McLean: So under voluntary restrictions, we’ll talk about – obviously it’s very important where we were, but from the data we had at the time we were probably at about 60 on the X axis, most children still in school, still R way above 1. Then on March 23, when lockdown came in, we were more like at about – and all schools were closed, we were more like round about 20 on that X axis. All schools closed, so in the middle of the grey band, the R number round about 0.7.
So this was, this was a very quick and easy way to see, roughly speaking, if we do the following things what will happen. And one of the things you see from these graphs – I don’t know if it’s possible to zoom out a little bit? – is that – well, if you compare the left-hand graph – on the top row, if you compare the left-hand graph and the right-hand graph, you can see that a little bit of contact tracing – so the right-hand graph is if contact tracing could prevent one in five onward transmissions, 20%, well, that doesn’t – there’s not a huge difference, is there? Whereas, if you go to the bottom graph, if contact tracing could prevent four out of five onward transmissions, then we start to have quite a lot more room to sort of roam up and down this bottom axis.
So the bottom axis is sort of how hard you have to intervene, the different bands are how much the schools are open, and the different pictures in this particular representation is how much contact tracing might we be able to build.
Counsel Inquiry: Indeed. And on each of the graphs it sets out what the parameters are?
Professor Dame McLean: Yes.
Counsel Inquiry: So, taking the top one, we see that the grey band is “Schools closed”.
Professor Dame McLean: Yes.
Counsel Inquiry: Then the blue one, “50% of 5-11 year olds at school” as an alternate.
Professor Dame McLean: Yes.
Counsel Inquiry: Yellow, the 5 to 11-year-old category at school.
Professor Dame McLean: Yes.
Counsel Inquiry: And then “Schools open”.
Professor Dame McLean: Yes.
Counsel Inquiry: Then, as you say, you see, if we go to the right one, we then see “Schools closed + 20% [contact tracing]” reduction –
Professor Dame McLean: Yes.
Counsel Inquiry: – and so on and so forth?
Professor Dame McLean: And if I could add one further thing: this is actually based on data from I think it – well, I think it is tens of thousands of people in something that – a study that the BBC ran, long before the pandemic, on what kind of contacts people have with other people of what age in what context.
Counsel Inquiry: And this was a graph, as we will come to later, that was being dealt with at a very early point in time, in fact, in the pandemic, pre-lockdown, but post voluntary measures being announced?
Professor Dame McLean: I’m not sure we had this particular graph, because actually if you look at the date that these emails were written, I think this is – no, I think we actually got this representation in more like May. This idea that we needed to be down round about 75% of contacts outside the home, so the idea that we needed to be way, way down on – back to the top left graph – only requires a pretty straightforward calculation.
Counsel Inquiry: We’re going to move to exactly what that required, as I say, when we start to look perhaps slightly more chronologically –
Professor Dame McLean: Yeah.
Counsel Inquiry: – at the response, as opposed to these topics.
And perhaps we can take that down now.
Lady Hallett: Just before you do, and now I’m going to show just how bad I am with graphs. Could we have it back up again? Sorry.
The left-hand graph, you’ve got – bottom axis you’ve got up to 100% contact –
Professor Dame McLean: Yeah.
Lady Hallett: – yet we’re looking at the grey line, if schools are closed.
Professor Dame McLean: Yes.
Lady Hallett: Well, if schools are closed you haven’t got 100% contact, have you?
Professor Dame McLean: So this is active work and leisure contacts beyond – so work, adults; leisure, everybody (apart from school). So, yes, you’re quite right, this is apart from school. What’s everybody doing apart from the children’s school contacts. Thank you for reminding me to clarify that.
Lady Hallett: I was just thinking that obviously when schools are open –
Professor Dame McLean: Yeah.
Lady Hallett: – or schools are closed, there’s an awful lot of contact –
Professor Dame McLean: Yes.
Lady Hallett: – that is reduced –
Professor Dame McLean: When schools are –
Lady Hallett: – when they’re closed.
Professor Dame McLean: Absolutely. And I don’t think that’s in here. So the fact that when schools are closed parents can’t go to work, I don’t think that was captured in here.
Lady Hallett: The other thing, can I just ask before – I’m sorry to interrupt, Ms Cecil.
Ms Cecil: No, not at all.
Lady Hallett: Looking again at the left-hand graph, and remembering that one of the problems I have with graphs is it all depends on how big a gap you give between different measurements –
Professor Dame McLean: Yeah.
Lady Hallett: – when we look at school closures and school openings, the difference isn’t perhaps as great as some of us might have expected. So if you’ve got – well, let’s go for the 100%, just because it’s easier – 100% of other contacts, but you close schools –
Professor Dame McLean: Yeah.
Lady Hallett: – with schools closed, you’re still up at an R number of over 2.
Professor Dame McLean: Yeah, correct.
Lady Hallett: And with schools open, you’ve got an R number of 3. Well, you said earlier, anything over 1 we’re in trouble. So is that as great a distinction as laypeople like me might have expected?
Professor Dame McLean: I would look at that and say only closing of schools would have been – wouldn’t have helped us – well, would have helped us very little, I agree.
Lady Hallett: Thank you.
Ms Cecil: Perhaps that’s the advantage of the ready reckoners and the visual comparators on the page, in fact.
But these were incorporated, as a consequence, into both consensus statements and SAGE minutes?
Professor Dame McLean: They were.
Counsel Inquiry: Yes. Just to deal, perhaps, and picking up my Lady’s comment in relation to the gaps on graphs, certainly that is one of your primary issues with how politicians and – not just politicians and decision-makers but policy-makers, individuals that are not acquainted with graphs, potentially utilise them and certainly when it comes to getting a ruler out, for example, that’s a very big no-no to mark –
Professor Dame McLean: Yes.
Counsel Inquiry: – the gap between them or indeed to take a specific point on many of the graphs that were produced by SAGE or SPI-M-O as being a critical accurate point?
Professor Dame McLean: I think that was reflected in Graham’s comment about knowing what you can’t do with these things. I mean, my – I was showing you earlier, my version of these graphs, that I’m extremely fond of and often carry around with me, actually has little – I drew myself a little picture of a ruler with a “Don’t go there” sign on it. You know, we shouldn’t use these things to say, “Oh, well, if we had, you know, 45% active work and leisure rather than 40% and – we could do precisely this or precisely that”. That’s not the point. The kind of lesson to learn from graphs like this is: look just how much – look how good your contact tracing needs to be before it gives you lots and lots of space to have fewer interventions in terms of how much people can be out and about.
Counsel Inquiry: Indeed. And was that one of the challenges you and your colleagues faced during the pandemic in relation to the understanding of graphs, and indeed numbers, statistics and other scientific data and outputs?
Professor Dame McLean: Yes, I think – I think I would say it’s an issue all your life, as a sort of rather technical person, is that – to find people as interlocutors who will listen, but also challenge in a really constructive way, is really important. Because it’s just as bad if they believe everything you say, because that’s not very helpful, if you need somebody – I mean, most of my academic life was done in collaboration with people who were not mathematicians, not modellers, and by far the best collaborators are – will listen and criticise and say, “Well, why did you do that? And should I really believe, you know, that confidence level? How did you draw the confidence interval?”
So I think one of the things I would always say to any colleague is if a scientist comes and tells you something and you don’t understand what they say, you must say to them, “Say it again, I didn’t understand”. It’s their job – I think it’s scientists’ job to explain what it is that they’ve done.
Counsel Inquiry: With regard to that point and understanding, perhaps if I can pick that up here, perhaps if I can take you to paragraph 57 of your witness statement on page 17, we’re going to turn to decision-making in respect of NPIs, as I say, in due course, but one of the factors that you identified as being a difficulty during the pandemic was the understanding of two key concepts, the first being the implications of fast exponential growth and the second being lagged controls.
Can you just explain exponential growth and its importance in this context for us, please.
Professor Dame McLean: So exponential growth arises when you have a process where what’s fixed is not the slope of line but the time that it takes to double whatever the quantity you see. So exponential growth and fixed doubling times go together. So when we say the doubling time is a week, we instantly know: oh, we’re talking about exponential growth. And I think as you heard very eloquently from Chris Whitty, you know, exponential growth, once it gets going, grows really shockingly fast.
Counsel Inquiry: Exponentially.
Professor Dame McLean: Exponentially.
Counsel Inquiry: Indeed.
Professor Dame McLean: And lagged controls, well, that was particularly pertinent here because what we were trying to do, we were trying to stop too many people ending up being admitted to hospital, and admission to hospital was something that we expected to happen sort of ten or eleven days after you got infected, so if we have – so the place where you could make an intervention was people getting infected, whereas the thing that you were worried about happens ten days later. So if you wait until the thing you’re worried about is really, really bad, and growth is exponential and fast, you could very easily end up with things twice as bad at the hospital door, even if you put in a brilliant intervention. So this idea that things where whatever your control measure is doesn’t fix your problem until ten days later is a really important part of why this was such a difficult problem, and really, as I point out in this paragraph, needed to be understood because it made “watch and wait” tactics very damaging.
Counsel Inquiry: Indeed, the failure to take a decision or to wait is a positive decision in itself when it comes to issues of exponential growth?
Professor Dame McLean: Indeed.
Counsel Inquiry: And from your perspective, that is perhaps one of the most important lessons for the future in terms of developing that understanding –
Professor Dame McLean: Yes.
Counsel Inquiry: – is that right?
Professor Dame McLean: I think so.
Counsel Inquiry: And as we will see as we move chronologically through that period, that informs what you consider to be one of the most significant shortcomings in relation to decision-making in both – well, to some extent in the early part of the pandemic but certainly in the autumn period of 2020?
Professor Dame McLean: I agree, I think we made the same mistake three times.
Counsel Inquiry: Thank you.
Now, with regard to that understanding, do you consider that that requires a scientific mindset?
Professor Dame McLean: No, I don’t think it requires a scientific mindset. I think if you – you can draw it out in a picture in a way that anybody who’s prepared to listen and think about it ought to be able to grasp.
Counsel Inquiry: Indeed, you give some examples within your witness statement of the director general for analysis in the Covid-19 Taskforce.
Professor Dame McLean: Yes.
Counsel Inquiry: Somebody with an entirely non-scientific background, but able to pick up those concepts and work with those.
Professor Dame McLean: Yeah.
Counsel Inquiry: Now, just picking up on the scientific mindset aspects, there are also differences that you identify in culture and approach between civil servants and indeed scientists. Perhaps if I can just break it down a little bit further into three categories. You have your scientific advisers, you then have your civil servants and policy-makers, operational and taking a lead from the decision-makers in government?
Professor Dame McLean: Yes.
Counsel Inquiry: So those three categories. And in respect to that can I please bring up paragraph 22 on page 7 of your witness statement, because you describe there two very different cultures. So perhaps turning firstly to academics and scientists, and that culture, you explain that academics tend to focus on points of disagreement, speak pointedly, directly about their views. What was the difference, as you saw it, in terms of your interactions during this period?
Professor Dame McLean: So really the nicest thing that an academic can do for a colleague is point out why they’re wrong before it goes out into the world and somebody unfriendly points out why they’re wrong. So that was why under Graham’s leadership on SPI-M-O our mantra became “Tell me why I’m wrong”, and – whereas it is very frequent in a civil service meeting that as somebody stands up the very first thing they will say is “I agree with everything that’s been said”, and you’re sat there thinking, “Well, you can’t have been listening then”. And it’s – I don’t think they really mean it, actually, I think it’s a sort of a saying that means “I’m here to work with you, we’ve got things we’ve got to deliver, I might disagree with some of the details of what you’ve said, but let’s work together”. And, I mean, I always found it – do I still? It’s always quite difficult for an academic who becomes a civil servant to understand why people are saying this sort of weirdly emollient thing, when actually our values are so similar: we are trying to get at the truth. I think it’s a difference between: are you really trying to get at every detail of the truth, or are you trying to make something workable that you can deliver? So I think it’s summed up quite well by “Tell me why I’m wrong” (academics) versus “I agree with everything that’s been said” (civil servants). I think the values are actually very close, but they’re different ways of approaching working together.
Counsel Inquiry: And, indeed, different ways of communicating.
Professor Dame McLean: Absolutely.
Counsel Inquiry: Did that cause any difficulties during the pandemic?
Professor Dame McLean: Yes, there were several occasions when I had to paper over the cracks, I would say, because it was usually – was it usually this way? – yes, I think it was mostly that an academic on SPI-M-O had told a civil servant why they were wrong in some way that the civil servant felt was rude. And so, yeah, there were occasions when – when I – and I felt it was my job, I was very happy to do it – was in contact with people to say, “I’m sorry that was upsetting for you, that was – they didn’t mean to be rude to you personally, what they – you know, they – what they were talking about was your work”, you know.
Counsel Inquiry: Indeed.
If I could just call up INQ000215900, it’s an email with Professor Medley and it relates to perhaps one of those scenarios that arose during the pandemic with a member of – a civil servant.
Within this, what we see is in the top part it’s an email from you. Second paragraph down, you explain that a gentleman was unhappy about SPI-M-O on Wednesday so you sent him an email, which you copied in to Professor Medley just so that he was also in the loop, and you explain:
“I think Civil Servants have different ways of being robust with each other from academics. Perhaps he found our ways of expressing ourselves more direct than he is used to. No action required.”
Then you explain you’ll try to find out why he’s uncomfortable and report back.
So is that an example of what you have been –
Professor Dame McLean: Indeed.
Counsel Inquiry: – referring to?
Professor Dame McLean: Indeed. And, I mean, what you can see here is the wonderful Clare Gardiner was able to ring me up and say “Angela, that went a bit far on Wednesday, can you try to cheer Tom up a bit”.
Counsel Inquiry: And the underlying issue there was a meeting in SPI-M-O where members were expressing some level of frustration with the testing and tracing situation?
Professor Dame McLean: I believe that – I believe so. Elsewhere there’s a response from Tom saying he’s not surprised people are frustrated with the progress of the test and trace system.
Counsel Inquiry: Now, if I may turn to separate issue and that’s the one in relation to further attempts to assist policy-makers and government decision-makers in a slightly different way, and that was the creation of a toy model. And we’ve heard a little bit about that already, but if you could just explain very shortly in a sentence what a toy model is, please.
Professor Dame McLean: So a toy model – I think the phrase really comes from physicists – is an absolute caricature. It is something where you keep things as simple as possible, either perhaps so you can do some analytical calculations, you know, on a piece of paper, or in this case we wanted to make something that could be freely available both to policy-makers and, if they wanted it, decision-takers, to build their understanding and intuition about how infectious disease systems work. We knew that we couldn’t build for them a full sort of well parameterised model with lots of the complexities about how different parts of society mixed together. So we were very clear that this was a pedagogical tool.
Counsel Inquiry: Indeed, within the toy model documentation itself, it makes clear that it’s a teaching tool.
Professor Dame McLean: Yeah.
Counsel Inquiry: It’s not designed to give accurate forecasts; it is so that people can play around with it to see what the potential impacts of different interventions could be, but in a very general way.
Professor Dame McLean: That’s right. So going back to this issue that we talked about right at the moment, right early on, that if something is growing very fast and the control lever that you have only acts with a bit of delay, you’re going to get this big overshoot after you’ve made things better, that sort of thing. And when I say “we built”, it was built by a team in JBC, a very able team led by Fergus Cumming.
Counsel Inquiry: And then quality assured and then sent out to various government departments.
Professor Dame McLean: That’s right. So my role – so I was incredibly keen that they should have something that was internally correct. I mean, it wasn’t a great model but it didn’t have mistakes in it, so that it could be relied on in that sense. So yes, sent it out to be basically peer reviewed by some academics and it was also very carefully reviewed by some modellers at the Defence Science and Technology Laboratory.
Counsel Inquiry: We’ve heard a little bit of evidence already in respect of Clare Lombardelli from the Treasury with regard to an email chain that you were involved in, along with Philip Duffy and Ben Warner, relating to Treasury playing around with and changing that toy model, and what you say there, in relation to that, is:
“Given their inability to spot egregious errors in other things they were sent I do not have any confidence in their ability to hack a simple, sensible model.”
As a consequence, anything they have to say about infectious modelling is very much on them, as opposed to quality assured or endorsed by you or SPI-M-O.
Professor Dame McLean: It was me, this was – SPI-M-O were actually quite clear that they felt it was not their job to quality assure government work, and I think that was right, they were already doing enough, so it was me as – really, it was me as CSA MoD, I would say, who took this, found some – actually, some of them were SPI-M-O members. But – so that was done outside SPI-M-O, and I think rightly. But, yeah.
But to go back to the – in the documentation, I think you’ll – there are things saying, “Please don’t change it”, because once you’ve changed it, it is no longer quality assured. You know, we had gone to a lot of trouble to make sure it was correct, and so we said to people, “Please don’t change it, please feel free to use it however you like”. It had been made into this beautiful, rather easy-to-use thing, I believe, although I never got to play with it myself.
And, I mean, that is a source of some regret to me, because if Treasury had come to us and said, “Oh, this is quite interesting, it doesn’t quite do what we need, would you – if we make some changes to it, properly document and explain to you what we’ve changed, would you re-quality assure it for us?” And I think I would have sighed because it was a lot of work, but I would have done it. And actually that could have formed the basis for quite an interesting – a strong interaction.
Counsel Inquiry: Indeed. And one of the themes that you do refer to within your witness statement more generally in relation to HMT and Treasury is a lack of transparency over the economic modelling or advice?
Professor Dame McLean: Yes. I mean, I think there was an issue that the scientific advice that came through SAGE was completely transparent, everything was in the public domain, on the day that a decision was announced, and whatever modelling Treasury was doing to consider the economic case, I’ve still never seen.
Counsel Inquiry: And with regard to, you may have heard that there was some attempt at epi-macro modelling by HMT?
Professor Dame McLean: Yeah.
Counsel Inquiry: By Treasury. And what you do refer to in your email are “egregious errors in other things”. Did they have adequate or sufficient epidemiological modelling experience in your view to do that?
Professor Dame McLean: I think they could have used some more. I mean, in the same way that DHSC looks for outside help via SPI-M, even in peacetime, and there’s plenty of good modellers in DHSC, but they have the, I think, very good sense to go to academics who, you know, who are world class leaders in the subject. So I think it would be sensible for Treasury if they wanted epidemic models to have reached out that way.
Counsel Inquiry: Thank you.
Then one final topic before we turn to the governmental response and the response to Covid-19, please, and it’s that of data and data flows, and we can deal with this relatively briefly.
We’ve heard a lot of evidence so far in relation to data and the absence of data, but that’s also something that you experienced, certainly at the very beginning of the pandemic but also throughout the pandemic, albeit getting better as the pandemic progressed. Would that be a fair summary?
Professor Dame McLean: Yes, that’s a fair summary.
Counsel Inquiry: If I can just pull up, please, INQ000213194 and go to page 2, what we have here – it’s the bottom of an email from you that I’m interested in. It’s halfway down the page:
“That does bring me to the elephant in the room Mike.”
This is an email exchange that’s taking place towards the end of March –
Professor Dame McLean: Yeah.
Counsel Inquiry: – of 2020, 28 March:
“You are going to be horrified when you find out what the data flows coming out of the NHS are like. I just want to warn you. I actually choked when Peter Bruce said SPI-M must be drowning in data.”
So we are obviously at this point in lockdown. We’re there. We still have, on your view, significant issues with the data flows coming out of the NHS. Is that right?
Professor Dame McLean: Yes, that’s right.
Counsel Inquiry: How did that impact upon your work at that stage?
Professor Dame McLean: There was – there was real trouble with doing the sorts of analysis that we needed because the data weren’t available. It’s that straightforward.
Counsel Inquiry: Thank you.
Professor Dame McLean: It did get much better later, so I … I can’t remember the exact dates, but around this time – I think it – I never really knew what happened, it was a bit – it was quite sort of elves and the shoemaker. I came down one day and DSTL had sorted it all. I think what happened was that my very able private secretary in the Ministry of Defence, who came from the defence science labs, what they did was they set themselves up as what I would call a data haven. Anybody would look at them and say: well, surely these people know how to keep very sensitive data secret. So they could be trusted by the NHS to take the data, clean it, make sure that nothing was identifiable to an individual, on the one hand; and on the other hand, they could handle all the non-disclosure agreements that were absolutely necessary from people who were going to access that data.
So they set themselves up that way and they became the people – a main conduit – not the only conduit, but the main conduit – for data, particularly out of the NHS, into idea – into the modelling groups.
Counsel Inquiry: So, essentially, a trusted broker?
Professor Dame McLean: Exactly.
Counsel Inquiry: Something of that nature?
Professor Dame McLean: Yes. And, actually, I mean, I would like to sing their praises, because I think that act of looking after data, cleaning data, making sure that only people who should access it do access it, is often – they are unsung heroes, those people. They weren’t the modellers; the modellers could not have done their work without them.
Counsel Inquiry: And just picking up on two other aspects, if I may, of data. If I can call up, please, an email at INQ000061765. It’s an email, again around the same time period, 30 March of 2020 through to the 31st, between you, Sir Patrick Vallance and Professor Medley.
Here, what’s being flagged again is, we see from the second email down from Graham Medley:
“… the lack of data from devolved administrations should … be highlighted.”
If we go over the page, please, what we have at the end of that email, the penultimate line before the sign-off:
“A key political issue is that we still have no real-time data from outside England.”
So what we’re seeing here are significant issues in relation potentially to Scotland, Wales and Northern Ireland.
Professor Dame McLean: That is correct.
Counsel Inquiry: Again, what impact did that have on the early stages and did that position improve?
Professor Dame McLean: That was a – that was a difficult issue for quite some time and it made it very difficult for SPI-M-O to do work that was specifically relevant to other – to the devolved administrations. It did get much better over time, and in time particularly Scotland and Wales actually created very good analytic and modelling capability of their own and data flows from other parts of the UK did get better.
Counsel Inquiry: And with respect to that sharing of data and the data flows, at what point in the pandemic did you see a significant improvement? Obviously not necessarily the date, but just broadly.
Professor Dame McLean: My sense is that by mid-May it was much better. You have to understand that modellers are a bit like farmers and the weather, you know, there’s never enough data.
Counsel Inquiry: Of course. Did you or SAGE or SPI-M-O ever experience any difficulties in obtaining data from Scotland, Northern Ireland or Wales, effectively were there any blocks put in the way by any of those devolved nations or was there a free flow of data, once the capacity was there?
Professor Dame McLean: I don’t think I can answer that question because that was – that would have been handled by my co-chair and the secretariat.
Counsel Inquiry: Of course. No, thank you, Professor.
Another area of data, just briefly on ethnicity, if I may, you make it plain within your witness statement that with regard to ethnicity there was insufficient data to account for intersectional disparities, so ethnicity and indeed other aspects; is that right?
Professor Dame McLean: That – particularly in these main flows of data that were driving parameter estimation for the big models, yes. There were sometimes other particular questions that we could address with particular datasets but yes I would say in the main data streams there wasn’t enough data, and for the kinds of policy questions we were addressing I don’t really – I can’t think of policy questions that really would have driven that kind of modelling. Because there’s no point in us making a model more complicated if it isn’t necessary to address a particular policy question.
Counsel Inquiry: Indeed. And similarly there was an absence of data on wider societal outcomes which feeds into those intersectional issues also?
Professor Dame McLean: Yes.
Counsel Inquiry: We –
Professor Dame McLean: Sorry, can I just –
Counsel Inquiry: Of course.
Professor Dame McLean: I don’t think we’re going to visit it here, but there was work done by a different group, not by SPI-M-O, on what Chris Whitty refers to as – what we always thought of as the CMO’s four harms. So because – so that was handled by Ian Diamond and John Aston.
Counsel Inquiry: Yes.
Professor Dame McLean: So that the – ways of accounting for the harms wider than Covid hospitalisations and deaths.
Counsel Inquiry: And we have heard some evidence in relation to that at the outset of this module as well from Professor Sir Ian Diamond.
Professor Dame McLean: Good.
Counsel Inquiry: Similarly, if I may, data and care homes, just touch on that briefly here. With respect to care homes and data, were you also experiencing problems in accessing data flows and data streams?
Professor Dame McLean: We had very little data about outbreaks inside care homes, so for a long time the data we tended to see was: yes, this care home is affected, no, this care home is not affected. But that made it very difficult to say anything helpful about what was happening inside care homes.
We did set up a separate care homes group and had modellers specifically on there, so in a sense the care home modelling was – was delegated to a different group.
Counsel Inquiry: Indeed, and really I’m just dealing with the data aspect –
Professor Dame McLean: Yes.
Counsel Inquiry: – at this moment with you. Perhaps just to round off that topic in terms of your evidence, because we’ve heard evidence obviously from other individuals too, Professor, but from the outset did you expect that there would be problems arising in relation to care homes and outbreaks?
Professor Dame McLean: Yes. I think that was – you only have to look at historical big epidemics, particularly of respiratory infections, that you would have expected that.
Counsel Inquiry: Just again briefly, because there will be a module dealing with this in greater detail in due course, was outbreaks, the incidence of outbreaks and problems within care homes, was that something that was a foreseeable issue from the outset of the pandemic?
Professor Dame McLean: Yes.
Counsel Inquiry: Indeed, within both SAGE and the subgroup, we see that testing is –
Professor Dame McLean: Yes.
Counsel Inquiry: – one of the –
Professor Dame McLean: That’s true.
Counsel Inquiry: – tools that is repeatedly referred to respect to care homes?
Professor Dame McLean: Yes.
Counsel Inquiry: And that concerns were being raised within SPI-M-O?
Professor Dame McLean: Yes, that’s right. It was clearly going to be an issue. Of course, at that very early stage we did not have many tools in our pockets for helping, and testing would have been one of the few things we could do.
Counsel Inquiry: Were you and SPI-M-O concerned that not enough was being done in relation to care homes?
Professor Dame McLean: Yes, and I think SAGE too, I think there were SAGE comments from quite early on about how particular attention would need to be paid to care homes.
Counsel Inquiry: And as you’ve already referred to, we see that a separate subgroup, a working group, was set up specifically to deal with that issue?
Professor Dame McLean: Yes.
Counsel Inquiry: Thank you.
Now, if I may move now to start with the actual Covid-19 response, and so taking you back, if I may, all the way to your first interactions in terms of SAGE, which was on 11 February, I understand that you were aware of Covid-19 prior to that as a consequence of interaction with Professor Edmunds and – were you concerned at that stage?
Professor Dame McLean: I think I mention in my statement that on 25 January I remember being at an infectious disease public understanding of science event actually in Oxford, so there were sort of lots of us together, and somebody asking me about it, and I remember saying, “Well, John’s worried, and that makes me worry”. Because, I mean, you know, we’ve lived through all of – you know, umpteen times that there has been a pandemic and so we know how different people react; the fact that John found it worrying was a pretty strong signal, I would say, even mid-January.
Counsel Inquiry: Is he normally somebody that is cautious then, and so a concern in that respect would be a very significant concern?
Professor Dame McLean: Yes.
Counsel Inquiry: Now, if I may take you then to the first few weeks of March, and if I can take you to paragraph 116 of your statement, you explain that you:
“… began to feel that there did not seem to be a plan within government, or a clear sense of how many people were going to die.”
Why was that?
Professor Dame McLean: Where are we … I’m just trying to look – “first few weeks” … it seemed incredible, and from what I’ve heard now it was incredible, that there could possibly be a strategy of – of a – even a slightly mitigated epidemic, that the kinds – I mean, you’ve talked quite a lot about other people’s calculations. We might look at some I have made. If everybody could catch it and it spreads quite well, so that you might expect something like three-quarters of the population to get it, even if the infection fatality rate is only 1%, that’s just an unbelievably large number of people. And that was what led me to say to Ben on that – one of those days, the 10 March day, have decision-takers really understood what they’re confronting here.
Counsel Inquiry: And 10 March that you’re referring to is a SAGE meeting?
Professor Dame McLean: Yeah.
Counsel Inquiry: And Ben is Ben Warner –
Professor Dame McLean: Yes.
Counsel Inquiry: – who was also in attendance. We also know that Professor Riley was there, Professor Ferguson.
Professor Dame McLean: I think Professor Riley was not there but we spoke about an important paper of Professor Riley’s.
Counsel Inquiry: Yes, and it was his paper that was being discussed in any event at that meeting?
Professor Dame McLean: The point about that paper was, remember, Professor Riley had lived and worked in Hong Kong, so he had experience that was lacking for many of us. And, you know, he expressed this very strong view: we’re going to have to go into lockdown and stay there. And so that was 10 March.
And, I mean, I actually hadn’t heard about Exercise Nimbus until I heard Ben Warner giving evidence to you, and, I mean, actually – so if I’d known about Exercise Nimbus on that day I would have thought, “Oh, well, they’ve had an exercise on it”. It was a flu pandemic exercise, but it’s still a very, very large number of deaths. So if I’d just known that Exercise Nimbus had happened, I might have been encouraged; actually, if I had known who went to Exercise Nimbus, I might have been a bit discouraged.
Counsel Inquiry: If I can just pick up on that, please, with Exercise Nimbus, and certainly it was not the case that all of the CSAs from the various departments were present?
Professor Dame McLean: No.
Counsel Inquiry: Certainly you weren’t aware of it?
Professor Dame McLean: No.
Counsel Inquiry: So there was no opportunity to feed in from that scientific perspective?
Professor Dame McLean: I think GCSA was there. I’m not – I think at least one of the DCMOs were there.
Counsel Inquiry: I mean from the CSA – I mean from the broader CSA community within government.
Professor Dame McLean: Yes, absolutely. Yes, that’s true. I would also – the people who were present at Exercise Nimbus were not the secretaries of state who would be sat round the Cabinet table making these decisions.
Counsel Inquiry: So at that point did you – were you concerned that government had not got a grip on the situation?
Professor Dame McLean: I was concerned that the people who were being asked to make these very consequential decisions that were coming our way very fast may not have got their heads round what it would feel like to have three-quarters of the population infected and 1% of them die. I mean, that’s – it’s clearly unconscionable – whatever the word is – not something any politician can conceivably agree to. So I wasn’t clear what it was they’d agreed to on that – on that day, on the 10th.
Counsel Inquiry: Indeed. And as you say, that’s what prompted you to speak to Ben Warner –
Professor Dame McLean: Yes.
Counsel Inquiry: – about whether or not those decision-makers in government –
Professor Dame McLean: Yes.
Counsel Inquiry: – ie the politicians –
Professor Dame McLean: Yes.
Counsel Inquiry: – the Prime Minister and members of the Cabinet –
Professor Dame McLean: Yeah.
Counsel Inquiry: – secretaries of state had understood the consequences?
Professor Dame McLean: Yes.
Counsel Inquiry: The overwhelming of the NHS –
Professor Dame McLean: Yes.
Counsel Inquiry: – and the tsunami of deaths that would potentially be coming –
Professor Dame McLean: Yes.
Counsel Inquiry: – the – in the way?
Your involvement then continued, and indeed you attended SAGE 15, meeting 15, then on 13 March of 2020, and at that point ICU hospital capacity was being discussed by Professor Edmunds. What was your view in relation to hospital capacity and what you knew about the potential pandemic?
Professor Dame McLean: So this was the first time I saw a picture that compared potential pandemic and ICU capacity, and it was really shocking. Because – I mean, you’ve all seen it now, but it is this line right down at the bottom, not so many at the top. And I did also – a relative of mine was working in a London ICU then, and from what she described and from what I knew about exponential growth – you know, they didn’t have many people but if the doubling time was less than a week, it was just very obvious that they would be in big, big trouble in a few weeks’ time.
Counsel Inquiry: Indeed. And that prompted you to send Professor Sir Patrick Vallance an email.
And if I can just pull that up, please, that’s INQ000195889.
And this is your own calculation –
Professor Dame McLean: It’s not a calculation, it’s just a drawing.
Counsel Inquiry: A drawing. I mean, “calculation” places it too high? It’s probably –
Professor Dame McLean: On purpose actually, because it’s – see, I was worried that people were looking at models and saying, “Oh, it’s just modelling”, and so I wanted to say this isn’t really about modelling, this is about have we somehow been making the wrong assumption about where capacity lies relative to what we’re going to do.
Because on Friday we’d been shown the picture where the dotted line is way down the bottom, and if the dotted line is way, way down there, all this discussion about are we going to mitigate or are we going to suppress, well, if you’re going to stay below the dotted line, to mitigate is to suppress. It was – it was – once you – once – once you see where that lies it’s not a complicated question –
Counsel Inquiry: No.
Professor Dame McLean: – if you are not going to exceed capacity.
Counsel Inquiry: You don’t need a model?
Professor Dame McLean: No.
Counsel Inquiry: You don’t need modellers?
Professor Dame McLean: No.
Counsel Inquiry: You just need to apply basic facts and, to some extent, that word common sense –
Professor Dame McLean: I think what modelling might – would help you with is this sense of how fast is it growing, how long have I got.
Counsel Inquiry: Indeed. And this document, you explain that you know there were many uncertainties, you’re looking at realistic current capacity versus reasonable worst case epidemiology as well within there, but really focusing in here on just NHS capacity and it being overwhelmed?
Professor Dame McLean: Yeah.
Lady Hallett: Sorry just to interrupt again. What made you pose the question: but what if it’s here? To lower the line.
Professor Dame McLean: Yes, the meeting that we’d had on that Friday, where John Edmunds had shown a picture where – I think he’d had some real data – I think it was just from one county, actually – and had drawn, effectively, that picture.
Lady Hallett: So who had given you the higher dotted line?
Professor Dame McLean: That was my interpretation of what we seemed to be saying, that the situation was going to be something where we make it a little bit better and then we’d stay within capacity –
Ms Cecil: And the NHS would cope, effectively?
Professor Dame McLean: Yeah.
Counsel Inquiry: But actually capacity seemed to be at quite a distance from that?
Professor Dame McLean: Yeah.
Counsel Inquiry: And as a consequence would be overwhelmed and swamped very quickly?
Professor Dame McLean: But other people who were having conversations – I mean, this is me at home in Oxford, you know, doing little drawings. Other people who were in London that week were in the process of finding out how far along – or, in real life, how far along those lines we were, which was actually, as you heard earlier this week, the much more compelling piece of evidence.
Counsel Inquiry: Indeed. If I can just then take you down slightly further on your page, this is where you set out what you consider to be the combinations of options:
“If capacity is nearer the low line …”
Professor Dame McLean: Yeah.
Counsel Inquiry: “… what other combinations of options are there?”
Professor Dame McLean: Yeah.
Counsel Inquiry: This is on 15 March. And we see, at the top: “Lockdown”?
Professor Dame McLean: Yeah.
Counsel Inquiry: “Intermittent lockdown”?
Professor Dame McLean: Yeah.
Counsel Inquiry: Presumably coming into lockdown, coming out, going back into lockdown?
Professor Dame McLean: Yeah.
Counsel Inquiry: “Spread out [over] time to achieve immunity”.
What does that mean?
Professor Dame McLean: Other ways of – intermittent lockdown is one way to spread out when your infections happen. We could have thought – I’m sure if we’d applied brain we could have thought of others.
Counsel Inquiry: And “Continue contact tracing”. We’ll come to that a little bit later.
And then:
“Others?”
Professor Dame McLean: Yeah.
Counsel Inquiry: So we see that you are flagging here to Professor Sir Patrick Vallance those options, if this is where we are?
Professor Dame McLean: Yeah.
Counsel Inquiry: You raise herd immunity effectively to demonstrate the numbers that it would take to reach a level of population immunity?
Professor Dame McLean: Well, actually, if you look at what is happening here, I’m not actually doing any kind of herd immunity calculation. There’s no 1 minus 1 over R here, it’s just if you wanted to end up with half the population immune what would happen. And so that’s that first row. And that’s the sort of numbers that would have been looked at in Exercise Nimbus. It’s not exactly those ones but it would have been something like that.
And, I mean, you just get to these numbers that clearly no one’s going to tolerate. No one is going to tolerate 2,000 deaths each week.
Counsel Inquiry: Indeed.
Professor Dame McLean: So a sense that – I guess what I’m saying at this stage is what Chris said two days ago: nobody was ever considering this. And I guess I was getting up to speed with this was not something that could be considered.
Counsel Inquiry: Indeed. And then you send this document the same day to Professor Medley?
Professor Dame McLean: Yes, because that, I did not want to be – remember I’m not on SPI-M at this stage, so I didn’t want to be treading on his toes, just making sure he sees it.
Counsel Inquiry: Indeed.
Now, just going back to the NHS data point that we discussed earlier, would you have expected better quality data at this stage to inform these sorts of calculations in terms of ICU capacity bed space?
Professor Dame McLean: Yes, I think it would have been very useful if, in one of the SAGE – as I say at the beginning, there’s a discussion that I missed that SAGE – if it has occurred. So, I mean, that – I think that’s a sort of polite way of saying: why on earth have we not had a discussion in which we look at some of these potential waves we’re thinking about and plot them against our known capacity?
I think there’s con – I mean, from other things I’ve seen you look at, perhaps those conversations were happening somewhere else.
Counsel Inquiry: If I can just also just pick up on one further point before leaving the document, you also raised nosocomial infections, so infections take place when an individual is admitted to hospital, and certainly that was also a concern of yours at this stage; is that fair to say?
Professor Dame McLean: Yes.
Counsel Inquiry: We then move through the pandemic in terms of – in terms of announcements. On 16 March, just so that you’re aware, that’s when the Prime Minister says “Now is the time for everyone to stop non-essential contact and travel”, and by 18 March you, within SAGE, and indeed SPI-M-O as a consequence, had some data in respect to what – how people’s behaviours had changed; is that right?
Professor Dame McLean: That’s right, there was, this was paper – sorry, this was data that we looked at at SAGE on 18 March. So this is two days after voluntary stay at home.
Counsel Inquiry: What we see from that is that they had achieved around a sort of 40% reduction –
Professor Dame McLean: Yeah.
Counsel Inquiry: – in social contacts, but was that sufficient?
Professor Dame McLean: No, we knew that we needed about 75% reduction in contact. So I think – look, this is something I think is quite important to remember, that we did actually data that very day that said that voluntary reductions were not enough.
Counsel Inquiry: We see quite significant – in fairness, we see quite significant voluntary behavioural change in reality. We see that “16% of those with school age children have already stopped their children going to school”. We see the public reacting to that announcement?
Professor Dame McLean: Already.
Counsel Inquiry: But as you say, it simply was not enough in terms of –
Professor Dame McLean: No.
Counsel Inquiry: – what you considered was necessary to prevent the tsunami of potential infection?
Professor Dame McLean: Indeed.
Lady Hallett: Did you have enough data? You said you had some data, but I think I have heard other people say that it would take more than just two days to get sufficient data as to –
Professor Dame McLean: Yes.
Lady Hallett: – whether or not it was working. So what conclusions can we get after two days?
Professor Dame McLean: What conclusions we get after two days is that after two days we haven’t got enough. I think there are other – I mean, that’s all we had and a decision had to be made.
So I think there are other data streams that tell us that the voluntary measures weren’t enough, and in particular the fact that hospital admissions peaked on April 2nd, and that’s ten days after March 23rd. If 16 January had been enough – sorry, if 16 March had been enough to get R below 1, we would have expected hospital admissions to peak ten days after that.
Ms Cecil: And that’s your lag point as well?
Professor Dame McLean: That’s the ten-day line.
Counsel Inquiry: Indeed.
Professor Dame McLean: Yeah.
Counsel Inquiry: So broadly accurate but insufficient?
Professor Dame McLean: A big – I mean, I think all of us who were there – I mean, actually I have a photograph on my phone of an empty train as I went into London that week. It felt enormous. But actually, I think, if we remember, it was not as enormous as the next week. I mean, the next week it was really sort of wind down an empty street, wasn’t it?
Counsel Inquiry: Indeed. And that’s when, of course, lockdown was announced?
Professor Dame McLean: Yes.
Counsel Inquiry: Now, with respect to the announcement of lockdown in terms of its timeliness –
Professor Dame McLean: Yeah.
Counsel Inquiry: – what is your view on that?
Professor Dame McLean: You’ve already heard from colleagues that it was too late. So if we’re doing a with benefit of hindsight exercise here, I would say it should have been two weeks earlier, you know, that that would have made a really huge difference. Now, we didn’t have the data two weeks earlier, so … by the 16th we had – we had enough data. In my opinion we should have gone into lockdown on that Monday the 16th.
Counsel Inquiry: And that’s the critical period from your perspective, the 16th? The 16th is that critical timing, in terms of the datasets that you had at the time –
Professor Dame McLean: Yes.
Counsel Inquiry: – and the knowledge base that you had at the time?
Professor Dame McLean: I think on the 16th, given what we knew about how fast this epidemic was spreading, given what we knew and could surmise about the fact that there seemed – that probably everybody could catch it, I mean, probably everybody was susceptible to catch it, I think there was enough information on that date to say “We need to stop all non-essential contact”.
Ms Cecil: My Lady, I’m going to turn to another topic. It’s slightly earlier than would ordinarily be the break but it may be that now is an appropriate moment.
Lady Hallett: Thank you, I shall return at 10.50.
(10.37 am)
(A short break)
(10.50 am)
Lady Hallett: Ms Cecil.
Ms Cecil: My Lady.
Professor, if I may just pick up very briefly on lockdown. We’d just got to the point of the first lockdown and the stay at home guidance. You were expressing your views on the timeliness of that lockdown.
Can I just be clear, is that from a public health perspective?
Professor Dame McLean: Yes. I’m not entirely sure it’s sensible to completely separate out the public health perspective and all the other costs. I think, actually, you had strong evidence from my colleague Tom Hale in Oxford that the countries that did best were countries that kept incidence low, and they had both better health outcomes and better economic outcomes. So the idea that it was this pure trade-off, one thing or the other, I don’t think is a helpful mindset.
Counsel Inquiry: Indeed. But, of course, when considering lockdown –
Professor Dame McLean: Yeah.
Counsel Inquiry: – there are other factors and there are other broader considerations alongside the public health considerations, as you have identified, economics, which may go one way or the other.
Professor Dame McLean: Yes.
Counsel Inquiry: Indeed.
Then just dealing with your point about lagged delays. So we have the announcement of the lockdown on 23 March and stay at home, and we see – and you’ve set it out within your witness statement – that, again, peak hospital admissions then subsequently fell ten days later on 2 April.
Professor Dame McLean: Yes.
Counsel Inquiry: What does that mean in terms of the R number, from your perspective?
Professor Dame McLean: From my perspective, that tells us that the R number fell below 1 for the first time about ten days earlier, namely on 23 March.
Counsel Inquiry: So we’re seeing those correlations, and you’ve given two examples now –
Professor Dame McLean: Yes.
Counsel Inquiry: – in your evidence so far.
In terms of support for that view, what you also set out is the alternative, if the R number had been higher during that second half of March.
What implications would that have had in relation to the first wave?
Professor Dame McLean: Well, let’s – there are various possibilities. If it had been higher and above 1, hospital admissions would have continued rising, I think. I mean, that would have been intolerable. We were – everybody was very, very worried those days in early April. Was it going to peak? Would the stay at home law – so would the imposed lockdown be enough to bring R below 1? That was the first thing. So that’s – a terrible outcome would have been if hospital admissions had carried on rising.
But even if it had fallen a little bit below 1, say – we think now it fell to about 0.7. If it had fallen but not that much, that first wave would have been bigger. It would have – so we’d have had a peak, but it wouldn’t have come down so fast.
I think most people feel that the first wave was bad enough.
Counsel Inquiry: I suspect that’s a view that’s broadly shared –
Professor Dame McLean: Yeah.
Counsel Inquiry: – and uncontroversial.
If I can ask you questions then about your involvement in the exit from lockdown. You’ve already touched upon one aspect of that by reference to your colleague, Professor Thomas Hale –
Professor Dame McLean: Yeah.
Counsel Inquiry: – in relation to low incidence –
Professor Dame McLean: Yes.
Counsel Inquiry: – and the role that that may have played in relation to pandemic response and outcomes.
Now, in April, on 10 April, you attended a working group on the science of exit from lockdown, and at that meeting, that working group, there were two scenarios that were being discussed, weren’t there: a low incidence scenario and a high incidence scenario.
Can you just explain for us in simple terms what a low incidence scenario is, and then we’ll move in a moment to the high incidence.
Professor Dame McLean: So I think a good way of labelling those – we ended up labelling them “hospitals empty” or “hospitals full”. So high incidence actually wasn’t all that full. And the question – actually, what we wanted to do was start to have strategic think-through about: what are we going to do? You know, we’re in a deep hole here. We’ve got a nasty infectious disease circulating that is – makes many people very ill, and sadly kills quite a lot too, and most of our population is susceptible to it, and we don’t know when we might have either drugs that are so great that we can treat infections really well, or a vaccine. So we don’t know how long this is going to go on for, let’s start to have a think through what we can do about it.
And so in some ways I would say the low incidence and the high incidence comparison that we ended up making was an attempt to start a conversation, both with policy-makers and decision-takers, along the lines of: well, what is your strategy? What’s the plan?
Counsel Inquiry: Indeed, and a lack of strategy or clear plan or strategic aim is one of the primary themes that’s contained within your witness statement.
Professor Dame McLean: Yes.
Counsel Inquiry: If I can deal with that briefly with you now.
You explain that the primary strategy that evolved or the closest thing you got to was the focus on the R number.
Professor Dame McLean: That’s right.
Counsel Inquiry: What impact did that have in terms of strategic thinking and your ability within SAGE and indeed SPI-M-O –
Professor Dame McLean: Yeah.
Counsel Inquiry: – to model interventions and to provide, effectively, options that could be developed to policy?
Professor Dame McLean: So I think if we were to be very straightforward, we could say the ends were: you will not collapse the NHS. So that was the strategic aim. The ways were: well, we’ll control mixing so the R number is slightly less than 1. And my feeling was that was only really half of an explanation of what we were trying to do, because R round about 1 just means that the number of infections each day is flat. So you can have R round about 1 with hardly any infections each day, or R round about 1 with lots and lots of infections each day. So it didn’t express an opinion about what those in power thought was the right way to work our way through this very difficult situation, I felt.
Counsel Inquiry: For example, by otherwise considering other targets, such as the number of infections each day, or even, as unpalatable as it sounds, the maximum tolerable limit in terms of deaths.
Professor Dame McLean: Yes, or we could perhaps have had – I think it would have been helpful if we had had an expression from the NHS of how many people could they manage in hospital at any one time with Covid, whilst also doing all the other things that we need the NHS to do. But there was no appetite ever to express with such clarity what the plan was.
Counsel Inquiry: And the consequence of that is that there’s no target that’s breached –
Professor Dame McLean: No.
Counsel Inquiry: – potentially, and effectively a trigger – or for use of a shorthand, to trigger other interventions or to bring in further aspects of a plan.
Professor Dame McLean: There were some levels, weren’t there? There were those five levels I expect other people have talked to you about. But I don’t think we ever had from central government: we want R slightly less than 1 and the number of new infections per day less than, let’s say, some thousands of numbers.
Counsel Inquiry: And did you request further guidance or a clear strategic aim?
Professor Dame McLean: I certainly requested them of my civil service contacts, and, I mean, they got to a stage where they knew what I was going to say, you know, because the plans would come back that it was, you know, sort of a tolerable number or something, and they knew I was going to say, “Well, what is a tolerable number? What number is that?” But, I mean, I think it’s very clear that that was a choice, not to articulate a number on what was tolerable.
Counsel Inquiry: Indeed. So that in itself was a positive decision.
Professor Dame McLean: Indeed.
Counsel Inquiry: The consequence from your perspective – and I appreciate this is from a public health or science advisory perspective that I’m asking you to speak about here – was that it was very difficult – well, was it very difficult to therefore model and plan and provide a route through?
Professor Dame McLean: So if you’re not told what’s the objective, it becomes very difficult to say, “Watch out, you’re three weeks from breaching your objective”, say. So we always had to impose an objective of our own. So somewhere else in these documents you will see a document where we say, “Well, you’re a few weeks from having more admissions every day than you had in the peak of the first wave”. That wasn’t because somebody else had said, “Please do that calculation”; it was because we felt decision-takers needed to see that calculation because things were getting so bad.
Counsel Inquiry: Indeed. So with a clearer goal or level or strategic aim in mind –
Professor Dame McLean: Yeah.
Counsel Inquiry: – would it have been possible, looking back, to have managed the pandemic more effectively?
Professor Dame McLean: Looking back, let us imagine that in September 2020 we had breached some then specified level – actually we did, we breached the reasonable worst-case scenario, which had been specified by Covid-S, not by us – we – you could imagine a world where we had said – well, where decision-takers had said, “Oh, gosh, we’ve breached the target, let’s get a grip”, and that is not what happened.
Counsel Inquiry: We’re going to move to that in due course.
But coming back, then, to 10 April and this working group, this was an effort in terms of low and high incidence –
Professor Dame McLean: Yeah.
Counsel Inquiry: – running a pandemic, also you’ve put it, in hot or cold terms –
Professor Dame McLean: Yes.
Counsel Inquiry: – to engage or get decision-makers and policy-makers to engage with what it was that they saw as a clear strategy.
Professor Dame McLean: Yes, and the point of that document was to lay out how different things would be with respect to a whole lot of different factors. For example, contact tracing is only really going to be able to make a huge difference if you’re running a cold epidemic, if you’ve got low incidence, because once incidence is really high, it becomes very difficult to do contact tracing well enough to find everybody who’s got infected and get them into isolation. So there is quite a long table in that document of sort of careful thinking about what would be the difference between these two.
Counsel Inquiry: Thank you.
Professor Dame McLean: If I may, there is – I think really the closing paragraph of that document finished the question for us, in which somebody makes the point or the point is made: well, let’s just imagine that low incidence is about one-fifth of high incidence, that means we’re accruing immunity five times more slowly, that means – if we think roughly speaking – we did think roughly speaking we’d get to a useful amount of immunity in one year with high incidence.
Counsel Inquiry: With high incidence?
Professor Dame McLean: With high incidence. That means if we think we might get a vaccine or a really good pharmaceutical, a really good drug, in anything less than five years, then we should go for low.
Lady Hallett: Can I –
Professor Dame McLean: And that was sort of the killer for us. That was the end of the question for us.
Yes.
Lady Hallett: Sorry to interrupt.
Can I just go back to the point about not having a plan.
Professor Dame McLean: Yeah.
Lady Hallett: I appreciate having a plan or a strategy would make your life and the lives of your colleagues a great deal easier to provide what you considered to be more accurate and sensible advice, but provided the experts advising decision-makers were getting the message across that this was going to be a nightmare, the NHS would be overwhelmed, do you have to have a target that gets breached?
Professor Dame McLean: No. No, we don’t. We might come to that at the end, because there was never any target expressed in the 2021 spring documents. There’s no numerical target.
I would say it’s probably more to do with politics and values and acting fast. I mean, I think the fact that fast action was required, I think that is a scientific issue, because it’s to do with the system science of – it’s basically to do with fast exponential growth and fast talking. Fast exponential growth and lag delays, those are scientific issues. I think articulated targets might have driven faster action, and in that case would have been good from the point of view of pandemic control.
Lady Hallett: Thank you.
Ms Cecil: We’ll touch upon that as we come into the autumn period in due course, and then indeed we will turn to the roadmap and the targets and objectives that were outlined there and the policy objectives.
Perhaps just to round off this, if I can just bring up INQ000212100. This is an email from you. It’s the one that attaches your paper that we’ve just been discussing. But you boil it down to Sir Patrick Vallance within this email – if I can just go down slightly further – into a very simply dichotomy, in many respects –
Professor Dame McLean: Yeah.
Counsel Inquiry: – for politicians, so decision-makers:
“Do you want to keep COVID deaths as low as possible until pharmaceuticals produce a solution [that’s your vaccine or your medicine]
“Or
“Are you prepared to define a tolerable level of COVID deaths that would allow us to start moving towards an immune population whilst we wait.”
And of course, as you say:
“The devil then is how small can ‘tolerable’ be and still move us towards an immune population at some meaningful rate.”
And then you explain further, as you’ve just touched upon:
“… if you want to be at population immunity within a year, we cannot imagine getting there with any fewer than N deaths …”
As a simple way of explaining to those decision-makers what the consequences of either hot or cold, low or high incidence, would be.
Now, in terms of SAGE and your colleagues, the general consensus was that the low incidence approach was the preferable one.
Professor Dame McLean: Correct.
Counsel Inquiry: And that was communicated upwards.
Professor Dame McLean: I assume so. Yes, I think – so I’m pretty sure that what happened is that Chris and Patrick wrote their own version of this document, which they, I assume, then took to Cabinet.
Counsel Inquiry: We touched upon that already in terms of some of the evidence that we’ve heard.
Now, just if I may now turn to another aspect, that alongside all of this, while you’re running through those scenarios, you’re also considering the possibility, at least, of elimination.
Professor Dame McLean: Discussing, yeah.
Counsel Inquiry: Indeed, and you raised that –
Professor Dame McLean: Yeah.
Counsel Inquiry: – on 18 April and indeed on 19 April, firstly in an email to Professor Medley on the 18th, and then secondly in a conversation with Professor Sir Patrick Vallance. In respect of that, you’re essentially saying: have we properly considered it? Have we ruled this out as a potential option?
You also address within that the potential for the health and social care infections to be driving the community epidemic as opposed to the other way round, with the community epidemic driving the health and social care infections.
We’ve not seen any further material in relation to pursuing elimination as a strategy, but what were your views at that time, and was it a possible strategy to be pursued?
Professor Dame McLean: So quite quickly, because the infection was so widely seeded across the population, and as we were finding out more about asymptomatic infections, it was very clear that it was not feasible. At that point, I – we probably had a discussion in which we said: well, we could do a bunch of calculations, we could make a model, we could, you know, do some squiggly Greek letters, but at the end of the day we’re just going to say exactly those words. So this was a place where doing some modelling simply doesn’t add anything, so let’s not do it. So that was elimination.
I think I did feel then: let’s challenge that a bit, let’s make absolutely clear, because Australia and New Zealand were aiming for elimination, but – so let’s be clear in our heads why we think it’s not going to be possible. And for people like us, the way to be clear in your heads is to think it through with a little model. But it clearly wasn’t a useful way to spend a lot of time for SPI-M.
Counsel Inquiry: Indeed.
Professor Dame McLean: Was the – were the hospital and care home epidemics driving the – did we need a three – basically, a three-part model, so a model that had community and care homes and hospitals? I think we probably put that to modellers and they said, “No, we don’t think so”. One of the big models did end up with care homes in it, but fundamentally I think we ended up with a decision that: no, they weren’t driving. They were important in terms of places where large numbers of very vulnerable people gathered together, but they weren’t important in terms of driving transmission back into the wider population.
Counsel Inquiry: Just touching, if I may, on elimination more generally, this was obviously in April, but looking back now, would elimination have ever been possible on what is known?
Professor Dame McLean: Certainly not after we’d seeded the epidemic the way we did after half term in February.
Counsel Inquiry: Thank you.
Now, as we emerged from lockdown 1, and moving then into the summer months of then May 2020, you took part in – well, over the course of the pandemic – a number of Number 10 Downing Street press conferences.
In May 2020, in reference to coming out of lockdown and any changes in relation to lockdown, you explained that the scientific evidence was clear, and that any changes to lockdown were also dependent the track and trace system being in place.
Now, that was obviously your comments then in May 2020. Was that track and trace system ever in place to an adequate level to enable that to actually take place?
Professor Dame McLean: I think our estimates in the summer of 2020 was that it was probably blocking about one in five, so 20%, of onward infections, and that in order to have a really – in order to have so substantial an impact that big changes could be made to how much mixing we could have without driving R above 1, that needed to be more like four out of five.
Counsel Inquiry: Thank you.
Further in that press conference, you also said that any lifting of restrictions should be based on observed levels of infection and not on fixed dates.
Professor Dame McLean: Yeah.
Counsel Inquiry: So effectively data not dates, in shorthand. Was that observed at that period in the pandemic?
Professor Dame McLean: I do not remember exactly what happened with the unlocking of the lockdown through the summer of 2020. I’m sorry, I can’t exactly remember.
Counsel Inquiry: Not at all.
Professor Dame McLean: Numbers were low then.
Counsel Inquiry: Thank you.
In terms of any feedback loop that you had, what did you consider the main drivers within government would have been in relation to exit strategies from lockdown and, more generally, the loosening of restrictions?
Professor Dame McLean: There were very clear indications that, quite reasonably, recovery of economic activity was a very strong driver. We can tell – we can remember now that getting children back to school for sure for September was a very strong driver, and I can remember debate that if we wanted children back at school – and clearly we did – we might well have to put a lot of restrictions on other kinds of activities.
Counsel Inquiry: Thank you.
Professor Dame McLean: Especially given that contact tracing was not ramping up as fast as we had hoped.
Counsel Inquiry: Indeed.
Now, if I may take you, please, to paragraph 120 of your statement at page 36. This is dealing with the position coming out of that first initial lockdown and, indeed, in April of 2020 through to May. You explain there that – it’s about halfway down:
“I do not know what people in government understood the characteristics of Covid-19 to be, but we were worried that for whatever reasons, decision-makers had not taken on board quite how serious it was.”
You explain then by reference to an early meeting that you had in the Ministry of Defence, where your comment that it would take at least 18 months was met with disbelief.
Was that a view that you saw more widely across government?
Professor Dame McLean: I think if we’d been in the room together – of course, it was all a Zoom meeting then – I would have used the phrase “you could have heard a pin drop”. Perhaps “disbelief” is a little bit hard. But I think people – I think – I mean, it was quite shocking, wasn’t it, I think, for all of us, the thought that – that was quite a hard idea to get your head round, that we were in so much trouble that it might take us more than a year to get out of that trouble. And, as I say, there were midway reviews in April which – we were certainly not midway in April, were we?
But I think in retrospect, one of the things that I wish we had done is this sort of – what I think of as the missing commission. So in that summer of 2020 when, you know, things were under control, I really wish there had been a cross-government commission that recognised all this, that said, “Well, we’re in this for the long term, it’s going to take until we get a vaccine, and then another year, so what are we going to do? There aren’t really good options; are there any less worse options?” And I would have – in retrospect, I think we should have used the expertise that we had, both inside government and had already gathered from outside government, to pause and think really carefully about a long-term plan.
Counsel Inquiry: Thank you. Would you describe that as a missed opportunity?
Professor Dame McLean: I do think that was a missed opportunity. Again, with the benefit of hindsight. I didn’t ever ask for it at the time.
Counsel Inquiry: That’s the next – indeed, you’ve already foreseen my next question.
But perhaps then therefore going to the summer of 2020, and you’ve explained that infections were low, the R rate was around 0.7 or so at that stage in the summer, we then move into the June, July, August period, and of course in July, the Eat Out to Help Out policy was announced.
We know that SAGE were not consulted on that policy; is that right?
Professor Dame McLean: That is right.
Counsel Inquiry: Was SPI-M-O consulted?
Professor Dame McLean: We were not consulted.
Counsel Inquiry: Indeed, you’ve been through both the SAGE and the SPI-M-O consensus statements and there’s no references to it there.
Professor Dame McLean: Correct.
Counsel Inquiry: Do you have any knowledge at all about what, if any, scientific advice informed that scheme?
Professor Dame McLean: No, I don’t know anything about any scientific advice that went into that.
Counsel Inquiry: In terms of your view on that scheme, and the advice that you would have given at the time, what would that have been?
Professor Dame McLean: It would have been along the lines of advice that we were giving routinely, which is that there wasn’t much room for increasing mixing, and the kind of mixing that should be avoided is between households indoors. So we would have said, “Could you not find some other way to stimulate the economy?”
Counsel Inquiry: If I can just call up, please, a SPI-M-O paper which deals with social distancing measures. It’s dated 22 June 2020, and it’s INQ000074930, it’s page 1, and if I can go to paragraph 4.
Here, what we see within SPI-M-O is effectively it’s looking at how one goes forward and takes NPIs forwards and relaxation, and what’s set out here is that:
“Rather than focusing on re-introduction or relaxation of individual measures in isolation, it is necessary to consider a package of interventions as a whole and what implications one measure may have for the choices in [another].”
It’s trade-offs, in short; is that right?
Professor Dame McLean: Yeah. Absolutely.
Counsel Inquiry: You explain you could use the ready reckoners that we’ve already discussed and touched upon to explore the impact on transmission from one intervention to be weighted against other potential relaxations. None of that work, as far as you are aware, was conducted in relation to the Eat Out to Help Out scheme by SPI-M-O or SAGE?
Professor Dame McLean: Certainly not by SPI-M-O or SAGE, I don’t know if by other people.
Counsel Inquiry: Then if we go to paragraph 5, you explain here that – this is SPI-M-O’s view.
Professor Dame McLean: Yeah.
Counsel Inquiry: So the committee:
“… do not believe it is possible to return to a ‘pre-COVID’ normality, without levels of contact tracing and COVID security effectiveness that would be difficult to achieve without some sort of additional increase in immunity …”
Or vaccines, and so on.
Just to be clear, Covid security; effectively, NPIs?
Professor Dame McLean: Covid security is more things like everybody washing their hands very carefully, maybe wearing masks, do you remember there were all those screens that went everywhere, restrictions on how many people were in a room. So it was more the – yes, those sorts of NPIs, yes.
Counsel Inquiry: If we continue at paragraph 5, it states:
“In order to be able to re-open schools in September without causing a second wave, it [is] therefore critical that some measures remain in place.”
So that the reproduction number (R) remains below 1 at the start of September when they all return to school.
Professor Dame McLean: Yes.
Counsel Inquiry: That’s the position in June; would that have still been the position in July?
Professor Dame McLean: And August.
Counsel Inquiry: And August.
Professor Dame McLean: And September.
Counsel Inquiry: Indeed.
Now, at that point of the advice in June and through July, the R number was 0.7 to 0.9, and it began increasing in August. Indeed, upon school return in September, it was between 0.9 and 1.1, and then increased to an R rate of 1 to 1.2 by 11 September, and then we saw an increase upwards.
So in respect of that second wave, was that second wave foreseeable?
Professor Dame McLean: Yes, that second wave was foreseeable. I mean – but because – for the simple reason that virtually nobody had had it.
Counsel Inquiry: And, indeed, winter was also coming.
Professor Dame McLean: Yes.
Counsel Inquiry: And we’ve heard from Professor Sir Chris Whitty that history has taught us that, in pandemics, second winter waves often far exceed the first wave.
Professor Dame McLean: They do indeed. Actually, I think most parents know that September is a time of year when respiratory infections are often rife.
Counsel Inquiry: Indeed, September to December is constant germ after germ.
Professor Dame McLean: Yeah.
Counsel Inquiry: So if I can then move into the September period, so schools returning, and if I could just take you, please, to paragraph 153 of your statement. It is on page 47.
You describe this quite acutely as the “worst moment of the pandemic”. Why do you say that? Why do you describe it in those terms?
Professor Dame McLean: It was very frustrating for us to have been asked to advise the government, and to advise the government that the autumn would be difficult and that that difficulty would manifest as rising numbers of infections, and then we had this astonishingly good ability to watch that happening with the ONS Covid infection study, and it proceeded to happen, so we said, “You should do something now”, but nothing happened.
Counsel Inquiry: Do you recall the earliest point at which you said, “You should do something”?
Professor Dame McLean: Let’s have a think. I … we had made the – in the summer, we had made the new reasonable worst case, so that was the one that sort of ran from, I should think, about August into late autumn, and in the reasonable worst case – which, as I say, was based on actions specified by Covid-S – cases start to tick up in early September, as we would always have expected it to have done, and I can’t remember where the words came from, but in the reasonable worst case, somebody gets a grip, so actually what happens is that cases are then flat through September.
So it would have been in our minds all along that if we wanted this time to keep infections flat whilst they were still low, so not get ourselves into a panicky situation where it’s all running away from us, this was when we needed to do it, and, you know, this idea that the interventions that keep an epidemic flat are not as bad, not as damaging, as the ones that you have to impose if you’ve got to get cases down really fast.
So that was the time to act, we felt, and we kept saying so, and I suppose we couldn’t understand: why weren’t we explaining clearly enough that this was what we needed to do?
Counsel Inquiry: Indeed.
If I could just call up the SAGE minutes from 17 September of 2020.
Professor Dame McLean: Yeah.
Counsel Inquiry: – it’s INQ000061565, and it is paragraph 3 on page 2.
Professor Dame McLean: Yeah.
Counsel Inquiry: What we see here is advice in relation to a circuit breaker, and it explains:
“… where more stringent restrictions are put in place for a shorter period could have a significant impact on transmission. Modelling indicates that a 2-week period of restrictions similar to those in force in late May could delay the epidemic by approximately 4 weeks.”
Professor Dame McLean: Yes.
Counsel Inquiry: So was a circuit breaker the advice that was being given at that point?
Professor Dame McLean: Yes, that was the SAGE advice. So a circuit breaker is an intense intervention where what you do is you bring cases down, say for a fortnight, and then you let go again.
Counsel Inquiry: So something short of, effectively, a full lockdown, or if you were looking at it in a slightly different way and using your earlier terminology, an intermittent lockdown of a shorter period.
Professor Dame McLean: Yes.
Lady Hallett: What’s the point of doing that if it’s just going to come back, if you don’t know when you’re going to have a vaccine?
Professor Dame McLean: That eventually you’re going to have to do something. So keeping infections low may be with intermittent lockdowns, so you do circuit breakers for two weeks, you go back to normal life for four weeks, but that is not as damaging as the – what Tom Hale described as the rollercoaster, where you let infections grow until you’re just about to break the NHS, and then you bring in a massive, massive lockdown. So it’s a way of keeping infections low whilst not being in lockdown all the time.
Lady Hallett: Why aren’t intermittent lockdowns a rollercoaster?
Professor Dame McLean: Because it’s a very boring, little rollercoaster. So, I mean, you’re just going like this (indicated).
So, I mean, for example, your contact tracing works better because you’ve never got very high incidence. Your hospitals work better because they’re not completely full. I mean, one of the things that we often – well, that we saw was that fatality rates in hospital were higher when the hospitals were fuller.
There were plenty of good reasons why intermittent, short lockdowns could well have been better than the long, harsh lockdowns that we had to live because we put them off to the last possible moment.
Ms Cecil: And that’s pulling it back to the low –
Professor Dame McLean: Yes.
Counsel Inquiry: – incidence rate, as opposed to the high incidence rate, running an epidemic hot or cold?
Professor Dame McLean: Yeah.
Counsel Inquiry: Trying to keep a lower level of infections, albeit they go up and down and rise up and down. They don’t meet that peak, effectively.
Professor Dame McLean: That’s right.
Counsel Inquiry: Now, you were subsequently invited to a meeting with the Prime Minister on 20 September of 2020, and I just want to deal with something very shortly before that and prior to the meeting on 18 September.
It is some messages with Sir Patrick Vallance. It’s on INQ000229601. It’s the bit at the bottom that I’m interested in. It says:
“I have an invite to a zoom with the [Prime Minister] at 1730 on Sunday. I’d be honoured to accept that invitation. However I assume this is the meeting you and Stu were organising yesterday [presumably a reference to Stuart Wainwright at GO-Science]. Does it fit your plan if I rock up and say ‘RWCS [reasonable worst-case scenario] assumes someone gets a grip at this stage of things and it would be great if that happened’.”
Can you explain in your own words what you were trying to impress upon certainly Sir Patrick at that point and your view?
Professor Dame McLean: I wanted to – I’m quite a believer in the single voice of consensus science. So what I was checking here was – basically running past Patrick what I’m planning to say so that he knows in advance of the meeting. And “[Reasonable worst-case scenario] assumes someone gets a grip at this stage”, we just talked about that.
We were all invited to write a single-page explanation of – I think the title of the meeting was something like, “Should the government act now?”
Counsel Inquiry: Indeed, I’m going to move to that in just a moment –
Professor Dame McLean: Okay, fine.
Counsel Inquiry: – and we’ll discuss the meeting and what views were put across within that meeting and, indeed, your view at that point.
Professor Dame McLean: Yeah.
Counsel Inquiry: And then what we see here, just to round this off so we can take it away, from Patrick Vallance back is:
“This is a meeting where the [Prime Minister] wants to hear from a range of scientists (specifically the Heneghan and Gupta let it rip variety). We have got a rather balanced group to make sure he hears all sides. Message re getting a grip - yes please.”
Indeed, I’m going to maybe just deal with that now: do you consider that you got across that message within that meeting?
Professor Dame McLean: I said those words. I don’t know – I mean, nothing happened, so inadequately at best.
Counsel Inquiry: If I can turn to that meeting now, and you were just speaking about speaking with one voice. So Sir Patrick Vallance was on the same page as you, is that fair to say, at that point?
Professor Dame McLean: I think so, yes.
Counsel Inquiry: SAGE and SPI-M-O?
Professor Dame McLean: Yes.
Counsel Inquiry: So all unanimous going into that meeting in terms of that perspective.
Now, if I can just call up the meeting, please. Thank you. This is the “Covid-19 small group scientific discussion”, that was the formal name given to it. We see that, indeed, you’re right about the question, the essay question, as it may have been posed, or exam question: “Should government intervene now and if so …”
We see a list there of attendees. We have the names redacted, but the reality is it’s all in the public domain in any event and, indeed, we have a statement. The first of those is Professor Gupta and the second of those is Anders Tegnell, the Chief Scientist in Sweden. But we see the Prime Minister, the Cabinet Secretary, who is chairing it, Sir Patrick Vallance, Professor Sir Chris Whitty, Professor John Edmunds – and we’ll move to him in a moment – Professor Carl Heneghan, who we’ve also heard from, and then you.
For the purposes of this meeting, as you’ve just explained, you were asked to set out your views in a one-page document, a very short document.
If I can just deal with the position in relation to the varying views around the table, or on Zoom, online at that time, but just deal with points of similarity.
Was it the case that at any point anyone in that meeting was expressing a view that the government ought not to do anything at that time?
Professor Dame McLean: My memory is there were some people who felt more studies were necessary, which was pretty close to nothing, in my view.
Counsel Inquiry: Indeed.
Then we have Anders Tegnell. Just pull up his document for one moment. That’s INQ000137281, page 11, please. Chief Scientist in Sweden. He set out a short note, as requested, for the benefit of the meeting. He explains in the second paragraph down that his answer to the question, “Should government intervene now and if so …”:
“… in my opinion yes. The myth that Sweden did nothing during the pandemic is false.”
He talks about a wide range of activities that were initiated there. He speaks about the public health community. He continues to go down and says:
“I believe there is a strong consensus that with a pandemic a government needs to be active even if we know that most of the non-medical measures have comparatively little effect and the evidence for how and when they work is limited. But even so there is a possibility to make a difference.”
So that’s Professor Tegnell’s view.
If I can now take you to your view, that’s at page 13 of this document. I don’t know if we can rotate it. Is this the paper that you prepared?
Professor Dame McLean: Yes.
Counsel Inquiry: We’ve heard reference already to the reasonable worst-case scenario.
Professor Dame McLean: Yes.
Counsel Inquiry: And you explain that’s a Covid-S –
Professor Dame McLean: That’s right. So that little picture at the top left was given to SPI-M-O by Covid-S saying, “Do something a bit like the top – the red line here”, so a difficult autumn followed by a large winter peak. So that red arrow, I think, that I’ve put on there says: this is roughly where we are towards the end of September. Things were okay in July, they’ve been getting a bit worse. There it is, with the – so can you see the dotted red line being flat for a while through October. So that wasn’t going to happen without some substantial intervention.
Counsel Inquiry: So this is your, as you say, reasonable worst-case scenario.
You then set out a position where with interventions. At the bottom of that page, to the left, you explain that both scenarios assume that decisive action is taken now.
Professor Dame McLean: Yes.
Counsel Inquiry: And it says – expands a little bit:
“… assume decisive action in mid-September brings R back to 1 so that new infections remain flat for 6 weeks.”
Professor Dame McLean: Yeah.
Counsel Inquiry: You then go on to set out in the middle, “How do numbers compare today?”
Professor Dame McLean: Yes.
Counsel Inquiry: Can you just run us through that very briefly?
Professor Dame McLean: Very good. So this is sort of the second bit of the argument: where are we? The reasonable worst-case scenario says, roughly speaking – prevalence is how many people out there are infected. Reasonable worst-case scenario thinks about 78,000, now it happened to be 71,000. The fact that these are pretty close in agreement is kind of irrelevant; the point is that we had made this plan, the first column, that things would get a little bit worse in September and then we’d do something about it, and this is me saying: that has happened, things have got a bit worse, they are about where we were afraid they would be, and then – and they’re getting worse.
I think the point I was trying to make with these numbers was: you are about to exceed your own reasonable worst-case scenario, and that means all the plans that you have made are going to fail because they were made against the reasonable worst-case scenario. If it has any purpose, the purpose for reasonable worst-case scenario is that it lets government make plans in which the – and assume that – on the assumption that the situation here, the disease, the level of infection, won’t be so bad as to break those plans. So we’re about to break – things are getting so bad that they’re worse than the RWCS. When you specified what you were going to do, you said you would do something now.
Counsel Inquiry: This was an internal target, effectively, set by Covid-S, or objective.
Professor Dame McLean: Up to a point, except – well, except that there’s no numbers on the Y axis in the Covid-S graph.
Counsel Inquiry: And you set out below it a short graph which effectively illustrates the fact that hospital admissions –
Professor Dame McLean: Yeah.
Counsel Inquiry: – are really following the first wave pattern in terms of regions.
Professor Dame McLean: Yes.
Counsel Inquiry: So those that were most badly hit in the first wave are also being most badly hit in the second wave.
Then finally, in part 3 of your paper –
Professor Dame McLean: Yeah.
Counsel Inquiry: – you explain what happens next, where does this end up –
Professor Dame McLean: Yeah.
Counsel Inquiry: – the trajectory.
Professor Dame McLean: Yeah.
Counsel Inquiry: And what you explain here is that under the current trajectory, hospitalisations will increase exponentially, surpassing the first wave by early November.
Professor Dame McLean: That’s right.
Counsel Inquiry: Then you go on to explain about the governmental planning, you explain that epidemiology is in line with the reasonable worst-case scenario but infections are still rising, and you explain that you expect that reasonable worst-case scenario to be breached.
Professor Dame McLean: In days.
Counsel Inquiry: In days.
Professor Dame McLean: And I think that closing sentence is worth noticing:
“[Test and trace] will not function effectively in a large second wave.”
Counsel Inquiry: And, of course, that’s one of the tools in the pandemic toolbox.
Professor Dame McLean: Yeah.
Counsel Inquiry: Now, Professors Gupta and Heneghan put forward an alternative view within that meeting. A large part of that was effectively advanced on segmentation or protecting and isolating vulnerable groups, and establishing a degree of herd immunity.
What were your views in relation to those alternative views?
Professor Dame McLean: I think our experience had already been that it was extremely difficult to protect vulnerable groups; that first of all it was practically very hard to put in enough protections so that infection never reached the known vulnerable, that’s thing 1; and, secondly, there were lots of people who ended up very ill, either with acute Covid or with Long Covid, who were not amongst the known vulnerable. So we didn’t think – I didn’t think it was a practical approach at all.
Lady Hallett: Ms Cecil, I don’t know if you’re going to come to it, but you’ve referred us to the Swedish expert’s views on the screen, and Professor McLean’s views. Are Professor Gupta and Professor Heneghan’s views going to be displayed, or are they not in this document?
Ms Cecil: They are in this document. I wasn’t going to take you to them in relation to Professor Heneghan because he has explained his views earlier in the evidence, but I certainly can. If I can just call it back, they’re in the pages that precede this one. I believe they’re on pages 10 and 11, from recollection, I’m afraid, if I can just go to those, but we can certainly have a look at them. (Pause)
Back one further page, in that case. Start on page 9.
This is Professor Heneghan’s views. We see here that, halfway down the first paragraph, he takes the view that:
“Recent responses are out of proportion to the threat. They are underpinned by a lack of understanding of the data, the role of community pathogens and an overreliance on predictive modelling.”
He very strongly bases that on the fact that it has effectively been influenza preparedness, and that that has had a significant impact upon the advice that’s been provided, and effectively that advice is wrong.
What are your views in relation to that?
Professor Dame McLean: I think that we were expecting a large autumn wave and that something needed to be done to prevent it. Sadly, that large autumn wave did happen. I don’t really think that’s to do with was this influenza or was it a different respiratory infection; it was a respiratory infection to which there was very, very little immunity in the population at that time because, dreadful though the first wave felt, it actually infected rather a small proportion of the population.
Counsel Inquiry: If we can just look a little bit further down this page, please. I touched upon it earlier in relation to the control strategies that they were – collectively, there are differences between their papers, but one aspect of it was about those targeted measures and segmentation, and there has been a criticism levelled that segmentation was never considered properly by SPI-M-O or SAGE.
What do you have to say about that?
Professor Dame McLean: It was quite carefully considered. Segmentation can be used in several different ways. One way of thinking about it would be simply on age. Should we have let the over 40s – sorry, the under 40s or the under 45s live a normal life whilst everybody else was in lockdown? I would say it’s very clear. You don’t need modelling. You can just look at the data that we have about household composition, so what age of people live with other people, or we have beautiful data about who mixes with whom. I talked a bit about that with the BBC data. It was very, very clear that there was far too much mixing between different age groups for that sort of segmentation plan to work, because even a little bit of leakage from – if you had half the population leading a normal life, back into the segmented, is enough to be very, very damaging at this point in time, when immunity in the population was so very low. So that’s age segmentation.
Then other ideas about protecting the vulnerable by making sure the people who come into contact with them are doing, say, lots of testing, always seemed to me intuitively appealing, but probably needed to work in a context of very low infection in the community, because they weren’t going to be perfect, so if – they would work best if there was not much infection in the wider community. And, of course, there are the points that have been made to you earlier this week by Professor Whitty and Professor Vallance that those put a huge, huge burden on more vulnerable people.
Counsel Inquiry: Just dealing, if I may, then with segmentation. Indeed, there’s various different ways of referring to it; we have heard about shielding, we’ve heard about super-shielding and we’ve heard some evidence on cocooning as well. But in terms of SAGE, SAGE had indeed sought earlier advice and notes on segmentation –
Professor Dame McLean: Yeah.
Counsel Inquiry: – all the way back in the summer, effectively, June/July, and indeed shielding conversations had taken place much, much earlier than that.
Professor Dame McLean: Yes.
Counsel Inquiry: Thank you.
One aspect that you may have found some level of agreement with Professor Heneghan in relation to was that relating to care homes that he flags.
Professor Dame McLean: Yeah.
Counsel Inquiry: There is an aspect in relation to nosocomial infections. He’s advancing something that is effectively a much less restrictive set of NPIs, with a 50% work at home strategy; on young people, simplify messaging; and then also, in his view, seeking to increase the personal threat perception should also be reconsidered, and that, alongside a couple of others, was considered to be sufficient.
In your view, as at 20 September 2020, would those measures have been adequate or sufficient to have prevented the second wave?
Professor Dame McLean: I think not. Particularly – I mean, if you look at what’s happening here, the only community-level intervention here is 50% work at home strategy. If you think about those pictures I showed you earlier of ready reckoners, 50% wouldn’t be enough. We hadn’t acquired a whole lot of new immunity between May and September that would have made our situation better, and contact tracing was revving up, but was more like 20% efficacy than anything higher.
Counsel Inquiry: Thank you.
Then if I can just take you, please, to Professor Gupta, and she is a professor of theoretical epidemiology at Oxford University.
Lady Hallett: The same department you have been in.
Ms Cecil: Indeed, at the department of zoology. She has been a fairly high-profile critic of the approach undertaken by, indeed, SAGE, SPI-M-O and the government during the pandemic.
In summary, her views, as espoused within this document, are that restrictive measures that have been imposed have been outweighed by the cost, particularly for those poorest or most vulnerable, firstly. That is a broader issue, rather than simply the epidemiological position, or the public health position, because obviously that takes – that’s looking at socioeconomic considerations and other considerations. But also refers to herd immunity, if I can just … It’s at page 8 of the document, please.
The starting premise here in terms of the key issue from her perspective in terms of her note was:
“… whether or not it is justified to take extraordinary measures in response to Covid-19 - given that no extraordinary measures are in place for other infectious diseases such as influenza, pneumococcal pneumonia, and … other coronaviruses.”
And that’s because:
“We have reached an accommodation with [those] and accept that they cause a level of disease, suffering and death, but not sufficient to change our way of life.”
She accepts it’s not possible or realistic to attempt to eliminate Covid-19, but that the goal should be to achieve levels of herd immunity.
She then goes on to speak about herd immunity not being a policy and gives a little bit more of a description there.
What is your view in relation to that?
Professor Dame McLean: I think these issues about: could we – I think it says here we can’t tell – we don’t know how close we are to the herd immunity threshold. I would disagree with that statement. I think we could tell from quite straightforward antibody tests that were available at that time that could be applied in closed populations with big outbreaks, where we could see how extensive an epidemic would be before it naturally came to an end. But we did have reasonable measures of how close we were to herd immunity and that we were a very long way from it, and could therefore expect a large autumn wave, which indeed did then happen.
Counsel Inquiry: At the very end of her document she posits two scenarios, ultimately. The first is to bring in population-wide restrictions to keep infection levels down until the vaccine becomes available. The downside to that for her is that it comes at huge social and economic cost. Not clear that such a policy is sustainable until that development of that vaccine.
The second solution, which is – and I’m assuming it’s the one that was posited within the meeting – is to:
“… take steps to protect the vulnerable … while allowing those that are at low risk to accumulate immunity [which is going back to that herd immunity point that you’ve already addressed] such that the risk to the former is reduced as rapidly as possible to levels that [are acceptable] for other respiratory pathogens.”
Professor Dame McLean: Yeah.
Counsel Inquiry: She speaks about:
“… the very low death rates of Covid-19 in much of the population, while permitting and supporting the rest to adopt social distancing measures commensurate with their risk.”
And in fairness, Professor, I think you’ve already dealt with those issues, because really it’s talking about, again, segmentation or cocooning or shielding in some way, and then herd immunity.
So in terms of the meeting or the group and how it progressed, were each of you given an opportunity to present your papers and present your views?
Professor Dame McLean: That’s right, that’s how it went.
Lady Hallett: Looking at your paper, Professor, I heard the expression this week that the advice had to be electrifying if you wanted to trigger the action. Could I confess that I don’t find your paper electrifying?
Professor Dame McLean: Yeah, but you don’t like graphs.
Lady Hallett: No, but your audience may not have liked graphs either.
Professor Dame McLean: No, that’s a very good point. I think it’s better than all this text, myself.
Actually, you know, I think you raise a really important issue, which is: how are scientific advisers going to get a whole lot better at communicating what we think? Because, I agree with you. I thought that was a pretty electrifying page, and it’s very interesting for me to hear that you don’t find it electrifying, and I certainly – I mean, I ran the experiment and they didn’t do what we said, did they?
So I think – so, for me, pictures are better than text. I think you’re right; one has to remember that there are many people that – that might be a cultural thing, and there might be people – there are lots of people for whom text is better than pictures.
Ms Cecil: Indeed, in your witness statement, just picking up on that point, one of the lessons to be learned, as you identify it, is that science advisers – SAGE, whoever it may be – need to be more unequivocal in their advice; more forceful, effectively, in their advice; is that right?
Professor Dame McLean: Yes.
Counsel Inquiry: And what you say in that is that, as advisers, you should have thought more critically about the state of mind of those who you were advising and – and this is in the context of delay – the reasons for that delay, not least because you needed to assume that elected officials do not want to make unpopular decisions, extremely difficult for them to do so.
Professor Dame McLean: Yes.
Counsel Inquiry: And you’re talking here about lockdown, and:
“If we had a better sense of how unpalatable lockdown was to decision-makers, if anything this would have expedited strong advice to lock down, rather than give us cause to delay providing the advice or to weaken its terms.”
And you make it very plain that, looking to the future, advisers should err on the side of giving unequivocal advice earlier in the context of advising on time-sensitive matters –
Professor Dame McLean: Yes, and –
Counsel Inquiry: Here specifically about pandemics.
Professor Dame McLean: Yes, I agree, and clearly more electrifyingly.
Lady Hallett: I do apologise.
Professor Dame McLean: No, it’s fine.
Ms Cecil: In terms of how those views were expressed, obviously that’s how they were expressed on paper; you’ve already explained that you did say to those in the meeting, which of course included the Prime Minister and other senior members of the government, that they needed to get – that somebody needed to get a grip.
Professor Dame McLean: Yes.
Counsel Inquiry: How was that received?
Professor Dame McLean: In silence. I mean, they just sat there in silence and listened to us. I don’t remember there being many questions, except – I mean, a few – except towards the end, where I think somebody said, “What do you think we should do?” They just went round the four of us and said, “What do you” – well, five of us, sorry, “What do you think we should do?”
No, there wasn’t a lot of discussion, that’s what I remember.
Counsel Inquiry: When asked, “What do you think we should do?”, what was your response?
Professor Dame McLean: So I actually gave my own personal response, which I realise perhaps I shouldn’t have, but anyway, I said I think we should go into lockdown with schools open.
Counsel Inquiry: With schools open?
Professor Dame McLean: Yeah. And I think that was an honest reflection that I didn’t really think two weeks was going to be enough.
Counsel Inquiry: And in terms of the others in the meeting at that point, so Professor Gupta, do you recall what she said?
Professor Dame McLean: I don’t recall.
Counsel Inquiry: No. Professor Heneghan?
Professor Dame McLean: I’m sorry, I don’t remember.
Counsel Inquiry: Not at all.
You may not recall in relation to Dr Tegnell, Anders Tegnell?
Professor Dame McLean: No.
Counsel Inquiry: Or indeed –
Professor Dame McLean: John I do remember, because John said we need to be in lockdown now, and it was unusual – and I remember thinking: oh, well, gosh, is he right and I’m wrong? Can we sort of afford – you know, have we got enough – if we just need to keep incidence flat, can we manage that with schools open?
Counsel Inquiry: Indeed, we can bring up – I’ve just realised we’ve not taken you to Professor John Edmunds’ paper, but that’s on page 7 of INQ000137261, and we see that he sets out the current picture within the UK epidemiologically.
Professor Dame McLean: Yeah.
Counsel Inquiry: In dealing with the herd immunity point, perhaps bullet point 4 is relevant. His view was that only around 7% of the population had been infected. Did that accord with your view?
Professor Dame McLean: Yes, that’s right. No, we had epidemiology. So we knew that 7% of the population had antibodies, but we also knew from a big outbreak that had happened on a fishing vessel that antibodies appear after you have been infected.
Counsel Inquiry: It’s explained here:
“Yet, around 50,000 have died. Letting the epidemic run in the remaining 93% would result in around half a million deaths.”
Explains large incidence, including increase of incidence in care homes. Epidemic is doubling every seven to eight days. It then deals with a need for a package of measures, lockdown and closure of all facilities, et cetera, and all of those in March combined reduced the R number to about 0.7. Indeed, that’s what we were looking at, if you recall, earlier –
Professor Dame McLean: Yeah.
Counsel Inquiry: – when we looked at what the R number was in the summer, June, when SAGE and SPI-M-O met.
So what he then says is:
“… to meet [Her Majesty’s Government’s] aim [as it was then] of keeping R below 1 a large package of interventions will have to be implemented, not just one or two.”
It talks about educational institutions; if they are to remain open, a very wide package of other interventions will be essential. And then what he talks about is the imperative for speed of action. Response “needs to be fast and large. The harder the measures, the less time they need to be in place for.”
Professor Dame McLean: Yeah.
Counsel Inquiry: It then continues to explain that the UK responded slowly in March and paid a heavy price for this in terms of deaths.
“This shows - unambiguously - that the key factor for the large number of deaths in the UK was the lateness of our response. We should not make the same mistake again.”
It goes on:
“Immediate action has an enormous impact when cases are increasing exponentially, which they now are.”
He sets out his graphs – more graphs, I’m afraid – which show the effect of an immediate circuit breaker.
“Any delay will result in far more cases ([and you see the] dotted line on Figure 1b) and therefore hospitalisations and deaths.”
Then unequivocally he ends with:
“No intervention would be disastrous …”
In terms of your views and Professor John Edmunds’, did they align?
Professor Dame McLean: I think pretty much, in that the bit where he says if we want – well, I certainly agree that no interventions would be disastrous, that’s for sure. I think the bit where he says if we want to keep educational institutions open, we will have to have very substantial measures pretty much everywhere else, I think that was a different way of saying the same thing: lockdown, schools open.
Counsel Inquiry: He speaks in here about not making the same mistake again in relation to delay.
Professor Dame McLean: Yes.
Counsel Inquiry: Did you consider that government was potentially making the same mistake again at that point in September?
Professor Dame McLean: I felt we were at that stage at risk of making the same mistake again. If we had acted decisively then, we would have learnt from March, but we didn’t; implication: we had not learnt from March.
Counsel Inquiry: We know that there was no circuit breaker in September at this stage.
Professor Dame McLean: No.
Counsel Inquiry: Was that in your view, from your public health perspective and epidemiological perspective, a mistake?
Professor Dame McLean: Yes, I believe that was a mistake. I think if we’d had a circuit breaker in September, we could have kept cases – cases would have dropped a little bit and then we would have bought some time.
Counsel Inquiry: In the absence of a circuit breaker at that stage, again, what were the consequences, from your perspective?
Professor Dame McLean: The number of infections kept rising through September and October with attendant hospitalisations and, sadly, deaths.
Counsel Inquiry: Had there been a circuit breaker, therefore, again, in your view, would the number of deaths have been lower?
Professor Dame McLean: Yes.
Counsel Inquiry: Now, in terms of the remainder of that meeting, were any views expressed by the Prime Minister that you can recall?
Professor Dame McLean: I don’t remember the Prime Minister saying anything.
Counsel Inquiry: The Cabinet Secretary?
Professor Dame McLean: No, I remember one person, but I don’t remember who it was, asking this question about: what should we – meaning they, the government – do, which we’ve just talked about.
Counsel Inquiry: Did either of Sir Patrick Vallance or Professor Chris Whitty express a view in the meeting?
Professor Dame McLean: I’m sorry, I can’t remember.
Counsel Inquiry: Then we also understand that the Chancellor was present.
Professor Dame McLean: Well, I think perhaps he called in. I’m not certain. I’m sure he was there.
Counsel Inquiry: Did he make any contribution?
Professor Dame McLean: Well, you see, I think it was him who asked, “What should we do?”, but perhaps that’s just an incorrect memory.
Counsel Inquiry: Now, after that meeting, the following day, there was a further SAGE meeting on 21 September, and if I can just pull that up, it’s INQ000061566, page 2, please.
It’s paragraph 2. It starts by setting out that Covid-19 instances increasing across the country; talks about the effect on schools, colleges and universities; doubling time could currently be as short as seven days.
Then it goes on to make recommendations at this point:
“A package of interventions will need to be adopted to reverse this exponential rise in cases.”
And it then goes on to talk about single interventions, coming back to the single or package of interventions that we’ve discussed:
“Single interventions by themselves are unlikely to be able to bring R below 1 …”
And we see the confidence intervals. We’ve discussed those previously in evidence.
Professor Dame McLean: Yeah.
Counsel Inquiry: High confidence in that assertion.
“The shortlist of … (NPIs) that should be considered for immediate introduction includes …”
And that’s where we see:
“• a circuit-breaker … to return incidence to low levels.
“• advice to work from home …
“• banning all contact within the home with members of other households …
“• closure of all [retail and hospitality, and so on] …
“• all university and college teaching to be online …”
So at this point, these are recommendations with schools staying open.
Professor Dame McLean: Yeah.
Counsel Inquiry: So that’s the recommendation of the 21st.
We then see, on 24 September, a further SAGE meeting, and that’s at INQ000061567. If we can go to page 3, please, at paragraph 16. If we look at paragraph 16, it talks about SAGE’s previous advice, the one that we’ve just seen:
“… a 2-week ‘circuit-breaker’, where more stringent restrictions are put in place for a shorter period, could have additional impact. A shorter break of a week or less is likely to be less effective in reducing the number of infections and slowing the growth of the epidemic.”
So at this stage the advice is still consistent: circuit breaker.
Professor Dame McLean: Yeah.
Counsel Inquiry: At any point was there any alternative advice in September, aside from the need to have a circuit breaker to deal with the rise in cases?
Professor Dame McLean: No.
Counsel Inquiry: So looking and turning to the issue about delay and delay in decision-making, at this stage, no decision had been taken.
Professor Dame McLean: That’s correct.
Counsel Inquiry: And that, as we’ve discussed, is a positive choice in itself with consequences.
Professor Dame McLean: Yes.
Counsel Inquiry: You’ve described a period of frustration; how were you feeling at this stage?
Professor Dame McLean: Very worried, because having lived through the first wave with its horrible consequences, I couldn’t understand why we weren’t doing things to try hard to avoid a second autumn wave. We’d been telling them since we started that there will be an autumn wave, and I suppose I’d thought in the summer, with the Covid-S scenario, that that had been brought on board, that we would try to do things, inasmuch as we could, to prevent an autumn wave, and nothing was happening.
Counsel Inquiry: We subsequently had the tier system that was introduced in October of 2020, 14 October. You described that as being suggestive of a lack of caution on the part of decision-makers. Why is that?
Professor Dame McLean: Because of the way it was introduced. So if what you do is you introduce a set of tiers where in places where incidence is low, you put in controls that are insufficient to stop incidence from growing, all that will happen is that in all those places, incidence will grow. We sometimes referred to it as the levelling-up scheme. It was a scheme that would allow incidence of infection to rise in many, many parts of the country.
Counsel Inquiry: Now, just to be clear, neither SAGE nor SPI-M-O were asked to advise on that policy.
Professor Dame McLean: That’s correct.
Counsel Inquiry: In your view, at that stage in October, moving through into November, were the tiers working or were they failing?
Professor Dame McLean: In October? Well, we did a big study on that afterwards. They were failing in the sense that incidence across the country – in gross measures, incidence in the country was rising, which was not what we wanted. In the parts of the country that were in Tier 3, or Tier 3 and a bit more, which is what some places did, you can actually see that incidence did fall in those places.
Counsel Inquiry: Now –
Professor Dame McLean: Can I just add, I didn’t – there’s nothing wrong with geographically targeted measures, it’s just this business of starting off with something very low, letting it grow, putting in something that barely keeps it stable, so that it grows in most places.
Counsel Inquiry: Thank you.
I’m going to deal with the report –
Professor Dame McLean: Yeah.
Counsel Inquiry: – that was subsequently written in due course, but if I can just keep to the chronology –
Professor Dame McLean: Yeah.
Counsel Inquiry: – at the moment, just so that we know where we were at the time –
Professor Dame McLean: Very good.
Counsel Inquiry: – or you were there at the time –
Professor Dame McLean: Okay, but we would have said – if we had been asked, we would have said: no, this is the wrong way round.
Counsel Inquiry: Now, on 23 October of 2020, you emailed Sir Chris Whitty and Professor Sir Patrick Vallance. It’s at INQ000062800. What you ask here – it is the SPI-M-O chairs and the secretariat that are talking, and you explain here:
“After Sage on Thursday SPI-M Chairs and secretariat asked themselves, how long have we got?”
And then you go on to set out some back-of-an-envelope calculations that you made. Presumably those are the ones that you made out of that meeting.
Professor Dame McLean: So at –
Counsel Inquiry: These are the calculations that you made between you at that meeting, the SPI-M-O – the –
Professor Dame McLean: We will have made these by correspondence, yes.
Counsel Inquiry: By correspondence?
Professor Dame McLean: Between the four of us.
Counsel Inquiry: Thank you.
What you explain here, as we go on down, is that you were projected to hit the level of admissions – and let’s just deal with this, this is about the assumption of avoiding the first wave of peak hospital admissions. At that point, that was around the 3,100 mark, just below.
Professor Dame McLean: That’s right.
Counsel Inquiry: And you’ve done some calculations and you explain that you will exceed that on 21 November.
Professor Dame McLean: Yeah.
Counsel Inquiry: To stop that, you need to reduce the R to less than 1 by 10 November.
Professor Dame McLean: Yeah.
Counsel Inquiry: And if you want to do better than the first wave peak, for example 2,000 hospital admissions a day, you have to get the R below 1 by 28 October, so five days’ time.
Professor Dame McLean: Yes. I think this was an attempt for us to arm Chris and Patrick with some numerical reasoning to say: we are running out of time.
Counsel Inquiry: So was this an intervention, effectively, by SPI-M, the secretariat?
Professor Dame McLean: The four of us, yeah.
Counsel Inquiry: The four of you.
Professor Dame McLean: I mean, I don’t think we thought Chris and Patrick didn’t agree, we were just trying to – we were searching for evidence that we could give to them to take to decision-takers.
Counsel Inquiry: Were you trying to prompt some level of action at this stage?
Professor Dame McLean: Oh, yes.
Counsel Inquiry: Now, on 24 October, the following day, Wales instigated their firebreaker. Do you consider that that was a success, first of all?
Professor Dame McLean: It was probably better than nothing. It didn’t bring – if I remember rightly, we might be able to look at it, actually, because there will be a graph of it. I don’t think it had a huge – it didn’t cause a great decrease in cases, is my memory. On the other hand, what’s the counterfactual? What would have happened if they hadn’t done it?
Counsel Inquiry: I’ve been asked to ask: do you consider that that was early enough, the firebreaker in Wales, or should that have been earlier?
Professor Dame McLean: I think all of these things should have been done in September, so that whilst incidence was low, we could have kept it low and given ourselves time to come to terms with the fact that: yes, we are having an autumn wave, we don’t know when we’re getting vaccines, what are we going to do about it?
Counsel Inquiry: Indeed, you’re subsequently tasked with the task and finish group on the impact of recent NPIs across the UK, and that involves an evaluation of the tier system, firebreaks and other NPIs that were put in place across the four nations.
Professor Dame McLean: Yeah.
Counsel Inquiry: And you present a subsequent paper that is amended or updated slightly later with some new material, but in short, it’s broadly the same paper.
Professor Dame McLean: Yes.
Counsel Inquiry: And that’s presented to SAGE initially on 19 November of 2020, it’s the UK’s four nations autumn interventions, the updated version presented to SAGE on 26 November 2020.
In terms of England, what it states in there, if I can just pull it up, please, it’s – thank you very much … I believe it’s towards the end. I’m afraid I’ve missed off the paragraph reference. But what it says is:
“Throughout the autumn England waited until after prevalence had increased to impose measures just about able to slow or stop epidemic growth. The inexorable outcome was high prevalence in many places and the need for four weeks of national restrictions.”
Professor Dame McLean: Yes.
Counsel Inquiry: “For the future a more logical procedure might be to introduce measures (such as Tier 2) that can be hoped to retard the growth everywhere and maintain low prevalence.”
Professor Dame McLean: Yes.
Counsel Inquiry: And that’s a reference back to what you’ve discussed in terms of how to implement it.
“As soon as rising prevalence is detected, measures should escalate to interventions that are associated with negative growth rates (such as Tier 3).”
Professor Dame McLean: Yes.
Counsel Inquiry: So looking back in terms of an evaluation of those autumn interventions, were they successful, in your mind?
Professor Dame McLean: They were successful in some places.
Counsel Inquiry: And what places were they?
Professor Dame McLean: Tier 3 – if you look at the places that were put into Tier 3 and look at the epidemic growth rate the week before they were put in Tier 3 and the week after, what you see is that the growth rate is always lower, and usually negative, in places that were under Tier 3.
We do have to be really, really careful because these weren’t experiments. Places that were in Tier 3, there was probably something pretty special about them that they needed to go into Tier 3, but this is what we had. So we need to be very careful to say: this was the pattern we saw, and not – try really hard not to use words that implies causality. But you can look at the – you can look at the patterns of growth rate before and after a tier was introduced.
Counsel Inquiry: Then we come to the second national lockdown.
Professor Dame McLean: Yeah.
Counsel Inquiry: You described that in your witness statement as a “terrible moment”. Why was that?
Professor Dame McLean: Well, because the thing that we had been trying to avoid by having smaller interventions at lower prevalence had had to be done, and in the same – it felt like March all over again: we wait till the last possible moment, we delay and delay a decision, and then we have to slam the brakes on as hard as possible with the attendant social costs and economic costs.
Counsel Inquiry: At that stage schools were also closed.
Professor Dame McLean: Is that right? I thought schools were open already.
Counsel Inquiry: Have I got that wrong? It may be that I have got that wrong and it’s schools were closed in – schools were certainly closed in the third lockdown. It may be me.
Professor Dame McLean: Yes, I think that’s right.
Counsel Inquiry: I’m turning to that now, if I may.
Before we get to the third lockdown after that, we then have the Alpha wave that comes through in December –
Professor Dame McLean: Yes.
Counsel Inquiry: – of 2020 through to January – well, indeed, the winter of 2020 into 2021.
You describe some successes there in relation to surveillance and genomics.
Professor Dame McLean: Yes.
Counsel Inquiry: Can you just expand a little bit in terms of surveillance, firstly?
Professor Dame McLean: So I think we’re all really, really proud of what the Office for National Statistics did with their Covid infections survey, so we knew what prevalence of infection was across the country every week, and with actually quite a lot more detailed local investigation of what was happening with infection, much of which came actually from test and trace, we could see – right as we came out of the November lockdown, we could see straightaway that there was a problem in the south east and that infections were rising very fast in the south east, and that was the first observation, so just there were lots more positive tests in this part of the country, what’s happening? And then because of COG-UK, because of the amazing genetic studies that we had, we could see straightaway that the virus that was spreading there was different.
So in a – you know, it was a triumph of science. We not only observed right from the early days the Alpha wave, we also knew why we had it.
Counsel Inquiry: Indeed, throughout this period you had been armed with much, much greater levels of data.
Professor Dame McLean: Yes.
Counsel Inquiry: Synthesisation of data, all of those things, surveillance. Testing now had a 24-hour turnaround.
Professor Dame McLean: Yes. We had a good picture of what was happening with this infection in our four countries at this stage.
Lady Hallett: Could I interrupt? I’m being asked to take a break, which is obviously going to be apparent.
I’m getting very concerned about time, Ms Cecil.
Ms Cecil: Of course.
Lady Hallett: As you know, but others may not, I have to finish at the very latest at 3.45 this afternoon, and we’ve got another witness. So I’m going to break now for five minutes to give the stenographer a rest, and please can people discuss how we ensure that I leave here at the very latest by 3.45.
Ms Cecil: Of course.
Lady Hallett: Thank you.
(12.09 pm)
(A short break)
(12.14 pm)
Lady Hallett: Ms Cecil.
Ms Cecil: Thank you.
Picking it up in May to December of 2020, again SAGE meets, 17 December, says additional interventions may need to be considered, and that’s two and a half weeks before the eventual lockdown that takes place on 5 January. Then on 6 January, that’s when we enter the third national lockdown, that’s when schools are also closed.
Now, in respect of that, there is a communication between you and I believe it’s Professor John Medley(sic) on 17 December in which he expresses the view that you had missed the timing of lockdown with half term – this is, as I say, 17 December:
“… and today the politicians just went ahead and made policy anyway, without any guidance from SAGE, so it is finally a victory for common sense but actually we have failed to inform policy over the last few months.”
Was that a view that you shared?
Professor Dame McLean: Yes.
Counsel Inquiry: Now, as we come out of the third national lockdown, that’s when you begin working, certainly just before that, with the Covid Taskforce.
Professor Dame McLean: Much more closely from then on, that’s right.
Counsel Inquiry: And there’s quite a lot of thinking that is done then in January and February of 2021, is that fair to say?
Professor Dame McLean: That’s right, I mean, I think the work that was led by Rob Harrison and turned into those plans to unlock from the third lockdown are a wonderful example of using scientific evidence in order to make a long-term plan, and I don’t – I think the reason, if you could take a tiny bit of time to look at them, is I think they make a useful contrast to events in 2020.
Counsel Inquiry: Of course. I’ll just call that up briefly now. It’s INQ000238597.
We have this document, Professor, so please don’t think that we won’t be looking at it. And indeed you make various of these points in your witness statement, and so even if we don’t go into detail now, please be assured that that evidence will be taken into consideration in due course.
If I can go to page 4, please, and for the first time we see, in terms of the roadmap, that coming out of – I say coming out of lockdown or easing restrictions, there is a roadmap with a test. And that’s about a third of the way down, it says:
“This assessment will be based on four tests.”
And we see (a) to (d): vaccine deployment, that the vaccine separately sufficiently effective in reducing hospitalisations and deaths, and that those infection rates do not risk a surge in hospitalisations placing unsustainable pressure on the NHS, and that the assessment is not changed by variants.
To be clear, in relation to that, one of the priorities that is then set out later in the document, on page 10, there are various objectives that also inform this roadmap out. Again, we see (a), (b), (c) and (d). We see again the issue in terms of pressure on the NHS, deployment, protection of the public. But one of the aspects that is a priority is the resumption of face-to-face teaching in schools?
Professor Dame McLean: It’s not just a priority, it’s the priority.
Counsel Inquiry: The priority.
Firstly, it’s a more transparent document, but secondly when we were talking earlier about the lack of strategy and aims in terms of – from a SPI-M-O/SAGE perspective, with respect to modelling and providing that advice, does this accord with something that you were really looking for, something more like this, with objectives and policy aims?
Professor Dame McLean: Objectives, things we’re going to measure, things that we are actually able to measure, and actually we haven’t found it, but the bit that says “and we’re going to space these things out, we’re going to space these decisions out in a way that is consistent with being able to measure how much difference did the last set of measures that we lifted make”.
Counsel Inquiry: Indeed.
Professor Dame McLean: So I view that as a document that’s paid proper attention, and I mean that quite carefully, actually, not too much but proper attention to what can be done with all kinds of scientific evidence, including modelling.
Counsel Inquiry: It’s a fairly lengthy document, and as you say at the outset it does say that it’s based on data not dates. Dates are wholly contingent on data and are subject to change if the four tests are not met.
So what we then have is the deployment of this roadmap, and indeed later, I think it’s stage 4, it gets delayed because of concerns about a new variant?
Professor Dame McLean: That’s right.
Counsel Inquiry: And so you have those triggers.
As I say, we’ve heard some evidence already in relation to the roadmap out, but I just wanted to use this as an example of how you say policy objectives and advice can be aligned in a much better way in terms of –
Professor Dame McLean: That’s right.
Counsel Inquiry: Deliverability?
Professor Dame McLean: Yes. Can I just say, so I think some of why this was possible was that Rob Harrison, through taskforce, put together a team from across government, bringing in advice from all sorts of different people, working together at the officials level, to absorb advice into government at the level of official working.
Counsel Inquiry: Indeed. And it’s not just epidemiology that we see within the document, we also see analysis of socioeconomic impacts, mental health impacts, all – other forms of inputs and issues that need to be taken into consideration. As I say, it’s a substantial document in that sense.
If I may now just move very briefly to just ask one very quick question in relation to children –
Professor Dame McLean: Yeah.
Counsel Inquiry: – and transmission. You and John Edmunds wrote a paper on that back in October of 2020 suggesting that children indeed can be infected and do contribute to transmission. Does that remain your view?
Professor Dame McLean: Yes.
Counsel Inquiry: Thank you.
Then finally, if I may just take you to the issue of testing, we know that the will of the World Health Organisation at the time was to test, test, and test, and you set out within your statement that testing plays both a role at the initial stages of the pandemic but also subsequently, both in relation to surveillance but also in relation to it being a tool in the arsenal.
In terms of testing in the early stages in March of 2020, and the decision to stop community testing at that stage, SAGE was not – am I correct that SAGE and SPI-M-O did not advise in relation to that?
Professor Dame McLean: That is correct.
Counsel Inquiry: And your understanding is that it was not a clinical decision, it was a resource-based decision?
Professor Dame McLean: That is my understanding.
Counsel Inquiry: Limited tests and therefore a need to prioritise to those areas which were most in need, effectively?
Professor Dame McLean: Yes.
Counsel Inquiry: Thank you.
Just in relation to that World Health Organisation advice and developing and less developed – more developed and less developed countries, is it as applicable to a state such as – a western country such as the UK as it is to a developing country?
Professor Dame McLean: Yes, I would say at least as applicable, in that with our age distribution, where we had many, many more elderly people than many less developed countries would have, testing was even more important for us.
Counsel Inquiry: In fact within your statement, I don’t need to take you through it now in detail because you set it out there, you refer to the experiences of both South Korea and Germany as inspiring and examples that the UK should look to?
Professor Dame McLean: Yes.
Counsel Inquiry: Thank you. And indeed that there are lessons to be learnt there in terms of their experiences and the use of that technology and testing, surveillance and tracing?
Professor Dame McLean: That’s still my view, yes.
Ms Cecil: Thank you very much.
Thank you, Professor, I’ve no further questions for you.
Does my Lady have any questions?
Lady Hallett: No, I don’t, thank you very much indeed. And again, I apologise for the – your evidence was certainly very illuminating.
The Witness: Thank you.
Lady Hallett: Even if I didn’t find the graphs electrifying. Thank you very much.
The Witness: Thank you.
(The witness withdrew)
Mr Keating: Yes, please, thank you.