Clare Craig

Ambitious Interpretation of Results of the Oxford Vaccine Group’s Latest Paper

by Dr Clare Craig FRCPath On February 1st the Oxford Vaccine Group published their latest findings on the Oxford/AstraZeneca vaccine. While the findings are encouraging, the way they have been interpreted is questionable. The study is underpowered for the conclusions that are being drawn from it and there has been extensive data mining undertaken retrospectively in an attempt to draw more powerful conclusions. They concluded that in the vaccinated group two thirds fewer people were infected. Despite admitting that they did not study transmission, they still commented on it. The conclusions reached were the overall percentage testing positive was 54% lower “indicating the potential for a reduction of transmission”. The 54% figure was deduced from positivity including asymptomatic positives. This is not a reasonable conclusion to draw on two counts. They have assumed that asymptomatic positives are a major source of transmission and there is minimal evidence to support that assertion; and they failed to account for false positive test results. Asymptomatic positives were looked for only in the UK participants. They have not stated how often these people were tested, but it can be inferred that they were tested 10 times each on a weekly basis for follow up from day 22 to day 90. That is 82,070 tests. A remarkably low false positive rate of 0.16% would be...

What Does Endemic Covid Look Like?

by Dr Clare Craig FRCPath, Jonathan Engler MBChB LLB and Joel Smalley MBA 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. Figure 1 Total deaths by date of occurrence shown in green...

All the Syndromic Data in one Place

by Dr Clare Craig FRCPath One thing that Public Health England has been world beating for before and during this pandemic has been the sharing of data. Data is collected from every aspect of the healthcare system and we now have the full dataset for 2020. The beginning of the graphs therefore give an indication of the levels expected at this time of year. A selection of this data is presented that tells the story of a Spring pandemic. However, what this data reveals about Autumn and Winter does not fit the hypothesis that there has been a second wave. PCR testing results are an outlier in the data and only data related to PCR test results has led to the impression that there is currently a Covid problem. Let’s take each dataset in turn. NHS 111 data Patients phoning NHS 111 or visiting online are classified according to their symptoms. A Spring pandemic can easily be identified with a spike in presentations of patients with cold/flu symptoms; cough, fever and difficulty breathing. In September, when schools returned, there were epidemic levels of common cold symptoms and cough but not difficulty in breathing. A few of these were classified as Covid and there were regions of the country, which had been affected last and least in Spring, where excess deaths...

Dr Clare Craig: “We Are In A False Positive Pseudo-Epidemic”

This is a lightly edited transcript of a recent interview with Dr Clare Craig on Alex McCarron's latest Escape from Lockdown podcast. Alex McCarron: Hello, and welcome to Escape from Lockdown, the show all about how we got into this madness and how we are going to get out of it. Now today I have another of the great pathologists. Very early on I interviewed Dr. John Lee, and his interview set the podcast on fire and set the whole lockdown escape community on fire, really. It had real crossover. And today I think is going to be no different or even better. I'm speaking to a very brilliant person who is doing some incredible work and really putting themselves out there, exposing some really terrifying conclusions that she's come to, to all of us. It is of course the pathologist Dr. Clare Craig. Clare, how are you doing? Welcome to the show. Dr Clare Craig: Thank you very much for having me. Alex McCarron: Can you tell the listeners a little bit about your professional background and how you got to be where you are? Dr Clare Craig: I'm a consultant pathologist. I've worked in the NHS as a consultant pathologist for many years, and I moved to work on the cancer arm of the 100,000 Genomes Project for...

How Covid Deaths Are Over-Counted

Dr Clare Craig FRCPath Who you gonna call? Virus busters The system for counting deaths from Covid is not working properly and we are over-counting Covid deaths. This can be fixed, easily, by improving cross-checking and retesting all alleged positive PCR test results. Accurate data is a basic prerequisite for good policy choices. The remedial steps needed are simple and relatively inexpensive. Central government should mandate them to be done immediately. When trying to understand the impact of increased testing on case numbers we look to the percentage of tests reported as positive. In a similar way, it is important to double check other data points against each other, as percentages, to truly understand how the epidemic is progressing. Using this approach, it appears that we are over-counting deaths because there are not enough severely sick people from Covid to account for them. In other words, there are proportionately more Covid deaths per case and per hospital admission since the Summer. This paper explains this phenomenon and calls for proper scientific cross-checking to be instituted before a Covid outbreak is declared. Contradictions in the data The ONS carry out random testing of the population to estimate how many people have Covid in the UK each week. A sample of people are randomly tested and then modelling is used to predict...

False Positives in Care Homes

by Dr Clare Craig FRCPath Outbreaks of Covid in care homes appear to have spiked in September in the UK. Does this mean we will see a resulting spike in deaths? This article explores the possibility that a significant number of the alleged outbreaks in care homes could be based on false positive test results. The continuing absence of systemic cross-checking of alleged positive results against established clinical and diagnostic evidence such as loss of smell and distinctive CT chest scans remains deeply disappointing. At an absolute minimum, anyone who receives an alleged positive Covid result should be retested from scratch. The percentage of tests carried out in the community that were reported as positives reached a steady state over the summer at 0.8 per cent of tests. Reaching a steady state like this over a period of weeks is suggestive of having arrived at the baseline false positive rate. Similar figures have been used by SAGE. Matt Hancock has said the figure is “less than one per cent”. The argument in support of the idea that a significant proportion of national UK Covid diagnoses in July and August 2020 were actually due to false positives is provided in a separate blog post. This paper addresses the narrower issue of alleged outbreaks in care homes. This is how a false...

Is the Increase in Cases Just an Artefact of Increased Testing?

by Dr Clare Craig FRCPath The story of how false positive test results can create the illusion of actual infections in the population will be a familiar one by now for many readers of this site. Assuming that the false positive percentage remains reasonably constant, then increasing numbers of tests inevitably lead to a higher absolute number of false positive test results over time. Uncritical policy decisions made without discounting for this effect have no evidenced-based validity. One real potential problem as the number of tests increases, however, is that the underlying number of actual cases – and their location – may ironically be somewhat obscured by steadily increasing and randomly distributed false positive results, caused by the higher volume of testing. By contrast, a rapid rise in the percentage of tests that are returning positive results should normally indicate that the real number of Covid cases is increasing and the false positive results will become less and less important because they are usually constant. Unfortunately, the acceleration we have seen in the recent case numbers is increasingly out of synch with crucial data from other sources. The ONS random population sampling, Zoe App and NHS triage data all show a slowing and even a plateau in the number of actual cases in the last fortnight. Either the data in all...

Flu-Like Illnesses

by Dr Clare Craig FRCPath How many people with ‘flu-like’ illnesses are being mislabelled as Covid? Cases of Covid appear to have surged recently. Hospital admissions for Covid are now also starting to rise. To question how much of this rise is genuinely the result of Covid is to challenge the prevailing narrative, but as a scientist it is essential to ask hard questions. It is critical that we understand when someone is ill, but it is not Covid. We have limited resources for ‘Track and Trace’ and it is important that they are used wisely, especially when real outbreaks occur. Scientists are grappling with what the rate of false positive results are with the current Covid test. The risk of a false positive result comes not only from aspects of the testing process itself but may vary from one population to another. It may even vary over time. Every country has systems of external quality control for their laboratories. A summary has been published of attempts by these bodies to establish the risk of false positive Covid testing from other coronaviruses (one of the causes of the common cold). They tested against two strains of non-Covid coronaviruses. These showed between 0.58% and 0.96% were false positive with Covid testing. With large numbers of tests each day, this level of...

When is COVID-19 not COVID-19?

Dr Clare Craig FRCPath The Covid Pimpernel: They seek it here, they seek it there, those testers seek it everywhere. Is it in Leicester, or in Torbay, that damned elusive RNA. On 7th September Public Health England announced a change to testing criteria. The change is designed to address the problem of false positives, people that test positive but do not in fact have COVID-19. The consequences of these false positives stretch far beyond the inconvenience to an individual who has to self-isolate unnecessarily. Counting false positives when a disease is not very prevalent can result in misleading, fear-mongering news articles and mistaken health policies. The impact of this change in testing criteria is yet to affect the case numbers being reported. The new criteria means some cases will need further assessment before being reported so those results will be delayed.   Until Public Health England published this guidance, the working assumption was that false positive test results are irrelevant for testing carried out for COVID-19. This assumption is not true. However, in times of an epidemic, a few false positives does not make a material difference to the reported numbers of infected cases. When 30% of results are positive then 1% being false positive would be immaterial. When only 2% of your results are positive then 1% being false positive is important....

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