After a few months of the Hallett pantomime, we are quite clear what the Covid Inquiry is not about – evidence-based policy.
The obsequiousness to modellers, distortions of the precautionary principle, character assassinations, Teflon flip flops and swear words are ample evidence that the U.K. taxpayers are being taken for a ride.
Next time will be worse: the precedent for depriving citizens of their civil rights, abandoning the elders and muzzling entire populations on the basis of no evidence and no real expertise has been set.
We have received many public and private messages of support, and we think the time has come to stop the media circus and get down to answering why evidence was ignored, why gaps were filled with models and Hancockisms and why we did not fill the evidence void with clinical trials designed to answer urgent questions. We still have time, and that is what we should be doing now, not tomorrow, but now. To paraphrase the head of WHO: test, test, test. Dr. Tedros was referring to PCR, which, when mismanaged, distorted everyone’s perception of the threat. He now should repeat the phrase to refer to plugging the many gaps in our knowledge.
It seems that even Private Eye’s MD shares this view.
If we are going to spend 200 million on a ‘gold standard’ pandemic inquiry it needs to determine what the ‘gold standard’ pandemic management should have been for Covid, and should be for a future pandemic. And it should do the science before it determines how far off the U.K. was from best practice.
Our readers know how far the U.K. was from best practice based on personal experience and what they have read in Trust the Evidence.
However, rather than going on about the Hallett Inquiry and its biased chair, let’s look at what could be done now to prepare humanity for the possible ravages of whichever next respiratory agent.
We have documented the prominent role played by nosocomial infection with SARS-CoV-2 found in up to 40% of people admitted for reasons other than Covid.
A retrospective study using data from 2015 to 2021 was conducted in a paediatric hospital in the USA, looking at the effects of a bundle of interventions against hospital-acquired respiratory infections.
The authors report a 68% decrease in infection over the period using caregiver screening, symptom-based isolation, personal protective equipment, hand hygiene, staff illness procedures and monitoring of environmental cleanliness. All these measures were enhanced when the pandemic started.
The infection decrease is marked, but it is what you would expect from an observational study. This mix of interventions has yet to be tested in randomised trials. Some may work, but we don’t know which ones and by how much.
The forthcoming influenza and respiratory viral theme park season is near and would provide an ideal testing ground to advance science and knowledge. Alternatively, good old rhinovirus is always on hand.
The US researchers found that:
Rhinovirus emerged as the predominant cause of HAVI [healthcare-associated viral infections] during the pandemic period. It was the only reported respiratory HAVI in our cohort for an entire year with HAVIs due to all other respiratory viral pathogens virtually eliminated. This finding corresponds with what was observed in the epidemiology of communal viral activity during the [2009 influenza] pandemic, and is widely reflected in both reports of significant increases in hospitalisation for respiratory infection secondary to rhinovirus, and in the persistence of rhinovirus/enterovirus detection despite stringent public health measures.
Many treat this RNA agent with contempt, perhaps because no licensed remedies exist. However, rhinovirus is always present and circulating with peaks of up to 35-40% positivity in surveillance, creating epidemics without apparent seasonal patterns. It also likes to coinfect, so it is a menace. Like most respiratory viruses, the illness is mostly mild, but it can cause serious pathologies, especially in those with asthma or chronic obstructive airways disease, and also can reinfect people who had recently been infected by a different serotype (there are over 150 rhinovirus serotypes). So, it is the near-perfect proxy for respiratory viruses as targets for preventive physical interventions.
Activists tried to obstruct the carrying out of research trials to fill the evidence gaps during the pandemic and partly succeeded in creating a climate of intimidation.
However, they would have a difficult time objecting to such a design on ethical grounds as the comparator would be current practice. If we are willing to educate ourselves rather than submit to the will of influencers and activists, we may learn some valuable lessons.
We could do all sorts of trials with different packages or bundles of measures, and it would probably cost a lot less than the KCs’ fees for the rest of the inquiry and infinitely less than the 37 or so billion wasted on mass testing or the equivalent stolen from the exchequer by criminals. It also might educate some folk about science and the progressive accumulation of knowledge.
Once again, do write to your MPs, as now is the time.
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.
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