The UK government released more than 50 documents on Friday – including the minutes of 34 meetings of the Scientific Advisory Group for Emergencies (Sage). The documents set out how scientists tracked – and reacted to – the pandemic. By mid-March, a sense of panic was setting in. 22 January – Poor data from China In the first Sage meeting responding to the outbreak of coronavirus in Wuhan, the committee agrees there is considerable uncertainty around the data coming out of China, meaning “a reasonable worst case cannot be made reliably”. 28 January – Test ready by end of week The committee says a test for coronavirus should be ready by the end of the week, with a capacity to run 400 to 500 tests per day. It agrees on the importance of behavioural science informing policy. 3 February – Sage rejects travel restrictions The committee considers imposing restrictions on travel into the UK. It concludes that reducing imported infections by 50% would maybe delay the onset of any epidemic in the UK by about five days. “Only a month of additional preparation time for the NHS would be meaningful.” 5 February – Nervtag recommends masks Nervtag (New and Emerging Respiratory Virus Threats Advisory Group) recommends symptomatic people should be encouraged to wear a surgical face mask, “providing that it can be tolerated”. Sage agrees that shutting down public transport or restricting public gatherings would “probably be ineffective” in delaying the spread of the virus. 6 February – Sage extends self-isolation guidance The virus is in the UK and Sage notes that a third person, a man who had recently visited Singapore, had tested positive for coronavirus. It now advises that those who have travelled from Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau and are showing symptoms self-isolate. 11 February – Prediction that mass testing will end Sage predicts an eventual end for any attempt at mass testing and contact tracing, saying it is not possible for the UK to accelerate coronavirus testing capacity alongside regular flu testing. It recommendeds that Public Health England establishes a criteria for when “contact tracing is no longer worthwhile”. 13 February – Prediction that stockpiling could be an issue Sage hears that “scepticism and general inaction dominate” among the general public and will continue to do so until the first coronavirus death in the UK. They warn there could be perceived competition for limited resource (e.g. food, medicines). 18 February – PHE contact tracing limited Sage concludes that “priorities would shift during a potential outbreak from containment and isolation on to delay and, finally, to case management”. It says Public Health England could cope with “five new cases a week (requiring isolation of 800 contacts)”, with potential capacity to increase to 50 new cases and 8,000 contact isolations. 20 February – Physical distancing could slow the spread Meeting hears the first evidence “of local transmission unlinked to individuals who have travelled from China, in Japan, Republic of Korea and Iran”. It is also told there is some evidence from China and Hong Kong “that social distancing measures have had some impact in limiting the outbreak”. 27 February – Committee hears 500,000 deaths possible Meeting discusses the “reasonable worst case scenario” in which 80% of the UK population is infected, with a 1% fatality rate – which would mean up to 500,000 deaths, a key move towards eventual lockdown. This was modelling from Prof Neil Ferguson of Imperial College, who was at the meeting. 3 March – Start of lockdown guidelines being drawn up A key conclusion from this meeting is that PHE is ordered to start drafting public guidance on potential lockdown, informed in part by behavioural science advice. 5 March – First mention of isolating people with Covid The meeting concludes that there would be a need, within one to two weeks, to make symptomatic people isolate for 14 days, and then about two weeks later to consider “cocooning” older or otherwise medically vulnerable people. 10 March – Transmission is under way This meeting concludes that “transmission is under way in the community” and that modelling suggests “the UK is 10-14 weeks from the epidemic peak if no mitigations are introduced”. It hears that the UK could have up to 10,000 cases already, and is about four to five weeks behind Italy. There is also, it says, a “priority” to get more antibody testing. There is also an acknowledgment of the looming crisis to come in care homes. “Sage advised that special policy consideration be given to care homes and various types of retirement communities.” 13 March – ‘Things are worse than we thought’ This meeting finds there were more cases in the UK than previously expected at this point, and that household isolation and protecting older and more vulnerable people should happen “soon”. “Sage now believes there are more cases in the UK than previously thought and we may therefore be further ahead of the epidemic curve …” 16 March – Sage advice changes This meeting hears of a significantly different situation: now, it says, “there is clear evidence to support additional social distancing measures be introduced as soon as possible”. The minutes add: “These additional measures will need to be accompanied by a significant increase in testing and the availability of near real-time data flows to understand their impacts.” It is possible, the committee is told, that the UK could now have up to 10,000 new cases per day. Sage also speaks of the possibility of closing schools. “While Sage view remains that school closures constitutes one of the less effective single measure to reduce the peak epidemic, it may nevertheless become necessary … to push demand for critical care below NHS capacity.” 18 March – Evidence backs schools closures This meeting is told that “available evidence now supports implementing school closures on a national level as soon as practicable to prevent NHS intensive care capacity being exceeded”. The UK now seems to be two to four weeks behind Italy. It considers measures just for London, such as closing restaurants and bars, saying the capital appears to be one or two weeks ahead of the rest of the UK. 23 March – Lockdown is announced The day the lockdown is announced, and Sage sets out some of its key concerns. The reproductive R rate is high – and London could run out of ICU capacity in 10 days. “The science suggests the [R rate] is now around 2.6-2.8. High rates of compliance for social distancing will be needed to bring the reproduction number below one and to bring the cases within NHS capacity.” On the NHS: “The NHS is surging bed capacity over the next fortnight with a focus on London. The data suggest that London is 1-2 weeks ahead of the rest of the UK … case numbers in London could exceed NHS capacity within the next 10 days.” It adds: “Increased community testing and surveillance will be invaluable to measure the effects of the interventions taken. Sage noted that social distancing behaviours have been adopted by many but there is uncertainty whether they are being observed at the level required to bring the epidemic within NHS capacity.” Sage also notes “there is a worldwide shortage of reagents, platforms and equipment”. 26 March – ‘No hasty decisions’ on treatments The meeting agrees that, once R is below 1 and demand on critical care is brought within capacity, a focus is needed on behavioural and social interventions and on the testing regime necessary for exiting lockdown. The scientists advise that no hasty decisions should be made on treatments, such as the malaria drug chloroquine, based on insufficient or conflicting data. The meeting hears that nosocomial transmission – the spread of Covid-19 in hospitals – needs urgent attention. Advisers re-emphasise “the importance of urgently ramping up testing of appropriate quality”. 7 April – Face masks have ‘minimal effect’ The meeting hears that the increased use of face masks would probably have minimal effect in terms of preventing the spread of infection. However, questions are raised about whether this conclusion would change if it were known that there were high levels of transmission between asymptomatic individuals. 9 April – The Peak? The meeting is told that the epidemic may be reaching its peak, but could remain at a plateau for some time. The chief veterinary officer advises the meeting that the risk of transmission from cats to humans is low. 14 April – R-value coming down The meeting hears that the R-value of the epidemic is probably between 0.5 and 1 – but that relatively small changes to social distancing measures could push R back above 1. However, the spread of infection within hospitals is making up an increasing proportion of cases and care homes are also flagged as a concern, with Sage noting the lack of data available. The scientists discuss the extensive pros and cons of recommending face masks, but conclude that “evidence does not currently support [their] use” in the general population. 21 April – Obesity is a risk The scientists decide there is “enough evidence to support recommendation of community use of cloth face masks, for short periods in enclosed spaces, where social distancing is not possible.” They add that any policy decision on masks “must not jeopardise supply” to health and social care settings. Discussions about who is most vulnerable to the disease flags up that “there is a clear signal that obesity is a risk factor”. 23 April – No game-changing existing drugs Sage is downbeat on the potential for existing drugs to be repurposed to treat Covid-19: “Repurposed medicines are unlikely to deliver a ‘game-changing’ breakthrough for treating the virus.” 28 April – Stick with 2 metres The committee notes that a possible complication has emerged in children. The “kawasaki-like syndrome” has “a probable link to Covid-19 …” “The 2 metre rule remains appropriate though short-duration closer contacts are likely to present very low risk.” 1 May – Test and trace Sage discusses the test-and-trace system and agrees “that at least 80% of contacts of an index case would need to be contacted for a system to be effective”. “For the test-and-trace system to be effective, isolation of contacts of individuals with Covid-19 within 48 hours was desirable. “The aim should be to develop the capability to test index cases in less than 24 hours … It is considered essential that this testing capability is reached before the autumn/winter flu season when a large number of those reporting symptoms may not have Covid-19.” 5 May – Focus on care homes Sage calls or a focus on reducing transmission in health and care settings. It is “necessary to reduce transmission in care homes and hospitals in order to effectively manage the epidemic”. Sage says relaxing lockdown measures should not happen until new cases have dropped to a low level – not on a fixed date. 7 May – Ferguson thanked after he quits Sage reiterates there “should be extensive testing of healthcare workers including asymptomatic workers”. It notes “the important contribution made by Neil Ferguson over the course of the response and [agrees] the importance of continuing to draw upon the work of the Imperial College London team.” Preliminary results of a study indicate that “the virus decays rapidly when exposed to artificial sunlight”. It notes some rare symptoms or complications that are emerging, including “cerebrovascular events, renal disease and systemic endothelial and organ dysfunction. Also notes longer term health problems, including “extreme tiredness and shortness of breath for months.” The creation of “bubbles” are beneficial for mental wellbeing and allowing children to be shared between households, but could “reconstruct extensive networks” that could “enable transmission through the population”.