The UK isn’t learning the right lessons from lockdown

This month, the UK’s Department of Health and Social Care published a Technical Report on the Covid-19 pandemic in the UK. 

The report is a long 11-chapter document describing the UK’s response and pointing out suggestions for dealing with future pandemics.  

The report is described as ‘independent’, but the authors are public health civil servants and a handful of academics. Given that the authors were instrumental to a greater and lesser degree in implementing the catastrophes of lockdowns, this report is as independent as President Xi marking his own homework in China. 

It is hard to reconcile some of the report’s content with what we have written about in the past. For example, there is no mention of the misuse of PCR tests or of Britain’s failure to follow the example of other countries, whose contact tracing systems were overwhelmed in days.

There is also no apology for the evidence-free mass testing programme, the segregation of healthy people, and the lack of identification of truly infectious cases.  

The report says: 

‘Pre-symptomatic and asymptomatic transmission, in the absence of routine mass asymptomatic testing, are a huge challenge for even a highly effective contact tracing system.’ 

It would have been better if the report admitted that contact tracing is hugely challenging, that it would never have achieved its intended outcomes and was, therefore, a waste of £37 billion. This is something health officials in Lombardy, Italy had realised by the beginning of March 2020. The UK Parliament has also pointed out that the contract tracing programme had an ‘unimaginable’ cost.    

Hospital-acquired infections are also ignored in the report. This is even though up to 40 per cent of ‘hospital cases’ were infections acquired in hospitals. The distribution of these cases mirrored the way the disease spread in the surrounding community, suggesting that whatever ‘protection’ measures hospitals were taking did not work. 

When it comes to the low risk to school children and teachers, the report portrays this as a tension between missing education and stopping transmission: 

‘In restricting attendance in educational settings 

This must be heavily caveated with the health and wellbeing impacts of limiting attendance in educational settings to priority groups – which are substantial. They include: 

• missed learning 

• a reduction in non-COVID-19-related healthcare utilisation 

• exacerbation of existing inequality for both children and parents’ 

But school-age children had the lowest Covid risk, and we are now reaping the effects of this immunological segregation, with a whirlwind of influenza-like illnesses sweeping across the country. The costs to children socialising and the impact on their schooling are mere details in the report.  

There are a few mentions of the true costs of lockdowns, with the report mentioning:  

‘There is little doubt that delays in presentation, reductions in secondary prevention (such as statins and antihypertensives), postponement of elective and semi-elective care and screening will have led to later and more severe presentation of non-COVID illness both during and after the first 3 waves. The combined effect of this will likely lead to a prolonged period of non-COVID excess mortality and morbidity after the worst period of the pandemic is over.’ 

However, the type of evidence cited in the report’s footnotes and references is remarkable. It mainly relies on models, i.e. opinions formulated by those with a long history of getting it wrong or citing selective pieces of work. 

Our requests for the cause of the current excess in deaths have gone unanswered. If lockdown has caused these excess deaths, as stated in chapter 10 of the report, then this suggests that the harms of lockdown restrictions outweigh any benefits. But this lack of analysis damages the credibility of any calls for future restrictions.  

There is no mention of the need for proper planning to plug known gaps in the evidence. For example, suppose you need to know whether masks or other physical interventions work in the community, you prepare protocols for trials designed to find this out in a short time. In that case, you get prior ethical approval and fire the starter pistol when the WHO declares a pandemic or earlier.  

There is plenty of precedent for this kind of preparation. That is what happened in 2009 with mock-up influenza pre-pandemic vaccines. So there can be no excuses here, just a disregard for crucial gaps in the evidence and a reluctance to address them. It is even easier in the case of non-pharmaceutical interventions (NPIs) as there are no regulators breathing down your neck. 

The report says: 

‘There are also gaps in the evidence base on NPIs, which we expect will continue to evolve in the coming years…’ 

Yet there’s still only one randomised trial assessing the wearing of masks in the community. The reluctance to reduce uncertainties over whether and which NPIs work remains unclear.  

As the report observes: 

‘It may never be possible fully to disentangle some of the effects of individual NPIs in this pandemic, as many were used together…. 

Observational studies on NPIs were often complicated by several potential confounders.’ 

Due to the sheer number of interventions tried at any one time, we may never know what works, particularly if we also rely on low-quality observational studies – as we have done – to inform policy.  

But none of this matters: it’ll be more of the same next time.