Driving the Wrong Way in Pandemic Response

Imagine driving down a freeway exit ramp in the wrong direction. That's the metaphorical situation the world finds itself in as governments prepare to combat the next pandemic using the same strategies that failed during the Covid-19 pandemic. The irony lies in the fact that these governments view their response to the pandemic as a triumph, believing that their actions saved millions of lives and that minor improvements will lead to even better results next time.

The Next Pandemic is Just Around the Corner

Experts are already warning that the next pandemic could be imminent, with threats like bird flu or 'Disease X' looming. Yet, evidence continues to pile up suggesting that the response to Covid-19 was at best ineffective and at worst, responsible for many deaths that could have been avoided. Despite this, we are told that there is a 'scientific consensus' that the methods used were effective and valid. However, this can't be true. The existence of the Great Barrington Declaration, signed by over 16,000 medical and public health scientists, is proof that there is no such consensus.

The Flawed One-Size-Fits-All Strategy

Governments worldwide were persuaded to adopt the one-size-fits-all strategy proposed by the Imperial College London 'Report 9'. This strategy aimed to stop the spread of SARS-CoV-2 by reducing the general level of activity in the population by 75% until a vaccine could be developed and deployed. However, this strategy was implemented without any hard evidence of its effectiveness. Comprehensive reviews of the use of non-pharmaceutical interventions (NPIs) in respiratory epidemics and pandemics had concluded that there was only weak evidence in favor of them.

Weak Evidence and Inconsistent Results

Despite numerous studies claiming that the measures were successful, each of these studies is based on carefully chosen parameters and assumptions that are open to scrutiny. Different combinations yield different results. One study ran nearly 100,000 models based on possible variations in design parameters and found that about half of all models suggested government responses were helpful, and half unhelpful. This indicates that we cannot conclude that there is compelling evidence to support the notion that government responses improved or worsened the Covid-19 burden.

Problems with Studies Supporting the Macro Strategy

Studies that seek to reinforce the macro strategy often focus on the effect the chosen measure may have had on infections, assuming that reducing infections in a window of time will lead to better outcomes in terms of severe illness and mortality. However, this assumption is flawed. The reduction in infections may have come about anyway without intervention. This is particularly the case with epidemics, which follow an epidemic curve. To prove that the intervention changed the course of the epidemic curve, it should be evident when graphed, but this is hardly ever done.

Distortion of the Scientific Record

There are several ways in which the scientific record can be distorted to support a preconceived and biased policy position. Decisions about what topics to research can be biased by the availability of funding and by groupthink. Even when evidence for alternative treatments is available, it is often ignored. Studies can be designed with parameters that favor the preferred intervention. Conclusions that are not justified in the findings can be reached. And systematic reviews of the evidence can be crafted so that they support the favored position.

The Case for Masks

For example, a recent systematic review of masks for the prevention of respiratory infections concluded that 'masks work.' However, the data reviewed does not support the scenario of general mandates for the entire population to wear masks all the time while outdoors. They believe they have shown that 'masking is an effective intervention for controlling the spread of respiratory infections', but they have not. Despite this, the 'scientific consensus' will be represented as 'masks work,' even though the scientific record does not show this.

Failure to Draw Lessons from Science

One key factor in the derailment of rational public health principles has been the complete policy failure to draw sound lessons even from the science that does get done, and to allow for the fact that the playing field is tilted by commercial interests to favor some policy positions over others.

Blinded by Science

Policy-making is dominated by a naïve realism – if some scientists recommend something, no government can stand against them, because they are seen to be putting forward objective reality. This could be termed an apparent objectivity fallacy. The science is dumbed down so that it can be given to the politicians, who decree standard operating procedures on a one-size-fits-all basis, and governments then use public relations techniques to reduce this further to sound bites that can be sold to the voters.

The Need for Critical Inquiry

Non-specialist policymakers need to be on their guard. Scientific conclusions can be fabricated, and government policy advisors need to run their own checks on what they are being told, looking for non-sequiturs, rhetorical manipulation, and cheap tricks. The way the system should work is that specialists make out their best case to non-specialists, who listen to a diversity of specialist views (much as in a courtroom) and then use critical inquiry to assemble the most sound opinion and evidence into a policy.

The Failure of the Macro Strategy

It starts with the very definition of the problem and with the macro strategy that was advocated, snapped up, and implemented within weeks in February 2020. I can see no hard evidence that it is possible, or desirable, to 'stop the spread' of a respiratory pandemic over the medium term, as opposed to the unrepresentative slices of time in research studies. Covid-19 swept across the globe despite all attempts to stop it. And we have no empirical evidence that attempting to stop it lowered all-cause mortality over the period 2020-2022. Modelling is not evidence.

Building Resilience is the Key

Large numbers of people with positive SARS-CoV-2 tests died in that time. But only a small proportion of them did not have the famous 'comorbidities,' only 6% according to the CDC in 2021. This tells us that it was in fact the comorbidities that were the problem. Too many of our elderly are living with poorly controlled hypertension, obesity, diabetes, heart disease, etc. A moderately unusual virus came along and pushed many of them over the edge. But this would not have happened if they had been in more resilient good health in the first place.

Building that resilience is an important goal for public health but has been overshadowed by pandemania.

Final Thoughts

It's clear that the world's response to the Covid-19 pandemic was flawed in many ways. The one-size-fits-all strategy, the reliance on weak evidence, the distortion of the scientific record, and the failure to draw lessons from science have all contributed to a public health disaster. As we prepare for the next pandemic, it's crucial that we learn from these mistakes and adopt a more effective approach. What are your thoughts on this matter? Do you think the world's response to the pandemic was effective? Share this article with your friends and let's start a conversation. Don't forget to sign up for the Daily Briefing, which is everyday at 6pm.