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What could we expect from the UK Covid-19 Public Inquiry? – Part 2 The deployment of non-pharmaceutical interventions and the consequences

  • United Kingdom
  • Inquiries and investigations
  • Litigation and dispute management

05-04-2022

This is the second article in our series where we consider some of the areas of investigation suggested in the draft Terms of Reference (“draft ToR”) of the independent statutory public inquiry into the Covid-19 pandemic (the “Covid-19 Public Inquiry”)1. In this article we consider the deployment of non-pharmaceutical interventions and the consequences of those measures. Read our first article, What could we expect from the UK Covid19 Public Inquiry here.

During the pandemic, the UK Government has deployed various strategies to manage the transmission of Covid-19. Health and public health are, however, devolved matters, and so the approach to the pandemic has varied across England, Wales, Scotland and Northern Ireland. The Joint Inquiry2 heard evidence in relation to the deployment of non-pharmaceutical interventions from a number of scientific experts and Government advisers. The Joint Inquiry summarised its findings in its report “Coronavirus: lessons learned to date” (“the Report”) and made recommendations which it considered could assist whilst the Covid-19 pandemic is ongoing, and with any future pandemics.

In this article, we have focussed on the following topics, which upon review of the draft ToR, we consider are likely to be investigated:

  • early non-pharmaceutical measures deployed;
  • the public’s compliance with the measures; and
  • the incidental impacts of the measures.

i). Early non-pharmaceutical measures deployed

The initial strategy

The Government has always been clear that the strategies employed to combat Covid-19 were based on the scientific advice, specifically the advice from the Scientific Advisory Group for Emergencies (“SAGE”).3 The Report agreed that the Government did not deviate from the scientific advice it received during this early period until 23 March 2020.4

The Government’s strategy for management of Covid-19 initially began with a pursuance of so-called herd immunity,5 understood to be based on scientific advice that the Government should not try to suppress the virus completely.6 On 12 March 2020, the Prime Minister introduced self-isolation for seven days for those with a new continuous cough or fever. It was not until 16 March 2020 that SAGE advised a full lockdown, although the Joint Inquiry noted that was only three days after SAGE had advised that “measures seeking to completely suppress the spread of Covid-19 will cause a second peak”, which was not then implemented by the Government until 23 March 2020. Professor Devi Sridhar (Chair of Global Public Health, University of Edinburgh) explained the change in advice from SAGE: “in February, it was to stay open and mitigate: the 2011 flu plan. In early March, when they started to model and saw the hospitalisation rate in Italy and what it would mean for the NHS, they pushed for lockdown at that point.”7 This concords with the official communications from the Government stating that they followed the scientific advice as it changed, and the Joint Inquiry accepted this in its Report.

The Report also concluded that “during the days before 23 March, multiple people within the Government and its advisers experienced simultaneous epiphanies that the course the UK was following was wrong, possibly catastrophically so.” 8 The Joint Inquiry found: “it was principally the threat of the NHS being overwhelmed that forced—belatedly—a change in direction.”9

The draft ToR for the Covid-19 Public Inquiry include: “in relation to central, devolved and local public health decision making and its consequences: how decisions were made, communicated and implemented; the availability and use of data and evidence; [and] the use of lockdowns and other ’non-pharmaceutical’ interventions, such as social distancing and the use of face coverings.” Therefore, the Covid-19 Public Inquiry is likely to consider this initial strategy employed by the Government, the evidence on which this was based, and the effectiveness of that strategy.

Groupthink

Mr Dominic Cummings (former Chief Adviser to the Prime Minister) suggested in his evidence to the Joint Inquiry that there was a fundamental ‘group think’ problem in respect of the initial strategy of herd immunity,10 meaning that the reasoning behind that approach was not challenged by anybody. He stated: “it was literally a classic historical example of group-think in action. The process was closed, and that is what happens in closed group-think bubbles: everyone just reinforced themselves. The more that people from the outside attacked, the more people internally said, “Well, they don’t understand, and they haven’t got access to all this information” and whatnot. It was this classic group-think bubble."11 Mr Cummings suggested that the Government’s decision to pursue herd immunity first was based on flawed logic, and a decision to isolate, quarantine and enforce wearing of masks should have been made earlier in 2020.12 As we know, the strategy to manage Covid-19 developed further during the pandemic, with the Government introducing further non-pharmaceutical measures, again suggested to be based on scientific evidence as it became available, including wearing face coverings.

Given the Covid-19 Public Inquiry will consider how decisions were made by central and devolved governments, within this it could investigate whether there was sufficient challenge to the proposed approach to manage the pandemic, before any decisions were made.

The timing of the first lockdown

The UK’s first lockdown commenced on 23 March 2020. The Joint Inquiry examined the decision to employ this measure, including whether it was appropriate to enforce a full lockdown, and the timing of such lockdown. In his evidence to the Joint Inquiry on 21 October 2020, Dr Max Roser (Director at Oxford Martin Programme on Global Development, University of Oxford) confirmed that “it has always been clear that the pandemic should not be controlled by lockdowns. Lockdowns are the bluntest weapon that we have, and it is only once every other public health intervention has failed that countries should consider a lockdown.” Professor David Heyman (Professor of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine) agreed with this, and suggested that the success of Asian countries was due to the fact they did not “lock down bluntly”, but instead used epidemiological tracing to shut down specific areas and ensure that there were no mass gatherings.12 These two witnesses were therefore not critical about the initial decision of the Government to pursue herd immunity, but perhaps suggested that a more structured (i.e. less blunt) lockdown should have taken place in March 2020, having exhausted other options. More targeted lockdown strategies were employed by the Government later in the pandemic, when using the tiered system in England, with different non-pharmaceutical measures being used dependent upon area. Similar locality-based restrictions were also introduced in Scotland and Wales by their devolved governments.

The All-Party Parliamentary Group on Coronavirus (“APPG”) has also conducted an inquiry into the UK Government’s handling of the Covid-19 pandemic and has produced several reports. The APPG’s ‘Interim Report’ dated December 2020 (“December 2020 Report”) concurred with the witness evidence heard by the Joint Inquiry that: “lockdowns are a means of slowing down the incidence of the pandemic when all other means to control the virus have broken down… Lockdowns should be treated as a last resort measure.”14

Overarchingly, the Report by the Joint Inquiry concluded that: “as a result, decisions on lockdowns and social distancing during the early weeks of the pandemic—and the advice that led to them—rank as one of the most important public health failures the United Kingdom has ever experienced.”15

In respect of the timing of lockdown, the Report found that “there was a desire to avoid a lockdown because of the immense harm it would entail to the economy, normal health services and society. In the absence of other strategies such as rigorous case isolation, a meaningful test and trace operation, and robust border controls, a full lockdown was inevitable and should have come sooner.”16

As the draft ToR suggests the use of lockdowns will be one topic under investigation, it is likely that the timing of the first lockdown will be examined by the Covid-19 Public Inquiry; it may also consider whether the lockdown should have happened earlier, and any impact this may have had on the way the pandemic progressed in the UK. The bereaved and survivors of Covid-19 may be particularly interested in whether an earlier lockdown would have reduced the number of lives lost early in the pandemic.

Differences within the devolved governments

On 10 May 2020, the UK Government announced that England would begin to reopen, in a staged manner. At this point, the approach in England, Wales, Scotland and Northern Ireland began to diverge. For example, on the same day, the First Minister for Scotland confirmed that Scotland remained in lockdown. Over the course of the pandemic, both Scotland and England went on to implement a local tiered system in respect of restrictions, with Scotland having more tiers than England. Wales was the only nation to implement ‘circuit breaker’ lockdown for 17 days in October 2020, in an effort to avoid further restrictions, but unfortunately still had to move to further measures in December 2020. It was suggested during the Joint Inquiry that the divergence in rules, and the accompanying public health messaging, caused confusion and impacted compliance with the rules, which we address below.

The Joint Inquiry did not consider in detail the divergence in approach between the four nations. Scotland has committed to hold its own public inquiry, has appointed the Chair of its Inquiry, Hon Lady Poole, and has published its Terms of Reference, which include the decision to lockdown and to apply other restrictions17. However, the draft ToR for the Covid-19 Public Inquiry confirm it intends to cover all four nations, and it will look at the devolved public health decision making, although it will “seek to minimise duplication of investigation, evidence gathering and reporting with any other public inquiry established by the devolved administrations.” Specifically, one topic it intends to investigate is “intergovernmental decision-making”, within which it could consider the “four nations” approach specifically, and whether there are recommendations that could be made for future health pandemics.

ii). Compliance with the measures

One of the difficulties with implementation of non-pharmaceutical measures alluded to in the Joint Inquiry was the compliance of the public as the pandemic continued. It is difficult to avoid acknowledging that the measures implemented by the Government would only be successful in managing the virus whilst the public complied with them.

During the hearing on 21 October 2020, it was confirmed by Aaron Bell, a member of the STC, that “the Science and Technology Committee heard some evidence early on in the pandemic about the possibility of fatigue. It was acknowledged at the time that it was very uncertain, but the feeling was that fatigue would be there.” Professor Mark Woolhouse OBE (Professor of Infectious Disease Epidemiology at the University of Edinburgh) confirmed there was no modelling available for predicting when fatigue with the restrictions would set in, however the Government would have had advice from the Independent Scientific Pandemic Influenza Group on Behaviours (“SPI-B”) in respect of behavioural science, including advice on what the appropriate length and strictness of lockdown might be. However, in respect of isolation, social distancing and prevention of public gatherings specifically, the SPI-B said on 4 March 2020 that: “empirical evidence for the behavioural and social impact of, and adherence to, each of the strategies is limited. We are not aware of any evidence on their interaction.”18

Sir Mark Walport (Government Chief Scientific Adviser (2013-2017)) acknowledged in his evidence that lockdown fatigue had begun to set in with the second lockdown: “people were very observant of the lockdown and were quite slow once it was initially relaxed... Initially, there was no evidence that there was a concept of lockdown fatigue. There is now pretty strong evidence that that is happening. We are seeing that, second time around, it is much harder for people. I think people in general are finding it harder to cope.”19

Professor Sridhar explained to the Health and Social Care Committee (“HSCC”) during a separate inquiry that the public are more likely to comply with rules that are clear and easy to understand. He said: “you have to take the public with you. The public will comply, not because they are forced to, or because there is military on the streets, but because they want to. People generally want to follow the rules if they understand them.”20 The Report agreed that “during the first lockdown, the simplicity and clarity of public health messaging did indeed translate into high levels of compliance with the stay at home order.”21

The British Medical Association (“the BMA”) submitted written evidence to the Joint Inquiry which also dealt with the question of public compliance. The BMA believes that “the effectiveness of Government messaging waned over the course of the epidemic and through several iterations of restrictions, causing initially high public ‘buy in’ to wane as the pandemic progressed.”22

The Report acknowledged there was a shift in compliance with non-pharmaceutical measures as 2020 progressed, and the Joint Inquiry found this was linked with the change in public health messaging, rather from ‘fatigue’. The Report stated: “the two months between September 2020 and 31 October 2020 were an unsatisfactory period in which the comparative simplicity of the rules in place from the evening of 23 March onwards were replaced by a complex, inconsistent, shifting and scientifically ambiguous set of detailed restrictions. The rules had previously been a matter of broad national consent, but that sense of national solidarity began to erode, as the uncomfortable stand-off in Greater Manchester showed.”23 This lack of understanding of the rules led to a lower level of compliance with them. The Report confirmed that, following this change in rules, “self-reported compliance was consequently also much lower, with just over 40% reporting ‘complete compliance’ with guidelines, compared to 70% earlier in the pandemic.”24

In terms of the impact public compliance had on the Government’s decision making, the Report concluded that “in advance, it may not have been unreasonable to assume that the public would have a limited tolerance of such draconian restrictions. But that assumption turned out to be wrong. In the event, compliance with social distancing measures was at a level and for a duration beyond what was anticipated. If a belief that people would not comply delayed a full lockdown, and caused an initially limited set of non-pharmaceutical interventions to be adopted, this was a poor guide to policy.”25 Additionally, one of the reasons that the Joint Inquiry gave for their finding that there was a “significant error in policy and advice early in the pandemic” was “assumptions about public compliance with rules that turned out to have underestimated the willingness to conform even for long periods.”26

Whilst the Report made the above findings in relation to public compliance, and the impact the Government’s views on compliance had on the strategy for the pandemic, it does not go as far as considering the extent to which behavioural science did, or should, influence strategy and policy in a pandemic, or consider whether there are other ways public ‘feeling’ about measures could have been assessed, prior to deployment. Compliance is also not a topic specifically set out in the draft ToR for the Covid-19 Public Inquiry, however, it could well fall within other topics of investigation such as decision making and the use of data and evidence in the pandemic. This will be of interest to Central and Local Government departments dealing with planning and strategy for any future pandemic. We will also be considering the public’s compliance with isolation and testing in our next article.

iii).  Incidental impacts of the measures

Evidence was also heard by the Joint Inquiry in relation to some of the incidental impacts of the non-pharmaceutical measures adopted. During the pandemic, it has been widely reported in the press that there has been an impact on maternity services, a deterioration in the public’s mental health, an impact on care home residents and their families and an increase in reports of domestic violence28, for example. These issues were briefly referred to during the Joint Inquiry, however, the Report does not specifically address these issues. They are, instead, likely to be considered within the Covid-19 Public Inquiry, whose draft ToR include “the response of the health and care sector across the UK, including: the management of the pandemic in care homes and other care settings…[and] the consequences of the pandemic on provision for non-COVID related condition and needs.”

a). Maternity services

Sir Simon Stevens (Chief Executive, NHS England and NHS Improvement) briefly addressed the impact on maternity care in his evidence, confirming that “there has been an ongoing debate about visits of partners of women who are pregnant to maternity units during the course of the pandemic… But there is no part of the health service that has not been affected in some way, and that is certainly true of maternity care.”28 However, he confirmed there was evidence that quality of care was improving by this point in January 2021. Reviews have however also considered the impact of Covid-19 on maternity services and outcomes. One published review considered whether Covid-19 has impacted maternity and neonatal outcomes, finding that “there was no evidence for a negative impact of the Covid-19 pandemic on maternity services, as demonstrated by maternal and neonatal outcomes.” 29 Another study asked 573 pregnant women to complete an online survey between June and July 2020, in order to assess pregnant women’s satisfaction with antenatal care and social support. The study found that:women reported that restrictions implemented in the maternity services limited their face-to face interactions with healthcare professionals and meant their partners could not attend antenatal appointments or support them in the postpartum period in the maternity setting. The lack of information on COVID-19 and pregnancy meant women had greater uncertainty about pregnancy and birth.30 This suggests that the restrictions did have an impact on both the type of care received (such as limited face to face interactions) and on the experiences of pregnant women.

Any findings and recommendations from the Covid-19 Public Inquiry in respect of maintaining quality and availability of maternity services during a pandemic will affect acute and community NHS Trusts, hospital staff (in particular those working in the maternity unit), and generally, women in the community.

b). Mental health

The Nuffield Trust considered the impact of Covid-19 on mental health services in their evidence to the Joint Inquiry and noted “the Opinions and Lifestyle Survey asked adults about symptoms of depression between June 2019 and March 2020, and again in June 2020. Between June 2019 and March 2020, 10% of adults were experiencing moderate to severe symptoms of depression. In June 2020, this had almost doubled to 19%.”31 Sir Simon Stevens also acknowledged to the Joint Inquiry there is likely to be an ongoing increased demand for mental health services following the pandemic (or, as the pandemic continues), and confirmed whilst there has been a significant expansion of mental health services, this needs to be underpinned with an expansion of the mental health workforce.32

In respect of the impact of lockdown on mental health, Dean Russell, a member of the HSCC, indicated his view that support for the mental health of those affected by the pandemic should be prioritised by the Government and the Department of Health and Social Care (“DHSC”). Mr Matt Hancock (former Secretary of State for Health and Social Care) confirmed the importance of treatment of mental health to the Government, and stated: “ There are undoubtedly mental health impacts of lockdown and, very sadly, some quite serious mental health impacts of coronavirus itself, because in some it can be a neurological condition. It is a very serious challenge, and we are putting in extra funding to support colleagues in the mental health field.”33

Professor Sir Graham Thornicroft (Professor of Community Psychiatry at Kings College London) also considered the mental health impacts of the pandemic in his article on 9 December 202034, identifying that during the early pandemic, anxiety and depression were higher among young adults, women and people with risk factors for Covid-19. He also suggested that mental health consequences could be more long term, and it follows from this that there will be increased demand for mental health services. He stated: “but it is now looking possible that the worst mental health consequences of Covid-19 may be in the longer-term, and will not [be] from the direct effects of the virus, but from the indirect effects of economic recession” and “the experience of the SARS and MERS epidemics shows us that stress related disorders can last for month[s] or years.” Professor Thornicroft made some recommendations on how to respond to the mental health implications of the pandemic, including to integrate mental health into the mainstream Covid-19 response, provide emergency mental health, psychological and social support in the community and to make mental health care and support an integral part of primary care and universal health coverage.

In the APPG’s ‘Public Inquiry’ report dated October 2021 (“October 2021 Report”), they acknowledged “Covid-19 has brought despair to individuals, families, and communities, leaving many people feeling unsafe and disconnected… The fallout of the pandemic has resulted in fractured relationships, isolation, debt, unemployment, and grief (Mind). On top of this, access to services or support has been limited or completely unavailable. Beat [the UK’s eating disorder charity] told the APPG that further restrictions or cancellations to services will have a significant impact on mental health both now and as we move out of restrictions.”35 Mind told the APPG ‘that though ‘the peak of the pandemic may have passed; we are already experiencing a knock-on mental health emergency’. The APPG also found that (i) those with pre-existing mental health conditions have seen their mental health decline further throughout the pandemic; (ii) many individuals are experiencing mental health problems for the first time as a result of complex grief; (iii) throughout the pandemic there has been a reduced access to services and support as a result of Covid-19 restrictions; (iv) the reduction in normal activity and increased isolation has caused many to experience mental health problems for the first time; and (v) there is specific concern for the mental health of key workers.36

This increased need for mental health services will undoubtedly affect NHS and private mental health providers, and staff within those organisations; it may indeed lead them to require further staff. We considered short staffing in the NHS in our first article in this series.

c). Care homes

The Joint Inquiry heard both anecdotal evidence from family members of those in care homes, and evidence from those working within the sector, on the impact of measures implemented by the Government, in particular, the impact of lockdown and social distancing on residents and their families due to visiting restrictions. Restrictions on visiting in care homes is one of the topics specifically set out in the Covid-19 Public Inquiry’s draft ToR.

Visiting of residents in care homes has been, at times, restricted during the pandemic in light of lockdown and social distancing measures being implemented. In respect of visiting residents of care homes, Philip Scott (a carer) stated: “it is great that the home has been facilitating Skype and, in the summer, introducing garden visits, but it is not the same as actually being able to see her, hug her or hold her hand. During March and April, when the virus was ripping through care homes, it was a time of considerable anxiety for both myself and my sister.”37 Mr Greg Clark, one of the Chairs of the Joint Inquiry, acknowledged the STC and HSCC received evidence of the “difficulties and strain it can put on loved ones who cannot see someone who is in a care home.”38 It was also described as a human rights issue, and that visiting was important for residents’ well-being.

Professor Chris Whitty (Chief Medical Officer for England), in his evidence to the Joint Inquiry, acknowledged the tension between visitations increasing risk, both to the person being visited and others, and the loneliness of the residents, whilst Dr Jenny Harries (Deputy Chief Medical Officer) confirmed that testing can reduce but not eliminate the risks.39 She confirmed there was no risk-free solution to the issue of visiting.40 Theresa Steed, who runs a care home in Tunbridge Wells, gave evidence in respect of the process for visiting at her care home, in October 2020, confirming that they had given time slots to families, and on occasion they had to limit the number of visits, for fairness, to allow all residents to have visitors.41

The purpose of restricting visits in care homes, in light of lockdown and social distancing, was to reduce the number of deaths within them, although there has been criticism of the time it took to make the decision to restrict visitors. However, during the Joint Inquiry, comparisons were drawn with other countries that restricted visiting in care homes from an early stage of the pandemic, for example, Spain, and confirmed that it was not clear that a stricter, or earlier, ban on visiting would have reduced the numbers of deaths in care homes.42 Mr Jeremy Hunt, one of the Chairs of the Joint Inquiry, confirmed the Committee’s understanding that there were “16,000 deaths in care homes between March and September, about 40% of all the Covid deaths. Many of them, in different ways, were linked to infection prevention and control issues, whether lack of PPE, agency staff working in multiple care homes, not stopping visitors early enough or lack of testing.”43 Mr Hunt also suggested that it was necessary to ensure that the care sector learned lessons for future pandemics.

Barbara Keeley, a member of the HSCC, also implied she was critical of the delay in testing of visitors in care homes, which would have enabled visits to recommence more quickly, although Mr Hancock denied there was a delay, instead indicating it was going ahead (at that point in November 2020) as quickly as it was safe to do so.44 One of the urgent key recommendations recommended by Amnesty International UK in their written evidence to the Joint Inquiry was to: “ensure meaningful visits to care homes can take place, including through provision of regular testing for visitors.”45

In the APPG’s December 2020 Report, they found the guidance on visiting care homes during the pandemic has been unclear. They also highlighted that advice on visits to care homes was out of line with advice on hospital visiting, and with the advice in other jurisdictions, such as Scotland.46 At that time in December 2020, they concluded continued isolation was having a devastating impact on residents in care homes and their families. The APPG suggested that this could have been alleviated by the availability of tests with short turnaround times, such as used in Germany and Italy.47

The Joint Inquiry did not, however, consider in detail the differences in approach to care homes within the four devolved nations, and the impact of this. There has been criticism of the measures taken in respect of preventing Covid-19 in care homes in all nations. For example, in Wales allegations have been made that the Welsh Government urged care homes to accept patients without Covid-19 tests; in Scotland, it has been alleged that Scottish government guidelines suggested Covid-19 positive residents in care homes should be managed in the care home and not transferred to hospital and in Northern Ireland there have been allegations that there has been a disproportionate number of deaths in Northern Irish care and nursing homes, an allegation supported by Amnesty International UK. The Terms of Reference for the Scottish Inquiry specifically include: “in care and nursing homes: the transfer of residents to or from homes, treatment and care of residents, restrictions on visiting, infection prevention and control, and inspections.”48

The draft ToR for the Covid-19 Public Inquiry suggest that the management of the pandemic in care homes across the UK will be considered and within this, it may consider the divergence in approaches to care homes across the four nations, and generally whether the four nations approach worked, or whether a different approach should be taken in future pandemics. 

Preparing for the Covid-19 Public Inquiry

In the APPG’s October 2021 Report, it was suggested that “the Public Inquiry’s unique competence will be the ability to scrutinise the UK Government’s decision making process during the Covid-19 pandemic in the UK. It should identify what was known at the time, which organisations, committees and individuals were listened to and how advice was weighted in order to establish the timeliness, quality and consequence of key decisions.”49 From the draft ToR of the Covid-19 Public Inquiry, it appears the Baroness Hallett heeded this message, and included it within the draft ToR. It is likely to be a significant topic for investigation, given the wide-ranging implications of the decisions to deploy non-pharmaceutical measures, and the number of people affected.

The findings and recommendations from the Covid-19 Public Inquiry, in respect of non-pharmaceutical measures will be of interest to us all; we have all been required to comply with various measures implemented by the Government, from wearing face coverings, to lockdown and wearing Personal Protective Equipment (“PPE”). In addition, these measures have impacted some organisations, businesses and industries more than others. For example, the lockdown and closure of the borders significantly impacted the hospitality, retail and travel industries; social distancing also affected the night time economy and events industries, and education establishments; and all businesses will have needed to source and provide PPE to staff and customers. Any evidence heard by the Covid-19 Public Inquiry in respect of this area of investigation, and any subsequent recommendations, would therefore impact, and have the potential to benefit, a wide range of businesses and industries.

As we have suggested in our first article, it is important to consider what action can be taken now to help prepare for involvement with the Covid-19 Public Inquiry. This area of investigation will be of interest to those directly affected by Covid-19, from bereaved families to survivors of Covid-19, Governmental departments, acute and mental health NHS Trusts and their staff, care homes including their residents, staff and relatives residents and other organisations with an interest in the care home sector. For those likely to be impacted by this evidence, a timely review of the Report and its recommendations is recommended, in advance of these issues being considered in more depth by the Covid-19 Public Inquiry.

In the next article in this series we consider testing and contact tracing. However, should you have any queries in the meantime in respect of preparedness for the Covid-19 Public Inquiry please do not hesitate to contact one of the authors of this article.


  1. UK COVID-19 Inquiry: draft terms of reference (HTML) - GOV.UK (www.gov.uk)

  2. Meaning the “Coronavirus: Lessons Learnt” inquiry conducted jointly by the Science and Technology Committee and the Health and Social Care Committee.

  3. Transcript of oral evidence 21 October 2020, page 16, Mr Greg Clark, one of the Chairs of the Joint Inquiry, stated “we know that SAGE does not make policy. It gives advice on policy, but the Science and Technology committee has taken evidence that, in every material respect, during those early days the Government followed the advice of SAGE”.

  4. Coronavirus: lessons learnt (parliament.uk), page 59.

  5. There has been some debate during the oral hearings in respect of the semantics of the term ‘herd immunity’.  We have used this to denote the initial strategy to not to socially distance or lockdown and to potentially build up some immunity in the community (for example, see comments by Sir Patrick Vallance at the Government press conference on 12 March 2020).

  6. Transcript of oral evidence 21 October 2020, page 15, where Mr Clark, as Chair, provides quotes from Patrick Vallance on 12 March 2020 in relation to herd immunity, and from SAGE minutes, assumed to be around the same time.

  7. Transcript of oral evidence, 24 November 2020, page 15.

  8. Coronavirus: lessons learnt (parliament.uk), page 39.

  9. Coronavirus: lessons learnt (parliament.uk), page 36.

  10. Transcript of oral evidence, 26 May 2021, page 45.

  11. Transcript of oral evidenced, 26 May 2021, page 22.

  12. Transcript of oral evidence, 26 May 2021, pages 15 and 43.

  13. Transcript of oral evidence 21 October 2020, page 6 for comments from both Dr Roser and Professor Heyman.

  14. The APPG’s Interim Report dated December 2020, page 26.
  15. Coronavirus: lessons learnt (parliament.uk), page 34.

  16. Coronavirus: lessons learnt (parliament.uk), page 10.

  17. COVID-19 Inquiry - gov.scot

  18. SPI-B insights on combined behavioural and social interventions - 4 March 2020 (publishing.service.gov.uk)

  19. Transcript of oral evidence, 2 December 2020, page 13.

  20. https://committees.parliament.uk/oralevidence/747/html/

  21. Coronavirus: lessons learnt (parliament.uk), page 56.

  22. See document CLL0129 submitted to the Joint Inquiry.

  23. Coronavirus: lessons learnt (parliament.uk), page 51.

  24. Coronavirus: lessons learnt (parliament.uk), page 57.

  25. Coronavirus: lessons learnt (parliament.uk), page 47.

  26. Coronavirus: lessons learnt (parliament.uk), page 60.

  27. See for example Domestic abuse during the coronavirus (COVID-19) pandemic, England and Wales - Office for National Statistics (ons.gov.uk) which discusses the increase in reports, and increase indemand for domestic abuse victim services during the coronavirus pandemic, and whether this can be directly attributed to the pandemic.

  28. Transcript of oral evidence, 26 January 2021, page 4. The impact of the Covid-19 pandemic on maternity services: A review of maternal and neonatal outcomes before, during and after the pandemic - PubMed (nih.gov

  29. The impact of COVID-19 on pregnant womens' experiences and perceptions of antenatal maternity care, social support, and stress-reduction strategies - PubMed (nih.gov)

  30. What impact has Covid-19 had on mental health services? | The Nuffield Trust

  31. Transcript of oral evidence, 26 January 2021, page 26.

  32. Transcript of oral evidence, 24 November 2020, page 38.

  33. The Silent Pandemic: Covid-19 and mental health | Feature from King's College London (kcl.ac.uk)

  34. The APPG’s Public Inquiry Report dated October 2021, page 83.

  35. The APPG’s Public Inquiry Report dated October 2021, pages 84-87.

  36. Transcript of oral evidence, 13 October 2020, page 3.

  37. Transcript of oral evidence, 13 October 2020, page 9.

  38. Transcript of oral evidence, 9 December 2020, page 39 and 40.

  39. Transcript of oral evidence, 9 December 2020, page 48.

  40. Transcript of oral evidence, 13 October 2020, page 11.

  41. Transcript of oral evidence, 13 October 2020, page 30.

  42. Transcript of oral evidence, 13 October 2020, page 13.

  43. Transcript of oral evidence, 24 November 2020, page 41.

  44.  See document CLL0004 submitted to the Joint Inquiry.

  45.  The APPG’s Interim Report, page 52.

  46.  The APPG’s Interim Report, pages 64-65.

  47.  COVID-19 Inquiry - gov.scot (www.gov.scot)

  48. The APPG’s Public Inquiry Report dated October 2021, page 10.