Transcript of Module 2A Public Hearing on 24 January 2024
(10.00 am)
Lady Hallett: Mr Dawson.
Mr Dawson: Good morning, my Lady. The first witness this morning is Professor Mark Woolhouse OBE.
Lady Hallett: We meet again.
1. Professor Mark Woolhouse
PROFESSOR MARK WOOLHOUSE (affirmed).
Questions From Lead Counsel to the Inquiry for Module 2A
Mr Dawson: You are Professor Mark Woolhouse?
Professor Mark Woolhouse: I am.
Lead 2A: You have helpfully provided a statement to this module of the Inquiry, along with other statements provided to previous modules. Your modular statement for this
Inquiry is dated 14 December 2023 and has the reference
INQ000369765. Is that your statement?
Professor Mark Woolhouse: It is.
Lead 2A: Do the contents of this statement remain true and accurate as of today’s date?
Professor Mark Woolhouse: They do, though we have sent a handful of further exhibits to the Inquiry, but I don’t think they materially affect this statement.
Lead 2A: Thank you very much indeed.
You’re a professor of infectious disease epidemiology at the University of Edinburgh?
Professor Mark Woolhouse: I am.
Lead 2A: You sat during the course of the pandemic on the body called SPI-M-O between January 2020 and early 2022?
Professor Mark Woolhouse: That’s correct.
Lead 2A: You’re also a member of a group about whom we have heard evidence, the Scottish Covid Advisory Group from March 2020. You attended that group regularly, apart from a two-month absence from meetings in February and March 2021?
Professor Mark Woolhouse: That’s correct.
Lead 2A: You did not attend the SAGE meetings that we’ve heard about?
Professor Mark Woolhouse: I didn’t.
Lead 2A: Thank you.
You were awarded an OBE in 2002 for service to the control of infectious diseases?
Professor Mark Woolhouse: I was.
Lead 2A: You’re a fellow of the Royal Society of Edinburgh?
Professor Mark Woolhouse: I am.
Lead 2A: Of the Academy of Medical Sciences and the African Academy of Sciences?
Professor Mark Woolhouse: I am.
Lead 2A: We’ve heard some evidence about your role in providing early information and advice to the Scottish Government, in particular through Dr Catherine Calderwood, the then Chief Medical Officer. You have given some evidence about that to the Inquiry already, but I’d like to ask you some more questions in the particularly Scottish context of this module. Could we have up on screen, please, INQ000352450. If we could go to – yes, that’s the right one. This is a chain of emails which you have helpfully produced to the Inquiry between yourself and Catherine Calderwood; is that correct?
Professor Mark Woolhouse: It is.
Lead 2A: And I understand that you first contacted Dr Calderwood in connection with your concerns about the emergence of a new virus on 21 January 2020; is that right?
Professor Mark Woolhouse: It is.
Lead 2A: What prompted you to contact Dr Calderwood specifically at that time?
Professor Mark Woolhouse: This seemed to be a matter that very quickly would require the Scottish Government to engage with, and since I wasn’t at the time part of any formal advisory system, it seemed to me the logical route to channelling my concerns to the government was through the Chief
Medical Officer for Scotland.
Lead 2A: And presumably, given the fact that you, as well as having contact with people at a UK level, contacted the
Chief Medical Officer for Scotland, you were under the impression that the Scottish Government had the ability to do something about this?
Professor Mark Woolhouse: Yes.
Lead 2A: Health and indeed public health are matters devolved to the competence of the Scottish Parliament and hence the Scottish Government?
Professor Mark Woolhouse: Indeed.
Lead 2A: We’ve looked at some of the text of these emails before. You – I think the context, please correct me if I’m wrong, of this email is that it follows on from an announcement of recognised human-to-human transmission of the virus the previous day; is that right?
Professor Mark Woolhouse: That’s right.
Lead 2A: What was the significance of the emergence of that piece of information about the virus?
Professor Mark Woolhouse: We already knew about cases of what was then actually called Wuhan pneumonia, at those very early stages, and there was a possibility that these had been acquired from an animal source, a non-human source. And it is possible – there are many diseases like this – that the infection would spread from the animal but could not then spread from person-to-person. So a human is a dead end from the virus’s point of view.
Now, that doesn’t mean it’s not serious, some of these sorts of infections, like rabies, for example, around the world are very serious. But nonetheless that kind of infection would not cause a pandemic.
Lead 2A: So the evidence which had emerged the day before about human-to-human transmission was a significant piece of information which would affect your assessment of the likelihood of the virus transmitting and potentially reaching epidemic or pandemic proportions?
Professor Mark Woolhouse: Well, yes, but it confirmed my fears. I had already received, I think on January 9 or 10, a report from – that was sent to me, unexpectedly, of the Wuhan municipal health authority that already was describing that this was quite a sizeable outbreak and had been persisting for some weeks. So I was already thinking this is unlikely to be just an animal origin epidemic, as in the only cause of human infections is from animal sources. It was already – so I was expecting this news that it was human-to-human transmissible. I’d feared that for over a week, ten days.
Lead 2A: I see. So this very recent piece of evidence about human-to-human transmission had added to and confirmed your fears about previous information which had been made available to you earlier in that month?
Professor Mark Woolhouse: Correct. I thought we were going to have a pandemic or it was very likely that we would have a pandemic from round about January 10th.
Lead 2A: Thank you.
You say – it’s on the second page of the page we have here – in the second paragraph:
“There are some instructive parallels with the H1N1 pandemic in 2009-10. Indeed, one possibility is that this could turn out to be quite similar in some key respects: a widespread epidemic fuelled by mild cases but with mortality among vulnerable patients.”
Can you tell us why it was that you were seeking to draw to Dr Calderwood’s attention parallels with the 2009-10 H1N1 pandemic and the various features which you identified as being a possibility of the pandemic which you were predicting for the novel coronavirus at that time?
Professor Mark Woolhouse: I think that was the most instructive parallel available. And it wasn’t just the characteristics of the infection – which, as the Inquiry has heard a lot of evidence for, turned out to be significantly different from influenza – but also the nature of the response. And I had been involved in the Scottish response to the H1N1 pandemic in 2009, and there were deficiencies in the response at that time, and I was very anxious that history didn’t repeat itself.
Lead 2A: Yes, I think we’ll get to that very expression that you use in one of these messages. But what was it about the information that you had that suggested that it would be an epidemic fuelled by mild cases, with mortality amongst vulnerable patients?
Professor Mark Woolhouse: It’s a respiratory infection and that’s a pretty standard textbook expectation for respiratory infection.
Lead 2A: As far as the ability to detect the spread and therefore significance of the virus, what is the significance of the fact that it would be fuelled by mild cases?
Professor Mark Woolhouse: That simply means that it would be very difficult to track by detecting people with – reporting with symptoms. You wouldn’t see a lot of the cases, so you would need other ways of identifying those –
Lead 2A: Cases –
Professor Mark Woolhouse: They wouldn’t know they were cases.
Lead 2A: Yes, so people would have mild symptoms that they wouldn’t necessarily associate as anything out of the ordinary and therefore might not report for testing, such that chains of transmission might go undetected; is that the broad idea?
Professor Mark Woolhouse: Yes, and, as you may want to discuss later, that turned out to be a huge problem.
Lead 2A: Yes, indeed, at the moment I’m focusing on what it was you were predicting. You were also predicting mortality amongst vulnerable patients as being a feature of a respiratory virus of this nature, based on your extensive experience?
Professor Mark Woolhouse: Yes.
Lead 2A: You say – although in that paragraph you are pitching your prediction as a possibility, in the previous paragraph, based on the not unexpected announcement, as you’ve explained, of human-to-human transmission, you state that “this will become a pandemic, and therefore will affect Scotland”. That was your position at the time?
Professor Mark Woolhouse: Yes.
Lead 2A: And that was why you wanted to bring this to the attention of the Scottish Government through the Chief Medical Officer?
Professor Mark Woolhouse: Absolutely.
Lead 2A: Thank you.
Could I just then go to the next paragraph where you highlight, in light of your predictions and the particular features of the prediction you’re making, what it is you think will need to be done to try to cope with this. You say:
“Such an epidemic would be difficult to track. As in 2009-2010 what would be needed is an integrated surveillance set up that combines clinical surveillance, genomic surveillance, and serological surveillance. (The latter requiring an appropriate test; we and I am sure, many others are working on this already). This should be unexceptionable. My reason for writing now is to emphasise that, based on experience of 2009-10, that that system needs to be put in place in advance of the arrival of the virus, so the sooner the better. If we wait until after the virus has arrived then we will miss information of public health value and our efforts to prevent the control of the pandemic will be compromised.”
So the message you were trying to convey was, based on your previous experience of what you considered to be similar viral outbreaks, one needed to act fast in order to try to keep the spread under control?
Professor Mark Woolhouse: Correct.
Lead 2A: Can you help us a little bit with the requirement for clinical surveillance, genomic surveillance and serological surveillance; what would those different components have been aimed towards achieving?
Professor Mark Woolhouse: So I’m actually taking this straight from what my team did in 2009/2010 on behalf of the Scottish Government. They asked us to do this eventually, and that’s the work that we did. There is a clinical surveillance system, not just in Scotland but more widely, for influenza-like illnesses, respiratory infections, essentially. That’s useful, but what we’d found in 2009 was it wasn’t extensive enough, and what we were able to do, working with colleagues in Health Protection Scotland, was get that – it’s based around general practices, and we got that scaled up very quickly and that provided very useful information quickly during 2009.
Genomic surveillance – I don’t know how much evidence the Inquiry’s heard about the value of whole genome sequencing? It wasn’t something that Scotland actually was geared up to do in 2009, so again, my team, we had to introduce that – it was relatively new technology at the time, we had to introduce that into the process. And that was extraordinarily valuable, just as it was with Covid-19, but not nearly as advanced at that time.
And serological surveillance, and that’s again what we did in 2009, it’s basically detecting people who have antibodies to infection, so it’s tracking an infection by taking blood samples, and detecting who has had the infection. So it’s not the same as the PCR tests and the lateral flow tests that came along with Covid. Now, I – in this I didn’t anticipate those. But it was a very useful tool in 2009, this serological surveillance.
Lead 2A: Obviously, as you said, you were seeking to convey a sense of urgency about the need to create these systems and develop these systems specific to Covid. What was your understanding of Scotland’s ability to do that at that point?
Professor Mark Woolhouse: So, prior to this chain of emails, I’d been in touch with my colleague Chris Robertson, at Health Protection Scotland, and through him with Jim McMenamin, who I believe you’ve already heard from.
Lead 2A: That’s right.
Professor Mark Woolhouse: And so I was getting a sense of what level of activity was going on in Scotland, and I didn’t get the impression that it was, in my view, treating the situation with the seriousness or the urgency that I felt it needed.
Lead 2A: I see. So did that apply simply to the reaction to the information that was emerging but also to the practical requirements that were – you were recommending needed to be put in place in order to deal with that threat?
Professor Mark Woolhouse: Yes. So in a perfect world I would, in this email, be pushing at an open door, and the reply I would get to that email was “Thank you, Professor Woolhouse, we’re already doing this”. And I believe you heard from Gregor Smith earlier, and – I watched his testimony, and he said, and I’m paraphrasing slightly, “Professor Woolhouse is just telling us textbook stuff, we know all this”. And he’s absolutely right, I was.
Lead 2A: Right.
Professor Mark Woolhouse: But textbook stuff needs to be acted on.
Lead 2A: Yes.
Professor Mark Woolhouse: And the thing that I was particularly concerned about was that although, you know, I’m very well aware of all the systems in place in Scotland and elsewhere to respond to an outbreak, including an influenza outbreak, I was already convinced at this early stage that this was going to be considerably worse, and so I was really trying to push this. But I would have been very happy with a response to this email saying “Thank you, we are already doing this”.
Lead 2A: Right. You say this was your impression. I think from various materials, including your book, you were also in contact with other people in the UK at this time, you’ve mentioned Chris Robertson, you mention Neil Ferguson, Jeremy Farrar, and others, some in Scotland, I think, with whom you were discussing these matters around this time. Were they of a similar view to you? Was there a consensus –
Professor Mark Woolhouse: Oh, yes, absolutely. Absolutely. No question. We were all very concerned –
Lead 2A: Yes.
Professor Mark Woolhouse: – at this point, all those people you’ve mentioned there.
Lead 2A: Lest it be suggested that this was simply your view, this was a view which you had discussed and developed along with other experts in the field?
Professor Mark Woolhouse: Yes.
Lead 2A: You say in your statement at paragraph 186 that:
“Better surveillance, coupled with genomic studies, would have facilitated better advice and better decision making during this crucial period.”
Had these systems been ramped up in late January and into February, as you had advocated, would this have been early enough to allow for the spread of the virus to have been restricted more than it was before the lockdown was imposed eventually in March?
Professor Mark Woolhouse: Yes. So I’m suggesting a programme of gathering data, gathering information. There’s a whole – obviously another rather important layer of what you then do on the basis of that information, but obviously if we have better information, we are better informed, we can make better decisions, which might well have the consequence that you outlined. But I am here concerned with getting the information.
Lead 2A: Of course. There is a theme, I think, which we’ve discussed with some other witnesses, that runs throughout the testimony and the many documents you’ve provided, which is a frustration, which I think you held and pre-dated this period and indeed had been the subject of some correspondence with Dr Calderwood in the years prior to this, about the lack of data access for those like yourself in the research community in order to be able to provide the level of assistance, support, input that you would have liked to have provided in a situation like this.
Could you tell us what the background to that was, broadly, and whether these frustrations remained active at this time?
Professor Mark Woolhouse: Well, the second point, the answer is a simple yes. The first point, that emerges again from experience in Scotland of 2009/2010 influenza, and – you mentioned I was a fellow of the Royal Society of Edinburgh, we did a post hoc report of the management of that incident in Scotland, and we made a series of recommendations precisely about this, that we needed to have the mechanisms of obtaining, sharing and analysing data in place, ready to go, should another pandemic arise. Quite a detailed report. And I already was aware that this report had not really been acted on, so that’s one of the things about my frustration. What I wanted to know – what I wanted to happen here, me and others, through the Royal Society of Edinburgh, had recommended over ten years ago. Not quite ten years, sorry, 2011/12, so getting on for ten years ago.
Lead 2A: Right.
Professor Mark Woolhouse: And it hadn’t happened, hence the frustration.
Lead 2A: I see.
We heard some evidence from other witnesses, including – we heard evidence together from two Health Protection Scotland witnesses, you mentioned Dr McMenamin, I think, and we also heard from Professor Nick Phin, who spoke – although he wasn’t in Scotland at this time, spoke on behalf of Health Protection Scotland, and when they described their attitudes over this period, both, if I recall correctly, were keen to emphasise the previous swine flu experience was a substantial factor in their thinking about the threat, but perhaps in the opposite way to the way in which you were using your experience of previous viral outbreaks. You were drawing on your previous experience, which led to you, I think, suggesting this was a significant threat, whereas it seemed that their evidence was to the effect that the swine flu outbreak was something that was making them more cautious about coming to the conclusion that this was a significant threat.
I wonder if you could comment on that and whether the attitude, as I’ve characterised it, from them was a prevalent one at the time?
Professor Mark Woolhouse: It was, and the reason is fairly straightforward, actually. In the – swine flu turned out to be, by the standards of these respiratory infections, really quite benign. Its case fatality rate, the fraction of people who are infected and die, was somewhere in the order of one in a thousand, which is low. Obviously it’s significant, it’s a public health problem and needed to be managed, but it’s relatively low.
The early estimates of the infection fatality rate for this virus were, and I think that comes later in this email chain, somewhere in the order of 4%. Well, that’s 40 times higher, so you can immediately see that this potentially then is going to be an enormously greater event.
The reason why I personally, unlike my colleagues you’ve mentioned –
Lead 2A: Yes.
Professor Mark Woolhouse: – leant towards the more concerning or alarming –
Lead 2A: Yes.
Professor Mark Woolhouse: – figure, because we knew, again, going back from the – certainly the first half of January, well before this, from genome sequencing studies done on material from China, that this virus was extremely closely related to the SARS-CoV-1 virus. That had a case fatality rate of 10%. So from my point of view we’re in this territory. This is a very, very similar virus to something that had a case fatality rate of 10%. That’s a completely different magnitude of problem than swine flu.
Lead 2A: Yes. Yes.
Professor Mark Woolhouse: That’s why I –
Lead 2A: So you are bringing, I think it fair to say, a number of different experiences of previous viral threats, swine flu, H1N1, and the information that you had, the original SARS, as you’ve just outlined, with its high infection fatality rate, you – your view, bringing all of this evidence together, was not that there was evidence suggesting that this was not a matter for concern, very much the opposite, it was a matter of significant concern?
Professor Mark Woolhouse: Very much the opposite, yes.
Lead 2A: Thank you.
You mention in your email the possibility that there could be mortality amongst vulnerable patients. We’ve heard significant evidence in this and other modules about the fact that Scotland relative to other parts of the United Kingdom had a relatively elderly population with significant health inequalities and comorbidities.
Was it therefore all the more necessary, given this possibility of mortality, against that background, to start to consider doing something to protect that large cohort of vulnerable patients in Scotland?
Professor Mark Woolhouse: Yes. I wouldn’t want to overstate my level of understanding of the situation at this very early stage. We still hadn’t – there still wasn’t good evidence as to what a vulnerable patient was for this. You know, there were indications from previous experiences with SARS and indeed influenza, so we had some idea, but, you know, this was all quite uncertain at that stage. But that, as I said, was, seemed to be the most likely –
Lead 2A: Yes.
Professor Mark Woolhouse: – course this would take.
Lead 2A: But if that possibility did eventuate, that would be a particular problem for the particular characteristics of Scottish society, given the pre-existing –
Professor Mark Woolhouse: Yes, I would not pretend to you that I was thinking at the time that Scotland – at the time – that Scotland was particularly vulnerable to this. Just that Scotland was vulnerable to this, full stop.
Lead 2A: Did that start to become part of your thinking over the subsequent months?
Professor Mark Woolhouse: Yes. I mean, it depends what you compare Scotland with but, yes. The vulnerabilities are one thing – the main vulnerability, as you well know, is age, so very fact that the whole UK population is actually quite elderly, by global standards, is – was a concern.
Lead 2A: Yes, indeed, thank you.
A number of these emails – if we could scroll up through the emails, we could see the reply – scroll backwards, if you like, through the emails, you can see the reply from Dr Calderwood where broadly she says to you that – she acknowledges your email and I think tells you that PHE and HPS, as it was at that time, before the advent of PHS, were “actively considering the detailed surveillance needs and investigations required for this novel virus”, and apparently recognising the value of those surveillance systems.
How did you take that response? Were you satisfied that it sounded like they had things under control, or were you expecting a little more, given what you had said in your earlier email?
Professor Mark Woolhouse: I don’t regard “actively considering” as sufficient.
Lead 2A: Thank you.
If we go again back through the previous emails, we’re going to one on page 4, which is dated 25 January, and you say – you write to Dr Calderwood again, and you indicate there that you have discussed the matter with a number of others, including Jeremy Farrar, Neil Ferguson, as I’ve said, and that they had “independently reached the same conclusions and have advised Chris Whitty accordingly”.
You provide some further information, and then state that based on the case fatality rate, I think, the infection fatality – or case fatality rate you mentioned a moment ago of 4%:
“If you were to put those numbers into an epidemiological model for Scotland (and many other countries) you would likely predict that, over about a year, at least half the population will become infected, the gross mortality rate will triple (more at the epidemic peak) and the health system will become completely overwhelmed. We can formalise those predictions (and there are many caveats to them) but those are the ballpark numbers based on information from WHO. Please note that this is NOT a worst case scenario, this is based on WHO’s central estimates and currently available evidence. The worst case scenario is considerably worse.”
Again, what was the – what were you trying to convey to Dr Calderwood, again, about your developing understanding, your conversations with others and information that seems to have developed in the days since you last wrote a few days before?
Professor Mark Woolhouse: Yes, so the work that we – the actual science that we’ve started to do is – at this stage, this early stage, is trying to understand, like in the context of my team’s work, the scale of the threat to Scotland. And I’m reporting on what we now assess the scale of the threat to Scotland to be.
Lead 2A: Yes. A couple of lines down you say:
“Your reply to my earlier e-mail did not give any indication that here in Scotland we are preparing for a R0=2, CF=0.04 event. And I don’t have the sense that we are from my networks here either.”
So I think you are there conveying the information that the case fatality rate is 4% as you said earlier which is an alarming case fatality rate; is that right?
Professor Mark Woolhouse: Correct.
Lead 2A: And that the R being 2, that is that the R as 0 of the virus, which is an indicator of its transmissibility; is that correct?
Professor Mark Woolhouse: Yes. Actually that one turned out to be an underestimate, so …
Lead 2A: Indeed, but even with those numbers –
Professor Mark Woolhouse: Yes.
Lead 2A: – you are expressing there, as you’ve told us in your evidence, a degree of dissatisfaction with the level of the urgency within Scottish Government?
Professor Mark Woolhouse: Yes, and again we come back to Gregor’s comment that this is textbook. Yeah, it’s textbook. My undergraduates could do this calculation.
Lead 2A: Yes.
Professor Mark Woolhouse: My undergraduates could come up with this assessment. This is not difficult.
Lead 2A: Yes. One might say that that makes the lack of action all the more questionable and perhaps culpable?
Professor Mark Woolhouse: I think I’d better leave that to the Inquiry.
Lead 2A: But in any event, you were, as I say, trying to convey, based – applying basic epidemiology, if that’s correct, to the specific characteristics that emerged from the science, the R0 and the case fatality rate, to you it was fairly obvious that this was going to be a huge problem?
Professor Mark Woolhouse: Yes. And you mentioned the book I wrote. One of the things I put in that as the final explanation in my mind for why this wasn’t landing in Scotland or elsewhere was you put all this very, you know, as I say, fairly basic information together and what you get is an unfolding catastrophe. And I think a lot of people simply couldn’t get their heads round that. Even though, as I say, this is very simple. So you add this number and this number and this number and this number and you get a catastrophe. I think they couldn’t take that final step.
Lead 2A: Yes.
Professor Mark Woolhouse: Put all this information together and what’s going to happen, and …
Lead 2A: I think, therefore, you’re attributing to the medical advisers of the government at least the ability to do the basic epidemiology and arithmetic, but are you suggesting perhaps that, given the number that that came up with, they rather froze?
Professor Mark Woolhouse: Yes.
Lead 2A: Thank you.
Can we look again – go further back in – to page 2, please. This is a further email which you sent on 26 January, so the very next day.
While we’re getting that, one thing that was mentioned yesterday by Professor Sridhar that I just wanted to ask you about, a couple of things about the way in which information is communicated to people like yourself, she mentioned something called PubMed, which, as I understand it, is a source of information about developing epidemics or developing viral threats; is that right?
Professor Mark Woolhouse: ProMED.
Lead 2A: ProMED, I’m sorry.
Professor Mark Woolhouse: Yes.
Lead 2A: Could you just tell us a little bit about what that is and the extent to which that was used by you and others to be able to access information about the emerging virus?
Professor Mark Woolhouse: It’s been around a while. It’s – I don’t know quite what you call it, it’s maybe something a bit like a blog, but it pre-dates even blogs, so it’s a loose association of experts in the field who report to one another concerning events to do with infections, of which in a given year there will be dozens, if not hundreds, around the world. And that I’m inferring that Devi used this as one of the sources of information. I actually didn’t use that one.
Lead 2A: Okay. We’ve also heard some evidence from a number of the witnesses who have helpfully provided our Rule 9 responses of not necessarily at this period but in the period after this, as information started to emerge more, about the use of preprints in analysing the emergence of the threat.
Could you tell us what that is and the extent to which that was used in trying to understand what the threat was and the characteristics of the virus, et cetera.
Professor Mark Woolhouse: Yes. The gold standard for communicating scientific knowledge, of course, is the publication of a piece of research in a scientific journal, which is done subject to peer review. So it’s looked at by experts, it’s judged to be sound and it’s published. And that remains the gold standard. But in very fast-moving situation like this, that whole process – well, quite frankly, it can take up to a year sometimes and, in some circumstances, longer. It’s clearly far too slow.
So preprints is the practice of taking the paper that you’ve submitted or you’re planning to submit, but publishing it immediately. And it’s made very clear on the preprint servers that this is not peer reviewed research, so for that reason it hasn’t been quality controlled but it’s put out there so that the rest of the scientific community can see it. So it’s basically a very fast way of communicating your research outputs, but it loses the quality control element of peer review.
Lead 2A: Thank you. The reason I’ve asked you those questions, Professor, is that a number of other people, including the PHS representatives, suggested that the way in which evidence emerged over these early months, if we put it that broadly, from January onwards about the nature of the virus and hence the nature of the threat, was unreliable or contradictory or difficult to interpret. It doesn’t seem to be the case, even at this very early stage, and in fact you’ve referred to you developing views about this even earlier than this correspondence, that you, although no doubt are taking that into consideration, reliability of the evidence, that is restricting you from reaching the conclusion that this is a very, very significant problem about to happen.
Could you tell us about why it is that you felt confident enough in your professional assessment to be able to express these views, despite those concerns expressed by others?
Professor Mark Woolhouse: Well, one very simple way to do it is if somebody, whether it’s a scientist from China or the UK or anything, is publishing – wants to publish a paper, something they’ve put up as a preprint, in – beyond the preprint someone would have to peer review it, that person would quite likely be me.
Lead 2A: Right.
Professor Mark Woolhouse: So I felt perfectly qualified to peer review the evidence I was seeing myself.
Lead 2A: Yes, so you were able to evaluate –
Professor Mark Woolhouse: Yes.
Lead 2A: – what was in the peer review and use your extensive experience to be able to reach a judgement about whether this was reliable and sufficiently reliable information to be able to communicate these sorts of messages to government?
Professor Mark Woolhouse: Yes. And during the pandemic I didn’t have time to do this for the scientific journals, but it’s a job I routinely do for scientific journals, so I was simply doing it in real time in a different context.
Lead 2A: Thank you very much.
In this message you go back again, as we said this was the next day, and then you set out a number of different scenarios. Could we just scroll down a little bit further in that. There was one aspect of this where – just a little bit further than that, thanks – it’s where you get to:
“The measures we could consider are: …”
You talk there about a vaccine being part of the solution, I think. And what at that stage would you have been thinking? Obviously a vaccine would have been a very useful thing to have, but in terms of planning, what would your realistic expectations have been about when a vaccine might become available, based on your extensive previous experience?
Professor Mark Woolhouse: At that time I think the fastest a vaccine had ever been rolled out from scratch was four years, previously. Obviously there was going to be a great need to accelerate the process. I really got that estimate of a year through correspondence that you already mentioned, particularly with Jeremy Farrar, who is director of Wellcome Trust, and is very well – very, very well connected with the vaccine manufacturing base. So, you know, I agreed with Jeremy, but I think his estimate was much more authoritative than mine, and that was –
Lead 2A: So if we just scroll down a little bit further, you mention antivirals there. Again, you say effectively that’s something, for the time being at least, we’re going to have to live without. So I think you’re then pointing towards the need for what I think are non-pharmaceutical interventions in order to try to deal with the situation, and you mention there a number of different things with which we subsequently became familiar, case isolation, infection control and contact tracing, social distancing, but also the thing I wanted to focus in on particularly was public messaging.
What was it that you thought – you rather there suggest – you hoped that the government was already doing something about that. But what sorts of public messages do you think should have been emanated, sent out from that time onwards, in order to try to manage the balance required between not causing widespread panic but allowing citizens to be part of a bond of confidence with government about how their own health and safety is being managed?
Professor Mark Woolhouse: You summed it up perfectly, that’s exactly what I was worried about.
Lead 2A: Right, so you think that there required to be some level of public messaging that reflected the need to balance those two considerations?
Professor Mark Woolhouse: Yes, and I was doing – as part of my role at the university I would deal in media work, even at that stage, and I was having to walk this tightrope myself, and it would have been very helpful if Scottish Government had actually made some pronouncements that could then be discussed by the media and commentators and so on. So I was tiptoeing around exactly the problem that you –
Lead 2A: I see.
Professor Mark Woolhouse: – identified.
Lead 2A: I see. But is it correct to say, because this is one of things identified here, that a level of engagement of the public appropriately pitched was necessary?
Professor Mark Woolhouse: Yes, but I – and I wanted it to come from government. You know, obviously one thing I could have said in media interviews at that stage was what’s in these emails.
Lead 2A: Yes. Yes.
Professor Mark Woolhouse: For rather obvious reasons I did not want to do that. That should not come from me. But it wasn’t coming from anyone else, that was the problem.
Lead 2A: You were, I assume, speaking to the very person, these emails, from whom you thought it should be coming –
Professor Mark Woolhouse: Yes.
Lead 2A: – the Chief Medical Officer and the ministers whom she advised?
Professor Mark Woolhouse: Yes.
Lead 2A: There was then an exchange of emails, further emails, where you provided more information. Just for the sake of the record, the 31 January email is INQ000103352. Then in a further email which we’ve seen which is INQ000103215, we’ve seen an email which was sent not involving you but it was sent by Dame Sally Davies, who I understand was the former Chief Medical Officer to the UK Government, to Dr Calderwood on 5 February in which Dame Sally Davies, oddly, introduces you to Dr Calderwood. Was that email the result of some contact you had had with Dame Sally Davies about the position?
Professor Mark Woolhouse: Yes. So we’ve discussed my frustration with what I continued to perceive as the lack of action, so – I’m surprised you don’t have the email, but maybe you have it somewhere else. I wrote to Sally, who I knew, and – the email is there somewhere but I’m paraphrasing slightly – I’m saying “Sally, can you get Catherine to listen to me, because she’s not listening”.
Lead 2A: Thank you. Again, I think we have a series of emails again all joined together under this reference. If we scroll up there is a reply on 6 February to that message. You’re copied in to these messages, I should say, in which – indicating that you had emails in the very recent past with some extremely helpful modelling estimates, and she says to you, as you’re cc’d in:
“… let’s find the time to meet face to face.”
You eventually did have a meeting with her, I think, but on 28 February. Is that right?
Professor Mark Woolhouse: Yes, that’s correct.
Lead 2A: Again, did that timescale between your original contact, the need to try to engage the assistance of Dame Sally and the date of the eventual meeting give you the impression that Dr Calderwood was taking on board the level of the threat that you were trying to communicate?
Professor Mark Woolhouse: I – I was less concerned about the actual meeting at that stage. What I hoped that Sally Davies’ intervention had done would be – suggest to the CMO that it might be perhaps wise to revisit my advice and what I’d been telling her and take action accordingly. So I – I didn’t push for that second meeting, I left that to the CMO Scotland.
Lead 2A: I see. Could I just run through some of the things that I understood happened roughly between the time of this email and the eventual meeting on the 28th, just in order to try to get some key indicators of the developing knowledge of things that seem to us to be significant in the elevation of the threat.
A meeting of SAGE took place on 4 February in which it – it stated on the basis of their analysis that asymptomatic transmission cannot be ruled out and transmission from mildly symptomatic individuals is likely. It also indicated that human-to-human transmission outside China had occurred.
Now, obviously you’ve given us a lot of information across the various modules about the significance of asymptomatic or mild transmission. You had in fact predicted that it was at least a possibility, some time before that, that this would be the type of virus which could be transmitted by mild patients, and you’ve explained to us the significance of that.
As at that SAGE meeting of 4 February, what was your view about the reliability of the evidence base that the virus was going to be transmitted by either asymptomatic, presymptomatic or mildly symptomatic patients?
Professor Mark Woolhouse: Thank you for mentioning presymptomatic, because it’s very, very important on this.
The data on this was emerging in a very piecemeal way from China at the time, and me and many, many other epidemiologists around the world were trying to make sense of this data. I was – I had a slight in-built advantage in that in my research group at the time I had two very able Chinese students who were very useful in giving me intelligence and guidance as to what was going on in China and how we should interpret the sorts of information that was emerging. But China, and I believe the WHO, were at the time actively suggesting there was not much undetected cases, mild cases, that this was not the pattern. It was completely wrong but that’s what we were suggesting at the time. So this created a lot of doubt.
Lead 2A: It might be difficult to know how many undetected cases there were because the mild asymptomatic or presymptomatic spread means that it’s hard to detect them?
Professor Mark Woolhouse: Yes, but – they did surveys but they didn’t interpret the results the way I interpreted the results.
Lead 2A: Yes. So at what point over this period did the evidence base, which as you say was not entirely satisfactory, although you had the advantage of two able Chinese students assisting you, at what point over this period did it become apparent to you, based on the kind of judgement that you have explained you apply to evidence and papers, that asymptomatic, presymptomatic or mild transmission was going to be a likely feature of this particular epidemic?
Professor Mark Woolhouse: I don’t think the evidence for that became firm, the sort of evidence you would publish in a scientific journal, for quite some time, I think. I don’t think that happened in February.
Lead 2A: But it was definitely part of the thinking –
Professor Mark Woolhouse: Oh, yes – oh, no, it was absolutely part of the thinking –
Lead 2A: – time –
Professor Mark Woolhouse: – where you’re concerned, but again the evidence hadn’t emerged.
Lead 2A: Indeed.
Professor Mark Woolhouse: There were systems set up which Scotland was involved in, an exercise called the First Few 100 – I think you’ve heard of that?
Lead 2A: Yes, yes.
Professor Mark Woolhouse: And that was designed to provide, among other things, this sort of information. But of course in order to activate something called the First Few 100 – first few hundred cases – you have to have 100 cases here, in the UK or in Scotland – and we were nowhere near that number –
Lead 2A: Yes –
Professor Mark Woolhouse: – of course.
Lead 2A: Well, as far as testing is concerned, that was something else I was going to ask you about.
The earliest record that we have of tests being conducted in Scotland is around 10 February. When was it that a test, in its most basic form if you like, was available?
Professor Mark Woolhouse: Wouldn’t have been long before that, I don’t think that’s – I don’t think there was any – I don’t have any concerns about that.
Lead 2A: Yes.
Professor Mark Woolhouse: I think, you know, that first test date was pretty good.
Lead 2A: Yes. We know that because there were 57 tests conducted that day and all were negative, so were not contributing to positive –
Professor Mark Woolhouse: Yes, but the principle was established, I’m glad it was, that was a welcome development.
Lead 2A: Absolutely, thank you.
You met Dr Calderwood on 28 February. We have a briefing note, which is INQ000103216.
This is a note, I think, that you sent her in advance of the meeting. Further down towards the end you sent her a lengthy analysis of the position as of that date as things have developed since your initial correspondence.
Then a bit further down, thanks.
Yes, you say:
“There are two scenarios we particularly want to avoid:
“1. Doing nothing, as that is likely to result in the health system being overwhelmed in a matter of weeks once an epidemic takes off.
“2. Implementing extreme social distancing measures that, sooner or later, have to be relaxed and then, having already paid a high social and economic cost, experiencing a (delayed) epidemic that still overwhelms the health system.”
So there’s a degree of balancing, I think, required there as well.
What was it you were trying to urge, in advance of your meeting in this lengthy detailed briefing note, to – what were you trying to urge upon Dr Calderwood as important things to bear in mind in this overall scenario assessment?
Professor Mark Woolhouse: Yep, exactly what I say there. I mean, it was clear to me at that stage that we were going to have to walk a tightrope between an epidemic that took off basically and overwhelmed the health service or – I didn’t – I wasn’t thinking of lockdown in those stages, but – at that data, quite, but some very severe social distancing restrictions that would be extremely damaging in their own right. We were walking between two very, very unsatisfactory outcomes. This was going to be difficult.
Lead 2A: Yes. What was your view at this point, towards the end of February, about what Scotland could have done in order to try to handle the threat as it was at that point?
Professor Mark Woolhouse: Well, we started to discuss this in the meeting, I think it’s the next day, after this. So it’s … I don’t know if I say it in – using that phrase, in that meeting, but one of the things we’d been working on there was this idea that earlier intervention can be less drastic intervention. So if you want to avoid these very severe social distancing measures, then actually you’re going to have to go – intervene earlier.
But I’m not – I’m not sure I was quite at that stage in my thinking at this meeting. I think that maybe emerged – the first time I did a briefing on that, and I remember that one, was March 4th.
Lead 2A: Right.
Professor Mark Woolhouse: So I may have mentioned it to Catherine –
Lead 2A: Yes.
Professor Mark Woolhouse: – at that meeting, it was certainly in my mind, but I don’t think we’d actually written it up that earlier intervention could be less drastic intervention.
Lead 2A: There is some other email correspondence that we’ve seen – we can take that one down there, thank you very much – relating to the meeting, slightly after the meeting, in which one of the things that you refer to is social distancing measures were very likely to need to be introduced in Scotland, possibly very soon. In your statement you say that meant days, not weeks. And you also point out that there would be a need for a clear exit strategy, and also some level of analysis of the effect of social distancing, economically, socially and psychologically. So you’re setting this out presumably at or immediately after the meeting.
Could we just look at those different components. At that stage, as far as the measures that were concerned, what did you think needed to be done? The second was the exit strategy, and the third was some level of analysis of the effect of social distancing measures, economically, socially and psychologically. If you could explain the significance of those and your position at the time?
Professor Mark Woolhouse: Yes, so it is as you said, I’m setting out the need to balance harms. And this is absolutely fundamental to public health, in public health you’re always balancing harms, even if the harms are just monetary costs, but it’s always a balance you’re trying to strike. My concern here, and this comes back to the scale of the crisis that didn’t seem to be landing in government at that stage, is both harms, the harms that the virus could cause and the harms that the countermeasures could cause, were immense. They were absolutely enormous.
So when I’d been doing this sort of exercise over the years, you know, trying to make an intervention, a health intervention efficient, so not too costly, not damaging in other ways, you know, the stakes were nowhere near as high. You know, there’s a little bit of wiggle room, I mean, you get it wrong this way a bit or that way a bit and –
Lead 2A: Okay.
Professor Mark Woolhouse: – you know, it costs the government a small amount of extra money, but it isn’t – here the stakes are absolutely enormous. And we have to find the right path. If we go too hard or too soft, we’re going to end up paying an enormous penalty, and this was very obvious to me – well, as you saw from – during late February, that we were in this position.
So I’m trying to – I’m trying to lay the ground for this sort of decision-making that’s going to have to happen –
Lead 2A: Yes.
Professor Mark Woolhouse: – if we’re not to –
Lead 2A: And here –
Professor Mark Woolhouse: – damage.
Lead 2A: And I think you tell us or these documents show that you were not aware of any, you’re talking about the other side of the balance, if you like. We’ve heard something, which we’ll come on to later, which I think the Scottish Government introduced after this, in April, called the four harms strategy, the first harm being the harm of Covid itself, the other harms being harms caused by the measures taken to combat Covid, the non-Covid health harms, the societal harms and the economic harms.
Is it your understanding that at this stage within Scottish Government no analysis had been done of the effect of even the social distancing measures short of lockdown, which you were suggesting might be contemplated.
Professor Mark Woolhouse: None at all as far as I’m aware.
Lead 2A: Okay. The other element of what we discussed there was the exit strategy. Why was it important to have an exit strategy?
Professor Mark Woolhouse: Simply because the sorts of interventions, the social distancing, that were being contemplated at that stage were clear, and they’d include things like school closures that were on the table, were clearly very, very harmful, and equally clear they could not be implemented indefinitely. We couldn’t – well, it turned out to be a lockdown in the end.
Lead 2A: Yes.
Professor Mark Woolhouse: We couldn’t lock down indefinitely. So the lockdown had to come to an end, so what would be the strategy, the exit strategy? What would make you decide that you could exit lockdown?
And the reason that’s important is because the exit strategy is going to also determine how long the lockdown is. So what are we preparing for? You know, so you can imagine that came up later, the sort of circuit-breaker type approach where actually the lockdown is just a week or something, or all the way up to an indefinite lockdown until we got a vaccine. So there’s a range of possibilities.
So we – and it’s very difficult to advise on what the best strategy is unless you know what the government is willing to contemplate. I mean, can I give you a very simple example?
Lead 2A: Absolutely, very helpful.
Professor Mark Woolhouse: If the government was willing to contemplate an indefinite lockdown, and forget all the costs and the harms that that would do, they were willing to do that, then my advice would be: right, do it now. Lock down now. That’s the way to minimise the impact.
Lead 2A: Mm-hm.
Professor Mark Woolhouse: But obviously they can’t do that, we’d be locked down for possibly years if we had done that. Completely impossible. So as soon as you accept that the lockdown has to come to an end, then the question arises: well, then when is the best time to do it? And suddenly you’re in a different space. The decision is no longer nearly so easy.
And the reason this is causing us all such concern at that time, and there was a lot of work going on about the best timing and duration of, what turned out to be, a lockdown should be, so the severity of the intervention as well, is because it hadn’t been done before. Because we’d never contemplated lockdown as public health policy at all. This was clearly new.
We ourselves – I mean, you kindly called me an expert in the field, but I’ve never thought about this before, never contemplated it. So I got my team frantically working out how is this going to work, what’s it going to – what’s it going to look like? How long should it be? When should it be implemented? What’s the exit strategy? We’re – we’re working very, very hard to try to understand something that, if we known it was going to be on the table, we would have spent years researching before, so that we understood all the nuances and all the trade-offs and how actually we should do it. But none of that work had been done because no one around the world had ever contemplated lockdown. So we were in – we were frantically trying to catch up.
Lead 2A: Which explains why, I think, that your correspondence at this time isn’t referring to lockdown or anything like it, it’s referring to social distancing measures or even more extreme social distancing measures, because lockdown simply was not part of the narrative and had never been prepared for?
Professor Mark Woolhouse: No – so of course it was on the radar because, at that stage, the city of Wuhan had been locked down.
Lead 2A: Yes.
Professor Mark Woolhouse: Obviously we were very aware of that and discussed – that had been widely discussed. But I think the realisation that something like a lockdown would have to be contemplated for Scotland took rather longer.
Lead 2A: Right.
Professor Mark Woolhouse: And –
Lead 2A: Did you have the impression over this period and up to the point at which the lockdown actually occurred that there was any clear exit strategy in the mind of the Scottish Government?
Professor Mark Woolhouse: In the end, when we went into lockdown, I don’t think they had the faintest idea how long we would be in it for.
Lead 2A: And as regards the matters we discussed, the systematic analysis of the effect of the lockdown or social distancing measures, economically, socially or psychologically, did you have any impression that any such assessment had been done within Scottish Government?
Professor Mark Woolhouse: Absolutely none.
Lead 2A: You met with Dr Calderwood again on 6 March, and there is another email follow-up in the same way as you had done on the previous one summarising your position.
There is one element of this advice at this stage that I’d like to just draw your attention to specifically to ask you questions about.
You see there, there are three social distancing measures, informed by the modelling work of Imperial College, and communicated through SPI-M. It’s the third one I was interested in asking you about, if you could explain. One of the things that you’re suggesting is that there should be a policy of “cocooning” populations about the age threshold that you’ve mentioned. What is cocooning and why was it part of the strategy that you were proposing might be contemplated by the Scottish Government at this time?
Professor Mark Woolhouse: So our understanding has developed considerably by this stage. You pointed to my January 21st email that identified that there would be a sub – likely to be a subpopulation of very vulnerable people. We now had very good data that there was tremendous variation in the risk with age. So the idea then is: well, how do you protect people who are very vulnerable? This seems to me, I have to say, to be actually the absolute number one public health priority for Scotland and everyone else.
We’ve identified a subset of the population that’s at very considerable risk. We spoke about the case fatality rate, and we said that the case fatality rate of 4% was high, but in the elderly and the frail, it’s way higher than that. So these people are very, very vulnerable. So how do we protect them? And we hadn’t – I hadn’t thought of this concept of shielding as it had been – as it eventually was introduced, which is basically asking a lot of people in the community to protect themselves. So we had this idea of actually protecting people by protecting the people around them. So carers, family members, same household. That we had to pay particular attention to this. So that’s what I was proposing, and that’s an idea that we went on to develop –
Lead 2A: So –
Professor Mark Woolhouse: – lot over –
Lead 2A: So cocooning then is protecting not only those vulnerable people but the people who would be likely to engage with those vulnerable people, their carers and so on; is that right?
Professor Mark Woolhouse: Yes. Likely but not – not through choice but through necessity, because elderly people, particularly of course elderly people with other risk factors, other comorbidities, need care, whether it’s in the home or it’s in a care home, some in hospital, this is – this is a subset of the population that really couldn’t socially distance. It’s just not possible, they can’t.
Lead 2A: Yes.
Professor Mark Woolhouse: So clearly that wasn’t going to be – unfortunately was the strategy that was implemented, but – just telling people to isolate themselves – but it seemed to me that we needed to actually – they couldn’t isolate themselves so that wasn’t going to work, so how do we do it, and we do it by cocooning.
Lead 2A: Yes, I see. Was cocooning a policy which ever formed part of the Scottish Government’s response to the pandemic?
Professor Mark Woolhouse: No. And that wouldn’t have mattered had somebody – you know, there’s a lot of very smart people thinking about this problem – come up with a better way of protecting the vulnerable population. But what we got was shielding, in the form that it was introduced in Scotland, which in the community anyway was basically telling people to cut all contacts out.
Lead 2A: Mm-hm.
Professor Mark Woolhouse: Which – you know, there’s lots of evidence now that that didn’t work particularly well, and I can give you chapter and verse as to why it didn’t work if you want, but yeah, that didn’t seem to me, even at this stage, to be a very good approach.
Lead 2A: Thank you.
There’s a comment there as well, just on this particular suggestion, that:
“Gregor [who I’m assuming is the now Chief Medical Officer] raised the point that there might be vulnerable people below the chosen age threshold as well. Personally [you write], I don’t see any reason why risk factors other than age couldn’t be included in a cocooning policy, but it is for the clinicians to advise what those might be.”
So you’ve obviously identified age as the main risk factor on the evidence that you’ve seen, which of course turned out to be absolutely right, but there’s a suggestion made by the then Deputy Chief Medical Officer that we might need to consider other groups vulnerable to the virus as well, and you are open minded about the possibility of doing that because you recognise that there might be such groups who could be protected by a similar mechanism?
Professor Mark Woolhouse: Correct.
Lead 2A: Thank you.
Can we just go down, have the whole email up as well, please – over the page, I think. Yes.
Do you conclude this email by saying:
“One final point, perhaps the most important of all. A lot of work went into making containment work. Quite rightly. But it hasn’t, as was to be expected. A lot of work is now going into making delay work. Quite rightly. It may work, or partially work. But there remains every likelihood that it won’t work well enough to prevent an epidemic that does, sooner or later, completely overwhelm our health systems. This is not a prediction but it is an entirely possible scenario. If it happens, it could happen within weeks. So I do think that we should start thinking about the mitigation phase now.”
Can you summarise for us what you were trying to convey as to the strategy at this stage, what needed to be borne in mind as strategies started to be put in place in the weeks after this?
Professor Mark Woolhouse: Yes, so the UK Government had this strategy: “containment, delay” – there was a research arm, which is a little bit of a diversion, so “containment, delay and mitigation”, and this was – Chris Whitty, I think, was –
Lead 2A: Yes, I think it was part of the UK coronavirus action plan that was launched on 3 March to which the Scottish Government also subscribed.
Professor Mark Woolhouse: Thank you. You’re right. So I’m now trying to tailor my comments to fit in with the actual plan. I mean, there is now a plan, so that’s progress, but I’m trying to tailor my comments to fit in with that plan, but I don’t think that plan is going to work.
Lead 2A: Yes. What is that you’re counselling particularly about the dangers that that plan might not work?
Professor Mark Woolhouse: Well, I mean, what I’m saying is quite clearly that we should start thinking about mitigation, which is basically: okay, how do we deal with the fact that we’re actually going to have an epidemic? We haven’t contained it, we’ve delayed it as long as we can, and here we are, we have a pandemic, what are we going to do?
Lead 2A: Did you understand over this period, did you take the Chief Medical Officer and other medical advisers to the Scottish Government with whom you were speaking to be receptive to your advice in the period from January up until the first lockdown or not?
Professor Mark Woolhouse: Well, we’ve – we have discussed the difficulties I had getting myself heard up until February, so I think the only answer I can give you is: no, I wasn’t. I feel it did change, the tone did change in March, and that coincides with Gregor Smith getting more actively involved in the discussions I’m having with Catherine Calderwood, and I think the pace did pick up in – certainly in the first week in March.
Lead 2A: Was Gregor Smith then considerably involved in the planning as far as you were concerned around that time, it wasn’t simply Dr Calderwood –
Professor Mark Woolhouse: I don’t know, I’m simply referring to his involvement in the correspondence with me.
Lead 2A: Yes.
Professor Mark Woolhouse: And he was starting to ask questions that were the sort of questions I would, you know –
Lead 2A: Yes, we’ve heard evidence from him, for example, that he attended a number of the early SAGE meetings as an observer, where he was gathering information, and he was obviously then part of the discussions with you?
Professor Mark Woolhouse: Yes, but I – I mean, we’ve discussed before here that I don’t think and many other people think that those early SAGE meetings were doing a particularly good job of raising the alarm.
Lead 2A: Thank you.
After this of course you were attending SPI-M-O and you communicated, I think, some messages with information about what had happened at those meetings in early March to Dr Calderwood and Dr Smith; is that right?
Professor Mark Woolhouse: I did, so this became a modus operandi for us that I would brief the pair of them on the outputs of SPI-M-O. And I think – I think that was important. There were, as you well know, there were many sources of information coming in, but, in terms of the sorts of questions that needed to be tackled then, SPI-M-O was absolutely the repository of expertise and knowledge, and so I think it was – I felt it was important that they were fully appraised of what SPI-M-O’s thinking was.
Lead 2A: Okay. We’ve discussed the absence of certain features of the Scottish Government’s strategy before the first lockdown, but in that regard what was your understanding at this time within the Scottish Government of their planning with regard to the way in which Scotland might deal with a second wave of the virus were it to eventuate?
Professor Mark Woolhouse: I … I gave – in my briefings that we have been discussing to Catherine Calderwood, so this is – well, I think actually some of it’s even before we had cases in Scotland, but we’re – we have some idea of the sorts of social distancing intervention we might need. I said then that we were going to get – well, not that we’re going to get, as you well know I don’t do that, but we were very likely to get, should plan for the possibility of a second wave. And … do you want me to give the reasons for that?
Lead 2A: Yes, please, yes.
Professor Mark Woolhouse: Right. The reasons for that is I was acutely aware that lockdown or any combination of social distancing measures up to and including lockdown would not solve the problem. All they would do was delay the problem. And the first manifestation of that delay is, okay, you hit another wave, and then you push that – and I shared this scenario with them – you push that one down, the second wave, which as it happens in the briefings I gave was September 2020, the second wave, so pretty close, and you squash that one down and then you get another one in the early part of the next year. Now, you know, there’s no way you can predict with any precision how something like this is going to unfold over such a long timetable, so we wrote in very big letters in our graphs and briefings on this “This is an illustration, not a prediction”: this is the sorts of scenario that are coming up when we do our work, and we’re sufficiently confident in something like this happening, that the government should be aware of it and should be planning for it. I don’t think they had any understanding, not just in Scotland but in the UK, that they were going to get a second wave, that that was the likelihood, that they should be planning the expectation they’re going to get a second wave.
Lead 2A: Yes.
Professor Mark Woolhouse: I think there was a general belief that we would lock down, perhaps for a few weeks, and somehow the thing would be over. Extraordinarily naive view, but it clearly was circulating in political circles around the UK –
Lead 2A: And – and –
Professor Mark Woolhouse: – temporary measure.
Lead 2A: And indeed contrary, as you said, to the advice you were providing, about your experience of how these things tend to go, in the briefings you were giving directly to the Scottish Government?
Professor Mark Woolhouse: Yeah, more than how they tend to go and based on the best analysis we could possibly do of the data on this particular infection in the UK, in Scotland. So – so, no, not just based on expert guesswork, a lot more to it than that.
Lead 2A: At a general level as well, you say this both in your book and also in the evidence you have helpfully provided to the module, that you had the impression that the Scottish Government’s policy with regard to the management of the pandemic was that no death from coronavirus was acceptable. I’d be interested in knowing how you got the impression that that was the policy, if you like, or the approach, and also why it was you think that that policy caused significant problems.
Professor Mark Woolhouse: So I thought it because the phrase appears in the Scottish Government’s – I’ve got it here, framework for decision-making –
Lead 2A: – April document that I referred –
Professor Mark Woolhouse: – 2020, and because, as I recall, the then First Minister said it, on several occasions. That’s why I thought this was –
Lead 2A: Thank you.
The second part was why, if it is the case at that you consider it to be a problematic approach, it was a problematic approach?
Professor Mark Woolhouse: It’s empty rhetoric. It misleads everybody, it misleads – misleads the public. It gives an entirely false impression of what the future holds, how this pandemic’s going to look. The idea implies by “no Covid death is acceptable” is a world where no one dies of Covid. That had gone. That had gone from December 2019, that was – you know, as it turned out. But certainly I was clear it had gone by February 2020.
And that’s true, because this year, 2024, at current rates, and similar to last year, hundreds of people in Scotland are going to die of Covid. Is that acceptable? Well, we seem to be accepting it. I mean, that’s – there’s no great public health effort going on here to spare those hundreds of lives that are going to die of Covid.
And as an aside, I think we’re now not paying enough attention to Covid right now. It’s a serious infection. It’s killing people.
May I go on?
Lead 2A: Yes, please.
Professor Mark Woolhouse: The second issue is, okay, how are you going to achieve this “no death is acceptable”? The only possible way I could see of achieving it, other than literally some miracle cure, let’s leave that aside, is a zero Covid policy. And as I’ve explained to you before, the corollary of a zero Covid policy at that stage, this is April 2020 we’re talking about, is indefinite lockdown. And it would still fail eventually. You know, this was being discussed at the time, and of course zero Covid did fail globally eventually, and so therefore it was never deliverable.
And the other thing that upset me about this “no death from Covid is acceptable”, it devalues non-Covid deaths. And that isn’t just a sort of philosophical complaint. The intense, very strong advice in Scotland to spare the NHS during – particularly during the first wave, and not bother the NHS if you didn’t absolutely need to, led to a huge spike – well, first of all it led, as you’d expect, to a fall-off from a cliff, and the EAVE project, to what I was a part, studied this, on attendance at A&E or admissions to hospital. They just fell off a cliff.
Most of the hospitals in Scotland had their quietest time in living memory during the first wave, because no one else was going to hospital, and a lot of those people should have been in hospital. And in the UK thousands of them died at home. There was a massive spike in this. In Scotland I think it was probably hundreds, I wouldn’t want to put an exact figure on it. These people died. And so they died because the focus of the government was on preparing the NHS Scotland for Covid, and concentrating on that – because no Covid death is acceptable, other kind of deaths apparently are, and they rose.
Lead 2A: Thank you, Professor.
To put that in the language of the Scottish Government framework, there was a significant focus on harm 1, Covid-related harm and death, but too little concentration on harm 2, non-Covid-related harm and death?
Professor Mark Woolhouse: Absolutely, and – and that killed people.
Lead 2A: And one, it would be reasonable to assume, would it not – you mentioned the death – the non-Covid deaths, but of course there may be many people who have suffered significant morbidity as a result of not attending the hospital, whether that resulted in their death or not?
Professor Mark Woolhouse: Well, indeed. But, I mean, they – the non-fatal health harms went beyond that, and there was – we might come to this, there was a study looking at the sort of health effects of both Covid but also the implications of lockdown –
Lead 2A: Yes.
Professor Mark Woolhouse: – so the indirect effects of the countermeasures, and that showed, by their best estimation – this was done by the Office for National Statistics and the Department of Health and Social Care, across the UK – that actually those indirect harms, not so much during 2020 but accumulating over time, would be considerably greater than the harms that would be caused by Covid.
Sorry, having gone down this route, I must add an important rider.
Lead 2A: Yes.
Professor Mark Woolhouse: That is not a reason not to intervene against Covid. If you don’t, then that side of the scale increases enormously, so – but it is an indication that we haven’t got the balance right. So it’s confirmation, it’s another way of looking at the problem that you just highlighted as – in terms of neglecting harm 2, this is another piece of evidence that said: yes, we’ve neglected harm 2. But not just in the short term, in the longer term too.
Mr Dawson: Thank you.
My Lady, if that’s a convenient moment.
Lady Hallett: Professor, as you know, we take regular breaks for the stenographer. I shall return at 11.30.
(11.16 am)
(A short break)
(11.30 am)
Lady Hallett: Mr Dawson.
Mr Dawson: Thank you, my Lady.
Professor, we were discussing before the break your impression of some of the key Scottish Government policies towards the management of the pandemic and their effect. I just wanted to ask you about one particular thing you say in your statement which is related to the first lockdown, which is at paragraph 240, where you say:
“I do not know what Scottish Government’s understanding of the Covid threat was at the time Scotland went into lockdown, but I don’t believe that they truly accepted that the virus was here to stay. I am concerned that this short-term view of the crisis influenced both the politicians’ willingness to impose lockdown and the public’s willingness to accept it. The politicians were mistaken or misinformed and the public were misled.”
You’ve given some evidence about your general impression already. Is there anything, any element of that – anything you would like to add, based on that comment, in light of what you’ve already told us in this regard?
Professor Mark Woolhouse: Well, I can argue that what I say in that paragraph was correct. The reason I say that is because by the end of the summer 2020 Scotland was flirting with a zero Covid strategy. Well, that tells me that they didn’t accept that the virus was here to stay.
Lead 2A: And you think that was an important error in the way that they approached really the entire management of the pandemic, but certainly over 2020?
Professor Mark Woolhouse: I – sorry, what’s the error precisely?
Lead 2A: Well, the approach that – that their approach to the Covid threat was that they did not accept that the virus was here to stay.
Professor Mark Woolhouse: So I have to say I didn’t understand the Scottish Government’s strategy over the summer of 2020. The emphasis was on a very, very cautious relaxation from lockdown, and it seemed to be important to the politicians that it was more cautious than the one in England, so they were emphasising that. They didn’t articulate in any way that I understood what they thought the public health benefit of this caution actually would be, given what we’ve said about a second wave, and then they segued into this idea that actually the fall in cases in Scotland would somehow continue and we could end up in a zero Covid. So that, to me, was … I’m trying to think of a polite way of putting this. This was not consistent with the evidence that had been available since February 2020.
Lead 2A: So there’s two elements, I think, to that period. One is whether it was the best way to approach things to release the lockdown in the gradual fashion that the Scottish Government did, and secondly, whether the zero Covid policy that you understood to have existed within Scottish Government showed a misconception about whether that could be achieved and sustained.
So if we could try to take the two, one after the other. Just to put the first in context, you give an analogy at paragraphs 16 to 17 of your report, which I think attempts to try to explain your views on this, and I just want to try and unpack it a little, to do with a seesaw, whereby you talk about there being a difference between how far you go in relaxing restrictions and how quickly you get to that point.
Could you please explain your views about that in the context of the Scottish Government’s policy over that period which you’ve described?
Professor Mark Woolhouse: Yes. As I say, I didn’t – I don’t think the goals of the policy were clearly articulated. Not so much the immediate goals, they were laid out. I mean, May 2020 there was what was called a route map. So, I mean, that was clear, that was absolutely clear. But my concern, and had been for so many months, was: but what is the long-term plan? Where do you see this going? Where are we going to end up? And as you well know I was expecting to end up pretty much where we are now in 2024, but they didn’t seem to be thinking that way.
So the seesaw analogy is this: the emphasis on caution was somehow the idea that you could unlock – I think they – well, I’ll come back to this – all the way, you could come out of the pandemic by going very, very slowly, and the seesaw analogy is you’re standing, just you, on the one end of a seesaw, there’s a fulcrum in the middle of the seesaw, a tipping point, and the tipping point is actually the value R greater than 1, and the argument is – that I think the Scottish Government were making – is that if you go slowly enough along the seesaw you can go past the fulcrum and keep going. No. You can’t. It’s going to tip down. And I don’t think they understood that.
And I didn’t, I didn’t use the seesaw analogy at the time because I wasn’t absolutely sure that that’s Scottish Government thinking. But it became very clear to me it was when we got into the second Scottish lockdown, in January 2021, and repeatedly we heard that “We’re going to come out of this lockdown very, very slowly and cautiously, because we made that mistake before”. Well, no. That’s not – that’s not correct.
So what you have to avoid – what the strategy should have been was this: you can go as far as you can up the seesaw as quickly as you like, makes no difference at all if you take two great steps and get there, as long as you don’t go across it. If you want to go across it, then you have to do something else, you have to basically reduce the R number in other ways.
So what I wanted to see was two things. So one was immediate, much, much quicker than the Scottish Government did it, relaxation of restrictions that were not clearly going to take us to the tipping point – and do you want examples –
Lead 2A: For example, please, yes.
Professor Mark Woolhouse: Well, I can give you three.
Lead 2A: Yes.
Professor Mark Woolhouse: And there’s very, very good evidence for three now.
The stay-at-home orders, the fact that we were asked to stay in our homes. That was not contributing much, and – well, this is – this is getting complicated now.
Lead 2A: Okay.
Professor Mark Woolhouse: We can perhaps go back to a graph in the Scottish Government’s framework Covid document that shows this, but what that graph shows is essentially the R number coming down before we were told to stay at home. And when we were told to stay at home it didn’t actually come down any further. And actually it’s worse than that in Scotland, there are more ramifications –
Lead 2A: Just to pause at that point, what you’re telling me is that your scientific view was that the policy of gradually easing the lockdown didn’t make a great deal of sense to you, didn’t have scientific rationale?
Professor Mark Woolhouse: No, it –
Lead 2A: In particular – just take it stage by stage – in particular because your view was that you could get to the tipping point, ie release restrictions to a point where there was a degree of stability in the situation, and if you moved quickly towards that point rather than gradually, you would offset some of the ill effects of the countermeasures more quickly than a gradual release; is that broadly correct?
Professor Mark Woolhouse: Correct. I mean, the effect of the stay-at-home measures really – and they weren’t, I don’t think, released until May or June. I mean, it was ages before –
Lead 2A: And what I think you’ve identified is that there were a number of particular measures that you think could have been released more quickly?
Professor Mark Woolhouse: Two more.
Lead 2A: Yes, we’ll get on to the others, but just to take it stage by stage, Professor.
There were three particular types of restrictions that we all lived with that you think, based on that previous general rationale, should have been released more quickly, which would not have had a significant effect on the R number, and would have significantly released some of the other harms related to those restrictions being in place?
Professor Mark Woolhouse: Yes, not had no effect on the R number but at – given our understanding at that stage, we could be very confident they wouldn’t take us past the tipping point.
Lead 2A: Yes. The tipping point being?
Professor Mark Woolhouse: R becomes greater than 1.
Lead 2A: Yes, thank you.
Professor Mark Woolhouse: So one was stay at home, the second one was –
Lead 2A: Could we just deal with the first one quickly, just to be sure that we’ve understood this, because, Professor, it’s extremely interesting and important evidence and a number of people will be listening to this who perhaps need to be taken through it a little bit more slowly, just so we absolutely understand everything you say.
The first thing that you suggest could and should have been released more quickly, from a scientific perspective, in your analysis, was that the stay-at-home order could and should have been released earlier and you say that there is scientific evidence to say that that would not have tipped the R above 1?
Professor Mark Woolhouse: Yes, I mean, I would take that further, the stay-at-home order was never necessary.
Lead 2A: Right.
Professor Mark Woolhouse: The job was already done by the measures – and I say there’s actual evidence in the Scottish Government’s own report that that was the case.
Lead 2A: Yes, yes. So that is based on evidence which shows that the R was starting to decline even before the lockdown?
Professor Mark Woolhouse: Yes.
Lead 2A: Did that result from the fact that people were voluntarily imposing on themselves a degree of social distancing such that the R was starting to be brought under control without the need for that severe imposition of a lockdown?
Professor Mark Woolhouse: That’s my inference, and I think a good inference. There may be other explanations but that’s the one I would –
Lead 2A: Thank you.
Professor Mark Woolhouse: – highlight.
Lead 2A: And you were going to tell us what the other two significant restrictions were that you think could and should have been released more quickly?
Professor Mark Woolhouse: Outdoor activities. We had very good evidence coming back from China that the novel coronavirus transmits very poorly outdoors. Very poorly. So there was pretty much zero public health benefit to keeping us indoors. That was never required at all. We never needed to do that.
There are caveats, like if people are outdoors and being intimate, well, yes, okay, that’s something, but –
Lead 2A: Outdoors per se?
Professor Mark Woolhouse: Yes. There was never any need for that. And the evidence for that –
Lead 2A: Could I just dwell on that before we get to the third one, again.
Professor Mark Woolhouse: Yes, sorry.
Lead 2A: Just to understand, the restriction to stay indoors was something then that you say should have been released faster and earlier, in fact shouldn’t have been there at all –
Professor Mark Woolhouse: Correct.
Lead 2A: Would it be fair to say that had there not been restriction ongoing out of doors, that would have perhaps contributed to counterbalancing some of the other harms, such as the mental health harms or the physical harms that people might have started to suffer from being inside so much?
Professor Mark Woolhouse: Absolutely. But I heard or saw very, very little consideration for those harms when we went into lockdown. To be fair, they were, I think, fairly quickly recognised by Scottish Government, but when we took that decision I don’t think that was at the forefront of people’s minds. There was a lot of concern about how well people would tolerate lockdown, but that was an unknown. But I felt that discussion was more in the vein of, well, how long and severe a lockdown could we get away with, that the public would tolerate, rather than actually looking at evidence of components of it and saying we didn’t need them.
Lead 2A: Okay.
Lady Hallett: Professor Woolhouse, sorry to interrupt. When you talk about outdoor activities, are you meaning things like going for a walk in the park, or are you talking also about outdoor activities like football matches?
Professor Mark Woolhouse: Football matches were on the – on the cusp.
Lady Hallett: Well, because a lot of people are gathering, they’re going there by public transport, they might go to a pub together, all those different variables?
Professor Mark Woolhouse: Yes. That would – I mean, you would need to do, you know, a fairly detailed public health appraisal of where you drew the line. But we, in the UK, arrested people for going on solo walks in the mountains. It’s utterly absurd. That devalues the whole idea of social distancing, that anyone can see this is nonsense. But it was done.
May I?
Mr Dawson: Absolutely.
Professor Mark Woolhouse: Another good example, there was an absolute outcry in the summer of 2020 that people were going to beaches. There was never ever an outbreak of Covid-19 anywhere in the world linked to a beach. It was fine. People could go to the beach. But nonetheless we were very resistant to that.
Lead 2A: Thank you, Professor.
The third element that you were going to tell us about that could, should have been released more quickly was?
Professor Mark Woolhouse: So this is not in the category of things we knew well enough not to include them in the first lockdown.
Lead 2A: Yes.
Professor Mark Woolhouse: The first two we never needed.
Lead 2A: Should never have been –
Professor Mark Woolhouse: Yep. Third is schools. And it quickly became apparent through April and May 2020 that schools were contributing a little to the spread of the virus, but so little that there was essentially no danger that re-opening schools would take us past the tipping point.
Lead 2A: Just to pause there, I think – because you said it very quickly – I think you said there the closure of schools; is that correct?
Professor Mark Woolhouse: Yeah.
Lead 2A: It just wasn’t quite picked up by the stenographer.
Professor Mark Woolhouse: I beg your pardon.
So closing schools I accept as a – potentially as a precautionary element of the first lockdown, because, let’s face it, we were practically panicking at that stage, it was necessary, or justifiable, but we should have realised much, much more quickly, based on the evidence emerging from around the world, that this was not an essential element of our lockdown.
So in my view, and I – well, we’re going to this, I argued it repeatedly and frequently over that whole summer, schools in Scotland could have re-opened in May 2020, just as they did in Denmark.
Lead 2A: What about school closures as part of the second lockdown, which also occurred?
Professor Mark Woolhouse: One of the positive elements of the way the pandemic was managed in Scotland was that we were the first nation to re-open schools when, particularly in England, there was a lot of resistance to it. I think we did that partly – at least partly on the basis of the advice that came out of the Scottish Covid Advisory Group, which I was a part. I think that advice was too slow to pivot to it’s safe to re-open schools, but it did get there and we opened them in August. And I thought that was a real success story: an evidence-based decision by Scotland that was safe and so important to do.
Lead 2A: Mm-hm.
Professor Mark Woolhouse: And I was feeling that actually being an adviser was quite a good thing, that actually we could get things done that really helped. And then when we had the January lockdown, schools were closed again, arguably, because this was now the Alpha variant and there was more uncertainty, as a precautionary principle, yes, but it very quickly became apparent in that second wave that schools did not need to remain closed and we could still control the virus, and yet they weren’t fully re-opened here until May 2021. This was unnecessary. The – well … forgive me, this is one of the aspects of the pandemic management that I – I really feel very strongly, what we did to the children. And it would be bad enough if there was a detectable and measurable public health benefit to this, but there wasn’t. This wasn’t necessary, and we did it anyway.
Lead 2A: Could I just clarify one – it could be applied in connection with the schools, the evidence you’ve given, but it could be applied more generally. When you differentiated between the first two categories, which you say should never have been in place, and schools, which you accepted would have needed to have been in place but for a much shorter period than the restrictions actually applied, that is based on the position in which Scotland found itself when the lockdown was announced on 23 March; is that correct?
Professor Mark Woolhouse: It’s based on the evidence that was available when that decision was taken.
Lead 2A: Yes, but is it your position, if one takes it further back in our narrative that we have been discussing, to the discussions that we had about the warnings you were trying to convey to Scottish Government, if we were trying to assume a hypothesis which worked on the basis of those being heeded in the way that you had hoped they would be, would it have been possible to have avoided that happening in that scenario and, indeed, avoided a lockdown at all?
Professor Mark Woolhouse: Yes. May I hark back to Module 2?
Lead 2A: Yes, abs – if it puts it in the context which is required for Scotland –
Professor Mark Woolhouse: Yes.
Lead 2A: – that would be very welcome, thank you.
Professor Mark Woolhouse: So, Module 2, Mr O’Connor, who interrogated me quite hard about the difference between my maxim for managing this pandemic, of go early so you don’t have to go hard, and he pointed out Patrick Vallance’s counter, so – it’s that you should go harder than you want, earlier than you want, wider than you want. And Patrick Vallance, when he gave evidence after me, to Module 2, addressed this and he said “Well, yes, but how hard? You know, Professor Woolhouse says you don’t have to go so hard but you still have to do something, so is that not pretty much the same thing?” That was his argument. Well, my counter to that is no, it’s not, for the reasons we just gave.
So if we had gone earlier and done all the things, apart from the three I mentioned, and seen them working, we would never have had to close schools, we would have seen it wasn’t necessary. So I don’t accept Patrick Vallance’s counter to that at all. You know, his – his strategy led to us closing schools, mine would have let them stay open the whole pandemic.
Lead 2A: Thank you.
Could I address another general concept which flows through all the evidence I think that you’ve given, which we’ve touched upon, and again, to try to use the – developing a theme we’ve talked about earlier in the context of zero Covid policy, to use the language of the framework, the area that I’d like to explore with you is the extent to which the – what you perceived and understood the greater focus on harm 1 to be resulted in harms 2 to 4 being much worse than they really should have been.
Broadly speaking, can you explain, Professor, your view as to whether the Scottish Government policies took adequate account of the – we’ve already covered non-Covid health harms, but wider societal and economic harms?
Professor Mark Woolhouse: Very simply, in my view, no, they did not. But then we get into this very difficult territory, which the politicians exploited a lot, if you don’t intervene as hard, more people will die. And since they were working on this maxim that no Covid death is acceptable, clearly that’s not something they’re going to do. So, in order to counterbalance these relaxations you have to do other things. And not only me but Scottish advisory group was very clear on the other things you could be doing to keep the R number low but still allow you to relax restrictions and therefore avoid a lot of the harms that were being caused, harms 2, 3 and 4 as you say.
Lead 2A: We have evidence available to us from Scottish Government that during the course of 2020 for differing periods at different times a number of advisory bodies separate from the body to which you were affiliated, the Scottish Covid Advisory Group, were set up in order to try to provide advice and evidence, information, to the Scottish Government about a wide variety of things, including things that might broadly be described as falling in harms 2 to 4.
The remits of those groups are all set out. But if your position is that ultimately, in terms of effect, the Scottish Government’s policies failed adequately to recognise those harms over the course of the pandemic, must it be the case that those systems were ineffective, in that the ultimate impact from harms 2 to 4, as I understand your evidence, was larger than it should have been?
Professor Mark Woolhouse: I think to a large extent the four harms policy, which – when the four harms were first mentioned I was greatly encouraged.
Lead 2A: Yes.
Professor Mark Woolhouse: I was thinking – it was rhetoric, it was rhetoric. The emphasis was overwhelmingly on harm 1, even when, particularly during summer 2020, the public health benefits of continuing to suppress the virus were extremely small.
Lead 2A: Thank you.
I’d just like to focus in, we’ve talked about it already, the period when the cases started to rise again which eventuated in the second lockdown. Is it your view, in relation to any of the harms, frankly, that – the harm that you’re focused on, harm 1, or any of the other harms – that you think the Scottish Government learned lessons about the experience of the period up till, say, September 2020, as regards how best to manage the pandemic, or that they repeated the same mistakes?
Professor Mark Woolhouse: I think – now, the second lockdown in Scotland of course was January.
Lead 2A: Yes.
Professor Mark Woolhouse: And cases rose in the autumn, as you said, in the second wave, but also came down without a full lockdown in Scotland.
Lead 2A: Yes.
Professor Mark Woolhouse: So that – and that was a big difference from England. And may I –
Lead 2A: Just to be clear, there were – there was not a full lockdown, what’s known in the other nations as a circuit-breaker lockdown, but there were significant restrictions at times –
Professor Mark Woolhouse: Yes –
Lead 2A: – over the –
Professor Mark Woolhouse: – and I think – sorry, I’ve completely diverged from your original question, can I address this point and then come back to –
Lead 2A: Absolutely, thank you very much.
Professor Mark Woolhouse: Right.
I think one of the reasons that we didn’t, in lockdown – sorry, didn’t in Scotland go into that November lockdown was it would have been counter to the advice coming out of the group I was on, Covid-19 Advisory Group. We were not in favour of a lockdown at that stage. And, as I say, we had proposed many other interventions that would reduce. But even though most of those weren’t taken up, in fact we didn’t need the lockdown in Scotland.
Lead 2A: Just to be clear, Professor, you mentioned November, which is obviously when the English lockdown –
Professor Mark Woolhouse: Yes.
Lead 2A: – took place, there were other lockdowns, over that whole period, really from September onwards, there was consideration of a circuit-breaker; did it remain the Scottish Government Covid Advisory Group’s position that they didn’t recommend a circuit-breaker over that whole period?
Professor Mark Woolhouse: Correct.
Lead 2A: Thank you.
Professor Mark Woolhouse: Yes, and again harking back to Module 2 I’m afraid, I know the Inquiry was given evidence from a number of very distinguished scientists and advisers about the inevitability that this second lockdown in England was absolutely essential for controlling the virus. Well, we didn’t have one in Scotland and we controlled the virus. So I have to say I think that simple fact rather discredits all the evidence the Inquiry’s heard on this point before. Scotland proved what I have been claiming, that that second lockdown in England was unnecessary. It wasn’t necessary here, it wasn’t necessary in England either.
Lead 2A: Thank you. As regards the second lockdown in Scotland?
Professor Mark Woolhouse: Right, the second lockdown in Scotland was – was January. And yes – you asked me if Scottish Government had learnt some lessons. They learnt some. So the restrictions that were imposed on us during that lockdown were definitely less severe, the very strict stay-at-home orders, the amount of time you could spend outside, those were relaxed in that second lockdown. So that’s fine. And again proof of principle, even with a more infectious variant of the virus we didn’t need them, we still controlled it, so that proves what I was saying about the first one, we didn’t need those elements, but sadly they did close schools and kept them closed, so they didn’t –
Lead 2A: Which we’ve –
Professor Mark Woolhouse: Yes, but – well, I don’t understand how we went from the position of actually being quite evidence-based about decisions on school closures to suddenly forgetting all that in early part of 2021. It baffles me.
Lead 2A: And if I might ask again a question, a broad question, about the approach to the period thereafter, because the Inquiry has heard significant evidence about, as a result of Delta and then subsequently Omicron towards the end of the year, Scotland having very significant cases, even in comparison, obviously, the infectiousness of Omicron was higher, but the numbers compared to the rest of the UK being highest in Scotland, Scotland suffering a significant mortality, almost to the same level as the first two waves, in what one might describe as the third wave, and the NHS being driven to the point of procedures having to be cancelled, the military having to be called in to provide assistance.
One of the things that we noticed was that from June 2021 that the group that you sat on, with a considerable amount of expertise, sat much less frequently in that period. Other than a cluster of meetings around about December 2021 it sat really monthly, we think, from June 2021, at a time when the cases started to rise again as a result of Delta.
Do you feel that at that stage, although you’ve pointed earlier to there being a focus on harm 1, that there perhaps was an insufficient focus by that period on trying to control what was going on, such were the consequences which we’ve seen?
Professor Mark Woolhouse: I do. We’re now at that stage learning what living with this virus looks like, and it’s not pretty. It’s a serious infection, it’s causing a lot of disease, some death, it’s causing Long Covid as well, it needs to be managed. That doesn’t mean we have to lock down, close schools again, but it means we do need to manage it.
This is not a public health problem that has gone or is ever going away, we’re going to need to manage it for the foreseeable future.
Lead 2A: And do you think that given certainly the comparative levels of infection and mortality that it was mismanaged over that period?
Professor Mark Woolhouse: It’s your word, not mine, I hadn’t used that before, but I – the phrase I use, that I don’t think we paid sufficient attention to it throughout there. But, I mean, of course, attention was reactivated during the Omicron wave, and now we’re back to a stage where we’re not paying much attention to it.
Lead 2A: Thank you.
Could I ask you just one further series of questions. You were a member of the Scottish Covid Advisory Group, as we have established.
Professor Mark Woolhouse: That’s correct.
Lead 2A: As a member of that group or in any other capacity, did you have any means by which you could contact Scottish Government ministers directly?
Professor Mark Woolhouse: I don’t – I mean, I imagine I could have done if I’d wanted to, but I had – I wasn’t – there was no channel set up for me to do it. I could have cold called them, I guess, but I did not do that and I – I wouldn’t have done it at that time because there was now a formal advisory structure that I was part of.
Lead 2A: Did you contact or have any means of contacting any government ministers by email, telephone or other informal messaging systems?
Professor Mark Woolhouse: I never looked to see if I had their email addresses, it never – it never came up. I think I had the First Minister’s office email address because we actually – my group did a dashboard that – among other recipients of that was her office. But, so I suppose I could have contacted her through that way, but I didn’t do it.
Mr Dawson: I’ve no further questions, my Lady. I’ll just check. There are no core participant questions.
Questions From the Chair
Lady Hallett: I have just one question, I just want to make sure I’ve got down your evidence correctly, Professor Woolhouse.
Going back to the very cautious approach to the Scottish Government to relaxing restrictions, you said that the Scottish Covid Advisory Group were very clear on the other things that could have been done rather than just being very cautious, which you said wasn’t necessary because of the seesaw effect.
What other things do you think could have been done as opposed to being very cautious about relaxing restrictions?
Professor Mark Woolhouse: So the Scottish Government strategy didn’t pay no attention to this at all, it put all its eggs in one basket, as far as I could see, really, which was Test – what we called here Test & Protect, so – and it – it didn’t prove sufficient by itself, as we saw during the second wave, to really keep on top of any possible resurgence, but – so there were three …
So Scottish advisory group wanted to strengthen that, and there were two mechanisms for doing so. First of all, to increase compliance with the need to self-isolate. There was evidence that there was a lack of compliance, so we wanted to do that. I was very concerned about the fact that even in the second half of 2020 in Scotland we were only finding half the cases. We only knew this because of the Office for National Statistics surveys that started up, but we were only finding half the cases. If we could find the other half, we could obviously strengthen the whole Test & Protect system enormously. So that was something.
I had introduced into the discussion as early as March 2020 that we needed mass testing, and the advisory group repeatedly referred to the potential of mass testing all the way through that summer and into the autumn. It was trialled in England in November of that year but it wasn’t rolled out in Scotland for another year, the Omicron wave, so we didn’t do it.
And the final thing that we wanted to do was, going right back to almost the beginning of this discussion, was do more to protect the most vulnerable, because Scottish Government never embraced fully the idea that you could do more to protect the vulnerable, and that would just directly save lives. It doesn’t matter what else your strategy is, it could be anything – you know, we don’t have to argue about the strategy – just the plain fact of if you protect people who need protecting, fewer people will die. And they never embraced that, and yes, that was a big disappointment.
Lady Hallett: That’s not as straightforward as just saying “We’re going to put an iron curtain around a care home”, for example, because care home workers move between different care homes and the like, and they themselves obviously get infected, you have a shortage of staff, so it’s not as straightforward just to protect the vulnerable, is it?
Professor Mark Woolhouse: No, protection of care homes was better in the second wave, considerably better. So it’s not straightforward – so – and you’re right, if you want to avoid the harms of restrictions, all the way up to lockdown, you have to do the work, you’ve got to put the effort in, you’ve got to invest the resources, the time. And most importantly of all, you’ve got to see it coming and plan ahead. And when we have a government here that, in whenever it was, July/August was talking about zero Covid, they have clearly – clearly – not got their minds on preparing for future waves that will necessitate these alternative interventions, they’ve got – their thinking is completely in the wrong direction. So it’s not going to happen, is it? And we didn’t. We didn’t make the investment in all those alternatives.
Lady Hallett: So although you accept it wouldn’t be easy, you think there are ways, if people had put enough effort and planning and resources into it, it could have been done?
Professor Mark Woolhouse: Oh, absolutely. And actually though the most effective of these was the mass testing, which I’ve said I have been advocating for so long. I see that as – coupled with a vaccine, which is obviously important, but the reason why we managed to bring Omicron under control without going back into lockdown, and lockdown was being talked about in that period, that – it was the mass testing, I think, that kept us out of lockdown. Well, if we’d introduced it in Scotland and elsewhere in late 2020, when we had the technology, we knew it worked, we wouldn’t have needed a second lockdown here. We could have tested our way out of it. But we took another year to roll that out.
Mr Dawson: Thank you, my Lady. There’s just one matter I was going to bring up. The professor earlier talked about email correspondence he had had with Dame Sally Davies, which you will recall led to Dame Sally contacting Dr Calderwood, and he suggested that we had access to his email to Dame Sally, which indeed we do. Just to read it into the transcript for others who may be interested, the reference is INQ000352401.
Thank you.
Lady Hallett: Thank you very much indeed, Professor Woolhouse. I don’t know if I can say I’m not going to ask for your help again, but thank you very much for the help you’ve given so far.
The Witness: Thank you, my Lady.
Lady Hallett: Thank you.
(The witness withdrew)
Mr Dawson: The next witness, my Lady, will be Professor Stephen Reicher. Ms Arlidge will be asking the questions.