September 29, 2023 - 3:00pm
On Wednesday, the UK Health Security Agency quietly released a review which found that the evidence base for the effectiveness of non-pharmaceutical interventions (NPIs) on Covid transmission was weak. These include such measures as lockdown, the ‘rule of 6’, test and isolation, face coverings, border restrictions, and more.
The review identified 151 studies conducted in the UK. Two-thirds of the evidence identified was based on modelling studies, and there were only two randomised control trials included. Studies focused on measures to identify or isolate infectious people or reduce the number of human contacts were the most numerous. Only nine studies focused on measures to protect the most vulnerable.
The report concluded that “there is a lack of strong evidence on the effectiveness of NPIs to reduce COVID-19 transmission”:
The review noted the many challenges with evaluating NPI effectiveness, which makes the current evidence-base prone to confounding and bias.
This includes the way NPIs were implemented, levels of adherence and compliance, wider behavioural changes, the difficulties of isolating one NPI from a range (or ‘package’) of measures, endpoint measurements, poor study designs and study quality, and ethical considerations. The report went on to recommend a strengthening of evaluation research for NPI interventions in the future.
The report is part of ongoing efforts by the UKHSA, and other government departments, to digest the state of knowledge on NPI effectiveness in preparation for the next pandemic. However, as with a recent Royal Society Report current analyses have not yet focused on the wider social, economic, psychological and political impacts of NPIs.
The report fails to mention that public health research should, in principle, weigh the impact of specific interventions on a virus against their full societal impact, including their social harms and unintended consequences.
This myopic definition of “effectiveness” continues to hamper an intelligent and holistic assessment of whether NPIs were, all said and done, really the best of many bad options.
The decision to implement lockdown and the pandemonium of rules unleashed on the British public during the crisis were, in the end, political decisions. Epidemiological studies on Covid ‘effectiveness’ can only take us so far in trying to understand the Covid years, and what decisions should be made in future.
Luckily, next week the UK Covid Inquiry opens its nine-week second investigation (Module 2), focused on decision-making and political governance. In this regard, I am sure we will learn more about the ‘effectiveness’ of our contemporary British government.
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SubscribeA huge percentage of the population and the media shoulder a great deal of the blame. The public demanded that we were locked down. I would however, like to understand which government department was responsible for the barrage of fear porn and why they did that.
When I put in an FOI request to DHSS to find out what lay behind some obviously inconsistent policy, initially they said they were too busy to answer. I went to the Information Commission pointing out it was an FOI request not a general enquiry and they made DHSS answer. The answers I got basically said DHSS did not know and did not see it as their job to know.
The elderly and/or frail could and should have been advised to stay in their homes and have the state make provisions for shopping and care, so long as that was safe. Instead, these 3 factors came into play to produce the ruinous lockdowns:
1) Disproportionately elderly European populations maintained by medical and healthcare advances (85-100 years old). The disease spread like wildfire in hospitals and care homes.
2) Multiculturalism expressed in ‘mixed-generation’ households where the grandparents live with young people and parents who are studying or working and bringing the germ world back into the house
3) A lack of any sense of proportion about flu epidemics of the past, where excess deaths indeed reached into the 10,000s over a short period. Even when the vaccine was made available to the older generation – especially the over-75s who were particularly vulnerable – governments, bureaucrats and the media allowed themselves to be terrified by disproportionate excess deaths appearing in any shape or form. The result was at least another 12 months of lockdowns in the ongoing perpetuation of collective hysteria essentially taken more by in the idea of immortality than a synthetic flu could be created irresponsibly in a laboratory.
Delusional. Those vulnerable from covid make up about a third of the population. Are you really suggesting these people stay inside their homes and in cases of mixed generation in their own rooms for a year or more? That’s nearly 20 million people the state would need to make provision for in your scenario.
The appropriate suggestion is that the most vulnerable do whatever they want. If they are afraid of the disease they can isolate themselves from it. The point is that locking the less vulnerable down had profound negative effects on the less vulnerable and marginal benefit to the most vulnerable. It is the very definition of public health failure.
You speak of public health failure yet what you’re advocating is to have no policy at all. Brilliant.
It is a policy and almost certainly the best policy would have been ‘Keep calm and carry on’
We could have emulated Sweden.
Yes we could, and our covid deaths could have been a million.
Covid deaths in Sweden were in the middle of the range for Europe, their excess deaths since the pandemic have been much lower, and the damage to their economy and to trust in the government was much smaller.
Doctors used to first of all seek to ‘do no harm’.
That not having no policy. That’s having a policy of first of all not doing something that might make a bad situation worse. It’s waiting until you know what you are doing. Blindly doing ‘something’ because you need to ‘have a policy’ isn’t just the definition of public health failure, it’s reckless stupidity.
No policy is better than a harmful policy.
I know that is a blasphemous statement to many, but it’s true.
Elderly who live out in the community should not be told to become shut-ins. Isolation was and is a far bigger threat to their health and wellbeing. I am a volunteer befriender to such people and they are first and foremost struggling with loneliness and depression.
I understand advice to avoid large gatherings or crowds at the very peak of the wave in spring 2020, but telling people not to see their loved ones or have tea with a neighbour or cease going to a weekly exercise session will always be paternalive, prescriptive and counterproductive. In the end, all you’re doing is spreading fear.
Infection control in clinical and long-term residential settings which are full of very sick and frail patients is another matter.
To be fair, it seems that the report is about the effectiveness of the studies, not the effectiveness of the NPIs.
It is curious how widely this point is ignored in this debate. You would think the difficulty of determining if these vast govt interventions into society yielded any benefits would be a good reason not to endorse them.
Sorry, but that is a standard trick, mostly seen on the left. You have a vastly complicated problem, with no way for sure of determining what causes what? Simple: Just take it for granted that you are right and demand that we do it your way until the other side has proved you wrong beyond any possible doubt – which is of course impossible. I saw it first with the lady who demanded a ban on all pronography since ‘it was obvious’ what harm it caused.
No, the issue is a very different one: The measures taken were implemented by law, and those laws impinged on established laws – translated into the language of constitutional law, we have individual freedoms which the State can restrict only under exceptional and limited circumstances.
Our forefathers fought hard for the principle that the restriction of these constitutional rights have to jump a high hurdle. And the science underlying the so-called Covid restrictions simply does not jump this hurdle, not by a long shot.
It is very important to emphasise this point: The law is not preventing authorities from taking measures in accordance with medical science. It is the fact that medical science is not unambiguous (in the case of the “Covid” measures a sweeping understatement) that makes the measures taken unconstitutional. Hysterical “we’ve got to do something” is not a good enough reason to toss the Constitution overboard – as was done.
So you are saying that what matters is not the best way to save people ‘s lives. What matters is whether the measures match the wording of a 18th century document (as later amended). Which is of course only relevant to the US, as other countries (where many of us live) have other constitutions. A lawyer might agree. I do not.
First of all, we know now – positively, unambiguously, confirmed by multiple peer-reviewed scientific papers – that none of the NPIs saved any life, on an all-cause mortality basis. The NPI hysteria destroyed lives, culture, economy, etc. – all for nothing.
As for your derogatory reference to the principles of the Enlightenment, this is indeed an ideological, philosophical question. The totalitarian attitudes exhibited by “health” authorities and governments in their “Covid” measures seem to be very much en vogue again, and perfectly acceptable. That to me is the most worrying, dangerous, and distressing aspect of the whole sorry affair.
“I am sure we will learn more about the ‘effectiveness’ of our contemporary British government.”
There’s no need for sarcasm.
Sorry, but there’s every need. At other critical times in UK history, governments have generally stepped up to the mark. Not on this occasion, where the UK was run by an incompetent buffoon and a bunch of wannabe celebrities making it up as they went along, all united by their singular lack of any moral fibre whatsoever.
The information on the weakness of the evidence sounds about right. But let me get my retaliation in first and remind all of you that it is *not* always the wisest course to do nothing until you have had time to do mutiple randomised control trials and be sure of the effect.
As you may know, the evidence for the advantage in putting on a parachute before jumping out of an aeroplane is decidedly weak. There are not many control groups and very few randomised control experiments. And the few we have all show that parachutes do not help – since they were conducted with the aeroplane standing still on the ground.
We agree absolutely!
No.
The WHO’s 2019 review of NPIs and recommendations already said of all these measures: We KNOW they don’t work, don’t do it.
If it it was so clear then why did pretty much all the governments do it? Hysteria, big pharma corruption etc all added together only go so far (the economic, political, business interest were and are too diverse). Clearly it was not that obvious at the time. The job now is not to look back and blame (with the wonders of hindsight and high on schadenfreude); rather to carefully and clearly delineate, without shame, ad hominem blame, or politiking/grandstanding, what went wrong, what went right, what we should do next.
“Nothing humans did made ANY difference.” Does that include the vaccine, and the various measure even the Swedes put into place?
Good question. Maybe the various enquiries launched will go to answer it, but I’m not holding my breath. Still, the facts are stark – the WHO had until 2019 studied all the NPIs, reviewed the scientific literature, and come to the conclusion that they don’t work or work only in very narrow, specific time frames and circumstances. This century of accumulated epidemiological experience, wisdom and science was simply tossed overboard.
Yes. The way the “vaccines” were touted had more to do with religion than science. For a starter, they weren’t designed to stop infection, only severe progression – the magical claims were made by health authorities, not the manufacturers. Whether they actually did protect against severe progression, at least for the initial variants (which they were designed for) is still an open question. Also, it is a fundamental rule of public health that you should never vaccinate into an epidemic – bad things always happen when you do.
To my knowledge, Sweden restricted itself to drastically watered-down NPIs, they didn’t do anything special no-one else did. Tegnell said he regretted not taking measures to protect the old folks’ homes better – that certainly could have been done and no doubt there will be lessons learnt. Whether it would have made any difference is another matter. Overall, Sweden seem to have come out on top (or rather, bottom = best) in terms of all-cause mortality, which ultimately is the only sensible yardstick.
“Good question.”
The answer to the question is seen in the comments section of this thread. A pro-lockdown poster here has posted, as evidence of the merits of lockdowns, a journal article which shows that all cause mortality in Sweden in 2020 was within the range of all cause mortality from the previous five years – during a pandemic, without lockdowns!
And this is taken as evidence that lockdowns ‘work’ because lockdown-happy Norway had very slightly lower all cause mortality in 2020 than in previous years (0.2 fewer deaths per 100,000 people than the range from the previous five years). This data could just as easily be interpreted as suggesting we should lockdown all the time!
What we see here has nothing to do with disagreements over the measurement of data, and everything to do with the interpretation of vast, complex data sets which are subject to multiple possible interpretations. When there are numerous interpretive possibilities, we fall back upon our underlying assumptions and values to draw conclusions.
So this debate is really the expression of underlying tensions between the values of experts, planning, and safety, and the values of individuals, markets and freedom. These disputes will not be resolved through data analysis, but in poetry, narrative, worship, etc. One good movie with a pro- or anti-lockdown hero would do more to change our perspective than a thousand more complex data sets.
Exactly. There was PRIOR knowledge and agreement that lockdowns don’t work. With the possible exception of the first lockdown, the rest occurred due to fear (fear for their careers) and consequent paralysis on the part of ministers. We pay them to do better.
Agreed.
At first, there was justifiable concern that that the virus might be an escaped bioweapon.
By the time the data from the Diamond Princess and the German Heinsberg study were analysed, we knew all we needed to know – the mortality rate was on the level of a bad flu (in itself serious enough), and transmission was not by droplets or fomites, but aerosols.
All coercive measures taken after that time – March/April 2020 – were unjustifiable in science and therefore in law.
Another one of those Articles where the headline distorts the actual message arising from the Report referenced. It says much more that real difficulties distinguishing between multiple factors and running any sort of real RCA at the time – i.e largely blinkin obvious.
What we know is the transmission level dropped gradually, probably as a result of the NPIs, and the way behaviour changed regardless of NPIs, before vaccine availability. And that reduction was believed needed or emergency services would have completely melted down – at least so far as initial phase of pandemic in the UK. (Lockdown 2 and how necessary that was a whole other issue). But importantly the HSA flagging the other health consequences of Lockdown and other NPIs insufficiently captured too in what studies are available so the net effect can be gleaned.
Such reports do though add some confidence that the Public Inquiry, for which this is one of the submissions, is bringing to the fore what we need. Just wish they could speed it up a bit more for goodness sake.
“the transmission level dropped gradually, probably as a result of the NPIs”
Probably, ha! I was assured by zero Covid proponents that falls in transmission in 2020 and 2021 were solely the result of NPIs. What do we find since restrictions were lifted? The exact same wavy pattern of Covid cases. This strongly suggests that there was far more going in 2020 and 2021 than whether there was a lockdown or not. Unfortunately most of the public is convinced that they were effective so we are doomed to repeat this nonsense the next time a pandemic comes around.
Not sure what you mean DO by ‘since restrictions lifted’? Covid variants still circulated/circulate for sure, but population immunity with the vaccine and antibodies generated after having Covid, transformed the position as regards hospital attendance/admission.
Plus in 21 vaccine roll out (started late Dec 2 remember) changed the position and I doubt you’ll find any proper science saying that reductions in prevalence then just due to NPI. From Mar – summer 20 we were reliant on NPIs and changing behaviour to slow transmission rate
My point is that the effectiveness of lockdowns (as implemented in the West, ie shutdowns etc) is not clear from the data. See Nate Silver’s most recent piece where he notes that:
“1) Until vaccines became available, there was little difference in COVID death rates between blue states and red states.
2) After vaccines became available, there were clear differences, with red states having higher death rates, almost certainly as a result of lower vaccine uptake among Republicans.”
If falls in Covid cases were attributable to NPIs, this would be clear in the data. It’s not.
I agree – ‘not clear’ – although that’s not the same conclusion as ‘made no difference’, There could be multiple other factors at play too, different population densities being but one, which make distinguishing between actions and outcomes v difficult. So to learn the most I think we need to remain inquisitive.
The better way to put this is that the benefits of lockdown are ‘not clear’ – but the harms of lockdown are ‘bloody obvious.’
From a public health standpoint, it’s a no brainer.
I get the point KS but I think a bit too simple – you sort of took two points there but then your implied deductive leap quite a stretch. I think you were implying shouldn’t have Locked down as the consequences far worse – apols if misinterpreted.
The ‘unclear’ might still outweigh the latter but we don’t know and politicians at the time had to make a judgment with no hindsight.
I do think the navigation challenge though was different Lockdown 1 to Lockdown 2 in the UK. By the latter more information was available on which to base a decision and one can question the decision much more.
That said one suspects whether mandated or not a large element of Lockdown 2 would have occurred anyway with free choice. Many kids wouldn’t have gone to school and teachers would have been off sick. So normality wasn’t an outcome possible. Thus the public health issue may not have been much different. That’s often overlooked in the comparisons because context and other behaviours are removed from the analysis. Lockdown is compared with no change at all. That was never going to happen.
What’s crucial now is in learning for the future so we have a better weighting of the overall now, at least as far as one can do this. We defo agree on that.
No.
Comparing jurisdictions, the trajectory of SARS-CoV-2 infection was exactly the same in all jurisdictions, regardless of level of NPIs, intensity of NPIs, duration of NPIs, or point of time at which NPIs were introduced or discontinued.
Differences were due to the age profile of the population and seasonality.
Nothing humans did made ANY difference. That is why epidemics are called Acts of God.
Ping us the link to this research if you can JG. Interested.
Still feels counter intuitive. For the virus to transmit some proximity needed. Reduce proximity, via NPIs, the virus can’t as easily jump. Now it may be that NPIs weren’t adhered to? Slightly different conclusion.
It’s shame CCP won’t release any data on what happened with it’s severe Lockdowns – which really were enforced. Of course eventually they released them but with a population with less immunity as their vaccine wasn’t great. We may never know exactly what happened then.
Like J Watson, I would like to see evidence to support what I understand your claim to be.
It’s perfectly reasonable to make a case against govt passing laws to tell people to reduce their contact with each other (I’d rather not use the ghastly ‘lockdown’ term): The basis of a very clear one is to say that people would have done a lot of it anyway (see Sweden) but they would have been able to do it in a better way than simplistic central govt rules trying to regulate the interactions of 60m people.
Why do you need to make the basis of the case against ‘govt rules’ a claim that physically keeping people apart has literally no effect on transmission of a virus (and it’s all an Act of God)?
Would you say that sleeping with 100 men/women per year makes no difference to whether you’ll get an STD as ‘it’s all an Act of God’?
Despite the hint of sarcasm in that last paragraph, this is a serious question. There are lots of people (esp. on Unherd) who think like this and I really would like to understand where you’re coming from.
The ‘moral’ case for lockdowns and masking and the like, really resolves to an intuitive sense by their proponents that they must help reduce the spread of the disease… Surely this piece of fabric in front of your mouth limits how far the infectious agent can circulate? Surely physical distance between people limits how easily the infectious agent can spread between them?
The argument by opponents is that decent scientific studies don’t show they do much of anything helpful. What this suggests to me is that intellectual humility should be the order of the day. However likely it is that a piece of cloth does limit disease spread, there are lots of other factors that might work against it.
Of course, the rampant politicization of these govt rules – exceptions made for sex workers, exceptions made for race protests, etc. – amply demonstrated that the ‘intuitions’ were happily discarded when more important value commitments were put at risk. It’s hard to take lockdown activists seriously when they say mass gatherings are fine… provided you’re demonstrating for the *right* causes.
One of the chief side effects of the covid NPIs is a decrease/disruption of civic/political trust. To be fair, we should call out two groups for this- initially there were those who went too far, by hysterically advocating NPI and PI treatments, and who shunned and shamed sceptics; and those who more recently and continually, go too far, by hysterically attacking and denying the past treatments, and who call for the shunning & defenestration of those in charge at the time. The first lot indulged their fear and woke posing; the latter indulge their anger and tinfoil hattery.
In a democracy, accountability should start and end with elections.
Old school! That’d be a fine thing, it’s a 24/7 blood sport now.
Our lockdown was not as thorough as China’s. Too many people had to keep working and then going home to family. Even China had to abandon its strict lockdowns. Unless the whole population could have been confined to their homes 24/7, for a month, the virus would still find a way through, until herd immunity and vaccines took effect. It’s not as if Covid has ended. .
Actually, regarding the comments below that subsequent lockdowns are unfortunately more likely (in future pandemics), further lockdowns won’t happen. The country is broke, saddled as it is with 750 billion of debt it didn’t have before Covid. That’s roughly 10,000 extra debt per person. So the luxury of panicking won’t be available for future (sub)Prime Ministers.
Lockdowns failed a cost–benefit analysis by orders of magnitude
Nobody seems to be looking at the real facts here. 1 There has never been proof of contagion for any dis-ease, ever. 2 No ‘virus’ has ever been isolated and proven to cause dis-ease. 3 Observations of CPE under the microscope are merely the breakdown of toxic cells caused by the whole process of cell culture. http://www.whatreallymakesyouill.com
Here’s an alternative heading for the article without the obvious bias from the author:
Alternatively, here’s a report that clearly shows how lockdowns worked when comparing Norway and Sweden in 2020.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8807990/
Higher excess death in the country that didn’t implement a Lockdown, albeit only 2020 reviewed. Not sure this adds anything particularly conclusive. Both Countries population density markedly different from UK. Depending on which data one uses UK c30th, and Sweden/Norway up above 150th. This is not apples with apples, although still some lessons that can be learned.
I read the background of this things a dozen times and can’t make heads or tails of it. What does this mean?
“ Conclusions: All-cause mortality in 2020 decreased in Norway and increased in Sweden compared with previous years. The observed excess deaths in Sweden during the pandemic may, in part, be explained by mortality displacement due to the low all-cause mortality in the previous year.”
Sweden apparently had relatively few deaths in the year immediately before the pandemic started. Which may (or may not) mean that there were more weak and vulnerable people around for COVID to pick off. Another case where these analyses are so complicated that it is very hard for well-intentioned amateurs like you or me (or even for professionals) to figure out what it all means.
Yes, unfortunately labelled as the ‘dry tinder’ effect, the theory being that they had unusually high number of vulnerable senior people, which makes their decision for liberal policies even more absurd.
Sweden made massive mistakes with their treatment of people in long term care centres, just as many other jurisdictions did.
Apparently so, I recall a lady on here describing that in a very thorough post.
There are a few reasons why Sweden rightly implemented liberal policies as opposed to the idiotic, immoral, ineffective and ruinous lockdowns.
1. Public health policies are required by law to be based in EVIDENCE. There was NO evidence in existence for the effectiveness of lockdowns to justify their implementing them, and there still is NO evidence to justify lockdowns…
2. In emergencies, policy making decisions are handed over to the experts, the scientists. This is to avoid ‘ministerial rule’ or the politicisation of the pandemic. They literally followed the science. Whereas here in the uk politics getting in the way of decision making was a real problem, initially the tories looked like they weren’t going to do lockdowns until their political opponents started wetting the bed. Chris whitty said in the enquiry that the scientific advisors would NOT have recommended lockdowns had senior politicians not specifically asked them to do so…
But who chooses the scientists? What if they’re policies aren’t working? What if there is no ‘evidence’ to base decisions on – because there wasn’t any at the time.
The ‘evidence’ we had was basically one study, one piece of modelling from imperial college, and it turned out to be trash. Anders Tegnell said they couldn’t implement lockdowns based on that one study, first the study needs to be replicated and verified as is the scientific process. The swedes ran the modelling again, did their own modelling and decided the imperial study was wrong and the evidence not strong enough especially considering the public health costs of locking down. This is what it means to base the policies on evidence.
Imperial modelling predicted within a year if Sweden didn’t lockdown they would see more than 90,000 deaths. If they did lockdown they would see nearly 40,000. Within that year, with no lockdowns Sweden saw 13,000 covid deaths and that’s probably an overestimate.
As of today Sweden has 24,888 reported covid deaths.
Fauci was likely the singly most influential person in the world.
You beat me to the “dry tinder” – which assumption makes perfect sense given the data – I removed one downtick for you.
It’s not much use to only look at 2020. Better to look at the bigger picture, let’s also look at 2021 or 2022…
Yes Sweden experienced more Covid deaths in 2020 for many reasons including no lockdowns but then Norway and everyone else apart from Sweden experienced MORE deaths from OTHER causes after 2020, after the effects of lockdowns.
If you were to look at more of the pandemic than merely 2020, you will find Sweden has actually had LOWER overall excess mortality than both Norway or Finland.
In fact, in the end, the only country in Europe that had marginally lower mortality than Sweden was denmark…
Then you are asking a different question. The report I linked looks specifically at the effectiveness of lockdowns preventing covid deaths, which they clearly did.
I suppose I am asking a different question, the right question! Not merely were there benefits to lockdowns? But rather, do the benefits outweigh the costs? And I’m not just talking about £ costs, I’m talking about the cost of life.
There are plenty studies showing that lockdowns had some limited benefits, the consensus among these studies is that they may well have prevented a relatively small number of covid deaths… but that’s not good enough, that’s the point. The cost of life associated with lockdowns far far outweighs the benefits or lives saved.
“Here’s an alternative heading for the article without the obvious bias”
You betray your own bias. The reason your proposed headline is misleading is because whether or not the benefits of lockdowns on COVID transmission are clear, the downsides to lockdowns are overwhelmingly obvious.
The burden is on those propounding lockdowns – and it should be a very high burden that they have to meet.