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.