Dr Minh Alexander NHS whistleblower and former consultant psychiatrist 11 May 2020
Introduction
This post is to share records of this key government advisory group that has had little coverage.
On 1 May 2020 BylineTimes @BylineTimes reported that the UK government was aware in late February 2020 that there could be over a million Covid-19 deaths in the UK, but took little action for 3 weeks:
“On 16 March, ministers received advice from Imperial College modellers led by NERVTAG member Professor Neil Ferguson, who found that the Government’s stated approach at the time of simply ‘slowing’ the virus could result in as many as 250,000 deaths. The Imperial College paper had further warned that, in the absence of any control measures, an unmitigated epidemic in the UK would lead to 510,000 deaths in Britain.
It is widely believed that the formulation of these figures was the first time the Government had visibility of the catastrophic loss of life that could result from its own previous strategy. However, NERVTAG minutes dated 21 February reveal that, according to working assumptions at the time about the rate and deadliness of transmission provided to Government by its scientific advisors, anywhere between 833,313 and 1,333,330 Britons would potentially die.”
The source from which Byline Times’ figures of “833,313 to 1,333,330” potential deaths were derived was the minutes of the New and Emerging Respiratory Virus Threats Advisory Group meeting on 21 February 2020, which gave the following government assumptions at that time:
What is the “New and Emerging Respiratory Virus Threats Advisory Group” (NERVTAG)?
The government’s published material states:
“NERVTAG is an expert committee of the Department of Health (DH), and advises the Chief Medical Officer (CMO) and, through the CMO, to ministers, DH and other Government departments.
It provides scientific risk assessment and mitigation advice on the threat posed by new and emerging respiratory virus threats and on options for their management.”
This is the published NERVTAG members’ declaration of interests:
NERVTAG Register of Member’s Interests: update November 2018
This is the published NERVTAG code of practice:
Code of Practice for Members Version 1.0 – November 2015
NERVTAG is a joint venture by two government entities, the Department of Health and Social Care, and its subsidiary body, Public Health England.
Some have claimed that Public Health England is an independent agency and that it was responsible for poor decisions on the coronavirus crisis.
However, Public Health England (PHE) is an executive agency of the UK government, controversially formed by the coalition government in 2013.
PHE is part of the civil service, sitting within the line management of the Department of Health and Social Care.
Although the government states that PHE has “operational autonomy”, the Permanent Secretary of the Department of Health and Social Care has oversight of PHE, including monitoring PHE’s activities, intervening with regard to significant problems at PHE and reporting concerns about PHE’s activities to the DHSC board:
PHE’s performance is also scrutinised partly through “PHE’s Chief Executive meeting formally with Ministers on a regular basis.”
NERVTAG meetings
NERVTAG meetings are attended by members of the advisory group, representatives from the Department of Health and Social Care, representatives from Public Health England and Representatives from bodies such as NHS England.
The minutes of extraordinary NERVTAG meetings since 13 January 2020 in response to the novel coronavirus outbreak are a window into various aspects of advice given to the UK government and its pandemic response.
This is the link to all the government’s published NERVTAG meeting records:
NERVTAG meeting minutes 2014-2020
These are specific links to the extraordinary NERVTAG Covid-19 meetings held from 13 January 2020 onwards, (downloaded 11 May 2020):
NERVTAG extraordinary meeting 13 January 2020
NERVTAG extraordinary meeting 21 January 2020
NERVTAG extraordinary meeting 28 January 2020
NERVTAG extraordinary meeting 30 January 2020
NERVTAG extraordinary meeting 3 February 2020
NERVTAG extraordinary meeting 7 February 2020
NERVTAG extraordinary meeting 21 February 2020
NERVTAG extraordinary meeting 6 March 2020
NERVTAG extraordinary meeting 13 March 2020
NERVTAG extraordinary meeting 20 March 2020
NERVTAG extraordinary meeting 27 March 2020
The NERVTAG meeting records show contrasts with some countries like Taiwan, which reacted immediately to news from China of the novel coronavirus in December 2019.
For example, on 31 December 2019, Taiwan took immediate action to screen arrivals:
[Taken from a list of Taiwan’s government actions published in JAMA]
In contrast, on 13 January 2020, NERVTAG deliberations include an argument that it was not worth screening at ports of entry because China was believed to be conducting exit screening, and a view that the benefits of screening arrivals was “very unlikely to outweigh the substantial effort, cost and disruption.”
The minutes of a NERVTAG meeting on 6 March 2020 gave recommendations for ending self-isolation:
- A range of between 7 to 14 days for self isolation, with preference for a longer timescale initially
- That more cautious timescales be given to vulnerable groups such as those with compromised immunity
“3.25 NERVTAG’s recommendation for the length of time in self-isolation should be between 7 and 14 days and this could come down as transmission reduces. In the current situation NERVTAG would prefer this period to be towards the longer end of the range. The caveat accompanying this recommendation is that those in immunocompromised groups and those on steroids (including those with lung disease) to be considered for longer periods of self-isolation due to the reports of increased shedding and vulnerability. NERVTAG would revisit this when more data is available.”
The UK government issued advice to the public which diverged from WHO guidelines.
This is the UK government’s published guidance on ending self isolation:
I have not seen UK Government advice tailored for members of the public who may be immunosuppressed.
Herd Immunity
NERVTAG advice to the government diverged from some comments by Patrick Vallance, Government Chief Scientific Adviser.
On 13 March 2020 Patrick Vallance spoke and wrote about the UK government’s intention to pursue herd immunity, on Radio 4 Today and in The Spectator respectively.
He also told Sky News that the government wanted about 60% of the UK population to catch the virus, in order to produce herd immunity:
This is the Spectator article of 13 March 2020 by Patrick Vallance which is described as an “edited transcript” of his BBC Radio 4 interview:
“How ‘herd immunity’ can help fight coronavirus”, Patrick Vallance, Spectator 13 March 2020
Patrick Vallance’s comments implied that the UK government expected people infected with the novel coronavirus would develop immunity.
However, NERVTAG held a meeting on the same day, 13 March 2020, at which members acknowledged there was uncertainty about immunity to the new coronavirus.
NERVTAG agreed that the possibility of re-infection should be further investigated, and also reflected in modelling of the pandemic.
“NERVTAG discussed the evidence around reinfection/short term sterilising immunity. Concerns were raised that the length of immunity is unclear. Evidence from endemic coronaviruses is that after a mild infection antibody response may wane and individuals can become re-infected and shed further virus.
Three months may be a reasonable point after which susceptibility due to waning immunity may occur in those who suffered a mild initial infection. Members agreed that the novel nature of SARS-CoV-2 means that immune response may be more robust than for seasonal coronaviruses.
Members agreed that although there is considerable uncertainty, reinfection is a possibility that should be considered in modelling and longitudinal studies to identify reinfections are recommended.”
[My emphasis]
Obviously, unreliable and weak immune responses and reinfections within a short period of time would undermine the government’s claims of being able to achieve herd immunity by infecting 60% of the population.
NERVTAG recommendations to UK Government on PPE for pandemics and use of respirators
NERVTAG archives show that during Jeremy Hunt’s tenure as Health Secretary, NERVTAG made recommendations to the government on preparing for pandemics in terms of stockpiling PPE, and the need for eye protection. Some of the government’s responses to the recommendations are included in these documents:
NERVTAG Sub-committee on the pandemic influenza facemask and respirator stockpile: DH response
15 September 2017 Re: Updated advice from the NERVTAG subcommittee on facemasks and respirators
In 2019 under Matt Hancock’s tenure as Health Secretary, NERVTAG advised the UK government that gowns were preferable to aprons:
“Gowns are preferential to aprons (better coverage of uniform/clothes) where there is a risk of extensive splashing of blood or bodily fluid, and for aerosol generating procedures. Again, this is in line with HSE recommendations”
NERVTAG recommended that the UK government should add gowns to the pandemic stockpile:
“The committee agreed that the addition of gowns to the pandemic stockpile for use during splash-prone or AGPs would be of benefit, as this would bring the stockpile in-line with standard infection control procedures for seasonal influenza.”
As we have since learned, the government failed to do so and healthcare workers have been put at risk due to acute shortage of gowns during the current coronavirus pandemic. The UK is on course for the highest number of healthcare worker deaths in Europe:
Britain On Track For Highest Health Worker Deaths In Europe
Additionally, there are several recorded discussions about PPE in the minutes of the extraordinary NERVTAG meetings on Covid-19, listed above.
There was also a meeting of a NERVTAG subcommittee on 3 March 2020 which looked at non-invasive ventilation and nosocomial [hospital/ institutional] transmission of the virus:
Minutes of the NERVTAG COVID-19 NIV and Nosocomial Transmission Subcommittee Meeting 3 March 2020
RELATED ITEMS
1) Astonishingly, On 5 May 2020 Patrick Vallance denied that the UK government’s strategy had been one of herd immunity by natural infection:
2) Exercise Cygnus
The government ran a pandemic drill in 2014 and 2016, named ‘Exercise Cygnus’, which revealed issues with preparedness.
There was limited coverage at the time, although the Times did report some public comments by Sally Davies Chief Medical Officer:
NHS fails to cope with bodies in flu test
An NHS England document indicated that the plan was to publish a report on the outcome of the exercise:
However, on 28 March 2020 it was reported that the government decided not to publish the report because it was too “sensitive”.
The Guardian reported on 7 May 2020 that a copy of the Exercise Cygnus report had been leaked:
Revealed: the secret report that gave ministers warning of care home coronavirus crisis
What was Exercise Cygnus and what did it find?
This is a copy of the leaked Exercise Cygnus report that was redacted and uploaded by The Guardian:
Exercise Cygnus Report, Tier One Command Post Exercise, Pandemic influenza, 18 to 20 October 2016
3) UK coronavirus testing
The Chair of the UK Statistics Authority has written to Matt Hancock UK Health Secretary, advising that UK government statistics on testing need to be more trustworthy. His letter of 11 May 2020 is reproduced below.
Sir David Norgrove letter to Matt Hancock regarding COVID-19 testing
Sir David Norgrove letter to Matt Hancock regarding COVID-19 testing
Dear Secretary of State,
On 2 April the Government announced its goal to carry out 100,000 COVID-19 tests a day by the end of April and on 6 May announced its ambition for 200,000 tests a day by the end of May. There has been widespread media coverage of the Government’s progress.
I know you are a strong supporter of the proper use of statistics and data and that you will understand that for the sake of clarity and confidence it is important that the target and its context should be set out.
It should be clear whether the target is intended to reflect:
- testing capacity;
- tests that have been administered;
- test results received; or
- the number of people tested.
Each of these is of interest of course, whether or not they are targets.
In reporting against this target, sole focus on the total national number of tests could mask helpful operational detail. The way the daily tests data have been broken down by the different ‘pillars’ to illustrate the changing purposes of the programme is useful. Further breakdowns would provide more context, for example through showing the levels of testing by geographical area.
The daily data for the UK are currently reported on the gov.uk coronavirus page and a time series is available through the slides and datasets to accompany the daily coronavirus press conferences. However, there is limited detail about the nature and types of testing and it is hard to navigate to the best source of information. It would support trustworthiness for the testing data to be more straightforward to find, with detailed breakdowns and richer commentary.
The data around COVID-19 are inevitably complex, which makes it the more important that publications should meet the standards set by the Code of Practice for Statistics. We urge Government to update the COVID-19 national testing strategy to show more clearly how targets are being defined, measured and reported. Measurements will no doubt need to change and develop as we move into new phases for tackling the pandemic.
Yours sincerely,
Sir David Norgrove
4) Immunity Passports
The US and UK governments have given much emphasis to so-called “immunity passports” based on testing positive for antibodies. This is despite a lack of scientific evidence base. The human immune response to novel coronavirus has not been fully studied and the evidence so far suggests that some individuals produce low levels of antibodies in response to infection, which are not robustly protective and are unlikely to prevent reinfection. The World Health Organisation has rightly advised that the science does NOT currently support the use of “immunity passports” and that they may INCREASE virus transmission by giving false assurance. This is the relevant WHO scientific briefing of 24 April 2020:
WHO 24 April 2020 “Immunity passports” in the context of COVID-19 Scientific Brief
“The decision to pursue an approach of initially concentrating testing in a limited number of laboratories and to expand them gradually, rather than an approach of surging capacity through a large number of available public sector, research institute, university and private sector labs is one of the most consequential made during this crisis.
From it followed the decision on 12 March to cease testing in the community and retreat to testing principally within hospitals.
Amongst other consequences, it meant that residents in care homes—even those displaying COVID-19 symptoms—and care home workers could not be tested at a time when the spread of the virus was at its most rampant.”
Alexander's Excavations 
Just a very quick thank you.
Plenty to contemplate here and ponder the decision-making that emerged from such a complex and large organisational maze.
Notwithstanding that NZ and Taiwan are smaller nations, Germany also seems to have deployed proactive measures and better organisation than the UK, translated into superior outcomes.
Thank you – wishing you well.
LikeLiked by 1 person