Carl Heneghan | The Spectator columnists & writers

The hidden death toll of lockdown

The last patient I treated was 105 years old. She has lived through two world wars, a depression and at least five pandemics. It’s a real honour to treat centenarians. They teach me much about life: how it is and how it ends. I can also lighten the mood with my 80-year-old patients by telling them that they’re still young. It’s common to hear talk about an ‘ageing society’ being some kind of disaster befalling the country. Yes, people are leading longer, healthier lives now than ever before. Is this really a ‘demographic timebomb’? I’d call it the greatest achievement of our time. When my patient was born in 1915, average life expectancy was about 55. Thanks in large part to vaccination, the postwar years lifted life expectancy at birth from 70 to just over 80.

Landmark Danish study finds no significant effect for facemask wearers

Do face masks work? Earlier this year, the UK government decided that masks could play a significant role in stopping Covid-19 and made masks mandatory in a number of public places. But are these policies backed by the scientific evidence? Yesterday marked the publication of a long-delayed trial in Denmark which hopes to answer that very question. The ‘Danmask-19 trial’ was conducted in the spring with over 6,000 participants, when the public were not being told to wear masks but other public health measures were in place. Unlike other studies looking at masks, the Danmask study was a randomised controlled trial – making it the highest quality scientific evidence. Around half of those in the trial received 50 disposable surgical face masks, which they were told to change after eight hours of use.

Can Boris be reinfected with Covid?

Boris Johnson is self-isolating in Downing Street after hosting an MP who subsequently tested positive for Covid-19. As we all know, Johnson has already been affected by SARS-Co-V2. So can the Prime Minister, who has presumably built immunity to this virus, be reinfected? For once the answer is clear: it’s possible. We know this thanks to the work of the Medical Research Council’s Common Cold Unit (CCU). The unit, which worked on the site of a WWII American Red Cross base near Salisbury, ran over a thousand studies between 1946 and 1989. One of its last projects analysed the time course of the immune response to experimental coronavirus infection of man. Fifteen volunteers were infected with coronavirus 229E. They were followed up for 52 weeks with frequent nasal washings and had blood samples taken.

How many people are catching Covid in hospital?

One aspect of the original outbreak of coronavirus in March and April that has not received enough attention was the spread of the virus in NHS hospitals. With NHS staff lacking Personal Protective Equipment – and as we know now, suffering from a lack of preparedness – the virus spread at rapid speed between people in close proximity in hospitals – the very places where people expected to get better, not worse. In this first phase of the pandemic at least one in eight patients contracted the virus while already in hospital. These patients tended to be older and frailer, and if they survived, they ended up staying in hospital on average for more than a month. On 24 June, all NHS Trusts and Foundation Trusts were required by NHS England to apply the UK recommended Infection Prevention and Control Guidance more robustly.

The nine worst Covid-19 biases

We all suffer from cognitive biases that cloud our judgment and lead us to the wrong conclusions. But now that we are in the middle of a pandemic, and restrictions are being put in place that have a profound impact on people’s lives, it is more important than ever that we look to the evidence and challenge these biases before they lead to serious mistakes in our response to the disease. Unfortunately, this has not been happening. Here are nine big mistakes that have shaped our response to Covid-19: 1. Herd thinking From the offset, the government’s thinking about the pandemic was based on influenza modelling. The clue is in the title of the most influential modelling group which reports directly to the government’s scientists: the Scientific Pandemic Influenza Group on Modelling (SPI-M).

The ten worst Covid decision-making failures

Dealing with a pandemic requires a clear aim, planning, intelligence and supreme flexibility to react to the unknown. However, ever since reports broke in the West of a newly-identified virus in Wuhan in January, this has not been the case in Britain. The result? We have suffered a very high death toll, and substantial social and economic damage has been inflicted on our society. It did not need to be this way. Our Covid-19 outcome could have been very different if certain mistakes were not made. Here we list some of the major decision-making blunders made over the last eight months. 1. Lack of a clear aim In March, Health Secretary Matt Hancock set out ‘to protect the NHS by building it up and flattening the curve.

The Edition

The long winter – why Covid restrictions could last until April

39 min listen

The Edition

The long winter – why Covid restrictions could last until April

39 min listen

Why does the government think the second wave will be worse than the first? (00:49) Will a Biden presidency restore America's fortunes? (18:45) And finally, does Covid mark the end for the silver screen? (30:10)Spectator editor Fraser Nelson talks to Carl Heneghan, professor of evidence-based medicine at the University of Oxford; editor of The Spectator's US edition Freddy Gray is joined by columnist Lionel Shriver; and reviewer Tanya Gold is in discussion with The Spectator's arts editor Igor Toronyi-Lalic.Presented by Lara Prendergast.Produced by Gus Carter, Max Jeffery and Sam Russell.

Lockdown cycles

The appearance of SARS CoV-2 has been deemed worthy of extraordinary measures to contain or suppress its spread. With a rise in infections across Europe, politicians are once again scrambling to reintroduce a series of policies that amount to lockdown in all but name. France has introduced a curfew. Italy has made the wearing of masks mandatory outdoors. And London’s nine million residents have been banned from meeting people they don’t live with indoors. Such extraordinary measures imply that the epidemic of SARS-CoV2 has features that are out of the ordinary when compared to previous pandemics. But is this right? Or are we setting a precedent for the way we deal with infectious diseases? We are, of course, all familiar with acute respiratory infections and their effects.

Following the evidence for hospital admissions

The recent warnings of exponential growth of Covid-19 cases, inevitably followed by a rise in hospital admissions, is one focus of the Government's Covid messaging. Jeremy Hunt described this spike in admissions as a 'wake-up call' for the Government. But while this year the disease is newly identified, warnings of a winter crisis in the NHS occur annually. So should we be worried? For 20 years, 'influenza' has been blamed for putting hospitals under pressure in winter. Now, this fear has been substituted by 'Covid'. Yet both are one-track, one-pathogen scenarios, which ignores the reality that there are scores of different pathogens that cause respiratory infections across a community at different times of the year.

How is the Vallance Covid projection working out?

Prediction, projection, illustration — call it what you wish, but when you make a statement about what’s going to happen next, people are going to assess whether you’re correct or not. Sir Patrick Vallance, the Chief Scientific Adviser, said last week: At the moment we think that the epidemic is doubling roughly every seven days...If, and that’s quite a big if, but if that continues unabated, and this grows, doubling every seven days… if that continued, you would end up with something like 50,000 cases in the middle of October per day. Making projections is fraught with danger, but there are ways to caveat such statements that allow better understanding. For instance, it is looking gloomy today and the weather forecast says there is a 50 per cent chance of rain.

How is the Vallance Covid projection working out?

The rule of four: how to make sense of Covid case numbers

Are Covid cases doubling or not? And if so, in what time frame? If you listened to Boris Johnson and chief scientific adviser Patrick Vallance, you'd be forgiven for being confused. The Prime Minister said this week: 'The chief medical officer and chief scientific adviser warned that the doubling rate for new cases could be between seven and 20 days.' In fact, Vallance had said this: 'At the moment we think that the epidemic is doubling roughly every seven days.” And added, “It could be a little bit longer – maybe a little bit shorter – but let’s say roughly every seven days.' So what's going on? In order to understand what is happening, it's important to follow four steps when looking at Covid case numbers as reported each day: 1.

Boris’s ‘whack-a-mole’ Covid strategy is failing

Will the current cycle – lockdown; open up; eat out; restrictions; lockdown – go on forever? In their handling of coronavirus, Boris Johnson and his colleagues have become increasingly media-responsive, fear-bound, model-sensitive, sound-byte producing, u-turn prone and, quite frankly, embarrassing to all who believed the UK to be a beacon of rational thought. Has the Government lost the plot? We are not sure if it ever had one. This week at its annual meeting, the British Medical Association lamented the Government's lack of grip on the public health during the current pandemic and proposed a ‘near-elimination’ strategy. Put simply, this involves what the BMA called ‘sacrifice in the short-term to ensure that we can avoid a large-scale prolonged lockdown that would be ultimately much more detrimental to the health of our society.

What does a case of Covid-19 really mean?

‘What's in a name? That which we call a rose by any other name would smell as sweet,’ wrote the Bard. He was referring to a rose which is a rose, instantly recognised by its fragrance and its appearance. But a case of Covid-19 does not fit the metaphor, because it differs wherever you look. In the course of our evidence gathering activities, we have gone through a few thousand papers reporting studies on all aspects of Covid-19 spread. We found that not very many defined a case of Covid, which is a sign of sloppiness when that is what you are looking for. Those that did, reported different definitions and ways of ascertaining what they meant by a ‘case’. Now this may seem a pedantic academic remark, but in reality, it underlines the chaos which has crept into Covid-19 science and decision-making.

Boris Johnson needs to bin the rule of six

When Boris Johnson returned to work in April after his brush with coronavirus, he warned that lockdown restrictions must remain to prevent a second wave. Ever since, beset by anxieties, doubts and fear, and surrounded by a platoon of advisors, the PM has made one cautious, catastrophic error after another. Last week’s roll of the dice with the ‘rule of six’ could well be the policy that tips the British public over the edge. For it is a disturbing decision that has no scientific evidence to back it up, and may well end up having major social consequences. The government has decided to blame young people for the latest restrictions, having spent August asking them to revive the economy. What was the purpose of Chancellor Rishi Sunak’s ‘eat out to help out’ scheme if at the first sign of a rise in cases the PM’s hasty response is to lockdown again? We were told to get back to work, what did the government expect? Increased activity at the end of summer leads to an increase in acute respiratory infections, as it does every year.

Covid-19 cases and the weekend effect

There’s significant mounting interest in the increase in detected cases in the UK. However, it’s worth looking at the data to try and understand what is going on. First, it is essential to analyse cases by the date the specimen was taken, as opposed to reported. The second vital thing to do is to observe this data for emerging patterns, even before looking at the numbers. If you do this, then the Government’s Staging Data shows an emerging pattern, whereby the number of people testing positive on the weekend is significantly lower than that observed in the week. Furthermore, if you assess the data for the last week, you see this effect is accentuated by the Bank Holiday Monday on 31 August. This suggests people would rather not come forward for testing on the weekend or, alternatively, the system has less capacity at the weekend, meaning it is more challenging to get a test.

Covid-19 and the end of clinical medicine as we know it

When we trained at medical school we were taught to approach each patient on his or her own merits. We were taught to take a history: ask questions about past medical problems, drugs and present complaints; to do a physical examination and make a management plan including those tests that allowed us to narrow the range of possible diagnoses. Treatment was the next option. After we learned to do all this, we were awarded the title of doctor – professionally trained, licensed and regulated to carry out the procedures described. This model of actions which has a long history is called clinical medicine. But what impact has Covid-19 had on this tried and tested way of doing things? In the last 30 years, clinical medicine has had two important evolutions.

Coronavirus cases are mounting but deaths remain stable. Why?

Something rather odd is happening in the two Europeans nations worst hit by Covid-19. The UK and Italy have a rising number of cases but a stable and very low number of deaths, even weeks after the cases started rising again. At the time of writing, the UK records 1750 new cases daily and one death in a population of 67 million. With a roughly similar population and an average of 602 cases a day, Italy has had just over four deaths a day over the last month. The ratio of cases to deaths is nowhere near what it was at the height of the pandemic. The other notable feature is a shift of cases to a younger population. There can be several explanations for this trend. First, the viral agent may have mutated to a less virulent form.

It’s a mistake to think all positive Covid tests are the same

Italy was the first country in Europe to implement lockdown, so what can we learn from the country's attempt to impose restrictions to stamp out Covid-19? And what does Italy's experience of finding a path out of lockdown teach Britain as it emerges out of lockdown itself? Ten towns in the province of Lodi, Lombardy, and one town in Veneto were designated areas or 'red zones' on 23 February 2020: two days after the first Covid-19 death and three days after the identification of the first autochthonous case of Covid-19 (i.e. a case which could not be linked to contact with outsiders). By the time Italy's prime minister Giuseppe Conte announced the complete national lockdown – the 'orange zone' – on the 11 of March, there were 12,482 cases and 827 deaths.

Could mass testing for Covid-19 do more harm than good?

Making a diagnosis used to be a well understood and practised procedure: take a history from someone presenting with symptoms, examine them and do some tests to arrive at an overall diagnosis. It requires substantial training and experience to put this into practice. William Osler, known as one of the founders of modern medicine, often directed his trainees to ‘listen to the patient, he/she is telling you the diagnosis'. With Covid-19, however, clinical diagnosis is seemingly a secondary consideration in the face of mass testing. All you require is a positive PCR test; no symptoms, no signs, no other diagnostic proof. But our limited understanding of mass testing and PCR suggests this might not suffice. Detection of viruses using Polymerase Chain Reaction (PCR) is helpful so long as its accuracy can be understood: it offers the capacity to detect RNA in minute quantities, but whether that RNA represents infectious virus is another matter.

The real Covid-19 threat

Daniel Kahneman called it anchoring; I call it tunnel vision. It’s when we depend too heavily on our pre-existing ideas and first pieces of information – the anchor – to inform our judgments. How a problem is perceived, how it is described, how it makes us feel alongside our individual experience and expertise shapes the decisions we make. Anchoring ensures emerging evidence is ignored. Even in the face of this new contradictory evidence, we refuse to change our early decisions. In the week ending the 24th of July, 8,891 deaths were registered in England and Wales (161 fewer than the five-year average). This is the sixth week in a row that we have observed fewer deaths, a total of 1,413 fewer deaths than expected.

Why Covid cases in England aren’t actually rising

The government has restricted the movements of millions of people in England because Covid is apparently on the rise. But what happens when you start digging into the data? I have used two datasets to piece together the number of tests, cases and results for Pillar 1 tests (which are done in healthcare settings) and Pillar 2 tests (which are done in the community). Looking at the data for July, by the date PCR tests are reported, you can see a trend for an increased number of cases detected (from about 500 to nearly 750 a day). If you then look at the date the actual tests were taken, the trend is still apparent: Now all things being equal, the increase in cases is about 250 per day over a month – not an exponential rise and no sudden jump.

Coffee House Shots

What’s behind the excess deaths statistics?

23 min listen

Coffee House Shots

What’s behind the excess deaths statistics?

23 min listen

Statistics released this week showed that England had the worst excess death rate in Europe during the first half of 2020. Katy Balls speaks to Kate Andrews and Carl Heneghan, professor of evidence-based medicine at Oxford University about what's behind the numbers.

Coffee House Shots

What’s behind the excess deaths statistics?

23 min listen

Coffee House Shots

What’s behind the excess deaths statistics?

23 min listen

How many Covid diagnoses are false positives?

Test, test, test said the WHO. And globally, that’s what everyone did: tests have detected more than 14 million cases of Sars-CoV-2 so far. The thinking goes: turn up, have your test, and if positive, you must have the disease. But that’s far from the truth. When virus levels in the population are very low, the chances of a test accurately detecting Covid-19 could be even less than 50 per cent – for reasons that are not widely understood. There are two issues about tests to get your head around. The first is the sensitivity of the test: the proportion of people who test positive, out of the population who have the virus. The second measure, specificity, is about the proportion of people who test negative, out of the population who should have tested negative.

Studying sewage could help solve a coronavirus mystery

There are plenty of mysteries about how coronavirus spread around the world so quickly. But could we shed some light on this by looking in an unusual place? Several studies have been doing just that: tracing the emergence of covid-19 by investigating frozen faeces samples from sewage. This analysis cannot tell us where the virus originated from, nor can it tell us whether the recovered micro-organisms are still infectious. But they can give us ideas about how long we have been living alongside a virus which has so far killed more than half-a-million people. Coronavirus has been found in sewage from several countries predating the detection of the first confirmed cases in those areas: in Barcelona, in March 2019; Santa Catalina, Brazil in November 2019; and Milan, in February 2020.

Can antivirals defeat Covid-19?

Can antivirals help us defeat coronavirus? The odds don’t look good. The use of antiviral compounds against respiratory viruses has a chequered history. Hundreds have been tested; very few have made it to market. And even fewer make a difference. What’s more, the evidence of their impact on mortality rates – the most important outcome of all – is thin. The race for a magic bullet to overcome Covid-19 has been going for months now. At least 254 treatments are currently undergoing development, ranging from antibodies to cell-mediated treatments. And there are over 3,500 trials underway. Twenty-five different antivirals are in various stages of development, with a variety of funders, from industry to academia to governments and private donors, often in cooperation, sometimes in competition.

The data is clear – Covid is receding

The coronavirus data from across the capital – which shows that the numbers are coming down – is highly reassuring. On 15 May, there were just 56 people with newly diagnosed cases of Covid. And at least six London trusts are reporting no deaths in hospitals in the last 48 hours. Across the country, about 30 per cent of all trusts have had no deaths in the last 48 hours. The deaths are coming down. And actually, if you look at information like 111 calls and 999 calls, you're seeing a trend here that's showing coronavirus is disappearing at a rate that's speeding up, which is highly reassuring. On the threat of a second wave of infections, there are probably three points that need to be made. The first is to say numbers are now low enough for contact tracing to work.

Let’s bring back Britain’s fever hospitals

Could the future of pandemic planning lie in our past? A century ago, there were hundreds of so-called 'fever hospitals' dotted across Britain. These small institutions were built for diseases of a bygone age – smallpox, scarlet fever and typhus – but were designed for precisely the same problems we face today. They contained isolation wards, separate accommodation for different infections, laboratories, operating theatres and convalescent wards with activities for recovering patients. Given the current problems of the Covid-19 outbreak, we need to re-establish these medical relics. Fever hospitals were often built so that open-plan wards could be quickly converted into separated isolation rooms at relatively low cost.