The BMJ interview: Chris Whitty, England’s chief medical officer, on covid-19

Dear Editor,

I am disappointed that the opportunity was not taken to ask Whitty about the PCR test. He knows as everyone knows that it cannot be specific for covid-19 even under the most optimal of circumstances. He needs to provide the public with some clarity on this issue. We are implementing too many divisive and detrimental policy steps based upon myriad false positives.

Dear Editor,

Dr. Chris Whitty gave questionable arguments for why he rejects the Great Barrington Declaration.[1] And, unfortunately, this is not the first time these arguments are raised in the media against focusing protection on the groups vulnerable to COVID-19. So, I would like to take a moment and answer a few arguments and not all to fit the response space.

Dr. Whitty says that this approach is wrong because natural herd immunity is not how you control epidemics. And I agree, it is not how you control an epidemic, but it is how you control a highly infectious pandemic. I think that everybody including Dr. Whitty agrees that we are dealing with a pandemic with a high infection rate not seen on Earth since the Spanish Flu of 1918. So, when Dr. Whitty says that, for the great majority of the infections he has dealt with, we never got herd immunity, this raises the question: is SARS-Cov-2 infection like any infection he has dealt with before? If so, why did we need to lockdown planet Earth for this virus and not any other virus we faced before?

In order for a virus to stay in circulation, it needs new people to infect. That's why viruses like Ebola can stay in circulation, because the infection rate is not high enough to infect all people in a short period of time. This means that by the time the virus finishes infecting the whole original population, there will be new generations who are not immune to the virus and are ready for the virus to infect. We fight this kind of virus with annual mass vaccination specially for new generations to starve the virus of hosts to infect. Same applies for non-viral infections like Malaria.

If the virus though can infect people as fast as we vaccinate or even faster, then the same effect will be reached through natural infection assuming that infections result in immunity. Of course for viruses like HIV where infection doesn't result in immunity, herd immunity is not achievable because individual immunity is not achievable. But if this was the case for SARS-Cov-2, then talking about a vaccine as an option is off the table. So, does Dr. Whitty see SARS-Cov-2 as a similar virus to HIV in terms of gaining immunity as a result of infection?

Now, saying that highly infectious pandemics can't end with natural herd immunity is denying the fact that the Spanish Flu strain of Influenza ended with natural herd immunity and had to concede to other strains that are less deadly.[2] So if the only event of a highly infectious pandemic in the recent medical history ended with natural herd immunity, not with a vaccine, then the focused protection approach of the Great Barrington Declaration is the only approach that has the scientific foundation that all other approaches lack. Dr. Whitty's expectation that we will get medical countermeasures and his absolute belief that science will get us out of this hole that some public health experts dug us in is not scientific in its nature and qualifies as hopes or wishful thinking specially if we lose 40,000 people globally every week to COVID-19 waiting for these hopes to come true.[4]

For example, I will be pretty interested to read a peer reviewed study that can show that we can find a vaccine to any virus whenever we want, to show that such a vaccine is safe for all populations, or to show that we can end a highly infectious pandemic with a 50% effective vaccine before it runs its course. It is almost a year into the pandemic, and most of the questions about the vaccine are still unanswered.[3] On the other hand, there are many peer-reviewed studies that show that the pandemic can end with herd immunity [5][6][7][8][9] while I couldn't find a single study that shows that herd immunity can't end this pandemic despite some public health experts saying so.

The question of maintaining immunity as a result of natural infection with SARS-Cov-2 which Dr. Whitty says that it is still unclear. While we don't have any randomized controlled trials that tested reinfections of COVID-19, we have many surrogates of protection that show that the existence of antibodies is correlated with protection from reinfections. Studies of SARS-Cov and MERS-Cov in humans in addition to studies of SARS-Cov-2 show that antibodies provide protection from reinfection.[10]

When testing the neutralization capability of the antibodies on the spike protein of SARS-Cov-2 (the main target of neutralizing antibodies), it was shown that more than 90% of those who were infected before with SARS-Cov-2 neutralized the spike protein.[10] Another issue will rise if the existence of antibodies is not correlated with protection, which is that pursuing vaccines as a way to end the pandemic will be pointless as the main goal of a vaccine is to trigger an immune response which will generate antibodies that can prevent reinfections.

References:

[1] Great Barrington Declaration https://gbdeclaration.org/
[2] Waiting for the Flu: Cognitive Inertia and the Spanish Influenza Pandemic of 1918–19 https://academic.oup.com/jhmas/article/70/2/195/776261
[3] Understanding COVID-19 vaccine efficacy https://science.sciencemag.org/content/early/2020/10/21/science.abe5938
[4] Weekly epidemiological update - 3 November 2020 https://www.who.int/publications/m/item/weekly-epidemiological-update---...
[5] A mathematical model reveals the influence of population heterogeneity on herd immunity to SARS-CoV-2 https://science.sciencemag.org/content/369/6505/846
[6] COVID-19 zugzwang: Potential public health moves towards population (herd) immunity https://www.sciencedirect.com/science/article/pii/S2666535220300306
[7] COVID19 – Why open and honest public dialogue is needed https://www.sciencedirect.com/science/article/pii/S0033350620304157
[8] Rapid Epidemiological Analysis of Comorbidities and Treatments as risk factors for COVID-19 in Scotland (REACT-SCOT): A population-based case-control study https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1...
[9] Modelling a pandemic with asymptomatic patients, impact of lockdown and herd immunity, with applications to SARS-CoV-2 https://www.sciencedirect.com/science/article/pii/S1367578820300699
[10] Robust neutralizing antibodies to SARS-CoV-2 infection persist for months https://science.sciencemag.org/content/early/2020/10/27/science.abd7728

Dear Editor,

Prof Whitty is quoted as saying , “No one [in government] has ever said to me, ‘Gosh, you went a bit far there’ or ‘I want you to say this, and if you don’t there’s going to be trouble.’ They’ve always accepted that this role is an independent role, and it ceases to have use if people like me are having to cut our jibs just to suit the situation. It would no longer be helpful to the government. That’s the way it works, that’s the way it has always worked, and the way in my view it always should work”[1].

The above gives the impression that Prof Whitty is working with a group of politicians who subscribe to an extremely high, almost perfect moral, ethical and political standards and that they are entirely capable of completely divorcing themselves of both conscious & subconscious biases that could affect their decision making in relation to this pandemic. Particularly the following words, "No one [in government] has ever", "They’ve always accepted" and "that’s the way it has always worked" gave me the aforesaid impression.

While Prof Whitty’s role is “statutorily independent”, it is a fact that he has no choice as to the type of politicians he is compelled to work with; of course, the public-confidence in the government and where the politicians stand compared to doctors are well known facts which do not require elaborating here. Hence, it is understandable if the fair-minded public perceives him as an inherent part of the government machinery, and thus may well not be reassured as to his claimed level of statutory independence. I would add, it is extremely hard to put up ‘Chinese Walls’ to delineate the true level of ‘independence’ of a doctor when very closely working with a group of politically motivated people.

In relation to the question regarding Dominic Cummings saga, “I did think it was a party political issue at that point in time”[1], I don’t agree with Prof Whitty at all. Clearly, Cummings was not a patient, so there was no issue as to confidentiality. I believe, as a “statutorily independent” civil servant, Prof Whitty at least had a moral and ethical duty to respond to a question about an alleged violation of the pandemic-rules by a public figure who worked so closely with the Prime Minister. Prof Whitty’s apparent attempt to detach himself from this issue, could have to some extent, eroded the public confidence in his role as a “statutorily independent” doctor.

A question that does not seem to have been asked is ‘Why did Britain fail to act?” [2] by introducing a lockdown earlier at the time of the first-phase. I unashamedly re-quote a comment from The Lancet editor in this regard below [2]:

“Something has gone badly wrong in the way the UK has handled Covid-19. I know Chris Whitty, the chief medical officer, and Patrick Vallance. I have the utmost respect for both. They have had the services of some of the most talented researchers in the world to draw on. But somehow there was a collective failure among politicians and perhaps even government experts to recognise the signals that Chinese and Italian scientists were sending. We had the opportunity and the time to learn from the experience of other countries. For reasons that are not entirely clear, the UK missed those signals. We missed those opportunities.”

References
[1] https://www.bmj.com/content/371/bmj.m4235
[2]https://www.theguardian.com/commentisfree/2020/mar/18/coronavirus-uk-exp...