Day: 8 January 2021

A Defence of Lockdown Sceptics

What follows is a guest post by Toby.

I was disappointed to read the Spectator article by Lockdown Sceptics contributor Alistair Haimes about his departure from our ranks. The brilliant data analyst has been a valuable ally and I hope he will return to the fold in due course. 

His argument boils down to this: “When the facts change, I change my mind.” But what facts have changed? He cites three. First, the health service is under severe stress and unless we can reduce virus transmission over the next few weeks it’s at serious risk of being overwhelmed. That wasn’t true when the second national lockdown was imposed in November, he says, but it is today. Second, we now have two approved Covid vaccines, with more to follow, so any new restrictions will be short-lived. Third, there is a new variant of SARS-CoV-2 which is around 50% more transmissible than the pre-existing variants.

I’ll take each of these in turn – although I may digress a bit.

First, I’m sceptical of the claim that we have X number of days to save the NHS – a familiar trope that I thought the Labour Party had flogged to death. Let’s not forget that a winter bed crisis in the NHS is an annual event, as you can see from this collection of Guardian headlines. According to PHE, there was no statistically significant excess all-cause mortality in England in the final week of 2020 and while excess winter deaths this season are above the five-year average, they are currently below the peaks reached in 2016/17 and 2017/18. We published a piece on Wednesday in Lockdown Sceptics by Dr Clare Craig on Emergency Department Syndromic Indicators that looked at various indexes of ill-health, such as hospital admissions for Acute Respiratory Infection, Influenza-like illness and Pneumonia, and those are all below the baseline for an English winter – or were until a week ago. These data suggest that some of the people currently in English hospitals with COVID-19 have either been misdiagnosed or would have been hospitalised with something else if they hadn’t been laid low with Covid. In some NHS regions, Critical care bed occupancy numbers are currently above what they were in December 2019 – an unusually mild flu season – but there was still some headroom on December 27th, as you can see from this bar chart.

But let’s allow that things have got worse by an order of magnitude in the past week or so and some NHS trusts really are on the cusp of being overwhelmed, which they may well be. (See today’s report from the senior doctor.) Will the lockdown Boris announced on Monday do anything to avert this catastrophe, as Alistair seems to think? The only difference between the new national lockdown and the Tier 4 restrictions that were already in place in 80% of England on January 1^st is that restaurants and pubs can no longer serve alcohol to take away and schools will be closed. But schools had already closed when London went into Tier 4 on December 20^th and there isn’t much evidence that those restrictions reduced the R number in the capital. As SAGE member Professor Andrew Hayward pointed out on Tuesday, nearly 10 million key workers are still travelling to and from work. In addition, people are still going to supermarkets, chemists and corner shops. The statistician William M. Briggs, co-author of The Price of Panic, argues that it’s misleading to think of lockdowns as quarantines. Rather, they just create a number of ‘concentration points’, herding people into a limited number of spaces, and in that way increase the rate of transmission. If masks worked this mobility might not matter, but the recent mask study in Denmark suggests they don’t.

Some lockdown enthusiasts pick out a handful of examples where lockdowns have coincided with a fall in Covid deaths but that’s not a scientific approach. Numerous research studies, published in reputable, peer-reviewed journals, have concluded that there’s no association between Covid mortality and the standard suite of non-pharmacuetical interventions, such as mandating masks in indoor settings, closing schools and universities, shutting non-essential shops, imposing curfews and banning domestic travel. You can adjust the lockdown variables all you like – timing, severity, etc. – but there’s no signal in the noise. The American Institute for Economic Research has collected some of the best of these studies here and we’ve created a compendium of the evidence that non-pharmaceutical interventions don’t work at Lockdown Sceptics. The epidemiological models that SAGE uses to persuade the Government to ratchet up the restrictions rely on counterfactuals – if you don’t do y, x number of people will die – that cannot be falsified because the Government always end up doing SAGE’s bidding, as Alistair Haimes has pointed out.

On the other hand, it is incontestable that lockdowns cause harm. Lockdown sceptics are sometimes accused of putting profit before people, but I’m not just talking about economic harm – increased borrowing, businesses going bankrupt, growing unemployment. The negative impact of school closures on children has been flagged up by numerous educational organisations, including Ofsted, with the most disadvantaged paying the highest price. The Centre for Mental Health estimated in October that that up to 10 million people will need either new or additional mental health support, thanks to the trauma of enforced isolation, and reports of domestic abuse to the Metropolitan Police increased by 11% during the first lockdown compared to the same period last year. Drug overdoses in San Francisco killed more than three times the number of people last year than COVID-19. 

It’s also nonsense to imagine the economic damage caused by the lockdowns won’t have ruinous public health consequences – anything that hurts profits, hurts people. Professor Sunetra Gupta estimates that the global economic recession caused by the lockdowns will result in 130 million people starving to death and the United Nations predicts it will plunge as many as 420 million residents of the developing world into extreme poverty, with low-income countries seeing average incomes falling for the first time in 60 years. 

Even in the absence of the detailed cost-benefit analysis the Covid Recovery Group of MPs has repeatedly asked for, it seems overwhelmingly likely that the harms caused by lockdowns in the UK alone are greater than the harms they prevent. According to one study out of Bristol University, the ongoing restrictions will cause 560,000 deaths, 310,000 more than Professor Neil Ferguson and his team predicted would die absent a lockdown but with voluntary ‘mitigation’ measures in place. As the now disgraced President of the United States said, the cure is worse than the disease. That essential point hasn’t changed, so I see no reason why sceptics should change their minds about lockdowns now. Yes, the NHS may be in genuine peril, but that doesn’t mean we should set aside our well-founded doubts about the effectiveness of heavy-handed interventions. On the contrary, trying to quarantine people for a third time, given that the policy clearly hasn’t worked, seems like Einstein’s definition of insanity: doing the same thing over and over and expecting different results.

What about the vaccines? True, some sceptics did argue that shutting people in their homes until a vaccine became available was impractical because it might take years to develop one. But that was never the central plank of our case (see above). On the contrary, our preferred alternative to locking down is ‘focused protection’, as set out in the Great Barrington Declaration, and vaccines make that strategy more attractive, not less.

Our starting point is that the number of people who died from COVID-19 in English hospitals in 2020 who were under 60 with no underlying health conditions was 388 and the virus is less deadly than seasonal flu for healthy people under 70. Note, we’re not claiming that SARS-CoV-2 is less deadly than the average bout of seasonal flu for the entire population – although that’s true of some flu seasons – only that it’s likely to kill fewer healthy people under-70, including children. Whenever we cite that 388 statistic, critics accuse us of being callous, as though we’re saying older people and those with chronic conditions don’t matter. Far from it. We think the Government should pull out all the stops to protect those who are vulnerable to this disease, including care home residents, who made up about 40% of those who died from COVID-19 in the first wave (and 50% of those who died in Scotland). Shielding for people in these groups should not be compulsory – we believe in trusting people to make their own risk assessments and adjust their behaviour accordingly. But it should be a viable option, with all the necessary support. Meanwhile, the rest of us should be permitted to go about our lives, taking the same precautions we would in a normal flu season.

The arguments for and against ‘focused protection’ have been well-rehearsed, but the vaccines deal with one of the best objections – that it would be inhumane to expect the vulnerable to shut themselves away until the rest of the population develops natural herd immunity. That would create a two-tier society. But now that we have a vaccine, those groups only need shield until they’ve been immunised, at which point they can re-enter society (something they can’t do at present, even after they’ve had the jab, because there’s no ‘society’ to re-enter). The Government is planning to vaccinate 13.9 million people by mid-February – although that number includes everyone who works in health and social care settings – and there are about 16 million who fall into the above vulnerable categories.

So, yes, the vaccines do make a difference – they strengthen the sceptics’ case by making ‘focused protection’ more palatable.

What about the new variant? I’m reserving judgment on whether it’s more transmissible. As Mike Hearn pointed out yesterday, ONS infection survey data released on December 23rd show that the percentage of the UK population testing positive for the new variant began to fall in November before taking off again, and in some areas it has already started to dip, as was clear from the plot presented by Chris Whitty on Tuesday. If it’s 50% more transmissible than pre-existing variants, why isn’t the percentage just constantly rising in all parts of England? 

But suppose the new variant is more infectious. What evidence is there that the new lockdown measures will interrupt transmission? If the first two lockdowns didn’t stop the original virus in its tracks, why will a third stop a turbo-charged version? 

I sympathise with Alistair Haimes. He believes the NHS is at risk of falling over and wants us to do something – anything – to protect it. Lockdown sceptics also don’t want to see the NHS fall over, but where I part company with Alistair is in believing that a third national lockdown is the right mitigation strategy. Wouldn’t it be better to offer robust protection to the vulnerable and make vaccinating them an absolute priority? Not only would that be more likely to ‘save the NHS’, it would save the rest of us from the harms caused by yet another lockdown. ‘Focused protection’ is sometimes dismissed as not scientifically credible, but the 700,000+ signatories of the Great Barrington Declaration include over 13,000 medical and public health scientists and nearly 40,000 medical practitioners.

Alistair thinks this lockdown is more palatable than the others because there’s light at the end of the tunnel, thanks to the vaccine. Within 100 days, he estimates, it can be dismantled, hopefully never to be seen again. I wish I shared his optimism. At Tuesday’s Downing Street briefing, Chris Whitty said restrictions might well be back next winter and some people have called for masks to remain mandatory indefinitely. 

The problem with allowing the state to suspend your civil liberties is that you may never get them back. I treat the Government’s claims that it will relinquish the powers it has arrogated to itself when the crisis is over with extreme scepticism, just as I do every official announcement about the virus. 

One final point. Over the past week or so, some of the most prominent lockdown sceptics have been vilified in the media, accused of encouraging members of the public to ignore social distancing guidelines and thereby causing people to die. These attacks may ratchet up over the next few days as the NHS comes under more and more pressure, although it’s hard to imagine them becoming even more hysterical. Paul Mason wrote a column in the New Statesman on Wednesday saying that Allison Pearson, Laurence Fox, Julia Hartley-Brewer, Peter Hitchens and me should be consigned to the seventh circle of hell. But the assumption underlying these criticisms is that lockdowns work, which is precisely the point under dispute. Is it reasonable to expect us to just take that on faith and keep any doubts we have to ourselves? After all, we don’t ask the Paul Masons of this world to take it on faith that lockdowns cause more harm than good and accuse them of killing people by advocating for tougher restrictions. We think history will prove us right, but we’re not so full of righteous certitude that we want to silence our opponents. 

One of the most unpleasant aspects of this crisis is that it has brought out an ugly, authoritarian streak in so many people, particularly those in positions of authority. Before March of last year, I believed that totalitarianism could never take root in British soil because we are such a Rabelaisian, freedom-loving people, fiercely proud of our independence. Now, I’m not so sure.

Stop Press: Claire Fox defended lockdown sceptics in a House of Lords debate yesterday.

I managed two questions today.

First, I was somewhat a lone voice in the House of Lords opposing 'There Is No Alternative' lockdowns. I pointed out that, historically, sceptical enquiry has often been a driver of progressive change and scientific breakthrough… (1/3) pic.twitter.com/06MC5BRaX9

— Claire Fox (@Fox_Claire) January 7, 2021

London Hospitals Really Are in Crisis

What follows is the regular weekly update by our in-house senior doctor, based on the just-released NHS data. It makes for grim reading this week.

Toby has kindly asked me to have a look at the weekly data packet from the NHS hospital statistics website and draw some observations from what we can see in this information and from other data sources. Clearly it has been a busy week on the Covid front, with the closing of schools and a parliamentary vote on a further National lockdown. The media coverage of the issue becomes ever more shrill and disappointingly antagonistic. The usual caveats apply to the data – we can only see what the Government release and we take what is presented at face value.

The first thing I wish to look at is Covid inpatients in the English regions (Graph 1).

The steep rise of cases within London (the orange line) over the last two weeks is obvious, with increases in the South East, East of England and the Midlands. At the risk of sounding metro-centric, I am going to focus on the figures from the capital because I think London is going to be at a very critical point in the coming days. Since December 15th, cases have been rising remorselessly in London hospitals. Prior to mid-December, the numbers of patients did not look out of the normal range for the time of year, but they are well in excess of normal now. I commented last week that London hospitals were in for an extremely uncomfortable time over the next two to three weeks – that now looks like an understatement.

It is not entirely clear what has triggered the rise in cases, but applying Occam’s razor it is probable that the new more transmissible strain is responsible for the rapid increase. There is certainly something radically different between the beginning of December and the end of the month. In one major London hospital, the new variant accounted for 15% of cases admitted at the beginning of December. This week it accounted for 90% of cases. Graph 2 shows the Covid inpatients in London hospitals (orange bars) compared to the spring (blue bars). London hospitals now have substantially more Covid patients than at the spring peak and the trend is still upwards. (I’ve updated the figures below to Jan 5th, but wasn’t able to change the legend.)

Graph 3 shows the number of Covid patients in ICU in the English regions complete to January 7th. Again, the rise in cases in London is much faster than in the other regions and, with 961 cases as of January 7th, this is fast approaching the ICU spring peak with no sign of levelling off. This is an important graph because these are the sickest patients and use up a large number of resources. Further, ICU patients require the attention of the resource that is in critically short supply – intensive care trained nurses. I will return to this point later. Interestingly, the ICNARC data (intensive care audit) to December 31st shows that patients admitted since September 1st still have a survival advantage compared to the cohort to August 31st, but that this advantage has narrowed compared to earlier in 2020. There are multiple possible reasons for this – one of which is that as the volume of patients increases, the level of care may drop, particularly if nursing:patient ratios rise. The normal nursing ratio in ICU is one nurse per patient. This is now stretched to one to two in most hospitals and to as many as one to four in some places, which is really hard to sustain for long periods.

Graph 4 shows the comparison in London between the ICU occupancy in spring (blue) and in winter (orange) showing numbers in ICU approaching the spring peak and again the trend is still rising. (I’ve updated the figures below to Jan 5th, but wasn’t able to change the legend.)

Graph 5 shows the number of Covid positive patients admitted from the community every day. There is just a suggestion that the London admissions may be starting to level off, but there is still a significant upward trend which is higher than all the other regions.

So far the numbers look worrying. Is there any good news this week?

Possibly, from the ZOE app. For those that don’t know, this is a symptom tracker app run by Professor Tim Spector from King’s College Hospital. The data is uploaded by members of the public who have either tested positive for Covid or who have symptoms. Some people think it is a more reliable measure of the level of community infections than the officially released PCR test numbers – it has certainly proved useful so far in the pandemic. Graph 6 shows the data for London to December 31st. A rapid rise from mid-December followed by a slight tailing off, but the numbers remain much higher than in the earlier part of December, suggesting that there are substantial numbers of patients in the community who will present to London hospitals with symptoms in the coming days.

Analysing numbers can only get one so far. Talking to people on the ground is also necessary to get a better idea of what is going on. I have referred to the differences between the winter and the spring in previous posts – the critical problem now is staff absence due to illness or positive contacts. This can make interpretation of bed occupancy levels in comparison to previous years a bit misleading. For example, there has been a massive expansion of ICU beds in all hospitals and especially in London since the spring, but if there are not enough nurses to service those beds, they are of limited use. So even if bed occupancy on at 85%, a hospital may be at capacity because it can only staff 85% of the available beds. A few weeks ago, when we had sufficient nurses to staff the beds, bed occupancy rates were comparable with previous years. Now the nursing resource is so stretched, I’m not sure how much comfort we can take from those comparisons.

In previous posts I have noted the reduction in ward beds due to increased spacing requirements and the organisational friction caused by patient cohorting and constant use of fatiguing PPE. What is less measurable but more important is staff morale. Morale is difficult to quantify. It’s a bit like an elephant – hard to describe, but you know it when you see it. Low morale leads to increased absence with illness and stress. At a time of crisis, medical and nursing staff are often required to go the extra mile and encouraging a demoralised and tired workforce to do that is phenomenally difficult and subject to the law of diminishing returns. You get a harder ‘squeeze for juice’ ratio, until eventually there is no juice left. In that sense, the situation is worse than the spring when morale was very high. The responsibility for this rests squarely with senior NHS management for failing to prepare, train and rest critical workers for an anticipated winter surge which was a predictable and indeed predicted risk.

Further signs of stress in the system have become evident this week. Most London hospitals have now ceased all routine activity and several have ceased urgent work as well, particularly in the SE and NE sectors which are the most stressed. Graph 7 shows paired data for selected London trusts. This graphic can be a bit tricky to read, but one can see that Barts and Guys and St Thomas’s have had rapid rises in ICU patients to spring levels in the last week because they are increasing their bed numbers to offload peripheral hospitals. Their feeder hospitals of Lewisham and Barking are at capacity, the same as in the spring. There is still some spare capacity in the West of London at Imperial and St George’s, but numbers are rising there too.

Problems have arisen with oxygen supply at some hospitals – this is not due to lack of oxygen per se, but an engineering problem with the pipe pressure. Non-invasive ventilation with CPAP which most patients require needs a lot of oxygen and the requirement is more than the pipework can supply in some places. Some hospitals are unable to operate on surgical patients because all the operating theatres have been converted into temporary ICUs. Paediatric ICUs now have adult patients in them. Some outpatient facilities are being converted into temporary acute wards. Staff are being re-allocated from normal duties to support critical care and acute Covid wards. All these observations are as useful an indication of the stress in the system as the raw numbers.

So, what does all this mean?

Earlier this week, NHS England issued an Alert Level 5 – the definition of which is that there is a material risk of the NHS being overwhelmed and unable to cope with demand in several areas in the following 21 days.

Since September, NHSE has regularly been issuing exaggerated and hyperbolic statements about the risk of the service being overwhelmed that were not supported by the published data or the ‘ground truth’ – this has diminished trust and confidence with the public.

Unfortunately, they are not exaggerating now. The situation in London is the most serious I have seen in over 30 years as a doctor and it will probably get worse before it gets better. The deterioration in the last week has been incredibly fast and has taken people by surprise. The service is incredibly resilient but it is a finite resource and can be exceeded by demand in extreme circumstances.

The final question of course is will lockdown make any difference? I’m not convinced of the efficacy of lockdowns from experiences in 2020. It’s likely that community cases were already falling before the spring lockdown started. The multiple harms of lockdown have been well documented and many of these such as delayed treatment for cancer or heart disease will not become apparent for many months or years. On the other hand, faced with the current situation, there is literally no other intervention available. The current lockdown on this occasion fits the WHO definition of an intervention of last resort, which was not the case in the autumn. If the Prime Minister did not act, he would be subject to serious criticism should the London NHS be unable to cope in the coming weeks. Of course, that might happen anyway, but the Government have to be seen to act – so I don’t think there was any choice politically. Whether lockdown makes any practical difference to the number of cases presenting to hospital will not be known for several weeks and probably be the subject of intense debate.

The observation that the new variant was spreading rapidly even during the severe restrictions in December is worrying and suggests that there may be an ‘illusion of control’. One must hope that the ZOE app proves to be correct again and that cases have actually been falling in the community since the end of December. But even if that is true, hospital admissions will continue to rise at least for the next few days.

Eventually, we will get to the other side of this problem, but it will be a bumpy ride for the next few weeks with many difficult decisions to be taken.

Hancock: Freedom Will Be Restored Once Vulnerable Are Vaccinated

Health Secretary Matt Hancock has ruled out a “zero Covid” strategy and said restrictions will be lifted as soon as the vaccination of the vulnerable makes Covid a “manageable risk” – a target pencilled in for mid-February. Fraser Nelson and James Forsyth interviewed him for the Spectator.

It’s not yet clear what counts as a win in the game of Vaccine Monopoly. Hancock rules out eradication. “It is impossible for any country to deliver a zero-Covid strategy. No country in the world has delivered that, including the ones that have aimed at it,” he says. “Covid is going to be here, but it is going to be a manageable risk.” His focus is on fatalities and, he says, abolishing restrictions as soon as it is feasible.

When Covid hospital cases fall and pressure on the NHS is lifted, he says, “That is the point at which we can look to lift the restrictions.” So what about herd immunity, vaccinating so many people that the virus dies out? “The goal is not to ensure that we vaccinate the whole population before that point, it is to vaccinate those who are vulnerable. Then that’s the moment at which we can carefully start to lift the restrictions.” But at that point the majority would remain unprotected. Would he – as Health Secretary – still say it’s time to abolish the restrictions? “Cry freedom,” he replies. “Covid is going to be here, but it is going to be a manageable risk.”

Freedom, we say, is not a word that many would associate with him. People associate him with lockdown. “No,” he replies, “they associate me with the vaccine.” Do they really? “Yes.” Even when the rules go, Hancock thinks that some changes to behaviour will remain. “The social norm may well become wearing a mask on public transport, for instance, in the same way that after SARS the social norm in many Asian countries became to wear masks in public. Essentially out of politeness.” But he stresses that these decisions will be a matter of “personal responsibility”, not government diktat. Nor does he see immunisation certificates being brought in. “It’s not an area that we’re looking at.”

It’s clear he’s a true believer in the Ferguson-Imperial modelling complete with its dubious assumptions of no pre-existing immunity, high death rate, and lockdowns saving lives.

The moment he most looks forward to? “When I have the duty to declare that the Coronavirus Act is no longer required, upon medical advice. That will be a great moment: when we repeal these draconian laws.” He says he’s mindful of the side effects: people dying who would otherwise have been treated by the NHS. The economic devastation and business closures. But without lockdown, he says, both the Covid deaths and the side effects would be far greater. “I think that’s one of the things we’ve learned all the way through this. The public have totally got that: I mean, they are more strongly supportive of lockdown now than they were at the start.”

Politically, he feels events have justified the decisions he made. “I hope that one of the consequences of this crisis is that it emboldens politicians to do the right thing even if it isn’t the immediately popular thing. Because that is what earns you respect.”

That’s what we’re worried about, Matt: politicians emboldened to impose lockdowns every winter regardless of the cries of protest.

Worth reading in full.

Vaccination Priority List Ignored As NHS Administrators Use Up Expiring Stock

A reader has emailed with an anecdote about how the vaccine priority list is getting skewed by who happens to be available at the time.

My wife logged on to her village club meeting this week, now on Zoom of course. One of the regulars, who lives across the road from us, announced to general incredulity that she has had two Pfizer jabs already. What? She’s about 60 and works as a part-time NHS administrator in a department in a Midlands hospital – and she’s been working from home throughout! How can this be? It transpires that since the Pfizer jabs have to be used up in double-quick time, the hospital staff are bombarded with emails to come and make the most of the day’s slack because the oldsters can’t be wheeled in fast enough. Needless to say, the frontline staff are too busy in an “I-haven’t-got-time-to-check-my-emails-or-be-vaccinated” sort of way, so they are frequently being missed out. How much more of this has been going on? Since their biggest beef is the risks they are taking, why aren’t they being frog-marched down to be vaccinated with the leftovers? Still, I suppose at least it means the NHS can make sure its pen-pushers keep the outfit going.

Another reader tells us that at a hospital where a friend works, “all staff were contacted yesterday to come and get vaccinated as their stock of the Pfizer vaccine was about to expire”.

This is a known problem. Yesterday the Telegraph reported on the concerns of the BMA.

The BMA criticised the way hospitals are distributing jabs – especially doses left over at the end of the day – amid concern that frontline staff have been losing out to administrative workers. It follows fears that some hospitals are inviting any staff, including non-clinicians, to use up doses after vaccine clinics close rather than prioritising those in patient-facing roles.

Under rules set by the joint committee on vaccination and immunisation, frontline healthcare workers come in the second category of priority, behind care home residents and staff, but a number of trusts have allowed staff from all groups to come forward when stocks are at risk of going unused.

Dr Simon Walsh, the Deputy Chairman of the BMA Consultants Committee, said hospitals should ensure that the highest-risk staff come first.

“The BMA is very concerned about why, when there was quite a long run-up, the Government has not ensured that the NHS delivers the vaccine in a way that prioritises healthcare staff most at risk from Covid,” he said. “It would seem obvious that you should use systems the trusts already have to see which staff are at the highest risk – by virtue of their role, or age, for example – and prioritise them.

“We are astonished that this is not in place. The problem with calling anyone for a jab is that those most in need are those least likely to be able drop everything to come and get one.”

One unmentioned problem might be a reticence among healthcare professionals to get the experimental vaccine.

What Does Endemic Covid Look Like?

We’re publishing a new piece today by Dr Clare Craig, Jonathan Engler and Joel Smalley that explains what is going on this winter and how it relates to the pandemic in the spring.

Viruses do not disappear. When a novel virus is introduced to a naive population there will be an epidemic. Spread will be exponential, some susceptible people will die but eventually we will reach a point where there is sufficient population immunity that spread is slowed and the virus stops spreading in an epidemic fashion. Thereafter, localised outbreaks can still occur and susceptible people can still die but there is no longer a risk of epidemic spread because every outbreak is contained by population immunity.

Coronaviruses are seasonal, so it is only now that we have had some winter weather that we can assess what endemic Covid will be like.

Figure 1 shows the sharp spike in excess deaths seen with epidemic Covid in spring. These deaths were in excess of the usual winter hump. Compared with previous years, this year’s winter excess deaths started earlier but the shape of the curve is consistent with previous years. However, we have now reached the bizarre situation where so many deaths are being labelled as caused by Covid that, for the first time ever, this winter there are fewer non-Covid deaths in winter weeks than there were in summer.

They look at what might be causing the current pressures on the NHS.

Normally, hospitals work very close to or at capacity in winter. The only way this can be sustained is by a carefully choreographed flow of patients from admission to the wards and then back out. This flow has broken:

1. Bed managers, who organise the flow, used to only be concerned with whether a patient was male or female or needed a side room to avoid spread of other infectious diseases. They now have to try and keep patients with a Covid diagnosis separate from those with a suspicion of Covid and those without. This is no small feat in a full hospital.

2. In some hospitals patients are not being discharged until their Covid test returns as negative. Clearly returning patients to care homes during the window of infectivity would be a bad idea. Beyond that this policy is not justifiable. Some patients continue to test PCR positive for 90 days after infection.

3. PCR testing has led to a staffing crisis as even asymptomatic staff are made to self-isolate for two weeks, with 12% of staff absent when it would normally be 4%.

4. Staff are having to work in PPE and change it between patients, adding a significant additional burden to an already heavy workload.

If patients are no longer moving smoothly from the Emergency Department to the wards, then the former will quickly fill up giving the impression that the hospital has been overwhelmed. It is easy to see how this could cause a backlog of ambulances unable to drop off their patients.

Worth reading in full.

How Sweden Confounds the World

Kathy Gyngell in Conservative Woman has written a handy summary of Ivor Cummins’ latest “Crucial Viral Update” where Cummins shows how despite not locking down Sweden’s death toll from the virus is neither catastrophic nor unexpected.

Taking a look back over the last 10 decades, he shows that Sweden’s COVID-19 outbreak is of a very similar order to many of the flu epidemics that the country has experienced, and is hundreds of times lower than the Spanish flu of 1918 which, unlike Covid, had a median mortality age possibly as low as 40 (certainly less than 60) and included many infants in its grim toll. Which is not the case with Covid, with an average mortality rate of over 80.

Nor, he shows, is Sweden’s mortality rate materially different from ours, a ‘result’ if you want to call it that which has been achieved without crashing the economy or closing schools or putting the population under house arrest. The slight resurgence this autumn that many zealots have gleefully latched on to to say the Swedish model doesn’t work has a different explanation, he explains. Seasons must be compared with like seasons. Winters with winters, summers with summers. A low mortality winter season one year is likely to be followed by higher mortality one the next year. Deaths invariably catch up, for the elderly especially. Sweden had just experienced two “soft” autumn/winter seasons. This late 2020 spike and outcome was inevitable.

Cummins reminds us, too, that at the start of the pandemic the World Health Organisation did not recommend quarantine and that since then 25 published papers have continued to support their initial advice. These studies show that lockdown has no efficacy; and for those zealots who think the reason is because we are not obeying them diligently enough and we should crack down harder, he has this message: comparison of the stringency of lockdown across 50 countries shows that more stringency has no more impact than less draconian lockdowns. That is it makes no more difference than lockdown itself.

Cummins, Kathy writes, suggests the Japanese success story can be put down to the “far higher rate of metabolic health of the Japanese elderly (Vitamin D levels in particular, which by contrast are strikingly low in Italy)” and “prior SARS immunity and the quick accretion of COVID-19 antibodies in the population”. The US, by contrast, is suffering because “good metabolic health is low overall”.

Florida also confounds the lockdowners since early on it followed “the advice of Professor Michael Levitt of Stanford University, a scientist who’s argued that restrictions would have no impacts”. Thus, “the State Governor dropped them all and has proved Professor Levitt quite right. It has had no negative impact on Florida’s mortality at all.”

Cummins draws attention to the latest pre-print study from Stockholm’s Karolinska Institute, which shows “how futile the interventions of countries have been. Each country’s mortality rate could have been predicted before the Covid pandemic and no lockdown could ever have done anything about it.”

Worth reading (and watching) in full.

Stop Press: Photo-Journalist Sean Spencer and Claudia Adela Nye have released the fourth and final trailer for their lockdown film. It’s called “Schools Closures in the UK Again, while Sweden keeps their primary schools open…” and is worth a watch.

The Glitch that Stole Christmas

We’re publishing today a piece by James Ferguson, founding partner of research company MacroStrategy, which looks in-depth at the evidence around the new “super-contagious” Covid variant that was used as the justification for cancelling Christmas.

On December 20^th the UK Government put 44% of the English population into Tier 4 lockdown, cancelling Christmas get-togethers for 24m people, following a recommendation from the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG).

NERVTAG had identified a new variant of the novel coronavirus in the South East of the country, which was 70% more transmissible than its predecessor, carried a viral load up to 10,000x higher and which the primer on the widely used Thermo Fisher TaqPath PCR machines failed to pick up.

However, these conclusions are highly dependent on the interpretation of the data and logically (Occam’s Razor) none of the claims made at that time about the new variant’s increased transmissibility, higher viral load or ability to escape detection appear justified.

This is a thorough examination of the scientific data and evidence and is worth a read.

A Frontline GP Writes…

A GP has written a fantastic post on one of our forums entitled: “Why Lockdown Cannot be the Preferred Response to Coronavirus – The View of a Frontline GP.” He wonders how it is that lockdowns have suddenly become standard policy in response to a virus very similar to the ones that circulate each year.

It is true, that COVID-19 seems to be more transmissible than seasonal flu and, initially, there was no effective vaccine, meaning that peaks of infection and, therefore, peaks in admissions and deaths had the potential to be higher, though it is still not clear why ‘lockdown’ was considered to be the most appropriate response to these factors. Bearing in mind that the main risk factors for a poor outcome from COVID-19 infection can be reasonably easily identified (advancing age, chronic lung conditions, diabetes, obesity to name a few), surely it would make more sense for these people to stay at home with appropriate physical and financial support, whilst the rest of the fit and healthy population live their lives, go about their business and keep the economy afloat. Bearing in mind that a very large proportion of the at-risk group are already beyond retirement age, the removal of the remainder from the standing workforce could be anticipated to have a minimal effect on the overall economy.

Looking at a specific area of society, schools, raises even more questions about the appropriateness of ‘lockdown’. It is widely accepted that children and young adults are extremely unlikely to suffer significant morbidity or mortality from COVID-19 without significant underlying medical conditions, in fact, recent statements by the Chief Medical Officer (CMO) suggest that children are not affected by the new variant of Covid at all – schools are full of children and, on the whole young adult teachers, the parents of these pupils will generally also be young adults – so how can we justify closing all the schools and cancelling all exams? This makes no sense whatsoever.

Whilst we consider the subject of ‘saving lives’, the current ‘lockdown’ response to the COVID-19 threat is entirely at odds with the government’s usual response to circumstances and conditions which are known to cause significant morbidity and mortality amongst the UK population. Data published by the NHS tells us that in 2019, 78,000 deaths and 490,000 hospital admissions were related to smoking, the ONS have published data which identifies alcohol consumption as the cause of 7,500 deaths in 2018 and the Diabetes UK website informs us that diabetes (the major cause of type 2 diabetes in the UK being obesity) treatment uses 10% of the annual NHS budget and is responsible for 24,000 early deaths every year. This being the case, why are the government not banning smoking, excessive alcohol consumption and over-eating? I imagine that to do so would be considered an infringement of human rights and an attack on personal freedom (which it would). This being the case, how can we now justify effective house-arrest for the entire population of the UK with no right of appeal, fines for those who disobey, no right to protest and no clear end-point in sight?

Far from saving lives, it is reasonable to believe that the significant curtailments to ‘normal life’ in the UK is storing up a great deal of trouble for the future. We already know that patients with signs and symptoms of cancer are not presenting to their GP surgeries at anything like the predicted rates, often due to fear of exposure to COVID-19 or the belief that normal GP services are not available – these patients still have cancer and will, eventually, present to the NHS but probably too late to be effectively treated resulting in early and potentially preventable deaths. Poverty is on the increase due to growing unemployment – poverty leads to poorer health and poor health outcomes – in brief, a poorer society is more unhealthy than a rich society, with more chronically unwell citizens and more early deaths – a greater burden on the NHS. Every week I meet patients with known mental health problems who are declining due to lack of contact with their usual social supports, lack of access to mental health services and anxiety caused by scare-mongering reports in the media – eventually these patients will present to mental health services and threaten to overwhelm them due to the sheer number of cases. Every week I meet elderly people who were previously active and independent, now too scared to leave their homes, many of whom will never join mainstream society ever again – these people will need care at home, a further unnecessary burden on their families and the social care budget.

What of the NHS which we are trying to protect? It seems to me that we would not need to be going to the extraordinary lengths discussed above to ‘protect’ our health service, if the health service had been properly managed and properly funded prior to COVID-19 arriving in the UK. Every year whilst I have worked for the NHS, I have received emails in October warning me of upcoming ‘winter-pressures’ and how we must all take care with referrals to hospitals and how services may be negatively impacted in the coming six months. These so-called ‘winter-pressures’ are entirely predictable well in advance, so why do they occur at all? The obvious answer is that the NHS does not, and in recent history has never had, enough clinical capacity to deal with predictable peaks in infection rates. If we recognise this fact, it was obvious that the NHS was always going to struggle with a new virus which blind-sided us as COVID-19 appears to have done. Surely, when designing a health service, we should plan for the peaks and not the troughs, we should build in flexibility, we should stock more of every medicine and piece of equipment than we will need in the next few days. If we had had an NHS which was already equipped to deal with ‘winter-pressures’, we would have been very well placed, strategically, to take COVID-19 in our stride. This may sound like wishful thinking but actually there are a few simple steps which I have been keen to see implemented in the NHS for many years which, I believe, would transform our ability to respond to threats such as that posed by COVID-19.

He offers some ways the NHS could improve its preparedness for pandemics, before going on to consider the use of state scaremongering and the importance of personal freedom.

Worth reading in full.

Call For Evidence on Lockdowns

The deadline for the call for evidence on the Government’s response to the COVID-19 pandemic from the Parliamentary Joint Committee on Human Rights is fast approaching on January 11th. The committee explains:

In order to seek to control the impact of COVID-19, the Government has introduced successive restrictive measures, with varying degrees of severity, both nationally and locally. The impact of these measures has been widely felt, and some groups have been more affected than others.

As part of the ongoing work into the Government’s response to the COVID-19 pandemic, the Joint Committee on Human Rights is examining the impact of lockdown restrictions on human rights and whether those measures only interfere with human rights to the extent that is necessary and proportionate.

More details here.

Question For The Legal Eagles

A reader asks:

If basic care is to be curtailed to promote vaccination programmes, can I sue the GP practice if my elderly mum doesn’t get the care she needs and then goes on to be hospitalised unnecessarily?

Answers to the Lockdown Sceptics email address.

Suggestion For the Researchers

A Lockdown Sceptics reader had a brainwave about how some hard data on the impact of Covid could be gleaned.

Having worked in business intelligence and data analysis for some years, I wanted to draw Lockdown Sceptics’ attention to a potential aspect of Covid analysis which – to my knowledge – I have not seen suggested or discussed elsewhere.

The idea crystallised after having seen Brendan O’Neill, Editor of Spiked, interviewed recently on the New Culture Forum’s YouTube channel (other video sharing platforms are available…) During Mr O’Neill’s very perceptive commentary around the Coronavirus pandemic he made the point that, irrespective of any epidemiological arguments, this has only ever really been “half a lockdown”, cleft largely along legacy social class lines. Although knowledge workers and laptop users, mostly middle-class, have been dutifully locked down at home, substantial sections of the workforce, predominantly working-class, have had to continue to work in the “meat-world” very much as usual: supermarket workers, delivery drivers, water and sewage workers, electricity grid workers, refuse collectors, care and support service providers, transport staff and so on.

In these workers, we have, therefore, a massive statistical sample (n=potential +/- ten million). Since many will be working for large organisations with concomitantly large and efficient HR departments / modern electronic data record systems, it would be entirely possible to collate and examine their data in order to see who developed coronavirus, for what length of time they became ill, and what any medical and health outcomes of all this were. 

Supermarket workers in particular have been in close proximity to the general public day-in day-out throughout the entire duration of the crisis. The chains for which they work are both extensive geographically, and are visited by tens if not hundreds of thousands of people every day. All of these large supermarket chains, for example Tescos, will have staff data showing [1] who their staff are [2] where they are [3] their demographic information and [4] their sickness information. What better way might there be to assess the actual dangers of proximity, transmissibility and severity than to study this data?

Given how flexible and adaptable these organisations have proved themselves to be over the past 10 months – and given the gravity of our current situation – it would surely not be impossible for these data sets to be anonymised and made available for analysis. Rather than relying exclusively on the highly questionable, if not downright inaccurate, ‘predictive models’ used by Imperial College and their ilk, we could perform additional analysis on this real-world operational data. What percentage of staff were falling ill due to the coronavirus? How long did their illnesses last? Were they fatal? How many employees suffered from “long Covid” symptoms?

Few organisations or businesses would rely on predictive analytics alone to draw-up or support their business plans, they would almost always analyse past data in order to show baseline figures and patterns around performance, sales, failure demand, customer numbers, complaints and so on.

It seems that in this case, however, when parts of our very society are hanging by a thread, we are relying solely on predictive analytics, and neglecting almost 10 months of actual, real-world data which might potentially yield some hugely important insights.

Theme Tunes Suggested by Readers

Three today: “Misery and Gin” by Merle Haggard, “No Face, No Name, No Number” by Traffic and “Virus is Over (If You Want It)” by Unknown Rebel.

Love in the Time of Covid

We have created some Lockdown Sceptics Forums, including a dating forum called “Love in a Covid Climate” that has attracted a bit of attention. We have a team of moderators in place to remove spam and deal with the trolls, but sometimes it takes a little while so please bear with us. You have to register to use the Forums as well as post comments below the line, but that should just be a one-time thing. Any problems, email the Lockdown Sceptics webmaster Ian Rons here.

Sharing Stories

Some of you have asked how to link to particular stories on Lockdown Sceptics so you can share it. To do that, click on the headline of a particular story and a link symbol will appear on the right-hand side of the headline. Click on the link and the URL of your page will switch to the URL of that particular story. You can then copy that URL and either email it to your friends or post it on social media. Please do share the stories.

Social Media Accounts

You can follow Lockdown Sceptics on our social media accounts which are updated throughout the day. To follow us on Facebook, click here; to follow us on Twitter, click here; to follow us on Instagram, click here; to follow us on Parler, click here; and to follow us on MeWe, click here.

Woke Gobbledegook

We’ve decided to create a permanent slot down here for woke gobbledegook. Today, Will Knowland in the Spectator describes the Eton kangaroo court that sealed his summary dismissal for transgressing the sacred precepts of wokery.

It was the boys themselves who suggested and named the YouTube channel Knowland Knows, which has since got me summarily dismissed. The axe fell swiftly after I asked why a video entitled “The Patriarchy Paradox” (originally intended as half of a debate on the new gender orthodoxies at the College, which never saw the light of day) should be deleted from this public platform. The reason given was the presence of an Eton disclaimer on the channel, originally added at the College’s own request.

I’ve since been called everything from a free-speech martyr to a misogynist. While the video has received views equivalent to more than 100 times the size of the Eton student body, it was the boys themselves who first came to my defence, with a compelling open letter saying they felt “morally bound not to be bystanders in what appears to be an instance of institutional bullying”. They boldly claimed that “young men and their views are formed in the meeting and conflict of ideas”, and correctly pinpointed free speech as the principle at stake – otherwise why was it so essential the video should come down? My disciplinary process was only the latest in a series of lustrations turning Eton into a monoculture

They had already sensed the need to resist a drastic narrowing of debate in the schoolroom, which has reportedly led them to set up private debating groups to test viewpoints forbidden in class. Their wit seems to have inoculated them against being wholly ventriloquised by the new regime blighting the school. “But sir” – deadpan again – “I thought the College was meant to be diverse?”

The charges kept changing, but in the end it was the college’s “approach to equality and diversity” that was deemed to have been transgressed.

At my hearing, two of the three “senior teachers” specified as disciplinary panellists by the College’s constitution were the headmaster’s new appointments to his inner circle, and the third was his own deputy. The College had lawyers present (at one point attempting to replace a Fellow with an external QC) while I did not. A colleague’s character witness statement was significantly altered, being restored to its original only after she protested in writing. Only in response to pressure did the school provide an external note-taker.

“A lie,” as James Callaghan said, “can be halfway round the world before the truth has got its boots on.” And so it was that the Provost – once described as “apt to mislead” in the pages of the Scott Inquiry – tried to quell the public outpouring of disquiet around my case by suggesting the video had breached the Equality Act. But neither the College’s initial legal advice nor my dismissal letter claimed anything of the sort.

It was not new legislation I’d transgressed, just a new religion with an old-time zeal to suppress dissent and punish heresy. The College’s “approach to equality and diversity” – which it finally claimed I had breached – has never been explained to staff, making it impossible to follow. 

Worth reading in full.

Stop Press: Ofcom is trying to “no platform” trans-sceptics, writes Neil Davenport in Spiked.

Speaking before Parliament’s Digital, Culture, Media and Sports committee in December, Melanie Dawes, chief executive of broadcast regulator Ofcom, said it was “extremely inappropriate” for broadcasters to seek to “balance” the views of transgender people by also giving airtime to the views of “anti-trans pressure groups”. Ofcom has now followed through on Dawes’ comments by expanding its definition of hate speech to include intolerance of transgender issues and “political or any other opinion”. As a result we can now expect many critics of trans ideas, from feminists to gay-rights campaigners, to be denied airtime.

“Mask Exempt” Lanyards

We’ve created a one-stop shop down here for people who want to buy (or make) a “Mask Exempt” lanyard/card. You can print out and laminate a fairly standard one for free here and it has the advantage of not explicitly claiming you have a disability. But if you have no qualms about that (or you are disabled), you can buy a lanyard from Amazon saying you do have a disability/medical exemption here (takes a while to arrive). The Government has instructions on how to download an official “Mask Exempt” notice to put on your phone here. You can get a “Hidden Disability” tag from ebay here and an “exempt” card with lanyard for just £1.99 from Etsy here. And, finally, if you feel obliged to wear a mask but want to signal your disapproval of having to do so, you can get a “sexy world” mask with the Swedish flag on it here.

Don’t forget to sign the petition on the UK Government’s petitions website calling for an end to mandatory face masks in shops here.

A reader has started a website that contains some useful guidance about how you can claim legal exemption. Another reader has created an Android app which displays “I am exempt from wearing a face mask” on your phone. Only 99p, and he’s even said he’ll donate half the money to Lockdown Sceptics, so everyone wins.

If you’re a shop owner and you want to let your customers know you will not be insisting on face masks or asking them what their reasons for exemption are, you can download a friendly sign to stick in your window here.

And here’s an excellent piece about the ineffectiveness of masks by a Roger W. Koops, who has a doctorate in organic chemistry. See also the Swiss Doctor’s thorough review of the scientific evidence here.

The Great Barrington Declaration

The Great Barrington Declaration, a petition started by Professor Martin Kulldorff, Professor Sunetra Gupta and Professor Jay Bhattacharya calling for a strategy of “Focused Protection” (protect the elderly and the vulnerable and let everyone else get on with life), was launched in October and the lockdown zealots have been doing their best to discredit it ever since. If you googled it a week after launch, the top hits were three smear pieces from the Guardian, including: “Herd immunity letter signed by fake experts including ‘Dr Johnny Bananas’.” (Freddie Sayers at UnHerd warned us about this the day before it appeared.) On the bright side, Google UK has stopped shadow banning it, so the actual Declaration now tops the search results – and Toby’s Spectator piece about the attempt to suppress it is among the top hits – although discussion of it has been censored by Reddit. The reason the zealots hate it, of course, is that it gives the lie to their claim that “the science” only supports their strategy. These three scientists are every bit as eminent – more eminent – than the pro-lockdown fanatics so expect no let up in the attacks. (Wikipedia has also done a smear job.)

You can find it here. Please sign it. Now over three quarters of a million signatures.

Update: The authors of the GBD have expanded the FAQs to deal with some of the arguments and smears that have been made against their proposal. Worth reading in full.

Update 2: Many of the signatories of the Great Barrington Declaration are involved with new UK anti-lockdown campaign Recovery. Find out more and join here.

Update 3: You can watch Sunetra Gupta set out the case for “Focused Protection” here and Jay Bhattacharya make it here.

Update 4: The three GBD authors plus Prof Carl Heneghan of CEBM have launched a new website collateralglobal.org, “a global repository for research into the collateral effects of the COVID-19 lockdown measures”. Follow Collateral Global on Twitter here. Sign up to the newsletter here.

Judicial Reviews Against the Government

There are now so many legal cases being brought against the Government and its ministers we thought we’d include them all in one place down here.

The Simon Dolan case has now reached the end of the road. But the cause has been taken up by PCR Claims. Check out their website here.

The current lead case is the Robin Tilbrook case which challenges whether the Lockdown Regulations are constitutional. You can read about that and contribute here.

Then there’s John’s Campaign which is focused specifically on care homes. Find out more about that here.

There’s the GoodLawProject and Runnymede Trust’s Judicial Review of the Government’s award of lucrative PPE contracts to various private companies. You can find out more about that here and contribute to the crowdfunder here.

And last but not least there was the Free Speech Union‘s challenge to Ofcom over its ‘coronavirus guidance’. A High Court judge refused permission for the FSU’s judicial review on December 9th and the FSU has decided not to appeal the decision because Ofcom has conceded most of the points it was making. Check here for details.

Samaritans

If you are struggling to cope, please call Samaritans for free on 116 123 (UK and ROI), email jo@samaritans.org or visit the Samaritans website to find details of your nearest branch. Samaritans is available round the clock, every single day of the year, providing a safe place for anyone struggling to cope, whoever they are, however they feel, whatever life has done to them.

Shameless Begging Bit

Thanks as always to those of you who made a donation in the past 24 hours to pay for the upkeep of this site. Doing these daily updates is hard work (although we have help from lots of people, mainly in the form of readers sending us stories and links). If you feel like donating, please click here. And if you want to flag up any stories or links we should include in future updates, email us here. (Don’t assume we’ll pick them up in the comments.)

And Finally…

Watch Dr Clare Craig talk to Julia Hartley-Brewer about the significance of the data from her recent Lockdown Sceptics piece on the strange alternative reality that appears when PCR tests aren’t involved.