Noah Carl

A Question for Chris Whitty

I haven’t watched any of the Government’s COVID-19 press briefings since the early weeks of the pandemic. The scientific parts seemed to be mostly concerned with projections from rather dubious epidemiological models, and the political parts were even less informative.

As I understand it, the Q&A that follows whatever Boris and the boffins have said often involves journalists demanding to know why there aren’t more restrictions in place (more rules, more limits, more penalties).

Ironically, these questions tend to come from people who a few months before the pandemic might have compared Boris Johnson’s Government to certain mid-20th century political movements that we now associate with authoritarianism.

What questions would I ask Boris and the boffins? There are many I’d like to raise, including: “Why hasn’t the government published a cost-benefit analysis of lockdown?” Such analyses are routine in policy-making, and you’d expect that something as far-reaching as a national lockdown would justify one.

Another query I’d like to make is: “What specific evidence led the government to change its advice on masks?” Back on 4th March 2020, Chris Whitty told Sky News that “wearing a mask if you don’t have an infection reduces the risk almost not at all”. And as late as 3rd April, Jonathan Van Tam said “there is no evidence that general wearing of face masks … affects the spread of the disease”.

However, the question I’d most like to ask – of Chris Whitty in particular – is as follows.

Professor Whitty, on 5th March 2020, you told the Health and Social Care Committee that “we will get 50 percent of all the cases over a three-week period and 95 percent of the cases over a nine-week period”. You said that we are “very keen” to “minimise economic and social disruption”, and mentioned that “one of the best things we can do” is “isolate older people from the virus.”  

This all sounds rather similar to the Great Barrington Declaration. Why then, in an interview with The BMJ on 4th November, did you describe that document as “wrong scientifically, practically, and probably ethically as well”? You said that the Great Barrington Declaration is “really a pretty minority view”, but it appears to have been your view as recently as eight months earlier.

As I’m sure you’re aware, there is a document titled ‘UK Influenza Pandemic Preparedness Strategy 2011’, which was published by the Department of Health. It says that attempting to stop the spread of a new pandemic influenza “would be a waste of public health resources and capacity”.

And as late as 2019, the World Health Organisation published a report titled ‘Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza’. This document classifies “quarantine of exposed individuals” as “not recommended in any circumstances”.

Given that the WHO, the Department of Health and you – as recently as March 2020 – have rejected suppression as a strategy for dealing with respiratory pandemics, why did you describe the alternative focussed protection strategy as “wrong scientifically”? Thank you for listening, and I look forward to your answer.

Google Mobility Data Suggest That ‘Freedom Day’ Will Not Cause a Rebound in Cases

New daily infections have fallen by 31% over the last seven days, causing some consternation and head-scratching in the epidemiological modelling community.

Neil Ferguson, for example, had claimed only ten days ago that cases reaching 100,000 per day was “almost inevitable”. Yesterday he backtracked, noting that “the equation has fundamentally changed”. (One hopes he was referring to the equations in his model.)

As to why daily infections have been falling, some epidemiologists have said the full effects of ‘Freedom Day’ are yet to appear in the data. ‘Freedom Day’, you will recall, was when some remaining lockdown measures were lifted on the 19th of July.

Yesterday, the Prime Minister told reporters, “Step Four of the opening-up only took place a few days ago, people have got to remain very cautious and that remains the approach of the Government.”

Aside from the fact that ‘Freedom Day’ was nine days ago, and you’d expect any effects to show up by now, there’s another indicator suggesting that a rebound in cases is unlikely – the Google mobility index.

Google publishes regular reports on the level of mobility in most of the world’s countries, based on smartphone data. Looking at the latest U.K. numbers, there is no evidence of any change in behaviour caused by ‘Freedom Day’.

The chart below shows the retail mobility index. (Numbers are percentage changes relative to the baseline; ‘Freedom Day’ is marked with a red line.) As you can see, there was no sudden increase on the 19th of July.

The next chart the residential mobility index. Once again, there was no sudden decrease on the 19th of July. (And the other four sub-indices show the same pattern.)

Of course, the Google mobility index isn’t a perfect guide to behaviour. And given that rapid decreases in case numbers have occurred in the absence of mobility changes, it’s possible that rapid increases could too. Nonetheless, these figures suggest that daily infections aren’t about to rebound, and we don’t need to “remain very cautious”.

Hospitalisations and Deaths Can “Increase” Simply Due to Higher Transmission

The Telegraph reported on Monday that more than half of patients counted in the COVID hospitalisation numbers did not test positive until they were admitted. (Everyone must take a COVID test before entering a hospital in England.) Only 44% tested positive prior to being admitted.

The data seen by The Telegraph correspond to 22nd July. On that date, 827 “COVID-19 patients” were admitted to hospital, according to the Government’s coronavirus dashboard. However, the true number of people hospitalised because of COVID-19 may be far lower.

Crucially, the hospitalisations numbers do not exclude people who were admitted for non-COVID reasons (say, a broken leg) but simply happened to test positive upon admission.

Given that tests are now widely available, it seems likely that someone who had symptoms resembling those of COVID-19 would take one before going to hospital. Consequently, many of those who only test positive upon arrival may be suffering from other ailments. The true number of “COVID-19 patients” admitted to hospital last Thursday could be as low as 363 (i.e., 44% of 827).

The Telegraph story highlights an important point, which lockdown sceptics have made over and over again during the pandemic. Testing positive on a PCR or lateral flow test is not the same thing as having the disease COVID-19. (It would be more accurate to describe a positive test result as “an instance of SARS-Cov-2”.)

One important implication is that the number of hospitalisations and deaths – indicators that supposedly capture the impact of the pandemic on public health – can increase simply due to higher transmission.

According to the ONS’s Coronavirus Infection Survey, the percentage of people in England infected with the virus went from 0.22% in the week ending 19th June to 1.36% in the week ending 17th July – an increase of 1.1 percentage points.

In July of 2019, there were 1.3 million inpatients admissions, or 42,000 per day. If the percentage of inpatients testing positive rose by 1.1 percentage points due to a general increase in transmission, that would yield an additional 462 “COVID-19 patients” by the end of the month.

Now this calculation isn’t an exact representation of what’s going on at the moment. We know that infections are concentrated among people in their 20s and 30s, who are unlikely to be hospitalised for any reason. But it illustrates the point that even the hospitalisation numbers have to be taken with a grain of salt. 

As I’ve noted many times, the only truly reliable indicator of the pandemic’s impact is excess mortality. And going by that measure, the pandemic has been over since March.  

Was Lockdown Illegal?

There has been much debate among lawyers as to whether the various “non-pharmaceutical interventions” (i.e., lockdown measures) that have been imposed over the past year and a half are actually legal.

In April of 2020, the barrister Francis Hoar wrote an article laying out the case for the illegality of Britain’s lockdown. While his piece is very much worth reading in full, I will do my best to summarise the main points here.

Hoar argues that lockdown measures were a “disproportionate interference with the rights protected by the European Convention on Human Rights”, and were therefore in breach of the Human Rights Act 1998.

To make his case, he appeals to the so-called Siracusa Principles, which were adopted by the UN Economic and Social Council in 1984. These principles stipulate that government responses to national emergencies that involve the restriction of human rights must fulfil certain criteria.

Specifically, they must be: carried out in accordance with law; directed toward an objective of general interest; strictly necessary to achieve that objective; the least intrusive way of achieving that objective; based on scientific evidence, and neither arbitrary nor discriminatory; of limited duration, respectful of human dignity and subject to review.

Hoar argues convincingly that lockdown measures failed to meet several of these criteria. For example, lockdowns were not strictly necessary, since the same outcomes could plausibly have been achieved with far less intrusive measures (i.e., a focused protection strategy).

And it’s highly doubtful that lockdowns were “respectful of human dignity and subject to review”, given that they initially proscribed all political gatherings and public demonstrations without exception – a measure unprecedented in British history.

Hoar suggests that, “were they challenged by judicial review”, the measures should be “disapplied if necessary”. (Recall that he was writing back in April of last year). Incidentally, a longer and more detailed version of his article is available here.

Another figure from the legal community to argue for the illegality of the UK’s lockdowns is Lord Sumption, the former Supreme Court Justice. In a lecture delivered to the Cambridge Law Faculty in October 2020, he claimed that lockdown measures were without legal basis, and described the U.K.’s response as “a monument of collective hysteria and government folly”.

As readers may be aware, there was in fact a major legal challenge to the U.K.’s lockdowns, brought by the entrepreneur Simon Dolan (and funded to the tune of £427,000). The challenge sought a judicial review of the lockdown measures. Unfortunately, it proved unsuccessful.

I’ve been told by people with legal expertise that mounting another challenge would be difficult, given the adverse judgement in the case brought by Dolan. It’s therefore unlikely the Government will be liable for claims from individuals and businesses who’ve suffered due to lockdown.

Nonetheless, it’s worth noting that legal bodies in each of the following countries have found at least some aspect of the lockdown policy illegal: France, Belgium, the Netherlands, Germany, Austria, Spain, Finland, Czechia, Scotland, Slovakia, Australia, New Zealand, South Africa and the United States.

So while the High Court in London did reject Dolan’s case against the Government, lockdown opponents have won important victories in a number of countries.

And given that the evidence against lockdown has only increased since the judgement in Dolan’s case, lockdown opponents will have plenty of ammunition if any future Government decides to lock down in response to a similar virus.

Has the Government Been Undermining Social Norms by Imposing Inconvenient Rules It Cannot Enforce?

Since the start of the pandemic, the Government has introduced a plethora of rules concerning when we can and cannot leave our homes.

Anyone with symptoms is meant to self-isolate at home. Ditto for anyone who tests positive or who comes into contact with someone who’s tested positive. People travelling to Britain from overseas must self-isolate too (except football VIPs). And during the lockdown last year, we weren’t supposed to leave our homes for any reason other than work, exercise or food shopping.

Needless to say, these rules have made life difficult for a lot of people – particularly those who travel regularly, or who manage a small business. The current ‘pingdemic’ is wreaking havoc on Britain’s economy, as service-providers struggle to meet demand for lack of staff.

While asking symptomatic people to self-isolate arguably makes sense, it’s less clear whether all the other rules and regulations can be justified. In a 2019 report on pandemic influenza, the WHO recommended things such as ventilation of indoor spaces and isolation of symptomatic individuals. However, it classified “quarantine of exposed individuals” as “not recommended in any circumstances”.

Aside from the considerable inconvenience they cause, there’s another potential downside of the lockdown rules. Because they’re so difficult to enforce, large numbers of people are simply ignoring them. And might this, in turn, be undermining general norms of law-abidingness?

A major study published in The BMJ back in March found that only 43% of symptomatic people fully adhered to self-isolation – and that was based on data from last year, when the disease was seen as much more of a threat. It’s likely that a similar or even lower percentage of people have been complying with all the other rules.

Why does this matter? Studies have shown that when people observe norms being violated, they become more likely to violate norms themselves, leading to the gradual erosion of norm compliance. For example, a 2008 paper found that people were more likely to litter when there was graffiti next to a “No graffiti” sign than when there were no obvious signs of norm violation.

Regarding the pandemic itself, there’s already evidence that the scandal surrounding Dominic Cummings’ trip to Barnard Castle had a negative effect on adherence to lockdown rules. People reasoned, “If he’s not following the rules, then why should I?”

But the effect might be even more general than that. After witnessing so many examples of lockdown violations over the past year and a half, might people have become more likely to break other rules in society as well? I’m not aware of any evidence of this at the present time, but it doesn’t seem at all implausible.

Of course, one might say: even if the lockdown rules have slightly undermined law-abidingness, they were worth it to control the epidemic. Given the lack of evidence on stay-at-home orders, I am rather doubtful of this. But at the very least, there’s yet another potential cost of lockdown for us to consider.

Age-Standardised Mortality Rate Comes in Below Five-Year Average for *Fourth* Consecutive Month

The ONS announced on Friday that there were 38,611 deaths registered in England in June, which is 9.1% more than in May, and 0.8% more than the five-year average. However, these increases are relative to an exceptionally low value the month before. What about the age-standardised mortality rate (which is the best overall measure)?

In June, the age-standardised mortality rate was 12.5% higher than in May, but was still 6.1% lower than the five-year average. It was also the second-lowest figure on record for that month. (The only lower figure was observed in June of 2019.)

This means that England’s age-standardised mortality rate has been below the five-year average for four consecutive months. In other words, we’ve had four months in a row of “negative excess mortality”.

This chart from the ONS shows the age-standardised mortality rate for the first six months of the year, each year, going back to 2001:

Although 2021’s figure was higher than the figure for 2019, it was 3.6% lower than the figure for 2015 and 2.4% lower than the figure for 2018. This means that – despite higher-than-expected mortality in the winter – the overall level of mortality in the first half of 2021 was actually lower than three years before.

The past four months have “cancelled out” more than 85% of the age-adjusted excess mortality observed in January and February. Unsurprisingly, COVID-19 was not among the leading causes of death in June. All in all, the first half of 2021 has been pretty normal with respect to the average level of mortality.

New Paper Claims Lockdowns Do Not Cause More Health Harms Than They Prevent, but It Misses the Big Picture

A new paper in BMJ Global Health purports to debunk lockdown sceptics’ claim that “the cure is worse than the disease”. However, it misses the big picture; in fact, it hasn’t shifted my priors one jot.

The paper contains no new data or analysis. Rather, it comprises a review of the existing literature. The authors focus on the claim that “lockdowns cause more health harms than COVID-19 by examining their impacts on mortality, routine health services, global health programmes and suicide and mental health”.

In other words, they attempt to show that lockdowns do not cause more health harms than they prevent. Notice: this is not the same as showing that lockdowns pass an overall cost-benefit test. Even if lockdowns were a net positive for public health, they could still be a massive net negative for society (taking into account their effects on the economy, education and civil liberties).

The strongest argument the authors make (with which I was already familiar) is that excess mortality in countries like Australia and New Zealand – which managed to contain the virus – was zero or negative last year. Since these countries did not experience an epidemic of COVID-19, but did see weeks or even months of lockdown, the lack of excess mortality suggests that lockdowns themselves do not cause many deaths.  

However, some lockdown sceptics would argue that – even if lockdowns don’t cause many deaths in the short-term – they do cause more deaths in the long-term, via missed cancer screenings, drug overdoses etc. And here the authors are much less persuasive.

They concede that “the connection between lockdowns and missed contact with health systems is very well established”. However, they claim this association “may be related to lack of capacity of healthcare services or impacts of the pandemic itself rather than measures taken by governments”.

There is “no doubt”, the authors admit, “that global health programmes have been disrupted”. But they argue such disruptions were caused by “multiple complex direct and indirect consequences of COVID-19, not just stay-at-home orders”.

So they acknowledge that lockdowns do have harmful long-term effects. And given that those long-term effects are yet to be quantified, the authors have little basis for concluding that lockdowns are “unlikely to be causing harms more extreme than the pandemic itself”.

Why Not Donate Our Remaining Vaccines to Other Countries?

In its latest U-turn, the Government has announced that full vaccination will be a “condition of entry” to nightclubs and other crowded venues from the end of September.

The Vaccines Minister, Nadhim Zahawi, had previously ruled out vaccine passports, noting, “That’s not how we do things”. Back in January, Claire Fox even asked him on Twitter, “Can we hold you to this?” and he replied, “Yes you can Claire”.

Given the number of delays there have been to the “full” re-opening, this latest U-turn hardly comes as a surprise. Indeed, the Government’s journey out of lockdown has had more about-turns than a middle-distance swimming event.

Making full vaccination a condition of entry for nightclubs seems designed not only to curtail super-spreading, but also to incentivise more young people to get vaccinated. But why is getting young people vaccinated a Government priority in the first place?

We’ve known since the beginning of the pandemic that COVID deaths among young people are vanishingly rare. As I noted recently, only 25 people aged under 18 in England died of COVID-19 up to February of this year, which equates to a survival rate of 99.995%. And the survival rate for 18–25 year olds isn’t much lower.

Rather than for their own safety, the main justification for vaccinating young people is to reduce the spread of COVID-19, i.e., for older people’s safety. But the vast majority of older people – for whom vaccination does offer clear benefits – are already vaccinated.

According to figures from the ONS, more than 95% of English adults aged over 50 have received both doses of the vaccine. And SARS-COV-2 will almost certainly become endemic, which means that most of us will catch it several times during our lives.  

The best we can do is vaccinate the elderly and vulnerable (check!) and accept that the disease will continue to spread in the population until it reaches an equilibrium.

Of course, young people should have the right to get vaccinated. But assuming that some have decided the benefits simply aren’t worth the risks, the Government ought to refrain from imposing even more costs on them that it already has. (I say this as someone who has had his first dose, and intends to have his second.)

Rather than trying to strong-arm every last 18 year-old into getting a vaccine they don’t need, couldn’t Britain’s remaining vaccine stockpile be put to better use?

There are still millions of elderly and vulnerable people in other countries who lack any immunity against COVID-19. Why not start donating our left-over vaccines to these countries (most of which are much poorer than the UK)?

The risk of death from COVID-19 among 70 year olds is about 300 times higher than among 20 year olds. Hence the benefit from vaccinating an additional 20 year old in Britain must be minuscule relative to the benefit of vaccinating a 70 year old in Africa, Asia or Latin America.

Having offered the vaccine to every high-risk person in Britain, isn’t it time we did something for countries with fewer resources than our own?

COVID-19 Mortality Rate Among Children Is Even Lower Than Previously Thought

We’ve known since the early weeks of the pandemic that age is the single best predictor of COVID-19 mortality, and that the risk of death for young people is vanishingly small.

A letter in the New England Journal of Medicine reported that zero Swedish children aged 1–16 died of COVID-19 up to the end of June 2020. And only 15 were admitted to the ICU, of whom four had a serious underlying health condition.

Of course, England is a much larger country than Sweden, and it’s been a whole other year since those Swedish data were collected. So how many English children have died of COVID-19?

In an unpublished study, Clare Smith and colleagues sought to identify the number of COVID-19 deaths among people aged under 18 between March 2020 and February 2021. They examined data from the National Child Mortality Database, which was linked to testing data from Public Health England and comorbidity data from national hospital admissions.

The structure of their dataset allowed the authors to distinguish deaths that were plausibly from COVID-19 and deaths that were merely with COVID-19.

3,105 under 18s died from all causes in England during the relevant time period. Sixty one of these involved people who had tested positive for the virus. However, the authors determined that only 25 were actually caused by COVID-19. And of the 25, 76% had a serious underlying health condition.

Given that an estimated 469,982 under-18s were infected with the virus up to February of 2021, the survival rate in this age-group (the inverse of the IFR) was 99.995%. What’s more, 99.2% of total deaths were caused by something other than COVID-19.

Smith and colleagues’ findings underline just how small a risk COVID-19 poses to young people, and hence – I would argue – why a focused protection strategy was preferable to blanket lockdowns.  

As early as 10th April 2020, Martin Kulldorff – co-author of the Great Barrington Declaration – published an article on LinkedIn titled ‘COVID-19 Counter Measures Should be Age Specific’.

Based on the data that were then available, he estimated one would need to stop 3.5 million children being exposed in order to prevent the same number of deaths as one could prevent by shielding 1,000 people in their 70s. He argued, therefore, that Covid counter-measures must vary by age.

A similar argument was made by George Davey Smith and David Spiegelhalter in a piece for The BMJ last May. These authors called for “stratified shielding”, while noting that this would “require a shift away from the notion that we are all seriously threatened by the disease”.

According to the medical researcher Russell Viner, who spoke to Nature, “There’s a general feeling among paediatricians that probably too many children were shielded during the first wave.” And the epidemiologist Elizabeth Whittaker said that efforts to shield children “have probably caused more stress and anxiety for families than benefit”.

In addition to “stress and anxiety”, there’s also the learning losses associated with months of online teaching. All this compared to the marginal impact closing schools had on the spread of COVID-19.

When we look back at the response to Covid, serious questions will have to be asked about the costs of lockdown, not only to society in general, but to young people in particular.

A Response to Scott Alexander on Lockdowns

The prolific blogger Scott Alexander has written a long post about lockdowns. It’s not too objectionable from a lockdown sceptic’s point of view. For example, he concedes that “lockdowns weren’t necessary to prevent uncontrolled spread” and says that it’s “harder to justify strict lockdowns in terms of the non-economic suffering produced”.

Nonetheless, I do disagree with him on several points, which I will highlight here.

First, he ignores most of the academic studies that have found little or no effect of lockdowns on mortality. For example, he doesn’t mention Simon Wood’s studies finding that infections were in decline before all three U.K. lockdowns. Nor does he mention the paper by Christopher Berry and colleagues which observed “no detectable health benefits” of shelter-in-place orders in the United States.

Despite ignoring these studies, he dedicates a whole section of his post to something called CoronaGame, which he oddly classifies as “Actual Evidence”.

Second, he compares the official COVID-19 death rate up to August 2020 in Sweden with various other countries, and claims that “Sweden comes out looking very bad, but not the literal worst”. He then claims that “it looks even worse when you compare Sweden to other Scandinavian/Nordic countries”.

However, if he had used age-adjusted excess mortality, and had extended his window of analysis up to the end of 2020, Sweden would not have come out “looking very bad”. As I’ve noted several times, Sweden saw age-adjusted excess mortality up to week 51 of just 1.7% – placing it 14 out of 22 European countries.

And there are several reasons why the “neighbour argument” – the argument that we have to compare Sweden to its immediate neighbours rather than the rest of Europe – isn’t very convincing. Sweden saw unusually low mortality in 2019; border controls (not lockdowns) made the difference in the first wave; and once you include the Baltics, Sweden no longer stands out.

Third, he claims the cost of lockdown “is measured in psychological suffering and economic decline”, noting that in order to do a cost-benefit analysis “we should figure out how much stricter lockdowns affected the economy”.

While the economic impact of lockdown certainly constitutes a major entry on the costs side of the ledger, Alexander neglects to mention another negative impact of lockdown, namely the switch to remote learning. As several studies have shown, this resulted in sizeable learning losses, which were concentrated among children from the most disadvantaged backgrounds.

Alexander’s post offers a decent overview of the debate, but he’s too charitable to the lockdown side, leading him to overstate the benefits of lockdown and understate the costs. Not his best piece of work, in other words.