‘What should we learn for the future?’

THE impact of the Covid-19 pandemic was unprecedented in most of our lifetimes. Not since the Second World War has anything had such a major and widespread negative impact on humanity.

In early 2020, the world was alerted to a novel coronavirus causing severe pneumonia in Wuhan, China. Initially, I was not overly concerned, as the previous coronavirus outbreaks in the last 20 years (Sars and Mers), although with reported high lethality, had been largely restricted to geographic regions. In fact, I had travelled to China towards the end of Sars in 2003 and recall being held up following an internal flight while the authorities checked travellers’ temperatures. Fortunately, I was released and allowed on my way once they were satisfied I had no signs of infection.

However, I became very concerned once the new disease hit north Italy, with media reports of hospitals being overwhelmed. There was no known proven treatment, and later, when it afflicted New York City, sadly 88% of those ventilated died.

In Guernsey, the CCA promptly convened. Although I don’t have any intimate knowledge of their discussions, I suspect the modelling from Neil Ferguson at ICL, which suggested that as many as 500,000 people could die in the UK if no action was taken, had a great influence on their decision making, and as a result the Bailiwick entered a full lockdown on 25 March 2020 – the day after the UK.

Guernsey’s Strategic Pandemic Influenza Plan, having only just been drafted in January 2020, has no mention of lockdowns. Although this was expecting influenza, that type of virus can potentially cause an even more fatal disease, such as that which occurred in 1918. No doubt the CCA were put in a difficult position, potentially having to face something much worse than ever envisioned.

In addition, Guernsey is geographically isolated and has limited healthcare resources, such as personnel and hospital/ICU beds, so deviating from a pre-determined strategy to quarantine the island while the threat could be fully evaluated was a reasonable initial approach.

Lockdowns went from ‘two weeks to flatten the curve’ to extended periods of months or more. Doing nothing was clearly not an option, however the prolonged closure of society brings with it undeniable collateral damage, including mental health problems, delayed diagnoses of serious diseases such as cancer, and a significant economic burden. Those who were able to work from home were less affected by the latter, but those with manual jobs were prohibited from working and earning. This resulted in significant cost – with most of the States’ pandemic expenditure of nearly £100m. spent on income and business support. Although Guernsey was able to return to relatively normal life on-island with fewer restrictions than the UK, travel was far from normal, requiring up to 14 days of quarantine for those arriving on the island. It could never be a long-term solution to essentially be cut off from the rest of the world.

So, was there any alternative strategy? Professor John Ioannidis of Stanford had published early on that the infection fatality rate was around 0.2%, and later found it was under 0.1% for those under 70 years of age. Increasing age beyond this was well documented to be the single greatest risk factor for severe Covid-19 and hospitalisation/death, and people with conditions such as obesity, diabetes and high blood pressure were also at higher risk.

In October 2020, three professors of medicine (Sunetra Gupta of Oxford, Martin Kulldorff of Yale and Jay Bhattacharya of Stanford) suggested a different approach; the Great Barrington Declaration – targeted protection of the vulnerable, while allowing the rest of society to continue relatively normally. Would this have been a better strategy?

Mandated non-pharmaceutical interventions were later brought in. These included masking, social distancing, and hand-washing. Early on, a number of health officials stated there was no recommendation for masks in the community, yet later this advice was reversed, despite a Danish randomised study and later a Cochrane review concluding there was little or no evidence for mask effectiveness.

The advice was also inconsistent – one would have to enter a pub or restaurant wearing a mask but could sit for hours without one. Social distancing may have reduced spread by larger exhaled droplets, but spread by aerosols (smaller particles), which can remain in the air for longer periods, was under-appreciated.

The strategy had become one of varying restrictions while waiting on the proposed solution – a vaccine. Several pharmaceutical companies produced candidates which quickly entered trials. In late 2020 results of these were published from three companies, all claiming efficacy rates over 90%, albeit these were relative risk reductions. They were proposed to be safe, although there was no medium- or long-term data.

The mass vaccination programme started in late December 2020, beginning with the elderly, the most vulnerable and front-line healthcare workers. Undoubtedly Covid-19 could be a severe and fatal disease, so on a risk-benefit analysis, offering such an investigational therapy to those at risk could be justified. However, they were subsequently offered to younger and younger age groups. The Joint Committee on Vaccination and Immunisation met and decided there was insufficient benefit to offer them to 12-15-year-olds. Despite this the chief medical officers in the UK decided they should be, and soon after Guernsey followed suit (then later offered them to children as young as five years old). This was especially perplexing given that it was a disease of negligible risk to children and there was a known risk of myocarditis (heart muscle inflammation), especially in teenage males. A study analysing the original trial data reported an overall serious adverse event rate of one in 800.

Although the vaccines were never mandated, there was coercion to take them. I frequently heard that individuals were only taking them in order to travel. While some of this was outside Guernsey’s control, local people who had not taken the vaccines were subject to isolation requirements on-island. At the same time visitors and tourists who had taken them could enter without any restriction or testing. There were some studies at the time showing similar viral loads in people whether vaccinated or not, suggesting limited impact on infection and transmission. Real world data supports this. The last figures published by the States on 28 March 2023 shows over 95% of reported cases of Covid-19 had taken at least a primary course of vaccines. In addition, a recent Cleveland Clinic study suggested that with cumulative doses, one was more likely to get Covid.

Even if the vaccines were proven to reduce infections and transmission, would it have been ethically right to impose conditions on those who had chosen not to have them?

So how effective are the vaccines at preventing death? Data just released by the ONS shows that between 1 April 2021 and 31 May 2023 in England there were 8,850 deaths involving Covid-19 in the unvaccinated and 52,000 deaths in the vaccinated. Between January and May 2023, 95% of deaths were in the vaccinated.

Is the widespread use of a vaccine that does not significantly impact on infection and transmission helping to promote variants?

Why wasn’t a more holistic strategy adopted, such as promoting weight loss, exercise and maintaining a sufficient level of vitamin D? Deficiency of the latter was correlated with worse outcomes in several studies, while being a safe and inexpensive intervention.

Repurposed drugs with an established safety profile such as hydroxychloroquine and ivermectin were vilified. Both are inexpensive drugs known to work on more than one condition. The data from human studies remains mixed (and fraudulent negative data was published in the Lancet on the former), but at the same time expensive drugs such as remdesivir were approved – it didn’t reduce mortality in hospitalised patients and increased the risk of kidney failure, at a cost of £2,000 per course.

An inexpensive pharmaceutical intervention that did become proven for severe Covid-19 were corticosteroids – showing a significant reduction in mortality in patients requiring oxygen or ventilatory support. Unfortunately, the WHO had recommended against them from the outset of the pandemic. Dr Pierre Kory went before the US Senate in May 2020 to testify on their use, based on existing published data on acute respiratory distress syndrome and reports from doctors using them as being a ‘game changer’. Two months later, they were adopted as a standard of care when Oxford published the results of their recovery trial.

Data from the Greffe shows there was no increased mortality in 2020 and 2021, yet Guernsey experienced the most deaths for at least a decade in 2022. This echoes similar excess ongoing mortality in the UK and multiple other countries. What is this due to?

The States’ recent Covid Review was a missed opportunity to properly evaluate the response to the pandemic.

I ask, how much of the disruption to our lives was due to the virus, and how much from the response to it?

Was it all proportionate, and what should we learn for the future?