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The UK's key coronavirus decisions – what the Government advisory papers reveal

Scientific Advisory Group for Emergencies documents show thinking on areas including testing and how to end Britain's lockdown

Britain's failure to quickly ramp up testing may have cost it dearly, the Government's chief scientific advisor admitted on Tuesday as he was questioned about key decisions that have left the UK with the highest coronavirus death rate in Europe.

Sir Patrick Vallance's remarks came as the Scientific Advisory Group for Emergencies (Sage) released 16 papers revealing their thinking as Britain moved towards lockdown and their more recent discussions about how the restrictions could be relaxed.

Getting out of lockdown  

A "traffic light" system advising the public about the risks of different activities could be used to ease the lockdown, the Government's scientific advisers have said. 

2020欧洲杯网站The proposals, drawn up last month, suggest changes should be made "very gradually" and warns against relaxing rules for workplaces without allowing social activities to resume. 

It says the abrupt lifting of social distancing measures2020欧洲杯网站 and a subsequent increase in coronavirus infections could undermine public trust in health policy and mean people are less likely to comply with future demands. 

2020欧洲杯网站The paper was drawn up by the  scientific pandemic influenza group on behaviour (SPI-B), and considered by Sage at its April 2 meeting.

The documents are among 16 papers submitted to Sage and released as Boris Johnson prepares to unveil a "road map" for how to "unlock the various parts of the UK economy".

One, called Easing Restrictions on Activity and Social Distancing, says: "If strict restrictions are retained for months and then abruptly eased and people are told it is safe to resume social contact, they will expect this to mean that the risk of infection has ceased or significantly reduced. 

"If there is then an increase in infection rates that necessitates a reintroduction of restrictions, this is likely to be seen as a serious failure of policy and trust in public health advice will be lost, leading to lower adherence to advice to restrict or to resume activity. We would advocate trialling easing restrictions very gradually.

2020欧洲杯网站"To maintain public trust and support, it will be important to have acceptable and equitable criteria for selecting which activities can be resumed. For example, it may be difficult to justify easing restrictions solely for economic activities without any easing of restrictions for low-risk activities with significant social and psychological benefit."

The paper says a traffic light system might be used to provide advice about the relative risks of different behaviours and activities and suggests using methods previously employed in public health campaigns to motivate changes in lifestyle such as a healthy diet. 

"Methods that have been used successfully for helping people understand how to implement other behaviour changes (such as healthy eating) include providing a 'traffic light' list of examples of high (avoid), medium (do rarely and carefully) and low (do freely) risk activities and 'modelling' stories describing how other people like themselves in similar situations have overcome barriers to implement guidance successfully," it says. 

The document also suggests that health and safety legislation should be used to address coronavirus infection control risks at work. 

2020欧洲杯网站The two-metre social distancing rule is currently being reviewed by the Government in the hope that relaxing it could allow businesses and schools to reopen.

But Sir Patrick told MPs that the infection risk at one metre was as much as 30 times higher than that at two metres, saying: "The evidence is – as far as you can get very firm evidence on this – that essentially a minute at two metres contact is about the same risk as six seconds at one metre, so that gives you some idea of why the two metres becomes important. 

2020欧洲杯网站"And the risk at one metre is about 10 to 30 times higher than the risk at two metres, so the distancing is an important part of this."

Fears that antibody testing could create a two-tier society 

Rolling out antibody testing to see whether people have had coronavirus could result in discrimination at work, Government scientists have warned. 

2020欧洲杯网站In a briefing document considered by Sage on April 14, scientists said managers may prioritise those who have tested positive when offering jobs. 

This could lead to widespread "gaming" of the system in which people desperate for work deliberately get infected with Covid-19, they said.  Alternatively, a black market for counterfeit positive test results could emerge.

Since the early days of the crisis, ministers have touted widespread access to antibody tests as a potentially powerful tool to enable the easing of restrictions.

Assuming that the presence of antibodies indicates at least some immunity from future infection, a positive test result could enable a form of "immunity passporting", experts have said.

2020欧洲杯网站It might also allow parts of the country to leave lockdown earlier than others, a strategy Sir Patrick acknowledged is being examined. 

2020欧洲杯网站Promises of home testing kits were quickly dashed when it emerged the technology was not accurate enough, but there are hopes laboratory-based blood testing systems will be available this month.  

But the paper, drawn up the day before the Sage meeting, reveals the feared downsides of such tests, saying: "Some employers may discriminate on the basis of antibody status. This might include not permitting those testing antibody negative to return to work, or only taking on new staff with antibody positive test results."

The Sage committee also examined evidence suggesting that even a test that met Government requirements to be at least 98 per cent accurate could result in a significant number of false positives. Under one scenario, one in four people who test antibody positive may actually not have antibodies, according to a flowchart prepared by the University of Cambridge.

The document was released on the day Sir Patrick told the health committee that fewer than one in six people2020欧洲杯网站 have any sort of antibody protection from Covid-19.

2020欧洲杯网站He said data from around five weeks ago suggested "something like a 10 per cent antibody positivity in London", with three per cent to four per cent antibody positivity in other regions and even less in some areas. On Tuesday, he said he would currently "not expect to see antibody levels much above mid-teens" in any region.

2020欧洲杯网站Sir Patrick said geographical variations could mean certain parts of the country come out of lockdown sooner, adding: "We know that cities and densely-populated places have a higher prevalence than rural places... and an option that could be considered is to think about whether measures could be done locally versus nationally."

The role of face masks 

On Tuesday, Sir Patrick acknowledged acknowledged for the first time that mask-wearing by the general public can have a "marginal positive effect"2020欧洲杯网站 when social distancing is not possible. 

After Boris Johnson last week said he believed the use of masks or face coverings2020欧洲杯网站 would give people "confidence" to go back to work, Sir Patrick said there could be times where their use is "beneficial". 

Currently, British advice is in line with that of the World Health Organisation and does not recommend masks for the general public, with officials including Sir Patrick previously describing the evidence for public use as "weak". But it is likely that this advice will change as Britain moves out of full lockdown. 

Asked about the use of face coverings, Sir Patrick said that while it was not "straightforward", there was evidence that they have a marginal impact in reducing "the spread of infection from one person to another".

2020欧洲杯网站"Masks may have a marginal positive effect in those situations, or face coverings of some sort," he said. "Where masks have a role is where distancing may not be possible. So there may be some cases where that is not possible, situations where there is undue crowding when wearing masks may be beneficial to stop the spread." 

Fears the situation in China had spiralled out of control 

By early February, Government scientists believed the outbreak of coronavirus in China was 10 times higher than the regime acknowledged.

2020欧洲杯网站A document drawn up by one of Sage's sub-groups on Feb 3 concluded that the number of symptomatic cases was being drastically under-reported. The document reveals that, as UK modellers frantically tried to draw up plans for a British response to the pandemic, they were hampered by a lack of data from Beijing.

Also among the newly published papers are the results of genomic analysis of new UK cases up to March 20 which found that the majority originated Europe.

Sir Patrick said scientists have now been able to "sequence thousands and thousands of viral genomes" when looking at Covid-19, and found cases came from Europe.

"One of the things that it looks like, very clearly, is that early in March the UK got many, many different imports of virus from many different places," he said. "And those were particularly from European countries with outbreaks."

The days before lockdown approached

On March 2, scientists from Sage subcommittee SPI-M-O, the Scientific Pandemic Influenza Group on Modelling, said: "It is highly likely that there is a sustained transmission of Covid-19 in the UK at present." But lockdown did not start until March 23. 

2020欧洲杯网站On the day of the national lockdown, Sage discussed modelling evidence which said "it is very likely that we will see ICU capacity in London breached by the end of the month, even if additional measures are put in place today".

2020欧洲杯网站The same document, written on the previous Friday by SPI-M-O, warned that the rest of the country was one to two weeks behind London, with intensive care capacity also likely to be breached elsewhere without action being taken. 

Mass school closures would "increase the likelihood" of avoiding ICU capacity being breached across the country, it said, with the decision to close schools taken on the same day the paper was drawn up.

The mistakes made 

2020欧洲杯网站"I'd be amazed if, when we look back, we don't think: 'Yep we could have done something differently,'" Sir Patrick told MPs.

2020欧洲杯网站Asked what he would have changed, he singled out testing, suggesting that the speed with which Britain rolled out tests had worsened the crisis. "I think if we'd managed to ramp up testing capacity quicker, it would have been beneficial" he said. "And, you know, for all sorts of reasons that didn't happen."

2020欧洲杯网站But he insisted: "It's completely wrong to think of testing as the answer – it's just part of the system that you need to get right."

2020欧洲杯网站England's deputy chief medical officer, Dr Jenny Harries, said lack of capacity explained the decision to abandon routine contact tracing as the UK entered the delay phase of efforts to battle the pandemic. 

2020欧洲杯网站"If we had unlimited capacity, and the ongoing support beyond that, then we perhaps would choose a slightly different approach," she said. 

Sir Patrick also suggested that allowing the Cheltenham Festival to go ahead may have been a an error, saying he had "no doubts" there would have been occasions where things "could have been done differently". 

Asked whether Cheltenham and a Liverpool FC Champions League match should have been allowed to take place in the days before the lockdown was imposed, Sir Patrick said: "I think that is something in the future for us to look at, and certainly there will be times where evidence didn't allow you to make decisions you can make now. 

"There will be times where you look back at and say things could have been done differently – I've got no doubts about that." 

On the wider issue of the lockdown, he said: "When you look at everything that has happened and the speed in which it happened, maybe days either side may have made a difference."

The scientific modelling in numbers 

10,000 – the number of first wave deaths in an optimistic scenario by Imperial and Warwick universities.

3.6 million2020欧洲杯网站 – the number of Covid-19 hospitalisations predicted by Sage on  February 26.

102020欧洲杯网站 – Sage scientists thought the true number of symptomatic cases in China was 10 times higher than reported.

28 per cent – Evidence considered by the committee suggested around one in four positive antibody tests could be a false positive.

50 per cent2020欧洲杯网站 of households would comply with lockdown restrictions under a pessimistic prediction by Imperial College London.

75 per cent of households would comply under Imperial's optimistic prediction.