I have said many times that the definitive study of the coronavirus pandemic should wait until it is over, which in the UK may mean awaiting the final report from the Hallett Inquiry. However, I don’t think that my diary of the plague years will have a lot more to say, other than repeat what has already been said or hypothesised. And anyway I can’t wait that long. As time goes by the chorus of voices that dissent from the official narratives has been growing. Doubt has been cast on the benefit of lockdowns, on vaccine efficacy, on vaccine risks, on mask-wearing, on the source of the virus. The causes of excess deaths post pandemic peaks remain a conundrum. The role of some drugs remains unclear as trial and counter-trial are dissected. Some dissenters have found themselves no-platformed, threatened with the loss of their jobs, and finding their research papers have been retracted. Attempts have been made to deny the truth, to conduct selective data collection, to ignore that which does not conform. It is only relatively recently that the real economic costs of the pandemic have been properly balanced against the risks; the wastage of money is now being analysed, whether this is from fraudulent claims under the furlough and business support schemes or the awarding of contracts for PPE to political cronies or chancers. The whole scenario is no longer scientific in principle and some of the squabbling has become unpleasant.
I have almost completed my submission to the Hallett Inquiry. My main argument is what I have always argued from almost the beginning – that the coronavirus provokes (in some people) a cytokine storm which can be fatal, but is treatable, and that it is little different from other viral triggers. It’s almost worth hiring an advertisement hoarding to put up a message in giant type: IF THE VIRUS DOES NOT KILL PEOPLE, THEN IT DOES NOT SIGNIFY. If the Inquiry does show that there was a significant and unwarranted delay in implementing proper investigation and treatment regimes for those who developed severe disease (and I believe that it will find this, not least because I have underlined my own early, ignored but informed advice) then I think there will be a further cost – that of compensating the relatives of those who should not have died. And possibly the General Medical Council will have something to say about some of the senior medics involved and hold them to account.
And it is increasingly evident, through mutation and diminution of severity as well as from the eventual implementation of proper treatment of severe events, that it does not signify. Other researchers are now publishing stuff, nearly three years after me, that agrees essentially with my statement. Look for example at the recent piece out of Johns Hopkins University – which is hardly a bastion of deniers, freaks and anarchic scientists – at https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu.
You can play spot the difference. In other places the experts are now agreeing that a death with a positive Covid test is not a death from Covid. A quote:
“The debate over COVID’s mortality rate hinges on what counts as a COVID-19 death. Gandhi and other researchers argue that the daily death toll attributed to COVID is exaggerated because many deaths blamed on the disease are actually from other causes. Some of the people who died for other reasons happened to also test positive for the coronavirus.
“We are now seeing consistently that more than 70% of our COVID hospitalizations are in that category,” says Dr Shira Doron, an infectious disease specialist at the Tufts Medical Center and a professor at the Tufts University School of Medicine. “If you’re counting them all as hospitalizations, and then those people die and you count them all as COVID deaths, you are pretty dramatically overcounting.” (Ref https://www.npr.org/sections/health-shots/2022/09/16/1122650502/scientists-debate-how-lethal-covid-is-some-say-its-now-less-risky-than-flu)
To be fair there are also articles claiming that it is much worse than flu, but if it is true that the case fatality rate is currently only 0.1% (whether or not even that is too high because those that have died have not had early enough specific cytokine storm treatment, as I suspect) then it really isn’t. Meanwhile the vaccination risks are exactly what one would expect; in those who are susceptible, through genetics or risk factors, to the systemic side-effects of coronavirus infection then they will be at risk of developing these if the vaccine contains the specific antigen that confers the risk of the virus itself. And as evidence suggests that it’s the spike protein that initiates the immune cascade of Covid-19…
Another of my Hallett recommendations is that the exclusion of relatives from hospitals and care homes was immoral. Today’s “The Times” echoes this in a front-page article “Care homes told to stop shutting out loved ones”. Some reports show a misplaced fanaticism, where people are even denied the opportunity to pick up a phone lest they infect it or become infected by it.
I was driven to respond to another article in the British Medical Journal – “Learning networks in the pandemic: mobilising evidence for improvement” (BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2022-07021 5 (07 October 2022: BMJ 2022;379: e070215). The article contained, I thought, too much jargon and management-speak, but my response was (and as usual it is not entirely new, so regular readers will have another déjà vu episode – sorry about that):
Dear Editor,
The aim of this article is to develop “an effective mechanism to generate and implement evidence rapidly into clinical practice”, but it falls immediately short by stating “Covid-19 was a new disease with no evidence on treatment”.
It was not a new disease and there was plenty of evidence. The virus, SARS-CoV-2 was a new virus but what it caused, Covid-19 (and we remain bedevilled by the failure to differentiate SARS-CoV-2 infection and Covid-19), was not. It now appears to be generally accepted that Covid-19 represents a hyperimmune response to viral infection, or a cytokine storm. Covid-19 has every hallmark of this; SARS-CoV-2 is not the first virus to do it. Not everyone has this response, which is partly determined by genetic makeup. All the accumulated evidence confirms what it is, from the investigation findings down to the treatment. Anyone who had seen a cytokine storm (and recognised it for what it was) should immediately have understood Covid-19 – and more importantly employed the correct treatment of steroids and immune modulators.
It may be accepted now, but I advised this in April 2020 in a Rapid Response to the BMJ (1). I signposted the existing literature. I wrote to the Chief Medical and Scientific Officers, the Secretary of State and the Chairman of the Commons Select Committee with my advice. I offered to present my evidence to SAGE. I recommended the textbook which explained it all (2) and which I believe remains unread by those in charge. All of these approaches were ignored. On the false premise, as stated in this article, that Covid-19 was a new disease the RECOVERY trial was instituted, and while it was conducted well and speedily enough it was completely unnecessary. The right treatment had already been tried and tested in other types of cytokine storm syndrome. How many lives would not have been lost if my (evidence-based) advice had been implemented when I gave it?
Whether we need learning networks as suggested or not, I consider that the major lesson to be learned is that informed evidence should not be cast aside without proper examination. In this pandemic which experts should have been involved? Those with experience of immunological disease – in other words, rheumatologists and haematologists, who deal with hyperimmune states from Kawasaki disease to haemophagocytic lymphohistiocytosis and macrophage activation syndrome. I would argue that in the absence of these the learning networks involved the wrong specialists. And there appears to be a mental block in using steroids in infections, but anyone who has treated significant sepsis or toxic shock syndrome – something I saw frequently wearing my rehabilitation hat in patients with multiple sclerosis – will understand the importance of giving them without delay. What matters is not the infection, but the immune overactivity it causes.
In future I suggest that any pandemic management system should have the provision, indeed the necessity, to receive and consider evidence from all interested parties who can claim specialist knowledge – and that the rejection of any such evidence must be notified to the correspondent with a valid scientific explanation.
References:
- Bamji AN. Rapid Response to “Paying the Ultimate Price”. https://doi.org/10.1136/bmj.m1605 (28th April 2020)
- Cron RQ, Behrens EM. Cytokine Storm Syndrome. Springer, 2019
And I still ask, without any response: how many of the movers, shakers and planners, not to mention the acute physicians who treat Covid-19, have read Cron and Behrens? As Paul Daniels would have said – “Not a lot!”
The Wry Observer 