2. Dr Roland Salmon

DR ROLAND SALMON (sworn).

Questions From Lead Counsel to the Inquiry for Module 2B

Lady Hallett: I hope we haven’t kept you waiting too long.

The Witness: No.

Mr Poole: Dr Salmon, could you please start by giving us your full name.

Dr Roland Salmon: Yes, I’m Roland Laurence Salmon.

Lead 2B: Dr Salmon, thank you very much for attending today and giving your evidence. If I can just ask you to keep your voice up so that we can hear you, also so your evidence can be recorded. And if I ask you anything that isn’t clear, please do ask me to rephrase it.

Now, you have kindly given a witness statement to this Inquiry, INQ000224354. We can see that on the screen. We don’t need to go to it, but at page 16 you’ve signed and dated this statement on 14 July last year, are the contents of that statement true to the best of your knowledge and belief?

Dr Roland Salmon: Yes, they are.

Lead 2B: Dr Salmon, in terms of your professional background and career, between 1990 and your retirement in 2013, is it right that you worked as a regional epidemiologist for the Communicable Disease Surveillance Centre Wales, and from 1998 you were its director?

Dr Roland Salmon: Yes, that’s correct.

Lead 2B: You spent eight years, up to 2019, as a member of the Department of Health’s Advisory Committee on Dangerous Pathogens, including two years as acting chair and eight years as chair of its transmissible spongiform encephalopathy working group; is that right?

Dr Roland Salmon: Yes, that’s correct, I was succeeded by one Chris Whitty.

Lead 2B: The Inquiry knows him well.

From 2003 to 2013 you were a member of the Scientific Advisory Committee (Conseil Scientifique) of the French National Institute for Public Health

Surveillance and subsequently, until 2016, a member of its management board; is that right?

Dr Roland Salmon: That’s correct.

Lead 2B: I think you have been a senior crematorium medical referee for Cardiff Council Crematorium since 1999; is that also right?

Dr Roland Salmon: That’s also correct.

Lead 2B: In terms of your role in the Welsh Government’s response to the pandemic is it right you never sat on TAG or TAC or any of their subgroups?

Dr Roland Salmon: I had no formal role at all.

Lead 2B: And is it right you had no formal communication at any level with the Welsh Government or its advisory groups throughout the pandemic?

Dr Roland Salmon: Yes, that’s also correct.

Lead 2B: Now, I plan to ask you some questions in a moment about the overall notion of population immunity and shielding, but first, if I may, I want to address some comments you have made concerning the pre-eminence of modelling and modellers in the pandemic and the figures that those modellers used.

Now, in your witness statement you have commented that in TAC it was, your words, “mathematical modellers that dominated the agenda”.

Now, you have obviously confirmed you were not a member of TAG or TAC. The Inquiry has heard evidence from a member of TAG and TAC a moment ago, Dr Chris Williams, who was a consultant epidemiologist. The Inquiry has also received written evidence from other members of TAG, so Jonathan Price, he is the chief economist, Dr Catherine Moore is a microbiologist, Dr Brendan Collins is the head of health economics, and later on this afternoon we will hear from Professor Ann John, who is an expert in public health and psychiatry. So on the face of it the membership of TAG appears broad. I just want to understand the basis for your comment in your statement that it was mathematical modellers that dominated the agenda.

Dr Roland Salmon: Yes, certainly. I mean, you’ll be the first to point out, Mr Poole, that that is, of course, hearsay, and I would be the first to concede that point, and to recognise that there were – as I think I put in my statement, there are a number of other individuals with other skills particularly relevant to communicable disease.

However, the outputs and the emphasis that was put on particularly the R number and on social distancing suggested to me that the particular discipline of mathematical modelling was rather more dominant. And I also drew on my own experience of being on these sorts of committees, and we had of course had interaction with mathematical modellers on the Advisory Committee on Dangerous Pathogens, on the committee in France.

And one of the things which you will find with any group of scientists in the room is that there will be a number of opinions, or at least two or three opinions. They have to be synthesised in some way. And then of course along come the mathematical modellers with some very neat numerical constructions, and there’s always a little bit of a tendency to heave a sigh of relief and to follow the way that that guides.

And in many ways that can be very helpful, but you do have to detach yourself a little bit from that and ask: well, how do these models, in my own qualitative assessment, relate to the infectious disease problem as I see it? And I didn’t get a sense of that happening. Particularly from the public commentaries from TAC and particularly on one of two of their online published outputs.

Lead 2B: So is the problem you describe perhaps less a TAG and TAC issue, is it more a political one? Might it be said that – so one of the roles of, say, a Welsh minister, a non-expert in the field, is to receive the technical, the scientific advice, the modelling advice and weigh that up against other kinds of impacts and harms; would that be fair?

Dr Roland Salmon: I think that’s fair, and I think it’s very fair to say that: does the problem exist with the construction of the advice, its communication or its reception? And I think, frankly, problems can occur at any one of those stages.

Lead 2B: We are going to hear later on this afternoon from Professor Michael Gravenor. He was one of the modellers with TAG and TAC. He explains in his witness statement that the problem wasn’t with too little modelling per se but with the fact that there was insufficient data and capacity to build sophisticated models accounting for, say, economic impact, social harms, indirect health harms and so on, to be able to fully model the impact of NPIs. Have you got any comment on that statement?

Dr Roland Salmon: I mean, only to say that that is true and that is a common complaint that you hear.

Lead 2B: Changing topic, then, and moving to population immunity or, as some refer to it, herd immunity. You have said in your statement at paragraph 16, just to sort of orientate you, you say:

“Herd immunity is not a strategy but rather a time honoured epidemiological term that is used to characterise the resistance of a community to an infectious disease.”

Now, that statement is uncontentious, but perhaps you can explain to those following the evidence what you mean by that.

Dr Roland Salmon: Yes. I think I mean to – I mean, I think that the quote that I’ve put in there describes it very clearly and I’m not entirely sure how I can improve upon that, but I think it describes the circumstance where sufficient people have been exposed to a disease previously that new introductions of an infection can’t hold and spread – can’t get a hold and spread to any appreciable degree.

Lead 2B: Now, as a perhaps important caveat, it’s right, isn’t it, that the notion of population immunity was built into modelling work that was done by SPI-M and SAGE? So it’s not as though they ignored it altogether, they accounted for the fact that as community transmission figures grow, at some point people will develop immunity, so the virus peaks and case rates fall?

Dr Roland Salmon: Yes, I mean, that is one of the ordinary underlying assumptions of what’s called SIR modelling, which I think was the predominant form of modelling used both by SAGE and with TAG. Though, as you point out, I wasn’t there, so I can’t say that with any certainty.

Lead 2B: Likewise, by late February 2020, so when containment had ended in the UK, the scientific and policy approach was not that Covid could be suppressed indefinitely, which – the knock-on effect of that is that almost every conceivable long-term strategy for tackling the pandemic would involve some form of herd immunity, really would you agree the issue for the politicians and the decision-makers was: what is the best way to get there?

Dr Roland Salmon: Yes, I mean, I would go further than that, I think that was always the issue right from the outset. I mean, you provided me with Professor Whitty’s statement to read as part of the evidence bundle and he does a briefing note for the special adviser at Number 10 Downing Street on the – I think it’s 28 February 2020, and when I look at that his summary of the situation and the possibilities I have to say is almost exactly the same kind of parameters of any summary that, had I had to write one, I would have come up with.

Lead 2B: Moving on then. Am I right in summarising your position in the following way: that the epidemiological notion of acquiring population immunity can be part of a policy of managing Covid-19 in a population as an alternative to the imposition of stringent population wide NPIs? So that policy would be one of, I think you used the phrase, “focussed protection” of the most vulnerable to Covid-19?

Dr Roland Salmon: Yes, I mean, I suppose the problem I have is that I consider the policy to represent what you would do either as a politician or a public health agency, and you don’t “do” herd immunity; herd immunity or population immunity is where you might get to, dependent on what the actual actions you take are.

Now, the actions that were taken were rather stringent lockdown measures. My own view was that measures more focused on the individual would deliver a similar position eventually. But I think you’re right to say that in both of them the state of population immunity features is an important end point.

Lead 2B: You say in your statement that acquiring population immunity is more of a beneficial byproduct of the strategy of focused protection?

Dr Roland Salmon: Yes.

Lead 2B: Is it perhaps not more accurate to say that population immunity and focused protection are really two sides of the same coin? So, for those who are vulnerable, for them to return to a semblance of a normal life, the population around them needs to acquire a degree of immunity, thus enabling vulnerable individuals – we’re obviously talking in a pre-vaccine world here – to receive healthcare, receive visitors, go into their communities and so on; is that right?

Dr Roland Salmon: I mean, I’m – I suppose I’d say you’re welcome to make that distinction. It’s not one I would feel particularly necessary to make. I think – or the way I’ve described it as a byproduct probably has sufficient clarity for everybody’s understanding.

Lead 2B: Now, I just want to go through some of the concerns that have been expressed about this general approach, just to –

Dr Roland Salmon: Yeah.

Lead 2B: – get your comments on them, please, Dr Salmon.

First, Professor Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, also a member of SPI-M, he has said in his statement to the Inquiry in Module 2 that it was not known in the early stages of the pandemic whether the immunological resistance acquired from catching and recovering from Covid would be 100% effective in preventing reinfection.

So just pausing there, this means that allowing the disease to move through the population in, say, March and April 2020 without any guarantee that previous infections would ensure immunity would be a highly risky strategy. Do you agree with that?

Dr Roland Salmon: Well, actually I don’t. I mean – and interestingly I think there are some contradictions in Professor Woolhouse’s own witness statements in this.

I mean, he makes the point that if you had taken more modest interventions somewhat earlier than they were – I mean, he uses it – calls it cocooning, I call it focused protection – then it would have been possible to detach the epidemics that were taking place among vulnerable populations in places like hospital and care homes from the wider transmission in the community. I think that’s correct, and I think that transmission in the community might reasonably have been expected to bring with it a measure of protection.

Now, you wouldn’t have known how much until the epidemic had progressed, but I think you would have felt reasonably confident that you would have – while that was happening, be protecting the most vulnerable elements of society.

Lead 2B: So do you take exception with me describing it as a highly risky strategy? Would you accept that it was a risky strategy then?

Dr Roland Salmon: I mean, I think it would have been a relatively straightforward and safe strategy and I think many of Professor Woolhouse’s own comments tend in that direction.

Lead 2B: Another concern, and do correct me if I’m wrong, with the approach of a protect vulnerable individuals while allowing population immunity for everyone else, is that does it not assume that population immunity could be reached within a matter of months or within a short period of time?

Dr Roland Salmon: Well, no, it doesn’t. I mean, it will take as long as it will take. I mean, I think the question you have to ask yourself are: what are your alternatives given the disruption that other approaches will take?

Yes, ideally you would hope it would arrive relatively quickly. I mean, there is an interesting historical example that I think Professor Heymann introduced at the very beginning of the proceedings of the Inquiry, and that’s the coronavirus OC43, which was almost certainly a pandemic virus at the end of the 19th century, yet, certainly by the time we’re able to identify it and study it, we think of it as a common cold virus and it seems quite likely it transitioned to that stage in a relatively short space of time. So there were reasonable biological grounds for a degree of optimism about what would happen here.

Lead 2B: Related to the point I just made about the population immunity might take a significant period of time is a point that Sir Chris Whitty makes in his evidence in Module 2. His witness statement is at INQ000248853, and we’re looking at paragraph 6.23.

Sir Chris says:

“The biggest scientific weakness is that it starts from the thesis that inevitably herd immunity will be acquired if you leave things long enough. That is not the case for a very large proportion of the most important diseases in the world. For most of the major disease I have worked on, you never acquire full herd immunity. Basing a policy on the assumption that eventually immunity in the less at risk population will protect the others is not a safe starting point.”

What do you say in response to –

Dr Roland Salmon: Well, this is very like –

Lead 2B: – so –

Dr Roland Salmon: This is very like a comment he made in the BM – British Medical Journal, and I frankly thought it was bizarre, because your jumping-off point – and the examples he used in the British Medical Journal were the Ebola virus and the human immunodeficiency virus, HIV. Now, of course your jumping-off point for any consideration of your strategy is the biology of the virus that you’re dealing with, and those viruses are so fundamentally different in their properties that, yes, of course you wouldn’t adopt a herd immunity strategy for them, but my point is that the underlying virology of the coronavirus is such that that becomes a reasonable option and, in my view, one that – about which you could have made relatively optimistic predictions from a fairly early date.

Lead 2B: There are a few other concerns that have been expressed with a focused protection policy. If I just outline a few of them so we can know your response –

Dr Roland Salmon: Please.

Lead 2B: – Dr Salmon.

Dr Roland Salmon: I’d be keen to respond, to be –

Lead 2B: First, people who are not in the vulnerable group will contract Covid-19 and die, so this would happen at greater numbers due to a greater rate of transmission before – obviously we’re talking before vaccine development. I mean, do you agree with that?

Dr Roland Salmon: I’m not convinced about that either. I mean, what you’re talking about is how do these different strategies work out in practice. Now, the strategies that we did adopt, with the rather extensive lockdowns, also – because, I would argue, of the loss of focus, also resulted in rather large casualty rates among the vulnerable in care homes and hospitals.

Now, it’s quite true that you have to craft your focused protection rather carefully and it’s also true that you might modify that as it goes along. But I don’t see that intrinsically that would necessarily lead to more infection in a wider population, and indeed it might lead to less infection of vulnerable people due to, a point that I also make in my witness statement, that the number of severe cases is not merely, as John Edmunds erroneously said, a function of the number of cases, it’s also a function of the time over which the virus circulates. The longer it circulates, the more opportunity it has to go into those risky situations, like care homes, like prisons, like meat factories, like hospitals, where it will infect vulnerable people with, you know, the sorts of consequences that we’ve seen.

So, as I say, I don’t accept actually the point that Professor Whitty is making here.

Lead 2B: Now, it may be that you will give the same answer to this next concern that you’ve just given, because another concern about focused protection is that hospitals would exceed capacity and not be able to provide other required forms of urgent care, let alone treating those that require assistance with Covid-19. Do you agree or disagree?

Dr Roland Salmon: I mean, as I say, I think my previous answer substantially addresses that point.

Lead 2B: What about, finally, the effect of focused protection on Long Covid? That’s entirely unknown and could be severe and significant?

Dr Roland Salmon: Yes, I mean, Long Covid is one of the unknowns in all of this. I mean, it’s less unknown now than it was, and I … I can’t claim I’ve looked at this in a lot of detail but there were papers in The Lancet from an Oxford-based group, based on millions of health records in the United States, and the takeaway message from that is not that Long Covid is trivial or that we can discount it, not at all, but that it’s very similar in both its frequency and in the range of symptoms to long forms of other viral and infectious diseases, which we know exist and which we co-exist with.

I have some knowledge of this because in the late ’90s, with Dr Sharon Parry of Cardiff University, we did a long paper for the Health and Safety Executive on the chronic sequelae, the chronic consequences of infectious diseases.

So whilst I, as I say, fully acknowledge the uncertainties around Long Covid and I fully acknowledge its seriousness, it seems to me it’s of a piece with consequences from other infectious diseases about which we don’t take similar protective measures.

Now we need to understand all of these a lot better and if Covid gives a stimulus to research into this sort of thing, I feel that can only be a good thing, but what I don’t think it calls for is particular extra preventive measures over and above those that are used for acute Covid, because the final point is that the very – the worst, the most serious sequelae of Long Covid appear to be proportional to the seriousness of the initial illness. So inasmuch as we control that initial illness and control its serious forms, whether by vaccination, whether by letting the vaccine(sic) circulate among people when they were younger and safer, rather than letting them get to being old and vulnerable, we will also be preventing the worst aspects of Long Covid.

Lead 2B: Dr Salmon –

Lady Hallett: Are you moving on?

Mr Poole: I am, my Lady.

Lady Hallett: Can I just ask, I don’t know how easy it is to do in a few sentences, but could you give me some practical information on how focused protection would work? In other words, supposing my mother was still alive and living alone – I mean, how do you find the vulnerable – what place – what measures do you put in place? How does it work?

Dr Roland Salmon: Yes. Sure. This was the kind of thing that I was trying to address when I wrote to a number of politicians here in Wales. And I might commend the correspondence I have with Rhun ap lorwerth to you.

I mean, essentially for the vulnerable population it doesn’t look terribly different from the lockdown that they had already. What is rather easier for them, however, is that services around them should be working rather better.

I feel that on top of that shielding of those high-risk individuals, like your mother, for example, would be particular attention to the locations which we rapidly identified were a risk for spreading the disease – we’ve talked about these a lot – hospitals, care homes, prisons, meat factories. That is where I would have used test and trace, particularly when the numbers of tests available were rather limited.

And there is a very simple reason for that. I mean, I’ve done my share – not as much as the environmental health officers – of chasing people around the community and trying to actually manage a system of contact tracing in a wider community. It’s extremely difficult and resource-intensive. Whereas if you have a population for which you have a convenient register and you know who they are and you wish to stop the spread among them, whether that’s staff of a care home, staff in a hospital, that is much easier to organise in an efficient and effective way, and actually eliminates the largest part of the problem.

The final thing I would have done, and again I mention this in my letter, is promoted the use of protective equipment in at-risk occupations. And again, in the first two or three months of the epidemic we were pretty clear what those occupations were. I mean, it is an abiding scandal that the PPE stocks had been depleted between 2009 and 2020.

So I hope that gives you a feeling for how I see this would work out in practice. And this was the suggestion, as I say, I made to several Welsh politicians, I mean, largely on the ground that they were contemplating the firebreak, which struck me as a thoroughly bad idea, but Mr Poole may well wish to come on to that.

Mr Poole: Dr Salmon, let’s just explore this then a bit further with you, because I think the letter you’re referring to is the letter of 18 October 2020.

Dr Roland Salmon: Yes.

Lead 2B: So we’ve got that displayed, INQ000130868.

Who did you send this letter to? I think you’ve said –

Dr Roland Salmon: Oh, gosh.

Lead 2B: – Welsh ministers?

Dr Roland Salmon: Yeah, it’s – do you want me to run through –

Lead 2B: I don’t need an entire distribution list, but just give me a sense of who was in the –

Dr Roland Salmon: I essentially sent it to politicians – I’ve had a long career in Wales, and Wales is not a big place, so I essentially sent it to politicians I had met under some other heading in the past.

That was two Plaid Cymru politicians, Dai Lloyd and Rhun ap Iorwerth, the Conservative leader, Andrew RT Davies, and three Welsh ministers, Mark Drakeford, Vaughan Gething and Julie Morgan.

Lead 2B: Thank you. If we have a look, please, at the second paragraph, you list the matters that the letter concerns.

Number 4:

“Workable approaches centred on the person (‘targeted shielding’, ‘focussed protection’).”

Which is what you’ve just been –

Dr Roland Salmon: Yeah, I –

Lead 2B: – my Lady.

If we go to that section then of the letter, I think it’s page 2, you describe here how the framework would work in practice, and you suggest at (i) at-risk people, at-risk locations and – thank you – and then, over the page, to – the next page – at-risk occupations, which you’ve just alluded to.

In terms of at-risk persons, you say:

“Effectively shield vulnerable people by a combination of advice to (to wear masks, avoid situations where they couldn’t control their personal space) and the necessary social support to make this do-able.”

Then in terms of at-risk locations, the next bullet point, you say:

“Ramp up infection control and bring in regular screening and exclusion of infected/symptomatic persons from locations where spread occurs readily. This would include:

“• Hospitals

“• Care Homes

“• Meat Factories

“• Prisons

“• Universities”

And I just want to focus, in the time we’ve got, on those two in particular, because it is known that the vast majority of deaths from Covid-19 in Wales occurred in hospitals and care homes.

Some of those deaths in hospitals were of course contracted in the community but we also know that rates of nosocomial infection were high throughout the pandemic.

Professor Woolhouse has said about this, he says it wasn’t made clear how well the vulnerable segment could be protected from infection in practice.

Now, the Inquiry understands from February to March 2020 Public Health Wales and NHS Wales were devoting considerable effort to infection control measures, testing staff and patients, attempting cohort infectious and non-infectious patients and care home residents, and so on, and yet still Wales had a significant number of deaths amongst those who were being shielded, and that was a pattern that was seen across the whole of the UK.

Now, against that backdrop, Professor Woolhouse’s comments might seem like an understatement. I mean, what effective practical protections could have been provided to those who needed to shield from March 2020, that were available in March 2020, that were not provided to vulnerable people in hospitals and care homes in Wales?

Dr Roland Salmon: I mean, okay. I think shielding of vulnerable people at home just to dispose of that first was precisely the sorts of things that people were doing on their own initiative before the lockdowns were brought into place, a point, again, that I think Professor Woolhouse rightly makes.

In terms of protection in the location, like hospitals and care homes, I’m not going to sit here and pretend there are any very easy solutions to this. I just I think would make the point that it didn’t become any easier to do this because the whole of the population was locked down. In fact, quite the reverse. A degree of lack of focus, in my view, made spread in those particular locations occur more readily. I mean, the sort of things that you have to do, having adequate personal protective equipment and having adequate capacity to test and trace, probably should have been anticipated on the basis of the pandemic flu plans and yet apparently hadn’t been, and – yes, I think that I’ll conclude there perhaps.

Lead 2B: Would you agree that targeted shielding for social care workers in March would have been extremely difficult, would it not? You have a finite number of care workers, you have care homes that were not set up to enable isolation rooms and cohorting, and on top of that you have a business model predicated on social care workers moving between sites.

Dr Roland Salmon: I mean, all the above is true but, I mean, I think the question the Inquiry might wish to ask itself is: did the introduction of lockdowns actually make that any easier to manage? And I would argue no, it didn’t.

And that reminds me of the other point that, with advancing age, I’d forgotten, the other problem that we have is the lack of capacity in our acute hospital sector. Our hospitals run often at 85% to 90% occupancy all the time. With that you really don’t have the space and resilience for efficient and effective infection control.

One way around that might have been to have used the Nightingale hospitals for step-down care rather than imagine that they would have been used for acute care. But as far as I can see that never happened either.

Lead 2B: There is one other matter I just want to ask you before we move on. Targeted shielding assumes that people who are vulnerable can be protected by virtue of their vulnerability, defined, presumably, as a health vulnerability. However, obviously the Inquiry understands that those with pre-existing health vulnerabilities who are on the shielding list compared with vulnerabilities of whole communities are not necessarily one and the same thing. So, for example, we heard earlier this week from Professor Ogbonna and the findings of his socioeconomic subgroup that reported in June 2020, and they concluded that the risk of Covid-related death in males and females of black ethnicity was 1.9 times higher than those with white ethnicity, and that the risk of Covid-related death from men of Bangladeshi and Pakistani ethnicity was 1.8 times higher than white males.

Now, I assume you are not proposing that Wales should or could lock down and shield communities that are already minoritised within society?

Dr Roland Salmon: No, not at all. And I think a bit of context is quite helpful here, if you’ll allow me.

Easily the biggest driver of vulnerability is age. I mean, a point that Professor Woolhouse makes, and I endorse, and comes from the original OpenSAFELY study available on 7 May – as a pre-print – in 2020 is that the risk to an 80-year old is 10,000 times the risk to a 20-year old, the risk of death.

Now, if you slightly – what’s the word? – cheating slightly put that into a “what is your year-on-year rising risk?” it’s about – your risk goes up about 1.16 per year. So that means, of course, that someone from a black and minority ethnic group has the same risk as a white person about five years older than them, when you sit and do the sums.

So what that also tells us is that younger members of those communities, although they may be at more risk than their white equivalents – and this is quite wrong and shouldn’t be the case, I entirely concede that – though they be at more risk are not at substantial enough a risk that they need to change their behaviour patterns at all, it’s just that the levels at which vulnerability kick in are at a younger age group in those communities, as I say by about some five years, based on some fairly crude maths.

Lead 2B: Dr Salmon, I want to change topic now, and you’ve anticipated that I might have wanted to ask you some questions about the firebreak, which I’m going to do now.

Dr Roland Salmon: Sure.

Lead 2B: You described in your letter to the Welsh Government that we looked at a moment ago.

And perhaps we can have it back up, it’s INQ000130868. If we can have a look at page 2, please, the first bullet point on that page.

You say:

“• ‘Good adherence to measures’ is required.”

In the second bullet point:

“• The incubation period of Covid-19 (2-14 days) combined with high asymptomatic carriage rates (c30% in youg adults) ensures that the virus will be reintroduced into the community as soon as the circuit breaker is finished.”

Then finally the third bullet point:

“• ‘If regulations and behaviour then return to pre-circuit break levels, there would be a return to exponential growth’ meaning any respite is a very small number of weeks, too short to remedy problems with track and trace systems and too soon for a vaccine to be available.”

I assume you stand by the concerns that you expressed at that time in that letter?

Dr Roland Salmon: Yes, I do, and, I mean, within the inverted commas are quotes from SAGE minutes that I’d taken from the time, so in a sense these are quotes from the proponents of this scheme that seem to me to suggest that it won’t work rather than anything that I may have introduced into the debate.

Lead 2B: You say in your witness statement:

“… from a simple eyeballing of the observed COVID incidence, it would be difficult to conclude other than any effect was marginal at best.”

So do you think that the matters that you’ve identified already, so especially – we’ve still got it on the screen – especially the second and third bullet points of the letter, prove to be borne out?

Dr Roland Salmon: Yes.

Lead 2B: Would those issues have appeared had the firebreak been implemented for longer, in your view?

Dr Roland Salmon: No, I don’t think there would have been, because I think there would have been sufficient circulation in the community or sufficient opportunity for reintroduction that yes, possibly we might have had a slightly longer pause, but exactly the same situation would have re-established itself very quickly.

I understand the enthusiasm for some clinicians for the firebreak. I mean, I am a doctor, I have worked, admittedly many years ago, in busy clinical settings when almost any respite is so welcome, but I do think this one was particularly expensively bought, and really is hard to justify on broader social grounds.

Lead 2B: Changing topic again slightly, talking about NPIs. At paragraph 24 of your statement, you say that you consider many decisions regarding NPIs that were made by the Welsh Government were, your words, “inappropriate and lacking justification”. You identify as two examples the Welsh Government’s decision to close selected supermarket aisles and pubs being prohibited from selling alcohol. Can you just briefly explain why you considered those two examples to be inappropriate and unjustified?

Dr Roland Salmon: Yes, because I can think of no basis on why you might think they would work. If we consider supermarket aisles, I mean, case control studies in France, the ComCor study at the Institut Pasteur showed that large supermarkets and large department stores were not a setting where increased risk took place. So whether you leave the aisles open or you leave them shut really doesn’t matter. And actually if people are going into the supermarket why do you want to shut one aisle and not the other one? It seemed quite – I mean, I think one of your witnesses yesterday was talking about a lack of lived experience, but that seemed to suggest a lack of lived experience of even going to the supermarket.

And also the pub with no beer. I mean, the problem with any setting – and yes, restaurant and pub settings are an issue – are when people congregate in them, and that those people who are vulnerable are best avoiding them and advised to do so. But sort of opening it up and not have beer seems to me perhaps an overly enduring legacy of the chapel heritage, I don’t know.

Lead 2B: Dr Salmon, finally, you wrote a blog post titled “The … View from Wales”.

We have it at INQ000130866.

Perhaps we can just look at that together, if we can –

Dr Roland Salmon: Yes, of course.

Lead 2B: – please have a look at page 2, the third paragraph, please, that starts “Finally”, I’m grateful:

“Finally, the Wellbeing of Future Generations Act, some of Wales most forward thinking legislation singularly failed to translate into any sort of systematic evaluation of the downsides of global ‘lockdown’ approaches; downsides most likely to impact on just those future generations whose interests the Act seeks to protect.”

Please can you just briefly expand on your views there on lockdowns in the context of the Wellbeing of Future Generations Act.

Dr Roland Salmon: Yes, I mean, what I had in mind here was the loss of educational and employment opportunities to younger cohorts, I mean children, students, young adults in work, who bore a disproportionate share of the economic and social burden. And it’s easy to think that, “Well, that’s economics and on the other hand we’re saving lives”, but what I think we lose sight of unless we take a whole-life view of public health is that those losses of opportunities and that economic loss will translate into – and there are plenty of examples of this – ill health and loss of life expectancy. It may not be as immediate, but it will certainly be there.

Now, how we level those up, we’re starting to stray into where people’s values are, and I think where the politicians are reasonably expected to come in, but I did feel that this particular dimension wasn’t even considered.

And when I say “I”, I mean we, and if you’ll forgive me I might draw attention to who my fellow authors are. I mean, Meirion Evans received the OBE for his work on SARS in Hong Kong in 2003 with the World Health Organisation; Stephen Palmer had worked in Atlanta and set up the Communicable Disease Surveillance Centre in Wales; and John Watkins has spent his – who I think has submitted written evidence to this Inquiry – has spent his life working on influenza and respiratory disease epidemiology. So these are not lightweight opinions, whatever view you may take of mine.

Lead 2B: Would you have supported a full lockdown if it permitted schools to remain open?

Dr Roland Salmon: No, I don’t think I would because I don’t, frank – it has always been my view that the purpose of epidemiology is to target attention on those people who are vulnerable, who are at risk, in the terminology, and those behaviours that constitute a risk. That is why you do it. And you do it in such a way as to keep the restrictions that you impose as targeted as possible and to allow as much of the ordinary life that people want to lead – whether you approve of it, whether you disapprove of it – to go on as much as possible. That is the whole scientific not to say ethical basis of the discipline. So just to sort of think “Well, this is hard work, let’s just shut everything down and that will spare us any further thought on the matter” seems to me quite the wrong way to approach it. And I don’t always agree with Professor Woolhouse, who I know distantly, but the title of his book “The Year the World Went Mad” is one I’m entirely in tune with.

Mr Poole: Dr Salmon, I have no further questions for you.

The Witness: Thank you.

Lady Hallett: I don’t think there are any Rule 10 questions.

Mr Poole: No, my Lady.

Lady Hallett: Thank you very much indeed for your help, Dr Salmon, I’m very grateful.

The Witness: My pleasure.

(The witness withdrew)

Lady Hallett: Right, well, so that everyone can make their plans, we have to finish by 4.15 at the latest. So shall we break now for lunch?

Mr Poole: I think if we can, my Lady, yes.

Lady Hallett: And then return at 1.30?

Mr Poole: That’s fine.

(12.34 pm)

(The short adjournment)

(1.29 pm)

Lady Hallett: Yes, Ms Spector.

Ms Spector: My Lady, please can I call Professor Ann John.