- January 9, 2021
ON FRIDAY Nicola Sturgeon addressed the nation yet again and openly considered the possibility of tightening current Covid restrictions further. Where is Scotland now? How did we get here? Where are we going?
Let me lay my cards on the table: I’m a lockdown sceptic. But like any good scientist/sceptic, I am constantly re-evaluating my position. Every day I ask myself repeatedly: am I wrong?
I’d love to be wrong.
So yesterday, in an act of unusually brave self-flagellation, I listened to BBC news. I was dutifully informed that hospitals are about to collapse in South East England. I am quite familiar with the English hospital data and so I am aware that there are hospitals struggling there, and this is clearly worrying. It makes me wonder if I’m wrong about the situation in Scotland, but then, again, the statistics were released as usual at 2.00pm. My fear was once again fed that we in Scotland will never get out of this positive feedback loop we are in: our obsessive fear and testing of Covid is creating more of a problem than the disease itself.
The problems we are storing up are: medical, societal, personal, economic, democratic. The present and future damages just go on and on.
Our First Minister, Nicola Sturgeon, thinks that Covid impact is reduced by limiting social contact. This has become her whole Covid mitigation strategy, along with many other leaders around the world. She has created this idea, which has stuck, that humans generally, and Government specifically, can manage the spread of a virus. She has sold this idea relentlessly, with the help of the media, who have provided her with endless propaganda to help. Now, if she wants to reduce cases, the only tool at her disposal is to further reduce social contact - without regard or respect for the costs of such measures; the costs we know land disproportionately on the most vulnerable: the children, the elderly, the poor.
But many people have had enough and their number is growing. We are heading for a crisis whichever way you look at it and it seems that people are perhaps beginning to understand this.
Put simply, there is no evidence that lockdown works to prevent the spread of a virus.
We know the government told us this in March - and it was correct. Lockdown and the quarantine of the healthy is a bizarre experiment – never tried before but not treated as the experiment it is. We talk as if we have always dealt with viruses this way. There has been no rigorous analysis of the virological results of lockdown at all, much less the societal effects. We haven’t asked what effects this will have on our immunity either. Are we storing up huge health problems for next year and the years beyond?
How would it go down with the electorate of Scotland if they were told that it is possible (or likely) that lockdown actually makes viral spread worse?
There has been longstanding knowledge in epidemiology (up until the year 2020 when we suddenly forgot) that if we try and prevent a virus transmitting in the parts of the population that are not vulnerable, all we do is increase disease burden in the vulnerable parts of the population (see ‘Too Little of a Good Thing: A Paradox of Modern Infection Control (Epidemiology 19(4):588-589).
Donald A Henderson, an epidemiologist credited with eradicating smallpox (among others) wrote in the paper ‘Disease Mitigation Measures in the Control of Pandemic Influenza’ (BIOSECURITY AND BIOTERRORISM: BIODEFENSE STRATEGY, PRACTICE, AND SCIENCE Volume 4, Number 4, 2006):
Experience has shown that communities faced with epidemics or other adverse events respond best and with the least anxiety when the normal social functioning of the community is least disrupted. Strong political and public health leadership to provide reassurance and to ensure that needed medical care services are provided are critical elements. If either is seen to be less than optimal, a manageable epidemic could move toward catastrophe.
It is clear in 2020, transmissible diseases in the community were significantly reduced. When I started to form my own lockdown-sceptic views, I believed lockdown was ineffective at limiting the spread of a virus. I was wrong and I can see that now, in light of what I have learned! Lockdown does hinder the spread of viruses. But does it follow this is desirable?
We know the Government Statutory Notification of Infectious Diseases for England and Wales, published on 13th December 2020, showed extraordinarily significant reductions compared to previous years for the following diseases: acute meningitis, enteric fevers, food poisoning, measles, meningococcal septicaemia, mumps, rubella, scarlet fever, tuberculosis and whooping cough. Norovirus has also been reported to have been at extraordinarily low levels during the first lockdown. What will happen next year? Is it possible these diseases will spring back with a vengeance upon us? Why are people not asking these questions?
It is clear from the data that social interactions are significantly lower than usual and it is logical to conclude that lockdown will hinder Covid transmitting in the community. But why do we want that? Surely it would be better to shift the burden of disease on to those least vulnerable to it?
Patrick Vallance also thought it was unwise to suppress a virus too hard in March when he said:
“If you suppress something very, very hard, when you release those measures it bounces back and it bounces back at the wrong time. Our aim is to try and reduce the peak, broaden the peak, not suppress it completely. Also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission, at the same time we protect those who are most vulnerable to it. Those are the key things we need to do.” Independent 13th March 2020.
Covid is a virus spread by aerosol transmission, and as any physicist or immunologist knows, aerosols get everywhere – like glitter. Once a virus like this arrives in a building, it gets everywhere. The good news is that at least half of people are not susceptible to Covid, which is why so many are exposed and never develop symptoms. We saw this in the first wave. Half of those living with an infected person never developed the disease (see https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774102).
We currently screen every hospital admission, every hospice admission, all hospital patients and all care home residents. We know (because it’s mathematical law) that there will be false positives in the results and yet we do not correct for those. Why not?
We also know that care home residents and hospital patients as a group have a high mortality rate. So we are over-sampling a very high mortality group and then are frightened by the high Covid death count. This is not contributing to our understanding of the case fatality rate at all; in fact, it only makes Covid look more terrifying while conversely also telling people it is possible to be infected but not be diseased (‘asymptomatic’). We are also treating vulnerable patients in Covid wards who may not have Covid at all, in part due to this new belief in asymptomatic ‘disease’.
The reader may be interested to know that since mid-September, Covid has become more than four times more deadly, according to Scot Gov figures (applying an 18 day delay from positive test to death). And yet, we know that healthcare staff say it is becoming easier to treat as they gain experience and improve their treatment protocols – and they are surely right. The data are therefore strongly indicative that we are over-testing the dying and then panicking about an apparently high death toll.
Further evidence that we have a problem with hospital-acquired infections has emerged since Christmas Day, when all the measures of positive tests, Covid ITU occupancy, Covid hospital occupancy and Covid deaths all started rising in unison. This should not happen. There has to be a delay, surely, in seeing these measures change – since one leads to the other – but they all started rising in unison on Christmas Day. If we have a problem with hospital-acquired infections, is it helpful to shut down the whole of society, or would it be better to focus our attention on hospitals?
My heart is breaking for Scotland. Every person in the community is truly doing their best, and yet the whole effort is flawed and upside down and I cannot see how we are ever going to get out of it if alternative and more informed views than the current ones influencing government are not listened to.
Let me leave you with an anecdote I heard this week – similar to many anecdotes I hear every week in the course of my voluntary work now:
An unfortunate young-to-middle-aged chap has been ill for weeks, not seen his GP, puts it down to stress. After Christmas he becomes seriously unwell with internal bleeding. He calls an ambulance, but is told it will be a 2 hour wait because of the stresses of the pandemic. His sister takes him to hospital, against the advice of the 999 call operator, ‘in case he has Covid’. On arriving in the hospital, he gets admitted to a ward for investigations and has to be left by his sister because visitors are now not permitted. This man needs blood transfusions he has been so unwell. On day 4 of his hospital stay he is examined by endoscope and on day 5 he is diagnosed with a cancer with a very poor prognosis - alone. He is told he needs a CT scan to determine the extent of any spread and for samples to go to Pathology, which has a backlog due to Covid issues. On day 9 he still has not had a CT scan, but on this day, after three negative tests, he gets a positive PCR test. He has no Covid symptoms. He gets put on the Covid ward, which is full and in which there are no beds for him, so he has to sit up in a chair. He is vulnerable because he is very ill but he is exposed to Covid. There are no rooms isolating patients on this ward. On day 11 he still has not had a CT scan but gets a chest x-ray to see if there are any signs of Covid in his lungs. He still has no Covid symptoms. On day 13, he gets his CT scan, and without any confirmation of his Covid status he is discharged and sent home to self-medicate.
Is this the Scotland we want to live in? Is this how our health service should be run?
What are we doing, and why do we not want better for ourselves? We must demand better if we do not want to live like this forever - and surely we do not want this forever.
Christine Padgham was a health physicist who now is analysing Scottish health trends following the Coronavirus crisis with the help of many other professionals, scientists and activists.
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