UK Approach to COVID 19

I posted on April 3rd 2020 to suggest that the UK approach to COVID 19 was accepting very high costs from social distancing measures based on very little evidence, while medical judgements were being held to a far higher standard of evidence. I am deleting the original post because it reported claims about the efficacy of hydroxychloroquine treatment that turned out to be false.

At the time, Didier Raoult and his colleagues in Marseilles were claiming a nearly 100% cure rate for treatments involving hydroxychloroquine in combination with zinc and an antibiotic. At the time, though not based on double blind trials, Raoult argued that the results were based on successful treatment of 1500 patients and it would be unethical to offer a placebo. At the time he was the most cited infectious diseases expert in the world, and the treatment was based on drugs long in use and was both low cost and involved negligible risk even if ineffective. The mainstream profession was sceptical based on double blind trials which had reached negative conclusions. Rauolt argued that the treatment only worked in the early stages, whereas the trials had only included patients with advanced disease. There was clearly a need for better trials, but there didn’t seem to be a good reason meanwhile for banning the treatment.

It subsequently became clear that the results claimed were false, and could be argued to be fraudulent. They were based on comparing two groups of patients with different characteristics, and some cases with worse outcomes had been excluded from the reported results. I also became aware that Raoult’s eminent position in the literature had been achieved in part by having his name added to virtually every article published by his institute. I am therefore deleting the post.

The other point made in the post was that the approach to the pandemic in the UK (and in most other countries) involved costs that were disproportionate to any benefits from deaths averted.  It fails the UK Government’s own criteria for cost effective health interventions by a wide margin.

I still think it is reasonable and indeed essential to ask questions about how much damage to our economy and society it is reasonable to incur in order to avert additional deaths. I would not necessarily want to insist on rejecting measures that exceed the NICE guidance that a year of extra healthy life is worth £30,000. I would, however, have expected a far more rigorous approach to assessing which interventions work at acceptable cost. It is appalling that after nearly a year, we have the highest per capita death rate from COVID 19, have incurred deep damage to our economy and society, yet still do not have the epidemic under control. For an island nation, none of that was inevitable. It reflects:-

i. a decade of neglect of the health service, including not maintaining adequate stocks of PPE

ii. not closing the borders

iii. not using existing resources for test, trace and isolate, relying instead on setting up an over-centralised and enormously expensive system contracted to Tory party cronies with no experience. The system is still not working nor is there any prospect that it ever will, but political embarrassment prevents it being abandoned despite ruinous cost in both lives and billions of pounds.

iv. Ditto, multiple other decisions that have wasted time and money and lives by being over-centralised and let to inexperienced contractors with nothing to recommend them but an unhealthily close relationship with the Government. Normal procurement processes have been overturned in ways that can only be described as corrupt.

v. Despite claiming to follow the science, a series of confusing, inconsistent and largely ineffective social distancing measures, poorly timed and poorly coordinated without much consultation with those affected. Some forms of high risk interaction are allowed, others are banned, with the boundaries of what is permitted continually shifting without much rationale.

Had we been willing to learn from the experience of other countries, especially those in Asia and Australasia, much of this was avoidable.