The Wry Observer’s Covid-19 update (228): The End

“The time has come”, the Walrus said “To talk of many things”… This is my last Covid blog. For nearly four years I have tried to examine the pandemic was an unjaundiced eye, made numerous mistakes along the way, admitted when I was wrong and tried all the time to keep a positive and helpful attitude. I have probably read more articles, blogs and books than was good for me. I have submitted protocols to government but my advice was ignored. I have submitted evidence to the Hallett Inquiry but in light of the treatment there of Professor Carl Heneghan I suspect I shall not be called to give oral evidence as I requested. I have developed a profoundly different approach to pandemic management than that put forward by non-clinicians and modelling fantasists – in summary, that you do not have to devise draconian protection strategies if the infective organism doesn’t kill people. You simply protect those at risk and treat those who get seriously ill.

SARS-CoV-2 made many people very ill at the beginning, and many died, largely because the complication called Covid-19 was not recognised as a hyperimmune state, akin to that described as a result of other infective organisms, drugs, genetic makeup and more. And it was wrongly treated. Latterly the global strain has mutated to a less virulent form and the emergency treatment I recommended has been established, albeit after a long and unnecessary delay. SARS-CoV-2 is little more of a risk than influenza viruses or even the common cold. The virus was well-established worldwide long before any protective measures were put in place, and those were necessarily incomplete so would not have worked. Testing was fatally flawed. There was no robust evidence that masking was effective. Models exaggerated the risk at least in public perception but were flawed – indeed those using them had an excellent track record of prophesy failure. Vaccines have risks that have been understated; trials of them were flawed and data was manipulated. When criticisms have been raised, and conclusions questioned or branded as wrong, not once have any of the establishment provided a rebuttal of those criticisms. I venture to suggest that it is because they cannot.

Against this background we have the unpleasant spectacle of a Galileo-like Professor of evidence-based medicine being aggressively attacked by the Hallett Inquiry counsel with revelations that senior government medical advisers behaved in a most unprofessional way by calling him a fuckwit, and disparaging his advice, honestly offered and backed by good evidence, because by training he is “only a GP”. The Inquiry appears to have ignored his long written submission entirely. Frankly those advisers should be held to account by the General Medical Council for unprofessional conduct. I doubt that they will be; they have been fawned over by the Inquiry instead and praised for their valiant efforts, never mind that to a clinician versed in the management of immunological disease (me) they were and indeed are barking up the wrong tree and have made a grave error in not listening to proper clinicians who do actually know what they are talking about.

In that context I quote, via Norman Fenton’s “Trust the Evidence”, the listing by counsel of the qualifications of Jeremy Farrar:

“You trained, I believe, in medicine, with postgraduate training in London, Chichester, Edinburgh, Melbourne, Oxford and San Francisco. You have a DPhil PhD from the University of Oxford. You were a director of the Oxford University Clinical Research Institute at the Hospital for Tropical Diseases in Ho Chi Minh City in Vietnam from 1996 to 2013. From 2013 you were Director of the Wellcome Trust, and from May 2023 have you been the Chief Scientist at the World Health Organisation? Have you throughout your professional career served as a chair on a multitude of advisory bodies, for governments and global organisations? Have you received a plethora of honours from a number of governments, institutes and entities?”

So?

If I was there I would add a few supplementaries:

Have you examined the historical context of pandemic management, and thus understood that each pandemic has been at some point mismanaged for the last 100 years? (Ref: Mark Honigsbaum’s “The Pandemic Century”)
Have you ever managed a patient seriously ill with septicaemia?
Have you ever looked after severely disabled patients who are prone to develop sudden septicaemia?
Are you aware of the entity known as a cytokine storm, or hyperimmune state?
Do you understand the correct treatment for such a condition?
Have you read the textbook “Cytokine Storm Syndrome” by Cron and Behrens?
Do you therefore understand that Covid-19 is, in all its manifestations, a hyperimmune state?
Do you believe that all your illustrious appointments qualify you to take clinical decisions?
Do my 86 published letters in “The Times” refute the possibility that I could be a fuckwit? (Note – you can find one of them in the little anthology “Sir” on page 178)

Of course were I to appear before the Inquiry I would also ask the same questions of the inquisitor, even if he was to try and undermine my evidence by suggesting that I was not an epidemiologist, pulmonologist or intensivist and further that I was so long retired as to be bordering on senility. To which I would then respond that it is quite reasonable to make diagnoses on paper patients (there’s a quiz each week in the BMJ), that being an epidemiologist is irrelevant to clinical management, that I did part of my training at the world-renowned Brompton Hospital in London, that I have managed seriously ill patients in intensive care and that, by way of an analogy, once you have learned to ride a bicycle, or swim, you do not forget how to do it. I have saved lives by giving septicaemic patients high-dose steroids, counter-intuitive as it may seem. Sitting on fancy committees does not necessarily fit you to manage seriously ill patients in an emergency. I would then repeat: if an infection does not make you seriously ill it doesn’t signify (example – we don’t test for common colds and then isolate anyone who gets one). If it makes you seriously ill you need to focus on how and why and then administer the correct treatment. If you are going to apply epidemiologically-based restrictions to an entire population when only 2% of them get seriously ill you are wasting resources.

I might also mischievously ask how many letters he has had published in “The Times”.

I have written many tens of thousands of words in the public domain. I have written to government, government health advisers, the media, the medical press. I have never had a formal response. I doubt my own submission to the Hallett Inquiry will be taken seriously; after all, I am “only a rheumatologist”, and a retired one at that. I have observed the self-serving evidence of the Chairman of the British Medical Association whose main aim appeared to be to protect doctors and who has not listened to clinical advice. If one is to be consistent one could argue that he hasn’t a clue because he’s not versed in epidemiology, he’s “only a gynaecologist”.

Professor Heneghan asked in his latest blog whether he should bother to go on with his Covid analyses. I don’t think he should. However others have disagreed, and he is going to persevere. When I expressed my own doubts about continuing to blog some while ago I had a number of readers asking me to go on. I am grateful to them for their confidence, but there comes a time to stop banging one’s head against a brick wall, and for me that time has come. I shall continue to watch this space but comment rarely. The Hallett Inquiry, unless there is some dramatic change, will be a useless whitewash and as four years of my attempts to help have been spurned, and I expect to be unable to put my views in person, the time has come to talk of other things – or, given the other horrors in the world, bury my head in the sand and hope it will all go away.

PS I hope my diary will become a book. I might revisit in a few years when the Inquiry is complete. Regular readers might like to look at my book “Mad Medicine” (available on Amazon) and thereafter understand oxymoronic medicine and deja vu. I might blog on other “many things” but two novels call.

The Wry Observer’s Covid-19 update (227): Don’t know, don’t do

A few years back we were on a trip to New Zealand, where I had been asked to give three lectures at a conference in Auckland. We had decided it was pointless for me to fly there alone and straight back, so we arranged a tour encompassing Dunedin, Queenstown, the west coast of South Island, a drive across to Christchurch (I got a speeding ticket then), flight to Wellington and a drive to Napier before returning to Auckland.

While in Queenstown we arranged a trip to Milford Sound in a small plane. I loved it. My wife did not, not helped by our homestay owner asking jocularly as we set off for the airport whether we had made our wills. I had promised my wife a larger plane than the six-seater we had. The scenery as we crossed the mountains was amazing and as it turned out the pilot had been a barman in one of our local pubs in England. After we had landed, he said we had been lucky as the weather forecast the next day was for cloud, so he would not be flying. My wife asked why not. “Well,” he said, “You can never tell whether a cloud might have a hard centre”.

That’s a long anecdote to illustrate a principle. The principle is – if you don’t know, perhaps you should not take a chance. Clouds can hide mountain tops. But in medicine there are many “don’t knows”, and while it might be acceptable to judge the risk-benefit on an individual basis it may not be appropriate to apply a blanket approach for an entire population.

Of course, if you don’t know that there is a risk you might construe that as being that there is no risk. But if you don’t know… well, you don’t know. And what if someone raises the possibility of a risk? Would you still plough on regardless, or would you wait until you knew for certain?

There’s an Arab proverb: “He who knows not, and knows not he knows not, he is a fool—shun him; he who knows not, and knows he knows not, he is simple—teach him; he who knows, and knows not he knows, he is asleep—wake him; he who knows, and knows he knows, he is wise—follow him.” My father added another two: “He who knows not, and knows that he knows, is dangerous – avoid him. But he who knows, and knows that he knows not, he is wiser still – take heed, for he has true understanding”.

I would like to think I am one of those last…

I posted a response to an essay on the Net as follows in response to one of the growing number of analyses of Covid vaccine risks:

“One thing bothers me, and always has – with this and all other disputed items [the issues of Covid and climate change have become interweaved]. If the so-called vaccine deniers who have done careful analyses of available data, like this, are wrong, why are these analyses not properly and scientifically debunked? All we get is bluster, very occasionally quoting improperly conducted trials. There is of course a good reason they are not debunked, and that is because they are correct. Am I wrong?”

I only had 24 “likes” but that’s 22 more than any other of my responses. And this concern is especially important right now as there are official mutterings about the worry of a coronavirus resurgence and the need for booster vaccinations. But there are many unknowns. What is the real risk of post-Covid vaccination myocarditis? What are the potential risks of DNA contamination of M-RNA viruses? Could the introduction of plasmids cause short or long-term changes within cells that have substantial and perhaps frightening consequences?

The answer is – we don’t know. Maybe, but maybe not. The research has not been done (or if it has the results have not been revealed). Given the potential risk, particularly the long-term risk of incorporating foreign DNA into cell nuclei, would it not be wise to suspend vaccination programmes until we do know?

This link underlines the potential problem; also see this one and this one.

And this which underpins my “Don’t know, don’t do” argument: here Maryanne Demasi interviews Phillip Buckhaults, a cancer genomics expert at the University of South Carolina. Initially fearing that a report by another expert, Kevin McKernan, on the risk of DNA contamination was “conspiracy” he decided to debunk the work, only to find out that his own investigation confirmed it. In a remarkably balanced and non-polemical set of answers he makes the point that there may be risks – but we don’t know whether there are, what they are and, if so, how big they are. He suggests “It’s possible that long bits of DNA that encode spike are modifying the genomes of just a few cells that make up the myocardium and cause long term expression of Spike… and then the immune system starts attacking those cells… and that’s what’s causing these heart attacks. Now, that is entirely a theoretical concern. But it’s not crazy and it’s reasonable to check.”

You can access McKernan’s paper here.

That’s an awful lot of concern. It needs to be allayed.

And here’s a ruthless takedown of a paper on vaccine effectiveness.  Oh boy.

I have tried to avoid mixing my Covid posts with things about climate change but the above principle of “Don’t know, don’t do” also applies to that. There is undoubtedly climate change and there always has been. Is what we are seeing now due to human activity? I think some of it is, but it may pale into insignificance compared to the effects of sunspot activity, volcanic eruptions and other natural disasters and I suspect that the contribution of fossil fuel use may be less important than deforestation and water diversion (see Brazilian rainforest and Himalayas for examples of the first, and the shrinking of the Aral Sea for the second). Does an increase in CO2 actually matter? Probably not, as it will aid plant growth. Is global warning as bad as is being made out? Probably not, as temperature measurements are distorted by changes in the local environment of sensors (for example, by becoming more urbanised, or in the most egregious case of the UK’s hottest day ever in 2020 being caused, extremely short-term, by jet aircraft roaring past the sensor with their afterburners going). Most of the “need for change” is driven by modelling, so is no more than prophesy, not least if the models have garbage going in, for then garbage will come out. Many people have raised serious and credible concerns on this and pointed to the reality of observational data which contradicts the prophesies and even the here and now (Great Barrier Reef coral bleaching has reversed; Antarctic warming and ice loss is over the top of active underwater volcanos; the biggest greenhouse gas problem came from the Tonga volcanic eruption which threw vast quantities of water vapour into the high atmosphere), but I have yet to see any serious and credible counter-argument explaining why the sceptics who state these facts are wrong. If there were such arguments, surely they would and should have been deployed. That they have not lends credence to the accuracy of the sceptics’ views and makes one wonder whether the whole climate crisis is just an artificial one that has somehow turned into a cult. If the major drivers of climate change are natural phenomena we are only fiddling with the fringe – the old 1%-99% argument. And that’s before we examine the other side of the coin: is Net Zero economically feasible? Is the overall cost of going electric higher than the cost of the status quo? Can we go all-electric when there are insufficient charging points and the demand on the National Grid will be unmanageable? I fear our politicians and some of our scientists are people who know not and know not that they know not. Maybe some are beginning to grasp reality, but the rest are, as in the proverb, fools. Some are in the know not, but know that they know group, and are dangerous. If we don’t know, let’s not do until we do know, and meanwhile beware of false prophets.

I am not alone in thinking this. Only today David Seedhouse posted a piece on the “Daily Sceptic” site, which he concludes by saying

“We are constantly bombarded with unanalysed assumptions, often presented to us by people with obvious vested interests. Some years ago there was a variety of ways to challenge these assumptions. For example, decent journalists in serious publications would do this and these challenges would filter into the public consciousness. But this seems to happen less and less in the mainstream, where ‘experts’ are presented as authoritative voices on X or Y simply because they say they are, or have a prestigious title, and it is impossible to challenge them directly.

The failure to think deeply, the abandonment of reason, the rush to the preferred conclusion, the desire – even the need these days – to go along with the majority view without questioning it – these are symptoms of a cultural descent into myth, superstition and collective madness. The truth is what we want it to be and what our ‘experts’ say it is and that’s all you need to know.

I submit that this abject thoughtlessness – not ‘the climate crisis’ – is the real ‘test of our times’.”

Hear, hear.

Of course the fool on the hill, in the Beatles song, is actually wise: he sees “The sun going down, but the eyes in his head see the world spinning round”… the most profound Beatles lyric ever? A nod to the sceptics of old – Galileo and Copernicus?

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Here’s a piece that will make everyone think; Raw data for “Unnatural evolutionary processes of SARS-CoV-2 variants and possibility of deliberate natural selection” | Zenodo 

The abstract reads: 

Over the past three years, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has repeatedly caused pandemics, generating various mutated variants ranging from Alpha to Omicron. In this study, we aimed to clarify the evolutionary processes leading to the formation of SARS-CoV-2 Omicron variants, focusing on Omicron variants with many amino acid mutations in the spike protein among SARS-CoV-2 isolates. To determine the order of mutations leading to the formation of the SARS-CoV-2 Omicron variants, we compared the sequences of 129 Omicron BA.1-related, 141 BA.1.1-related, and 122 BA.2-related isolates, and attempted to clarify the evolutionary processes of SARS-CoV-2 Omicron variants, including the order of mutations leading to their formation and the occurrence of homologous recombination. As a result, we concluded that the formation of a part of Omicron isolates BA.1, BA.1.1, and BA.2 was not the product of genome evolution, as is commonly observed in nature, such as the accumulation of mutations and homologous recombinations. Furthermore, the study of 35 recombinant isolates of Omicron variants BA.1 and BA.2 confirmed that Omicron variants were already present in 2020. The analysis showed that Omicron variants were formed by an entirely new mechanism that cannot be explained by previous biology, and knowing how the SARS-CoV-2 variants were formed prompts a reconsideration of the SARS-CoV-2 pandemic. 

Now this is only a pre-print and being a natural sceptic I will only say that if what they say is true it is extremely worrying. You can also find an analysis of it at “Unnatural evolution”: indisputable evidence for deliberate and systematic creation of circulating covid variants (substack.com). I will let readers make up their own minds. 

In the three years that I have been blogging on the SARS-CoV-2 saga I have never been trolled, until last month when I posted a response to an article on another site suggesting that the serious illness of Covid-19 was in fact a bacterial pneumonia. Shades of the Spanish Flu suggestion… I responded with a brief summary of my cytokine storm theory to be told that I should not bother with unreliable textbooks (I had cited Cron and Behrens, referenced here many times). Well. I was delighted to find someone who had actually read it and asked for an explanation of why they found it unreliable. I was then asked for my area of expertise, which I provided, to receive a summary of theirs. Once again I requested a critique. No, came the reply, I have never read it. 

Is this what medical science has come to? On the one hand doing gain of function research that kills people while on the other offering put-downs having not examined the evidence? I despair. Sadly the whole process of scientific research seems to have been affected (infected?). It is quite appalling that one must distort one’s results into a form that editors, or the majority consensus, finds acceptable or the work remains unpublished. In case you don’t know what I am referring to see I Left Out the Full Truth to Get My Climate Change Paper Published | The Free Press (thefp.com). For balance also see Editor of Nature journal slams climate scientist Patrick Brown’s ‘highly irresponsible’ research after he said publications reject studies that don’t ‘support certain narratives’ | Daily Mail Online. 

I am not clear from the second piece whether it is Brown’s research that is highly irresponsible (in which case why was it published) or the post-publication statement he has made. I know which I think, but you decide! 

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An interesting link… I didn’t listen to the podcast but read the transcript of “Dismantling The Covid Pandemic & mRNA “Vaccine” Narratives” at https://wherearethenumbers.substack.com/p/dismantling-the-covid-pandemic-and?utm_campaign=reaction&utm_medium=email&utm_source=substack&utm_content=post and responded as follows:

I agree that the virus origin is irrelevant, though the politics of it are interesting. Two things you missed out. First, ventilation contributed to deaths. The lung pathology in severe Covid is alveolar leakage and no amount of ventilating will beat that – indeed, it will make things worse. Pierre Kory has written an elegant exposition of this (https://pierrekory.substack.com/p/the-premature-use-of-mechanical-ventilation). Second, the underlying mechanism of the severe systemic effects is a cytokine storm (which, as it happens, can be provoked by other viruses) probably generated by the original version’s spike protein. The huge peak in deaths was due to ventilator misuse on the one hand, and failure to deploy treatment for the cytokine storm on the other. Once this was done using steroids and tocilizumab, pari passu with the spike protein mutation resulting in a much decreased risk of CSS, the fatality rate plummeted. My experience of attempting to bring the second point to the attention of the UK authorities underlines the resistance of those authorities to any hypothesis that challenged the “Settled Science” view; the refusal of said authorities to admit their mistakes; and the virtual impossibility of a retired physician (me) to get my points across. I would argue further that by the time any infection is at risk of being identified as a pandemic it is too late to stop spread; if most people don’t get sick it doesn’t matter, and if a few do get sick then the proper treatment must be instigated immediately. I outlined an investigation and treatment protocol in the UK in May 2020. Bits of it were adopted by January 2021. How many deaths might have been prevented had there not been an 8 month delay?

Last week we went to see the play “Dr Semmelweis” starring Mark Rylance. A remarkable performance. Apart from being brilliant some of the dialogue describes attitudes of those in authority identical to those of today, with failure to be critical of old ideas and listen to new ones. The one big difference is that today’s Semmelweis’s are somewhat less confrontational than the original, though not a lot of good does that do us! The Simon and Garfunkel song “The Boxer” expresses it well… “a man hears what he wants to hear, and disregards the rest”, which I referenced in September 2020. Why does this persist despite all the evidence that it is foolish and wrong? At least as yet I have not gone mad, unlike poor Ignaz Semmelweis. Neither (so far as I know) have any of the other dissidents who have been rather more publicly cancelled than me – Carl Heneghan, Norman Fenton, Jay Bhattarcharya, Sunetra Gupta, John Campbell and Pierre Kory among others – although some of our offerings have perhaps become a little more intemperate as frustration has built up.

An editorial in the BMJ caught my eye; “Where now in the danse macabre of covid-19 and misinformation?” (BMJ 2023; 382 : p1884; https://www.bmj.com/content/382/bmj.p1884). I responded:

“You ask a few questions but let’s be clear about terminology before we conclude that Covid-19 is on the rise again. I have said before that Covid-19 is a subset of those infected with SARS-CoV-2 – a subset that develops a systemic hyperimmune reaction or cytokine storm. So while SARS-CoV-2 infections may be rising, what evidence is there that these new infections are causing those infected to be hospitalised? The new variants appear to have a spike protein mutation that is far less immunogenic, so if Covid-19 admissions are not rising there is no need to panic.

Your questions, and my answers:

 What are now the right policies for protecting vulnerable people and limiting transmission in healthcare settings?

We cannot protect anyone from acquiring the infection, either by lockdowns or vaccination, as the data over the last two years has clearly demonstrated. There is no good evidence that masks work, , as the last Cochrane review indicated. What we can do is identify at-risk groups and ensure that they are rapidly investigated, and treated, at the first signs of infection translating to a hyperimmune state (incidentally there has been little reaction to the studies suggesting that patients with rheumatoid arthritis on biologics have a lower risk of developing Covid-19 following SARS-CoV-2 infection, implying that immune suppression may actually be beneficial) (1-3).

Does anything need to be done to prevent transmission among the general population?

On the basis that the vast majority of the population who are infected do not become seriously ill – no.

Why, when accountability on behalf of those most affected must be paramount, is the UK’s Covid inquiry failing to be responsive to bereaved families?

I disagree that bereaved families are not receiving a response from the Inquiry. They have already been given ample opportunity to present their stories. But I cannot see how this will help us either to decide what these stories add to either the issue of what was done wrong, or how they will inform future preventive measures. They are tragic, sad and irrelevant.

What was done wrong in the initial stages was to fail to listen to those who understood quite early the mechanism of why people got seriously ill, and the failure to administer in a timely fashion the treatment that might have saved many of them – treatment that required no trial, because it was already identified.

1. Favalli EG, Monti S, Ingegnoli F, et al. Incidence of COVID-19 in patients with rheumatic diseases treated with targeted immunosuppressive drugs: what can we learn from observational data? Arthritis Rheum. 2020;72(10):1600–1606.

2. Ddf N, Leon L, Mucientes A, et al. Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79(11):1393–1399.

3. Murray K, Quinn S, Turk M, et al. COVID-19 and rheumatic musculoskeletal disease patients: infection rates, attitudes and medication adherence in an Irish population. Rheumatology. 2020. cited 2020 Dec 30. Available from: https://doi.org/10.1093/rheumatology/keaa694“

Arvind Joshi from Mumbai asked:

“If I understood what Dr Andrew Bamji has said, it means:

1) Masks, Lockdowns, Vaccines are not able to protect people from getting CoVID-19.

2) Immunosupprssants mitigate manifestations of CoVID-19.

Shall/should this be taken as gospel truth?

Do we need a consensus statement?

Since CoVID-19 cases have already risen 80% according to a recent statement by WHO, there is good scope for trials aimed at verifying Dr Andrew Bamji’s views. Should such trials be undertaken at the earliest and in earnest?

This is not to doubt Dr Andrew Bamji’s views, but to put these views to use if found correct.”

And I replied:

“Dr Joshi asks whether masks, lockdowns and vaccinations protect against SARS-CoV-2 acquisition.

The most recent Cochrane review of masks found that there is no clear evidence of benefit from mask-wearing. That is not to say that they don’t work, merely that the evidence does not prove it, but if one considers the likelihood that a flimsy paper or cloth mask can filter out viral particles, plus the evidence for transmission by touch, it is theoretically unlikely.

Lockdowns cannot work because they can never be complete. In the UK the number of exemptions for critical workers (not just in the health service but also in public transport and logistics) provide ample opportunity both to catch and spread any infective agent. Furthermore if those exempted bring it home to a closed environment the likelihood that they will give it to their cohabitees is extremely high.

It now appears generally accepted that vaccination cannot interfere with spread, not least because so many vaccinated people acquired the virus (myself included). Whether the risks (such as induction of myocarditis and coagulopathy) outweigh any benefit (such as reduction in severity) remains unproven, not least as there are confounders such as the reduced risk of developing Covid-19 from newer mutant strains whose spike proteins are less immunogenic.

As for immune suppression, I highly recommend the textbook on cytokine storm syndrome by Cron and Behrens (Springer, 2019), which gives the rationale for using steroids and immunological agents such as IL-1 and IL-6 antagonists. Dexamethasone was trialled in Covid-19 and proved to be effective, and this together with tocilizumab are currently recommended in those developing a cytokine storm syndrome from SARS-CoV-2. Never mind that Cron and Behrens describe their use in cytokine storms caused by other things (including other viruses) which in my view rendered any trial in Covid-19 unnecessary. It is not hard to believe that pre-existing treatment with these might have modified the risk of developing Covid-19.”

Dr Joshi’s further response suggests he is happy with my analysis. There are no critical or debunking ones, which suggests either few people read the responses, or there is not a lot wrong with my argument. Misinformation? I think not and certainly hope not.

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Various bits of news require an update for completeness.

The release of correspondence casts more doubt on The Lancet article that firmly denied the possibility of a lab leak in Wuhan. Although it appears that some of the senior players had their doubts, the party line seems to have been toed out of political expediency. Such interference bodes ill for the future of scientific and medical research, although we are (mostly) only too aware of the bias introduced by the suppression of publication of drug trials that fail to show benefit.

The problem of post-vaccination myocarditis is explained in an article/blog which turned up in my inbox yesterday (although it appears to be a year old). See https://wmcresearch.substack.com/p/spike-protein-induced-cardiotoxicity?utm_source=cross-post&publication_id=770713&post_id=135784167&isFreemail=true&utm_campaign=516896&utm_medium=email

Note the role of TNF and IL-1. I have suggested that anyone with symptoms or signs of trouble should have steroids as soon as possible. Apropos immune mediators it’s also interesting to see the early apparent success of biologics administered intrathecally to reduce amyloid formation in Alzheimer patients. It’s over 12 years ago that the Professor of Rheumatology at Guy’s Hospital, Gabriel Panayi, noted the disappearance of renal amyloid in patients with rheumatoid arthritis treated with TNF blockade, and I suggested back then that they should be tried in Alzheimer’s. Ahead of the game again…

There are rumblings about a new Covid wave that will be caused by a subtly different variant of Omicron. This has caused an Omigod reaction with loud screams in the media. Yet increasing analysis of historic data leads one to think – what fatal wave? It’s time to stop panicking. Not only should one not cross one’s bridges until you come to them, but you should not worry about crossing those bridges until you are sure that there are bridges. There’s enough unnecessary panic about. Don’t start me on climate change (I have kept that out of this blog, but if you want my sceptical views you can find them in my Substack blog at https://drandrewbamji.substack.com/); just to add that the latest evidence for why global temperature has risen this year is because of the massive release of water vapour into the stratosphere following the Tonga eruption. Fossil fuel use pales into insignificance. If Nobel prizewinners in Physics don’t believe the climate change mantras then neither will I. I mention this because there is a common thread; climate change prophesy is based on computer modelling just as pandemic death risk is. GIGO (or for the acronym virgins, garbage in, garbage out).

All quiet on the Inquiry front.

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The Heneghan/Jefferson dialogue on their “Trust the Evidence” blog underlines the disappearance of the Hallett Inquiry from the news now that the Big Beasts have given their evidence, which wasn’t worth much anyway. Having trawled through the module list again I looked at the core participants and was perhaps unsurprised to find that they were almost without exception people who could have had no insight into the pathological mechanisms of Covid-19. As for the module remits there is but one sentence in the Vaccines and Therapeutics module that gets to the heart of the matter – when people get very sick with Covid-19, how should they have been treated. I am somewhat concerned that they are going to spend time analysing trials, which I have stated many times were unnecessary.

When will the clinicians (hello, here I am!) get their chance to explain things? I am still waiting to be called… never mind that I am retired, medicine in many ways is like swimming or riding a bicycle, you never forget how to do it. A single case will, if significant enough, stick in the mind forever. Significance can take many shapes; amusing, challenging, upsetting, revelational, oxymoronic among others. There are many examples in my book “Mad Medicine” (https://www.amazon.co.uk/Mad-Medicine-maxims-National-Service/dp/1688011897) which any student of medicine or the NHS would do well to read, not least so they don’t fall into the traps that I did or underestimate the importance of institutional memory.

(Written 13th July)

The Wry Observer’s Covid-19 update (222)

Well, I am obviously insignificant, as I have had a response from the Department of Culture, Media and Sport saying that the Counter-Disinformation Unit does not have me on its list of miscreants. But that means I still do not know why my email account is on a spam list and I dislike being insignificant. Meanwhile, as I watch the Hallett Inquiry grind on with ever-continuing ill-thought justifications emanating from people who should know better, we spent a splendid Friday at the Headingly Test Match – full day’s play, bright sunshine all day – taking our leave to beat the taxi queue just before Khawaja was caught by Bairstow off Woakes, and hearing the roar from underneath the West Stand. Oh, the glory of mobile phones. We got an instant replay. Tonight – a concert. Normality is returning, though I have a nasty cold that went straight to my chest. That was all I brought back from Leeds; memories of Covid from Cardiff. Maybe it is safer to stay at home. Better soon!

The Wry Observer’s Covid-19 update (221)

My despair over the progress of the Hallett Inquiry deepens. To start with on the website it announces itself as the Covid-19 Inquiry. Which it isn’t. It’s an Inquiry into the SARS-CoV-2 pandemic of which the clinical syndrome of Covid-19 is but a small though significant part.

So far evidence has been taken from a number of people, listed below.

Jimmy Whitworth                    Epidemiologist

Charlotte Hammer                 Epidemiologist

David Heymann                       Epidemiologist

Bruce Mann                            Civil servant

David Alexander                      Risk and disaster reduction

Michael Marmot                     Epidemiologist

Clare Bambra                          Public health

Katharine Hammond              Civil servant

David Cameron                       Politician (Prime Minister)

Chris Wormold                        Civil servant

Clara Swinson                          Public health

Oliver Letwin                           Politician

George Osborne                      Politician

Sally Davies                             Past Chief Medical Officer

Mark Walport                         Past Chief Scientific Adviser (ex rheumatologist)

Roger Hargreaves                   Civil servant

Oliver Dowden                        Politician

Jeremy Hunt                            Politician

Chris Whitty                            CMO

Patrick Vallance                      Past CSO

Jim McMenamin                     Public health

Emma Reid                              Civil servant

Rosemary Gallagher               Civil servant (nurse)

Jenny Harries                          Past deputy CMO

Matt Hancock                         Politician

Duncan Selbie                         Public health

Gillian Russell                          Civil servant

Caroline Lamb                         Civil servant

Jeanne Freeman                     Civil servant

Some have expertise in infectious diseases and public health, many do not (politicians and civil servants, although some of the latter may I suppose have had medical or nursing training) and only one of whom, in my opinion, could possibly have any experience of managing patients with immune-mediated diseases. While I am sure that some are very good at planning for disasters they are irrelevant to the key concept of Covid-19 – which is that, for some people who are infected with SARS-CoV-2 and get very sick, it is because they have developed a hyperimmune state. And if that is the key concept, what the hell are all these people doing here? Why plan for a disaster if, for the vast majority of the population, it isn’t going to be a disaster? It is clear from Matt Hancock’s evidence that he in particular has failed to understand this, by suggesting that stricter lockdowns (anyway impossible) might have reduced deaths and that there was over-concentration of dealing with the deaths. What about looking at why people died and then stopping them from dying? We now know that countries without lockdowns (Sweden) have lower excess mortality than countries that did lock down, so the idea that a more ruthless lockdown would have prevented deaths is an oxymoron. There is this philosophical block in thinking that refuses to acknowledge that you do not need restrictive measures for a widespread organism that doesn’t kill people, so you do not need to discuss planning, disaster management, public health matters, vaccination, anything.

OK. What about my one expert who might have had something useful to contribute? Sir Mark Walport, once a rheumatologist whom I know well.

I began to watch his evidence but as this would have taken up two hours of my time I read his witness statement instead. It is worth reading as it discusses many of the issues of risk reduction and mitigation (see https://covid19.public-inquiry.uk/wp-content/uploads/2023/06/21183841/INQ000147707-1.pdf).  However it is heavily focussed on just those two parts, and the place of government and civil service in designing them, with a single line comment that the response has been discussed elsewhere (I am not clear where, or what is contained in “response” – perhaps this is in written evidence I have not seen). He was involved with risk assessments for Ebola and Zika, and in particular I noted the conclusion that the risk of the latter in the UK was zero because the only vector of transmission is a mosquito that isn’t present. I also noted his equivocation on the value of masks and his comment that “Although there were very many researchers and other expert advisers attending and contributing to SAGE, there were very many who were not. Amongst these were many who had deep expertise and very strong opinions as to what should be done and many who had little expertise but nevertheless had equally strong opinions.” But he offered no elaboration on what was done, or should or should not have been done with these non-contributors to SAGE. A pity. I would like to know, as someone who places themselves in the first category, why SAGE and government chose to ignore us.  But I was also hoping that Walport, an experienced ex-rheumatologist, would offer something about the clinical aspects of SARS-CoV-2 and Covid-19. He did not. Also a pity.

The Wry Observer’s Covid-19 update (220): The Hallett Inquiry sets sail

The Hallett Inquiry is at last under way, and before even a day has passed there has been widespread criticism of its structure, preconditions (such as an apparent requirement for participants to wear masks and have lateral flow tests) and already there is a suggestion that the result will be a foregone conclusion because it is following the government’s agenda. I hope not.

To me the Inquiry modules seem reasonable, although there will be substantial overlap between them, which will make it difficult for witnesses to get across their full message. My initial concern is that the thing has started upside down. While I have enormous sympathy for the grieving relatives of those who died I fail to see any benefit in a long queue of people holding photographs, hoping to recount their stories at length. We have already heard many of them before, and while they are distressing they add nothing to the thrust of what the Inquiry should be, as they are a consequence and not a cause. All they can contribute is an emotional catharsis, not a scientific judgement.

Was there sufficient planning for a pandemic? Yes. It was done at length over ten years ago. Was the plan implemented? No. The hysteria induced by stories and videos from China and later Italy, amplified by the media, provoked panic along our politicians, who adopted a “me too” approach and locked down. Did lockdown work? No. There were too many exclusions. It was always going to be too late; by the time it was appreciated they there was a major problem the virus was out there and unstoppable. Hospital patients were discharged untested to care homes, thus upping the risk in these, to which was added the movement of staff between care homes.

What was the response of the health service? Panic again. Once the virus was in hospitals nothing short of body suits and respirators would stop spread. Standard masks were useless, not least when worn on the chin. The presumption that serious illness was just a pneumonic issue was a serious error and ventilation probably killed more people than it cured. The predictive experts or modellers were wildly off – perhaps unsurprising as their track record in previous epidemics was appalling. – but policy was based on worst case prophecy and not real data. Adjustments to death certification made the death rate look far worse than it was, despite requests to distinguish with COVID from from COVID. Testing was inappropriate and improperly policed, with the PCR test being interpreted differently in different labs, without regard for the oversensitivity causing non infectious people to be forced to isolate.

While the roll-out of vaccines was impressively speedy hindsight has shown (although it might have been predicted from previous attempts to vaccinate against respiratory viruses) that the programme was flawed. There is little point in vaccinating those at no risk of serious disease. Vaccination did not produce longer-term immunity, nor did it affect transmission. Despite repeated requests for caution, especially when some apparently significant side-effects occurred, those who counselled greater care and outlined porr pharmacovigilance – sacrificed in the name of speed – were vilified as “anti-vaxers”. One effect of both the virus and the vaccine was to cause myocarditis (a function of the immune response to introduction of the spike protein) but the official narrative ignored this and continued to maintain that vaccination was safe (which is probably isn’t in some cases) and effective (which it certainly isn’t). Another worrying subject is what is actually being injected; it is not an antigen, but an RNA sequence which, once in a cell, promotes the production of an antigen to which the body then mounts an immune response. So it is not a vaccine in conventional terms but a form of gene therapy. Furthermore there is evidence that the RNA sequence is not the only introduced element, but subcellular components or plasmids containing DNA accompany it, and these can persist. If so – and there is no evidence either way – this might explain the development of “Long Covid”, which itself appears to be no different from other postviral fatigue syndromes.

With the mindset of “Settled Science”, which is in itself an oxymoron, much of the debate on all of this has been suppressed and indeed it now transpires that a government group, the Counter-Disinformation Unit or CDU, deliberately arranged the censorship of critics. Science is never settled. New research provides new explanations and hypotheses; old research is subjected to critical analysis that may disprove a conclusion. Ventilation is a case in point; it is now clear – and should have been if based on sound physiological principles – actually contributed to severity and death.

Can any of this influence future planning? Of course not. After the First World War immense planning was undertaken by the French to avoid a further invasion in the building of the Maginot Line, but it was incomplete and the Germans anyway went round the back. We have no idea what form any future pandemic might take; respiratory, neurological, gastrointestinal etc. So I recommend that no future planning takes place until we know what the enemy really is. It reminds me of the NHS planning for a nuclear war in the mid-1970s, when it became apparent that the logistics of inter organisational communication were impossible, so we decided to await the reality rather than speculate on imponderables. One might add that “modelling” – which is little better than prophesy by the Delphic oracle, has proved utterly useless in every infectious disease scenario in which it has been employed. For planners to continue to rely on the discredited would be a big mistake.

As for treatment… I have done to death my explanation for serious illness. But no one listened. No one had read the seminal textbook. None of the “experts” were clinicians, which makes it all the more incomprehensible that they didn’t listen to those who actually treated the patients. This for me is the nub of the problem. If a virus doesn’t kill people it is of no consequence. If it does, then the reasons why need to be understood and the right treatment instituted. Forget isolation and vaccination; they are unnecessary, not least if they don’t prevent spread (they don’t) or diminish they risk of serious illness (they don’t).

A group of US physicians got the treatment right in March 2020. I sent my own, similar recommendations to the DoH in May 2020. Nothing happened, except someone hypothesised that steroids might be a good idea, and a trial was set up, which was completely unnecessary as they were of proven success in other forms of hyperimmune state, as was tocilizumab. I had recommended both. The trial proved what was already known but resulted in a six month delay in institutional use, by which time the virus had mutated and the risk of serious illness markedly reduced. One might therefore argue that if the correct treatment had been correctly deployed in the fist wave against a virulent and dangerous organism then many deaths would not have occurred – and the later reductions in hospitalisations and death had more to do with diminished virulence that any preventative measures.

The Inquiry must not be led up a blind alley over risk factors. Certain ethnic groups are genetically predisposed to develop hyperimmune states as a result of different triggers. This predisposition is chromosome related. Social circumstances may influence acquisition but not severity. Obesity possibly increases risk through hormonal mediation. Leptin, produced in fat cells, is a pro-inflammatory substance. There is no actual or theoretical reason to presume that deaths were due to inequality, deprivation or racism. I believe that any contributor to the Inquiry should, as a prerequisite, read “Cytokine Storm Syndrome” by Cron and Behrens. Failure to do so condemns their evidence to be dismissed as junk.

The Wry Observer’s Covid-19 update (219): What are they, and who are they?

A splendid Coronation. The fact that I mention this is to remind myself that I started writing this a month ago, but a funeral and a wedding at some distance took a couple of weeks out, and thereafter the allotment needed weeding.

So – a piece appeared in the BMJ entitled “What are the latest covid drugs and treatments?” (BMJ 2023; 381: p872 (doi: https://doi.org/10.1136/bmj.p872, published 3rd May). They might not have been deemed the latest had I been listened to, so I responded:

“It is pleasing to see that steroids and interleukin blockers for Covid appear at the start of this article, an acknowledgement at last of what I stated in May 2020 – that the serious illness of Covid-19 is a hyperimmune response, or cytokine storm syndrome (CSS). However I remain puzzled by the continuing search for antiviral agents, the success of which with other viruses has been very poor.

If a virus makes you a bit ill then it requires no treatment. If a virus makes you seriously ill through a clearly defined mechanism for which treatment is available then (a) you need to identify developing serious illness and (b) administer appropriate treatment. The diagnostic tests for showing the development of CSS are clear. The treatment is clear. As only a small percentage of those infected with SARS-CoV-2 go on to develop CSS, and most have little more than a bad bout of flu, I see no need to provide antiviral drugs (or, for that matter, vaccines (or gene therapy in this case, not least as immunity conferred by infection seems superior to that conferred by vaccines). One can, certainly, be on the lookout for those who might be more at risk because of underlying disease, obesity or racial origin but the best predictors of serious illness remain oxygen saturation, platelet count and acute-phase reactants such as D-Dimer and ferritin. Thereafter early treatment with steroids, tocilizumab and anakinra should be obligatory.

The debate on Covid-19 has been hijacked by those who apparently fail to see that preventing transmission has been a complete failure. All that is needed is treatment for the serious illness- and that we have, and indeed had before the Covid pandemic, as anyone who had read the definitive CSS textbook by Cron and Behrens would know.”

In the intervening month the usual arguments have raged; lockdowns do or don’t work, the virus did or didn’t originate from the Wuhan laboratory, the gain of function research which did or didn’t happen was outsourced to Wuhan from the US following the moratorium there on gain of function research, vaccines do or don’t prevent transmission, vaccines were or were not properly tested, children and young adults do or do not need to be vaccinated, government was or was not duplicitous, its members should or should not submit unredacted WhatsApp messages to the Hallett Inquiry, critics were or were not flagged by a secretive committee called the Counter-Disinformation Unit. A lorra stuff. In the context of my BMJ response most of it is irrelevant to patient management and I hope Baroness Hallett will treat it with the scant respect any of it deserves.

But the critics are still being targeted. This week’s BMJ carries a report “Doctors launch bid to challenge GMC over its failure to act on “high profile doctors” who spread vaccine misinformation” (BMJ 2023; 381: p1220; doi: https://doi.org/10.1136/bmj.p1220 published 26th May 2023). This is the most appalling thing. The report says that a group of doctors have launched a campaign to fund legal action against the General Medical Council because said council has been “reluctant” to investigate doctors accused of vaccine misinformation. I do wonder whether this group understands the difference between misinformation and disinformation; it would be embarrassing if it doesn’t. But more importantly the group wishes to remain anonymous – and the “high profile” doctors they accuse remain unnamed, and their supposed misinformation is unidentified.

I wrote a response:

“I think it is irresponsible of the group of doctors working with the Good Law Practice to remain anonymous. By remaining so it denies others the ability to determine whether they have any conflicts of interest. Do they have something to hide? Are they government medics? Do they have funding from vaccine manufacturers? By the same token it is important that we learn who are the “high profile doctors” they are complaining about. Or indeed what the exact details of the “misinformation” is. There is no transparency here.

There remain substantial concerns over coronavirus vaccines, which are anyway not strictly vaccines at all, but gene therapy. There is substantial evidence that they do not protect against viral acquisition, do not influence transmission, that their effect is short-lived, that they can provoke serious side-effects (not a surprise, as the virus can do so too, the immunogenic entity causing myocarditis, among other conditions, being the spike protein). There are questions to be answered about what the “vaccine” is supposed to be protecting against in the very low risk young population, the risk of introduction of DNA contaminants and the absence of any longer-term follow-up. Raising these concerns, specifically relating to coronavirus management, does not undermine the general consensus on the effectiveness of traditional vaccines.

I have reviewed a great deal of evidence and my review has raised sufficient doubt in my own mind about benefit and risk that I will not be having another “Covid jab” – and my personal evidence is that I still acquired coronavirus after two jabs and a booster.”

To date there are three others saying essentially the same thing. The BMJ report says the group cites repeated or implied claims that Covid-19 vaccines do not work (which, depending on the meaning of “work”, they do or don’t, so reasonable to ask questions); that harms outweigh benefits (much evidence supporting such a claim, not least as immunity following infection seems to produce a better antibody response than the vaccine, the effect of which is anyway short-lived) and that, without evidence, particular deaths are due to the vaccine (for which claim there is substantial if circumstantial evidence, so it again seems reasonable to raise questions).

By remaining anonymous it becomes impossible to know whether this group’s members are independent, employees of government or the pharma industry, in receipt of grants from that industry and qualified to raise such serious allegations. By not naming the “high profile” doctors they accuse, and by not detailing the supposed misinformation, it is impossible to decide whether the claims are valid. I suppose by not naming names they are protecting themselves from a libel action. I am not a GMC member, but if I was I would be firmly on the side of being reluctant, and were I to be one of these high profile doctors I would certainly be consulting my lawyers.

The report notes the suspension of Andrew Bridgen from the Conservative Party. What he was suspended for was to repeat a quote given him by a high-profile doctor, with which I can see no problem except perhaps for use of the H- word. Two wrongs don’t make a right.

Group – name yourselves, and name those you accuse, or remain tarred as cowardly ignorami. I mentioned this shadowy committee or whatever called the Counter-Disinformation Unit. It exists, and dissenters have been reported to it. One is Dr Ros Jones, a paediatrician and member of HART, who describes her experience in an interview with John Campbell (https://www.youtube.com/watch?v=HvEXX985RKA). I am wondering whether the email interference I have suffered since writing to the DoH, resulting in one email address appearing on a spam blacklist, is because I too have been reported. Watch this space.