Home Office preparedness for COVID-19 (coronavirus): management of the borders Contents

1Government decisions on the border up to and during lockdown

COVID-19 border measures prior to 13 March

6.Throughout the pandemic, the UK Government has stressed that its policy has been guided by scientific advice. This advice has primarily been provided by the Scientific Advisory Group on Emergencies (SAGE), which is itself informed by other groups offering external advice. These include the Scientific Pandemic Influenza Group on Modelling (SPI-M), the Scientific Pandemic Influenza Group on Behaviours (SPI-B), and the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG).2 Government Chief Scientific Advisers, including the Chief Scientific Adviser to the Home Office, Professor John Aston, are members of SAGE.3

7.SAGE first met to consider COVID-19 on 22 January.4 SAGE discussed advice provided to it from NERVTAG on 21 January concerning initial measures to take at the UK border to reduce the risk of the virus arriving from the then-epicentre of the pandemic, the city of Wuhan in China. Approximately 1,484,800 people arrived by air into the UK that week—similar to the equivalent week of the previous year.5

8.The minutes suggest that, at this early stage in the pandemic, consideration had not yet been given to quarantining arrivals. The minutes also state that “NERVTAG does not advise port of entry screening, irrespective of the current limited understanding of the epidemiology”. This advice was supported by SAGE on the basis that “Temperature and other forms of screening are unlikely to be of value and have high false positive and false negative rates”.6

9.On 27 January, the Government advised that anyone entering the UK from Wuhan should self-isolate for 14 days. The Secretary of State for Health and Social Care told the House that he had “directed Public Health England to take a belt-and-braces approach, including tracing people who have been in Wuhan in the past 14 days”. He added

From today [ … ] we are asking anyone in the UK who has returned from Wuhan in the last 14 days to self-isolate. [ … ] The Foreign Office is rapidly advancing measures to bring UK nationals back from Hubei province. I have asked my officials to ensure that there are appropriate measures in place upon arrival to look after them and to protect the public.7

There is no published scientific advice related to this direction from SAGE, Public Health England or elsewhere. The Secretary of State told the House that the “belt-and-braces approach” was because “this is a new disease, and the global scientific community is still learning about it”. He said the approach “has been guided by the chief medical officer, Sir Chris Whitty”.8 During this last week in January, 1,474,500 people arrived in the country—again a figure at near parity with 2019.9 On 28 January, British Airways suspended all flights to and from mainland China.10

10.SAGE considered international arrivals in the UK at its second meeting, on 28 January. SAGE considered advice from NERVTAG about whether those coming into close contact with returning travellers to the UK, “e.g. Border Force agents”, needed additional infection control measures.11 NERVTAG’s minutes of 28 January state at paragraph 7.4 that “NERVTAG does not recommend PPE for professional staff exposed to healthy individuals from at-risk areas”. SAGE endorsed this advice.12 It also considered the UK’s “reasonable worst-case scenario” and concluded that the scenario “should assume that some of those who have returned from China are infectious”. It further agreed that the scenario should be based on “pandemic influenza planning”. No other discussion of border measures, including quarantine, is included in the minutes.

11.On 31 January the first evacuation flight returning 83 UK nationals and 27 foreign nationals from Wuhan landed at RAF Brize Norton. Arrivals were transferred to Arrowe Park hospital in the Wirral for 14 days’ quarantine.13 These people were later joined, on 2 February, by 11 individuals who had been evacuated from Wuhan via France.14 A total of 273 UK nationals were quarantined from four flights: alongside the 94 accounted for above were 147 arriving from Wuhan on 9 February (alongside 104 from Germany, Italy and France who were transferred to their home countries) and 32 arriving on 22 February from Tokyo, where they had been passengers aboard the stricken Diamond Princess cruise liner.15

12.On 3 February, SAGE discussed the potential impact of travel restrictions from China. Notably the minutes suggest that the focus of the discussion was on how travel restrictions might help give the NHS additional time to prepare, but not on whether they might reduce the scale of the epidemic or the overall number of people infected. SAGE’s minutes record its conclusion that a reduction of imported infections of 50% may delay the onset of the epidemic by 5 days; a reduction in imported infections of 95% or more “maybe buys a month”. SAGE concluded that “only a month of additional preparation time for the NHS would be meaningful” and that an additional five to 10 days “would be of limited value”.16

13.SAGE minutes also note that “to prevent imported infections along these lines would require draconian and coordinated measures, because direct flights from China are not the only route for infected individuals to enter the UK.”17 It agreed an action that the Department for Transport and the Home Office would “produce more wide-ranging estimates on people entering the UK from China for the next SAGE meeting (4 February)”.18 These numbers have not been published and are not mentioned explicitly in the minutes of SAGE for 4 February. At that 4 February meeting, SAGE minutes show that the response was focused again on preparation time for the NHS. Despite recognising that “a delay now in the arrival and spread of WN-CoV [i.e. COVID-19] in the UK would be beneficial for improving NHS readiness and ability to handle cases”, the committee “remain[ed] content with the validity of the statement (issued 3 February) on the impact of international travel restrictions on delaying spread of WN-CoV [i.e. COVID-19]”.19

14.On the same day, a SPI-M operational sub-group (SPI-M-O) paper looked at the possible efficacy of non-pharmaceutical measures on the trajectory of the pandemic. This paper was provided to SAGE on 4 February. Among interventions “judged to have a greater potential to delay a UK pandemic” were “Restricting travel from countries with outbreaks (if there is not unseen sustained transmission in the UK at present)” and “Quarantine of those people returning from China”. SPI-M-O advised that

While it is possible that a combination of these could produce a meaningful delay in a UK epidemic uncertainty is even greater when the interaction of combinations of interventions is considered. As such, no meaningful conclusions could be drawn as to whether it is possible to achieve a delay of a month.20

15.At approximately the same point in time, other countries began to take steps to prevent importation of the virus from China. For example, on 22 January Singapore began to require the 14-day quarantine of all symptomatic arrivals from China. By 29 January it had begun to temperature check all incoming flights, and to deny entry to all arrivals from Hubei province. On 1 February these measures extended to deny entry to anybody who had been in China in the previous 14 days. The following day, the USA similarly banned the arrival of anybody who had been in China during the previous 14 days apart from returning US residents. New Zealand took the same measure on 3 February.21

16.Later that week, on 6 February, a case of COVID-19 was confirmed in Brighton. The patient lived in the UK, arriving on 28 January after having travelled from Singapore via France.22 Also on 6 February, SAGE met and advised that:

in light of new evidence of human-to-human transmission beyond China, SAGE advises that the UK geographical case definition should be widened, taking into account available information on air travel volumes from Hubei to other countries, numbers of reported cases in other countries, and understanding of other travel routes. SAGE now advises that individuals in the UK who have travelled from Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau and are showing possible symptoms of WN-CoV should also be included in the case definition.23

Five days later, on 11 February, SAGE acknowledged that “the UK has 8 confirmed cases, all of whom acquired the virus overseas.”24

17.Two days later, SAGE was provided with two papers relating to international measures, which at the time of writing had not been published on the SAGE website. These were ‘Singapore: Summary’ and ‘The effect of travel restrictions on the spread of the 2019 novel coronavirus outbreak’. A paper of the same name as the second of these has since been published online in Science.25 This paper examined the possible effect of travel restrictions upon the early spread of the virus in China. It found that the travel ban had led to a “77% reduction in cases imported from mainland China to other countries” until mid-February, and that at this time the majority of cases exported from China were to neighbouring countries such as Japan (13.8%), Thailand (13%), and South Korea (11.3%). However, it noted that “sustained 90% travel restrictions to and from mainland China only modestly affect the epidemic unless combined with a 50% or higher reduction of transmission in the community” and that “early detection, hand washing, self-isolation and household quarantine will likely be more effective than travel restrictions at mitigating this pandemic.”26

18.On 14 February, the Government issued guidance for those who had “travelled or passed through (such as transit through an airport)” China, Hong Kong, Japan, Macau, Malaysia, Republic of Korea, Singapore, Taiwan and Thailand. The guidance advised that any passenger who developed symptoms should self-isolate “as you would with the flu”. Self-isolation was advisory rather than compulsory and it was not enforceable.27 On this date, the World Health Organization (WHO) reported that confirmed cases had reached 63,932 in China, with Singapore (58 confirmed cases), Japan (33), Thailand (33) and Korea (28) the most affected countries elsewhere in Asia. In Europe, the UK had nine confirmed cases, compared to sixteen in Germany, eleven in France, three in Italy and two in Spain.28 Government advice for international arrivals therefore focused on Asian countries and not on potential importations of the virus from Europe, where confirmed cases were much lower.

19.On 25 February the Government published expanded guidance about international travel measures, reportedly following a joint decision from Public Health agencies for arrivals in the UK from certain countries.29 At this time, the WHO reported that there were thirteen confirmed cases in the UK, compared to 229 in Italy, sixteen in Germany, twelve in France and two in Spain.30 Arrivals in the UK were 2% lower than during the equivalent week in 2019, at approximately 1,812,000.31 The guidance, titled ‘COVID-19: specified countries and areas with implications for returning travellers or visitors arriving in the UK in the last 14 days’, would be modified several times over the ensuing fortnight before its withdrawal on 13 March. It created two categories of risk:

Table 1: extract from guidance issued on 25 February

Category 1: Travellers should self-isolate, even if asymptomatic, and call 111 to find out what to do next. Go home or to your destination and then self-isolate.	Wuhan and wider Hubei Province, China; Iran Daegu or Cheongdo, South Korea
Category 2: Travellers do not need to undertake any special measures, but if they develop symptoms they should self-isolate and call NHS 111.	Cambodia; rest of mainland China; Hong Kong; Macau; Japan; Laos; Malaysia; Myanmar; South Korea beyond Daegu and Cheongdo; Singapore; Taiwan; Thailand; Vietnam; Northern Italy

Source: Public Health England, ‘COVID-19: specified countries and areas with implications for returning travellers or visitors arriving in the UK in the last 14 days’32

20.Arrivals from category 2 countries/areas therefore did not need to undertake precautions over and above those required by people already in the UK; namely, to self-isolate if symptomatic and call NHS 111. Except for Northern Italy, arrivals from Europe were not subject to special measures, regardless of whether they were symptomatic.

21.Requirements on arrivals from category 1 locations were stronger, requiring individuals to self-isolate immediately on arrival in the UK. These measures focused on the same countries/areas as those taken by other national governments, although the nature of the measures differed: for example, from 28 February Germany required all arrivals from China, South Korea, Japan, Italy and Iran to report their health status before entry.33 Singapore banned all arrivals from Cheongdo and Daegu in South Korea on 26 February, and New Zealand banned arrivals from Iran on 28 February. South Korea, which had begun screening and quarantining arrivals from Wuhan from 3 January, had by the end of January established 288 screening clinics offering tests and required arrivals from China to undertake quarantine.34

22.SAGE’s minutes suggest that it did not discuss borders or international travel ahead of this guidance being issued. International travel is not mentioned in SAGE minutes between 6 February and 27 February. At its meeting on 27 February, SAGE discussed the “risk posed by national and international travel associated with large events (e.g. sports)”. It concluded that the question “should be further investigated” and the minutes note an action for the Department for Transport to “produce numbers indicating numbers [sic] travelling to major sporting events, compared to overall numbers travelling, including from abroad”. At its next meeting on 3 March, SAGE concluded that “there is currently no evidence that cancelling large events would be effective”.35

23.At the same meeting, on 3 March, SAGE also considered a paper from scientists at two London universities titled ‘Adoption and impact of non-pharmaceutical interventions for COVID-19’.36 This paper explored the effect of travel restrictions within China on the in-country spread of the virus. It found that restrictions “slowed the rate of spread between cities, delaying arrival by approximately 2.9 days”. The paper also found that, in China, “measures implemented pre-emptively could reduce cases in the first week of introduction by 37%” and that “had interventions been applied earlier, for example by 3 weeks, the effects would have been greater, leading to a 95% reduction in cases”. A study referred to in the SAGE paper estimated that earlier pre-emptive measures could have reduced the number of Chinese cities affected from 308 to 61.37 The paper also referenced a study led by Asami Anzai of Hokkaido University in Japan, which estimated that travel restrictions out of Wuhan prevented 226 cases being exported “corresponding to a reduction in exported cases of 70%.38 SAGE minutes up to this date do not suggest that SAGE considered papers describing alternative studies of non-pharmaceutical measures taken in other countries during the start of the pandemic.

24.Also on 3 March, the UK Government published its four-phase ‘Contain, Delay, Research and Mitigate’ strategy.39 Echoing the language of the paper considered by SAGE on 13 February concerning travel restrictions in China, the Government favoured an approach that sought to mitigate the effects of the virus rather than suppress it entirely. The strategy described the UK as “having undertaken significant preparedness work for an influenza pandemic for well over one decade”. It described mitigation as the required step “if transmission of the virus becomes established in the UK population”, which would focus on “provid[ing] essential services, helping those at risk to access the right treatment”. The strategy does not explicitly describe moves to reduce the number of COVID-19 positive arrivals in the UK, or quarantine options, instead saying that “it may be that widespread exposure in the UK is inevitable; but slowing it down would still nonetheless be beneficial”.40

25.The Government’s new guidance for travellers arriving in the UK was altered flexibly as the virus spread, as the relative risk of importation changed and grew. On 5 March, category 2 status was expanded to the whole of Italy. At the time, the WHO reported that there were 89 confirmed cases in the UK, compared to 3,089 in Italy, 282 in France, 262 in Germany and 198 in Spain.41 Northern Italy42 was upgraded to category 1 on 8 March, followed on 10 March by the rest of the country.43 Neither Spain nor France were ever added to either the category 1 or category 2 list.

26.1,490,100 people arrived in the UK in the week ending 10 March—14% lower than the equivalent week the previous year.44 By the time the whole of Italy was upgraded to category 1 on 10 March, it had recorded 9,172 cases and 463 deaths. This rose to 15,113 cases and 1,016 deaths by 13 March.45 The accelerated spread of the epidemic in some European countries like Spain, Germany and France compared to the UK is illustrated by figures published by the WHO on confirmed cases and deaths. The table below compares the emerging infection threat in three countries not considered for self-isolation guidance (Germany, France, Spain) with Italy, and with countries from category 2 (data is not available for Myanmar and Laos).

Table 2: Confirmed cases and deaths between 25 February and 13 March

Country	Total to 25 February:		Total to 10 March:		Total to 13 March:
	Cases	Deaths	Cases	Deaths	Cases	Deaths
UK	13	0	323	3	594	8
France	12	1	1,402	30	2,860	61
Germany	16	0	1,139	2	2,369	6
Italy	229	6	9,172	463	15,113	1,016
Spain	2	0	1,024	28	2,965	84
Cambodia	1	0	2	0	5	0
China (incl SARs)	77,749	2,655	80,879	3,139	80,942	3,179
Japan	157	1	514	9	675	19
Malaysia	22	0	117	0	129	0
Singapore	90	0	160	0	187	0
South Korea	977	10	7.513	54	7,979	66
Taiwan	30	1	45	1	49	1
Thailand	37	0	53	1	75	1
Vietnam	16	0	31	0	39	0

Source: World Health Organisation, Coronavirus disease (COVID-2019) situation reports

27.At a time when Vietnam, Taiwan, Thailand and Singapore all remained on the category 2 list, arrivals from Spain, France and Germany remained subject to no specific precautionary guidance despite the clearly significant and increasing numbers of infections in those countries. Furthermore, while data is not publicly available on a daily or weekly basis, Civil Aviation Authority figures show that, during February and March 2020, 3,482,702 people travelled between UK and Spanish airports, 1,305,441 between the UK and France and 1,401,837 between the UK and Germany. By comparison, 190,170 people travelled between the UK and Singapore, 136,068 between the UK and Thailand, and 23,861 between the UK and Vietnam.46

28.On 11 March, 8 days after SAGE advised that there was no evidence in favour of cancelling mass gatherings, and at a time when Spain already had over 1,000 recorded cases, Atletico Madrid played Liverpool Football Club in a Champions League match hosted at Anfield; an estimated 3,000 people travelled from Madrid to attend the match.47

29.On 12 March, the Chief Scientific Adviser stated at a Downing Street press conference that, in terms of scale of the outbreak, the UK was “maybe four weeks or so” behind Italy, and “behind where Germany and France are as well”. Other countries were continuing to extend their border restrictions, as is described later in this Report.

30.On 13 March, the Government lifted all special guidance for international arrivals from specific countries/areas. From 13 March until 8 June there would be no quarantine or self-isolation requirements for asymptomatic travellers, and no screening or testing at the border.

Incremental quarantine and self-isolation measures targeted at high-risk countries/areas

31.We set out later in this Report the evidence on the number of people arriving in the UK with COVID-19 during February and March, but it is clear that even by early March there were significant and rising numbers of imported infections. A genomic study published in June (see paragraph 64 onwards) estimated that only 0.08% of UK imported infections came directly from China, to which the earliest travel restrictions were applied. From Italy, it estimates that imported cases started to rise in early February and then to gradually fall again after around 25 February. Imported cases from Spain rose from late February until the middle of March, and imported cases from France rose from early March until late March before falling significantly in April.48 The analysis in this study has also been referred to by the Government’s Chief Scientific Adviser.49

32.The Government and its scientific advisers faced a huge challenge in early 2020 from a fast-moving virus in circumstances where information was changing constantly and decisions about borders had to be made at pace. Inevitably those decisions were difficult, and some will look different in hindsight. However, scrutiny is important to ensure lessons are learned. As COVID-19 has not gone away, many of these challenges could recur.

33.The incremental introduction of international travel measures during the period from late January to early March corresponded to the practice in other countries during this time and reflects the great uncertainty with which governments were grappling. It was right to adjust and extend self-isolation provisions as the virus became established, starting with Wuhan and China, but also extending provisions to cover places like Italy as the virus spread. Many other European countries were beginning to be affected by coronavirus in the same way, and many took a similar incremental approach as the UK. Evidence shows that the number of cases of direct transmission from China into the UK was extremely small, and that the number of cases from Italy started to fall after 25 February when border measures were introduced. However, it is impossible to distinguish between the impact of border measures and other factors such as lockdowns in Wuhan and Italy or falling overall passenger numbers which may have had a much bigger effect.

34.It is also clear that, overall, the border measures in the UK and many other European countries in early March were not sufficient to contain the cross-border spread of the virus. Had stronger early measures been taken—such as requiring legally-enforceable quarantine for arrivals—it is likely that the spread of the virus could have been slowed. The UK Government did not recognise soon enough the increased risk of importations from European countries owing to the greater amount of travel between these countries and the UK, and the speed at which case numbers were increasing. Many of those returning to the UK during that period were British residents, and we agree with the SAGE assessment that border closures would not have been appropriate.

35.However, the failure to advise people travelling or returning from Spain in particular to self-isolate for 14 days (in line with category 1) or, at the very least, to monitor symptoms and call NHS 111 (in line with category 2) was a mistake. With border measures in mind, there should have been particular surveillance focus on the countries that have high levels of travellers into the UK, particularly Spain and France. We are concerned that we have not seen evidence of that happening during the early stages of the crisis, and that, as a result, Spain was not added to the list of countries for self-isolation measures when it should have been. As a result, large numbers of passengers from Spain continued to arrive, including to attend the Atletico Madrid-Liverpool football match, without any requirements being placed upon them.

36.We are also concerned at the lack of clarity over who was responsible for the continued monitoring and assessment of emerging infection threats from different countries, and for drawing up policy options for Ministers to respond. Any future inquiry into the UK’s handling of COVID-19 should consider not only whether the UK Government should have acted more quickly at this time to prevent cases of the virus arriving in the UK and spreading in the community, but also whether the arrangements for monitoring and assessing emerging threats and considering policy options were fit for purpose.

Other potential approaches at the border

37.Testing and screening at the border were not pursued throughout the first phase of the epidemic. The advice of SAGE and NERVTAG on 22 January against port of entry temperature screening was reiterated by Emma Moore, Border Force’s Chief Operating Officer, in oral evidence to us on 20 March. She told us that “temperature checks at port are not effective, and that is the very clear scientific advice we have had consistently throughout”.50 However, Professor Gabriel Leung, Dean of the Li Ka Shing faculty of medicine, University of Hong Kong, told us that temperature testing had had some limited utility in other countries during the early stages of the pandemic. Although they were “quite leaky”, temperature checks were “able to act as sentinels to warn us to step up further measures at the border”.51

38.On 10 June, in evidence to the Science and Technology Committee, Professor Neil Ferguson, Imperial College London, suggested that part of the reason that the decision not to impose stronger border measures, such as screening passengers, was “to do with testing capacity and PHE capacity to actually implement that on the huge numbers of travellers coming in from Heathrow and other airports”. He told the Committee that:

Had we had the testing capacity—and we have to bear in mind that there were testing capacity limits—certainly screening everybody with symptoms coming in would have given us a much better impression of where infection was coming from.52

39.We recognise the difficulties faced by the Government in considering temperature checks, screening or testing at the border, and we also recognise the limited UK testing capacity at that time. However, given the success of targeted COVID-19 testing on arrivals demonstrated by South Korea during early March, more should have been done to assess the feasibility of such approaches in the UK even if they could not immediately be introduced. The lack of existing testing capacity should not have prevented proper analysis of the options and a strategy to develop and expand testing as part of border measures.

40.Overall, in the early phase of COVID-19, insufficient emphasis was placed on the importance of controlling importation from overseas as a method for containing the virus or delaying its spread. The decision by SAGE only to consider measures that could deliver a full month’s delay to the spread of the virus was a mistake and it is very hard to understand why that approach was taken. Additive measures that could have contributed to more effective containment should have been considered, and delays even of a few days alongside the introduction of other domestic measures such as social distancing and lockdown could have had a significant impact on the scale of the outbreak in the UK.

41.Dismissing strict border measures as “draconian” on 3 February was erroneous, as it was their strength that could have made a significant contribution and potentially mitigated the scale of domestic restrictions that were later needed. SAGE papers suggest that prioritising delay of spread rather than suppression of cases was influenced by the conclusion that the virus ought to be treated similarly to pandemic influenza, but this has been retrospectively proved wrong.

COVID-19 border measures after 13 March

Withdrawal of travel advice and move to ‘delay’

42.On 13 March, the Government withdrew its travel advice for specific incoming countries. No reason was given for the withdrawal of the guidance at the time, other than that it had been “superseded by information in COVID-19: stay at home guidance” which was published on the same day.53

43.In a letter to the Committee on 4 May, the Home Office Chief Scientific Adviser, Professor John Aston, confirmed that:

This advice was removed on 13 March when the incidence in the UK had increased and the ‘stay at home’ guidance to everyone in the UK, regardless of whether a new arrival or not, came into force.54

This was reiterated by the Second Permanent Secretary of the Home Office, Shona Dunn, in oral evidence on 1 July:

As Professor Aston has explained, the position on 13 March, when the guidance was removed—because that was the point in time when the stay at home guidance came into effect for all people regardless of whether they were already within the country or coming into the country—was that specific guidance with respect to self-isolation for people coming in from particular routes was no longer regarded as being appropriate.55

44.The new guidance for all households in the UK was significantly less stringent than the guidance for travellers from identified high risk (category 1) areas like Italy and Wuhan that it replaced. It was also significantly less stringent than the quarantine arrangements introduced for everyone on 8 June, which we cover in the next chapter.

45.This new guidance, for households with possible or confirmed coronavirus (COVID-19) infection,56 came into effect following a press conference held by the Prime Minister on 12 March in which he advised that:

From tomorrow, if you have coronavirus symptoms, however mild—either a new continuous cough or a high temperature—then you should stay at home for at least 7 days to protect others and help slow the spread of the disease.57

Four days later, on 16 March, the Prime Minister gave another press conference in which he advised that:

[ … ] even if you don’t have symptoms and if no one in your household has symptoms, there is more that we need you to do now.

So, second, now is the time for everyone to stop non-essential contact with others and to stop all unnecessary travel.

We need people to start working from home where they possibly can. And you should avoid pubs, clubs, theatres and other such social venues.58

46.From 16 March, everyone in the UK was encouraged to avoid all unnecessary social contact, but not to self-isolate when asymptomatic, as had been required of ‘category 1’ travellers prior to 13 March. UK residents were at that time advised to avoid pubs and restaurants, but they were not discouraged from going to the shops or going to work if it was not possible to work from home. These conditions, which superseded the withdrawn guidance for international arrivals, therefore reduced the level of restrictions applying to the travellers deemed as having the highest risk of infection.

47.The announcements on 12 March (followed by accompanying guidance) and 16 March were also not the same as the introduction of ‘lockdown’, which was announced on 23 March and brought into force using secondary legislation on 26 March.59 ‘Stay at home’ guidance was voluntary, as opposed to ‘lockdown’ regulations which were enforceable by Fixed-Penalty Notices, with some specific measures varying according to constituent part of the UK. These regulations in turn contrast with legislatively underpinned quarantine measures that were brought in on 8 June, discussed in chapter 2 of this Report, which restricted persons to a greater extent than ‘lockdown’ regulations; for example, those subject to quarantine regulations cannot leave their home to exercise or to buy essential goods without exceptional reason.

48.13 March was also the date on which the UK moved from the ‘Contain’ phase of its strategy to ‘Delay’. Under ‘Delay’, the Government’s intention was to “slow the spread in this country; if it does take hold, lowering the peak impact and pushing it away from the winter season”.60 It noted that “based on experience with previous outbreaks, it may be that widespread exposure in the UK is inevitable; but slowing it down would still nonetheless be beneficial”.61 It was in the context of discussing the move from ‘Contain’ to ‘Delay’ that Sir Patrick Vallance told Radio 4’s Today programme that “it’s not possible to stop everybody getting it and it’s also actually not desirable because you want some immunity in the population. We need immunity to protect ourselves from this in the future”. Ministers have subsequently stated that “herd immunity” has never formed part of the Government’s strategy.

49.On 13 March, 134 new confirmed cases were recorded in the UK, and there had been 594 confirmed cases in total. There had been eight deaths. On 23 March, 669 new confirmed cases were recorded, and there had been 5,687 confirmed cases in total. There had been 281 deaths.62 Minutes for the fourteenth, fifteenth and sixteenth SAGE meetings in mid-March provide situation updates and indicate that true case numbers were much higher than indicated by confirmed cases, and were rising rapidly. On 10 March, it was estimated that “the UK likely has thousands of cases—as many as 5,000 to 10,000—which are geographically spread nationally”.63 On 12 March, Sir Patrick Vallance confirmed at a Government press conference that “it is much more likely that we’ve got somewhere between 5,000 and 10,000 people infected”.64 On 13 March, an update was provided which stated that “there are probably more cases in the UK than SAGE previously expected at this point”.65 On 16 March, SAGE discussed the possibility that there were “5,000–10,000 new cases per day in the UK” with the caveat that there was “great uncertainty around this estimate”.66

International comparisons

50.Research from the Pew Research Centre in the United States, published on 1 April and referred to by Professor Gabriel Scally in evidence to the Committee on 22 May, estimated that “more than 90% of the world’s population currently lives in countries where there are public health restrictions on travel to and from those countries”.67

51.While the UK withdrew its guidance for international arrivals in mid-March, comparator countries (i.e. travel hubs and major economies) were instead formalising their border measures. On 15 March, Singapore banned all arrivals from Italy, France, Spain and Germany and required all arrivals from the UK, Switzerland and ASEAN countries to self-isolate for 14 days. Only those with Singaporean residency or citizenship were permitted into the country. In its guidance on self-isolation, issued on 22 March, the Singapore Government estimated that “around 80% of recent [COVID-19] cases were imported”.68 All arrivals at that time—which were only Singaporeans and residents—were provided with a ‘Stay-Home Notice’. This required the holder to remain in their residence for 14 days. They could not leave even to purchase food and essentials, instead using delivery services or enlisting assistance from others. On 28 March, Singapore began to place arrivals from the US and UK in hotels to prevent any possible spread of virus within households. At that time, about 1,200 Singapore residents were returning each day from the UK and US. It is estimated that the Singaporean government had booked in excess of 7,500 hotel rooms for the purposes of quarantine. Those quarantined in hotel rooms could not leave their room to use hotel facilities.69

52.Giving evidence to us from Singapore, Professor Teo Yik-Ying explained that:

We are still facing an upward trend in the outbreak around the world. In Singapore we have opted to communicate very clearly the message that the travel restrictions are very likely to remain in place until the later part of this year or even beyond. [ … ] In Singapore it is a very clear situation that until the rest of the world has its situation contained, we will not be rushing to release the border control measures and to allow for mass market travel at the moment.70

53.Tony Smith CBE, a former interim Director General of Border Force, praised the incremental approach taken by the Singaporean Government, based on frequent reviews and updates. He described this approach favourably relative to the UK’s approach, telling us:

I would have thought that I would have seen more of an incremental approach, such as I described was in Singapore, where a risk assessment would be done almost daily, but certainly every couple of days, as part of the critical incident command structure, which would be informing Government on what we ought to be doing at our borders. I am not sure that that is what has happened. I think we have very much, and maybe rightly, diverted our attention away from our borders and into the country to focus upon the health and safety of our indigenous population, which is perfectly understandable, but I think we may have been able to introduce more incremental steps, in other ways, that might have reduced the transmission from abroad, and I’m afraid by the time we actually did get round to doing that, it was too late.71

54.New Zealand also introduced mandatory 14-day quarantine for all arrivals, including New Zealand citizens, on 15 March. This was followed on 20 March by complete border closure to non-residents, with some exceptions such as for Pacific Islanders with no other route of transit to their home countries.72 Sir David Skegg from the University of Otago told us that, like Singapore, New Zealand “decided very early on that trying to eliminate this virus was not just best for the health of the people, it was also best for the economy”.73 Notably, while New Zealand was able to lift all domestic restrictions on its people at midnight on 9 June, it still enforces rigorous border restrictions.

55.European countries also began to tighten border restrictions during this period. On 16 March, the European Commission adopted a communication to the European Parliament and Council calling for restriction on non-essential travel into the Schengen area, while still permitting transit arrangements “for the repatriation of EU citizens and their family members stranded in third countries.74 While residents of Schengen countries, Ireland and the UK were exempt from this restriction, individual EU member states chose to implement their own stringent border measures. On the same day as the Schengen measure came into force, Spain closed its borders to all except returning Spanish residents; this included land borders with Portugal and France.75 The measures originally ran until 11 April but were extended until 25 April. On 20 March, Germany restricted border crossings at its overland borders to a limited number of points and to necessary purposes only, including for people returning to their country of residence via Germany.76

56.In Canada, on 14 March the Government advised against all international travel and advised all arrivals to self-isolate for 14 days; this would become compulsory from 26 March under the terms of the federal Government’s Quarantine Act.77 On 18 March, international arrivals were banned except for returning Canadian residents, and the land border with the USA was restricted on 20 March to only key workers and family members. Restrictions on the land border were extended for 30 days on 17 April.

57.In Hong Kong, the Government began to close border crossing posts on 3 February. It faced possible strike action by medical staff during February for its perceived reluctance to close further border posts, particularly with mainland China; however, by 25 March the Hong Kong border was closed to non-residents including a moratorium on transferring flights in Hong Kong. A 14-day compulsory quarantine order was imposed to be served either at home or a hotel, with mobile phone tracking used to enforce the order.78 Professor Annelies Wilder-Smith, Professor of Emerging Infectious Diseases at the London School of Hygiene and Tropical Medicine, told us that, despite its firm travel ban, “Hong Kong test[ed] everyone” on arrival into the territory, with those testing positive sent for treatment and those testing negative required to quarantine for 14 days.79 Professor Gabriel Leung, Dean of the Medical School at Hong Kong University, said:

For Hong Kong, we have found that because we applied these border restrictions very early, from essentially the second week of January onwards up until now—they have been progressively layered on and we still to this day have not relaxed any bit of it—the most striking decline in our real-time effective reproductive number, the RT, is when we started the test and hold policy. That is that no one can come in, regardless of who you may be, until you have been tested at the port and then you go straight either into isolation as a confirmed patient or into quarantine as a potentially infectious individual for 14 days. Once you do that, you make sure that quarantine is enforced and enforceable.80

58.Professor Leung added that Hong Kong’s experiences of the 2003 SARS pandemic had informed its approach to the COVID-19 pandemic:

You can see that the countries and places that have gone through SARS have all, almost uniformly, acted early and much earlier than their neighbours, so it is not geographic, it is not even political, but it is that indelible societal imprint of SARS. I give you the example of mainland China, Hong Kong, Singapore, South Korea, and if you compare Canada’s response with the American response, I rest my case.81

While it is difficult to know precisely how best to design an approach to any new virus, it is notable in this context that at its second meeting on 28 January, SAGE’s minutes note that “SAGE urges caution in comparing [COVID-19] with SARS and MERS: the transmission dynamics are different”.82

59.We are concerned that the UK’s approach to border measures in the period from 13 March to 8 June was very different from countries in similar circumstances. This should have raised serious questions within the Government about whether it was taking the correct decisions. We have not seen any evidence that, at the time it was making its own decisions, the UK Government was examining and evaluating the approaches taken by other countries to controlling importations of the virus from abroad.

Importation of the virus in the UK in March

60.In light of the significantly different approach to border measures taken by the UK in March, when compared to comparator countries, we sought to examine the consequences of the decision to withdraw all measures aimed at international arrivals on 13 March and to maintain that position until 8 June, and the particular implications the decision had for the spread of the virus in the UK in that period.

61.On 5 May, Sir Patrick Vallance, the Government’s Chief Scientific Adviser, told the Health and Social Care Committee that ahead of lockdown on 23 March “we saw a big influx of cases, probably from Italy and Spain, looking at the genomics of the virus in early March, seeded right across the country”.83 He speculated that this might be “people returning from half term”.84 Speaking to the Science and Technology Committee on 16 July in a session reflecting on lessons learned, Sir Patrick said that:

in mid-March it became obvious that [the pandemic] was accelerating faster [ … ] and that moment was when the advice changed to say, “Implement the measures as soon as possible. [ … ] The advice changed [to favour lockdown] when we realised we were not four weeks behind Italy and the infection rate was about twice what we thought it was to start with.85

62.For the first three weeks of March, figures provided to us by Border Force confirm that inbound travel remained substantial: 1,688,100 passengers arrived in the UK in the first week of March, 7% lower than the same week in March 2019. Figures for the following two weeks were 1,490,100 (down 14%) and 1,352,000 (down 24%) respectively. By the week ending 22 March 2020, arrivals were down 67% relative to the equivalent week in 2019 but 587,300 passengers still arrived in the UK.86 The number of international arrivals into the UK then fell precipitously following the introduction of legally enforced lockdown in late March: Home Office statistics released on 28 May show a 99% drop in air arrivals into the UK during April 2020 compared to April 2019.87

Figure 1: Number of arrivals into the UK by air, January to April 2020

Source: Home Office, Statistics relating to COVID-19 and the immigration system, 28 May 2020

63.In oral evidence on 22 May, Professor Annelies Wilder-Smith, London School of Hygiene and Tropical Medicine, discussed the likely impact this volume of arrivals had:

If you say that there were about 1 million people [arriving in the UK] in those few weeks [between 13 March and 23 March], I think that there would have been at least 1,000 infected people—probably up to 10,000—who brought it in. We know that it was probably the Spanish, because Italy had already locked down. It was probably the Spanish who came to the football game. That was a mass gathering, and probably a super-spreading event. Indeed, an earlier lockdown would have helped the UK, but that is hindsight now.88

64.Professor Gabriel Leung drew the Committee’s attention to a genomic study from academics from the University of Oxford, University of Edinburgh and the COVID-19 Genomics UK (COG-UK) consortium, published in non-peer reviewed format on 8 June 2020.89 The study estimated the number of UK COVID-19 transmission incidences originating overseas based on the numbers of inbound travellers to the UK, estimated numbers of infections worldwide, and genome sequencing undertaken by the COG-UK consortium. The study detected 1,356 transmission lineages in the UK up to the date of its publication.90 This indicates a minimum of 1,356 cases that originated outside the UK—and were therefore imported—and that spread to at least one other person. The study notes that “for methodological reasons [the 1,356 figure] is likely to be an underestimate of the actual number of times the virus has been introduced to the UK with subsequent onwards transmission”.91

65.The 8 June study broke down the transmission lineages by probable country of origin and time of importation. It estimated that nearly a third of importation lineages were from Spain, with a further 43% from Italy and France. Only 0.08% were from China:

Figure 2: The estimated fraction of importation events that are attributable to inbound travellers from each country

Source: Pybus et al, ‘Preliminary analysis of SARS-CoV-2 importation & establishment of UK transmission lineages’, 8 June 2020

66.The study also broke down the estimated dates of importation lineages. It found that the majority of importation events occurred throughout March, during which “the diversity of source locations also increased”.92 The paper notes the increased prevalence of importations from France as March progressed, suggesting that “the relative contribution of cross-channel movement to all international arrivals likely increased through time due to the collapse in inbound air travel”.93

Figure 3: The estimated number of importation events that are attributable to inbound travellers from source countries

Source: Pybus and Rambaut et al, ‘Preliminary analysis of SARS-CoV-2 importation & establishment of UK transmission lineages’, 8 June 202094

67.The above graph indicates that, for the period of the first two weeks of March, the highest number of transmission lineages brought into the UK were from Spain, which was not at any point subject to special international travel measures. The study showed a possible lag time of around 10 days between the estimated importation date of cases and the associated peak of cases associated with the lineages that were imported.

68.The same study suggests that the number of infectious people entering the UK per day (estimated importation intensity on the graph below95) may have reached 600 by 8 March, rising to approximately 800 on 13 March and peaking at around 900 on 15 March. The study cautioned that “further work is needed to evaluate whether these assumptions are reasonable”.96

Figure 4: Estimated importation density into the UK from January to May 2020

Source: Pybus and Rambaut et al, ‘Preliminary analysis of SARS-CoV-2 importation & establishment of UK transmission lineages’, 8 June 2020

69.The study concluded that the peak in imported cases occurred because “there was a period in mid-March when inbound travel to the UK was still substantial and coincided with high numbers of active cases elsewhere”. It further concluded that “Peak importation intensity was highest for Spain because there was a window of time when large numbers of inbound travellers from Spain coincided with high prevalence there”.97 The study suggested that 34% of transmission lineages arrived from Spain: in March, 1,273,872 passengers travelled by air between the UK and Spain.98 None of those passengers arriving from or returning from Spain in March were required to self-isolate or quarantine.

70.Professor Neil Ferguson, who was a member of SAGE during March, later reflected that “what we now know [ … ] is that probably 90% of cases imported into this country were missed by those border measures because we were not checking people.99

71.Professor Gabriel Scally was clear that it was a mistake by the Government not to consider stronger border measures:

It was said that the virus had now spread so much within the community that there was no point in doing these things. I completely disagree with that. One of the major failings has been the failure to regard measures as additive. It seems to me that there was often a desire to find the one thing that would work; cancelling mass gatherings, for example, is another one that was seen as not making much of a contribution, but those measures are additive, and it all adds up to dealing with the virus. You need all those contributions. They are sometimes synergistic, as well.100

72.It is now apparent that many more COVID-19 cases were imported to the UK from Europe in mid-March than was estimated at the time, when, with the exception of Italy, the focus remained largely on potential importations of the virus from Asia. As evidenced by genomic studies and referenced by Sir Patrick Vallance in oral evidence, a large number of instances of the virus—up to 1,356 importation strains and up to 10,000 cases—were imported during the period leading to, and following, the abandonment of special measures for international arrivals on 13 March, even though the overall number of people arriving in the UK was decreasing. Evidence shows it is highly likely that uncontrolled importations of the virus from European countries contributed to the rapid increase in the spread of the virus in mid-March, and the overall scale of the outbreak in the UK.

73.Not having any special border measures applicable to people arriving from Spain and France during March, and only having time-limited self-isolation measures for arrivals from Italy, therefore had a material effect on the number of cases circulating within the UK. Border measures in the UK were lifted rather than extended on 13 March at a time when the number of infections being imported from abroad was still rising. Evidence suggests that thousands of new infections in the UK resulted from cases arriving from Europe in the ten days between this decision and the introduction of lockdown on 23 March. The failure to have any special border measures during this period was a serious mistake that significantly increased both the pace and the scale of the epidemic in the UK, and meant that many more people caught COVID-19.

74.Although the full scale of the epidemic in Spain and later in France was not properly known in mid-March, that is not a justification for the lifting of border measures. Evidence of the epidemic escalating, especially in Spain, was already available. Other countries with the same information as the UK introduced stronger measures—for example, quarantine or limiting international arrivals so that only residents could enter the country—and proved justified in doing so. The UK was extremely unusual in choosing not to introduce measures of this kind; it is evident that this was the wrong approach.

Decision to withdraw measures for international arrivals

75.Given the seriousness of the consequences of the decisions made about border measures for returning travellers and visitors in March, we have sought to understand the reasons behind the decision to lift rather than extend the self-isolation guidance on 13 March.

76.As far as can be ascertained from publicly available information, the UK Government’s withdrawal of border measures at this time did not follow any specific scientific guidance from SAGE. There is no minuted discussion of border measures in SAGE between 3 March and 23 March.

77.By mid-March the Government stated that it was sceptical of the efficacy of border measures. In response to a question from Stephanie Peacock MP in the House of Commons on 16 March, asking whether the Government intended “to implement stricter measures at our airports, ports and rail terminals”, the Secretary of State for Health and Social Care indicated that the Government did not consider border measures to be worthwhile at the time. He focused his remarks on restricting flights rather than the screening and quarantining measures implemented in other countries. He told the House that:

Now that there is onward transmission in the UK, those sorts of measures are less efficacious. Of course, we have been doing that all along and strengthening it, but there are also those who said, “Go further and stop all the flights.” Of course, the Italians were the ones who initially stopped flights from China and ended up as the European epicentre of this anyway.101

78.At its 23 March meeting, ten days after guidance was withdrawn, SAGE considered a paper dated 22 March titled ‘Scientific advice on restricting flights from specific countries’.102 The paper noted that limiting flights from Italy, France and Germany would have “very low” impact as “we can have confidence that these countries are at a roughly similar stage of the epidemic to the UK”. This paper only considered restricting flights and not measures such as restoring self-isolation guidance for asymptomatic travellers from hotspots, putting in place additional screening or imposing enforceable quarantines on arrivals.

79.The 22 March paper indicated that while Spain was also “likely to be at a similarly stage of the epidemic”, “the number of passengers is far higher” thus making “flights from Spain, relatively speaking, a higher risk”.103 SAGE concluded at its meeting on 23 March that “closing borders would have a negligible effect on spread” as “numbers of cases arriving from other countries are estimated to be insignificant in comparison with domestic cases, comprising approximately 0.5%”.104 It is not clear whether this number referred to total cases or only to symptomatic cases. Subsequently, no measures were taken to introduce any checks or quarantine rules, or to reduce flights from Spain or from other emerging hot spots, such as New York State.

80.In the 10 days between guidance being withdrawn and SAGE discussing border measures, Border Force statistics indicate that 1,174,700 international passengers arrived in the UK.105

Scientific evidence and advice informing decision-making

81.We asked the Government what advice was procured ahead of the decision on 13 March. On 23 March, in response to a Parliamentary Question from the Chair of this Committee, the Minister for Immigration Compliance and the Courts, Chris Philp MP, told the House that:

On mandatory self-isolation for people returning from high-risk countries, she is right to say that the advice changed. However, let me reassure her by saying that it is under continual and ongoing scientific evaluation. The Home Secretary and I have both asked recently for refreshed scientific advice, and that is being monitored almost daily. If the scientific advice says that the safety of our country requires a further change in policy, we will certainly do that in response.106

82.We therefore sought to discover what “refreshed scientific advice” was being provided as a result of “almost daily” monitoring. On 3 April, we sent a series of questions to the Home Secretary about the advice Government had taken in respect of its policies, asking specifically to receive the information mentioned by Mr Philp. We noted that, at the time the letter was sent, Australia, Canada, Germany, Ireland and New Zealand specifically recommended or required quarantine for people arriving into their countries.107 Responding on 9 April, the Home Secretary wrote:

Whilst I understand your concerns around this matter, let me be clear that there is no need to enforce additional self-isolation requirements on those entering the UK. The scientific advice is very clear that doing so at this time would not have any significant impact on epidemic progression in the UK. The same social distancing rules apply to new arrivals into the UK as apply to the population as a whole, and, in particular, anyone developing symptoms will be required to self-isolate. The number of imported cases is a very small percentage of current cases in the UK, and incoming travellers from other countries which are also experiencing COVID-19 epidemics do not present a significant additional risk.108

83.The Home Secretary drew the Committee’s attention to the SAGE paper of 22 March and consequent conclusion on 23 March, but her letter did not address the issue of scientific advice considered before the withdrawal of borders guidance on 13 March. Therefore, during oral evidence provided by the Secretary of State for Health and Social Care to the Health and Social Care Committee on 17 April, our Chair asked the Secretary of State to provide any advice his department had received that informed the decision to end special international travel measures at that time.109 The Secretary of State undertook to “ask the Chief Medical Officer to publish the explanation behind the decisions that were taken”, as well as the analysis which informed those decisions.110 A week later, we wrote to the Secretary of State to confirm our desire to receive this information.111 To date this information has not been provided.

84.On 28 April, the Chair of this Committee asked the Chancellor of the Duchy of Lancaster when we could expect the advice to be published. He responded that “it is not for me to dictate what SAGE, NERVTAG or any of our independent scientific committees should or should not do, but I know that our chief scientific adviser has spoken about the importance of building confidence, and more will I am sure be said in due course”.112

85.In oral evidence on 29 April, we asked the Home Secretary again to explain what advice had been provided concerning the decision to withdraw guidance on 13 March. She said that “all advice is based upon SAGE and Public Health England” and that “border measures have been constantly under review”.113 She emphasised that the Home Office Chief Scientific Adviser, Professor John Aston, was a member of SAGE. When asked to estimate what percentage of people arriving on flights were infectious with COVID-19, the Home Secretary said that she understood “that the estimate was 0.5%” of arrivals.114 This was later clarified by the Second Permanent Secretary, Shona Dunn, as the estimate of the total number of community transmissions in the UK resulting from imported cases as of 23 March.115 However, no Home Office witness was able to provide an estimated percentage or number of individuals arriving in the UK ahead of 23 March who were infectious. The Second Permanent Secretary offered to provide any available numbers concerning the absolute number of arrivals—and the proportion—who were infectious.

86.In response we received a letter from Professor John Aston, the Chief Scientific Adviser to the Home Office, on 4 May. In his letter, Professor Aston explained that the figure of 0.5% referred to the estimate of “total domestic cases” resulting from importation. He explained that:

This figure was calculated using estimates of incidence of disease within hotspot countries, derived from death data. Using death data is the most reliable method available to estimate numbers of infections within countries. These data were combined with numbers of incoming air passengers from those hotspot countries. SAGE is in the process of publishing papers and has committed to publishing the paper that informed this analysis in the next two to three weeks.116

87.Professor Aston did not provide estimates of the number of infectious people who had arrived and were still arriving in the country, or what proportion of overall arrivals might be infectious. The letter did not set out what guidance had informed the withdrawal of guidance on 13 March. He did not include a list of “hotspot countries”, nor the estimated prevalence rate within that group of countries. He did however note that “median population prevalence worldwide is likely less than 1 in 1000”.117 As a global median figure would include countries which at the time of his writing were not yet heavily affected by the virus—including many in South America which now are—it is difficult to be confident in this figure as an appropriate placeholder for an estimate for the proportion of arrivals into the UK with the virus in the run-up to, and following on from, SAGE’s advice on 23 March.

88.On 5 May, in the Chamber, the Chair of this Committee asked the Secretary of State for Health and Social Care to publish evidence behind the decision to withdraw self-isolation guidance on 13 March. He responded that he would “look into the question that the right hon Lady raises”.118

89.On 11 May, we responded to Professor Aston’s letter to ask which hotspot countries were included in the calculation to reach the figure of 0.5%, how many people had arrived in the UK from those countries, and how the median figure of 1 in 1000 people related to the approximate prevalence rate in countries from which the majority of people were arriving in the UK.119 We also asked what estimate had been made on 12 March of the proportion of cases resulting from importation ahead of the withdrawal of guidance, in light of Sir Patrick Vallance’s consideration that total importations from Spain and Italy had been high during that period, (as would later be corroborated by the study of 8 June).

90.On 13 May, the Chair of this Committee asked Professor Aston whether the decision to withdraw self-isolation guidance was informed by an estimate of the number of people arriving each week who might have COVID-19. Professor Aston responded that:

At that point in time, when that decision was made, an estimate was made of what the effect would be of putting further restrictions on the border—that it would delay the epidemic by a small amount of time and therefore was deemed unsuitable.120

91.Professor Aston responded further to this point in a letter to the Committee on 5 June. However, rather than drawing the Committee’s attention to advice received at the time the decision was made—13 March—he directed the Committee to the minutes of the SAGE meetings of 3 and 4 February, writing to the Chair that “your questions around the limited amounts of delay that would have been potentially possible if strict measures had been imposed are addressed in those minutes”.121 No information about advice considered subsequent to the 3 and 4 February, but prior to 13 March, has been provided.

92.He did not explicitly address our questions about hotspot countries. He sought to reassure us that “the Home Secretary, Ministers and Officials in the Home Office have constantly asked for scientific advice when making decisions around COVID-19”.122

93.On 3 June, the Home Secretary made a statement in the House of Commons concerning refreshed UK border health measures, which we discuss in the next chapter of this Report. Our Chair asked that the Home Office provide a figure for how many people had arrived in the UK ahead of 23 March with COVID-19, and particularly during the period from 13 March to 23 March, again drawing attention to the withdrawal of self-isolation guidance for international arrivals on 13 March. She also asked that an estimate be made of how many people arriving in the UK over the three weeks from 3 June would likely be infectious.123 The Home Secretary responded that:

I have given examples of the number of airports, territories, airlines and flights that were monitored throughout the period from 22 January to 12 March. In terms of publishing the advice, I think the right hon. Lady refers specifically to advice from the Home Office, and I will ensure that the Home Affairs Committee receives it. On the number of incoming passengers, it is well known and documented through air passenger data—that does not include ports, which are separate—that the number of passengers travelling to and arriving in the United Kingdom has been at an all-time low and completely fallen off. We obviously cannot predict those figures for the next three weeks, but working with the Department for Transport we will collate that information and make it public.124

The Committee has not yet received the information promised by the Home Secretary.

94.On 1 July, the Committee took oral evidence from the Permanent Secretaries at the Home Office and again asked what specific advice was provided ahead of the decision to withdraw all self-isolation guidance for international arrivals on 13 March. The Second Permanent Secretary said:

as Professor Aston has explained, the position on 13 March, when the guidance was removed—because that was the point in time when the stay at home guidance came into effect for all people regardless of whether they were already within the country or coming into the country—was specific guidance with respect to self-isolation for people coming in from particular routes was no longer regarded as being appropriate.125

95.The Second Permanent Secretary reiterated that the prevailing figure at that time was 0.5% of community transmissions resulting from importation. The Second Permanent Secretary committed to asking Professor Aston to provide the Committee with “an account of the days in advance of 13 March, after this Committee meeting, in detail”. She accepted that “clearly the material he has provided, so far, has not given you that day-to-day account”.126 We have not yet received that day-to-day account.

96.In total, Members of the Committee have made nine appeals for information concerning the advice behind the decision to withdraw guidance on 13 March:

i)a question from the Chair to the Minister for Immigration Compliance and the Courts in the Chamber on 23 March;

ii)in correspondence from the Committee to the Home Secretary on 3 April;

iii)in oral evidence from the Secretary of State for Health and Social Care, via the Chair acting as a ‘guest’ of the Health and Social Care Committee, on 17 April;

iv)a question from the Chair to the Chancellor of the Duchy of Lancaster in the Chamber on 28 April;

v)in oral evidence from the Home Secretary on 29 April;

vi)a question from the Chair to the Secretary of State for Health and Social Care in the Chamber on 5 May;

vii)in correspondence from the Committee to the Home Office Chief Scientific Adviser on 11 May;

viii)a question from the Chair to the Home Secretary in the Chamber on 3 June;

ix)in oral evidence with the Home Office’s Permanent Secretaries on 1 July.

97.The failure of the Home Office and other Government Departments to provide us with the scientific advice behind the decision to withdraw special measures for international arrivals on 13 March despite their repeated promises to do so is completely unacceptable. Despite many appeals for this information, the Government has only drawn our attention to SAGE advice and analysis on 22 and 23 March, ten days after the decision, and to SAGE papers from 3 and 4 February, nearly six weeks before the decision. Given the rapidly changing circumstances of the epidemic, we do not accept that these SAGE discussions adequately explain or justify decisions made on 13 March.

98.The Government has still has not given any indication that it will provide the evidence behind the withdrawal of guidance on 13 March. These appeals have been made to three members of the Cabinet, to one further Minister, and to three of the Home Office’s most senior officials. It is unacceptable that the information we requested concerning the decision to withdraw measures for international arrivals on 13 March has not yet been made available to us. The Committee has been reassured time and again that it would receive copies of the advice it had requested. After more than three months of being repeatedly promised this information, it will be difficult for this Committee to accept that there are any grounds why the Government cannot provide it to us; if there were such grounds, it has had ample time and opportunity to explain what these might be. It could at any previous juncture over this period have offered reasons for non-compliance or agreed terms for information to be given privately or with redaction. In such circumstances as these, the Committee could quite reasonably conclude that the advice we have requested simply does not exist.

99.The Home Office—and other departments of Government if necessary—must either publish or provide to the Committee immediately a full account of the scientific evidence and advice leading to its decision to withdraw guidance for international arrivals on 13 March. If this does not exist in written form, the Committee should receive a full account of what considerations were made and a summary of orally tendered advice, including the dates on which it was provided.

100.The decision to lift all COVID-19-related guidance for international arrivals on 13 March, just as other countries were expanding their border measures, is inexplicable. The Committee does not accept the argument that the introduction of voluntary ‘stay at home’ guidance for households with possible coronavirus infection on 13 March was enough reason to withdraw all guidance for returning travellers or visitors. Advice to stay at home applied only to those households with a suspected case of COVID-19 and was not legally enforceable for another 13 days. The Government stated that its priority in mid-March was buying time for the NHS. Imposing firmer measures on all international arrivals—including travellers from parts of Europe that had never been subject to specific guidance—would have contributed to this to some degree, as part of a cumulative or “additive” approach. Removing measures for international arrivals rather than extending them was the wrong thing to do.

101.Nor do we accept that falling numbers of arrivals justified the lifting of border measures in mid-March. Although passenger numbers started to fall, a further one million people were to arrive between 13 March and lockdown on 23 March, and possibly hundreds of thousands more by mid-April. That is likely to have included thousands of people with COVID-19.

102.We also do not accept the Home Office’s suggestion that no measures were needed after 13 March because imported cases made up only 0.5% of total UK infections. That figure was not calculated until 22 March by which time a million more people had arrived and the epidemic had rapidly escalated in the UK. It is likely to have been substantially higher at the time when guidance was lifted. We set out further concerns about the Home Office reliance on this measurement from paragraph 108.

103.The Government does not seem to have examined the full range of possible measures affecting international travel and considered their additive effect. It is understandable that the Government did not consider it practical or effective to simply restrict flights, not least because of large numbers of British residents seeking to return home. However, the failure to properly consider the possibility of imposing stricter requirements on those arriving—such as mandatory self-isolation, increased screening, targeted testing or enforceable quarantine—was a serious error. In mid-March, the Government had a limited sense of how many infectious people were arriving in the UK, or where they were arriving from, and had limited means of controlling the onward spread of the virus from such cases. In the circumstances, a precautionary approach aimed at continuing suppression of imported cases of the virus should have included more comprehensive measures for passengers arriving from places which had significant numbers of infections.

104.Firm border measures introduced in June were considerably stronger than both the ‘stay at home’ guidance and lockdown restrictions imposed in mid-March. Indeed, they were exactly the “draconian” measures initially rejected by SAGE, enforceable in law. Justifying the decision to lift measures on 13 March on the basis that, at that time, measures applying to international arrivals were at parity with ‘stay at home’ guidance issued the same day is not consistent with the Government’s eventual chosen strategy. That later strategy, discussed in the next chapter, places more onerous legal restrictions on arrivals from overseas than have been placed on any other group in the UK, at any point over the course of the pandemic.

The decision-making process

105.In view of our concerns about the lack of evidence to justify this decision, we have tried to understand how this decision was taken and who was responsible for taking it. In oral evidence to the Science and Technology Committee, Professor Aston did not specify who had made the decision, but responded that “It was likely a Government decision across the board” and that “Because it was a SAGE piece of advice, that would come from the Government’s point of view”.127 Professor Phil Blythe, the Department for Transport’s Chief Scientific Adviser, and Professor Aston confirmed that neither of them had given advice to Cabinet on the decision, although Professor Aston “talked to the Home Secretary at all times about the effect of people crossing the borders”.128

106.In later evidence, Professor Neil Ferguson said that “this is really about decisions by the Foreign Office and the Department of Health and Social Care, not by SAGE.” He did not specifically mention the Home Office or the Department for Transport.129

107.It is not clear who was responsible for making the decision to withdraw self-isolation guidance on 13 March, or on what basis. It is hard to reconcile Professor Aston’s suggestion that advice was provided at the time the decision was made with either his own indication that he was not involved in the decision, or his later emphasis on advice given six weeks prior to the decision, on 3 and 4 February. Urgent clarity is needed on what scientific evidence was considered and advice provided in relation to self-isolation measures in the days preceding the decision of 13 March, given its likely significant impact in the number of cases imported into the UK in mid-March. Despite this, no Cabinet Minister or official whom we have asked has been able to provide any explanation for the process by which, and the basis on which, the decision was made. It is not clear who was responsible for gathering the evidence, formulating policy options or scrutinising and testing the advice. It is not clear whether there was a lead department or a lead institution, or which Minister took lead responsibility for the decision. The lack of clarity about the responsibility for decision making in this crucial area is very serious and may well have contributed to mistakes being made.

Appropriateness of Home Office calculations and analysis

108.We have asked many times for the Government’s estimate of the number of people likely to be arriving in the UK with COVID-19. We have repeatedly been told that the Home Office does not have those figures, that senior Ministers and officials variously have not asked for or have not been given any such estimates, and that actual numbers of people arriving is not an appropriate figure on which to base policy decisions. The Home Office has told us instead that the most significant figure is new arriving infections as a proportion of domestic cases. Since first being asked about scientific evidence informing Government decisions on international travel, the Home Office has relied upon its estimate that the proportion of community transmissions in the UK resulting from imported cases is below 0.5%. The Committee has repeatedly sought to understand the rationale for using this calculation as the basis for decision-making.

109.In Professor Aston’s most recent letter to the Committee, dated 15 July, he suggested that the proportion of 0.5% represented a threshold, below which “numbers of cases arriving from other countries were estimated to be insignificant in comparison with domestic cases” and above which the proportion was considered to be “significant”. He told the Committee that he was “confident” that the figure remained below 0.5% between 23 March and 8 June, but gave no indication of the date at which the proportion had fallen below the threshold (because of widespread community transmission) or the rate at which the figure had fallen in the days and weeks preceding 23 March.130 Given that the genomic study discussed in the previous section estimated that hundreds of individuals with COVID-19 were likely entering the UK each day before and after 10 March, the date when the Government was working on the basis that there were between 5,000 and 10,000 total cases in the UK, it is probable that the proportion was very much higher than 0.5% in mid-March.

110.In oral evidence to the Science and Technology Committee on 13 May, attended by the Chair of this Committee, Professor Aston described the process behind the calculation of the 0.5% figure:

Effectively, we looked at the likely numbers of cases within the UK and overseas, while understanding that there is, of course, underreporting. That is not under-reporting being done deliberately; it is, of course, because the number of tests do not reflect the number of people who have the virus. We have used estimates of how to take reported cases to total cases, and we have used that to estimate the ratio between imported cases and the total number of cases.131

111.When asked whether a number for incoming cases with COVID-19 existed, he said:

I personally do not feel that that figure is a particularly robust estimate. The ratio itself is a much better estimate—first, because it gives you an idea about the actual risk that is posed by people coming across the border. Secondly, it is much more stable than the estimate of particular incoming cases. The reason for that is you have to take the estimate of the prevalence in a particular country, be that in the UK or in other countries, and understand the infection fatality rate, because from the best statistics in countries across the world it is possible to estimate the number of true cases in the country. You also want to look at the number of reported cases in the country and use that. The infection fatality rate is subject to uncertainty, and the number of symptomatic cases is subject to uncertainty. However, the ratio between domestic and overseas cases means that they cancel out on both sides, so that uncertainty drops out. The 0.5% figure is far more robust than particular figures about the number of cases coming across the border or the number of cases in the UK.132

112.We asked scientific experts whether the use of a measure based on community transmission (i.e. the Government’s 0.5% figure) was appropriate for estimating the relative risk presented by imported cases. Sir David Skegg, University of Otago, New Zealand, told us that he “would certainly be looking at the absolute number” of arrivals as well as the proportion of community transmissions they constituted. He added:

by the way, the 0.5%, I do not know how that estimate was derived, but I am sure it is not necessarily a very precise one. I think at the time that those decisions were made in the UK, as I understand it, there was an acceptance that this virus was going to spread through the community.133

113.Professor Teo Yik-Ying, of the National University of Singapore, was similarly sceptical about the appropriateness of the Government’s reliance on the 0.5% figure:

I think it boils down to how one is quantifying that figure of importations leading to primary and second infections. Because if you do not have any contact tracing procedures in place what it means is if I enter the UK today and I am infected I could spread it on to perhaps five other contacts around me, and those five other contacts could go and spread on to other people, perhaps another five each, so that will be 25 or 30 people in total. Are all 30 people attributed to me or is it only the first initial five? [ … ] I see this to be absolutely crucial because when we start to think about figures like 0.5% it will grossly underestimate the impact of importation risk, because everyone that comes in we will perhaps see additional clusters. Each member within that cluster will go on and that is the dangerous nature of COVID-19 being so infectious.134

114.Professor Gabriel Leung, Hong Kong University, agreed. He explained that:

when you try to build a model of spread, and there have been many builds in the UK as well as elsewhere, one of the most important things that we do is to look at how we seed that model. It is the absolute number of seeds that matter, it is not the proportion.135

115.Professor Gabriel Scally, University of Bristol, noted that, as the virus was imported from overseas to begin with, the proportion of cases in community circulation must have been considerably higher than 0.5% for some time:

I have seen some of the assessments—the figure of 0.5% is used quite widely—and I must admit that I get quite confused, because it seems to me to be quite imprecise as to what exactly people are talking about. Clearly, at some point in this epidemic, it was 100% of cases that had been imported. That, for me, is the important thing. We should not regard it as, “Because we failed to contain it inside the country, there is no point in stopping new cases.”

[ … ] In my view, every single opportunity should have been taken to detect cases and stop transmission. That includes border control and the importation of fresh cases from abroad.136

116.We asked witnesses whether it was possible to estimate the absolute figure for the number of individual importations that could have contributed or led to the spreading of the virus in the community. Professor Scally said “I would have thought it must be hundreds or thousands”:

Chair: If the ONS assesses the current prevalence in the UK to be 137,000, that 0.5% would end up being around 700 new infections from abroad. Is your view that we should not be troubled by 700 new infections from abroad because we already have 137,000? Or, given that we are trying to bust a gut to get those 137,000 cases down, should we be doing everything possible to stop those 700 as well?

[ … ]

Professor Gabriel Scally: Actually, to me it does not matter; a case is a case. If you are importing—I think you mentioned 700 or so earlier—700 cases is 700 people who can go on and transmit, or 700 people who could lose their own lives, or be responsible, not deliberately but accidentally, for infecting other people and causing death.137

117.In his letter of 15 July, John Aston explained that the figure of 0.5% of community transmissions was in his view still a reliable estimate of the number of cases in community circulation that had resulted from importation:

Since that time [23 March], we have continued to monitor whether the proportion of cases at any time has likely become significant, defined as being greater than 0.5% of UK cases. Due to the considerable drop in passenger numbers, we are confident that this did not happen between 23 March and 8 June, and the proportion remained less than 0.5%. On June 8, mandatory self-isolation was put in place, in which case, this mitigated any risk. On July 10, countries with lower risk were exempted from the regulations, and we continue to be confident that the proportion of cases coming from other countries not subject to mandatory self-isolation remains insignificant compared to domestic cases, as it is less than 0.5%.138

118.It is deeply concerning that the Government is not able to provide any estimates that were produced at any point of the cardinal number of imported cases during March. The Home Office should have requested advice on the estimated number of importations, and the rough proportion of overall arrivals which that estimated figure represented. While the figure of 0.5% of circulating cases resulting from importation is a useful one and indeed may still be reliable as of 15 July, evidence to us demonstrates that these other figures are also crucially important to deciding border policy and should have been made available to Ministers. Nothing the Home Office had told us demonstrates beyond doubt that these other figures were asked for or made available. Having actual estimates of the number of people likely to be affected by any decision is important and can lead to qualitatively different decision-making processes than just relying on figures expressed as small proportions. Estimates should have been available to Ministers throughout March to allow them to make fully informed decisions.

Transparency of Government scientific advice

119.The Government’s professed adherence to scientific advice was not at first matched by transparency about the content or nature of that advice. SAGE first met to discuss the pandemic on 22 January 2020, but it was not until 20 March that the Government consented to begin publishing minutes of SAGE’s meeting, and a limited number of SAGE’s advice papers.

120.Although most SAGE papers are now being published, not all Government advisory documents have been published within one month of their consideration. There is no explanation provided as to why certain papers have not been published, or why there has been such a delay in publishing others. It is reasonable to consider that some papers may be subject to ongoing peer review, others may be relevant to national security, and others have been provided to the Cabinet—but as the list of SAGE papers provided by Government does not indicate any reason for non-publication it is difficult to discern why some papers are have been published in line with the Government’s commitment whereas others have not.

121.Professor James Wilsdon, Vice-Chair of the International Network for Government Science Advice, told us on 10 June, following the introduction of border quarantine measures, that he was “not clear myself what new, fresh advice they [SAGE] are giving to support the policy changes we are seeing now”:

Unless I have missed it, I have not seen an updated statement from SAGE to support the measures that are now being introduced. It may be that that advice exists and has not yet been published, but as we have seen through the course of recent months, the importance of transparency in the advisory process is clearly paramount at this point.139

122.Speaking in July, Sir Patrick Vallance said that “SAGE is an advisory body” that was “always dealing with uncertainty”. Part of its “job is to express that uncertainty to allow Ministers and others to make decisions as to which policies they wish to follow [ … ] We say “There is uncertainty here, but within the bounds of this uncertainty here is some advice”.”140

123.It is not clear to us how the Home Office interrogated the advice received by SAGE, either about the 0.5% figure, or the conclusion that only a 95% reduction in border crossing could achieve meaningful delay of a month to the pandemic. SAGE’s advice is based on “uncertainty”; evidence from Home Office officials and the Home Secretary does not indicate that due regard was given to the uncertainty inherent in the advice provided. Otherwise, as discussed earlier in this report, we could reasonably expect other figures to have been asked for and considered when formulating policy.

124.Public Health England has been a key reference point for Government action during the pandemic and continues to inform key Government mechanisms such as the Joint Biosecurity Centre (discussed from paragraph 197); despite this, its internal scientific analysis has not been published. This makes it difficult to reach conclusions about the extent to which rigorous assessment was made by Public Health England of the importation risk, or of the efficacy of measures taken in other countries to control the virus and how these might relate to that importation risk. We note that the Science and Technology committee raised similar concerns in a letter to the Prime Minister.141

125.In a public health crisis transparency is crucial, both to ensure that analysis is tested and to build trust and confidence. We welcome the decision to publish SAGE papers. However, transparency cannot be selective without clear explanation, particularly when the advice relates to policy decisions as important as those concerning the introduction of border measures, which affects wide swathes of the economy and disrupts millions of peoples’ plans. Where it has not been able to meet the commitment to publish papers within a month of the relevant meeting, the Government should explain clearly why.

126.The Committee shares the concern of the Science and Technology Committee that bodies advising Government, including Public Health England, are also insufficiently transparent about the nature and content of the advice they are providing.

127.It still stands that no evidence has been provided to us about what advice was provided to the Home Secretary or to other Ministers, when, or by whom.142 It is also not clear whether any senior officials from the Home Office beyond Professor Aston were privy to SAGE papers and what specific scrutiny the Home Office carried out of advice from SAGE where it was relevant to the department’s remit. The Permanent Secretary told us on 1 July that “Home Office officials have played a central role in helping to advise Ministers on all aspects of the COVID response that are relevant to the Home Office” and added that “the Home Office continues to be joined-up [ … ] in terms of Professor Aston being a Member of SAGE, and the Second Permanent Secretary and myself taking part in Permanent Secretary meetings”. However, when pressed on the internal scrutiny of SAGE advice and related advice concerning the removal of international arrivals guidance on 13 March, the Second Permanent Secretary could refer only to published SAGE advice and not to any further analysis or consideration by the Home Office.143

128.Professor James Wilsdon suggested that the Government’s strategy required “at least greater transparency instead of indications of the science as a sort of singular thing followed by somewhat shifting policy responses”. He said that:

Where we have had problems arising here—not just with respect to border measures, in many other areas too—has been at various points an overly simplified, singular account of the science as supporting simple decisions rather than greater acknowledgement of the plurality of advice and evidence, which clearly exists, as we are seeing from other sources. There is also the messy interface between the scientific and the political, which is at the heart of these sorts of situations.144

129.The Home Office has stated repeatedly that it followed scientific advice from SAGE and from its own Scientific Adviser ahead of the Government’s decision to withdraw guidance for international arrivals on 13 March. By the same measure, the Government’s Chief Scientific Adviser has been clear that advice from SAGE includes an inherent degree of uncertainty. This is reasonable, particularly in a rapidly evolving situation such as COVID-19. However, we have heard no evidence to suggest that the Home Office requested additional information that could have fed into its border policy, nor that it interrogated the inherent uncertainties around SAGE’s advice or around the limited figures it was given. We are forced to conclude, therefore, that the Department took at face value the advice provided; it should not have done so.

2 HM Government, ‘Scientific Advisory Group for Emergencies (SAGE): Coronavirus (COVID-19) response’, accessed 12 July 2020

3 Government Office for Science, ‘List of participants of SAGE and related sub-groups’, last updated 3 July 2020, accessed 12 July 2020

4 Scientific Advisory Group on Emergencies, Minutes of first meeting relating to COVID-19, 22 January 2020

5 Border Force (COR0007)

6 Scientific Advisory Group on Emergencies, Minutes of first meeting relating to COVID-19, 22 January 2020

7 HC Deb, 27 January 2020, col 559 [Commons Chamber]

8 HC Deb, 27 January 2020, col 559 [Commons Chamber]

9 Border Force (COR0007)

10 BBC News, ‘Coronavirus: Britons on Wuhan flights to be quarantined’, 29 January 2020

11 New and Emerging Respiratory Virus Threats Advisory Group, Minutes of the NERVTAG Wuhan Novel Coronavirus Third Meeting, 28 January 2020

12 Scientific Advisory Group on Emergencies, Minutes of second meeting relating to COVID-19, 28 January 2020

13 BBC News, ‘Coronavirus: Britons evacuated from Wuhan arrive at quarantine facility’, 31 January 2020

14 HC Deb, 3 February 2020, col 49 [Commons Chamber]

15 Written Parliamentary Question 41459 [Migrants: Quarantine], 4 May 2020

16 Scientific Advisory Group on Emergencies, Minutes of third meeting relating to COVID-19, 3 February 2020

17 Scientific Advisory Group on Emergencies, Minutes of third meeting relating to COVID-19, 3 February 2020

18 Scientific Advisory Group on Emergencies, Minutes of third meeting relating to COVID-19, 3 February 2020

19 Scientific Advisory Group on Emergencies, Minutes of fourth meeting relating to COVID-19, 4 February 2020

20 Scientific Pandemic Influenza Advisory Committee Modelling Operational sub-group (SPI-M-O-), Statement on the impact of the possible interventions to delay the spread of a UK outbreak of 2019-nCov, 3 February 2020

21 The Guardian, ‘Travel bans plunge China into deepening isolation over coronavirus’, 1 February 2020

22 The Guardian, ‘First British national to contract coronavirus had been in Singapore’, 6 February 2020

23 Scientific Advisory Group on Emergencies, Minutes of fifth meeting relating to COVID-19, 6 February 2020. A case definition is the criteria applied to an individual to assess whether they are recordable as a case of a particular condition for epidemiological purposes.

24 Scientific Advisory Group on Emergencies, Minutes of sixth meeting relating to COVID-19, 11 February 2020

25 Chinazzi et al, ‘The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak’, Science, 24 April 2020, pp395–400

26 Chinazzi et al, ‘The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak’, Science, 24 April 2020, pp395–400

27 Department for Transport and Public Health England, ‘COVID-19 Guidance for staff in the transport sector’, 14 February 2020

28 World Health Organization, Coronavirus disease 2019 (COVID-19): Situation Report 25, 14 February 2020

29 Scottish Government, ‘Coronavirus travel advice updated’, 25 February 2020

30 World Health Organization, Coronavirus disease 2019 (COVID-19): Situation Report 36, 25 February 2020

31 Border Force (COR0007)

32 The ‘page history’ attached to this guidance online demonstrates where changes to the categories were made over the ensuing days

33 Bloomberg, ‘Germany Tightens Border Checks in Bid to Curb Coronavirus Spread’, 28 February 2020

34 Center for Strategic and International Studies, ‘A Timeline of South Korea’s Response to COVID-19’, 27 March 2020

35 Scientific Advisory Group on Emergencies, Minutes of eleventh meeting relating to COVID-19, 27 February 2020; Scientific Advisory Group on Emergencies, Minutes of twelfth meeting relating to COVID-19, 3 March 2020

36 MRC Centre for Global Infectious Disease Analysis, Imperial College London, and the Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Adoption and impact of non-pharmaceutical interventions for COVID-19, 3 March 2020

37 Lai S.; Ruktanochai, N.; Zhou, L.; Prosper, O.; Luo, W.; Floyd, J.R.; Wesolowski, A.; Santillana, M.; Zhang, C.; Du, X.; Yu, H.; Tatem, A.J., Effect of non-pharmaceutical interventions for containing the COVID-19 outbreak in China, medRxiv, 3 March 2020 [pre-print]

38 Anzai, A.; Kobayashi, T.; Linton, N.M.; Kinoshita, R.; Hayashi, K.; Suzuki, A.; Yang, Y.; Jung, S. M.; Miyama, T.; Akhmetzhanov, A.R.; Nishiura, H., Assessing the Impact of Reduced Travel on Exportation Dynamics of Novel Coronavirus Infection (COVID-19), Journal of Clinical Medicine. 2020, 9, 601; A further study found that preventive measures such as travel bans between cities and cancellation of public gatherings had slowed the spread from Wuhan to other parts of China by up to 2.91 days; Tian, H., Liu, Y., Li, Y., Wu, C-H., Chen, B., Kraemer, M. U., Li, B., Cai, J., Xu, B., Yang, Q., Wang, B., Yang, P., Cui, Y., Song, Y., Zheng, P., Wang, Q., Bjornstad, O. N., Yang, R., Grenfell, B., Pybus, O., and Dye, C., Early evaluation of transmission control measures in response to the 2019 novel coronavirus outbreak in China, medRxiv 2020.01.30.20019844

39 Department of Health and Social Care, ‘Coronavirus action plan: a guide to what you can expect across the UK’, 3 March 2020

40 Department of Health and Social Care, ‘Coronavirus action plan: a guide to what you can expect across the UK’, 3 March 2020

41 World Health Organization, Coronavirus disease 2019 (COVID-19): Situation Report 45, 5 March 2020; For the purposes of this Report, Northern Italy refers to the provinces in footnote 42.

42 ‘Northern Italy’, as defined by 8 March guidance, includes areas of Lombardy (“Milan, Bergamo, Como and provinces”), Emilia Romagna (“Modern, Parma, Piacenza, Reggio Emilia, Rimini”), Marche (“Pesaro e Urbino”), Piemonte (“Alessandria, Asti, Novara, Verbano-Cusio-Ossola and Vercelli”) and Veneto (“Padova, Treviso and Venezia”)

43 Based on Committee analysis of the history of the guidance page.

44 Border Force (COR0007)

45 World Health Organization, Coronavirus disease 2019 (COVID-19): Situation Report 50, 10 March 2020; World Health Organization, Coronavirus disease 2019 (COVID-19): Situation Report 53, 13 March 2020

46 Civil Aviation Authority, ‘Airport data 2020’, Table_12_1_Intl_Air_Pax_Traffic_Route_Analysis

47 Liverpool Echo, ‘Official investigation launched into Liverpool-Atletico Madrid match coronavirus link’, 24 April 2020

48 Pybus, O. and Rambaut, A. with du Plessis, L., Zarebski, A. E., Kraemer, M. U. G., Raghwani, J., Gutierrez, B., Hill, V., McCrone, J., Colquhoun, R., Jackson, B., O’Toole, A. and Ashworth, J. on behalf of the COG-UK consortium, ‘Preliminary analysis of SARS-CoV-2 importation & establishment of UK transmission lineages’, 8 June 2020; The World Health Organisation defines genomics as “the study of genes and their functions, and related techniques. The main difference between genomics and genetics is that genetics scrutinises the functioning and composition of the single gene whereas genomics addresses all genes and their inter-relationships in order to identify their combined influence on the growth and development of the organism”.

49 Oral evidence taken before the Health and Social Care Committee on 5 May 2020, HC 36, Q390

50 Q71

51 Q754

52 Oral evidence taken before the Science and Technology Committee on 10 June 2020, HC 136, Q837

53 Public Health England, ‘COVID-19: guidance for households with possible coronavirus infection’, first published 12 March 2020, accessed 12 July 2020

54 Letter from the Home Office Chief Scientific Adviser on the border and Covid-19, 4 May 2020

55 Oral evidence taken on 1 July 2020, HC 536, Q7

56 Public Health England, ‘COVID-19: guidance for households with possible coronavirus infection’, first published 12 March 2020, accessed 12 July 2020

57 10 Downing Street, ‘Prime Minister’s statement on coronavirus (COVID-19)’, 12 March 2020

58 10 Downing Street, ‘Prime Minister’s statement on coronavirus (COVID-19)’, 16 March 2020

59 Heath Protection (Coronavirus, Restrictions) (England) Regulation 2020 (SI, 2020, No. 350); The Health Protection (Coronavirus) (Restrictions) (Scotland) Regulations 2020 (SSI, 2020, No, 103); The Health Protection (Coronavirus Restrictions) (Wales) Regulations 2020 (SI, 2020, No. 353 (W. 80)); The Health Protection (Coronavirus, Restrictions) Regulations (Northern Ireland) 2020 (SR(NI), 2020, No. 55). The Northern Ireland Regulations came into force on 28 March as opposed to 26 March.

60 Department of Health and Social Care, ‘Coronavirus action plan: a guide to what you can expect across the UK’, 3 March 2020

61 Department of Health and Social Care, ‘Coronavirus action plan: a guide to what you can expect across the UK’, 3 March 2020

62 World Health Organization, Coronavirus disease 2019 (COVID-19): Situation Report 50, 10 March 2020; World Health Organization, Coronavirus disease 2019 (COVID-19): Situation Report 36, 23 March 2020

63 Scientific Advisory Group on Emergencies, Minutes of fourteenth meeting relating to COVID-19, 3 March 2020

64 Business Insider, ‘The real number of coronavirus cases in the UK could be up to 20 times higher than official figures’, 12 March 2020

65 Scientific Advisory Group on Emergencies, Minutes of fifteenth meeting relating to COVID-19, 13 March 2020

66 Scientific Advisory Group on Emergencies, Minutes of fourteenth meeting relating to COVID-19, 10 March 2020; Scientific Advisory Group on Emergencies, Minutes of fifteenth meeting relating to COVID-19, 13 March 2020; Scientific Advisory Group on Emergencies, Minutes of sixteenth meeting relating to COVID-19, 16 March 2020

67 Q641; Pew Research Center, ‘More than nine-in-ten people worldwide live in countries with travel restrictions amid COVID-19’, 1 April 2020

68 Government of Singapore, ‘Check on travel restrictions before you fly overseas during this COVID-19 period’, 25 March 2020

69 Bloomberg, ‘In Singapore, Quarantine Comes With Sea View, Room Service’, 29 March 2020

70 Q740

71 Q601

72 New Zealand Ministry of Health, ‘COVID-19—current cases’, 5 June 2020

73 Q751

74 European Commission, COM(2020) 115 of 16.03.2020, 16 March 2020

75 International Network for Government Science Advice, ‘Closed border to most non-EU residents’, 16 March 2020. Exceptions included “non-Spaniards who cite reasons of force majeure”, cross-border workers, health professionals, goods transportation workers and flight crew required to carry out air freight activities.

76 German Federal Ministry of the Interior, ‘Coronavirus: Questions and Answers’, accessed 12 July 2020

77 Government of Canada, ‘Pandemic COVID-19 all countries: avoid non-essential travel outside Canada’, updated 19 April 2020

78 Government of Hong Kong SAR, ‘Exemptions for inbound travellers from the Mainland, Macao or Taiwan’, updated 28 May 2020; Government of Hong Kong SAR, ‘Exemptions from Compulsory Quarantine Arrangement for inbound travellers from foreign places’, updated 28 May 2020

79 Q651

80 Q741

81 Q763

82 Scientific Advisory Committee for Emergencies, Minutes of second meeting relating to COVID-19, 28 January 2020

83 Oral evidence taken before the Health and Social Care Committee on 5 May 2020, HC 36, Q390

84 Oral evidence taken before the Health and Social Care Committee on 5 May 2020, HC 36, Q390

85 Oral evidence taken before the Science and Technology Committee on 16 July 2020, HC 136, Qq1043–4

86 Border Force (COR0007)

87 Home Office, Statistics relating to COVID-19 and the immigration system, 28 May 2020

88 Q678

89 Pybus, O. and Rambaut, A. with du Plessis, L., Zarebski, A. E., Kraemer, M. U. G., Raghwani, J., Gutierrez, B., Hill, V., McCrone, J., Colquhoun, R., Jackson, B., O’Toole, A. and Ashworth, J. on behalf of the COG-UK consortium, ‘Preliminary analysis of SARS-CoV-2 importation & establishment of UK transmission lineages’, 8 June 2020

90 The study defines a “UK transmission lineage” as “two or more UK infection cases that (i) descend from a shared, single introduction of the virus into the UK from elsewhere, (ii) are the result of subsequent local transmission in the UK, and (iii) were present in [the researchers’] virus genome sequencing dataset”

91 Pybus, O. and Rambaut, A. with du Plessis, L., Zarebski, A. E., Kraemer, M. U. G., Raghwani, J., Gutierrez, B., Hill, V., McCrone, J., Colquhoun, R., Jackson, B., O’Toole, A. and Ashworth, J. on behalf of the COG-UK consortium, ‘Preliminary analysis of SARS-CoV-2 importation & establishment of UK transmission lineages’, 8 June 2020

92 Pybus, O. and Rambaut, A. with du Plessis, L., Zarebski, A. E., Kraemer, M. U. G., Raghwani, J., Gutierrez, B., Hill, V., McCrone, J., Colquhoun, R., Jackson, B., O’Toole, A. and Ashworth, J. on behalf of the COG-UK consortium, ‘Preliminary analysis of SARS-CoV-2 importation & establishment of UK transmission lineages’, 8 June 2020

93 Pybus, O. & Rambaut, A. with du Plessis, L., Zarebski, A. E., Kraemer, M. U. G., Raghwani, J., Gutierrez, B., Hill, V., McCrone, J., Colquhoun, R., Jackson, B., O’Toole, A. and Ashworth, J. on behalf of the COG-UK consortium, ‘Preliminary analysis of SARS-CoV-2 importation & establishment of UK transmission lineages’, 8 June 2020

94 N.B. the descriptor for the Figure as it appears in the paper: “The estimated number of importation events that are attributable to inbound travellers from each of several source countries. Values shown are per day and not cumulative. Estimated dates of importations are obtained by combining the size-dependent importation lag model with the TMRCAs [time to the most recent common ancestor]. Note that this is a statistical inference of the overall importation process, and cannot ascribe a specific source location to any given UK lineage”.

95 The study calculated estimated importation intensity by multiplying the estimated proportion of people in each country who are infectious on each day (see item (ii) above) and the number of people entering the UK from that country on that day (see item (i) above). Caveats include that the estimate assumes that fatality rates are accurate and constant across countries, and that the probability of a traveller being infectious is the same as the proportion of infectious people in their source country on the day of travel.

96 Pybus, O. and Rambaut, A. with du Plessis, L., Zarebski, A. E., Kraemer, M. U. G., Raghwani, J., Gutierrez, B., Hill, V., McCrone, J., Colquhoun, R., Jackson, B., O’Toole, A. and Ashworth, J. on behalf of the COG-UK consortium, ‘Preliminary analysis of SARS-CoV-2 importation & establishment of UK transmission lineages’, 8 June 2020

97 Pybus, O. & Rambaut, A. with du Plessis, L., Zarebski, A. E., Kraemer, M. U. G., Raghwani, J., Gutierrez, B., Hill, V., McCrone, J., Colquhoun, R., Jackson, B., O’Toole, A. and Ashworth, J. on behalf of the COG-UK consortium, ‘Preliminary analysis of SARS-CoV-2 importation & establishment of UK transmission lineages’, 8 June 2020

98 Civil Aviation Authority, International Air Passenger Traffic To and From Reporting Airports for March 2020; Graphs available at Appendix 4 to the study (Pybus and Rambaut et al, op. cit.) shows that approximately 400 cases were imported from Spain on 15 March.

99 Oral evidence taken before the Science and Technology Committee on 10 June 2020, HC 136, Q830ff

100 Q642

101 HC Deb, 16 March 2020, col 726 [Commons Chamber]

102 Scientific Advisory Group on Emergencies, Scientific advice on restricting advice from specific countries, 22 March 2020

103 Scientific Advisory Group on Emergencies, Scientific advice on restricting advice from specific countries, 22 March 2020

104 Scientific Advisory Committee for Emergencies, Minutes of eighteenth meeting relating to COVID-19, 23 March 2020

105 Border Force (COR0007)

106 HC Deb, 23 March 2020, cols. 12–13 [Commons Chamber]

107 Letter to the Home Secretary on Covid-19 checks at the UK border, 3 April 2020

108 Letter from the Home Secretary on Covid-19 checks at the UK border, 9 April 2020

109 The Chair attended the Health and Social Care Committee as a ‘guest’, under the provisions of Standing Order No. 137A.

110 Oral evidence taken before the Health and Social Care Committee on 17 April 2020, HC 36, Qq344–47

111 Letter to the Secretary of State for Health and Social Care on border quarantine, 24 April 2020

112 HC Deb, 28 April 2020, col. 228 [Commons Chamber]

113 Qq344–46

114 Q319

115 Qq332–6

116 Letter from the Home Office Chief Scientific Adviser on the border and Covid-19, 4 May 2020

117 Letter from the Home Office Chief Scientific Adviser on the border and Covid-19, 4 May 2020

118 HC Deb, 5 May 2020, col 509, [Commons Chamber]

119 Letter to the Home Office Chief Scientific Adviser on the border and Covid-19, 11 May 2020

120 Oral evidence taken before the Science and Technology Committee on 13 May 2020, HC 136, Q521; The Chair attended the Committee as a ‘guest’, under the provisions of Standing Order No. 137A

121 Letter from the Home Office Chief Scientific Adviser on the border and Covid-19, 5 June 2020

122 Letter from the Home Office Chief Scientific Adviser on the border and Covid-19, 5 June 2020

123 HC Deb, 3 June 2020, col 872 [Commons Chamber]

124 HC Deb, 3 June 2020, col 872 [Commons Chamber]

125 Oral evidence taken on 1 July 2020, HC 536, Q7 [Shona Dunn]

126 Oral evidence taken on 1 July 2020, HC 536, Q14

127 Oral evidence taken before the Science and Technology Committee on 13 May 2020, HC 136, Q532; The Chair attended the Committee on 13 May as a ‘guest’, under the provisions of Standing Order No. 137A

128 Oral evidence taken before the Science and Technology Committee on 13 May 2020, HC 136, Q533

129 Oral evidence taken before the Science and Technology Committee on 13 May 2020, HC 136, Q834

130 Letter from the Home Office Chief Scientific Adviser on Covid-19 and the border, 15 July 2020

131 Oral evidence taken before the Science and Technology Committee on 13 May 2020, HC 136, Q512

132 Oral evidence taken before the Science and Technology Committee on 13 May 2020, HC 136, Q518

138 Letter from the Home Office Chief Scientific Adviser on Covid-19 and the border, 15 July 2020

139 Q744

140 Oral evidence taken before the Science and Technology Committee on 16 July 2020, HC 136, Q1015

141 Letter from the Chair of the Science and Technology Committee to the Prime Minister on lessons learned so far in the Covid-19 pandemic, 18 May 2020

142 Oral evidence taken before the Science and Technology Committee on 13 May 2020, HC 136, Q533

143 Oral evidence taken on 15 July 2020, HC 561, Qq39–40

144 Q745

< Back

Next >

Published: 5 August 2020