Not much makes sense during a pandemic but in recent weeks the Covid puzzle has become a deeper mystery. When local lockdowns failed, the solution was to try even more of them. Manchester was put into Tier 3 restrictions when its Covid cases were falling; now there’s talk of a Tier 4. Confirmed infections are nowhere near the 50,000 a day that Boris Johnson’s scientific advisers warned about last month - but the panic now seems far greater.
The fear, of course, comes from what officials think will happen next. We’re told that the Prime Minister fears a second wave larger than the first, but we’re not really told why. Decisions are made to tighten restrictions on the basis of figures, scenarios and documents that are not shared with the public. Perhaps the biggest question is how long this new phase will last. If we’re hunkering down in fear of what happens if we don’t, when might it all end? And have we already settled down to a very long winter?
Many of the answers lie with the Scientific Advisory Group for Emergencies, its name perhaps chosen so it could produce the acronym Sage. It is fed by modellers, called SPI-M, who produce what’s known as a ‘reasonable worst-case’ scenario, or RWC. In the UK system, government plans around this worst-case basis. But if the country ends up being run around this scenario, then we enter problems. There is little scrutiny of the Sage assumptions, because so many of them are unpublished. Some of its papers are released sporadically. But some of its major planning is kept secret even from senior members of the government.
The secrecy is odd. In classic pandemic theory, governments are supposed to keep the public informed at every stage about what they know and don’t know. The risk is that a lack of transparency erodes confidence in ministers, and creates space for misinformation. The other risk is that if government is relying on modelling, much depends on the accuracy of the modelling. If it’s not scrutinised, mistakes are more likely to go uncorrected. More fundamentally, if people are being deprived of their liberty, they deserve to know why.
That’s why The Spectator is publishing a document which the government has not until now acknowledged the existence of: the ‘reasonable worst-case scenario’ for this coming winter. The document is on our website and makes for grim reading: 85,000 dead from a new Covid wave, about a third more than have died so far. It envisages 356,000 heading for hospital. Deaths are expected to peak at a lower rate than the first wave — but what is very different, this time, is the duration. The second wave is expected to get steadily worse until March.
The Sage document starts with an important caveat: it’s a hypothesis, not a prediction. The clue is in the name: a ‘worst-case planning scenario’ is not the most likely outcome. But as it says, under the UK system, this is the basis on which plans are being made. The document, published on 30 July, explains why lockdown measures were never properly relaxed. It also explains why ministers are so worried. If its forecasts are even half-right, we’re not remotely close to the end of the Covid story. While Swedes regard Covid as a near-exhausted enemy, the Brits see a monster ready to strike even harder as soon as normal life resumes. Which is why there’s no rush to resume normal life.
The core Sage assumption is of ‘a difficult autumn followed by a large winter peak’, with the virus doubling every two weeks. After a month of this, restrictions would be tightened ‘to reduce non-household contacts to half of their normal pre-March 2020 lockdown levels’ but schools would remain open. So far, so accurate: this has been pretty much the story to date. Which makes the next assumption in the Sage plan significant: ‘These measures are sustained until the end of March 2021.’ This is a plan to keep the restrictions until April. Perhaps longer.
Then the deaths. According to the RWC they will start to surge in December, with 500 dying each day for ‘at least’ three months and peaking at 800 a day in ‘late February 2021’. This means 85,000 more dead by the end of March, but it does not stop there. Deaths will continue ‘past the end of the scenario’ to numbers yet to be calculated. Crucially, this is all far bigger than the first wave. Last time, the number in hospitals peaked at 19,849. Now, the NHS is being asked to prepare for 25,000.
Perhaps the most striking point is the tsunami expected to be heading toward the National Health Service’s intensive care beds. By Valentine’s Day, new Covid infections will peak at 100,000 a day. The RWC assumptions suggest that of these people, 2,400 will later be hospitalised, 492 will end up in intensive care and 700 will die. In April of this year, at the peak of the first wave, Covid patients occupied 3,301 intensive care beds. In the second-wave scenario this level will be surpassed by Christmas, and will peak by ‘early March 2021’ with 5,000 in intensive care in England, 300 in Scotland and 400 in Wales.
You might, reading this, think it all a hysterical exaggeration. You might think it perfectly sensible. Or an underestimate: cases actually started rising in September, not November as Sage expected back in July. But what matters is that these figures — or a modified variant of them — are now behind government policy. The report spells this out: the Cabinet Office, it says, ‘currently advises that HM Government should plan based on the RWC scenario’. The Reasonable Worst Case might never come to pass, but it ought — still — to be what ministers plan around. This is what’s terrifying Boris Johnson.
To see this scenario — and the date it was published — explains why the PM suddenly went cold on Rishi Sunak’s eat-out-to-help-out scheme, and was talking about a second wave when his Chancellor was fronting a back-to-work drive. This helps explain why Manchester and Liverpool are under Tier 3 now. It’s not about the situation as it stands, but as Sage modelling suggests it could be: another Covid deluge on top of normal winter NHS mayhem (which typically peaks in February).
Now imagine the Prime Minister plonked in the middle of all of this. Throughout his career he has mocked gloomsters. Famously, he once declared that ‘the real hero of Jaws is the mayor, a wonderful politician — a gigantic fish is eating all your constituents and he decides to keep the beach open’. He might think the Sage scenario is alarmist. But, he asks friends, how can he dismiss it? On what basis? That it doesn’t look right? He’s being given detailed warning of a second wave even larger than the first, and he cannot dismiss this possibility. No. 10 is structured in a way that there is no second opinion, no other team of experts to critique the Sage documents and assumptions.
So it’s easy to understand his dilemma when infections did start to rise again in September. It is harder to argue (as the Swedes do) that this is a manageable risk. The scenario he was being given showed that when a second wave starts, it won’t stop for months. Chris Whitty, the chief medical officer, gives him the maths: just 7 per cent of the country have had the virus, so 93 per cent are probably vulnerable — therefore Covid is still capable of killing 500,000 people. And this figure — half a million deaths, far more than the Sage document — is still being used and defended in No. 10.
Those in government who argue that Sage is being overcautious will struggle to produce their own models. And other studies tend to be bleaker still. A study commissioned by Sir Patrick Vallance, the chief scientific officer, came back with an estimate of 120,000 winter deaths — far greater than Sage’s ‘worst case’ of 85,000. It also agreed that there would be a Covid crescendo in early March: the numbers change but the date does not. In short, the Chancellor’s optimism is no answer to Sage’s calculations. At present, nothing is.
But some in the Department of Health are scarred by Sage advice from the first wave and think that any modelling that looks more than two weeks into the future has vast error margins. Health officials were told on 1 March that 90,000 ventilator beds could be needed for Covid patients — use peaked at 3,300 beds. Later advice — dated 17 March — suggested 138,000 beds, 40 times the peak figure. At one stage, the NHS was told to prepare for two million Covid patients needing hospital care — ten times more than the eventual figure.
The big question is whether these assumptions are, as Sage says, ‘reasonable’. And if not, who is likely to say so? The Sage scenario assumes 66 per cent of people with Covid showing symptoms: the last UK sample put this figure at 33 per cent. It assumes an ‘infection fatality ratio’ of 0.7 per cent: a World Health Organisation paper recently put the average estimate at 0.3 per cent. There is no ‘red team’ of experts in No. 10 challenging the assumptions; and there can be no debate about them in public when they are being kept secret.
It’s not hard to see the problem. If the government prepares for a tsunami that never arrives, it can end up using language that scares people away from using hospitals and seeking care. Then you end up with what we had last time: 40,000 empty NHS beds at the peak of the virus and many of those who would otherwise be treated dying at home. Not that this is discussed much in Covid strategy meetings. Sage, SPI-M and the Joint Biosecurity Centre — which all shape the Covid strategy — are focused only on the virus. There is no equivalent group calculating the harm done by lockdown: the cancer deaths, mental health caseload and the loss of life that always accompanies economic crashes.
During the 2009 swine flu outbreak, the ‘reasonable worse-case scenario’ from Sage envisaged 65,000 deaths. There was no lockdown. Just 457 died. The subsequent inquiry had plenty to say about the wisdom of planning around an unlikely, gloomy scenario: better to plan for the most likely scenario, it suggested, while ‘monitoring events closely and changing tack as necessary’. No. 10 may be trying to edge towards this approach now, but if the Prime Minister discards the advice of his only group of expert advisers, he has no scientific or political cover.
And here’s the thing: Sage could be right. The virus has surprised us before, and will doubtless do so again. But right or wrong, the figures explain why the government is in a panic — and why we can forget about the Prime Minister’s previously expressed hope of a ‘significant return to normality’ by Christmas. Inside government, people have started saying that about next Christmas. For now, it seems that normality will not return for some time to come.
To read the full ‘reasonable worst-case’ Sage document go to: spectator.co.uk/sage