June 10, 2021

expert reaction to evidence given by Matt Hancock to the Science and Technology Committee and Health and Social Care Committee on Coronavirus: lessons learnt

Matt Hancock, the UK’s Secretary of State for Health, today gave evidence to the House of Commons Science and Technology Committee and the House of Commons Health and Social Care Committee as part of their joint inquiry on the government’s handling of the COVID-19 pandemic.

Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, Respiratory Sciences, University of Leicester, said:

“Despite these statements from government ministers/advisors, there was already ample growing evidence for asymptomatic infection and transmission of this novel coronavirus from as early as March 2020 – as can be seen in this early ECDC document:

(page 7)

[From document] “Infection in asymptomatic individuals: Asymptomatic infection at time of laboratory confirmation has been reported from many settings [24-27]; a large proportion of these cases developed some symptoms at a later stage of infection [5,28]. There are, however, also reports of cases remaining asymptomatic throughout the whole duration of laboratory and clinical monitoring. Viral RNA and infectious virus particles were detected in throat swabs from two German citizens evacuated from Hubei province on 1 February 2020 who remained well and afebrile seven days after admission to a hospital in Frankfurt [29]. A mother and her child (from a family cluster) who both tested positive by quantitative RT-PCR (nasopharyngeal swab samples) remained asymptomatic (including normal chest CT images during the observation period) [30]. Similar viral loads in asymptomatic versus symptomatic cases were reported in a study including 18 patients [31]. Persistent positivity of viral RNA in throat and anal swabs was reported in an asymptomatic female patient after 17 days of clinical observation and treatment [28].”

“Transmission in pre-symptomatic stage of infection: No significant difference in viral load in asymptomatic and symptomatic patients has been reported, indicating the potential of virus transmission from asymptomatic patients [5,32,33]. Major uncertainties remain with regard to the influence of pre-symptomatic transmission on the overall transmission dynamics of the pandemic because the evidence on transmission from asymptomatic cases from case reports is suboptimal. Pre-symptomatic transmission has also been inferred through modelling, and the proportion of pre-symptomatic transmission was estimated between 48% and 62% [34]. Pre-symptomatic transmission was deemed likely based on a shorter serial interval of COVID-19 (4.0 to 4.6 days) than the mean incubation period (five days). The authors indicated that many secondary transmissions would have already occurred at the time when symptomatic cases are detected and isolated [35].”

“Further summarised in this review article that highlights early reports of asymptomatic transmission.

“Although this review article was published online in May 2020, some reports from China from much earlier are cited in the review, clearly demonstrating this virus’ ability to cause asymptomatic infection and to transmit from such asymptomatic cases.

“If you ask any clinical virologist who works with respiratory viruses, this would not be a surprise. One can always ask and wait for more evidence, but people define ‘sufficient’ and ‘evidence’ in different ways. But in an evolving pandemic, you cannot wait too long.

“The lack of testing capacity in the UK during the early, first wave of the pandemic likely skewed government policy away from testing asymptomatic cases, as well as symptomatic cases in the community – but this is quite a separate issue from saying that asymptomatic cases are not infectious and do not transmit the virus.

“At this point, sadly, it was less that government policy followed the science, more that government policy followed what testing capacity was available – which could have been much more if the threat was taken more seriously, earlier, in January 2020 – as indicated by these early papers, for example:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159271/

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.3.2000044

– giving diagnostic labs the time to ramp up their testing capabilities – to allow the wider testing of milder symptomatic and asymptomatic cases in the community, hospitals and care homes, which have now been shown to be important drivers of the pandemic.

“From very early on, the UK approach to the pandemic has been quite naive – mainly due to a lack of experience. Fortunately ministers are now readily admitting this, which is a helpful step to doing better next time. 

“More specifically when dealing with a viral pandemic :

– the WW2 approach to pandemic of “Keep calm and carry on” 

– together with a belief that the British public would not tolerate a national lockdown 

were both wrong – as also highlighted in this early article:

https://www.nejm.org/doi/full/10.1056/NEJMp2005755

“Unlike a war setting, where committing too early could have fatal consequences, delaying action in an evolving pandemic just lays the ground for the seeding of more cases with subsequent wider spread, necessitating a longer lockdown – as we have seen.

“This misunderstanding, coupled with a lack of testing capacity and a misplaced belief that asymptomatic infections were not infectious, combined with the delayed national lockdown had a catastrophic impact on the UK population.

“The extraordinary thing is that even whilst it’s European neighbours were locking down, the UK was still delaying this, even holding sporting events, which allowed massive crowds to mingle, further spreading the virus – a phenomenon that some have referred as ‘British exceptionalism’:

https://committees.parliament.uk/oralevidence/1323/pdf/

(page 13)

“Q728 Carol Monaghan: You said earlier that you felt British exceptionalism had contributed to our response. Is British exceptionalism going to delay us coming through or coming out of this pandemic?

“Professor Dame Sally Davies: I posited British exceptionalism as one issue, because we do not seem to have learnt from Asia very quickly, but clearly, we are on a much better track now, so I hope it will not get in the way.”

“The flip side of the disaster coin was that the UK then started opening up after the first wave lockdown, very quickly, allowing cases to surge again, and then delayed initiating a further lockdown when these cases rose too quickly:

https://www.nejm.org/doi/full/10.1056/NEJMp2032508

“as if it hadn’t learnt from the earlier experience. The second wave proved more devastating than the first – topping 60,000 new cases and over 1800 deaths per day in January 2021.

“Yet, all the while, the virus was doing exactly what we expect a pandemic virus to do – spreading quickly amongst the non-immune that were too close together, mutating to enhance its transmissibility and immune escape capabilities – and spreading locally, nationally and internationally, whenever and wherever the opportunities arose.

“Regardless of the in-fighting between the various politicians, the lesson to be learnt here is that when dealing with a viral pandemic, we need to react quickly and comprehensively. 

“Even if we ‘over-react’ (and this is not easily defined, e.g. suppressing some or all of the virus – like New Zealand?), this is not a bad thing. Any lockdown/restrictions can be lifted earlier if the virus is brought under control, earlier – and now, people understand this better and will accept it.”

Prof Stephen Reicher FBA, Professor of Social Psychology, University of St Andrews, & Member of SPI-B, said:

“Hancock claims that earlier lockdown would have gone against the scientific consensus and that ‘the clear advice at the time was that there’s only a limited period that people would put up with it’. This is quite simply untrue.

“It is an old claim that has been comprehensively debunked. Such advice didn’t come from the Government’s own behavioural advisory group. Such an idea was publicly disputed by behavioural scientists (see https://behavioralscientist.org/why-a-group-of-behavioural-scientists-penned-an-open-letter-to-the-uk-government-questioning-its-coronavirus-response-covid-19-social-distancing/).

“So I don’t know what Hancock means when he talks about ‘the clear advice at the time’ but it was not the scientific advice, and certainly not the behavioural science advice.”

From: https://twitter.com/ReicherStephen/status/1402953378053959685

Prof John Drury, Professor of Social Psychology, University of Sussex, & Member of SPI-B, said:

“Public ‘fatigue’ rears its ugly head again, now in Hancock’s re-write of history. Here’s the truth about public ‘fatigue’ in covid, by Susan Michie, Robert West and Nigel Harvey: https://blogs.bmj.com/bmj/2020/10/26/the-concept-of-fatigue-in-tackling-covid-19/

“If there was ‘fatigue’, levels of adherence would decline in a linear way – but they did not; levels of adherence respond to level of risk and actions/ communications by the government: https://blogs.sussex.ac.uk/crowdsidentities/2020/12/27/mitigating-the-new-variant-sars-cov-2-virus-how-to-support-public-adherence-to-physical-distancing/

“’Fatigue’ is another example of dangerous folk-psychology being applied by the authorities to the management of an emergency.

“As the SPI-B document from March last year indicates, there was not a ‘consensus’ among scientists that the public would not ‘put up with’ the restrictions. The restrictions we were asked about in this briefing document were to do with reducing social contacts (i.e. physical distancing), not ‘lockdown’.

“At the time, unnamed experts said that people would get bored and that measures might be unsustainable. But you will not find reference to this in any of the documents produced for the government by SPI-B.”

From: https://twitter.com/ProfJohnDrury/status/1402955487868559366

Prof Martin Hibberd, Professor of Emerging Infectious Disease, London School of Hygiene & Tropical Medicine (LSHTM), said:

“Early on in the outbreak, most of the information was coming from China, and at this stage I think it is fair to say that there were a lot of unknowns. The early reports said there was little person to person transmission, suggesting that perhaps COVID-19 would turn out like MERS. While later, it was reported that there was no asymptomatic infection. However, by March, the data from Italy and from cruise ships, was clearly showing that this virus could rapidly spread in the community and that asymptomatic infection was occurring. As a result, scientists were calling for a rapid increase in testing and community wide testing, to ascertain what was really happening in the UK. At that time though, there were insufficient resources to do that, and it seems that what little resources were available were focused on symptomatic hospital testing – which is also a high priority. I think we should be clear that in April, the political decisions were being made based on pragmatic availability of resources and a perceived ranking of importance, rather than on science advice alone. Clearly community testing was seen as important, because shortly after this, large-scale community testing was launched.”

https://www.parliamentlive.tv/Event/Index/f6726bde-a69a-40e6-bbc1-de76b90f3cca

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Prof Martin Hibberd: “I have no conflicts to declare.”

None others received.