Dear Prime Minister, Chancellor, CMOs and Chief Scientific Adviser
We are writing with the intention of providing constructive input into the choices with respect to the Covid-19 policy response. We also have several concerns regarding aspects of the existing policy choices that we wish to draw attention to.
In summary, our view is that the existing policy path is inconsistent with the known risk-profile of Covid-19 and should be reconsidered. The unstated objective currently appears to be one of suppression of the virus, until such a time that a vaccine can be deployed. This objective is increasingly unfeasible (notwithstanding our more specific concerns regarding existing policies) and is leading to significant harm across all age groups, which likely offsets any benefits.
Instead, more targeted measures that protect the most vulnerable from Covid, whilst not adversely impacting those not at risk, are more supportable. Given the high proportion of Covid deaths in care homes, these should be a priority. Such targeted measures should be explored as a matter of urgency, as the logical cornerstone of our future strategy.
In addition to this overarching point, we append a set of concerns regarding the existing policy choices, which we hope will be received in the spirit in which they are intended. We are mindful that the current circumstances are challenging, and that all policy decisions are difficult ones. Moreover, many people have sadly lost loved ones to Covid-19 throughout the UK. Nonetheless, the current debate appears unhelpfully polarised around views that Covid is extremely deadly to all (and that large-scale policy interventions are effective); and on the other hand, those who believe Covid poses no risk at all. In light of this, and in order to make choices that increase our prospects of achieving better outcomes in future, we think now is the right time to ‘step back’ and fundamentally reconsider the path forward.
Professor Sunetra Gupta; Professor of theoretical epidemiology, the University of Oxford
Professor Carl Heneghan; Director, Centre for Evidence Based Medicine, the University of Oxford
Professor Karol Sikora; Consultant oncologist and Professor of medicine, University of Buckingham
Sam Williams; Director and co-founder of Economic Insight
- ‘Circuit break’ may be a grave error with terrible consequences for the health of the British people and for the health of the country.
- The Government is once again in the grip of doom-mongering scientific modellers who specialise in causing panic.
- The latest reliable data from Spain (up to September 3) which does not indicate any sort of upward curve in infections, let alone one coming to get us here in Britain.
- Anyone with clinical experience of dealing with respiratory viruses knows that the only certainty is uncertainty itself.
- Making comparisons between countries using different national data with different definitions is no more useful than trying to compare apples and pears.
- Latest study shows that nearly a third of all Covid-19 deaths recorded in July and August might have actually been the result of other causes –cancer, for example, or road traffic accidents.
- Sweden has probably suppressed Covid-19 to the same level as Great Britain but without draconian measures.
- Anyone going down with a new respiratory illness is likely to be suffering from a cold – not Covid.
Covid-19 accounts for an average of 11 of the 1,687 deaths in Britain every day, according to official statistics.
|Cause||UK deaths per day|
|Flu and pneumonia||124|
|Accidents at home||16|
Public Health England has listed 18 areas of intervention with stricter rules
They had only a combined 141 people in hospital as of September 3, NHS shows
One person in hospital for every 38,000 in a population of over 5.4million
Despite an infection rate of more than 120 cases per 100,000 people and local lockdown rules preventing people from meeting anyone they don’t live with, fears about the virus spreading translate to only two people in hospital.
Professor Carl Heneghan said there has been a 50% rise in coughs and colds
This is normal for September when children go back to school and university
But Government messaging about Covid-19 has left people ‘terrified’, he said
- A coughing illness would not normally be considered an epidemic until doctors were seeing 400 symptomatic cases per 100,000 – far higher than Covid-19 rates;
- The Eat Out to Help Out restaurant voucher scheme likely led to an increase in the spread of coronavirus;
- Increased testing is still only picking up a fraction of the true number of cases but it’s detecting more of ‘background’ infections because it’s more targeted, making it look like cases are soaring;
- Bolton may be experiencing high infections because the virus was not widespread there before lockdown lifted and people did not build up any immunity;
- Swab tests are still picking out too many people who aren’t infectious, and studying individuals’ viral loads could help officials to pick out those actually at risk of spreading it;
- The country cannot test its way out of the outbreak and there must be a coherent strategy for what to do with knowledge of case numbers and a level that is acceptable;
- Ambiguous phrases such as ‘Moonshot’ are not helpful for communicating the Government’s plans and have no basis in science, which should be paramount.
‘What’s in a name? That which we call a rose by any other name would smell as sweet,’ wrote the Bard. He was referring to a rose which is a rose, instantly recognised by its fragrance and its appearance. But a case of Covid-19 does not fit the metaphor, because it differs wherever you look.
In the course of our evidence gathering activities, we have gone through a few thousand papers reporting studies on all aspects of Covid-19 spread. We found that not very many defined a case of Covid, which is a sign of sloppiness when that is what you are looking for. Those that did, reported different definitions and ways of ascertaining what they meant by a ‘case’.
- The ‘rule of six’ has no scientific evidence to back it up, and may well end up having major social consequences.
- Increased activity at the end of summer leads to an increase in acute respiratory infections, as it does every year.
- Oxford University’s Centre for Evidence Based Medicine: no scientific evidence on the effects of measures such as distancing on respiratory viral spread. No study pointing to the number six. If it’s made up, why not five or seven?
- Admissions for Covid, critical care bed occupancies and deaths are now at an all-time low.
- There are currently 600 patients in hospital with Covid compared to over 17,000 at the height of the epidemic. An average of ten patients a day die with Covid registered on their death certificate, compared to over 1,000 at the peak.
- Shift in focus away from the impact of the disease is a worrying development.
- Severity of the pandemic was monitored by numbers of cases, numbers of admissions, and deaths. All three measures are open to misinterpretation if their definitions are not standardised.
- Cases are being over-diagnosed by a test that can pick up dead viral load.
- Hospital admissions are subjective decisions made by physicians which can vary from hospital to hospital.
- Even deaths have been misattributed.
- Cases will rise, as they will in winter for all acute respiratory pathogens, but this will not necessarily translate into excess deaths.
- Models ignore the vast expertise of our clinicians and public health experts who could provide a more robust approach based on their real-world healthcare experiences.
- The current Cabinet is inexperienced:
- the Health Secretary has been in post for just over two years now;
- the PM and the Chief Medical Officer a year;
- The Joint Biosecurity Centre is overseen by a senior spy who monitors the spread of coronavirus and suppresses new outbreaks;
- New chair of the National Institute for Health Protection who has little or no background in healthcare.
- The recognised alert threshold for ‘regular’ acute respiratory infections is 400 cases per 100,000.
- Britain’s mental health has deteriorated. During lockdown, a fifth of vulnerable people considered self-harming, routine healthcare came to a standstill, operations were cancelled, and cancer care put on hold.
- The most glaring initial blunder was not observing what was going on in other European nations and learning from their mistakes.
- Life should return to as close as possible to normality.
FORCING school children to wear masks is part of a scattergun approach by a government “lacking the political will” to study the actual evidence, a professor warns.
Dr Carl Heneghan said that the mask doctrine came into place even as the deputy chief medical officer admitted there was no strong evidence they would help with the disease. This was despite the social and psychological damage masking pupils would cause, he said. He pointed out that with drug interventions, high quality testing was required before they were implemented.
…He said: “Wearing masks can interfere with social wellbeing. We clearly understand with drugs the need to do proper research on the benefits against the harms before we use them.
This is a huge intervention to impose on society with many unknowns and potentially damaging consequences, but we are not doing the research to justify it.”
The main test used to diagnose coronavirus is so sensitive it could be picking up fragments of dead virus from old infections, scientists say.
Most people are infectious only for about a week, but could test positive weeks afterwards.
Researchers say this could be leading to an over-estimate of the current scale of the pandemic.
But some experts say it is uncertain how a reliable test can be produced that doesn’t risk missing cases.
Prof Carl Heneghan, one of the study’s authors, said instead of giving a “yes/no” result based on whether any virus is detected, tests should have a cut-off point so that very small amounts of virus do not trigger a positive result.
He believes the detection of traces of old virus could partly explain why the number of cases is rising while hospital admissions remain stable.
Britain is not entering a second wave of coronavirus infections and rising numbers of cases are a result of increased, more accurate testing picking up infections among younger people, experts say.
Professor Carl Heneghan, a medicine expert at the University of Oxford, said: ‘There is currently no second wave. What we are seeing is a sharp rise in the number of healthy people who are carrying the virus, but exhibiting no symptoms. Almost all of them are young. They are being spotted because – finally – a comprehensive system of national test and trace is in place.’
CORONAVIRUS is not as deadly as was thought and the public fear that is stopping the country returning to normal is unfounded, a leading expert says. Carl Heneghan, Professor of Evidence-based medicine at Oxford University, called for the government to intervene and “proactively reassure the population”.
He said exaggerated fears of Covid have led to “people going about their daily lives misunderstanding and overestimating their risk”.
And he said introducing local lockdowns could do more harm than good by forcing people into their homes, potentially infecting other vulnerable people that live with them.
Professor Heneghan – whose work led to a lowering of the official death toll after he revealed Covid deaths were being counted even if someone had subsequently died of other causes – spoke as he released new data revealing the infection fatality rate had fallen from 2-3 per cent in the height of the pandemic to 0.3.
A front line medic says there is no reason to fear a second wave of because the virus was “getting less angry”.
Dr Ron Daniels, an intensive care consultant at Good Hope Hospital in Sutton Coldfield, says Covid-19 is not now as deadly as at the start of the pandemic.
Dr Daniels said talk of a second wave was “hype” and told BirminghamLive : “I don’t want to sound like Donald Trump – but if you test more people, you will find more cases.”
CORONAVIRUS hospital admissions were over-counted at the peak of the pandemic as recovered patients returning to wards without Covid were included in the stats.
An investigation for the Government’s Science Advisory Group for Emergencies (Sage) found that people were being counted as ‘Covid hospital admissions’ if they had EVER had the virus.
Government figures show that, at the peak of the pandemic in early April, nearly 20,000 people a week were being admitted to hospital with coronavirus – but the true figure is now unknown because of the problem with over-counting.
This over-counting mirrors the problems with data for coronavirus deaths – where people who had died of other causes were being included in Covid-19 statistics if they had once tested positive.
Professor Graham Medley, of the London School of Hygiene and Tropical Medicine, asked by Sage to look into the situation, told The Telegraph: “By June, it was becoming clear that people were being admitted to hospital for non-Covid reasons who had tested positive many weeks before.
“Consequently, the NHS revised its situation report to accommodate this.”
- A review will examine reports that officials were “over-exaggerating” the number of deaths from coronavirus.
- On July 17, the Health Secretary asked PHE to urgently investigate the way daily death statistics had been reported, leading PHE to say it was “pausing” the daily release.
- Under the previous system, anyone who has ever tested positive for the virus in England was automatically counted as a coronavirus death when they died, even if the death was from a car accident.
- Weekly rather than daily counts could help improve accuracy for future death counts, but could also make it harder to draw comparisons in the event of a second wave of the virus.
- Prof Carl Heneghan, director at Oxford’s Centre for Evidence-Based Medicine, has called for a cut-off period for the way the death toll is calculated in England of 21 days.
- Chris Whitty, the chief medical officer, reportedly holds the view that excess deaths are the best measure to use, which will be unaffected by the PHE review.
- Public Health England was miscounting coronavirus death, official review found.
- Could see up to 4,000 deaths removed from England’s official toll of 41,749, or 10 per cent.
- Ministers count victims as anyone who died after ever testing positive for Covid-19 — even if they were hit by a bus after beating the disease months later.
- The statistical flaw was uncovered by Oxford University’s Professor Carl Heneghan and Dr Yoon Loke, from the University of East Anglia.
- The Office for National Statistics, another Government agency, also records Covid-19 deaths, and is considered the most reliable source.
- The ONS — which is not affected by the counting method — has confirmed at least 51,596 people have died in England and Wales up to July 24.
- Around 58 Brits are now succumbing to the life-threatening infection each day, on average.
- The deaths data does not represent how many Covid-19 patients died within the last 24 hours — it is only how many fatalities have been reported and registered with the authorities.
- Department of Health bosses say 820 Britons are now being struck down with the life-threatening virus every day, on average. The rate has been rising since dropping to a four-month low of 546 on July 8.
- The number of patients being admitted to hospital has yet to spike, bolstering claims from top scientists that the outbreak is not getting worse and cases are only rising because more patients are being tested.
- Just 109 coronavirus patients were admitted for NHS care across the UK on August 2 — a figure which has barely changed throughout July. During the darkest days of Britain’s crisis in April, around 3,500 patients were needing hospital treatment every day.
Imposing a widespread regional lockdown in the north west was a ‘rash’ decision which is not backed up by the data, an Oxford professor has claimed.
People in Greater Manchester, east Lancashire and parts of West Yorkshire were banned from meeting different households indoors, in a move that Matt Hancock, the health secretary said was ‘absolutely necessary.’
But Professor Carl Henegehan, director of the Centre for Evidence-Based Medicine at Oxford said the figures were skewed by delayed test results and when plotted by the date the test was taken showed no overall alarming rise.
“The northern lockdown was a rash decision,” he said. “Where’s the rise? By date of test through July there’s no change if you factor in all the increased testing that’s going on.
This recent crop of trials added 9,112 participants to the total randomised denominator of 13,259 and showed that masks alone have no significant effect in interrupting the spread of ILI or influenza in the general population, nor in healthcare workers.
The small number of trials and lateness in the pandemic cycle is unlikely to give us reasonably clear answers and guide decision-makers. This abandonment of the scientific modus operandi and lack of foresight has left the field wide open for the play of opinions, radical views and political influence.
2:55 – Masks
• Tom Jefferson: “Aside from people who are exposed on the frontlines, there is no evidence that masks make any difference, but what’s even more extraordinary is the uncertainty: we don’t know if these things make any difference…. We should have done randomised control trials in February, March and April but not anymore because viral circulation is low and we will need huge number of enrolees to show whether there was any difference”.
• Carl Heneghan: “By all means people can wear masks but they can’t say it’s an evidence-based decision… there is a real separation between an evidence-based decision and the opaque term that ‘we are being led by the science’, which isn’t the evidence”.
9:26 – Pandemic life cycle
• CH: “One of the keys of the infection is to look at who’s been infected, which shows a crucial difference when comparing the pandemic theory to seasonal theory. In a pandemic you’d expect to see young people disproportionately affected, but in the UK we’ve only had six child deaths, which is far less than we’d normally see in a pandemic. The high number of deaths with over-75s fits with the seasonal theory”.
14:00 – Covid seasonality
• CH: “The stability of the virus is far less when the temperature goes up but humidity seems to be particularly important. The lower the humidity, the more stable the virus is in the atmosphere and on surfaces… It’s now winter in the southern hemisphere, which is why places like Australia are suddenly having outbreaks.”
20:37 – Lockdown
• CH: “Many people said that we should have locked down earlier, but 50% of care homes developed outbreaks during the lockdown period so there are issues within the transmission of this virus that are not clear… Lockdown is a blunt tool and there needs to be intelligent conversations about what mitigation strategies can keep society functioning while we keep the most vulnerable shielded”.
25:20 – Nightingale hospitals
• CH: “They are the wrong structure. What you need is fever hospitals which were here until around the 1980s or 90s. They were on single floors and had isolation within isolation. Theere were no lift shafts and staff were trained, which meant that everyone was protected from each other… It looks like at leats 20% of people got the infection while they were in hospital”
27:30 – Suppression strategy
• CH: “The benefits of the current strategy are outweighed by the harms…When it comes to suppression, only the virus will have a determination in that. If you follow the New Zealand policy of suppressing it to zero and locking down the country forever, then you’re going to have a problem… This virus is so out there now, I cannot see a strategy that makes suppression the viable option. The strategy right now should be how we learn to live with this virus”
32:45 – Response to the virus
• TJ: “I am a survivor of four pandemics and for the other three, I didn’t even realise they were going on. People died but nothing changed and none of the fabric of society was eroded like this response… Do I see steps being taken at a European level about learning from our mistakes and changing policies? The answer is no…
39:30 – Politics of the virus
• CH: “We as individuals are part of the problem because sensationalism drives people to click and read the information. So it’s a big circle because we’ve created the problem — if we put the worst case scenario out there, we will go and have a look. If you want a solution, you’ve got to get people to stop clicking on this sensationalist stuff”.
43:30 – IFR
• CH: “We will be down about where we were with the swine flu: around 0.1-0.3% which is much lower than what we think because at the moment we are seeing the case fatality”.
• TJ: “If you look at the whole narrative, it was distorted from the very beginning by the obsession with influenza which was just one or two agents and nothing else existed. We’re no different now”.
• There was “massive confusion” about different Covid data between England’s health bodies. “Public Health England figures are about double the ONS figures because PHE are reporting anybody who has had a positive Covid death in the past… This will get increasingly confusing as we go into the next Winter because there could be a new outbreak and new deaths while also still reporting on historical deaths… This is a problem for epidemiologists and media… ”
• Even a “28 period cut-off is still not ideal for accurate death numbers because there is “immediate cause and underlying cause… Immediate cause means you’ve had Covid within 21 days but outside of that, it becomes the underlying cause — something that contributed to your death but wasn’t a direct cause. A 21 day cut-off would be helpful because it gives a clearer understanding of that distinction”
• “We follow excess deaths which is the most accurate information about what’s going on at that moment, but it can’t tell you what those deaths are caused by” (i.e. people not coming forward with heart attacks etc)
• “There’s an important distinction between lives lost and life years lost. One of the things we’ll be watching very closely over the next six months is how many people would have actually died in the next six months… That’s where the excess deaths really matter. If we start to see it trend significantly under for the next few months, we’ll start to come forward with information that suggests there was a group of vulnerable people that any respiratory infection would have shortened their life.”
• “In the media you’ll always hear about catastrophe and the consequences of that. One of the things we notice is that when you don’t hear anything that usually means there’s good news happening. So when Sweden looks worse you hear about it but when it’s not so bad, like now, you never see it in the media.”
Writing for the Telegraph, Professors Carl Heneghan and Tom Jefferson, from the University of Oxford, said there is little evidence to support the restriction and called for an end to the “formalised rules”.
The University of Dundee also said there was no indication that distancing at two metres is safer than one metre.
It is remarkable how many deaths during this pandemic have occurred in care homes. According to the Office for National Statistics, nearly 50,000 care home deaths were registered in the 11 weeks up to 22 May in England and Wales — 25,000 more than you would expect at this time of the year. Two out of five care homes in England have had a coronavirus outbreak; in the north-east, it’s half.
Not all these deaths, however, have been attributed to Covid-19. Even when death certificates do mention it, it is not always clear that it is the disease that was the ultimate cause of death. The data refers to people who died with Covid-19 present in their bodies, whether or not it was the direct cause. This raises questions about whether there’s another reason for many of these deaths which has gone largely unnoticed while attention has been focused on Covid-19. This is not just a British phenomenon, but one seen across Europe.