The Wry Observer’s Covid-19 update (199)

It’s been a long time since the last contribution, during which quite a lot has not happened on the Covid-19 front, viz. no repeat of previous hysteria as the infection rate rocketed. I suspect part of this is because even the most hawkish advisers expected a peak and subsequent fall, which is what happened, without the need to return to lockdowns etc. Mind you this is not the case in China, where a repeat of internment has caused havoc. The enforcement scenes are grim. Is this new lockdown worth it? I doubt it very much.

It’s also true that although UK infections have gone up, there has not been a major rise in the serious consequences, presumably because Omicron is “milder”. There is also increasing evidence that vaccines are not that effective. Certainly it seems that one can acquire SARS-CoV-2 despite having had two jabs and a booster, and even acquire it more than once. But mask-wearing remains voluntary and certainly life in Cardiff (where we went for a reunion over the weekend) appears to be entirely normal, judging by the numbers on the street on a Friday night (partygoers, bouncers and police alike). And I would add that covid susceptibility might be higher than elsewhere judging by the size of many revellers.

On the other hand quite a lot has been happening in terms of the slow process of unravelling or debunking government and department of Health policies and management. There’s an interesting piece by Carl Heneghan and Tom Jefferson at https://brownstone.org/articles/the-uk-covid-response-a-stool-with-three-legs/. Their three legs are PCR testing (and its misuse), attribution of death (which brings us back to what so many people have questioned – whether deaths are with or from) and the recording of hospital episodes. The article is yet another example of how following “The Science” is all very well, but the principle falls down when the science is critically evaluated and found to be wanting, more especially when those in charge refuse to listen.

A court case has determined that the UK government’s initial policy of decanting elderly people from hospitals to care homes was unlawful and on that basis it made a mockery of the then Health Secretary’s claim that a defensive ring was being placed around those care homes. I suppose one could argue that many people have said this for quite a while. Whether anyone will be fined, or go to prison, is a moot point. Matt Hancock claims that he was not given the right information, which is a reasonable way to try and avoid being blamed, although the buck stopped with him. Someone should fall on their sword. Hancock? An expert? This actually mirrors my longstanding contention that the government was relying on the wrong experts, as I have again pointed out in a BMJ Rapid Response to an article titled “An untrustworthy government during a pandemic—a lethal combination” (BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1011, published 20 April 2022):

Dear Editor,

Perhaps the real issue is not that the government got everything wrong with its management of the SARS-CoV-2 pandemic, but why it got it wrong. In my opinion it was because much of the expert decision-making was made by the wrong experts. It is clear now, and indeed was evident from early on, that not everyone who became infected with the virus went on to develop the severe and often fatal complications that were Covid-19, and why that should be was not a question that could be answered by epidemiologists and public health people but by clinicians who began to understand the underlying pathogenesis of severe disease – a major disturbance of immunological reactivity. These “wrong” experts failed to see the parallels with previous, similar trigger factors for a cytokine storm syndrome. They failed also to understand rapidly enough the investigation results that would confirm its development. They failed to realise that, just because the SARS-CoV-2 virus was novel, what it resulted in was not. Thus they failed to institute a system of rapid and appropriate diagnostic tests, relied on clinical signs that did not identify risk early enough, and failed to recommend treatments that already existed, deciding instead to embark on unnecessary trials.

Over the last two years I have conducted what seems like a one-man crusade to get the government and its advisers to include appropriate clinicians. My efforts were completely fruitless. I had no response to any of my submissions on testing and treatment (accurate as most of them turned out to be) – not even any acknowledgement of those submissions. Indeed I was later to learn that the inputs of so-called armchair commentators were immediately consigned to the waste paper basket or its electronic equivalent, the email junk folder.

Who then was responsible for this shameful and persistent exclusion of experts (I would argue the right experts)? Was it the government? Or was it the overblown SAGE committee that trusted in its own expertise? If the latter, then perhaps the government should not take the blame, not least if it did not know that there were other experts knocking on the door.

If SARS-CoV-2 infection never caused the severe sequel of Covid-19 the pandemic would indeed have had little more impact than a flu pandemic. So the only thing that mattered was to stop infection from progressing to Covid-19, thus reducing hospitalisation and intensive care requirements and reducing fatalities. This required the right tests and the right treatments, none of which were in the purview of the “experts”. Whether or not any community could contain or eradicate the virus (which time has shown to be impossible) is thereafter an irrelevance.

It has been very disappointing over the last two years to observe the blind and largely uncritical obedience of health workers to what had been proved to be flawed diktat. The one rule of research is that initial findings can be overturned later, so no-one can afford to be dogmatic. There is egg of faces when such dogmatism comes back to haunt you. I am pleased to see that some of my arguments are now being echoed by other non-governmental experts. How long will it be before the government’s “experts” are held to account? I imagine that first of all Lady Hallett has to set her Inquiry’s terms of reference.

The Wry Observer’s Covid-19 update (198)

After the total hysteria of previous rises in case numbers there has been almost complete silence from the UK government over the most recent. I suspect this partly reflects the distraction of the war in Ukraine (where, I might say, the denials from Russia remind me of the way in which small children continue to lie in the face of all the evidence). It may also be because (a) it is now abundantly clear to everyone (in the face of all the evidence) that vaccination does not stop acquisition (b) despite acquisition, people don’t seem to be getting so ill – which is probably a benefit of vaccination and (c) government has been taken severely to task over its so-called “Nudge Unit” which has previously been ramping up hysteria.

I have sent in my suggestions for lines of enquiry for the Hallett inquiry. Mainly to do with the absence of any analysis of the failure to implement timely treatment of Covid-19.

I have just finished the epidemiologist Mark Woolhouse’s book “The Year the World Went Mad: A Scientific Memoir”. I recommend it. He has been on the inside. His exposition is clear and easy to follow, and it is clear he does not think that lockdowns work – but targeted shielding does. Obviously the Chinese government, which has just locked down Shanghai, hasn’t read the book. It should. He is particularly scathing about the schools lockout which he concludes had no scientific validity. And while on about China it is amusing, or sad depending which way you look at it, that a traditional Chinese medicine of no proven benefit (but the usual slew of nonspecific reasons for efficacy) has been distributed to residents of Hong Kong. See Will Jones’ piece in the “Daily Sceptic” at https://dailysceptic.org/2022/04/04/hong-kong-sends-traditional-chinese-medicine-to-three-million-citizens/.

One thing though is glaringly missing from Woolhouse’s book – if something missing can glare. Treatment! It just confirms my prejudice or observation, made previously ad nauseam, that the people involved in managing the pandemic have been in many respects the wrong ones. I cannot believe that the delays in managing serious disease would have been anything like as bad had the right clinicians been involved (also, ad nauseam, not for want of my trying). I may not be hot on R numbers and models but I (and any competent rheumatologists) can manage immune-mediated diseases. OK, so what I suggested originally is now more or less in place, though I suspect not uniformly implemented.

It’s interesting that aspects of Long Covid are being attributed to the development of autoantibodies, which might provide an interesting line of research to look at standard autoimmune disease again for viral triggers. It’s been done before and failed, but maybe we weren’t quite looking at the right bits, a bit like the blind men and the elephant. That said, the list of Long Covid symptoms is pretty protean, and I have had then all since December 2019. Does that mean that I must have had Covid, all negative tests notwithstanding? Or is this a Jerome K Jerome moment; you may recall that in “Three Men in a Boat” he describes reading the household medical compendium and concludes that he has everything in it except housemaid’s knee. I think there’s a lot of research that needs doing on that.

I note also that it’s being suggested, much as the original SARS-CoV-2 has been labelled as an artificially created virus that leaked (and the tide goes in and out on that hypothesis) that Omicron, by virtue of the number and site of its mutations, is also a lab-engineered variant. It’s known that South African laboratories were working on SARS-CoV-2. Conspiracy? Cock-up?

Meanwhile the Ivermectin controversy rumbles on. The research debunking it is being debunked in its turn. Conspiracy theories swirl about (it’s so cheap that drug companies would lose billions if it was authorised etc). We shall see. I have discovered, though, when I went into our local farm store for some fleece to wrap our pear tree against the frost, that they have huge tubs of the stuff for the sheep, of which we have thousands down here, with more thousands on the way, because lambing has begun. It’s lovely to walk through the fields and see all these cute little things wobbling around, and watching them grow.

The Wry Observer’s Covid-19 update (197)

Still here. Much going on; ghastly war in Ukraine, P&O sacked 800 workers by e-video, and we have a new shed on the allotment, so we have spent quite a time repatriating the refugee garden equipment which had been kindly rescued by a number of our fellow allotment holders and safely stored. SARS-CoV-2 has slipped down the news columns, which is not surprising in the context of the appalling sights and sounds from Ukraine. Who would have thought, even three months ago, that we would become so familiar with the geography; I could draw a rough map, with major towns and cities, from memory. But the numbers of SARS-CoV-2 infections has been rising substantially to a level where previously we would be faced with the Prime Minister flanked by his advisors, telling us to lock down, wear masks, keep our distance etc.

So what has changed on the SARS-CoV-2 front? Firstly the increasing, indeed large numbers of infections are not translating to hospital admissions and deaths in the way that was true a year ago. Secondly the public has become blasé, not least as they encounter those who have acquired the virus but have not had much more than a rather bad dose of flu. Thirdly the effect on transmission from vaccination has been very limited; this contributes, I think, to the public’s rather dismissive attitude. Sadly vaccination has not proved to be the hoped-for magic bullet, though it may be responsible at least in part for the reduced severity. And lastly the ongoing analysis of case numbers placed against lockdown restrictions shows ever more clearly that lockdowns do not work (because, I believe, they can never be complete enough to work).

The Covid-19 Inquiry has set up its consultation on terms of reference, and I have submitted my additional suggestions to those already included – requesting that the effective exclusion of clinicians with knowledge be considered, and that the delays in instituting proper management protocols for severe disease requires examination. My other concerns will go into my evidence. The ever-rolling stream of time will fit them in at some point. I will make sure of it.

Meanwhile in the statin business the proverbial has hit the fan, with two statin sceptics, Malcolm Kendrick and Zoe Harcombe, bringing a libel action for defamation against the “Daily Mail” for accusing them of being statin deniers and being thereby responsible for the deaths of those warned off statins. This has echoes of the measles vaccine case, with the difference being that (at least from what I have seen and read) that Kendrick and Harcombe’s views are evidence based while Wakefield’s measles vaccine research was fraudulent. That they chime with mine is neither here nor there. The BMJ has covered the story briefly at https://www.bmj.com/content/376/bmj.o741 (BMJ 2022;376:o741). I have written a Rapid Response:

“The “Daily Mail” is quoted in your article as saying that two so-called statin deniers have placed people “at a greater risk of a deadly or debilitating heart attack or stroke by misleading them into the false belief that statins do not work and/or have debilitating side effects, and thereby leading them to refuse or to abandon the treatment that has been definitively proven by medical science to benefit health in critical ways including by saving lives while causing insignificant side effects in the process.”

On 27th January 2009 the same paper published a piece by me entitled “The hidden (and painful) cost of statins”

( https://www.dailymail.co.uk/health/article-1128333/Viewpoint-The-hidden-painful-cost-statins.html) in which I detailed my personal experience of side-effects – noting that symptoms recurred on rechallenge and that my creatine kinase levels rose significantly. The effect was far from “insignificant” and took over two years to abate completely. In my clinical practice I saw several patients with significant rheumatic symptoms that were also unquestionably caused by statins.

As far as I know the “Daily Mail” has not retracted my opinion piece.

I would add that my experience pre-dated the wide discussion on whether statins could produce muscle problems and long before the concept of a nocebo effect was articulated. In any case, to develop a nocebo effect requires one to know what side-effect might be likely, and in 2009 I did not.

Both before and after this publication I and many other researchers pointed out that (1) benefit was expressed in relative risk but adverse events in absolute risk, thus exaggerating the former while playing down the latter (2) that the original research linking heart disease and cholesterol was biased and scientifically flawed (3) that the substantial reduction of LDL cholesterol by PCSK inhibitors failed to produce an equivalent benefit in preventing heart disease (4) that blood cholesterol is affected, if not controlled by carbohydrate and not fat intake and (5) that proper understanding of the development of arterial plaque concludes that its development is a consequence of inflammation and not of a high cholesterol level.

It is interesting to read that the form of words is being examined. There is certainly a difference between a sceptic and a denier, and I am not aware of any commentator who states that statins do not have any clinical benefit. They do. But the effect is small (absolute risk reduction around 2-3%) and is anyway in all probability due to their anti-inflammatory effect. Whether this small effect is worth the vast expenditure on them matters more in relation to their mode of action – and I have written several times that their effect on cholesterol is merely an interesting, but irrelevant one – than it does to the generation of side-effects. If they are clinically ineffective then why use them?

Many scientists and clinicians are convinced that the major villain in heart disease is carbohydrate, as John Yudkin first outlined decades ago. I would venture to suggest that those who deny this are the ones putting patients at risk. The upcoming court case brings to mind the appearance of Galileo before the Inquisition, and who was right then?”

Meanwhile (sic) in the history of plastic surgery business I am delighted to report that my book “Faces from the Front: Harold Gillies, The Queen’s Hospital, Sidcup and the Origins of Modern Plastic Surgery”, first published in 2017, has been reprinted and is available in paperback.

The Wry Observer’s Covid-19 update (196): not done yet…

Yesterday’s “Daily Sceptic” was very disappointing in that it appeared to condemn the Pfizer vaccine for failing to deliver on its aim. But it had not read the small print. The quotation made it clear that vaccination was not designed to stop infection with SARS-CoV-2 (because that isn’t actually medically possible) but was designed to reduce the risk of infection turning into Covid-19. The Sceptic’s piece fell into the trap of assuming that SARS-CoV-2 and Covid-19 are the same. I don’t know how many times I have to say this before the message gets through – but Covid-19 is the immunological consequence of infection, and in its clinical manifestation is little difference from the cytokine storm syndrome provoked by other triggers, viral or not. And vaccination does seem to reduce that risk. Apropos risk it looks as if the case numbers are rising once more, but there has been a deafening silence from the lockdown proponents this time. Perhaps the hospital admission and death rates remain steady. Certainly people appear to think that the infection fatality rate is now much the same as flu.

In my eyes all of this simply reinforces my longstanding message that combating infection requires concentration on identifying and then treating Covid-19 when it follows infection. Which should have been the focus all along. Only two years later and some people are coming round to my point of view.

Another canard pursued by the Daily Sceptic site is that of vaccine risk. The Yellow Card risk reporting system may be all we have, but it should not be reviewed without a large pinch of salt. Many so-called side-effects of treatments are quite incidental, indeed impossible to attribute to the treatment. Likewise there seems to be great unease about vaccine doses spreading round the body. Where on earth do you expect them to go? Food does not remain in the gut; it is digested and passes through the liver. Inject something into a muscle and the bloodstream will carry it all over the place. I cannot understand why this is surprising. It is a physiological fact; indeed, if it were not found in the liver I would wonder whether it had ever been injected. Now if it were a microchip one would expect it to stay where it was first put. But have these fearmongers actually had a dose of vaccine? If so, did they not realise that it is a liquid suspension? Have they never had a bruise and wondered why it has not persisted in situ indefinitely? Regrettably the purveying of such ignorant pseudoscience undermines the credibility of the Sceptics site, sad as I am to say it.

Of course the disappearance of SARS-CoV-2 and Covid-19 from the media may reflect the appearance of another invading organism, which is ravaging Ukraine. I have been reading an account of D-Day 1944: (“D-Day through German Eyes: How the Wehrmacht Lost France” by Jonathan Trigg). What is remarkable, and salutary, is that the major problems encountered by the German army were much the same as those met by the Russian army in Ukraine – lack of appropriate transport, inadequate provision for re-supply, employment of substandard infantry (regiments often made up of non-German soldiers, even Russians), failure to control the air and underestimation of the opposition. Not a lot different from Ukraine today, though the air power disparity is reversed and the war is not entirely between two armies. But the fact that very similar circumstances pertained in 1944 makes one wonder why lessons were not learned nearly 80 years later. But then one could say the same about the lessons learned from pandemics. Are they learned? If so, then they get forgotten.

Stop press: yet another reason to concentrate on the immune system; see https://www.cell.com/immunity/fulltext/S1074-7613(22)00046-2 for an exposition on whether continuing post Covid-19 breathlessness is caused by persisting immune hyperactivity in the lung. I find this completely unsurprising. But I suppose someone had to prove it.

The Wry Observer’s Covid-19 update (195): Aftershock

The UK government has stood down the SAGE committee, a clear sign that it also thinks the pandemic is over.  I said it first.  However yesterday there was an “exciting” piece in “The Times” by Tom Whipple (again) puffing the RECOVERY trial, which had just come out in favour of baricitinib – a JAK inhibitor I mentioned on 8^th February.  He also pointed out that the serious nature of Covid-19 was because it provokes an immune overactivity.  Glory be – I have lost count of my attempts to explain this to the high-ups.  Have they really got it at last?

I felt compelled to write as follows:

“It is heartening to read that scientists finally agree that damping down immune activity is the way to treat severe Covid-19.  In a letter to “The Times” on 27th April 2020 I wrote “Therapeutic options should target CSS (cytokine storm syndrome) rather than the virus itself. They include high dose steroids and drugs that block inflammatory chemicals known as Interleukin-6 and Interleukin 1-beta.”

These had been used in CSS for years. There was never any need for trials. Baracitinib is just another drug which interferes with the immune cascade, thus targeting CSS. Had my suggestion been heeded (likewise my pleas for a rheumatologist to join SAGE, as we are experienced in managing immune mediated diseases) I believe that many, possibly thousands, of deaths would have been avoided.”

But then, dear readers, you know that, because I told you once before; it’s no secret any more (song reference: Whispering Grass by the Ink Spots, a name to conjure with in today’s world of wokeness).

The Wry Observer’s Covid-19 update (194): Finale?

Restrictions are lifting. Mask-wearing is becoming less necessary. Positive tests, hospitalisations and deaths are falling. The government has given up releasing figures at weekends and is seeking to charge for lateral flow test kits (the result of which, no doubt, is that people won’t use them and positive tests will fall further, and the percent positive – still the lowest of the major European countries – will rise as only those with symptoms will test). There is, at last, talk of living with SARS-CoV-2 and just shielding the vulnerable. Covid-19 seems to be off the pages of the newspapers and has not featured on the BBC News for a few days. So things are looking bright. I don’t believe I have anything more to say about Covid-19 that I haven’t said already, so I am happy to announce that the pandemic is now… OVER!

Of course the prophets of doom might be right and we get another coronavirus version that tips us back again, but I am doubtful.

However the disappearance from the media is on account of the war in Ukraine, a far-away country of which I knew little, but could now draw from memory a reasonably accurate map. I have studied a bit of history. The rhetoric of Putin, talking about denazification and freeing the Ukrainians from a genocidal regime sits at odd with the Ukrainian President being Jewish and the lack of evidence of any sort of genocide – except that the indiscriminate shelling of major cities is the very genocide that Putin stated he was going to prevent. No doubt the spinners will suggests that it’s all the Ukrainians’ fault for resisting. Leave your homes, they shout, because we are going to destroy them whether you are in them or not! I wonder what any homeowner would think if their next-door neighbour decided that your “unreasonable” behaviour warranted their violent invasion and occupation of what you owned. But the obvious distress of captured Russian soldiers who had been misled over what they were being asked to do is a reminder of the lengths to which leaders will go – and I cannot believe that the Russian people are in favour of Putin’s megalomania. What they could do about it is another matter.

The parallels with the Anschluss of 1938 and annexation of the Sudetenland by Nazi Germany are exact in their supposed justification. Putin has also forgotten (or more likely chosen to ignore) is that in 1939 the USSR and Germany signed a non-aggression pact and that the USSR massacred Polish army officers at Katyn. Now his army is massacring civilians in Kharkhiv and Maruipol among other cities, which seems a strange way of protecting them though it might be a good way of persuading Ukraine that resistance has too high a cost. And there has been no denial of the infiltration of mercenaries to murder Ukraine’s government. At least satellite imagery enables an unambiguous picture of reality.

It is a ghastly mess. As with the pandemic it is of academic interest to argue why it began and we have to deal with the present, but one thing is certain; bullies go on bullying until they are stood up to. Sanctions may work. Prosecution for war crimes seems inevitable to me, not just because civilians are being targeted indiscriminately but for all the other clearly identified reasons – use of illegal weapons, use of saboteurs in fake uniforms etc. It did, though, interest me to observe the difference between Putin’s macho aggression in the war and his pathetic personal attempts to avoid catching the coronavirus by sitting at the end of his over-long table, with his visitors or advisors clustered at the other end. If it were all not so serious it would be comic. But after hubris comes nemesis.

The Wry Observer’s Covid-19 update (193)

Yesterday’s “The Times” carried a long piece by Tom Whipple and Rhys Blakely titled “Lessons from the front line of our war on Covid-19”, comprising interviews with “scientists” -structured format, the same questions for each. The experts were Dame Sarah Gilbert (BSc, PhD), Dame Kate Bingham (MA, MBA), Sir Jeremy Farrar (BSc, MPhil, FRCP, FRS, FMedSci), Sir John Bell (BMedSci, BMBChir, FMedSci, FREng) and Professor Devi Sridhar (BS, MPhil, DPhil).

Have you noticed anything?

Of the five, only two have medical degrees. Those two (Farrar and Bell) specialise in infectious diseases, and immunology/genetics respectively. The other three are not doctors.

So to suggest that their contributions come from the front line is nonsense. The front line is where the hospital beds are. While they are all noteworthy (and worthy) brilliant people to say they are on the front line is akin to saying that the experience of the First World War is entirely derived from Army HQ in Montreuil-sur-Mer and the War Office in London.

The questions were:

1. What do you wish you had known in January 2020?
2. What has been the lowest point?
3. What has been the highest point?
4. What do the public still not understand that you wish they would?
5. What do we still not understand that you wish we did?

Sarah Gilbert highlighted teamwork in producing the vaccine, with her low point being the discovery of extremely rare serious adverse events from vaccination. Kate Bingham wished she had known more about asymptomatic transmission. Her low point was a moral one – that we were buying vaccines from India when the UK was relatively well-protected, but many countries had not begun vaccinating. She indicated we still needed better fundamental science understanding. Jermey Farrar said of January 2020 that “We knew everything we needed to know…”. His low point was the failure to introduce interventions to slow down and reduce the wave of infections in Q4 of 2020. He reckoned we underestimate our vulnerability to shared global threats. John Bell wished we had known how rapidly vaccines would appear, because it would have “been easier to get through the first year”. His low was in April 2020 when the NHS was under pressure; people were dying and there was no end in sight. His comment on what is still not understood is reproduced here in full:

“This is a disease of two types, severe disease associated with inflammatory pneumonia that is often fatal, and less-severe, flu-like disease or asymptomatic disease. It is increasingly clear that the vaccines after two (or three) doses have a remarkable impact on the incidence of the most severe disease, including pneumonias that cause the majority of deaths from Covid. Since the summer the vast majority of people dying have been unvaccinated or immunosuppressed and these accordingly account for the vast majority of people in the ICU. That has not always been made clear in the data and the immunological basis for this protection is not at all clear. What none of the vaccines do very well is to stop the transmission of the virus and this is exacerbated by the diversity of the variants. Until a transmission-blocking vaccine arrives, we will continue to have low-grade disease, sometimes like influenza, but largely benign, and fully vaccinated people will therefore have little to fear from the worst form of the disease. This along with drugs and antibodies mean that it is time to get back to normal living.”

Like John Bell, Devi Sridhar wished we had known that vaccines and therapies were round the corner; her low point was the heavy death toll in January/February 2021. She was also concerned about the impact of Long Covid.

For some reason Sir Martin Landray (PhD, FMedSci – medical degrees not listed) is not in the print version but online he wished that there had been a trials network already in place. He oversaw the RECOVERY trial of dexamethasone, so perhaps unsurprisingly his high point was the proof of success.

You may be able to access the full article at https://www.thetimes.co.uk/article/lessons-from-the-frontline-of-our-war-on-covid-19-lckcgdr88. If you hit the subscriber firewall that’s too bad. I think that John Bell’s comment as shown encapsulates much of the truth. As for the remainder it is mainly the view of non-clinicians, and even those who have medical training are not at the sharp end, but are backroom people. And some of what they have said appears to display some disconnection with reality. For example, how could Jeremy Farr say that in January 2020 “We knew everything we needed to know”? by golly we did not. Maybe he has been misquoted, but if not he is plain wrong. John Bell and Devi Sridhar would have been a lot happier had they realised early that there was a clear clinical pattern to severe disease, that it had been described previously and that there were already treatments for it. John Bell at least realised that there were two groups of SARS-CoV-2 patients, though he did not specify (as I think he should have done) that it’s the severe disease that is Covid-19 and the rest don’t matter a lot on an individual basis. And I am bemused that Martin Landray takes the RECOVERY trial as a high point when, if he had read the books, he would have realised it was completely unnecessary and only confirmed what was already known. And I don’t think Long Covid is clinically any different from all the other postviral syndromes we already know about (I had one, years ago, so I believe in it as a concept, but this one is nothing special).

My answers to those questions would be as follows.

1. I wish we had realised sooner that this was a virus that could cause severe and rapidly deteriorating disease, and that the pattern of this had been recognised earlier as being due to a hyperimmune state. I suspect that if I had still been working I would have done so. You see one rare thing, as I have, you don’t forget it.
2. My low point was when I identified this cause of serious illness in May 2020, flagged up both the investigations necessary and the treatment that would work, and then found I was completely ignored. And others (mainly rheumatologists) had come to the same conclusion. Why were we not listened to? Finding I was right added to my distress. It seemed that none of the decision-making experts were the right experts. Also when the “puzzle” of genetic susceptibility and some ongoing systemic effects, also provoked by vaccines, remained puzzles long after I had given the answers. It’s all been vaccines, vaccines, vaccines. What really mattered, and still does, is identifying the development of severe disease and treating it promptly and properly. Yes, vaccines do appear to reduce severity and risk of hospitalisation, but don’t abolish it.
3. Highest point? Being proved correct on steroids and biologic drugs – although as these treatments for cytokine storm were already established there was no need for trials. Waiting for the result of RECOVERY wasted months. So it’s also a low point, as above.
4. I actually think that the public understand what has happened better than the “experts” in many ways. This is thanks to the presence of rigorous analysis of data by the right experts on external sites such as the “Daily Sceptic” (and dare I say my blog)
5. The experts have never made it clear that there is a distinction between dying with Covid-19 and from Covid-19, partly because they have continued to conflate the terms SARS-CoV-2 and Covid-19. Neither have they acknowledged that projectional modelling is no match for retrospective data. They presided over a sloppy rule re-writing for death certificates which allowed anyone with Covid-19 on the certificate to be classed a Covid death. PCR testing was allowed at cycle thresholds that led to large numbers of false positives. The experts, supposedly experienced epidemiologists, allowed the flooding of care homes with hospital discharges, spreading SARS-CoV-2 into care homes. They failed to acknowledge, until very recently, that vaccination does not stop transmission, nor that anything short of a total lockdown can never work.

I’ll stop here, as our allotment shed was shredded by Storm Eunice and I need to sort out ordering a new one.

Open-access: scientifically sound?

I don’t often write scientific papers these days.  Being retired I am out of date in my specialty and much of what I submit is comment or related to medical history.  However I recently discovered something that made me uneasy.

I submitted a paper to a prestigious journal.  It was rejected.  That’s not unusual and I don’t get hung up about rejection; one is always convinced by the brilliance and originality of one’s own work but an objective dispassionate review will bring one down to earth.  It’s happened many times and I suspect to many people.  But what made my ears prick up was the suggestion that, were I to submit it to the open-access version of the same journal, it would probably be accepted.

Now I don’t have a spare $3000 to follow this course.  But I was under the impression that peer review was peer review.  If it’s not suitable for the journal it’s not suitable for any version of that journal, I imagined.  But clearly not.  Pay and be published, it seems.

Anyway I re-submitted the paper to a second prestigious journal.  Exactly the same thing happened (except I got better reviewer feedback – in fact I actually got feedback, which I didn’t from the first).  But once more I was shamelessly offered the opportunity to submit to the open-access version.  It cost less – about $1500 – but I would rather spend that redesigning my website, or buying some extra gizmo for my camera, or… whatever.

I’m not really fussed personally.  I don’t need more papers on my CV because I am not applying for any jobs.  At 68 the job market is small, though I fancy the House of Lords.  But the potential for bias is stupendous.  While an individual may not be able to fund a publication, a research department may, and a pharma company certainly will.  The former may require publications in high impact-factor journals to maintain its grants and prestige.  A drug company may simply wish to promote positive studies of its own new drug.  Of course they will pay up.  Yet if a prestigious journal with a high impact factor has dual acceptance standards for its main and open-access versions this disadvantages the individual.  Equally it raises serious questions about the peer-review process.  Are the reviewers different? Are they given different standards to meet? Which reviewers are right in deciding to accept or reject?

Cash for questions in Parliament has been decried.  Cash for publications is, I believe, just as pernicious. It is discriminatory, unscientific and dangerous.

The Wry Observer’s Covid-19 update (192)

I had no intention of writing today until I read Fergus Walsh’s piece on BBC News (“Covid: how new drugs are finally taming the virus”; https://www.bbc.co.uk/news/health-60390187).

It’s a good summary but regurgitates untruths. In particular he wrote of the new drugs “They include the cheap anti-inflammatory steroid dexamethasone, the first drug proven to save the lives of people seriously ill with Covid, which was discovered through a ground-breaking NHS trial.”

There was nothing ground-breaking about that trial. It was completely, totally (add other synonymous adjectives for emphasis) unnecessary. It proved what had already been proved.

Fact: Covid-19 is a hyperimmune state, or cytokine storm.

Fact: Cytokine storm treatment has included steroids for years if not decades. I treated one myself back in the 1990s – with steroids.

Fact: SARS-CoV-2 may be a new virus but it causes an old condition. Therefore no trial was ever necessary. Admittedly it was done quickly, but even so months of delay were caused by doing it.

This is not only true for steroids, but also for tocilizumab and anakinra (which last was approved here in December 2021, when I had proposed its introduction, along with the others, in May 2020).

I have tried to point this out before. I have written this in my blog before. What do I have to do to get through my firmly held, evidence-based view that those experts making decisions on what was clinically appropriate were the wrong experts? Walk naked down Whitehall with a sandwich board? That would not be a pretty sight.

I have finally finished reading “Viral! The Search for the Origin of Covid-19” by Alina Chan and Matt Ridley (4th Estate, 2021). I suggest that any serious commentator should read it. It is very thorough and very fair. It outlines all the pros and cons for the argument over whether the pandemic was caused by a lab leak or whether it was from a natural spillover. My own view is based on two simple premises. When a hypothesis has no evidence for it, it may yet be proved to be true; only when it has evidence against it does it fail. When attempts to prove or disprove a hypothesis are met with concealment of evidence, removal of evidence, obstruction of research, constructing ludicrous counter-hypotheses and downright lies it is highly suspicious. It has been suggested that there is no proof of a lab leak, so it can be discounted. Given the obfuscation of the Wuhan laboratories and those outside who have been associated with them I can only say – really? To me, the circumstantial evidence is overwhelming and underpinned by the diligence of lay seekers for truth, who have managed to unearth things intended to be hidden forever. Reading between the lines that is what Chan and Ridley imply, although they are too honourable to say so. Life would have been so much easier if a full, frank admission had been made at the outset. Accidents happen; they may have terrible consequences but they are nonetheless accidents. In all my experience of medical negligence I learned that to say sorry at the start is a winning strategy.

I have described this in my book “Mad Medicine”, as follows:

A patient with lupus was not doing well, and it was decided to start her on antimalarials. I was away. My locum commenced chloroquine, which I never used because of the risk of ocular toxicity. I failed to notice this and when the GP (who was issuing prescriptions) queried what monitoring was necessary I said none (which is true for hydroxychloroquine, which is the only antimalarial I used).

So perhaps it was no surprise that she developed retinal damage. I heard from the eye doctors and arranged to see her urgently. There was no doubting the diagnosis.

“What do I do?” she asked.

I suggested that as harm had been caused, for which we were all very sorry, she should consult a solicitor.

“Are you saying that I should sue?” she said.

I replied that if her legal advice was to that effect, then she should consider doing so.

She paused for a moment, then said “If I sue, will you still go on seeing me?”

There’s trust for you. I said I would (and I did until I retired). She sued, the lawyers briefly discussed whether the GP was to blame (for prescribing without monitoring) or I was to blame (for giving wrong advice about monitoring to the GP). In the end it was me that was considered at fault and she had a compensation award in six figures.

What if I had blustered and denied all? I expect we would have been on the front page of some red-top. I have so many times witnessed attempts to cover up the truth. It isn’t worth it. Apologise and explain. Chris Huhne would not have gone to prison if he had followed this advice. [A Liberal Democrat politician of some skill, he persuaded his wife to take the rap for a speeding offence so he didn’t lose his licence, and was found out with the ruin of his family and career (the marriage had already broken down, and the scorned wife couldn’t keep her mouth shut). He also got another speeding ticket so it was all in vain anyway.] And how different things would have been, in the terrible aftermath of the loss of Flight MH17 over the Ukraine, if those responsible had held their hands up and apologised. Of course it would not have brought back the 298 lost souls. But to acknowledge such a frightful error rather than hash up a series of increasingly bizarre and contradictory confabulations would have nipped the recriminations and bitterness in the bud.

The Wry Observer’s Covid-19 update (191)

Happy Valentine’s Day! Who thinks the pandemic is over? I do. Mind you, if the Prime Minister indicates that restrictions can now be lifted on that basis, can we believe him? Yes, but… no, but; events have conspired to induce a certain lack of trust. But on the one hand the number of positive tests has dropped well below 50,000 per day. On the other, an explanation could be that the general relief has led to less tests being done. But actually that does not appear to be the case, as there were still well over 1 million and the % positive graphs clearly show that the UK is well below the rest of Europe. Add to that a flattening or possibly reduction in both hospital admissions and deaths and things are looking good. Even while infection numbers were high they were not matched by the death and hospitalisation levels seen with previous waves, so Omicron is clearly not such a threat as Alpha or Delta. Perhaps it’s not much worse than flu now.

But there are always people who want to spoil the party. Some scientists are now saying “We had better not slacken off the rules yet, as there may be another variant coming along which is going to be really bad, just like Delta, because Omicron arose separately from a non-Delta source, and we don’t know but it could be really bad (again)”.

It’s the Eeyore mentality – or, alternatively the attitude satirised by Noel Coward:

There are bad times just around the corner,
The horizon’s gloomy as can be;
There are blackbirds over the greyish cliffs of Dover
And the rats are preparing to leave the BBC…

How long are we going to be hiding behind the excuse that something might happen? Possibly forever. If a new variant is less virulent it won’t signify. We might as well start testing for the common cold and lock down every winter if the tealeaves look threatening. If it is more virulent we now have the means actually in place to combat it. But I think it would be more sensible to deal with the problem when it happens, rather than keep defences up just in case it might happen. It’s a bit different from confronting the Russian threat to Ukraine, because if it did happen the system is already primed to swing straight into action. And so far the modellers, prophets and speculators have been spectacularly wrong. All we have to do, being sensible, is to be sensible. I have no problems with asking people with symptoms of a cold or flu to self-isolate until their symptoms abate; colds and flu will spread less. Many was the time when a patient would come into my outpatient clinic and say “You’ll have to excuse me coughing and sneezing but I’ve got a terrible cold.” Or they clearly had flu. And sometimes I caught it – and did I self-isolate? Not always; only if I was too rough to get up… but maybe I should have done. But personal lockdown in that situation is not the same as a nationwide lockdown that (a) isn’t, because of all the exceptions, (b) still lets people into the country from without and (c) doesn’t work anyway. If you confine families to their houses, and one member gets it, the risk that the others will may even be increased. We should of course still shield the vulnerable, but sensibly, not by imprisoning them behind glass walls and ruthlessly excluding relatives. If those relatives are well what risk do they pose? And are immunodeficient people at greater risk because the vaccine doesn’t “take”, or at less risk because their immune system will not overreact and produce a cytokine storm?

Before you say that maintaining a larger-than-before pool of people off work will lead to difficulties – yes, it will (not least if people use a sniffle as just an excuse to pull a sickie). But that can be adjusted for.

Let us now accept that we can and will live with SARS-CoV-2, just as we do with all the other myriad coronaviruses that cause respiratory infections. If we can develop tests that identify respiratory syncytial virus (RSV) that will be a useful spin-off – indeed, one might even manage a multiple test that diagnoses infections from several different viruses – not that this has any practical clinical benefit, but it might help us to understand epidemics better.

I still cannot get my head round the vaccination and borders issue which has caused havoc in Canada and elsewhere with Freedom Convoys and the like. We know that vaccination does not stop spread significantly, so why insist on testing, especially as air travel restrictions are being lifted? Muddled thinking, I think, and it is causing unrest. There’s enough to worry about in the world without imposing restrictions that don’t make sense and distract us from real problems.