The experience of the tiered system during the autumn was, however, unsatisfactory. In the absence of effective contact tracing, the regional restrictions proved not to be anywhere near watertight enough to prevent infections spreading, compounded by delays in getting test results. Professor John Edmunds, Professor of Infectious Disease Epidemiology and a participant of SAGE, told us that he had concerns about what the tiering system would result in and that he would not have followed such a strategy: What worries me a little bit is where the strategy leads at the moment. If you think it through, the targeted strategy—the tiered strategy—leads to a high level of incidence everywhere. Let’s say that tier 3 works and keeps the reproduction number at about 1. I do not think anybody really thinks it will reduce it to less than 1. Let’s assume that it manages to get the reproduction number to about 1. That means that in Liverpool, Manchester and the north-west, we will keep the incidence at that high level, which is putting hospitals under strain and causing significant numbers of deaths. We are going to keep it at that high level for the foreseeable future. 183 HC Deb, 12 October 2020, col 23 [Commons Chamber] 184 The ‘Rule of Six’ means that, apart from limited exemptions such as work and education, any social gatherings of more than six people will be against the law. For more, see: GOV.UK, Rule of six comes into effect to tackle coronavirus, 14 September 2020 185 National Audit Office, The government’s approach to test and trace in England—interim report, 11 December 2020, page 18 48 Coronavirus: lessons learned to date A few weeks later, the midlands goes into tier 3, so we then keep the midlands at a high level of incidence for the foreseeable future. London is shortly thereafter, and we keep London there. The logical extension of this means that we all end up at a high level of incidence, where hospitals are really under strain and we have large numbers of deaths.