The Lockdown Sceptics and Quillette websites have become a vehicle for a bit of a ding-dong between Christopher Snowdon and Toby Young, each using slightly different statistics to justify their opinions. I posted this on Quillette:
The question is: do lockdowns work?
Actually that depends on how you define lockdown and how you define work. If lockdown means total quarantining of the whole population, then it will work (probably). But as a previous correspondent has pointed out that means putting everyone under house arrest. If lockdown means a sort of partial, largely voluntary isolation then it won’t, because there will always be people out and about, spreading virus inadvertently, taking it in and out of hospital (look at the stories of how many people actually acquire it in hospital), bringing it into the country (by all means isolate air passengers; what about the truck drivers?). Even if one family member goes to the shops they could bring it home, and if the home has lots of people in it then they could all get it. Thus, although what we have is called a lockdown, it isn’t.
What do we mean by “work”? If we mean elimination of the virus, dream on. It will get in somehow from somewhere; bear in mind that although everyone thinks the virus came to the UK from Wuhan, in reality it came from France, Spain and Italy. The only virus ever eradicated is smallpox. Coronaviruses mutate and there are dozens of them. Neither is there any need to take drastic measures to combat something that isn’t dangerous.
If we mean reduce the prevalence of the virus, then yes, it does work. Somewhat, given the caveats above. That in turn will reduce the numbers of pateints ending up in hospital, which was the original aim of the first lockdown. But there again what has happened this winter is that people are dying of something that’s been identified, but not dying of “ordinary” flu. So from the point of view of deaths the excess from Covid-19 is counterbalanced by the much smaller number of flu victims. Compare the death rate now with that in 2008-9 or 2010-11; its not that different. Did we lock down then? No.
In terms of whether lockdowns and reductions in incidence are cause and effect my answer would be partly. It’s not possible to prove unless you have a population that isn’t locked down to compare with. But the case numbers remain obscure. Two reasons.
First, false positives. A recent FoI request was put in to ask how many cycles were being used in the PCR test (bear in mind, answers up to 30, OK, between 30 and 40 a bit iffy, over 40, junk, and that’s the WHO speaking, not me). I put the same request in 2 months back and never had an answer; this time there is still no answer for England – with obfuscation as to why – but for Wales? 45 cycles. So the portentous tones of Mr Drakeford are spouting policy based on junk.
Secondly the absolute numbers are useless. There was much angst as the figures rose and rose. But as a percentage of tests done they did not; bar a week or so the percentage of positives remained fairly level. test 200,000 and get 20,000 positives is the same percentage as testing 600,000 and getting 60,000 positives. But at the last count 3rd February, as results take a couple of days to come through) there were 801,949 tests done and 15,450 positives. That’s just 1.9%! And anyway positive tests are not cases.
We can manipulate the stats until we are black in the face and cherry-pick the “evidence” likewise. I put evidence in quotes because the more research is done, the more likely it is that the facts will change, something that non-scientists often forget.
Lastly do lockdowns work, however you define each term, in economic terms? That has a clear answer. No.
So I remain a lockdown agnostic. And I remain at home except for exercise. And today I get my first vaccine dose.
There is more than a touch of the blind men and the elephant. But more importantly I have had my first jab; I truly believe the end is in sight. But it does seem that, in comparison to the acceptance of high death tolls in flu epidemics, we have gone quite mad over this one. It looks as if almost no-one has died of “ordinary” influenza, so all we have done is replaced one potentially fatal disease with another, albeit one with nastier features. I remain sad that there are so many reports of people being admitted to hospital and acquiring Covid while there; I would be very interested to know whether the numbers of norovirus cases has dropped. It’s another one often acquired in hospital, or on cruise ships which sometimes appear to be much the same thing). Although I am reminded by myself that MRSA was often not hospital-acquired, merely hospital-identified.
In my book “Mad Medicine”, which I still urge you all to purchase, I wrote the following two essays way back about 2010:
Talk to many doctors and you will hear them say that their crumbling Victorian buildings had a charm and ambience (feng shui if you will) that is unmatched by a modern glass tower. But is the new building actually better? It may be filled with labour-saving and energy efficient devices but if the glass windows face into the midday sun it will get unbearably hot. And as it is air-conditioned you cannot open the windows. And maybe the air-conditioning cannot be used because the water cooling tanks harbour legionella. So the wards are sealed, and all the miasma of stale breath, infected wounds and sweat is unable to dissipate. This may be why so many modern hospital wards stink – made worse because there are not enough nurses to wash the decrepit patients.
On a personal note I will exempt Torbay Hospital from this diatribe, because the personal care my mother received during her terminal illness was exemplary and gave me hope that if the NHS can return to standards like theirs, all could be well.
The Victorians knew a lot about cross-infection, which is why they built serried ranks of wards separated by open corridors to prevent transport of infectious agents across the whole hospital. Lots of nurses kept the patients clean. Any floating microbes would drift through the ward to the centre, where a coal fire burned constantly, so that air was sucked into the tall chimney and the bugs were incinerated as they followed the air flow. Of course there were side-wards for highly infectious folk and the windows were often left open (or more recently extractor fans maintained flow; one has of course to remember that if the sideroom contains the infection and the main ward holds the immunocompromised then the fan must suck out, not in, while if the patient with no white cells is in the sideroom for their own safety…).
I like the idea of burning bugs. So let’s redesign all hospitals to include a gas or coal heating system, complete with tall chimneys, so the methicillin-resistant Staphylococcus Aureus (MRSA), Clostridium Difficile (C. Diff) and other such can be massacred.
Except we can’t, because with all the hysteria over climate change we won’t be allowed to burn fossil fuel, and electric fires won’t work. Let’s hope for a supervolcano eruption, releasing so much dust that we will have a mini Ice Age and can stop worrying. Or stop third world countries from cutting down their rainforests. Or stop cotton production in Russia so the Aral Sea can re-fill. Sorry. Got distracted.
That’s not to say that old hospitals are perfect. At the Brook Hospital in Woolwich the doctors’ dining room was in a converted ward. A couple of consultants thought the water tasted odd and complained. On the third complaint an investigation began, and the work department were puzzled to find that the water pressure to the drinking water tap seemed rather low. They had a thought, and went up into the roof space, to find the tap was fed from an uncovered cold water tank which contained several dead pigeons.
My musings on the value of old-fashioned techniques for sterilisation reminded me that there is another myth, sadly believed by politicians, that there is an important problem called hospital-acquired infection. There is a problem with hospital infections, but is it rightly named and if we changed a word might it take some of the hysteria out of MRSA?
Let me make it clear that I have no doubt that patients may acquire MRSA or C. Diff during a hospital admission. That’s why we had a policy on my rehabilitation unit that no patient could be admitted without being screened first – not that our bed managers cared, and we had frequent occasion to complain when unscreened patients were dumped on the unit so that A&E patients could be decanted within the four hour target time. Indeed I got into trouble when our experience was reported in “BMA News Review” in 2004 and I was threatened with disciplinary action for breaching the hospital’s whistleblowing policy, which I hadn’t (and it was unedifying to see managers lying about the issue). But MRSA doesn’t spontaneously appear like magic on a hospital ward, does it? I was seized with schadenfreude when, in a letter of response to my resignation, our Chief Executive told me how wonderful the Trust’s success has been in reducing hospital infection – when all he had done was to introduce my seven-year-old plan which he had never read!
One of the good things to come from targets (and the target was to reduce MRSA septicaemia, not actual surface infection) was that our microbiologist had to develop a good data set both to look at numbers of MRSA infections on wards and where in each case it had come from. Analysis over several months in 2009 revealed an interesting but perhaps unsurprising conclusion; the vast majority of MRSA came in from the community. Patients did not acquire it after hospital admission. They came in with it. Of course we all know that out there in the community the district nurses carry it about and the care homes let it spread among their inmates – or that’s how it seemed to me when I compared the lazy, laissez-faire attitude to MRSA colonisation with the stringent curative and preventative measures on my rehab unit. But it underlined the truth – that most MRSA is not hospital-acquired, it is hospital identified. How then it is government writ that a hospital can be penalised for high MRSA rates is beyond me, when its only “fault” is in admitting unscreened patients who are ill, and then testing them! So let’s have a campaign to distinguish acquired from identified, realise the scale of the problem is not that great, and concentrate on dealing with the source – the place where everything is better – the community!
Politicians like to pretend that they have fixed things, and I was particularly amused by a report in the “Sunday Times” in mid-April 2010 in which the then Health Secretary, Andy Burnham, trumpeted the news that good ideas from the NHS were to be exported worldwide – including how to manage MRSA! I found this rich coming from a government that, when my experience on how to manage MRSA was reported, threatened my managers; it was this that resulted in the attempt to silence me with disciplinary threats when all I had done was describe my unit’s good practice.
We went to Venice for a long weekend. I was tempted to visit one of the many shops catering for Carnival and purchase a Venetian cloak and hat together with a plague doctor’s mask, and wear this into the hospital during the next norovirus outbreak…
Prophetic, or what? Sadly I haven’t been able to get to Venice to buy my mask.
Paul Fürst, engraving, c. 1721, of a plague doctor of Marseilles (introduced as ‘Dr Beaky of Rome’). From Wikipedia, entry on Plague doctor costume
Finally a note about yet another new approach to treatment – Allocetra, which “resets” the immune system (see https://www.enlivex.com/, or for a more detailed slideshow of why macrophages are reprogrammed go to https://www.enlivex.com/wp-content/uploads/2021/01/enlivex-investor-presentation-jan-2021.pdf). It appears to be unrelated to the song of the same name by GHIML, whoever they are.
 This was brought home to me as an SHO at the Hammersmith Hospital, when the team visited a sick and septic patient in a sideroom on the haematology ward, which was full of aplastic and neutropenic patients. My boss, neurologist Nigel Legg, spotted the fan was going the wrong way so the bugs, instead of being sucked out of the window, were blowing under the door into the ward. As we shut the door to leave he looked down, stamped his foot carefully and grinned at us “Got one!” he said.
 Andrew Bamji, Tackling MRSA. Hospital Doctor, 22nd April 2004
 Alex Wafer, A&E Targets damage MRSA safeguards. November 13th 2004