COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

In this post, ‘following the science’ describes UK ministers taking the advice of their scientific advisers and SAGE (the Scientific Advisory Group for Emergencies).

If so, were UK ministers ‘guided by the expert recommendations of the 4 UK Chief Medical Officers and the Scientific Advisory Group for Emergencies’?

The short answer is yes.

They followed advice in two profoundly important ways:

1. Defining coronavirus as a policy problem.

My reading of the SAGE minutes and meeting papers identifies the consistency of the overall narrative underpinning SAGE advice and UK government policy. It can be summed up as follows:

1. coronavirus represents a long term problem with no immediate solution (such as a vaccine) and minimal prospect of extinction/ eradication
2. use policy measures – on isolation and social distancing – to flatten the first peak of infection and avoid overwhelming health service capacity
3. don’t impose or relax measures too quickly (which will cause a second peak of infection)
4. reflect on the balance between (a) the positive impact of lockdown (on the incidence and rate of transmission), (b) the negative impact of lockdown (on freedom, physical and mental health, and the immediate economic consequences).

If you examine UK ministerial speeches and SAGE minutes, you will find very similar messages: a coronavirus epidemic is inevitable, we need to ease gradually into suppression measures to avoid a second peak of infection as big as the first, and our focus is exhortation and encouragement over imposition.

2. The timing and substance of interventions before lockdown

I describe a long chronological story of SAGE minutes and papers. Its main theme is unusually high levels of uncertainty from the beginning. The lack of solid evidence, available to SAGE at each stage, should not be dismissed.

In January, SAGE discusses uncertainty about human-to-human transmission and associates coronavirus strongly with Wuhan in China. In February, it had more data on transmission but described high uncertainty on what measures might delay or reduce the impact of the epidemic. In March, it focused on preparing for the peak of infection on the assumption that it had time to transition gradually towards a series of isolation and social distancing measures. This approach began to change from mid-March when it became clear that the number of people infected, and the rate of transmission, was much larger and faster than expected.

Therefore, the Prime Minister’s declarations – of emergency on 16.3.20 and of lockdown on 23.3.20 – did not lag behind SAGE advice. It would not be outrageous to argue that it went ahead of that advice, at least as recorded in SAGE minutes and meeting papers (compare with Freedman, Snowden, More or Less).

The long answer

If you would like the long answer, I can offer you 35280 words, including a 22380-word table summarizing the SAGE minutes and meeting papers (meetings 1-41, 22.1.20-11.6.20).

It includes:

• The obligatory discussion of following the science: there is no such thing as the science, these phrases are rhetorical, they mean being guided by scientific advisers, they use this language to project governing competence, and they often do not take the advice of scientists.
• The ways in which SAGE tries to address its unusually politicized role, such as to try to distinguish between advice versus policy (strategy and values)
• A more nuanced (yes, I mean very long) account of policy and scientific advice, including the ways in which UK ministers are going ahead of the evidence to relax lockdown measures.
• Wider themes that arise from the SAGE minutes and other sources: the confusing language of intervention, the limitations to scientific advice (such as limited data and testing at key moments), and the role of ‘behavioural science’ in public communication.
• A detailed breakdown of each meeting and meeting paper (125 papers, estimated range 1-51 pages, median 4 pages, not-peer-reviewed, often produced a day after a request). At the end is a note on the abbreviations and all the words I had to google (including nosocomial, paucisymptomatic, and battle rhythm).

The full list of SAGE posts:

COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The role of SAGE and science advice to government

The overall narrative underpinning SAGE advice and UK government policy

SAGE meetings from January-June 2020

SAGE Theme 1. The language of intervention

SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

SAGE Theme 3. Communicating to the public

COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

Further reading

So far, the wider project includes:

• The early minutes from NERVTAG (the New and Emerging Respiratory Virus Threats Advisory Group)
• Oral evidence to House of Commons committees, beginning with Health and Social Care

I am also writing a paper based on this post, but don’t hold your breath.