X Close

Amid Covid crisis we can’t wait for perfect data With so many people dying each day, we must make fast decisions as best we can

Does mixing-and-matching vaccines actually work? Credit: Leon Neal/Getty Images

Does mixing-and-matching vaccines actually work? Credit: Leon Neal/Getty Images


January 6, 2021   9 mins

Perhaps my biggest mistake of 2020 was when I said I didn’t think the evidence for shutting borders was very good at the beginning of the pandemic. To make matters worse, I recently did it again, in an aside in a post about the new variant: I said that other countries shutting their borders to the UK now was probably “shutting a stable door on a long-bolted horse”.

Probably it is. But maybe it isn’t, and one thing I should have learnt by now is that, in this pandemic, the “maybe” is important. Maybe we can slow the spread of a new form of the variant; maybe that maybe is worth it. Last  March, we thought masks probably wouldn’t help – but we should have thought maybe they would. We need to think not in terms of certainties, but in terms of costs and benefits, gambles and payoffs. It’s an approach that’s all the more important as the vaccine starts to roll out. 

There was a piece in the New York Times about the British regime which illustrated this rather well. “Britain Opts for Mix-and-Match Vaccinations, Confounding Experts”, said the headline (later changed to “Britain Opens Door To
” etc). The British government, said the piece, was going to allow doctors to give patients a dose of one vaccine (for instance the Pfizer/BioNTech vaccine), and then a booster shot of a different one (say the Oxford/AstraZeneca one). This was, according to experts quoted, not a method supported by science: they “seem to have abandoned science completely now and are just trying to guess their way out of a mess”, said one.

British people, especially those with some understanding of how the British vaccination regime actually works, got understandably annoyed. “This is a complete misrepresentation,” said one fairly typical response; “fake news 
 false information spread by reputable media organisations”, was another.

That’s probably fair. As the NYT story did say, but didn’t make clear in its headline, the “mix and match” approach is a legitimate one of last resort: the guidelines tell vaccine administrators that “For individuals who started the schedule and who attend for vaccination at a site where the same vaccine is not available, or if the first product received is unknown, it is reasonable to offer one dose of the locally available product to complete the schedule.” 

It is not saying “Go to it lads, throw the vaccines around like you’re mixing drinks at a stag do”; it’s saying “If you can’t get hold of the vaccine you originally gave, it’s probably better to give a different one as a booster than none at all.” The BMJ has written to the NYT asking for a correction; the drug safety researcher Anthony Cox has written an excellent piece on why the story is unhelpful and dangerous.

So, bad NYT, do better, etc. But there’s a more interesting question: will the mix-and-match vaccinations actually work?

There’s a stock answer to this if you take a certain view of science and knowledge: they won’t. Or, at least, we don’t have any evidence to suggest that they will. It’s not “data driven”, says one expert quoted in the NYT piece. “There are no data on this idea whatsoever,” says another.

This is all true, of course. There have been no randomised controlled trials into whether a Pfizer prime and Ox/AZ boost works, or vice versa. And, traditionally, in medical science, if you haven’t got an RCT showing that your drug regimen works, then you haven’t got any evidence that it works.

But I want to argue that this sort of thinking doesn’t work in emergency situations like the one we’re in. More than that: it’s been a repeated problem throughout the pandemic that we have relied on this “we have the evidence/we don’t have the evidence” binary, meaning that we have moved slowly, waiting for rock-solid confirmation; but moving faster, making decisions on imperfect information, would have saved a lot of lives.

So what do we know? First, it’s worth noting that although the Pfizer and Oxford/AZ vaccines — and the Novavax, and the Moderna, and whatever else — all work through different mechanisms, at quite a fundamental level they all do the same thing. They all present the immune system with an antigen – a little thing that looks like a part of the virus, so that your body produces antibodies which will fight the real virus when it arrives. And in all cases, the antigen is the same thing: the spike protein, the little protrusions that come out from the surface of the virus.

In the case of the mRNA vaccines, such as Moderna’s, and Pfizer’s, the spike protein isn’t in the vaccine itself; the vaccine contains little lengths of RNA which get into your cells and tell them to produce it. The Oxford vaccine does something similar, but uses a genetically modified chimpanzee cold virus to get into your cells. Others, such as Novavax’s, use the spike protein itself. (You can read more about different kinds of vaccine here, should you wish.) But at base, they all work by making sure that your immune system will recognise the spike protein when it sees it for real.

So there are good theoretical reasons to think that a shot from one vaccine will work in combination with another. But there’s another reason as well: analogy from other vaccines. Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, told me that “heterologous prime-boost vaccinations” — that is, mixing and matching the two doses — have quite a long history: they were first proposed in 1992.

“The idea has mainly been studied in diseases for which we do not have an effective vaccine,” he said. “In HIV or malaria, or in dengue, where there is a single vaccine but it’s not very good.” In many cases, heterologous vaccinations like this can be more efficacious than homologous ones, he says (and there are papers to back him up). Most of the time, you don’t really need to get your vaccine efficacy up, because most vaccines are amazingly effective, hence their use in situations where the vaccines don’t work very well.

Of course, all those other heterologous vaccinations are backed up with RCTs. “We clearly do not have randomised trial evidence confirming efficacy of this,” says Evans. 

But those other vaccinations aren’t being carried out against a backdrop of about 500 people dying every day in the UK alone from a disease for which we have a working vaccine. “This is not an ideal, to do it until we’ve done the trials,” says Evans. “But in a situation of crisis where we’re not able to get people vaccinated with the same dose of the vaccine, it seems a reasonable thing to do to go beyond where we have trial evidence.”

Dr Zania Stamataki, a viral immunologist at Birmingham University, told me much the same thing. “We wouldn’t do this if we weren’t in a dire situation,” she said. “If we didn’t need to vaccinate as many people as possible as quickly as possible to save lives, we’d stick to the on-label advice. But at the moment we don’t have the luxury.”

It’s worth emphasising that this will only happen in extremis: if, say, the Pfizer vaccine has run out locally, or someone’s records are lost. “We’re anticipating that we stick to the regimen, and only in situations where we’ve run out supplement it with other things,” says Stamataki. But both Stamataki and Evans say that it’s a reasonable thing to do in those extreme cases. “Because the [the spike protein antigen] is the same,” says Stamataki, “we anticipate seeing the same result.”

Of course, it may not work. Babak Javid, an immunology lab director at the University of California San Francisco, says that the Moderna vaccine and possibly the Pfizer one introduced a small mutation to the spike protein to “stabilise” it, and that as far as he knows the Oxford vaccine didn’t; so the antigen may not be exactly the same. Will that affect it? Perhaps. It’s vital that we carry on monitoring; in an ideal world we might even do some randomisation, saying that certain GP practices should give the mix-and-match dose to patients where the original vaccine is unavailable, while other practices leave them on single doses.

But the point is that even though we don’t have 20 RCTs and a meta-analysis showing that heterologous vaccinations work for Covid-19, that’s not the same as saying that we don’t have any knowledge or evidence at all. There are reasons, from theory and from analogy from other vaccines, that it should work fine. As Robert Wiblin, the director of research at the evidence-based charity 80,000 Hours, says in this wise Twitter thread, there is a widespread attitude among certain decision-makers that “if a study hasn’t been done on a particular question we have ‘no data’, and therefore no basis on which to form beliefs or act”. But that is flat wrong, and dangerous.

It’s that form of thinking which led people — not just ordinary people, but the UK Chief Medical Advisor and the US Surgeon General, among many others; top, highly credentialled experts — to say early in the pandemic not just that we don’t know if masks work, but that masks don’t work, and to advise against them. They were right that there weren’t any good RCTs. (There still aren’t, really.) But there were theoretical reasons to think that masks might work, and reasons from analogy: we all accept that surgeons wear them to prevent infection during surgery, for instance. And as social interventions go, masks are relatively low-cost, compared with nationwide lockdowns or closed schools. If you multiply the good it might do by the chance that it works, and subtract the costs, the expected value looks pretty good.

You can understand the “no RCTs, no evidence” attitude. Over the last century or so, medicine has established a norm where the only evidence that really counts is lots of RCTs. There is an excellent reason for that: doctors’ intuition as to what worked and what didn’t was often extremely flawed, because doctors are people. So it is very important to show that your new drug or your surgical intervention does more good than harm before you introduce it.

But we simply can’t afford to wait for that level of certainty. Evidence, a wise man once said, is like money: “Obviously it’s useful to have as much evidence as possible, in the same way it’s useful to have as much money as possible. But equally obviously it’s useful to be able to use a limited amount of evidence wisely, in the same way it’s useful to be able to use a limited amount of money wisely.”

That means looking at the evidence you have, and making your best guess at the costs and benefits of one course of action versus another course of action. The costs of, say, closing schools are considerable. Meanwhile, the benefits are very hard to be sure about – how much do they influence transmission? How much are teachers at risk? But we can’t wait for more evidence to come in; we have to make decisions now, as best we can.

Similarly, there’s been a bit of a hoo-hah about another British plan to delay the booster jab for up to 12 weeks, so that we can get as many people the first dose (and some level of protection) as possible. Again, there are no specific RCTs looking into that – Pfizer only tested its booster three weeks after the prime, although the Oxford study did look at various different regimens including up to 12-week gaps. But again, we don’t have the luxury of demanding certainty and perfect evidence. The question is: do we think that a longer gap will work reasonably well, and if so, do we think the benefits of giving many more people their first dose outweigh the possible costs in efficacy? The MHRA obviously thinks so, and my own suspicion is that it’s pretty clear-cut. “We haven’t got the data” is partially true, but, again, it doesn’t mean we know nothing.

And in the case of mix-and-matched vaccines, once again, it’s true that we don’t have an RCT that says they’ll work. But we have good reasons to think they’ll work; perhaps not as well as the on-label regimen, but well enough to save lives and prevent severe disease and hospitalisations. 

And we know that the likely costs are low — there’s no evidence of any safety issues with heterologous vaccinations, and if the alternative is simply not giving the patient a booster at all because you’ve run out of the original vaccine, then this seems a reasonable course. “I don’t know of any instance where the heterologous prime boost has led to particular harms or to lesser efficacy,” says Evans, “although it hasn’t always led to higher efficacy.” This seems an obvious bet, in the rare cases when the original vaccine is unavailable.

With a bit of luck, we’re near the end of this. I’m sceptical that the Government will meet its target of getting the first dose to the four most vulnerable groups by mid-February, but March should be doable (and Nilay Shah, a professor of chemical engineering at Imperial, told the Science Media Centre that it the February target is “ambitious” and “needs everything to click every day”, but that it is “achievable”). 

So we’re no longer talking about delaying Covid deaths; we are talking about actually preventing them, if we can keep people from getting the virus for a few more weeks. And that means making decisions quickly, making decisions that are good enough rather than perfect, making decisions with limited information rather than waiting for the perfect RCT that shows that giving the vaccine in a red room works just as well as giving it in a blue one.

The NYT’s concern about the vaccine dosing is understandable: it is simply applying the same standard that medical science applies all the time, under usual circumstances. But we aren’t under usual circumstances. In this case, it is inadvertently propping up a decision-making system which has meant that we didn’t introduce masks until too late and which meant that we didn’t lock down or close borders until the virus was already spreading.

I got it wrong by saying that border closures “probably” wouldn’t stop the new variant; I should have talked about how likely I thought it was, and what the costs and benefits would be if it did. The MHRA, by allowing mix-and-match vaccines and a 12-week gap, is thinking in those terms, and doing the right thing. You can’t “follow the data” when there is none: you have to use the information that you have.


Tom Chivers is a science writer. His second book, How to Read Numbers, is out now.

TomChivers

Join the discussion


Join like minded readers that support our journalism by becoming a paid subscriber


To join the discussion in the comments, become a paid subscriber.

Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.

Subscribe
Subscribe
Notify of
guest

106 Comments
Most Voted
Newest Oldest
Inline Feedbacks
View all comments
Francis Lankester
Francis Lankester
3 years ago

We now know conclusively that masks don’t work and there is strong evidence lockdown doesn’t either. But we can be certain that it is crushing the economy and will result in a lower tax base and less money for public services. SAGE never recommended closing the border or indeed lockdown until Prof. Ferguson’e modelling. PHE data, confirmed by the Zoe app shows there is no second wave. It is Winter. We did not lock down in 2018 when the NHS was overwhelmed nor during heavy flu years which kill tens of thousands.

David Smethurst
David Smethurst
3 years ago

Spot on in every respect.
Will we look back in a few years and realise what a sham this all was?

Angela Frith
Angela Frith
3 years ago

That is not true. The Zoe site says just under 70,000 people in the U.K. have ACTIVE Covid, today.
My local hospital declared a crisis two days ago, and put out a call for emergency medical workers to come in.
That is what this is all about. It is not a sham.

Andrea X
Andrea X
3 years ago
Reply to  Angela Frith

We need to compare it to the past few years. What happened then in your area?

ralph bell
ralph bell
3 years ago
Reply to  Angela Frith

What I cannot understand is Covid has illustrated in March that the NHS/Government efficiency approach of having few ICU beds was not sufficient so at that point why wasn’t money used to get more available and staff (volunteers & retired) to support. Why are not all covid patients sent to specific covid units and temp hosp (Nightengale) whilst the remaining hosp can then treat other serious medical needs.
Also with all the new knowledge and treatment available for covid, do all patients need hosp admission?

Anne Poitrineau
Anne Poitrineau
3 years ago
Reply to  ralph bell

There is not enough staff. retired etc have come back, but some staff members are ill, some are in quarantine. The facilities are only one side of the equation.

Mark Corby
Mark Corby
3 years ago
Reply to  Angela Frith

Don’t let hysteria triumph. This whole synthetic crisis is predicated on unreasonable fear. The old and decrepit (such as myself) die, get over it.

Listen to what Lord Jonathan Sumption has to say on the matter. You can’t get more level headed than a former English Supreme Court Judge.

Mark Corby
Mark Corby
3 years ago

With 7 million unemployed and inflation running at 25% who will care?

kristinedonnan
kristinedonnan
3 years ago

Could you point us in the right direction of sound research that suggests/ proves that masks don’t work please? I’m sorry if that comes across as passive aggressive or sarcastic, it’s certainly not intended to be. I’m just naive in what to read seriously and what not to. Many thanks.

Tom Jaffray
Tom Jaffray
3 years ago
Reply to  kristinedonnan

Go to Ivor Cummins’ YouTube videos. There you will find a list of peer reviewed papers on the effectiveness or more accurately the non effectiveness of masks. Incidentally his videos are excellent.

Chris Milburn
Chris Milburn
3 years ago
Reply to  kristinedonnan

Hey Kristine. I’m a doc in Canada. The Oxford Centre for Evidence Based Medicine had a good review. Ivor Cummins (mentioned by Tom Jaffray) is a good source of data as well. Most all of the research suggesting masks help is observational, not controlled or randomized. One could have predicted that people who choose to wear masks would get less COVID. They are on average more nervous overall – they likely social distance more, handwash more, smoke less, have higher education/better overall health status, etc. So anyone would have predicted that they would have lower rates of COVID. The recent Danish study showed a 12% lower rate of COVID transmission from 3 months of continuously and properly wearing a mask. This study was reviewed by Freddie in a video with the study’s author. There are a few issues with it, but it may be a reasonable estimate. So what then needs to be considered is “is 12% over 3 months enough to justify mandatory masking for everyone” especially given the recent data on the rarity of asymptomatic transmission. One also needs to understand the difference between relative risk reduction and absolute risk reduction. ie: even if masks help a bit, it might make sense to wear one on the tube in London, but no sense in a country store in Wales.

Rasmus Fogh
Rasmus Fogh
3 years ago
Reply to  Chris Milburn

The big problem with that study is that it tested whether wearing a mask made you safer. Which it did, but only 12%. The biggest effect was always expected to be that wearing a mask makes *other people* safer. And the study did not check that at all.

Anne Poitrineau
Anne Poitrineau
3 years ago
Reply to  Rasmus Fogh

Exactly. Masks protect the people around the wearer. But I agree that masks wearers will usually be more risk aware and make some efforts to keep themselves and others safe!

Michael Cowling
Michael Cowling
3 years ago
Reply to  Chris Milburn

At least a while back the R for covid was oscillating at about 1.0. At that level, a 12% reduction in transmission is the difference between fizzling out and expanding. With the new variant the R is probably higher and 12% might not make a difference.

Marco Federighi
Marco Federighi
3 years ago

Interesting. Could you share the evidence about masks not working? I have heard quite a few conflicting opinions.

Andrew Fisher
Andrew Fisher
3 years ago

How do we know conclusively that masks don’t work? I have always been a bit of a lockdown sceptic, but I hope the emphasis is on ‘sceptic’, not like all too many commentators on here, not an out-and-out denialist.

By the way, it seems the orthodox view that there would be a 2nd wave was more right than Prof Sunetra Gupta’s position.

Stan Glib
Stan Glib
3 years ago

Frank Lankester & Others miss the point entirely on masks; there is a compounding effect of two people wearing one. If the odds of transmission are 0.3 with a mask just for example), they would absolutely not be suitable in a surgery theatre or covid ward but in an ordinary scenario if both people have masks on, the odds are now 0.3^2 = 0.09, that’s a 91% chance that it isn’t transmitted. On top of that, the odds of contracting a virus from a viral load goes up exponentially as the dose increases, further increasing the probability that it helps.

But one needn’t even know any of this maths; put all of it aside for a moment: unless you honestly believe that it’s more likely that masks cause harm than reduce the odds of transmission even by a fraction, then it’s a good, extremely cheap bet, when most other options are far more expensive and disruptive.

To spread fatuous claims that they’re harmful, purely because it rattles you that an irritating change to your life has to be made, is disingenuous or deluded at best.

The entire point of this article was that you can’t wait for certainty before making decisions. Most of your life is spent dealing with uncertainty. Hedge your bets, take the cheap options when you can.

carolstaines8
carolstaines8
3 years ago
Reply to  Stan Glib

Spot on!

Stan Glib
Stan Glib
3 years ago

Last March, we thought masks probably wouldn’t help ““ but we should have thought maybe they would

Who’s we? Many people thought they would help. Many thought they wouldn’t. Many insisted they would. Many insisted they wouldn’t. Many thought ‘what’s the harm in wearing one?’ and could appreciate a good bet when they saw one.

But I can’t see a ‘we’ in this narrative any more than I can see a ‘they’.

Edit: In response to some of the nonsense below:

Frank Lankester & Others miss the point entirely on masks; there is a compounding effect of two people wearing one. If the odds of transmission are 0.3 with a mask just for example), they would absolutely not be suitable in a surgery theatre or covid ward but in an ordinary scenario if both people have masks on, the odds are now 0.3^2 = 0.09, that’s a 91% chance that it isn’t transmitted. On top of that, the odds of contracting a virus from a viral load goes up exponentially as the dose increases, further increasing the probability that it helps.

But one needn’t even know any of this maths; put all of it aside for a moment: unless you honestly believe that it’s more likely that masks cause harm than reduce the odds of transmission even by a fraction, then it’s a good, extremely cheap bet, when most other options are far more expensive and disruptive.

To spread fatuous claims that they’re harmful, purely because it rattles you that an irritating change to your life has to be made, is disingenuous or deluded at best.

The entire point of this article was that you can’t wait for certainty before making decisions. Most of your life is spent dealing with uncertainty. Hedge your bets, take the cheap options when you can.

Andrea X
Andrea X
3 years ago
Reply to  Stan Glib

Indeed. I stopped reading the article more or less at that point.

Angela Frith
Angela Frith
3 years ago
Reply to  Andrea X

More fool you. It’s a good article.

Adrian
Adrian
3 years ago
Reply to  Stan Glib

I think it’s the royal we. Although Tom Chivers isn’t bad, he really doesn’t get science, which is about embracing doubt.

Acting while in doubt is courageous. But that shouldn’t remove the doubt. Doubt keeps you on your toes.

In March the available data showed that masks are essentially an unknown quantity. The available data still shows this, and better still, some of the studies in favour of masks have pretty awful things to say about face coverings, buried deep in the middle of the studies where the author can’t get hounded by the mob. As long as masks remain a totem doubt will not be tolerated.

Still they are better than the ridiculous plastic screens at the basket checkouts in the supermarket. Screens designed to protect you from your spatial neighbours, but which, due to the lack of ventilation, make your temporal neighbours far more dangerous to you.

Francis Lankester
Francis Lankester
3 years ago
Reply to  Adrian

The evidence shows masks are useless and in some cases can cause limited harms. We have no excuse now and what confidence can that inspire in SAGE & government.

lyntoninus
lyntoninus
3 years ago
Reply to  Adrian

‘he really doesn’t get science’ seems harsh. In any case Science may be about embracing doubt, but history is littered with scientists who exhibit implacable intransigence in the face of theories or evidence at odds with their own, often flawed beliefs. Bed Rest for heart-attack victims? That lasted for five decades.

Michael Dawson
Michael Dawson
3 years ago
Reply to  Adrian

Sorry for stalking your posts on here, but… Earlier you said that Tom’s article ignored the ‘first-do-no-harm’ principle. Now he’s guilty of ‘not embracing doubt’. I don’t think he’s guilty of either actually, but if he’s guilty of one, it’s hard to see how he can also be guilty of the other.

Andrew Fisher
Andrew Fisher
3 years ago
Reply to  Adrian

Tom Chivers ‘doesn’t get science’? What an absolutely off the wall comment, not showing much appreciation of Tom’s articles or indeed science. Science is all about ’embracing doubt’. Well, no that’s not all it is.

I read well argued articles sometimes on this site, and then all too often read whole load of simplistic dismissive comments which don’t even engage with the arguments made.

Alex Lekas
Alex Lekas
3 years ago

No one asked for ‘perfect’ data, but backing off the hysteria would be nice.

Maybe we can slow the spread of a new form of the variant; maybe that maybe is worth it.
So the lives of millions get ruined over a maybe? The hubris involved in believing man can “slow the spread” of this virus through means such as lockdowns, masks, and forced vaccinations is a convenient way of ignoring the spike in suicides and other mental health issues, the rise in abuse cases and overdoses, the impending bankruptcies of perhaps millions, and all of the other fallout.

Angela Frith
Angela Frith
3 years ago
Reply to  Alex Lekas

Don’t be silly, these are the only methods of slowing Covid down. Nobody is forced to have the vaccine. Go ahead, refuse the vaccination, and carry a card saying that you have refused the vaccine and do not want any treatment in the event of suffering any serious side effects.

Alex Lekas
Alex Lekas
3 years ago
Reply to  Angela Frith

Nobody is forced to have the vaccine.
Are you sure about that, because there have been plenty of musings about vaccination ‘passports.’ And that’s quite the straw man you have built re: not wanting treatment. By that reckoning, medical systems can stop refusing treatment to people with self-inflicted conditions or to motorists who were not wearing seat belts.

Kathryn Richards
Kathryn Richards
3 years ago
Reply to  Alex Lekas

You don’t have to fly. or go on holiday. That is your choice.
Some countries insist on production of vaccine certificates already (or they used to) to protect their populations. Why should this be any different?
Living is all about making choices.

Alex Lekas
Alex Lekas
3 years ago

Why should this be any different?
the survival rate of >99.5% might be a factor. It’s just amazing that the same medical community, and their parrots among laymen, who blasted the idea of HCQ which has been around for more than a half-century are insisting that everyone take a barely-tested vaccine for a seasonal respiratory virus that mostly impacts the elderly.

Stan Glib
Stan Glib
3 years ago
Reply to  Alex Lekas

the survival rate of >99.5% might be a factor

When hospitals are not full.

If a death rate is ~0.5% and a hospitalization rate is ~5%, once the hospitals (staff and space) are over capacity, your death rate is now closer to 5%.

Anne Poitrineau
Anne Poitrineau
3 years ago

Yes, and if you go to some exotic destinations and do not get a yellow fever jab, you are a bit of an idiot.

lyntoninus
lyntoninus
3 years ago
Reply to  Angela Frith

Spot-on. Plus the disinclination of the government to impose restrictive lockdowns has been only too evident, in England at least. No sign of hubris – or indeed of forced vaccinations – as far as I can see. No need.

Anne Poitrineau
Anne Poitrineau
3 years ago
Reply to  lyntoninus

This government was reluctant to do anything, and have the worst figures in Europe…that does confirm that a lockdown is not a bad idea!

Andrea X
Andrea X
3 years ago
Reply to  Angela Frith

Indeed. And the same should apply to those who smoke, drink, have promiscuous sex, cross the road where the shouldn’t, peel an apple with a knife or leaf a book, lest they get a paper cut.

Anne Poitrineau
Anne Poitrineau
3 years ago
Reply to  Alex Lekas

News for you: countries who have a pandemic do not have an economy. You are deluded if you think it is a choice between yielding to the pandemic or maintaining the economy. To some extent, I think the lockdown etc are hiding the effects the pandemic would have on the economy. Sweden tried to have a middle way (and they were no way as permissive as some people reported). It looks like they have now changed their strategy.

Stan Glib
Stan Glib
3 years ago
Reply to  Alex Lekas

ignoring the spike in suicides and other mental health issues, the rise in abuse cases and overdoses, the impending bankruptcies of perhaps millions, and all of the other fallout.

Everything you just listed will happen either way, and on an even more colossal scale if the virus got out of hand to the extent that all hospitals are glorified quarantine buildings, and people with any illness whatsoever are being told to simply stay at home and hope for the best.

We’re not comparing good scenario bad scenario here, it’s a horrible crisis or an even worse crisis

David Bell
David Bell
3 years ago

We need to be careful in how we act because of the old saying “act in hast repent at leisure” tells us the cost of bad decision making. Doing the wrong thing quickly is worse than doing nothing. In May Sage (and the inappropriately named Independent Sage) wanted the lock down extended and teachers basically refused to teach children because of the fear this generated. Now we know we should have released the lock down (helping business and school children) and the virus might have spread at a time when the consequences for those infected were a lot lower than they are in winter.

Reducing lockdown may have also made the economy a lot more resilient help us all in the future.

The reality is “following the science” is a fools game. The science is one piece of a jigsaw and preventing a non covid death should have the same importance as preventing a covid death.

We have got into a mess because we have only listened to one side of the story and the faster we rush to judgements the more mistakes we will make

Chris Milburn
Chris Milburn
3 years ago
Reply to  David Bell

I’m an ER doc. We have a saying: “Don’t just do something, stand there!!”. It’s an admonishment not to rush in and start treatments that may just as well be harmful than helpful. Until one is reasonably sure that intervening will be more positive than negative, one should stay humble and keep thinking rather than acting. “A conclusion is the place where thinking stopped”.

David Bell
David Bell
3 years ago
Reply to  Chris Milburn

Yes, a doctor once told me the most important line is “first do no harm”.

That has been missing from our reaction to Covid!

Jay Pierre
Jay Pierre
3 years ago
Reply to  Chris Milburn

I regret only that I can up-vote this but once. Excellent advice this.

Anne Poitrineau
Anne Poitrineau
3 years ago
Reply to  David Bell

We never refused to teach children. Schools have been open, are still open for vulnerable kids and kids of frontline workers. I should know, I am a teacher. However, some classes/schools had to close when the number of infections/quarantined staff was so high they could not function. If this government had provided access to technology, all kids could have been taught remotely, safely, all sorts of things would have put in place to ensure emotional support. Throughout, this government have acted as if there was no point planning for the long term because it was all going to go away soon, so everything has been done on the cheap, quickly, in a ramshackle fashion. Headteachers are losing the will to live!! And finallay: note that all the structures which have created vaccines are in fact self governing/independent from the state, even if they go get subsidies.

David Bell
David Bell
3 years ago

I am afraid my interaction with teachers has been less than encouraging. In my daughters school many of the teachers never set work, those that did never marked it or provided feed back (my daughter did and submitted every piece of work set on time).

During November the school closed for 16 days because of the number of cases and so many teacher self isolating. The notice was sent out 5 minutes before school was supposed to open that day. Children who travelled by bus were left with no way home, children who’s parents worked were left with no were to go. The teachers stood at the door and turned children away then got into their cars and drove home, leaving the children standing at the gate with no idea what to do! No work was sent home or put online in the 2 week period. My wife and daughter were in our local shopping centre on the first day of closure and she saw a number of the teachers, including a couple who were supposed to be self isolating.

This may be anecdotal but I fear not unusual

LUKE LOZE
LUKE LOZE
3 years ago

Interesting article, I particularly agree with governments strategy to get the first vaccine shot into as many of the vulnverable as possible – it appears based on simple maths to be the best gamble. I don’t know if there’s any RCTs on lifeboats vs no lifeboat, I know which I’d choose.

Similar to this is the form filling and box ticking that has surrounded volunteers – recently retired surgeons, nurses, GPs, current private GPs have been denied the chance to help. Personally I’d rather have help from an imperfectly qualified person than no one at all.

Masks are a bit more complex though, 1) they weren’t available in large numbers early on, so were de facto reserved for those in need. 2) they make the wearer feel falsely safe from infection, reducing distancing 3) they make the wearer feel less likely to infect others, meaning they may be more likely to go out when they’re ill.

Adrian
Adrian
3 years ago
Reply to  LUKE LOZE

…and they cut off 50% of a persons sunlight when worn outdoors. And face-coverings, and worn masks spit out masses of floaty cotton particles.

If face-coverings really reduce infection rates by 10% then they should be used, but this article ignores the ‘first-do-no-harm’ principle.

Michael Dawson
Michael Dawson
3 years ago
Reply to  Adrian

No, it doesn’t ignore it; it says that it is not a very sensible rule and that one should estimate the potential benefits and costs/risks, not wait around until conclusive prove of safety has been established. This seems to me an entirely sensible approach.

Adrian
Adrian
3 years ago
Reply to  Michael Dawson

We are not talking about conclusive proof of safety, we are talking about any evidence for efficacy.

And it still isn’t there.

Blowing warm infected air up above your head in the winter is not a good way to reduce transmission. Mandating that everyone does it is madness.

By Tom’s method, blood-letting would never have gone out of fashion, since everyone’s gut feeling was that it must work, and there was no conclusive evidence of it’s harm.

Obviously masks are an economic good, because they psychologically enable a greater number of fearful people to pack into a smaller space. That is a good thing.

Judy Englander
Judy Englander
3 years ago
Reply to  LUKE LOZE

I don’t think I’d want an imperfectly medically qualified person sticking a needle in my vein. But I really don’t care if they’re a radical Muslim or antisemitic white supremicist as long as they know what they’re doing (and I’m Jewish).

They could even lecture me on their beliefs while doing it and I wouldn’t care as long as the vaccine is administered safely.

Michael Dawson
Michael Dawson
3 years ago
Reply to  Judy Englander

Vaccines are not injected into a vein. They just need to be injected into the meaty part of the shoulder muscle. It’s not like taking a blood sample.

Judy Englander
Judy Englander
3 years ago
Reply to  Michael Dawson

Ah, I was getting the process mixed up with my annual blood test.

Anne Poitrineau
Anne Poitrineau
3 years ago
Reply to  Judy Englander

So basically, why don’t they hand those of us who know how to self-inject (I am not a diabetic, but I had to self inject antibiotics) the jab, and we just do it!

Johnny Sutherland
Johnny Sutherland
3 years ago
Reply to  Judy Englander

I’m diabetic, I inject 3+ times a day. Never received any training. On the other hand the qualified nurses that try and take a blood sample (note the word try) leave a little to be desired.

Anne Poitrineau
Anne Poitrineau
3 years ago
Reply to  Judy Englander

Oh Judy, I agree. What is required is good management: the vaccinators are using the correct syringe, with the correct chemical inside. I will even accept a bit of pain–can’t believe I am writing this–. Said vaccinators can be whatever shade of extremism, who cares!! it might even do them some good to participate in the communal good, to be part of the community, to feel useful and appreciated, and it might do more good than the “prevent programme”…

Judy Englander
Judy Englander
3 years ago

Good point, Anne.

Simon Latham
Simon Latham
3 years ago

“With so many people dying each day, we must make fast decisions as best we can”
Stop the scaremongering. There were no excess deaths in Week 52 of 2020. A&E admissions for respiratory conditions are well below normal for January. People are dying from a variety of conditions, many shamefully neglected from the moment the over-reaction to SarsCoV2 began. Total deaths for 2020 are within the envelope for a normal year. Listen to former Professor of Pathology, Dr John Lee on Talk Radio.

Anne Poitrineau
Anne Poitrineau
3 years ago
Reply to  Simon Latham

There are excess deaths, this is nonsense, but you are correct: other conditions are neglected, because the NHS does not have the resources (staff and facilities). A health system which is not able to deal with a pandemic is not fit for purpose, and this is happening to the NHS because of the defunding and because staff are not treated well enough.

Fran Martinez
Fran Martinez
3 years ago

Except that we do have data, and politicians and yourself keep bending it to fit your narrative. If you are going to crash the economy, cause huge amounts of mental health issues, long term health issues in young people, and destroy hard-earned freedoms, you should be “VERY” sure of what you are doing with very firm data.

We have very reliable data about the effects of povery on health, and the effects of not sending children to school.

Tom, you are analyses are just a big sad joke

Duncan Hunter
Duncan Hunter
3 years ago
Reply to  Fran Martinez

A lot of the data or evidence we should be able to see is either withheld from us, distorted or selectively presented – often using out of date information. Even Theresa May has pointed out that policy (a generous description) appears to be driving the data and not the other way round.

When challenged by the CRG and other backbenchers to produce the cost / benefit analysis driving the 2nd Lockdown, Hancock committed to provide it. Within days he had switched to talking up the new mutant strain and has evidently no intention of sharing it. Does it even exist? If so, where is it and why not share it? If it does exist and points conclusively to massive economic and social harm outweighing the benefits of their actions, then this is grounds for serious repercussions if they pressed on with their self-evidently ruinous ‘strategy’ regardless.

This isn’t the only instance of U-turning or inflicting yet more restrictions on us without sharing the underlying data. And then there’s reliance on wrong or inaccurate information, like Neil Ferguson and his consistently unreliable projections. Yet it seems the execrable Ferguson has been welcomed back to the fold to wreak more havoc in between his crosstown liaisons.

Everything begins and apparently ends with the highly unreliable PCR test, when even its inventor has repeatedly emphasised its unsuitability for accurate detection of viruses. I’ve read that it can be up to 97% unreliable. Yet every reactive, panicky decision from this government and many others is keyed off this massively misleading test.

Then there are lockdowns. It should be apparent by now that they don’t work. Even the WHO says so. The first two didn’t and even with an optimally rolled-out vaccine programme, every chance exists that this one will only exacerbate the collateral damage while merely kicking the can down the road until the next one. Except that we cannot afford another one. We can’t afford this one either.

It’s all very well claiming repeatedly to be following “the” science or being data / evidence driven. But if it’s dodgy data, then it’s bad science and look where this is getting us. If there’s no data, there should be blood for the misery of effective house arrest and psychological assault being visited on us for a virus which >99.5% of those infected survive.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
3 years ago
Reply to  Duncan Hunter

SAGE have done a bit of work on the downsides of NPIs :
Direct and Indirect Impacts of COVID-19 on Excess Deaths and Morbidity: Executive Summary 15 July

as have Independent SAGE coming at it from a different angle :
The Independent Sage report 16

PCR tests.
1) Prof Mullis died before Covid was even discovered. He was not talking about Covid.
2) He was making his comments in 1996 about how HIV is not the cause of AIDs.
3) Vast majority of scientists and doctors would conclude he was rather wrong about this…
People seem to be most concerned about operational false positives – only an issue when the general population prevalence of the virus is low (as it was in the summer). If you are interested, there is a very good description of this test and all the concerns by John Bye, on Twitter, posted on December 28.

Lockdowns. Since we haven’t opted NOT to have one in this country during increasing transmission there is no way of definitively knowing whether they are helpful in disease mitigation or not. They seemed to have worked country wide for NZ and in more local forms in Victoria Oz, Taiwan, Singapore and S Korea along with needle sharp test, trace and isolate.

Graham Farrar
Graham Farrar
3 years ago

Notwithstanding the lack of understanding of fundamental immunological process principles of vaccination, are we really going to condone using an unwitting UK public in phase three vaccine trial?

James Harkness
James Harkness
3 years ago

Loud applause from here. This is ‘war’ and while we should pursue peacetime standards wherever we can the horse is going to bolt if we sit staring at avaiable figures but waiting for all the data. There is an enormous body of sound information from other epidemics, and other viral diseases, which should be mined in constructing the response to a crisis like this one. As in war, some decisions have to be made as judgements partly based on past experience

Francis Lankester
Francis Lankester
3 years ago
Reply to  James Harkness

One of the lessons from this sound info. is quarantining the well doesn’t work.

Rasmus Fogh
Rasmus Fogh
3 years ago

@TomChivers
Exactly right. Sticking to established knowledge until the alternative is *proved* may be good science, but it is not good crisis management.

Chris Milburn
Chris Milburn
3 years ago

Interesting read. The one thing I would add/clarify is this: Perhaps it’s reasonable to suggest treatments/strategies without bulletproof evidence (masking, lockdowns, vaccines). But evidence should be at least very good before MANDATING these things (masks, lockdowns, and god forbid vaccines). The basis of western civilization is an individual’s right to choose what is best for them. The USA has an estimated 81,000 drug overdose deaths this year. Should we lock every drug user up “for their own good”? Or ban the production of opioids? Or shut down society completely in order to prevent these deaths? If not why not? I agree with Lord Sumption. If you are afraid of COVID, stay home. If you want to live your life and are willing to take the risk, go out. Government – stay the hell out of that decision as much as possible.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
3 years ago
Reply to  Chris Milburn

Some people don’t have a choice – they have to go out (to work) when they would rather work from home. In that situation these people are relying to a degree, on other people acting in a respectful way.

The problem with this little beastie is that the risk is distributed, it is not individual.

Athena Jones
Athena Jones
3 years ago

The risk is not distributed. Professor John Ioannadis, one of the world’s most noted science-medical experts, has said Covid is no threat to 95% of people. Other experts have said 99%.

If, like the Flu, Covid was killing people of all ages there would be some point to the hysteria. But it is not. The risk group has been known for months.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
3 years ago
Reply to  Athena Jones

Depends what you mean by “threat”. There are other things in life than death, like morbidity- as yet to be properly quantified for this multi organ disease.

This time around the risk of ending up in critical care seems to have shifted – maybe because older people are shielding better ?

From ICNARC
Admissions, critically ill with Covid, Sep 1 to Dec 12 :
53% 40 – 69 years
29% 70 – 80+
Of 7677 admitted to ICUs from 01.09, 88.5% did NOT have severe comorbidities

Adrian
Adrian
3 years ago

We still only have evidence that “maybe” masks (masks not face coverings) reduce transmission by about 12(ish)% percent.

Given that there was an international run on masks, it probably was not a bad idea to tell the ignorant they don’t work.

We know little more now than we did in March, regarding masks, face-coverings or transmission.

Given that there is evidence to suggest that certain face-coverings do more harm than good, and given that some people are walking along miles from anyone, cutting off over 50% of their available sunlight during winter, a degree of caution is still advised.

Currently the logic seems to be that masks can’t be doing any harm. That is still nonsense, even if the vast majority of peope have a cosy feeling about masks. We still have no evidence to contradict the WHO’s original assertion.

Given that mink can transmit coronavirus, are routinely kept in cages, and are being killed by the million anyway, separating two mink cages with various mask materials and comparing infection rates is not beyond the wit of man. We can even compare the infection rate when mink walk on a surface previously touched by infected mink.

p.s. Before quoting the raw 70% figure from the US Navy paper at me, please, please bother to read that paper and do a quick mental adjustment for confounders, and think about the lack of data in that paper on other unmentioned confounders such as sex.

Angela Frith
Angela Frith
3 years ago
Reply to  Adrian

They did that experiment! They used cages of hamsters. Who knew hamsters catch Covid? The experimenters, that’s who.
Putting a mask over the cages worked surprisingly well. It worked best when the sick hamsters cage was masked, not so well when the healthy hamsters cage was masked.

Isla C
Isla C
3 years ago
Reply to  Angela Frith

I feel like a hamster on a wheel right now…

Adrian
Adrian
3 years ago
Reply to  Angela Frith

Excellent. That does in fact ring a bell. I would have thought that masking a cage would be the same whether you masked healthy or unhealthy though. And I will have to check whether they did the fomite test. I imagine they did.

They really do need to do the research on different materials though. As ‘Which?’ pointed out a large number of face-coverings were letting 93% of particles through turning a possible 10% benefit into a less than 1% benefit in some cases. Also, given that research into face coverings seems to suggest that some of them increase transmission, it wouldn’t be a bad thing to test a little more…

Anne Poitrineau
Anne Poitrineau
3 years ago
Reply to  Angela Frith

Thank you Angela. I did not know this.

John Mcalester
John Mcalester
3 years ago

“about 500 people dying every day in the UK alone from a disease …… “

Technically the people are dying with covid, not from Covid.

Susan Lundie
Susan Lundie
3 years ago
Reply to  John Mcalester

Based on a positive PCR test of dodgy provenance?

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
3 years ago
Reply to  John Mcalester

If they hadn’t got Covid in the first place they wouldn’t have been tipped over the edge of whatever co morbidity they had – diabetes, renal disease, immuno compromised etc. Covid would appear in box 2 on their death certificate. Either way they are dead and would have been alive if Covid hadn’t happened.

The with / from argument is irrelevant.

Athena Jones
Athena Jones
3 years ago

How do you know they would be alive if Covid had not happened? And how alive? Some 99% of the dead are very old with 2-3 co-morbidities slowly killing them anyway, and in aged care. As the UK stats showed, the average age for a claimed Covid death was a year more than the average age of death!!!

And since no-one appears to die of the Flu, Cancer, Heart Disease or Strokes anymore, who says so many are dying of Covid? More so because these deaths are not categorically proven to have been caused by Covid and indeed, many were not even proven to have Covid given the totally flawed nature of the test used to supposedly ‘diagnose’ Covid.

Smoke, mirrors and snake oil. Whatever is killing people it cannot be categorically called Covid.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
3 years ago
Reply to  Athena Jones

This statistic about average age at death has been explained repeatedly on these threads – it refers to the average age of death at birth. The Actuaries (who possibly know more about death stats than anyone else) are clear, in the UK 80 – 89 year olds with 2 comorbidities can expect to live for at least another 5 years – they have survived because they are the toughies.

How do you know that these individuals would have died of something else this year ?

The PCR test has a specificity of about 99% and the operational sensitivity is 0.04 – 0.5% we know this from the testing done in the summer, when the disease prevalence was very low. There is a very good comprehensive Twitter thread by John Bye on Dec 28 on all the ins and outs of PCR testing if you are interested.

Death certificates. This is how the ONS counts deaths. From David Oliver (a doctor who fills out death certificates from time to time ) :

“There never was a formal requirement for a positive Covid-19 test to write Covid on a certificate if the clinical picture was clear and so yes, some patients, mostly earlier in the pandemic would have had Covid written down without yet testing positive.
That said, especially outside hospital the certifying doctors (usually GPs) might in some cases not write ‘Covid-19’ because of the lack of testing, even when it was quite likely. I would not assume overestimation.”
and
“(the government) It also switched its definition to deaths only in people with a positive Covid test and within 28 days of that test, which doubtless excludes people in whom Covid-19 was an important part of their final illness (it can cause lingering and relapsing ‘long covid’ symptoms and complications beyond that time).
So basically, the government’s own figures tend to underestimate not overestimate the overall numbers of Covid-19 deaths.”

dinoventrali
dinoventrali
3 years ago

If you test positive for Coviid and within 28 days die after getting hit by a truck, struck by lightning, murdered, or any of a myriad deaths totally unrelated to covid, it will still be recorded as a covid death.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
3 years ago
Reply to  dinoventrali

Not by the doctor who fills in the death certificate unless he is very sure that Covid was a cause contributing to death but not directly related (box 2 on the death certificate).

More detail from David Oliver consultant in geriatrics and acute general medicien in Manchester :
“Death Certificates contain causes 1a (cause directly leading to death) 1b and 1c (causes leading to 1a) and 2 (causes contributing to death but not directly related).
If Covid-19 is in our clinical assessment of the person we have assessed and treated the main cause of death, we will put it as cause 1a.
In other cases, someone might die from a complication of Covid-19 ““ for instance a pulmonary embolism (blood clot) or a bacterial pneumonia in which case that will be 1a with Covid as 1b or c.
In other cases, the person may have had Covid contributing to a death from another cause ““ perhaps by making the person weaker or more susceptible or starting a chain of events and may appear as 2.
As I explained earlier, this is based on our knowledge and belief based on our assessment of the patient we were looking after, not any kind of pressure to write Covid-19 down on any part of the certificate if we didn’t feel it was relevant, just based on a positive test.”

To be on the safe side you can choose to only look at the ONS stats – they only use straight death certificate data for their mortality calculations.

Mike Finn
Mike Finn
3 years ago

The real surprise here is that it has taken us quite so long to start to take advantage of this sort of positive uncertainty. Double blind trials and a robust regulatory process are clearly the best practices for normal times, but crisis management requires a more flexible and agile response. For example, multiple drug trials could be combined to more efficiently provided real-time data with fewer participants (only one placebo group), a rolling risk profile on vaccine distribution, and advanced data analysis to infer efficacy in a population without trial controls. We could perhaps have been distributing various vaccines for months in parallel with the phase 3 trials on a voluntary basis in a similar way to beta releases of software (of course once – and only for as long as – the ongoing safety and efficacy data proves promising).

I hope concept such as agile, fast-feedback cycles with voluntary early adoption are properly discussed after the crisis, and regulatory regimes adjusted accordingly to ensure the effective handling of any similar disease in future. Were such approaches in place today, it is entirely possible that the current wave might have been far less serious, regardless of the other actions of the state.

dinoventrali
dinoventrali
3 years ago

It irritatesd me that we are constantly being urged to ‘Protect the NHS’. Why? Why should it be my job to protect the NHS? If the NHS is not fit for purpose, and it clearly isn’t, it should be reorganised and knocked back into shape. Imagine this is the nationwide Internet system we were discussing. Record breaking use, streaming, gaming, online conferencing is all taking its toll, so what is the answer? Obviously, just ban all broadband and issue everyone in the country with a 56k dial-up modem. Problem solved… :-/

Tim Corn
Tim Corn
3 years ago

US FDA has issued a statement on vaccine dosing:
“We have been following the discussions and news reports about reducing the number of doses, extending the length of time between doses, changing the dose (half-dose), or mixing and matching vaccines in order to immunize more people against COVID-19. These are all reasonable questions to consider and evaluate in clinical trials. However, at this time, suggesting changes to the FDA-authorized dosing or schedules of these vaccines is premature and not rooted solidly in the available evidence. Without appropriate data supporting such changes in vaccine administration, we run a significant risk of placing public health at risk, undermining the historic vaccination efforts to protect the population from COVID-19.”

Michael Dawson
Michael Dawson
3 years ago
Reply to  Tim Corn

This is just the sort of approach that Tom rightly warns against. And it’s not just his view, but he cites some pretty credible sounding people in support.

Adrian
Adrian
3 years ago
Reply to  Michael Dawson

He sounds credible. But the FDA are the best drug evaluation body in the world. Thats why there were no Thalidomide injuries in the USA.

I don’t personally see the wisdom in denying a 70 year old 2 doses to get them to 95% survivability just so a 10 year old with 99.999% survivability can have a dose.

Anna Tanneberger
Anna Tanneberger
3 years ago
Reply to  Tim Corn

Anybody, (other than hospital staff, who are exposed daily to huge viral loads) who wants to be vaccinated against a disease with a 99% survival rate, deserves all the side-effects. This is the Darwin vaccination.

Barrie Clements
Barrie Clements
3 years ago

Does the “anybody” include the over 70’s like myself who stand a much greater risk of serious illness or death if we do catch it

Angela Frith
Angela Frith
3 years ago

Don’t be silly. Darwin will deal with the vaccine deniers. That’s why they still have polio in Pakistan. Vaccine refusal. Have you ever seen a British child dying of diphtheria, whooping cough or smallpox? No? Because of national vaccination.

Adam C
Adam C
3 years ago

Someone pass Tom the smelling salts. He’s come over all peculiar again.

Ladies in the 18th century used to see males doctors for a cure for hysteria. Maybe Tom should try the same.

Anna Tanneberger
Anna Tanneberger
3 years ago
Reply to  Adam C

Oh Lord! and wait until he hears this: 55 million people die each year! If they didn’t, climate change would be the least of our worries. And to make it even more scary – they are dying of all sorts of things: age, disease, accidents, self-harm, parasites, hunger, contaminated food and water and much much more. Oh my God this is so scary!

Angela Frith
Angela Frith
3 years ago

Also this is only one planet in a universe of billions of stars, and a human beings life span is insignificant on a planetary scale.
So it is obviously quite unimportant how much any individual suffers. By that foolish logic.

Athena Jones
Athena Jones
3 years ago

We must be grateful. In the age of Covid no-one dies of Flu, Cancer, Heart Disease or Strokes. It truly is a miracle. Get hit by a bus when you have tested positive, or not, and it is a Covid death.

Mark Corby
Mark Corby
3 years ago
Reply to  Adam C

Make sure he is wearing a full NBC suit!
(Nuclear, Bacteriological, Chemical).
Then off to Wuhan with him, to meet the lovely, cuddly Chinese for ‘treatment’.

Michael Dawson
Michael Dawson
3 years ago

Very sensible article. Some informed pragmatism is needed at this point.

David Uzzaman
David Uzzaman
3 years ago

There are a lot of intersecting questions about the pandemic and vaccines but we the public are being encouraged not to think about any of them but simply to obey instructions given by the government and their chosen experts. Given that this at least initially was a medical problem shouldn’t we at least be given enough information to give informed consent.

Adrian Smith
Adrian Smith
3 years ago

Where you say there are no good RCTs for mask are you saying the trials were not good or was the trial good but did not give a “good” result. I believe it is the latter. I also believe that these trials trialled “good practice” wearing of “good” masks. Whilst there is no RCT to prove this, there are sound logical arguments and analogies that would suggest that wearing any old bit of cloth which does not get changed / properly washed regularly actually does more harm than good.

I am all for taking calculated risks on imperfect information, but if you are going to do something at all, it should be done in the best way possible. Certainly not as a political gesture.

The idea that we should be focusing on protecting the vulnerable so that those less vulnerable, eg our children, could lead a normal a life, eg go to school and have the social interactions they need to develop into responsible and productive adults, was rejected on the grounds that it was not possible to protect the vulnerable. Clearly it is not possible to 100% protect 100% of the vulnerable. However if we put out minds to it we could find reasonably effective solutions. So why, alongside closing all the schools, did Boris also say and the vulnerable will also have to start shielding again. How many lives could have been saved if the vulnerable were told in early autumn ” you were let out for the summer but it is time to go back in, but we will provide genuine help and support. Could it have reduced the pressure on the NHS – the only reason why lockdowns are actually required enough that we would not have screwed up our children’s futures even more than we already have? Do we need RCTs to prove what makes obvious common sense?

Tim Corn
Tim Corn
3 years ago

FDA statement takes a different view.
https://www.fda.gov/news-ev

Rasmus Fogh
Rasmus Fogh
3 years ago

@disqus_l38IWORwgh:disqus

No random controlled trial has ever proved that parachutes protect those who fall out of airplanes.

Marcus Scott
Marcus Scott
3 years ago

Making decisions with imperfect information is a common part of life. The problem is where these decisions are based on assumptions that a higher power has decided may not be questioned and that anyone who does ask questions is to be ridiculed and exiled.

For example, early on, the WHO seems to have just decided, based on I don’t know what evidence, that COVID-19 is not seasonal and countries would experience a continuously growing wave of infection and death until the arrival of a vaccine.

https://www.theguardian.com/world/2020/jul/29/one-big-wave-why-the-covid-19-second-wave-may-not-exist-coronavirus

Until then, our government should chase the virus around the country using test and trace to generate information based on which targeted lockdowns would manage the problem. The blunt tool of national lockdowns would be but a memory. That’s working out extremely well in the UK I’m sure we can all agree. Best £25bn our government has ever spent.

Now, I’m no expert but it looks to me like COVID-19 is significantly seasonal. Countries in Central and Eastern Europe which did comparatively well in March and April are now getting proper spanked. They dodged the first bullet because the virus didn’t establish itself before the traditional virus season ended. Based on the WHO’s advice their governments had every reason to believe that their policies had “worked” and they didn’t plan around a second bullet later in the year.

Given that every other coronaviruses we know about that infects humans is seasonal I guess the WHO must have had VERY compelling data to decide that this particular one isn’t. Or maybe, the WHO decided there simply wasn’t time to, you know, give it some thought.

https://www.sciencedaily.com/releases/2020/04/200407164949.htm

fabnocivelli4
fabnocivelli4
3 years ago
fabnocivelli4
fabnocivelli4
3 years ago
fabnocivelli4
fabnocivelli4
3 years ago

https://www.theguardian.com
protect the nhs

Marco Federighi
Marco Federighi
3 years ago

Interesting article. I agree with Tom that in certain situations one can’t wait for solid evidence, and must act wth whatever is available. The problem is, how urgent is to act in the current Covid-19 situation?

Some of the comments here so far(and quite a few comments in the press over the last few weeks and months) suggest that the situation is not very serious (mortality rate not so different from flu, serious impact on health from the effect of restrictions on the economy being greater than the direct effect of Covid-19…). To me, the key metric is hospitalisations – given the average occupancy of hospital beds at 84% over an average year, according to official data, Covid-19 hospitalisations in excess of 15-16% pose a serious risk tohospitals. But then, other factors than the NHS have to be taken into account.

Some comments and press articles seem more about pressing a political point than about looking at the evidence. For example, the case for oragainst masks is not that clear-cut. Here is an interesting article reviewing the evidence: https://www.researchgate.ne

Athena Jones
Athena Jones
3 years ago

So, if rushing through and not waiting for data means we will see even greater harm done than Covid could do, the question must be – was it worth it and whose fault was it?

Act in haste, repent at leisure. If these rushed vaccines have long-term effects, already touted as possible, of severely damaged immune function, permanently crippling the health of millions, will anyone be able to say, it was worth it? Seriously?

Jonathan Patrick
Jonathan Patrick
3 years ago

Mr Chivers wrote “We need to think not in terms of certainties, but in terms of costs and benefits, gambles and payoffs”. I could not agree more. My question – how many lives do these lockdowns need to be saving in order for the immense cost that is being paid reaches normal thresholds for health interventions? Typically the threshold is $50,000 per life year saved. I don’t know the UK situation but in Canada our federal expenditure due to COVID is $380 billion (not to mention the provincial and municipal costs and the costs to businesses and individuals). With an average age of 80 (in Canada it is more like 84) for those dying with COVID, it is not difficult to estimate the number of lives that need to be saved by the lockdown to bring the cost down to $50,000 per life year saved. For Canada the deaths would need to be 20 000 lives saved per million or 740 000 lives saved across the country. I have a hard time seeing how our governments are taking costs into account in this whole process. This may sound harsh but it really isn’t because every dollar spent on COVID is a dollar not spent elsewhere. CBC recently wrote a story on a toddler who needs one shot of a drug to cure a genetic disorder. It costs 2.8 Million dollars CDN. The government won’t pay for it despite that amounting to a cost of $35 000 per expected life year saved. When we consider COVID interventions, it is not that you have lives saved on one hand and money saved on the other. Rather you have lives in danger on either side. Spend money on COVID and you have less to spend on those who need expensive cancer treatment, malaria prophylaxis, etc. It is a matter of being able to see beyond the immediate in order to truly consider both costs and benefits.

George Wiseman
George Wiseman
3 years ago

We don’t NEED ‘perfect’ data. We HAVE sufficient, adequate data that proves.

FIRST: The SARS-CoV-2 virus has existed endemically in humans for YEARS before the lockdowns.
In Spain in March of 2019
https://globalnews.ca/news/
And a Canadian study found SARS-CoV-2 virus in 2013 stored sewage samples”Š
7 YEARS before the lockdowns”Š
https://www.firstpost.com/h

SECOND: There were NO ‘excess deaths’ (total cause mortality) during all that time.

Recently Genevieve Briand, a John Hopkins Professor of economics and statistics posted a shocking video presentation”Š Proving (using CDC’s own DATA) that the COVID-19 death count was fraudulent. Main conclusions:

1. There have been NOT been ‘total cause mortality’ above normal for all cause deaths. No excess deaths above normal.

2. MOST of the deaths listed as COVID were taken from other categories, such as the Flu, heart disease, etc”Š

So deaths recorded in those categories dropped dramatically and almost EXACTLY matched the rise in deaths reported as COVID.

John Hopkins was FORCED to retract the Presentation due to pressures from the Vaccine Vested Interest(they are funded by Bill Gates) because “it MIGHT exacerbate ‘vaccine hesitancy’.

After all”Š If the pandemic is no worse than the common cold and is near 100% treatable with ‘at home’ treatments;

Why all the fuss to ‘warp-speed’ vaccinate every person on the planet with experimental vaccines that have unknown side effects?

Here is a copy of the retracted article:
https://drive.google.com/fi

Anyone can duplicate Ms. Briand’s work if they choose to, and the reporters for Restricted Republic ($7 per month subscription) did so. I advise to pay the $7 fee and binge watch hours of absolute truth.

https://www.restrictedrepub

https://www.restrictedrepub

Just for perspective”Š Before this ‘pandemic hysteria’ the third leading cause of death in the USA was MEDICAL ERROR, accounting for about 250,000 deaths per year”Š

https://www.cnbc.com/2018/0

This third place has been ‘replaced’ by COVID”Š
https://www.webmd.com/lung/

And now you know that this ‘third place’ was not ‘earned'”Š It was ‘stolen’ from other categories.

It was also part of ‘expected’ or ‘normal’ deaths. Hundreds of thousands of deaths are scary when you focus on them, but they are NORMAL”Š There is no News HYSTERIA for NORMAL!

No one suggested getting rid of DOCTORS to prevent 250,000 deaths by Medical Error”Š
Even though deaths go DOWN when Doctors go on strike”Š
https://www.qcc.cuny.edu/So

And KNOW”Š that MOST of the real COVID deaths, that were actually COVID (somewhere between 2% and 6% of the claimed total) mostly (97%) could have been PREVENTED if the Doctors had been allowed to use the proven (and suppressed) effective and efficacious treatments (you will learn about HERE) instead of the ventilators.

The Vaccine Vested Interest could NOT (will not) allow ANY treatment to be authorized or even recognized or they would not be allowed to get ’emergency’ classification; bypassing the already inadequate testing and animal trials.

Note that every RNA vaccine tried in the past has FAILED the animal trials due to side effects like Pathogenic Priming”Š

Now WE are the animal trial”Š

So the entire ‘premise’ of the above article is specious…
We do NOT need to worry about which vaccines to get because NO VACCINE IS NEEDED to ‘cure’ the COVID.

Frontline Doctors have proven that simple nutrition will mitigate most infections and for those that require additional help, there are SEVERAL treatments that can be applied AT HOME (no need for a hospital) to reduce mortality (even for ‘at risk’ with co-morbidities) to near ZERO.

We HAVE that data… Which tells us that an experimental, Warp Speed, never before success, vaccine is NOT NEEDED AT ALL.

And the same data, that we now know, shows that Masks and lockdowns do NO GOOD at controlling the spread of the SARS-CoV-2 and cause GREAT HARM.

We HAVE THE DATA to know we should give up on this world crushing experiment as a bad mistake and get back to our 2019 ‘normal’.

May the blessings be
George