‘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.
We get to grips with the unintended consequences of lockdown on the NHS & the health of the nation.
Martin Daubney interviews Ex-director of the WHO Cancer Programme Professor Karol Sikora. Consultant Neurologist and MS specialist Dr Waqar Rashid Dr Ellie Cannon NHS GP and Mail on Sunday Columnist Dr Tom Jefferson Clinical Epidomilogist- University of Oxford’s Centre for Evidence-Based Medicine Dr John Lee Former Clinical Professor of Pathology at Hull York Medical School and Consultant Histopathologist at Rotherham General Hospital & Director of Cancer Services at Rotherham NHS Foundation Trust.
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”.
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.
British epidemiologist Tom Jefferson tells the BMJ, “The sample [evidence from China] is small, and more data will become available. Also, it’s not clear exactly how these cases were identified. But let’s just say they are generalisable. And even if they are 10% out, then this suggests the virus is everywhere. If—and I stress, if—the results are representative, then we have to ask, ‘What the hell are we locking down for?”
Tom Jefferson, is an epidemiologist at the Cochrane Acute Respiratory Infections (ARI) Group and writes for thebmjopinion.
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