Carl Heneghan

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?

My patient has sepsis. The window for treatment is short; in less than an hour, he could die. In urgent care, the direct line to ambulance control bypasses 999: it lets the call handler know a doctor requires urgent attention for a sick patient. Ten minutes: no response. I’m on a second phone to central dispatch: what is going on? A critical incident has been called; the service is overwhelmed. Finally, after 15 minutes, the phone answers and help is on its way.  Worryingly, this is far from an isolated incident. Last week, it was reported that an ambulance service sent a taxi to a GP practice in Bristol to collect a patient with a broken hip after a nine hour wait.

Boris Johnson is self-isolating in Downing Street after hosting an MP who subsequently tested positive for Covid-19. As we all know, Johnson has already been affected by SARS-Co-V2. So can the Prime Minister, who has presumably built immunity to this virus, be reinfected? For once the answer is clear: it’s possible. We know this thanks to the work of the Medical Research Council’s Common Cold Unit (CCU). The unit, which worked on the site of a WWII American Red Cross base near Salisbury, ran over a thousand studies between 1946 and 1989. One of its last projects analysed the time course of the immune response to experimental coronavirus infection of man. Fifteen volunteers were infected with coronavirus 229E.

The recent warnings of exponential growth of Covid-19 cases, inevitably followed by a rise in hospital admissions, is one focus of the Government's Covid messaging. Jeremy Hunt described this spike in admissions as a 'wake-up call' for the Government. But while this year the disease is newly identified, warnings of a winter crisis in the NHS occur annually. So should we be worried? For 20 years, 'influenza' has been blamed for putting hospitals under pressure in winter. Now, this fear has been substituted by 'Covid'. Yet both are one-track, one-pathogen scenarios, which ignores the reality that there are scores of different pathogens that cause respiratory infections across a community at different times of the year.

Prediction, projection, illustration — call it what you wish, but when you make a statement about what’s going to happen next, people are going to assess whether you’re correct or not. Sir Patrick Vallance, the Chief Scientific Adviser, said last week:  At the moment we think that the epidemic is doubling roughly every seven days...If, and that’s quite a big if, but if that continues unabated, and this grows, doubling every seven days… if that continued, you would end up with something like 50,000 cases in the middle of October per day. Making projections is fraught with danger, but there are ways to caveat such statements that allow better understanding.

Are Covid cases doubling or not? And if so, in what time frame? If you listened to Boris Johnson and chief scientific adviser Patrick Vallance, you'd be forgiven for being confused. The Prime Minister said this week:  'The chief medical officer and chief scientific adviser warned that the doubling rate for new cases could be between seven and 20 days.' In fact, Vallance had said this:  'At the moment we think that the epidemic is doubling roughly every seven days.” And added, “It could be a little bit longer – maybe a little bit shorter – but let’s say roughly every seven days.' So what's going on?

Will the current cycle – lockdown; open up; eat out; restrictions; lockdown – go on forever? In their handling of coronavirus, Boris Johnson and his colleagues have become increasingly media-responsive, fear-bound, model-sensitive, sound-byte producing, u-turn prone and, quite frankly, embarrassing to all who believed the UK to be a beacon of rational thought. Has the Government lost the plot? We are not sure if it ever had one. This week at its annual meeting, the British Medical Association lamented the Government's lack of grip on the public health during the current pandemic and proposed a ‘near-elimination’ strategy.

When Boris Johnson returned to work in April after his brush with coronavirus, he warned that lockdown restrictions must remain to prevent a second wave. Ever since, beset by anxieties, doubts and fear, and surrounded by a platoon of advisors, the PM has made one cautious, catastrophic error after another. Last week’s roll of the dice with the ‘rule of six’ could well be the policy that tips the British public over the edge. For it is a disturbing decision that has no scientific evidence to back it up, and may well end up having major social consequences. The government has decided to blame young people for the latest restrictions, having spent August asking them to revive the economy.

There’s significant mounting interest in the increase in detected cases in the UK. However, it’s worth looking at the data to try and understand what is going on. First, it is essential to analyse cases by the date the specimen was taken, as opposed to reported. The second vital thing to do is to observe this data for emerging patterns, even before looking at the numbers. If you do this, then the Government’s Staging Data shows an emerging pattern, whereby the number of people testing positive on the weekend is significantly lower than that observed in the week. Furthermore, if you assess the data for the last week, you see this effect is accentuated by the Bank Holiday Monday on 31 August.

Something rather odd is happening in the two Europeans nations worst hit by Covid-19. The UK and Italy have a rising number of cases but a stable and very low number of deaths, even weeks after the cases started rising again. At the time of writing, the UK records 1750 new cases daily and one death in a population of 67 million. With a roughly similar population and an average of 602 cases a day, Italy has had just over four deaths a day over the last month. The ratio of cases to deaths is nowhere near what it was at the height of the pandemic. The other notable feature is a shift of cases to a younger population. There can be several explanations for this trend. First, the viral agent may have mutated to a less virulent form.