Carl Heneghan

We needed a Covid inquiry – but this isn’t it

What is the point of the Covid Inquiry? It should be to establish which parts of the government’s pandemic response worked, which parts didn’t, and what to do next time. Instead, it is a farce – a spectacle of hysteria, name-calling and trivialities.

The stakes could hardly be higher. Lockdown was the most disruptive policy in British peacetime history, with huge ramifications for our health, children’s education and the economy. At the time, lockdown theory was new and untested: there was no data around it. Now we have data. This is an opportunity for the inquiry to gather evidence and ask whether lockdown and other interventions actually worked. What were the benefits and the side-effects? What about masks? Care homes? Mental health? We need to learn from the results before the next pandemic.

It seems to be working on the premise that we should have locked down harder, sooner and longer

Instead we have a KC who seems uninterested in substance and obsessed with reading out rude words he has found in other people’s private messages. What Dominic Cummings said about his colleagues in moments of exasperation is treated like the real substance of the issue. The whole inquiry seems to be working on the premise that we should have locked down harder, sooner and longer – and that, if we had, Sars-CoV-2 would have melted away like snow. ‘Follow the models’ will probably be the inquiry’s closing motto.

The refusal to address the core issues – the denialism that seems encoded into the inquiry – is, in a sense, the culmination of a trend that took hold during the pandemic. I call it the silencing of science. It is a process in which supposedly science-led policies are made using either bad evidence or no evidence. It is the way in which dissenting voices, even in academia, are dismissed as malign or confused, or just brushed off as ‘sceptics’. When scepticism becomes a dirty word, science is in deep trouble.

I gave evidence at the inquiry last week. I had submitted a 74-page statement on what I thought it should discuss. Instead the main topic was rude words in old Whats-App messages. Was I the ‘f***wit’ referred to in messages from Dame Angela McLean, the chief scientific adviser? I replied that I had no idea but would never use such language about a colleague myself. The KC questioning me launched into an attack on my credentials. I’m a clinical epidemiologist and author of 450 peer-reviewed publications. During swine flu, I co-led the Cochrane neuraminidase reviews for preventing influenza in adults and children. I’ve advised governments and parliamentary all-party groups.

The KC argued that, as a generalist, my work counted for little alongside the epidemiological modellers (who have been given a fawning reception by the inquiry). To me, part of the problem with the government’s response to Covid is that it was overly influenced by modelling, despite its well-known past failures. This was accompanied by a failure to consider the wider implications of policies such as lockdown.

The pandemic desperately needed generalists who understood medical decision making. To my knowledge, there has never been an overall cost-benefit analysis of lockdown. To suspend such basic analysis marks a radical departure from traditional standards in public health policymaking, the equivalent of a see-no-evil policy. At the inquiry one witness was asked about the downsides of a particular policy, to which Baroness Hallett, the chair, interjected: ‘I’m sorry, I’m not following. If there’s a possible benefit, what’s the downside?’

Care-home residents were forgetting to drink and were dying of dehydration

Much of the rest of my time in the inquiry chair was taken up with a KC questioning me over the Great Barrington Declaration, a document put out by scientists who disputed the government’s Covid-19 response. I agreed with the declaration in general, but I neither drafted nor signed it. The inquiry may be right to examine the document (which called for younger people, less badly affected by the virus, to be allowed to return to something approaching normal life), but they should have quizzed one of the signatories. Why was my limited time as an inquiry witness taken up by this? Why did the inquiry not focus on documents I had signed?

The last thing that Lady Hallett said to me was that I should submit in writing anything further I had to say, which made it seem as though she didn’t know about my submission.

It is clear now that this inquiry – which may end up costing a quarter of a billion pounds – is evolving into an attack on those who questioned the official policies of lockdown, mask-wearing and so on. If officialdom is turning a blind eye to the results of lockdown in an attempt to exculpate its architects, the inquiry will be a missed opportunity of historic proportions. Academics who wish to have an evidence-based conversation need to go elsewhere. Our hope will be that the free press shows an interest that the inquiry does not. There is too much at stake for us not to have this conversation.

Did lockdown work?

The Hallett Inquiry’s first question should be: did lockdown work? Instead, it seems to have adopted the default position that it saved the country from a far higher death toll and that if it been imposed earlier, many lives would have been saved. This assumption matters hugely, because there is enough evidence now to show whether it worked. Much of the world tried lockdown; Sweden rejected it. We can compare the results. 

The theory advocated by Neil Ferguson’s team at Imperial College was that lockdown would work instantly, reversing the virus’s exponential growth. If this was true, we’d surely have seen a concomitant drop-off in Covid deaths. The mean period between infection and death has been estimated at 21 days. If you allow for a week’s worth of transient increase in household infections due to lockdown, then as the advocates claim, deaths should have dropped off sharply on 20 April, four weeks after lockdown began on 23 March. In fact, Covid deaths peaked on 8 April and then started to descend at a rate of a handful of deaths per day.

This would suggest that, in fact, infections in the first Covid wave peaked around the week beginning 9 March, before lockdown began. Google Mobility data shows that by the end of that week there was a huge decline in the number of people going to work or using public transport, because they were choosing to stay at home in response to news reports about the virus. This trend was also seen in the Royal College of General Practitioners’ surveillance data on respiratory tract infections – i.e. non-Covid viruses – which also shows a peak of infections around 9 March.

The inquiry should spend time examining this crucial point. Could it be that in a high-information democracy, people can make the informed decision to stay at home themselves, making mandatory lockdown pointless? Might the whole theory of lockdown have been based on a false premise?

It should also consider the messaging: the idea that we should ‘protect the NHS’ by not using it. This was always going to have calamitous side-effects that, again, are visible now, but the inquiry seems uninterested in that. Hospital care for non-Covid diseases dropped off a cliff. Across the UK, admissions for cancer during lockdown fell by 40 per cent, those for cardiovascular disease by 22 per cent and respiratory disease by 19 per cent. People didn’t stop falling ill, they just stopped going to surgeries and A&E departments because they were scared and because the message to ‘protect the NHS’ had worked too well. We can now see ‘excess death’ data for all developed countries during the pandemic, which records deaths from all causes, not just Covid. The country with the lowest is Sweden, the only country in the western world not to impose lockdown. How many of the excess deaths in the UK relate to the effects of lockdown on healthcare, the seven million missed GP appointments? The inquiry should find out.

The care home tragedy

The confinement of care-home residents turned out to be even more deadly. In the first Covid wave, nearly half of the deaths occurred in care homes. This figure shows the devastation that was caused by the virus getting into homes, but the inquiry should also investigate the terrible care inflicted on residents thanks to Covid restrictions. This is a subject on which I am especially well qualified to speak, as I worked as an urgent GP during lockdown and visited many care homes. A study in the southern Ile de France region showed that in homes with excess Covid-19 deaths, acute respiratory infection was not the primary problem. Rather, deaths were mainly caused by hypovolemic shock – fluid loss. Confined to their rooms, and with staff absences running at 40 per cent, residents were forgetting to drink and were dying of dehydration.

It took a pandemic to reveal what has been going on for years in Britain’s chronically underfunded and understaffed care homes. Rather than isolating and abandoning care-home residents, we should have been identifying the most vulnerable and giving them greater support. Staffing levels should have been increased sharply and movement of staff between care homes stopped (those who moved between homes were three times as likely to have Covid).

Closing care homes to visitors – which a House of Lords committee concluded was a violation of human rights – also meant that more residents suffered from depression and loneliness and were prevented from receiving help from unpaid carers. Good supportive care could have saved the lives of the frailest and the most vulnerable. Lockdown did not impede deaths in the places they were most likely to occur, but the human cost of restricting visits was immense. The law needs to stop this ever happening again.

The reliability of test and trace

What about the test-and-trace programme, imposed at such crippling cost to the taxpayer? In a very short time, we went from having a few laboratories carrying out small-scale PCR testing to mass testing and isolation being touted as a way out of the pandemic. Yet on its own, a PCR test cannot distinguish between people who are contagious, those who are convalescent and those who have tested positive in error. The test-and-trace programme had no clear evidence-based objectives. Many people were ‘pinged’ and forced to isolate needlessly, but we still ended up with two further lockdowns, and the programme cost the taxpayer a fortune. The initial budget was £22 billion. By the time it was halted in February 2022, it was £37 billion. To put this into perspective, the sum needed to repair the damage done to education by lockdown was reportedly put at £15 billion by Sir Kevan Collins, the government’s catch-up tsar. The sum was rejected, and Sir Kevan resigned in protest.

Models and masks 

Why isn’t the inquiry focusing on the accuracy of Sage’s epidemiological models? They were, after all, the basis for suspending the country’s liberty. One big question is why the modellers were trusted, when they had got it so wrong in the past?

It’s also not surprising, as Dominic Cummings pointed out, that No. 10 did not always have a proper understanding of the debate going on within Sage. It was set up as a committee of expert advisers, yet somehow morphed into a pro-lockdown lobby group. Its membership grew to more than 200 individuals – far too many to create a coherent evidence base. Yet when the prime minister wanted a second opinion he had to reach out to me and Sunetra Gupta, two jobbing professors from Oxford who had nothing to do with Sage, to lay out some of the basic facts.

Could No. 10 not find someone with an alternative view in the 200? Or given the toxic atmosphere, did Sage members consider it best not to demur from the consensus? The only predictable thing about acute respiratory infections is their unpredictability. Effective decision-making must remain flexible, given the degree of uncertainty.

That’s why epidemiological models will always have monstrous error margins: there are too many variables, as we knew long before Covid. The botched reactions to BSE and foot-and-mouth were both driven by overly pessimistic models. Professor Neil Ferguson, who led Imperial’s Covid work, said that ‘up to 200 million people could be killed’ by bird flu. The government started stockpiling antivirals at a substantial cost after being told that the ‘best-case’ scenario would involve 3,100 deaths in the UK. The actual death toll across the world was 457. Was the Covid modelling any more accurate? If not, why not? 

It is even harder to pin down the evidence for compulsory wearing of face masks in public. At the beginning of the pandemic, most experts seemed to agree that masks were a waste of time. Yet within a year, mask-wearing had become compulsory. What happened to change policy? 

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The most important new study was from Copenhagen University Hospital, and it seemed to support the original policy of discouraging masks, showing no significant effect for mask-wearers. The government’s own ‘evidence summary’ for the use of face coverings in schools found a difference in Covid absences of just 0.6 per cent between schools where masks had been worn and those where they had not, which the authors of the report had to admit was statistically insignificant. The abandonment of scientific debate and the failure to conduct new studies left the field wide open for radical views to influence government policy.

During the pandemic, police were asked to intervene if they saw people not wearing a mask. Masks impaired student learning and encouraged people to see each other as a threat. Was all this done with no real scientific evidence?

The need for a red team 

I’d have welcomed the chance to tell the inquiry that, in future pandemics, a ‘red team’ of academics and scientists should be set up to challenge Sage and the Cabinet Office. We saw how quickly the democratic checks and balances were kicked away. The opposition signed off all lockdown policies, parliament became a rubber stamp, and even the cabinet was left in the dark about Covid policy decisions. How could a prime minister make informed decisions in such circumstances?

A final point that the inquiry should ask: what fate befell those academics who did question government policy? I have a senior position at Oxford University: I can take risks. But at a time when Britain needed original thinking more than ever, an atmosphere was created where younger academics felt they would risk their career if they challenged orthodoxy.

Such an atmosphere only stops us from learning the lessons of Covid – it leads to the silencing of science, a move away from Enlightenment principles and into a new era where debate is seen as heresy and groupthink reigns.

Written by
Carl Heneghan
Carl Heneghan is professor of evidence-based medicine at the University of Oxford and director of the Centre for Evidence-Based Medicine

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