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Behind the Scenes at SAGE: Pressure, Anxieties and ‘Pastoral Support’ - The New York Times

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LONDON — When 50 British scientists and government officials got on a Zoom call on May 7, emotions were running high, and not just because Britain had overtaken Italy for having the highest death toll from the coronavirus in Europe.

Two days earlier, a prominent epidemiologist on the government’s Scientific Advisory Group for Emergencies, Neil Ferguson, abruptly resigned after being confronted by a newspaper with evidence that he had breached Britain’s lockdown rules by inviting a woman to visit him in his London apartment.

Dr. Ferguson was the undisputed star of the group, known by its acronym, SAGE. The models generated by his team at Imperial College London had guided the government’s response to the crisis from the earliest days. Yet, he was being branded “Professor Lockdown,” fodder for sneering tabloid headlines.

As the scientists vented their anxieties about their colleague’s defenestration — and the unrelenting pressure and scrutiny that comes with advising the government during a once-in-a-century pandemic — they were urged to seek out “pastoral support” from a new member, Ian L. Boyd, according to minutes of the deliberations.

A 63-year-old Scottish zoologist who advised the government during an earlier outbreak of avian flu, Dr. Boyd is a veteran of the tense interplay between scientists and politicians. He was brought into SAGE by its chairman, Patrick Vallance, Prime Minister Boris Johnson’s chief scientific adviser, to observe the group’s debates and to be a sympathetic ear for the rattled scientists.

“There was an internal dynamic going on that needed to be treated,” Dr. Boyd said, declining to get into details. “If it becomes pathological, it’s for me to call it out. But I hope everybody feels they’re listened to.”

That SAGE would need the equivalent of an in-house therapist is less surprising than it might seem. No other group has attracted more attention or aroused more suspicion during Britain’s pandemic than this elite panel of experts.

Credit...Reuters

At first, it operated under a veil of secrecy, refusing to disclose its members and offering only spare details of its deliberations. Then, under pressure from lawmakers, the government partly lifted the veil, naming all but a handful of the participants, who wished to remain anonymous, and posting redacted minutes of its meetings.

The group’s academic firepower is impressive: It includes experts in fields from virology to behavioral science, from labs at Cambridge, Oxford, Imperial College and the London School of Hygiene and Tropical Medicine.

But transparency brought its own set of challenges. The role the scientists played in Britain’s dilatory response to the virus has come under sharper scrutiny, especially because Mr. Johnson and his ministers repeatedly claim to be “guided by the science” in imposing or relaxing lockdowns. Some scientists worry that Mr. Johnson is setting them up to take the blame for the death toll, which now exceeds 43,000.

As the group’s work has come increasingly into the public eye, the members’ advice is now second-guessed on social media. Their academic quarrels are hinted at in the minutes of their meetings. And as Dr. Ferguson’s indiscretions showed, not even their private lives are off limits.

“It was utterly horrible to see what happened to him,” said Julia Gog, a professor of mathematical biology at the University of Cambridge. “It was also extremely unsettling to other modelers, especially to junior scientists. It was a huge shock to see one of our colleagues treated in this way, and it certainly had an effect on the researchers.”

Dr. Gog described a pressure-cooker atmosphere, in which the scientists are handed complex assignments on very tight deadlines and have to make recommendations in a rapidly changing environment — all while holding down their day jobs and dealing with the stresses of the lockdown in their personal lives.

“I am desperately worried about the well-being of lots of the scientists involved,” Dr. Gog said. “It has been so immersive. You can’t get away. Even when you are trying to not be working, everything on the news is this, everything anyone wants to talk about, and your life is also controlled by this.”

Academics relish debating with their colleagues. But debating while on a government panel in the heat of a public-health emergency is another matter. Members of SAGE said they had fierce arguments over whether to recommend that the government urge people to wear face masks. A glimpse of that back-and-forth is evident in the minutes.

At its April 21 meeting, the panel concluded, “on balance, there is enough evidence to support community use of cloth face masks, for short periods in enclosed spaces where social distancing is not possible.” But a week later, it amended its minutes to add a line noting that the “evidence is weak, and it would be unreasonable to claim a large benefit from wearing a mask.”

It is not clear what triggered the reversal, but it coincided with an issue where Britain has been an outlier among European countries. Although the government recently required people to wear face coverings on buses and subways, Mr. Johnson and his ministers have never actively encouraged their use, expressing doubts about their efficacy. As a result, relatively few Britons wear them.

Credit...Isabel Infantes/Agence France-Presse — Getty Images

One of Dr. Boyd’s mandates, he said, was to review SAGE’s minutes to make sure they accurately reflected the scientific advice. He declined to elaborate further on his role and Dr. Vallance turned down a request for an interview.

But Dr. Boyd clearly arrived at a charged moment. At its May 7 meeting, the panel said it needed “a better mechanism for filtering commissions and requests” from the government. Weeding out extraneous or convoluted requests would “help the resilience of participants of SAGE who will continue to work under intense pressure in the Covid-19 response for many more months.” It added that the “need for pastoral support to be available to participants was noted.”

In addition to their mental health, the government offered the scientists counseling on how to deal with abuse on social media, according to an official, who noted that a few even faced shouted epithets on the street early in the crisis, when the government was still debating how to respond to the virus.

  • Frequently Asked Questions and Advice

    Updated June 24, 2020

    • Is it harder to exercise while wearing a mask?

      A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


Dr. Ferguson, who did not respond to requests for comment, had his detractors in the group. Some bridled at his appetite for media coverage, which they said interfered with its work. Rivals noted that his early models underestimated how fast the virus spread. But others argued that changes in projections — even radical ones — were inevitable, given how little was known about this virus.

The constant uncertainty has posed a challenge to Dr. Vallance and Chris Whitty, the chief medical officer, who serves as co-chairman of the panel. They must navigate between politicians like Mr. Johnson, who often turn to them for validation of their policies, and the scientists, who are often divided about the proper response.

“The evidence is not clear even now,” said David Spiegelhalter, a statistics professor at the University of Cambridge and a member. “That means that there are hugely different interpretations of almost the same information. And there are presumably some strong personalities that can be dominant.”

Other scientists said some degree of dysfunction was understandable, given the panel’s history. Its last major assignment was to advise the government in the aftermath of the poisoning of a Russian former spy, Sergei V. Skripal, in Salisbury, England. That work was conducted at a high level of secrecy, involved narrow questions of security and intelligence and got very little public exposure.

“SAGE went from being this internal advisory group to something that is much bigger in the public domain,” Dr. Boyd said.

Some scientists worry that their advice is cherry-picked and politicized. Susan Michie, a professor of health psychology at University College London, noted that a SAGE committee on which she serves produced a detailed study of the risks of cutting the social distancing rule from two meters (six feet) to one meter.

It concluded that shortening to one meter raised the risk of transmission by twice to 10 times, though it said the dangers could be mitigated with protective measures like ventilation, plastic dividers and face coverings. Mr. Johnson said little about the heightened risks when, after considerable pressure from the hospitality industries, he announced the loosened rules earlier this week.

Credit...Andrew Parsons/10 Downing Street

“The overwhelming majority of our advice is ignored,” Dr. Michie said, “but the pieces are picked up and used for political purposes.”

As the government moves to reopen Britain’s economy, it may rely less on the advice of its scientific advisers and more on a new Joint Biosecurity Center, which it set up last month to detect outbreaks of the virus and advise the government on how to respond to them — for example, by closing schools or offices. The center is led by Clare Gardiner, a cybersecurity expert who worked at Government Communications Headquarters, or GCHQ, Britain’s secretive electronic surveillance agency.

Mr. Johnson cited the center’s Covid-19 alert system, which measures the prevalence of the virus, as one reason to ease the lockdown. The threat level was recently lowered from four, signifying high or exponentially increasing transmission, to three, signifying general circulation in the population.

For some scientists, the new center is a necessary recognition that the coronavirus will be around for a year or more, and the government cannot rely on SAGE’s ad hoc, overworked members to analyze every outbreak. Others, though, worry that politicians could use it to circumvent unwelcome advice.

“Now that the government doesn’t seem to like SAGE’s advice so much, they can set up their own review,” Dr. Michie said. “They can handpick their own scientists.”

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