Our national pandemic health protection response in the UK has been undermined at every turn by misinformation and disinformation from self styled “libertarians,” “lockdown sceptics,” “truth seekers,” covid deniers, conspiracy theorists, and professional attention seekers—whether high-profile media commentators, politicians, and lobbyists, or organised groups on social media.
Many of these activists are fond of asking “why are we doing this?” and encouraging people to “do your own research.” I wish they followed their own advice and put this question to themselves.
These factions, instead of engaging in debate in good faith, have repeatedly tried to argue that the pandemic and response have been a con. They assert, promote, and repeat mistruths as gospel. They quote and lionise a handful of rogue scientific experts (rarely credible within the subjects they are commenting on).
But as the evidence has mounted, their precarious Jenga tower of false beliefs is collapsing around them, block by block—not that they’d ever admit it. Even now, you’ll see them pointing at the rubble and talking as if it is the Empire State Building. Here are some of the blocks.
Bad science
“The pandemic is effectively over and there will be no second wave.” Well, looking at the current graphs on case rates, hospital admissions, and deaths, you’d think some of them might now admit they had got that badly wrong. Their predictions were up there with Chamberlain’s “Peace in our Time” promise, or those who thought that talking pictures would never catch on.
“This is no worse than a normal flu season, and there are no excess deaths.” On the contrary, on 12 January 2021, the Office for National Statistics (ONS) announced the highest increase in excess deaths since the second world war. [1] This was before December’s data, let alone data from January 2021. January saw the highest numbers of daily recorded covid-19 deaths since the first reported UK covid death in March 2020. [2]
“Hospitals are under no more pressure than usual, and intensive care occupancy is standard for this time of the year.” But intensive care units (ICUs) are now running at up to twice their normal capacity, and acute hospitals in early January had between a quarter and a half of their beds occupied by patients with covid-19, were having to postpone elective procedures and operations, faced high levels of staff sickness, and were facing growing problems with overcrowding and ambulance crews. [3-5]
“Covid-19 kills only older people or those with pre-existing conditions, who were likely to die anyway.” [6] Independent analysis from Glasgow University showed an average of ten years were taken off projected life expectancy in people dying from covid-19. They were not all at death’s door. [7] And individual life expectancy at 80 is not the same as average life expectancy at birth.
Besides which, many patients may not die, but go on to experience debilitating “long covid” symptoms for months—clearly described by the National Institute for Health Research (NIHR) and the National Institute for Health and Care Excellence (NICE). [8] And many more are admitted to hospital even if they don’t then die.
“But those death certificates were all false, and it was really people dying with covid, not from it.” Apart from the fact that in 90% of death certificates that included covid recorded it as an “underlying cause of death”. [9] Remember, certificates are completed by doctors who looked after the patient just before death, who have a statutory duty to complete them honestly and must discuss them with a medical examiner. At no point have we been instructed to certify people as dying from or with covid-19 if we don’t think it relevant.
The constant media reports framed with the government’s definition “deaths within 28 days of a positive test” don’t help public confidence, but they probably underestimate real death numbers. [10] The Office for National Statistics (ONS) data are based purely on certificates and not an arbitrary 28 day cut off. [11]
“The whole thing is just a case-demic because PCR tests are used to diagnose it, and they have a false positive rate of 80%, These are not even real cases.” This has been a recurrent assertion. PCR can’t tell you whether a person is currently infectious to others. But in reality, polymerase chain reaction (PCR) testing has a very low rate of false positive results (less than 1%) in people with symptoms, whose likelihood of having covid-19 is high. [12] Applied to a whole asymptomatic population as a screening test, when population prevalence of infection is low, it will turn up large numbers of people without covid as a function of sample size.
However, as the second surge has escalated, the “Positivity Rate” in people home tested in rolling research studies or presenting to acute care have increased dramatically this winter. [13] And hospital admissions, bed occupancy, ICU admission, and deaths in people with a positive test and clinical picture of covid-19 as assessed by the doctors looking after them surged to a January peak. [14] This is demonstrably not all some fake scare from a flawed test.
“Sweden got the response right. They didn’t introduce restrictions, went for a herd immunity strategy, and their economy has been protected.” In reality, Sweden’s covid-19 death toll has massively outstripped that of each of its Nordic neighbours, and its hospitals and intensive care units are under huge pressure now. [15] Sweden has recorded its own highest excess mortality increase since 1919. The country’s King and many senior politicians have admitted they got it badly wrong. [16,17] The World Health Organisation described herd immunity approaches as “dangerous and unethical.” [18] Sweden’s economy has not been protected from a hit. Sweden is now considering lockdown approaches akin to those in many European countries. [19] And besides, the policy approach actually involved far more behavioural modification and state social support for isolation than the contrarians want to admit. [20]
Good science
The countries with the best pandemic responses including several in South East Asia went for concerted testing, tracking, reverse tracing, identification of spreading events, isolation, quarantine, and behavioural restrictions to reduce transmission. This narrative does not suit the libertarian agenda and requires some humility from western nations which feel exceptional. [21]
New Zealand and Australia employed a mixture of robust and restrictive approaches including lockdown in Victoria and zero covid approaches without seeing collateral damage in terms of excess mortality for non-covid deaths. [22]
Lockdowns might be an admission of failure of other health protection measures. But they are based on what we know about the routes of covid-19 transmission, they have been adopted by numerous nations and when implemented, at least in the short term, covid infection rates do fall. [23]
If the deniers had, right from the outset, focused their arguments on the harms, costs, and risks of health protection measures and the coherence and competence of government policy, we might have got somewhere.
Even then, their argument may be a false dichotomy between pandemic health protection and the economy. An unchecked covid-19 surge would harm many sectors and put many out of the workforce and overwhelm key services. From the outset, many public health experts were arguing that lockdown was a measure of last resort if other measures failed. It never was “either/or” as an international scientific consensus statement in October 2020’s The Lancet made clear. [24]
The covid deniers, the conspiracy theorists and many of the lockdown sceptics who like to differentiate themselves from the first two groups without trying to distance themselves from or condemn their arguments, have spent months constructing a shaky belief structure made of dodgy building materials, which is now collapsing in slow motion, on contact with reality.
David Oliver is an experienced NHS consultant physician who has worked on acute covid-19 wards throughout the pandemic. He writes a weekly column in The BMJ.
Competing interests: none declared.
References:
[1] Covid: 2020 saw most excess deaths since World War Two – BBC News
[2] UK reports 1,820 more Covid deaths, the most recorded in one day | World news | The Guardian
[5] Almost 100,000 NHS staff off sick as number absent due to Covid doubles (telegraph.co.uk)
[7] New study finds coronavirus can cut life span by 10 years or more | TheHill
[8] NIHR Evidence – Living with Covid19 – Informative and accessible health and care research
[9] Behind the numbers: how to make sense of ‘excess’ deaths | Coronavirus | The Guardian
[11] Deaths from Covid-19 (coronavirus): | The King’s Fund
[12] Interpreting a covid-19 test result | The BMJ
[15] Covid-19: Sweden considers tougher restrictions as ICU beds near capacity | The BMJ
[16] Coronavirus: Swedish King Carl XVI Gustaf says coronavirus approach ‘has failed’ – BBC News
[18] WHO: Herd immunity for the coronavirus is a ‘dangerous concept’ (telegraph.co.uk)
[19] Sweden’s distinctive Covid strategy nears an end as lockdown proposed | Financial Times (ft.com)
[20] Anders Tegnell and the Swedish Covid experiment | Free to read | Financial Times (ft.com)
[21] The lessons from East Asia’s coronavirus successes | The Japan Times
[22] Covid-19: Learn from other countries about easing lockdown, researchers urge | The BMJ
[23] Can we believe the lockdown sceptics? – Full Fact
[24] Scientific consensus on the COVID-19 pandemic: we need to act now – The Lancet