COVID-19: an overview of the evidence

March 18, 2021

The data is in: lockdowns serve no useful purpose and cause catastrophic societal and economic harms. They must never be repeated in this country.

The ‘sunk cost fallacy’ is a well known one. World War 1 is the classic example. By Christmas 1914 it was obvious to all that the war was a catastrophe, but to admit this was to admit that all the lives lost had been lost pointlessly. And no country would confess that.

However, after a year of pain, suffering and enormous loss, the UK must reach for new solutions to the COVID-19 problem and any future respiratory disease outbreaks. We must learn from errors, acknowledge the harms of the measures we have taken and account for them moving forward. We now need a more holistic, measured approach.

Many international studies bear out that lockdowns have proven to be a complete failure as a public health measure to contain a respiratory virus. They did not succeed in their primary objective of containing spread yet have caused great harm.

Lockdowns were explicitly not recommended even for severe respiratory viral outbreaks in all pandemic planning prior to 2020, including those endorsed by the WHO and the Department of Health. The reasons for ignoring existing policies and adopting unprecedented measures appear to have been (i) panic whipped up by the media (especially scenes from China), (ii) a reluctance to do things differently to neighbouring countries and (iii) the unfaltering belief in one single mathematical model, which latterly turned out to be wildly inaccurate (Imperial College, Neil Ferguson).

We must find the courage to do things differently and to admit mistakes. The USA is leading the charge here, with more and more states turning their backs on lockdowns and mask mandates.

Moving forward, we would recommend the following steps:

1.     Reinstate the existing pandemic planning policies from 2019, pending a detailed review of the policies adopted in 2020. Look to countries and states which did things differently. There should be a clear commitment from the Government that we will never again lockdown.

2.     Stop mass testing healthy people. Return to the principles of respiratory disease diagnosis (the requirement of symptoms) that were well researched and accepted before 2020. Manufacturers’ guidelines state that these tests are designed to assist the diagnosis of symptomatic patients, not to ‘find’ disease in otherwise healthy people.

3.     Stop all mask mandates. They are psychologically and potentially physically harmful whilst being clinically unproven to stop disease spread in the community and may themselves be a transmission risk.

4.     Vaccination. Abandon the notion that vaccine certification is desirable and that children should be vaccinated. There is no logical or ethical argument for either.

5.     Devise a public education programme to help redress the severe distortions in beliefs around disease transmission, likelihood of dying and possible treatment options. A messaging style based on a calm presentation of facts is urgently needed.

6.     A full public enquiry into the extent to which severe/fatal COVID-19 is spread in hospitals and care homes. There is stark recent evidence on this from Public Health Scotland and if true for the rest of the UK, there needs to be better segregation of COVID-19 patients and staff within these settings.

7.     More funding and investigation of treatments for COVID-19, instead of only focusing on vaccination as a strategy. Given the high rates of hospital transmission, encourage a drive for more early treatment-at-home using some of the protocols discussed herein.

8.     Divert funds. The not inconsiderable money saved from ceasing testing programmes can be diverted to much needed areas, such as mental health, treatment research and an increase in hospital capacity and staffing. The vast debts accrued during 2020 will also need to be paid off, a fact that seems to be worryingly absent from economic recovery plans.

https://www.hartgroup.org/wp-content/uploads/2021/03/240321-Updated-HART-review.pdf

Our group of scientists, medics and public health experts have put together this rigorously and widely researched document. Topics included are:

• COVID policies and harm to children – Dr Ros Jones; Dr Zenobia Storah
• COVID-19 vaccination in children – major ethical concerns – Dr Ros Jones
• Vaccine passports – an ethical minefield – Dr Malcolm Kendrick
• Asymptomatic spread – who can really spread COVID-19? Dr John Lee
• Economic impacts – the true cost of lockdowns – Professor David Paton; Professor Marilyn James
• Mutant strains and the futility of border closures – Dr Gerry Quinn
• ‘Zero Covid’ – an impossible dream- Professor David Livermore
• Masks – do the benefits outweigh the harms? – Dr Gary Sidley; Dr Alan Mordue
• Psychological impact of the Government’s communication style and restrictive measures – Dr Damian Wilde
• Lockdowns – do they work? – Professor Marilyn James
• Mortality data & COVID-19 – Joel Smalley
• The ONS Infection Survey: a reevaluation of the data – Dr Clare Craig; Dr Paul Cuddon
• Promising treatment options – Dr Ros Jones; Dr Edmund Fordham
• Care homes – we must do better for the most vulnerable in society – Dr Ali Haggett
• Ethical considerations of the COVID-19 response – Professor David Seedhouse
• Vaccination certificates – impact on the high street – Professor Marilyn James
• Natural vs vaccine immunity: which is safer or more effective – Dr Gerry Quinn

 

 

Asymptomatic spread: who can really spread COVID-19?

https://www.hartgroup.org/asymptomatic-spread/

March 27, 2021

By Dr John Lee
retired Professor of Pathology

A respiratory virus needs associated symptoms in order to be clinically relevant.

One year ago, this belief would have been universally accepted by the wider medical community.

Download the briefing PDF

The Health Secretary, addressing the nation on television on 20 December 2020 stated that ‘If you act like you have the virus, then that will stop it from spreading to others.’ This messaging is clear in the many adverts and public health announcements currently circulating.

The response to COVID-19 has been predicated on the assumption that asymptomatic PCR positive individuals can spread disease. This assumption was simply accepted as fact and, thus far, has never been adequately demonstrated in the available scientific evidence.

This single assumption is driving most of the restrictions. It is being repeated on radio and other advertisements and is causing the populace great fear and distress. It cannot be left unscrutinised any longer. If there are flaws in PCR testing regimes that have perpetuated this idea, we must now bring them to light.

The proportion of people who test positive but have no symptoms ranges from 4%¹ to 76%.² This is, in large part, a function of how testing has been carried out. If ‘asymptomatic COVID-19’ was a type of presentation of a disease, like a cough, then you would expect it to occur in the same percentage of the patients no matter where or when you measured it. The large range here demonstrates that it is not measuring a phenomenon related to the disease itself.

These are the three situations where someone can be ‘PCR positive’ but asymptomatic:

1.     Pre-symptomatic – people who are in the incubation period of real disease and who go on shortly to develop symptomatic illness. For one to two days these people can transmit the virus to others and account for a maximum of 7% of spread.³

2.     False Positive test results – people who test positive but are not really infected, the rate of which is unknown, but is estimated to be between 0.8% and 4% of all tests carried out.⁴ The number increases as Ct cycles are increased. Anything above 25 Ct is now considered ‘uninfectious’. When carrying out hundreds of thousands of tests, and including results up to Ct 30 as is the case in the Government surveys, we are going to inevitably have an enormous amount of false positives. A respiratory virus needs associated symptoms in order to be clinically relevant. One year ago, this belief would have been universally accepted by the wider medical community.

3.     Immunity – people who have the virus ‘on board’ (detectable) but never develop symptoms. This category used to be referred to as “immunity” or “healthy people”. This occurs where, even if a virus is inhaled and present in the respiratory tract, the person is oblivious and remains completely well, as their immune system deals with the infection and they never develop symptoms. The evidence these individuals are a transmission risk is minimal.

Positive PCR is not evidence of infectiousness. Finding people who test positive but show no symptoms during an outbreak is often evidence of immunity, not evidence of transmission. Unfortunately, this has been largely overlooked in the current set of assumptions driving policy.

Evidence of transmission requires that an individual can be shown to be the source of infection for another person who then developed symptoms of a disease/illness.

Infectiousness or transmission of a virus requires active infection resulting in high levels of viral replication and shedding. Symptoms, such as coughing, are the real drivers of spread.

When the viral replication process is blocked by a healthy immune system, the virus is neutralised, preventing significant viral replication and shedding. This happens in approximately half the people exposed to the virus. Their immune system’s defences effectively ward off COVID-19 before it can take hold and cause symptomatic disease. It stops it dead in its tracks.

A review of all the published meta-analyses on asymptomatic transmission reveals that the same few studies have been recycled repeatedly by respectable institutions.⁵ On deeper inspection of the published studies we find that the evidence is of very poor quality. Robust evidence of asymptomatic spread is lacking and runs counter to all previous understanding of how respiratory viruses transmit.

The case studies cited as evidence of asymptomatic transmission amount to just 6 individuals who were alleged to have spread COVID-19 to 7 other people. The studies outlined below are the totality of the worldwide evidence for asymptomatic spread.

● Two of these case studies, originating from China, may well have been one patient,⁶ with the story repeated in separate publications.⁷ This was a situation where neither person involved in transmission had any symptoms. It therefore fails as evidence of disease spread, which requires the presence of symptoms.

● Two further cases of possible asymptomatic transmission were from Vo in Italy,⁸ where the whole town was tested. 1% of the tests were positive in the absence of symptoms. The Government’s own estimates for the percentage of tests that give a false positive result is between 0.8-4.0%⁹ and as this was a new test, a rate of 1% would have been very respectable. The alleged result of transmission was again claimed to cause ‘cases’ with no symptoms. These were likely false positive PCR test results, and assuming chains of transmission based on the degree of positivity of a test result is bad science.

● The final two examples were both from studies in Brunei.¹⁰ The evidence is weakened by a poor case definition (any symptom of any severity was considered real symptomatic COVID-19) and a high probability of false positive results. The first case was a father who remained asymptomatic but whose wife briefly had a runny nose and whose baby had a mild cough for one day. In the second case, a 13 yr old girl with no symptoms was alleged to have spread COVID-19 to a middle aged woman who had “a mild cough on one day”.¹¹

It is therefore arguable that the asymptomatic diagnoses last spring were all due to false positive test results. No testing system is perfect.

Failure to acknowledge this and misinterpretation of positive results in patients with no symptoms has been hugely damaging.

It would not be unreasonable to state that the current extreme interventions are entirely based on the assumption of asymptomatic spread of disease, because otherwise simply requiring the symptomatic and their contacts to isolate would be sufficient.

Given that asymptomatic spread assumptions drive all of the other non-clinical interventions (mass-testing of healthy people, mandatory wearing of masks, social distancing and lockdowns), the evidence here must urgently be re-evaluated by policymakers.

Endnotes

1.     Follow-up of asymptomatic patients with SARS-CoV-2 infection

2.     Three Quarters of People with SARS-CoV-2 Infection are Asymptomatic: Analysis of English Household
Survey Data

3.     Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23–March 16, 2020

4.     Impact of false-positives and false-negative s in the UK’s COVID-19 RT-PCR testing programme

5.     Covid: The woeful case for asymptomatic transmission

6.     Secondary Transmission of Coronavirus Disease from Presymptomatic Persons, China

7.     Modes of contact and risk of transmission in COVID-19 among close contacts

8.     Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo

9.     Impact of false-positives and false-negative s in the UK’s COVID-19 RT-PCR testing programme

10. Analysis of SARS-CoV-2 Transmission in Different Settings, Brunei

11. Asymptomatic transmission of SARS-CoV-2 and implications for mass gatherings

 

 

Masks – do benefits outweigh the harms?

https://www.hartgroup.org/masks/

March 28, 2021

By Dr Gary Sidley
Retired Clinical Psychologist

and Dr Alan Mordue
Retired Consultant in Public Health Medicine & Epidemiologist

Whilst masks are a successful psychological tool to remind the public to remain alert, they are not effective in preventing the community spread of disease.

Download the briefing PDF

In the summer of 2020, mandates were introduced to compel healthy people to wear masks in the community, purportedly to reduce the spread of COVID-19. Prior to this time, the World Health Organisation (WHO) and UK politicians alike did not support face coverings for the healthy but U-turned, apparently in response to political lobbying.¹

In the early stages of the novel coronavirus in the United Kingdom, public health advice remained that masks for the general public were of little benefit, and could even be harmful.² There is emerging evidence that cloth masks can amplify the spread of COVID-19 particles by acting as a ‘microniser’, transforming large droplets, which would ordinarily fall swiftly to the ground close to the person, into smaller, truly airborne & respirable droplets.³

As has been established in the preceding article on asymptomatic spread, for a person to be ‘clinically relevant’ in public health terms, they must have symptoms. The mandating of mask-wearing for the majority of the population who are perfectly healthy is not an effective public health measure to contain the spread of COVID-19. Prior to 2020 this was not a controversial position. Whilst masks have undoubtedly been a successful psychological tool to remind the public to remain alert, they have not achieved their primary objective, that is, to act as a safe and effective measure to curb the spread of disease.

Masks don’t reduce community transmission
Contrary to the Government message that it ‘follows the science’, the sudden change in advice by the WHO was not based on any new, high-quality scientific studies. By summer 2020, there was substantial evidence that non-medical masks for the general public did not reduce the transmission of respiratory viruses. A review of 14 controlled studies had concluded that masks did not significantly lessen the spread of seasonal ‘flu in the community.⁴ A Norwegian Institute for Public Health review found that non-medical masks achieve no benefit for healthy individuals, particularly when viral prevalence is low.⁵ From a common sense angle, scientists had argued that cloth masks contain perforations that are far too big to act as a viral barrier and therefore ‘offer zero protection against COVID-19’.⁶

Inevitably, the public often wear masks incorrectly, or improperly handle them when putting them on, or removing them, constituting an additional infection hazard. There has been recognition of this contamination risk in the scientific literature⁷ and other researchers have cautioned against the use of cloth face coverings.⁸ Potential harms to the wearer include exhaustion, headaches, fatigue and dehydration.⁹ Some doctors have suggested an increased risk of pneumonia.¹⁰ Furthermore, the widely varying physical characteristics of the face coverings used by people in the community, that are not standardised for material, fit, length of wearing, changes after washing and drying, and disposal, means that laboratory research on mask efficacy cannot be generalised to real-world situations.

With particular reference to COVID-19, the only large randomised controlled trial exploring the benefits of adopting face coverings in the community found that masks (even the surgical variety) did not result in a significant reduction in infection risk for the wearer.¹¹ A detailed analysis¹² of all research investigations, including those purported to suggest that masks might achieve some benefits, led to the view that there is ‘little to no evidence’ that cloth masks in the general population are effective.

Masks cause psychological harm
Masks impair verbal communication, render lip-reading impossible for the deaf, and stymie emotional expression, the latter effect potentially constituting a gross impediment to children’s social development. Acting as a crude, highly visible reminder that danger is all around, face coverings are fuelling widespread, irrational fear.

Wearing a mask will heighten the distress of many people with existing mental health problems and may trigger ‘flashbacks’ for those historically traumatised by physical and/or sexual abuse. Sadly, going without a mask (even as a means of avoiding psychological distress) can often attract harassment and further victimisation. In response to this, ‘exemption lanyards’ have been developed, which further stigmatise those who cannot wear face coverings due to health conditions or previous trauma.

Mandates in schools
Beginning March 8, 2021, secondary-school pupils are now required to wear masks in indoor areas for the entire day. In addition to the lack of demonstrable benefits as described above, it is most concerning that no comprehensive risk assessment of potential harms has been carried out before making these demands. Prior to imposing this requirement for masks, a full assessment should have been conducted, incorporating the following areas:

● Assessment of oxygen levels in mask wearer at the beginning and end of the day¹³
● Assessment of impairments to concentration and ability to learn¹⁴
● Assessment of impairment to children with hearing difficulties and special educational needs^15,16,17,18
● Assessment of impairment to psychological wellbeing¹⁹
● Assessment of possible damages from inhalation of micro-fibres²⁰
● Assessment of potential harms of repeated use of dirty cloth masks^21,22
● Assessment of impairment to non-verbal communication²³

Many of the potential harms may only become apparent in the long-term, thereby casting yet more doubt on the assumption that, for children, the benefits outweigh the risks. What is even more puzzling is that the masking requirement has been introduced at the time of year when there is almost no circulating COVID-19 in the community due to its seasonality. There is no justification for this move from the Department for Education. It should be rapidly retracted for the safety and well-being of all children.

Conclusion
Wearing a mask is not a benign intervention. Making masks mandatory would only be justified if science had shown they achieved a marked reduction in viral transmission. The evidence is simply not there. On the contrary, it is clear that face coverings for healthy people do more harm than good. Additionally, evidence demonstrating that asymptomatic, healthy members of society are unlikely to spread the virus strengthens the conclusion that mask mandates are unnecessary.

Endnotes

1. Daily Mail, Tuesday 14 July, 2020: Fines for not wearing masks
2. Face masks could increase risk of getting coronavirus, medical chief warns
3. Low-cost measurement of face mask efficacy for filtering expelled droplets during speech
4. Non pharmaceutical Measures for Pandemic Influenza in Non healthcare Settings—Personal Protective and Environmental Measures
5. Should individuals in the community without respiratory symptoms wear face masks to reduce the spread of COVID-19?
6. Cloth face masks offer zero shield against virus, a study shows
7. Advice on the use of masks1 in the community setting in Influenza A (H1N1) outbreaks
8. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers
9. Physical interventions to interrupt or reduce the spread of respiratory viruses. Part 1 – Face masks, eye protection and person distancing: systematic review and meta-analysis
10. Medical Doctor Warns that “Bacterial Pneumonias Are on the Rise” from Mask Wearing
11. Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers: A Randomized Controlled Trial
12. Are Face Masks Effective? The Evidence
13. Preliminary report on surgical mask induced deoxygenation during major surgery
14. Corona children studies “Co-Ki”: First results of a Germany-wide registry on mouth and nose covering (mask) in children
15. The challenges of facemasks for people with hearing loss
16. Lip Reading, Facial Expressions: How Masks Make Life Harder for People with Hearing Difficulties
17. Face masks and communication – coronavirus info for families of deaf children
18. The Challenges of Face Masks: Organisation of Autism Research
19. Corona children studies “Co-Ki”: First results of a Germany-wide registry on mouth and nose covering (mask) in children
20. Need for Assessing the Inhalation of Micro(nano)plastic Debris Shed from Masks, Respirators, and Home-Made Face Coverings During the COVID-19 Pandemic
21. Can You Get a Sore Throat From Wearing a Dirty Mask?
22. Face mask hygiene: how dirty is yours?
23. Masked education? The benefits and burdens of wearing face masks in schools during the current Corona pandemic