In his book Mark Woolhouse provides the story of the Covid-19 pandemic in Britain and his role as an advisor to the British and Scottish Governments.
His restrained story does not cover all aspects of the pandemic and the Governments’ response, but it is nevertheless pretty damning. He notes that that Scottish Government didn’t set up its own expert advisory committee and have its first meeting until three days after the first lockdown, ‘by which time the course of the epidemic in Scotland and the UK . . . was pretty much set’. He criticises the World Health Organisation (WHO) for only declaring a pandemic until well into March, so undermining early action in the UK, and by which time he deems it also ‘pretty much irrelevant.’
In fact, WHO comes in for other scathing criticism, including for its approval of China’s strict lockdown policy – “China’s bold approach . . . has changed the course of a rapidly escalating and deadly epidemic’ it said at the end of February 2020, even as Covid-19 had already spread to forty-eight countries. Nearly three years later China’s strict lockdown policy is falling apart and the call by the Director-General of WHO to follow its policy now looks foolish.
The UK had its own problems right from the start, including the assumption in its pre-existing planning that it was going to be fighting an influenza pandemic. As Woolhouse puts it, the modelling group he sat on ‘had to contend with one challenge right away; it was set up to tackle the wrong disease.’
The difference this made can be seen in the models created to inform decisions on what action to take against the spread of the disease. More appropriate for an influenza pandemic, the ‘new, bespoke coronavirus models’ included the impact of schools but not of care homes for the elderly. Covid-19 was a disease massively disproportionately affecting the elderly, with the average age of death in the UK at 78 and 80 for deaths attributed to coronavirus, but having generally only mild effects on children. The original influenza models also didn’t include lockdown.
Woolhouse says that ‘We’d done our homework, but we’d prepared for the wrong exam’. He still claims that they ‘were useful tools’ but also that ‘I wouldn’t want decision-making to be over-reliant on models either’. Unfortunately, he also says that ‘in March 2020 . . . you could easily get the impression that the UK government’s mantra of ‘following the science’ boiled down to following the models. That’s how it looked and that’s how the media presented it.’
The models were used to produce an R number every week: the average number of cases generated by a single case. ‘The R monster turned out to be quite dangerous . . . The relentless focus on the R number detracted from the usual public health priorities of saving lives and preventing illness.’ This, for him, was part of a wider problem, accusing many scientists of ignoring elementary principles of epidemiology and abandoning objectivity and common sense.
One example, that was employed as an ignorant term of abuse also on the left, was the damning of ‘herd immunity’, and he criticises the editor of the leading medical journal ‘The Lancet’ for continuing ‘to rail against their straw man version of a herd immunity strategy.’
This criticism of the approach of many scientists is measured and unpolemical, and he presents it from an insider perspective in which models create scenarios and not predictions. He nevertheless finds a particular target in the Imperial College report number 9, which generated a worst-case scenario of half a million deaths in the UK by the end of July. He admits to generating such a scenario himself. ‘The problem was that these worst-case scenarios weren’t realistic and weren’t intended to be.’ This one however had the very real consequence of making lockdown ‘accepted as a necessity the first time it was proposed.’
The strategic objectives were presented as saving lives and protecting the NHS. As Woolhouse notes, if this meant ‘trying to minimise deaths due to novel coronavirus while ignoring deaths from other causes, and if social distancing is the intervention of choice, then we don’t need a complex computer model to tell us what to do.’
Boris Johnson’s ‘flattening the curve’ to ‘protect the NHS’ had two problems according to him. Firstly, flattening infections and hospitalisation reduced peak demand on NHS services but prolonged it, and the NHS couldn’t cope with either. The NHS therefore required more resources and, while it got new hospital facilities, these remained largely unused because it didn’t get the required staff. Woolhouse claims the UK got what he predicted – ‘yo-yoing between intolerably severe restrictions and unsustainable pressure.’
In my own posts during the pandemic, I argued that protecting the NHS was attractive to politicians because it would also protect them from accountability for their prior policy of running the service down. Ritual hand-clapping on the street became the substitute, while we are now invited to condemn NHS workers for striking to recover the fall in living standards incurred over the past number of years. Perhaps these workers would be in a stronger position today if the failures of government had been exposed during the pandemic instead of demanding more of the same policy.
Woolhouse admits to supporting the introduction of the first lockdown despite concerns, because there was no other option on the table, he was unsure of the effect of earlier measures and he was not prepared to take the risk. The central message of the book however is that lockdown was wrong and there was an alternative. He argues that there were already marked shifts in people’s mobility before lockdown and that the latter ‘seems to have come late to the party and had surprisingly little effect.’ Imperial College published a counter-factual analysis ignoring this voluntary activity and exaggerating the effect of lockdown.
Woolhouse notes some problems with its analysis. Sweden never went into full lockdown but brought the epidemic under control. Imperial then claimed implausibly that its banning of mass gatherings had had the same effect. Other researchers came up with the quite different conclusion that the UK epidemic was already in decline before lockdown took effect. He doubts that ‘anyone would claim now that the March 23rd lockdown saved anywhere near half a million lives.’
His alternative was to act earlier, but not to introduce the lockdown that was implemented, while lifting restrictions earlier. ‘Lockdown was never going to solve the novel coronavirus problem, it just deferred it to another day, and it did so at a great cost. Epidemiologists and modellers knew that it was going to be the case from the outset. It turned out policy-makers did not . . .’
‘Lockdown was conceived by the World Health Organisation and China as a means of eradicating novel coronavirus once and for all from the face of the earth. With hindsight, this plan was doomed from the outset . . . The world was given an intervention that only made sense in the context of eradication as the preferred means to control a disease that was clearly here to stay.’
Many on the left maintained this position – of zero-Covid – long after this was obvious, while the World Health Organisation eventually backed away from the policy. In October 2020 it stated that ‘we really do appeal to all world leaders: stop using lockdown as your primary control method.’
As Woolhouse puts it – ‘tragically, this appeal came seven months too late and by that time a colossal amount of damage had already been done.’
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