We wrote about the Hallet Inquiry assuming “that the Inquiry would genuinely look at events of the last three years and the evidence decisions were made on. Chaired by a British judge who seemed to stand no nonsense from politicians, a widely respected member of the Upper House, what could go wrong?”
It’s beginning to look like “what could go right?” would be the more apposite question.
Mr. Keith, the lead KC of the Inquiry, started proceedings with a very long statement. The Inquiry
will focus on those areas of the pandemic and the United Kingdom’s response to it that have caused the greatest public concern, and where there may be a need in the public interest to make urgent recommendations so that we may be better prepared in the event of the next national civil emergency to befall us. That module starts today, Module 1. It commences that process. It investigates what the state of the whole country’s emergency preparedness response and resilience structure and systems were when the pandemic struck in January 2020.
So far, so good; this is a reasonable formulation of the purpose stated by Lady Hallet.
Mr. Keith, however, then makes a further statement which seems more appropriate for a Barrister in court. You know, the type that you see in the movies, horse hair and all:
The Inquiry will come to hear that the UK and Scotland was not prepared, that the capacity of the U.K. to cope with and recover quickly from difficulties caused by Covid was diminished by years of changes to critical establishment, underfunding, cuts, failures to address inequality, and the effects of Brexit.
Yes, yes, you got it right; read the statement on page 27 of the transcript.
So without a jury and no defence council, we have a series of culprits, including Brexit, that well-known facilitator of lockdowns.
Several points struck us:
Science and evidence are unlikely to play any serious part in what follows as the lead has assigned causality. Basic null hypotheses or questions such as “was the UK unprepared, and if so, why” have already been answered and bypassed.
Cuts, changes etc., seem to be the main culprits and the most improbable of all causes: the B Word.
Italy did not have Brexit but suffered equally. However, Italian healthcare workers did at least have sufficient plastic bin liners to separate those with symptoms in the emergency department.
Macron admitted France was unprepared for COVID-19. Will they claim that it was thoughts of FREXIT that swung it?
Perhaps we are thinking of a fair, logical and honest process. We see little sign of that so far. To be prepared, you must know what works and what doesn’t based on what evidence is available. Also, because you are dealing with respiratory agents, you must be flexible. If you do not have evidence or sound evidence, you should generate it; instead of defending evidence-free decisions by misleading as the CDC Director did with the U.S. Congress.
We’re also left pondering why so many organisations require lawyers.
Our burgeoning covid inquiry team – it’s still Carl and Tom with no lawyers – has noted some oddities in the opening statements.
The Cabinet Office thinks the vaccines saved the day: “Thanks largely to the vaccines, COVID-19 has now been brought under control.” No mention of natural immunity then and its role in the transition to an endemic state – it’s possibly too technical for the cabinet office, so it’s better not to go there.
The UKHSA set out their position and, in a nutshell, decided we’re swamping you: “UKHSA has provided the Inquiry team with evidence in response to two rule 9 requests via corporate statements and the disclosure of over three thousand documents, either as exhibits or part of general disclosure for Modules 1 and 2.”
The Directors of Public Health told the Inquiry we learnt about what to do on the BBC: “At the start of the pandemic, DsPH were learning about new policies and guidance at the same time as members of the public, when the televised 5 pm daily briefings were broadcast.”
On Thursday, the Counsel to the Inquiry set to work taking evidence from the experts. Part of the discussion turned to definitions.
However, the Inquiry is manifesting problems that downstream it might find hard to reconcile; relying on experts to come up with definitions off the top of their heads is troubling as their testimony will be riddled with inconsistencies.
Compare the definition given by Professor Whitworth and Dr. Hammer with Professor Heyman’s and see how much trouble the Inquiry already is.
Weds June 14th:
DR. HAMMER: So the case fatality rate means the proportion of individuals who have become ill who die.
Thurs June 15th:
Q: During the evidence of Professor Whitworth and Dr Hammer yesterday, we heard about something called the case fatality rate.
Answer: Yes.
Q: Is that the number of confirmed deaths caused by a virus in relation to the number of confirmed infections?
Answer: No. Confirmed cases.
Q: Confirmed cases, sorry.
Answer: Yes.
Q: The infection fatality rate is less certain because there are those who may be infected asymptomatically, et cetera?
Answer: That’s correct, yes.
The case fatality rates vary significantly over time because of many factors, little of which was discussed.
The number of cases detected by testing will vary considerably
Selection bias can mean those with severe diseases are preferentially tested
There may be delays between symptoms onset and death, which can lead to underestimation
There may be factors that account for increased death rates, such as coinfection, more inadequate healthcare, patient demographics (older age)
There may be increased rates of smoking or comorbidities
Differences in how deaths are attributed to Coronavirus: dying with the disease (association) is not the same as dying from the disease (causation).
The infection fatality rate might draw some flack; it’s a ratio, but let’s not worry about the semantics of correct epidemiological definitions.
“In epidemiology, the terms ratio, rate, and risk have clear definitions.” However, the rate is often used instead of the ratio. Importantly: ratios have no dimensions and can take any value, whereas rates have a time dimension. So, which is it to be?
These interactions offered opportunities to reveal, agree and clear up some vital issues at the outset. But they are glossed over:
Answer: That’s right. In an outbreak investigation, or whenever there’s a new disease, a case definition is rapidly developed based on what’s known at the time.
Q: But that would change over time, would it not?
Answer: Absolutely, it can change over time, and it generally does change over time.
So what was the case definition early on, and what did it change to, on what basis? Answers on a postcard, please.
Professors David Heyman’s testimony is vague on the case definition; he never once mentioned the crucial role the misuse and misreporting of PCR played and assumed asymptomatic to be asymptomatic at face value (oh, and forgot to mention presymptomatic transmission).
We have shown how unreliable the ascertainment of symptoms (or lack of) was.
Remember? As of March 31st 2021, out of 444 papers mentioning asymptomatics and/or presymptomatics, only 18 were of sufficient quality to answer the question on transmission, and none could shed light on the incidence of transmission from asymptomatics and/or presymptomatics.
A year later, only four more possible studies could be added, with the best quality paper remarking on the difficulties of attribution (note how fast the topic had gone ‘off the boil’ in biomedical literature). But none of these technicalities can disturb the witnesses so far: more certainty peddled to the Inquiry then.
We repeatedly warned the public and our readers about the importance of definitions and testing by PCR.
So, what is a case? The Inquiry is missing opportunities for clarity – it could set out the essential definitions and then ask the witnesses whether there are any they disagree with. If so, why?
We’ll continue to update you on the Inquiry, but if you spot any oddities or irregularities, do let us know.
Dr. Carl Heneghan is the Oxford Professor of Evidence Based Medicine and Dr. Tom Jefferson is an epidemiologist based in Rome who works with Professor Heneghan on the Cochrane Collaboration. This article was first published on their Substack, Trust The Evidence, which you can subscribe to here.
Stop Press: Kevin Bardosh in UnHerd agrees with Carl and Tom’s pessimistic prognosis: “In the 150 lockdown questions sent by Baroness Hallett to Boris Johnson, a number of them are leading questions, suggesting that he did not lockdown fast enough or hard enough. This appears to be the theme of the inquiry, which is continuing the same inversion of the precautionary principle that has dominated in the legal profession: the right to be protected from Covid stands above all other rights, even when scientific evidence is uncertain.” Worth reading in full.
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