Covid-19: Lockdowns and masks helped reduce transmission, expert group finds
BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1959 (Published 24 August 2023) Cite this as: BMJ 2023;382:p1959
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Dear Editor,
I fail to understand how there can be any success in a global pandemic in which literally everyone caught the virus despite precautions and vaccination. I would argue that lockdowns not only had detrimental mental health effects, but also prolonged the pandemic. We now have an endemic virus and are reaping the long term educational and economic harmful results of lockdowns across the world. Hardly successful or beneficial.
Competing interests: No competing interests
Dear Editor
The efforts to understand NPIs are compromised by subjective wishes to better communicate the goals of the intervention. Not unlike the age old problems of hoping our patients will change behavior and follow medical advice. No amount of research can change that. The political climate that arose during this time is the inherent factor immune to the hope of NPI effectiveness.
NPI efforts should be recommended not mandated as medication and advice is recommended not mandated.
Those who are in charge desperately want otherwise, but that’s emotional not scientific. Stay in your lane.
Competing interests: No competing interests
Dear Editor
The headline of this News item is not supported by the the most recent update on the effectiveness of physical barriers to respiratory viruses (1).
Carl Heneghan, Professor of Evidence Based Medicine at Oxford, has suggested that “The Royal Society review shows that some academics are losing their ability to think critically. Instead of retrofitting evidence to preconceived conclusions, it would be much better to report the uncertainties and set out those questions that need addressing. Refusal to acknowledge uncertainties does a disservice to society and undermines public trust in research. “ (2)
(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9885521/
(2) Heneghan C, Jefferson T. The lost lessons of the covid pandemic. How political imperatives sidetrack scientific enquiry. Trust the Evidence 25 August 2023.
Competing interests: No competing interests
Dear Editor
The statistics for the number of SARS-CoV-2 Alpha variant cases as of June 20, 2022, Delta variant cases as of June 20, 2022, and Omicron variant cases as of June 20, 2022, in the UK, USA, and France, respectively, were obtained from STATISTA.
That source did not specify whether or not those numbers were the cumulative totals up to June 20, 2022.
On the face of it, it would appear that those numbers are the cumulative totals up to June 20, 2022.
Competing interests: No competing interests
Dear Editor
In the context of the evaluation of the interaction between masks, lockdowns, test and trace, and transmission, one of the great mysteries of the covid pandemic is this:-
Why is it that, in comparison with other countries where masks, lockdowns, test and trace, and transmission interacted to a comparable extent, was the UK the only country to experience the highest prevalence of all three of the major variants, namely, alpha, delta, and omicron?
On the 20th June 2022, there were 276,337 cases of the alpha variant in the UK, compared with 249,812 cases in the USA, and 35,745 in France.[1] All this notwithstanding the fact that the USA has a much larger population than the UK, and France has a comparable population size, namely, approximately 68 million.
On the 20th June 2022 there were 1,159,560 cases of the Delta variant in the UK. That was second only to the USA, where there were 1, 492, 059 cases. In France there were 141,470 cases[2].
On the 20th June 2022 there were 1,197, 546 cases of the Omicron variant in the UK, well ahead of 1,190,748 cases in the USA. In France there were 137,123 cases[3].
Of the 3 highly developed countries, namely, the USA, the UK, and France, all three with comparable first world test and trace systems, only the UK departed from the recommended 3-4 weeks interval between the first and second doses of the state of the art covid vaccines. Initially, just before the alpha variant became firmly established, the interval between the first and the second dose was 12 weeks. Subsequently, throughout the delta wave and the omicron wave the interval between the first and the second dose was 8 weeks. In the Delta wave and Omicron wave eras, the knock on effect was a delay of 4 weeks before attainment of the eligibility for a booster dose.
The prolongation of the interval between the first and the second doses was not without controversy:-
On the one hand, the "UK vaccine adviser [said] delay of Covid second dose will save lives"[4]
On the other hand, doomsayers declared that "Britain takes a gamble with Covid-19 vaccines upping the stakes for the rest of us"[5].
In the event, excess all-cause mortality (June 2021-March 2022) was higher in the USA than in the UK, whereas, excess all-cause mortality was higher in the UK than in France[6].
Now that we might be on the brisk of another wave of variant-related surge in covid infection we need to interrogate the available data in order to ascertain whether or not a departure from dosing strategies based on robust clinical trials is a risk worth taking.
I have no conflict of interest.
References
[1] STATISTA. Number of SARS-CoV-2 Alpha varint cases worldwide as of June 20, 2022 by country.
[2] STATISTA. Number of SARS-CoV-2 Delta variant cases worldwide as of June 20, 2022 by country.
[3] STATISTA. Number of SARS-Cov-2 Omicron variant cases worldwide as of June 20, 2022.
[4] Elgot J. UK vaccine adviser says delay of Covid second dose will save lives. The Guardian 24th January 2021
[5] Branswell H. Britain takes a gamble with Covid-19 vaccines, upping the stakes for the rest of us. StAT News 2021 Jan 4.
[6] Bilinski A., Thompson K., Emanuel E. COVID-=19 and excess all-cause mortality in the US and 20 comparison countries, June 2021-March 2022. JAMA N January 3, 2023. January 3, 2023, Volime 329, Number 1, 92-94.
Competing interests: No competing interests
Dear Editor,
The findings of the group need to be carefully analysed as long as the threat of viruses and their emerging variants are on the health scene.
Lockdowns in particular received enormous criticism viewed from the disruptions caused - mobility, sheer livelihood issues and economic hardship - to most sections of society. Schooling issues were parental concerns as the duration of lockdown was extended. 'Liberty' indeed so precious being curbed and social behaviour controlled and infringed upon was the centrepoint of discussion and debate with time aplenty.
Masks turned into a highly controversial measure, with skeptics having a long list of difficulties in compliance. With no mask, no entry' boards, grudgingly adherence scaled up.
The duration of measures and being intermittent with 'surges' occurring were the reasons for distrust, opposition, and protests. Clear conclusions of utility of the 'restrictive' measures is vital for posterity and future threats, backed as they are by systematic study covering most aspects. 'Vagueness' reduced and 'demystification' done are the salient conclusions of this study, to be appreciated.
Prof Murar E Yeolekar, Mumbai.
Competing interests: No competing interests
Building orthodoxy on NPIs
Dear Editor,
With the full heft of the Science Media Centre gathered behind it, this Royal Society Expert report (1) is clearly expected to take on canonical status.
However you don't necessarily need to think that,
"....in comparison with the ‘gold standard’ of RCTs..... these reviews could be open to an interpretation that ‘we have learnt very little about the effectiveness of NPIs and that what we do know is unreliable" (p 63)
to wonder whether the conclusion that,
"evidence about the effectiveness of NPIs applied to reduce the transmission of SARS-CoV-2 shows unequivocally that, when implemented in packages that combine a number of NPIs with complementary effects, these can provide powerful, effective and prolonged reductions in viral transmission."(p 65)
or that,
"There is clear evidence from studies conducted during the pandemic that the stringent implementation of packages of NPIs was effective in some countries in reducing the transmission of COVID-19"
is to greatly overstate the case.
Yes, these measures can be got to work in some measure but "powerfully" and at what wider social cost? Ultimately judgement as to success or failure has to be based on the overall impact on the health of the population over the duration of the whole pandemic. As the report shows for its case studies of New Zealand, South Korea and Hong Kong, even the "some countries" referred to, above, experienced huge surges in cases, once measures were lifted. Were it not for the rapid development of particularly vaccines, something that commentators as diverse and well informed as Bill Gates and Patrick Vallance were not anticipating as late as July 2020, these "some countries" would have seen little benefit.
Without questioning, in any way, its combined brainpower, it is reasonable to ask about how much day to day experience in the management of infectious diseases, be that at the bedside, in the laboratory or in the community, the Expert Group actually has. Like many experts that populated our screens during the pandemic they are drawn from a variety of scientific disciplines. Further, what exactly is the reader to make of the role of "the then UK Government Chief Scientific Adviser, Sir Patrick Vallance, in helping the Society to refine the concept of this report and ensuring it has value for future science advisers and decision makers"(p 2)? Would Patrick Vallance have really conceived that measures for which he was an active protagonist were no use? Given this, he could hardly be criticised if he thought that the most useful thing for future science advisors and decision makers was a compendium of evidence that this stuff had worked and if this influenced the direction of the report. And a last curious point; Sir Mark Walport, Sir Patrick Vallance's predecessor, chaired the Expert Group from July 2023, just before the report's release. I looked in vain to see who had chaired the group previously, where they had gone and why.
Canonical authority is never a good basis for public policy. The BMJ 's readership would have been better served by a more questioning account of this Royal Society report.
Reference
1. Royal Society. Covid-19: examining the effectiveness of non-pharmaceutical interventions. Aug 2023. https://royalsociety.org/topics-policy/projects/impact-non-pharmaceutica...
Competing interests: Crematorium Medical Referee, Cardiff Council; remunerated on a fee for service basis. Member, Health Advisory and Recovery Team (HART)