House of Commons Covid Report Gets Some Things Right, Most Things Wrong

On Monday evening two House of Commons select committees – the Science and Technology Committee and the Health and Social Care Committee – published a joint report on the Government’s handling of the COVID-19 pandemic that was predictably damning. It was published in time to make the following day’s front pages – “Britain must learn from ‘big mistakes’ on Covid, says report”, reported the Times on its front page – but not in time for newspaper reporters or broadcast journalists to properly assess its findings. Not that that stopped all the usual suspects from using it as a stick to beat the Government with. For instance, Labour’s Shadow Health Secretary Jonathan Ashworth told the BBC that the “damning” findings showed that “monumental errors” had been made and called for the public inquiry – scheduled for next spring – to be brought forward.

The authors of the report say in the Executive Summary that the reason they’ve published it now, when there are still a large number of ‘known unknowns’ as well as ‘unknown unknowns’, is because we urgently need to learn from what the Government got right and what it got wrong so we are better prepared for the next pandemic, which might come along at any moment. But if it’s too soon to say what was a mistake and what wasn’t, that argument collapses. Indeed, a premature report that draws the wrong conclusions, e.g. that the Government didn’t lock down in March of last year early enough, which is one of the main findings of this report, is worse than useless since it may encourage future Governments to repeat the same mistakes.

I’ve now read the report – yes, all 145 pages – so you don’t have to.

What the report gets right

• It criticises the Government for discharging elderly patients from hospitals into care homes without testing them first to see if they had COVID-19 and without putting any measures in place in care homes to mitigate the impact of that policy, as well as for the lack of PPE in care homes. The report says these errors “led to many thousands of deaths which could have been avoided”. Hard to argue with that, although one of the oddities of the report is that it criticises the lack of infection control in care homes, but not in hospitals. Weird, given that ~20% of cases over the course of the U.K.’s epidemic have been hospital-acquired infections.

• The authors praise the RECOVERY trial for carrying out large randomised control trials of different COVID-19 treatments and identifying dexamethasone as an effective treatment. That too seems right.

• The report highlights the disproportionately high Covid death rates among black, Asian and minority ethnic populations and acknowledges that part of the explanation for that may be biological differences between those populations and the white British population. Even acknowledging that genetic factors may be part of the reason for these disparities makes a refreshing change. Unfortunately, the report goes on to play down these biological differences and claims that social, economic and health inequalities are much bigger factors.

• It criticises hospitals and care homes for issuing ‘Do Not Attempt CPR’ notices to patients/clients with learning disabilities and autism, often without the consent of their families. No argument there.

• Rather than blame Boris and other senior members of the Government for the decision not to lock down before March 23rd 2020, the report emphasises that they were just following the recommendations they were being given by their scientific advisors. As I’ve pointed out before, that is correct.

• The report is at least ambivalent about how effective a two-week ‘circuit breaker’ would have had in England in September of 2020.

It is impossible to know whether a circuit breaker in the early autumn of 2020 would have had a material effect in preventing a second lockdown given that the Kent (or Alpha) variant may already have been prevalent. Indeed such an approach was pursued in Wales, which still ended up having further restrictions in December 2020.

Unfortunately, having written this, the authors then go on to say:

It is likely that a “circuit break” of temporary lockdown measures if introduced in September 2020, and earlier lockdown measures during the winter, could have impeded the rapid seeding and spread of the Kent variant.

Make up your mind guys!

What the report gets wrong

• The report claims that the U.K.’s Pandemic Preparedness Strategy wasn’t fit for purpose because it prepared us for “an influenza-like pandemic” rather than a more serious infectious disease that was spread, in part, by asymptomatic transmission. Professor Devi Sridhar, who gave evidence to the joint committees, is quoted as saying the mistake our Government made was to assume COVID-19 was “just like a bad flu”. In fact, it was like a bad flu, as judged by the latest estimates of the infection fatality rate, and the jury’s still out on whether asymptomatic people who test positive for Covid are infectious.

• One of the reasons the Government didn’t lock down before March 23rd, according to the authors, is because its scientific advisors were guilty of following the flawed playbook of the Pandemic Preparedness Strategy. In particular, the initial advice was to try to ‘manage’ the spread of the virus through the general population rather than to suppress it altogether, which the authors believe would have been the correct strategy. They claim the Government didn’t realise this sooner because it had failed to learn the lessons of the SARS, Swine Flu and MERS pandemics and embed those lessons in its strategy. But, surely, one of the lessons of those pandemics is that national lockdowns aren’t necessary to contain pandemics – and that advice was embedded in the U.K. Government’s strategy document. The mistake the Government made was not to initially follow that advice; the mistake was to stop following it on March 23rd. The only time a government has tried quarantining entire regions as a strategy to mitigate the impact of a viral outbreak prior to 2020 was in Mexico in 2009 when something like a lockdown was imposed on April 27th in Mexico City, the State of Mexico and the State of San Luis Potosí. That was policy abandoned on May 6th because of the mounting social and economic costs.

• Bizarrely, the authors of the report claim the reason the British Government didn’t abandon the Pandemic Preparedness Strategy sooner was because of “groupthink”. But, surely, the reason for putting a carefully thought out strategy document in place, incorporating the lessons from the mistakes made during previous pandemics, was precisely to avoid Government decisions being influenced by groupthink. And that approach was successful until mid-March, at which point Boris Johnson and his closest political allies abandoned it and decided to copy what other Western leaders were doing, i.e. lockdown. In other words, it was groupthink that was responsible for the disastrous U-turn, not the comparatively sensible initial approach.

• One of the main conclusions of the report is that the Government should have locked down earlier than it did – that’s one of the “big mistakes” in all the headlines – and they quote Professor Neil Ferguson to that effect:

The initial U.K. policy was to take a gradual and incremental approach to introducing non-pharmaceutical interventions. A comprehensive lockdown was not ordered until March 23rd 2020 – two months after SAGE first met to consider the national response to COVID- 19. This slow and gradualist approach was not inadvertent, nor did it reflect bureaucratic delay or disagreement between Ministers and their advisers. It was a deliberate policy – proposed by official scientific advisers and adopted by the Governments of all of the nations of the United Kingdom. It is now clear that this was the wrong policy, and that it led to a higher initial death toll than would have resulted from a more emphatic early policy. In a pandemic spreading rapidly and exponentially every week counted. The former SAGE participant Professor Neil Ferguson told the Science and Technology Committee that if the national lockdown had been instituted even a week earlier “we would have reduced the final death toll by at least a half”.

• In fact, it’s far from clear that “this was the wrong policy” or that it “led to a higher initial death toll”. The authors of this report take it for granted that – in the words of Professor David Paton – “governments can turn infections on or off like a tap by imposing or lifting restrictions”, when all the real-world data we’ve accumulated in the past 18 months suggests that is hopelessly naive (see these 30 studies, for instance). Governments around the world, including ours, have been guilty of wildly over-estimating the impact of non-pharmaceutical interventions on the spread of the virus.

• In the British case, there’s no reason to believe that locking down earlier would have reduced the final death toll at all, let alone by half. As David Paton points out, the Czech Republic locked down on March 16th, imposed hard border controls and rolled out the first national mask mandate in Europe. Yet it had a second surge in the Autumn of 2020, prompting it to lock down again, and then an even bigger one in December, leading to a third lockdown. Cases surged again in Czechia in February and March of this year and, six months ago, it had the second-highest per capita Covid death toll in the world, according to Reuters.

More damning still is the comparison with Sweden, which didn’t lock down at all in 2020 and, as of today, is ranked 50th in Worldometers’ table ranking countries according to per capita deaths. The U.K., by contrast, is ranked 25th.

• There are only three mentions of Sweden in this report, two of them in a single footnote. Any assessment of the U.K. Government’s response to the pandemic that fails to compare it with that of the Swedish Government – particularly one advocating we should have locked down sooner and for longer – doesn’t deserve to be taken seriously.

• The report’s authors take at face value the “reasonable worst-case” scenarios that various modellers (including a sidekick of Dominic Cummings’) came up with in mid-March to show that if the Government continued to follow Plan A, i.e. the Pandemic Preparedness Strategy, the NHS was on track to become overwhelmed many times over. Here is Matt Hancock giving evidence on June 8th 2021, appealing to a prediction of “slightly below” 820,000 deaths, absent a lockdown:

I asked for a reasonable worst-case scenario planning assumption. I was given the planning assumption based on Spanish flu, and it was signed off at Cobra on January 31st. That was a planning assumption for 820,000 deaths. […]

In the week beginning March 9th, what happened is that the data started to follow the reasonable worst-case scenario. By the end of that week, the updated modelling showed that we were on the track of something close to that reasonable worst-case scenario. I think the numbers were slightly below that, but they were of a scale that was unconscionable.

• Rather than just take those projections at face value, couldn’t the House of Commons committees have interrogated the models a little bit? The report’s most damning criticism – that the Government’s delay in imposing the first lockdown resulted in thousands of unnecessary deaths – is contingent on not questioning those forecasts. In light of SAGE’s over-estimate of the likely uptick in cases following the easing of restrictions on July 19th of this year, as well as its more recent over-estimate of hospitalisations this autumn, wouldn’t it have been prudent to scrutinise those models? That’s a particularly glaring omission, given that the authors of the report criticise members of the Government for not challenging the scientific advice they were given: “Those in Government have a duty to question and probe the assumptions behind any scientific advice given, particularly in a national emergency, but there is little evidence sufficient challenge took place.” Why do “those in Government” have a duty to do this, but not those serving on select committees who are supposed to be holding the Government to account?

• In case further evidence is required that the authors of the report have credulously lapped up the doom-mongering of SPI-M and others, consider this passage:

It seems astonishing looking back that – despite the documented experiences of other countries; despite the then Secretary of State referring to data with a Reasonable Worst Case Scenario of 820,000 deaths; despite the raw mathematics of a virus which, if it affected two-thirds of the adult population and if one percent of people contracting it died would lead to 400,000 deaths – it was not until March 16th that SAGE advised the Government to embark on a full lockdown (having said on March 13th that “it was unanimous that measures seeking to completely suppress the spread of COVID-19 will cause a second peak”) and not until March 23rd that the Government announced it.

• Note the appeal to an IFR of 1% when even Neil Ferguson’s team at Imperial College, which predicted 510,000 deaths if the Government stuck with Plan A in its famous March 16th paper, assumed an IFR of 0.9%. In fact, a WHO bulletin put the IFR at 0.23% as long ago as October 2020.

• This unwillingness to interrogate the modelling data that underpins the report’s conclusions is particularly odd, given that the authors acknowledge the limitations of modelling elsewhere – “Models can be useful and informative to policymakers, but they come with limitations” – and at one point try to blame the delay in lockdown down on an “overreliance on specific mathematical models”! Again it’s a case of one rule for me and another for thee.

• The report compares the response of the British government in the first months of the pandemic unfavourably to that of various East Asian and South East Asian governments, but overlooks the fact that many Asian countries that successfully suppressed infection by closing borders at the beginning of 2020, and rolling out successful test, trace and isolate programmes, are now in the grip of devastating waves in spite of having vaccinated large swathes of their populations. That suggests their non-pharmaceutical interventions only succeeded in postponing the impact of SARS-CoV-2, not avoiding it. (It also fails to note that these supposed role models didn’t issue stay-at-home orders, close schools or shutter businesses in their initial responses to the pandemic.)

• The report criticises the Government for stopping community testing in March 2020 due to PHE’s lack of testing capacity and praises Matt Hancock for setting the 100,000 tests a day target to galvanise the system into massively ramping up that capacity. Indeed, the authors claim that had a proper test-and-trace system been in place at the beginning of 2020, the initial lockdown might have been avoided. That, too, is a shaky assumption. After all, the Government has spent £37 billion and counting on a ‘world-beating’ test, trace and isolate programme but that didn’t stop us locking down for a second and third time. The authors of the report acknowledge this point, but blame Baroness Harding for not doing a better job of running NHS Test and Trace. That seems a tad harsh, particularly as the authors repeatedly say – Uriah Heap-like – that it’s not their intention to apportion blame for the mistakes they’ve identified.

• The report praises the speed at which the Nightingale hospitals were created, although it acknowledges that, for the most part, they weren’t used. But the reason they weren’t used is partly because the NHS lacked the trained employees to staff them with – ICU nurses, for instance. Perhaps if they’d been built with less speed – at a cost to the taxpayer of roughly half a billion pounds, don’t forget – the Government would have had time to spot this obvious flaw in the plan. Or, more realistically, those aware of it from the start would have had more time to organise and obstruct this expensive PR stunt.

• The authors praise the Government – and the NHS – for at no point running out of ICU beds and becoming overwhelmed, as the health system did in some parts of Italy during the first phase of the pandemic. But given the enormous cost of protecting the NHS – both in terms of seriously ill people who were either discharged or went untreated, as well as the collateral damage inflicted by the lockdowns on the economy, education, family life, mental health, etc. – it’s impossible to say whether prioritising the NHS at the expense of absolutely everything else was in fact the right strategy. To bottom that out you need to do some cost-benefit analysis, of which there is precisely none in this report.

• The report concludes by praising the Vaccine Taskforce under the leadership of Kate Bingham and highlights the ‘success’ of the U.K.’s vaccine programme – “one of the most effective in Europe and, for a country of our size one of the most effective in the world”. But they ignore the fact that the efficacy of the Covid vaccines is much less impressive than the initial trial data indicated and looks less impressive with each passing week, something Dr. Will Jones has been meticulously documenting for the Daily Sceptic. So was the massive Government expenditure on the development and trialling of home grown vaccines, as well as procuring hundreds of millions of vaccines manufactured overseas, worth it? One notable omission from the report is any acknowledgement of the risks associated with a fast-tracked vaccine approval process – it just breathlessly praises the speed with which vaccines were made available to the public and expresses the hope that “in the future this could be conducted in much shorter time still”.

Conclusion

This is a pretty feeble document that seems to have been written with an eye on getting Jeremy Hunt and Greg Clark – the chairs of the two select committees involved – on the BBC news rather than making a serious contribution to understanding what the Government got right and what it got wrong over the past 18 months. It’s hard to argue with some of its findings, but its headline conclusion – that the Government should have locked down earlier – isn’t based on any serious analysis, let alone a careful consideration of the evidence that seems to point in the opposite direction. Talk about groupthink!

I hope the official inquiry, when it comes, is a bit more intellectually weighty than this.

Stop Press: Quite a funny Twitter joke by Burnside – at least, I think it’s a joke.