UK Covid Inquiry Failed to Ask the Key Question: Why Were People Dying?
The explosion of mainstream media headlines following the release of the Hallett Inquiry module two report has concentrated on the conclusion that 23,000 deaths occurred as a result of governmental delays in enforcing lockdowns.
While I admire the precision (not 22,000, not 24,000) the 23,000 figure is, as the inquiry states, an estimate based on modelling.
Whose modelling? If that of Neil Ferguson, who had previously been alarmist to the point of hysteria over a foot and mouth outbreak, then the model is fit for the dustbin. Garbage in, garbage out. But Baroness Hallett may not be so wrong – indeed the 23,000 may be an underestimate, but not for the reasons she has wrongly adduced.
SARS-CoV-2 was a novel virus. We now know, but not at the time, that it was accidentally released in China, but the exact mechanisms leading to that need not bother us. What mattered was that it appeared to be both very infectious and potentially fatal. However the fatality numbers are missing something (ignoring whether the figures were of deaths from Covid or deaths with Covid but from something else). Why was it fatal, leading to the acute syndrome of respiratory and other organ failure we now know as COVID-19?
I have read the lengthy report published on November 20th. It is a remarkable catalogue of governmental goings-on, but there is a glaring omission: there is nothing about medicine. There is science, epidemiology, statistics, models, but the fundamental question should have been: what is happening when people get suddenly sick, and how do we treat them if they do? If an infection does not kill people it is usually unimportant: we don’t go berserk over the common cold.
If it does we need to know why and fix it. This is not an investigation for epidemiologists, scientists, statisticians, public health doctors, politicians and others who have no experience of managing acute medical emergencies. It is for clinicians – front-line doctors who see an illness, do investigations and arrange treatment.
Where were they? And why has this report completely failed to ask the question – where were the clinical experts?
I have struggled through the full report. By a strange coincidence I submitted my own evidence to the inquiry three years almost to the day since this full report was published. It was an exposition of events and had recommendations. I stand by it years later. The inquiry chose both to ignore it and to not publish it. In the preamble to my evidence I pointed out that I was a physician, now retired, with extensive experience of immune-mediated diseases. As a rheumatologist I dealt with autoimmune conditions such as rheumatoid arthritis. Wearing my rehabilitation hat I managed people disabled by multiple sclerosis, who are prone to recurrent infections especially of the chest and urinary tract, which often led to sepsis.
I began blogging about the pandemic at the end of February 2020. Had I still been working I guess that I would have worked out the pathology of severe disease (for the sake of clarity I am calling simple infections SARS-CoV-2 and the severe complication of it COVID-19) earlier than I did, which was in mid-April 2020. Keeping a blog, a.k.a. a diary, I can be sure of my dates.
By the end of April I had, based on my knowledge of immune disease, developed a protocol for treatment which, as it happens, was almost identical to that proposed in the USA at the same time. I had also read extensively about the complications outside the lungs that formed part of the COVID-19 complex and understood what investigations should be done in patients who exhibited early signs of serious illness.
What we were seeing was a large outbreak of a hyperimmune response to SARS-CoV-2 infection, otherwise known as a cytokine storm.
I submitted this information in separate emails to Chris Whitty, Patrick Vallance and Matt Hancock, following up the last of these with a hard copy. I also offered my services to the SAGE committee, pointing out that it did not appear to contain any clinicians who might understand the pathology. But I did.
I heard nothing and no action was taken on my recommendations.
Thus, when Lady Hallett in her preamble to the latest report says “I have considered whether their decisions were reasonable and justifiable in light of the information that was then known, or which ought to have been known, to determine if things could have been done better and to learn lessons for the future”, the first thing I would ask is: how could any decisions be reasonable and justifiable when they had ignored an expert who was an expert clinician.
Lady Hallett’s preamble contains an interesting statement on Module 1 of the inquiry: “In particular, it found that there were fatal strategic flaws underpinning the assessment of the risks faced by the UK.”
The major strategic flaw, in my view, was that the risk assessment was wrong and based on the wrong premise, namely that there was no way of recovering those who got really sick. As for those who did not, nothing at all needed to be done. In this report she says:
Although the pandemic affected everyone in the UK, the impact was not shared equally. Older people, disabled people and some ethnic minority groups faced a higher risk of dying from COVID-19. For example, when taking into account age, people from a Black African and Black Caribbean background had the highest rates of mortality during the first wave of the pandemic. From the second wave onwards, the highest mortality rates were among people of an Asian or Asian British background.
Correct. But why did no-one ask why this should be? One reason had already been identified and published. I admit I did not clarify this in my own mind until mid-April, when I discovered a seminal textbook published before the pandemic (Cron and Behrens, Cytokine Storm Syndromes, Springer, 2019).
Its descriptions, identical to the problems of COVID-19, confirm that some of the significant elements of a cytokine storm depend for their severity on genetic makeup. And guess who was susceptible? I had seen such a case way back and successfully treated the patient.
Hallett does not refer to this science; at the time the ethnic risk was attributed to racial discrimination and deprivation, though why one high-risk group of Asian doctors could possibly be described as deprived escapes me. In fact they died because other doctors had not recognised the cause of COVID-19 and therefore failed to administer the right treatment.
Hallett also states: “When faced with a virus with the potential for exponential growth, interventions must be imposed earlier and ‘harder’ than might be considered ideal.”
Why? If that virus doesn’t kill substantial numbers of people the intervention you need is – nothing.
The next point I picked out is valid. Up to a point. Hallett talks about broadening participation in SAGE:
Open recruitment of potential experts and representation of the devolved administrations would ensure that advice to decisionmakers draws on a wide range of expertise. The inquiry also recommends extending the principles of transparency of scientific advice to other forms of technical advice provided to governments, so that the public can understand the range of factors beyond scientific advice that influence decision-making during an emergency.
Science? Technical advice? What about medical advice? Even so I will let this pass, as I offered my medical expertise free and no-one listened, in my opinion a literally fatal error. If you are dealing with a medical disease you need doctors. Actually I think I said that already. It is remarkable again that in the report’s section on understanding severity there is no reference to doctors.
This is, sadly, no new phenomenon. In 1921 the British Medical Journal published a comment on a report from the Queen’s Hospital, Sidcup, which had become a centre for facial reconstruction in the Great War:
We have received an exceedingly interesting publication… [from] the Queen’s Hospital, Sidcup, for sailors and soldiers suffering from facial and jaw injuries. … The report… gives an account of the last four years’ working of the hospital, and states that the end of its labours is now happily in sight. The admiration which we had for the Queen’s Hospital has, since reading this report, been greatly intensified, for it would appear… that the committee has achieved its thousands of brilliant results without the aid of any surgeons or dentists, except one honorary consulting surgeon and the presidents. … It does mention, it is true, that at one time some overseas medical officers were at the hospital… but otherwise the entire work of the hospital was apparently carried on by the vice-presidents, general committee, commandant, matron, honorary secretary and treasurer, accountant and auditor… absolutely no mention is made of the existence of any active surgical staff. A leaflet was enclosed in the report, printed in red ink, to which we turned eagerly as perhaps giving some explanation of this unusual method of staffing a hospital, but it merely expressed the regret of the honorary treasurer that, owing to an accidental omission, no mention had been made in the report of the Committee of the National Relief Fund. So the mystery – or the triumph – remains.
Sound familiar? Only 100 years ago! Substitute politicians, civil servants, bureaucrat doctors, statisticians and non-clinical scientists and one could very simply rewrite this antique piece to relate to the handling of the Covid episode.
The report in discussing strategy talks at length about public health measures with no reference to diagnosing severity (Para 1.39-47).
Throughout Section 2 there is detailed description of the political processes informed by non-clinicians. I cannot find any reference to the input of doctors who were either treating or knew how to treat those who became seriously unwell.
In Section 3 there is much reference to modelling, modelling and more modelling. Has no-one in the inquiry come across the well-known acronym GIGO? Garbage in, garbage out as I said at the beginning. That sums up modelling. Don’t get me started on climate change.
Para 3.35 starts us on an Action Plan which does not seem to address the immediate and urgent need there was for research into treatment. It summarises research to “better understand the virus and the actions that will lessen its effect on the UK population; innovate responses including diagnostics, drugs and vaccines; use the evidence to inform the development of the most effective models of care”.
I propounded the last of these, as I have outlined above. It’s no good working in a vacuum. I provided the evidence. It was not used. Why not? It goes on to say it must “provide the best care possible for people who become ill, support hospitals to maintain essential services and ensure ongoing support for people ill in the community to minimise the overall impact of the disease on society, public services and on the economy”.
Indeed it must. It didn’t. The right treatments were not widely introduced in the UK until November 2020, following a trial that only proved what we already knew and what I had outlined in April.
In Section 4.203 the report starts to talk about “scientific advice”. What about medical advice? In this panic situation do we not require it? Pull the other leg.
It was hard work getting through Volume 1, but the start of Volume 2 was depressing beyond belief. I recommend readers look at Section 9, and in particular the table in 9.31 (Table 39). Then see again what was said of Sidcup in 1921: “Absolutely no mention is made of the existence of any active surgical staff.”
Where, in this catalogue of participants, are the active medical staff? SAGE appears to have welcomed all sorts of administrative types, but no clinicians. Would you want a Chief Medical Officer, by definition a bureaucrat, supervising your acute medical care? By the time I reached 9.86. It’s all about science, science and more science. There was a faint hint of rationality.
Lucy Yardley, a psychologist is quoted as saying: “There was no time or resource available in the early stages of the pandemic to undertake a systematic search for a wide, representative group or to engage in formal processes for selecting and inviting members… only people with the capacity to free up substantial time for SPI-B from their day jobs and home commitments could make a significant input.” Yeah, right.
So I could have made a significant input, being retired and with few home commitments other than weeding the allotment and ironing my shirts. In heaven’s name I offered to help. I am an expert. No systematic search was necessary.
Section 10 covers differential risk. It is not proven yet, but I suspect the risk to elderly people is because their immune system is more volatile. The risk to obese people may be a hormonal issue; they have high levels of a pro-inflammatory hormone called leptin. I have already noted the ethnic issue; my first suggestion of a genetic predisposition was on April 24th 2020, but I was ignored (though ‘The Science’ was to prove me right) and there was much distraction setting up unnecessary committees to hunt for social and economic causes. Developing “cultural strategies” is a nonsense.
While transmission may be increased in multi-occupied housing that does not translate to an increased risk of developing COVID-19. It’s the genes that matter, as was first outlined in print in May 2020, but then I suspect none of these bureaucrats know how to look stuff up on the internet.
I skimmed most of the rest. It’s all about irrelevant political process. Maybe I missed in my skimming any reference to those clinicians who had correctly diagnosed the pathology of COVID-19 and sorted out treatment, but I doubt it. It is of interest that the two images of the Prime Minister Boris Johnson (para 12.21, figs 40 and 41) carry the message that staying at home will save lives. This is, of course, incorrect. The public were encouraged to stay at home even if they became ill, which ensured that if they had developed COVID-19 they would be at a higher risk of dying, because hospital admission at a late stage with cytokine storm syndrome has a much worse prognosis. As a corollary to this the one thing that would have saved lives but was not administered in the first six months of the pandemic was the correct treatment for a cytokine storm. Neither has it been commented upon that the suggestion that the NHS be protected from patients is an oxymoron.
In an alternative universe this would have happened:
At the end of April 2020 the Secretary of State, Chief Medical Officer and Chief Scientific Officer, were presented with a protocol for the management of the outbreak. Dr Andrew Bamji, a retired consultant rheumatologist with a wide knowledge of immune-mediated disease, outlined the process by which COVID-19 developed, described the investigations that would indicate pending severe illness and presented a comprehensive management plan. He pointed out that in the majority of SARS-CoV-2 infections serious illness did not appear, and thus that all that was required was to correctly treat those who developed COVID-19 and ignore everyone else. He suggested further that particular groups at risk with a genetic predisposition should be withdrawn from front-line medical care. His proposal was backed by existing research confirming that the features of COVID-19 were identical to those already described in other infections, and also that chromosome anomalies were likely to be responsible for differential risk.
The SAGE Committee invited Dr Bamji to join. His arguments were convincing and his strategy was adopted. As a result of early intervention based on diagnostic testing and the immediate administration of appropriate immunosuppressive treatment to those patients who had developed COVID-19, patients rapidly recovered. The fatality rate dropped precipitately. It was agreed that no further measures, such as masks and lockdowns, were necessary. As a result, plans for mass vaccination were deemed unnecessary.
I wish.
Subsequently we have learned that the immunogenic part of SARS-CoV-2 is the surface spike protein, and this is responsible for the systemic features of COVID-19 including vascular damage, coagulation disorders, myocarditis and stroke. It is thus difficult to understand the rationale for vaccination which involves, effectively, getting the body’s cells to generate variable quantities of spike protein for a variable time. Furthermore it is apparent that mutations have diminished the immunogenicity of the spike protein, so it no longer causes the same severe disturbance as the original.
May I turn now to planning? Paragraphs 15.3 et seq. are remarkable in their naïvety. They assume that you can plan how to cross a bridge before you come to it, but worse, plan how to cross a bridge before you even know there is one. With the right experts you don’t have to do this, because the right experts will work “at pace” to match a solution to the problem that is actually there. The only framework required is a list of the right experts.
Finally I reached the end. In Appendix A1.9 comes the statement that consideration must be given to “the initial understanding of, and response to, the nature and spread of COVID-19 in light of information received from relevant international and national bodies, advice from scientific, medical and other advisers”. Indeed. So, given that there appears to have been no medical advice from clinicians who understood the problem, why does the report not castigate the government for not only failing to consult clinicians but turning a blind eye to those clinicians frantically banging on the door?
Following publication there has been a great deal of comment in the press (in particular Lord Frost in the Daily Telegraph was scathing) but the same old tropes emerge: a blind belief in modelling prophesy and a blind belief that the Covid vaccines were safe and effective. Frost wrote:
The fundamental question that we still need answered, and which this report does not answer, is whether lockdowns saved lives. Were they the right response to a disease with a fatality rate of between 0.1 per cent and 0.5%? If we don’t learn this then the whole inquiry is a waste of time, because it has given us no guidance as to what to do if it happens again.
But actually the fundamental question is why, when all that was needed to stop the panic was the adoption of the correct treatment for the seriously ill, were the experts who directly advocated such treatment cast aside?
Lord Sumption wrote in the Times:
The main problem seems to be that Hallett relies almost entirely on the evidence of the government’s advisers. They were contemptuous of outside experts who rocked the boat by proposing different approaches. This is the worst possible kind of groupthink. Yet the inquiry uncritically adopts their line. Experts do not like being contradicted and understandably seek to justify the advice they gave at the time. But rather more is expected of an inquiry chairman who is supposed to be taking an independent view of these matters.
On September 1st 2020 I wrote a letter to the Times saying:
I first suggested protocols for the early diagnosis and treatment of COVID-19 in a letter to the Chief Medical Officer in late April. I had no acknowledgement of my original letter, nor to subsequent communications. I proposed the use of steroids in a detailed note to the British Medical Journal on April 28th. Four months later steroids are still not part of treatment guidelines. Had my suggestions (based on scientific evidence) been adopted at the start I estimate that around 11,000 lives might not have been lost. This is the consequence of the government choosing the wrong advisors. If clinicians versed in cytokine storm management had been involved at the start we would not be where we are.
It was not published. Later I revised my estimate to 20,000. Which is, of course, not far from Lady Hallett’s estimate of 23,000. Just a different reason.
But should we blame the politicians? In truth they are medically illiterate and so rely on their medical advisors, who in turn were clinically illiterate (and still are, it seems). The failure to introduce proper treatment regimes for COVID-19 is a failure of those advisors. They are the ones who should be held to account.
I submitted a substantial paper to the inquiry. As I said at the start my paper was politely cast aside, and because I was not called to appear before the inquiry in person it does not appear on the inquiry’s website in the list of evidence.
The inquiry interviewed a large number of clinically illiterate bureaucrats and while I feel deeply for those who attended having lost relatives, their experiences are only from a lay perspective. The fact remains that people died because clinicians were ignored, as a result of which the seriously ill were wrongly treated (or in the case of those ejected from hospital to care homes, not treated at all) and many died.
This second instalment of the Hallett inquiry report concentrates on process, devised and recalled by people with no medical knowledge who thought fit to exclude experienced clinicians from their discussions. I would be happy to hear from anyone who finds fault with my analysis as submitted and my recommendations for the future.
Dr Andrew Bamji is a retired Consultant Rheumatologist and was President of the British Society for Rheumatology from 2006-8. He blogs here.
source dailysceptic.org
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