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Asked by Emma Price, counsel to the inquiry, whether ministers had given “adequate consideration” to the indirect health harms resulting from Covid restrictions, such as the suspension of cancer screening and non-urgent elective work on March 17 2020, Ms Freeman said that “none of the decisions we were making were risk-free”.
She added: “They were always decisions about levels of harm and whether or not one could mitigate the harm that you anticipated would be caused by taking a particular decision.”
The priority was to “minimise the harm from the virus”, said Ms Freeman, but other harms “were given full consideration on the basis of how can we mitigate those harms”.
Ms Freeman also insisted that the Scottish Government “never ruled out” the possibility that the Covid virus could spread by airborne transmission, despite then-national clinical director Professor Jason Leitch stating during the first lockdown that the virus “is not airborne – it has to be spread by droplets”.
This was the basis for advice at the time on social distancing and hand-washing, but not initially ventilation or face masks.
Giving evidence to the inquiry on Friday, Professor Colin McKay – who was chief of medicine at Glasgow Royal Infirmary in 2020 – said his infection control teams were convinced Covid was airborne as early as April 2020, at a time when the World Health Organisation and NHS guidance stated this was not the case.
Ms Freeman said: “We never ruled out the possibility of aerosol distribution of the virus.
“While the focus was on droplet transmission, aerosol was never ruled out as a definite no in our minds so we were open to that.”
In May 2020, the Scottish Government diverged from UK-level infection prevention and control (IPC) guidelines by advising that healthcare and ambulance workers performing CPR – which was not considered an aerosol-generating procedure – should be able to request high-grade FFP3 filtration masks.
Ms Freeman said: “It was my view that where there was such a debate, the sensible approach was to go with the professional judgement of healthcare and clinical staff on the ground…if their professional judgement was that they should be wearing additional PPE, then we should provide that additional PPE.”
A nurse wearing an FFP3 respirator mask which provides wearers with maximum protection from airborne pathogens (Image: Getty)
The inquiry was also shown documents where Ms Freeman had been asked to sign off on the use of FFP3 which were recently past their expiry date but which had passed “stringent quality assurance” tests.
This was said to be due to “challenges in the supply chain” and the “fragile position” of stocks.
“This is a dilemma for our national procurement service in that, sensibly, you would think you should hold a volume of stock that is there ready to respond in the immediate period to an emergency that might arise,” said Ms Freeman.
“But equally, stock has time limit to it and this was a good example of stock that was held but at the point where the emergency arose and you needed to use it, it had passed on the basis of its time limit that [expiry] date.”
She said work was done to ensure the PPE would still be effective, and that she had sought “additional assurances” from experts including the Academy of Royal Colleges.
In future, she said there should be a “rolling program” whereby stock is distributed and replenished regularly, rather than “not reordering on the basis that you think you have enough”.
The inquiry has previously heard that concerns emerged that out-of-date masks were “falling apart” and did not strap onto NHS workers faces properly.
A BMA survey in April 2020 found that 55% of its members felt “pressured to work in a high risk area despite not having adequate PPE”.
Ms Freeman said the key issue was that the filtration device element of FFP3 masks functioned, and that other problems “could be solved”.
She added that she received daily updates on PPE stock position and distribution during her tenure, and that reports of shortages tended to be related to local and internal distribution to and within particular hospitals rather than nationally available supplies.
A mailbox was set up in April 2020 to enable health and care staff to report problems.
However, Ms Freeman acknowledged that sometimes staff had difficulty “getting their hands on PPE that I knew was there”.
She added: “My job was to try and resolve that issue.
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“If we actually had that stock, we needed it to get to the frontline…nothing will run smoothly all the time, so my concern was to make sure there were as many open channels as possible, but equally important to make sure we had follow through on those channels.”
Humza Yousaf, who was health secretary from May 2021 until March 2023 – when he became First Minister – also gave evidence to the inquiry.
Mr Yousaf said the decision to stand the NHS down from its emergency footing at the end of April 2022 was “an important signal to our health boards that we needed to put a significant greater focus on elective care”.
The inquiry heard that the number of hip replacements carried out on NHS Scotland had fallen 50% during 2020 compared to 2019, and had still not recovered by 2022.
Humza Yousaf gave evidence to the inquiry remotely (Image: YouTube/UKCovidInquiry) Elective care was “one of the biggest victims” during the early phase of the pandemic, said Mr Yousaf, adding: “Some health boards stopped elective care altogether, some continued at a much reduced scope.”
Even now, official statistics indicate that completed elective activity remains around 12% lower than pre-pandemic.
Mr Yousaf said that decision-making by ministers did not do enough to consider the impact on people with disabilities during the “opening up” phase as measures such as masking and social distancing were dropped.
He said: “That was welcomed by a lot of people, but I know that people with disabilities and their carers felt that that situation could make them even more vulnerable.”
By the end of 2021 – as the ultra transmissible Omicron variant began to spread – some healthcare workers were campaigning for FFP3 masks to be made compulsory in settings such as hospitals.
In April 2022, the Scottish Government issued guidance to the NHS that they should be made available to any healthcare workers who wanted to wear them.
Mr Yousaf said “evidence and clinical advice” did not support making them mandatory, and that many NHS staff found them too uncomfortable to wear for prolonged periods.
He said: “For all of those who were understandably proposing and advocating for greater availability of and use of FFP3, there was also a number of healthcare workers who did not and were very vociferous in their opposition to FFP3 masks being mandatory and that’s why we landed on the discretionary side of things.”
