Module Two of the Covid Inquiry is now up and running. This module looks at Government decision-making, the use of non-pharmaceutical interventions (NPIs) and the impact of lockdowns.
A statement by the Lead Counsel to the Inquiry, Mr. Keith, was up first on Tuesday October 3rd. Immediately, Mr. Keith came to a contentious issue.
The number of deaths across the United Kingdom, calculated by whether COVID-19 is mentioned on the death certificate, is now over 230,000. By the measure of excess deaths or excess mortality, the figures are likely to be similar.
The figures for England and Wales show that between Week 11 2020 to Week 38 of 2023 there have been 2,089,552 deaths, of which 207,814 (10%) mentioned Covid.
Compared to the five-year average, there is an excess of 195,951 deaths. However, we have just shown the methods used to calculate the excess affect the estimate; also, it is incorrect to assume that all Covid deaths equate to the excess.
It is incorrect to assume all Covid deaths (whatever that means) are excess deaths. Particularly given ‘Covid deaths’ could be assigned in 14 different ways, and as we have shown in 2022, the excess deaths remain unexplained.
However, Mr. Keith makes some useful comparisons:
But a broad comparison is still useful. It shows, for example, here that the United Kingdom had a lower burden of excess mortality than indeed many countries. The example that we’ve chosen here is Italy, which had a greater degree of excess death than the United Kingdom. So we were by no means the hardest hit, but we did have a higher burden in terms of the calculation of excess deaths than many other countries, and we’ve put on this chart France, South Korea, Sweden and Denmark.
A lot has been made of Sir Patrick Vallance’s diaries that have been passed onto the Inquiry. An entry from June 10th 2020 from Dr. Vallance records: “I am [worried] that a ‘SAGE is trouble’ vibe is appearing in No 10.”
It may even be the Government selected on occasion from SAGE what it wanted. There is a: “Paper from No 10/[Cabinet Office] for 1[metre]/2[metre] review,” notes Vallance. “Some person has completely rewritten the science advice as though it is the definitive version. They have just cherry-picked. Quite extraordinary.”
But, there’s also a perplexing explanation of modelling by Mr. Keith supporting its use and placing the onus on us – because we just don’t understand.
My Lady, little or no work had ever been done on the effectiveness of non-pharmaceutical interventions such as closing schools and lockdowns, not least because there hadn’t been a respiratory pandemic recently, and no such societal measures had been applied in the United Kingdom for over 100 years. But this field of mathematical and statistical models in public health is an extraordinarily complex one, and there was a basic difference between forecasting and the construction of model-based scenarios, both processes engaged in by this committee.
Forecasting essentially concerns asking the question: what do we think will happen? Model-based scenario construction asks the question: what might happen if we do X or Y? How effective will closing schools reduce the spread of the virus?
That difference between forecasting and model-based scenarios was crucial, because scenarios were often wrongly treated by many as forecasts, so that when a particular scenario didn’t come to pass, for example, the number of deaths that were estimated in that scenario did not come, and, for example, the number of deaths did not go up to the particular levels estimated on the closing of schools, or one of the other social restrictions that was imposed or could be imposed, this was treated as a failure of modelling or as the deliberate propagation of a climate of fear. It wasn’t.
The first reader to decipher this stuff gets a complimentary subscription to Trust the Evidence and our deluxe package: a pint at the John Snow in Broadwick Street with Carl and Tom (don’t worry, the pump’s handle is gone).
Not all is lost! Sir Patrick had some difficulty with this, too, back in September 2020, and there’s some element of recovery when the KC says:
The craving for certainty of what is to come, particularly in the early stages of a pandemic, may mean that model outputs are seen as ‘the answer’, which they can never be. …
So, was there an over-reliance on epidemiological modelling? Was too much time spent analysing the differences between the various models? Could more attention have been paid to tracking the policy responses of other countries and, as I’ve indicated, the likely economic and social impacts of the lockdowns?
But, again, the KC makes a flip-flop:
What may, however, be clear is that there is evidence from Imperial College in June 2020 that, had a lockdown not been imposed at all, i.e., had just the earlier measures of March 13th, March 16th, March 18th and March 20th been imposed, the virus would probably – probably – have continued to grow exponentially.
But the control in this is Sweden, which receives no mention – odd.
On page 103, the KC mentions the September 20th meeting that Carl attended.
On Sunday September 20th the meeting to which I’ve referred took place, chaired by Mr. Case and attended by the Prime Minister, the CMO, the CSA, and Professors Edmunds, Gupta and Heneghan, Dr. Anders Tegnell, from Sweden, and Professor Dame Angela McLean, the Deputy Government Chief Scientific Adviser, also attended. The Chancellor also attended, but he says in his written statement he doesn’t have strong recollections of that precise discussion.
Perhaps we should leave the last words for day one of the Inquiry to Dominic Cummings. “This is a shitshow. We should have gone a month ago as we said.”
On day two, Ms. Twite spoke on behalf of Save the Children U.K., Just for Kids Law and the Children’s Rights Alliance for England, pointing out how children were glossed over in the decision-making processes:
So we ask the Inquiry to start by recognising the distinct needs of children, and then we ask the Inquiry to ask whether the Government considered those needs.
To do that, we ask you look both at how those decisions were made. Did they carry out any impact assessments for children? Were modelling and analysis done about different rules for children? Were children mentioned in their discussions?
Mr. Stanton represented the British Medical Association (BMA). Seems they think there should have been more lockdowns, contact tracing, masks and reduced household mixing – the BMA stance is clear, we need more of everything – and while we’re here, let’s throw the kitchen sink at it next time.
The BMA believes that the United Kingdom Government’s response to the pandemic was categorised by a failure to take a sufficiently precautionary approach.
Also up was Joanna Goodman of the COVID-19 Bereaved Families for Justice, who gave a rather harrowing story of how her father passed away.
Ms. Goodman also painted a picture of several problems in the system that, here on TTE, we’ve banged on about.
Answer: “A lot of people who were in hospital for the entire period, so it was very clear that they contracted Covid. A number of people who also believed that their loved ones had contracted Covid, like we believed my dad did –”
Answer: “At an outpatient appointment. Also people not being tested on discharge from hospital, and often then going home, becoming ill, being re-admitted. Or actually going home to someone else who was vulnerable in the household. So particularly you can imagine elderly couples whereby one of them would have been in hospital, wasn’t tested, and on arriving home became ill.”
Answer: “And then their partner then went on to become ill. And, yeah, I think it’s one of the saddest things that there are a number of people in our group who lost both parents to COVID-19.”
As well as the issues in care homes
But also actually concerns around access to healthcare for care home residents. So a lot of members reporting that their loved ones contracted COVID-19 and having concerns about how it had come into the care home, but also feeling as though, because their loved one was a care home resident and had a number of health conditions, it was almost assumed that what they would need was palliative care and that that should be provided in the care home rather than it being possible for them to be admitted to hospital for treatment.
Also up was Dr. Alan Wightman of the Scottish Bereaved Families for Justice, who laid out the problems of confinement in care homes we’ve previously discussed:
The fact that care homes seemed to have been regarded almost as isolation hospitals. Which they’re not.
They’re not designed to hold people in isolation. They are designed to encourage older, predominantly older residents to mix, not be isolated, and not stay in their rooms. And yet, at a certain point in time, they were treated as isolation hospitals, which went against what the care staff had been trying to achieve in normal business.
As we said, some of this stuff is harrowing, but it highlights the sheer incompetence of the thinking:
But we’ve also got instances of where people appear to have been discharged because they were in their early 80s, they were sent home, knowingly having Covid. I mean, we’ve got an example of a gentleman, 84, sent home to his 82-year old wife, and known to be infected with Covid, but there was nothing more the hospital felt they could do for him, sent him home, she got Covid as well, and they both died because of it.
And the irrational approach to different rules access borders:
“It was very confusing which country had which rules. There was also people being treated, that lived on the borders, being treated in England; there was a lot of healthcare workers that lived in Bristol that were going to Wales, so there’s a whole big question around: was it right that different nations had different rules in place, and why, and should that happen again? I’m not here to judge, but it doesn’t seem logical when you’ve got porous borders to allow that, or –”
KC: “And did it make it extremely hard to adhere to, if there was an unnecessary degree of complexity or confusion?”
Answer: “Absolutely. I was travelling between England and Wales, so I was personally affected and I couldn’t – you know, it was difficult, was I wearing a mask here, wasn’t I wearing a mask there? You know, going across the Severn Bridge was like going across the Mexican border; you didn’t know whether you were going to get stopped.”
Perhaps we’ll leave the last word for day three to Mr. O’Connor, one of 11 KCs to join the legal team to support Hugo Keith (please don’t mention the costs of all this, though).
Research suggests that older people who previously did not need support to maintain their independence are now requiring care and support for the first time, and much earlier than would otherwise have been the case. Those who were already struggling to carry out activities of daily living, such as walking, eating, showering and getting dressed, are now finding things harder. The significant drop in activity levels amongst over 50s, and only a third of people aged 75 and over have been active during the pandemic.
Let us, however, leave our readers with a question: is the decline in independence the effect of SARS-CoV-2 or the effect of the restrictions?
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.