What advice did Sage give and when?

Documents from several meetings of the Scientific Advisory Group for Emergencies (Sage) have been published after calls for transparency over the group’s decisions.

Sage, which is advising ministers on the coronavirus outbreak response, published a cache of papers that have informed its advice.

Only 28 of the 120 listed meeting papers have been published and only cover meetings held up to April 16.

But the Prime Minister’s spokesman has said all documents will be published.

– February 4

The earliest published meeting of the group included a report from the Scientific Pandemic Influenza Group on Modelling (SPI-M) subgroup, discussing the initial consensus on the new virus.

Sage was told that cases in China were estimated to be at least 10 times higher than the confirmed figure.

The document also said it was unclear whether Covid-19 outbreaks can be contained by isolation and contact tracing if a high proportion of cases are asymptomatic.

Population-wide reduction in contact through the mass closure of schools would impact transmission but said the effectiveness was unclear.

On the day of the meeting, two people in York are the only confirmed cases of coronavirus in the UK as Health Secretary Matt Hancock said he expects more to follow.

Coronavirus – Wed May 6, 2020
Coronavirus – Wed May 6, 2020

A third case was confirmed on February 6 with a person who contracted the virus in Asia.

On February 10, the Government declares coronavirus a “serious and imminent threat to public health” and gives itself powers to forcibly quarantine people.

– February 11

A National Security Risk Assessment report compared what was known about the coronavirus outbreak in China and the worst-case scenario for an influenza pandemic.

In the worst-case scenario, a pandemic would come in up to three waves of approximately 15 weeks with around 50% of the population infected at least once.

This planning, which was conducted in 2019, put excess deaths at 820,000.

– February 18

There are nine confirmed cases of Covid-19 in the UK, with contact tracing under way.

The SPI-M group presented a consensus view on public gatherings, reporting that stopping large public gatherings would have a low direct impact on the spread of the epidemic as they represent a small proportion of a person’s contacts with others.

The group said the impact of stopping all leisure activities including gatherings at bars and restaurants, which happen more often, would be much larger.

– February 20

Advice on school closures was presented to the group, with the impact of mass closures uncertain.

In terms of the spread of the virus across the UK, some in the group believed sustained transmission would be established within the next few weeks, while others thought it was already taking place.

– February 25

Independent Scientific Pandemic Influenza Group on Behaviours (SPI-B), Sage’s behavioural science subgroup, found that large scale rioting is unlikely.

SPI-B, the Home Office, the Ministry of Justice and National Police Chiefs’ Council found public disorder would mostly be tied to perceptions about the Government’s response.

Coronavirus – Fri May 8, 2020
Coronavirus – Fri May 8, 2020

– February 27

In the meeting paper for February 27, the group warned that without action the NHS would not be able to cope with the demands placed on it.

The paper examined the differences between closing schools, isolating symptomatic people and their households, as well as social distancing.

Social distancing, when enacted early, was said to delay the peak of the virus between three to five weeks and reduce the peak by up to 60%.

– March 3

Sage reaches a consensus that “it is highly likely that there is sustained transmission of Covid-19 in the UK at present,” adding that it was “almost certain” to occur within the coming weeks.

If the UK reaches the R rate of 2 to 3 seen in Wuhan at the early stages of the outbreak, 80% of people may become infected, the group said.

It suggested that a population-wide reduction in contact will impact transmission but also said if strict measures were put in place to reduce the R rate below 1, cases would likely increase once they were lifted.

Social distancing measures, if enacted early and lasting at least 13 weeks, could reduce deaths by up to 25% even if schools remained open.

The Government unveils a national action plan to tackle coronavirus, including contingency plans to help police if they lose “significant numbers” to the illness, and new legislation.

It says it is prepared to implement social distancing guidelines if the virus spreads further.

– March 5

SPI-B said that isolating households and school closures will be a substantial and unequal burden on different sections of society.

They say the isolation of people with symptoms and isolation of at-risk members of the public is most likely to be socially acceptable.

They also acknowledge that lower-income families and single parents will find isolation difficult, with increased household bills, lack of social support provided by schools and no help from older relatives.

– March 10

On March 7 a total of 206 cases were recorded in the UK.

Sage said that any behavioural interventions would have to be Government policy for a “significant duration” such as two to three months to see the benefit.

Coronavirus – Wed May 6, 2020
Coronavirus – Wed May 6, 2020

The group advised that individual and household isolation would need to be enacted within a fortnight to be fully effective, with social distancing of vulnerable groups to follow.

– March 13

On March 11, the WHO declares Covid-19 a pandemic.

Sage’s behavioural arm presents its insights into public gatherings and said that 73% of people support staying away from crowded places, according to Department of Health surveys.

They reiterate the need to explain why public gatherings have not been banned or discouraged, especially as other countries take those measures.

The SPI-B report said: “Trust will be lost in sections of the public if measures witnessed in other countries are not adopted in the UK and that not pursuing such routes needs to be well explained.”

Top-level football competitions in England, Scotland, Wales and Northern Ireland are suspended.

The Government moves from the “contain” to the “delay” phase of its coronavirus action plan.

– March 16

On March 15, the Foreign Office advises against all but essential travel to more than 30 countries.

Sage’s behavioural subgroup agreed that social distancing and school closures should be implemented “as soon as practical, at least in the first instance” to control the epidemic.

“It was agreed that the addition of both general social distancing and school closures to case isolation, household isolation and social distancing of vulnerable groups would be likely to control the epidemic when kept in place for a long period,” the meeting paper said.

Matt Hancock addresses Parliament and asks everyone with potential Covid-19 symptoms to self-isolate at home as well as advising against all unnecessary travel or contact with others.

On March 16, the Cheltenham Festival begins, lasting several days.

In a meeting paper dated March 17, Sage discusses school closures again, suggesting the public would accept schools being kept open for the children of NHS staff.

On March 17, schools, nurseries and colleges are told they must close their doors from the end of the day on March 20 until further notice.

– March 18

Sage meeting papers show a discussion on a London lockdown as the capital is approximately one to two weeks ahead of the rest of the UK.

The group estimates serious capacity issues with London’s healthcare system within two to three weeks.

The group agreed a number of measures together would have the biggest impact including closing schools, bars and restaurants as well as closing places of work.

Coronavirus – Wed May 6, 2020
Coronavirus – Wed May 6, 2020

On March 20, Boris Johnson orders pubs and restaurants across the country to close.

– March 23

Sage’s modelling group suggested that it was very likely that ICU capacity in London would be breached by the end of March, even if additional measures are immediately implemented.

As the rest of the UK is one to two weeks behind the capital, the group said ICU capacity would be breached without additional measures.

The UK public is told that from this evening they will only be allowed to leave their homes for limited reasons.

All shops selling non-essential goods are told to close, gatherings of more than two people in public are banned, all events including weddings but excluding funerals are cancelled.

On March 24, Health Secretary Matt Hancock reveals the first field hospital called the Nightingale Hospital with a capacity of 4,000 is being prepared at the ExCeL Centre.

Coronavirus – Tue Apr 21, 2020
Coronavirus – Tue Apr 21, 2020

– March 26

On March 25, sweeping emergency powers to tackle coronavirus are set to become law after clearing the House of Lords without amendment.

Sage examined modelling from three different universities, Warwick, Imperial and collaboration between Exeter and Bristol.

The universities each modelled optimistic and pessimistic scenarios for whether the Government measures control the epidemic.

Both models from Imperial and Warwick estimated around 10,000 deaths in the first wave of an optimistic scenario.

– March 31

The Covid-19 Genomics UK Consortium (COG-UK) presented findings to Sage regarding the sequencing of Covid-19 genomes.

Coronavirus – Sun May 3, 2020
Coronavirus – Sun May 3, 2020

The group said in 12 days it had already sequenced and analysed 260 genomes which will help scientists understand the spread of the virus.

– April 2

Sage’s behavioural arm discussed the methods of easing restrictions on activity and social distancing.

The meeting paper, which is redacted in parts, said adherence to the measures is high and recommended easing restrictions gradually with clear explanations to the public as to why some activities were being resumed.

“While simple rules are easiest to follow, gradually resuming activity cannot be covered by a simple rule such as ‘stay at home’,” the paper said.

– April 14

After three weeks of the lockdown, Sage discusses antibody testing and the implications of incorrect tests leaving some people isolating unnecessarily or not isolating when they need.