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Myths and MisinformationUndermine the NHS
NHS consultant David Oliver punctures the dangerous fallacies surrounding the Coronavirus pandemic
I have been an NHS acute hospital doctor for 31 years, but I’ve never seen any event pose so many complex challenges to our services and at such speed as the COVID-19 pandemic. And nor have I seen so many armchair experts, keyboard warriors and conspiracy theorists.
These amateur authorities aren’t helping; quite the opposite. They are often wildly wrong yet still confident in their insights, ascertained through their chosen opinion leaders and groupthink.
There are very legitimate debates to be had about our national approach to the pandemic, from lockdown policy to border controls, test track and trace systems, and the big debate over the trade-off between the economy and the protection of life.
But we should have these debates accepting the one core truth that the pandemic is real and should be taken seriously.
The View From the Hospital Floor
Those of us who worked on the frontline during the first wave in March, April and May haven’t forgotten the traumas. Behind each of the 42,000 deaths was a person; a prolonged and distressing final illness or a rapid and unexpected demise, with families often unable to be with them at the end.
Many more were sick enough to be hospitalised or died in their care homes. Our colleagues were not exempt, with over 600 frontline health and care workers dying and many more becoming infected and ill at work. Severe shortages of personal protective equipment (PPE) and testing for staff compounded the strain, as did social distancing from our own families.
Intensive care bed capacity (lower, pre-pandemic than any other high income nation) doubled and trebled at remarkable speed, with staff co-opted from other clinical areas. Additional capacity was created in community health and social care services to help patients leave hospital sooner. Swathes of planned and outpatient care had to be put on hold and staff spent long, arduous shifts in hot, restrictive gear which impaired communication.
The health service entered the pandemic with serious structural problems, not least major workforce gaps across the sector, growing demand, serious resource and capacity issues in social and primary care, and one of the lowest number of hospital beds, per capita, among OECD nations.
In those painful early few months of the pandemic, the international medical and scientific community has learnt far more about the symptoms of the virus and the best approaches to investigation, treatment and aftercare. Despite well-documented problems, we do have better access to testing and PPE and better policies around transfer of patients to care homes – which have received a further short-term funding uplift.
Those of us doing the job can barely influence high-level political decisions made in Whitehall, and the boardrooms of arm’s length bodies. Decision-makers have made many missteps, and they have been economical with the truth, but all legitimate critiques start from the premise that COVID-19 does exist and does make people sick enough to die.
Arguing with people who believe the whole pandemic is a conspiracy – a manufactured or exaggerated hoax – is an unviable task. The problem is, though, that these fallacies are now spread so widely that many casual observers believe them.
I’ll pick five of many recurring myths to illustrate.
Some Myths to Slay
“Hospitals are literally half empty”
This has been stated recently both by the Telegraph’s Allison Pearson and seemingly soon-to-be chairman of the BBC Charles Moore, among many others.
NHS England produces quarterly summaries of hospital activity which indeed do show that for the months April to June, overnight bed occupancy in acute hospitals averaged 68% as opposed to the 90%+ reported before the pandemic. The Health Service Journal in May reported that there were “four times as many vacant beds as usual” in NHS general hospitals. On 8 October, we will see the statistics for the second quarter of 2020; occupancy will undoubtedly be rising but not yet over 90%. The figures I have seen suggest we are already back at around 80%.
Meanwhile, Accident and Emergency attendances at major consultant-led units are trending back up as they do every Autumn but are still down by about 12% on this time last year.
Let’s think about this though. In many hospitals there will sometimes be whole bays or wards closed to new admissions or even discharges because of proven or suspected COVID-19 cases, and physical distancing through the use of fewer beds may be needed for infection control and the separation of non-infected patients, including those coming in for planned operations.
Intensive Care Units must also factor in the rising demand imposed by COVID-19, limiting capacity for major planned surgery, as well as resources.
England has a very low per-capital hospital bed base compared to most developed nations – for instance Germany and France have four and three times many beds respectively.
Of course, some work had to be reorganised, cancelled or moved to other settings in the first wave and we are still playing catch up. There are very legitimate concerns about care for non-COVID patients, including those with proven or possible cancer, or others awaiting surgery. But dispensing with care for Coronavirus patients won’t fix a thing.
“COVID-19 data is being fiddled to exaggerate the number of real deaths”
Yes, this one has done the rounds for some time. It is true that the Office for National Statistics (ONS), the now deceased Government press briefings and Public Health England (PHE) have all counted and reported aggregate death data slightly differently and at one point changed definitions. Only the ONS is truly independent of political influence.
However, deliberately falsifying death certificates would be a serious breach of professional codes and potentially a criminal offence. Why would doctors risk censure in order to help the Government mask or exaggerate deaths? Nor are we paid to write death certificates.
We have to record the causes of death to “the best of your knowledge and belief”. So for instance, if we strongly suspect lung cancer based on X-rays and clinical picture yet there was no biopsy, we can still write “Bronchial Carcinoma” on the certificate.
Certificates for deaths in hospital are checked by medical examiners and sometimes discussed with coroners. It is legitimate to write “COVID-19” as one of the causes of death if the clinical picture makes this likely – even without a positive test.
If data manipulation has indeed taken place, it was when the Government decided to only present data on hospital deaths for those who had tested positive.
Nonetheless, the data from the ONS on excess (non-COVID-19) mortality and deaths in all settings including care homes is all in the public domain.
There is no mass conspiracy to falsify certification.
“COVID-19 is no more dangerous than seasonal flu”
The reason why COVID-19 is written on death certificates by doctors who were attending to the patient during their final illness is because it kills people.
Yes, you are far more likely to die from the virus with each decade of life beyond 50 and especially so if you are frail, or have underlying long-term health conditions. However, COVID-19 is not a benign disease for the rest of those who catch it.
Many are sick enough to be admitted to hospital with a range of other symptoms, not just severe breathlessness, cough and a high fever. A number of distinct symptom clusters have been identified. Even fitter, younger people have experienced weeks or months of debilitating symptoms, now being described as “long-COVID”.
And, ultimately, studies suggest that the Infection Fatality Rate for COVID-19 is 50 to 100 times higher than for seasonal flu.
Yes, right now, COVID-19 is well down the list of causes of death certified in the UK in September 2020 and, yes, young and middle-aged people with no pre-existing conditions are very unlikely to die from it. And if we look at “excess mortality” compared to the same months in 2020 for the previous 5 years many of the excess deaths were not due to Covid-19. That does not make it trivial. The flu did not kill or hospitalise thousands of frontline clinical staff across Europe just a few months ago. And of course, there are flu vaccines available
COVID-19 tests are so unreliable that the reported numbers are grossly exaggerated
This one was doing the rounds on social and mainstream media in September, repeated by the likes of Julia Hartley-Brewer on talkRADIO and Beverly Turner on Jeremy Vine’s TV show.
A ‘false-positive’ refers to a test that says you do have a condition when in fact you do not. According to Hartley-Brewer, 91% of COVID-19 cases were in fact false positives. Lockdown sceptic Toby Young amplified this, saying the Government was hiding the scale of the problem for “nefarious reasons”. I haven’t seen a retraction or apology yet.
In reality, the false-positive rate cited by Health and Social Care Secretary Matt Hancock had been 0.8%. Oxford Professor for public understanding of risk, David Spiegelhalter, told the media that the true figure was likely far lower, at around 0.05%.
Meanwhile false-negatives, where people who are infected test negative, are a much bigger issue, with one recent review identifying rates between 2% and 33%. Tests may be negative early in infection and then positive when tested a few days later, likely due to poor operator technique and the limitations of self-administered tests.
The consequences of false-positives when they occur are important (unnecessary self or group isolation, time off work) but false-negatives risk cross infection, outbreaks and death.
In August, a New England Journal of Medicine review suggested that the sensitivity of COVID-19 tests (including worse performing ones) was at least 70% and specificity 95%. So although the test will fail correctly diagnose or exclude Covid-19 in a proportion of people, grand statements about inaccuracies are misleading and unhelpful.
GP surgeries are closed for business and GPs are work shy
Before the pandemic, GP surgeries already faced considerable challenges. There are 600 fewer full-time equivalent GPs this year than last, while general practice has experienced a major increase in its workload over the past decade.
Any rational person should realise that, during a pandemic, we should not be encouraging large numbers of patients – many older or with medical conditions – to congregate in GP waiting rooms.
Naturally, GPs moved quickly to shift most of their consulting online or via telephone, though still retaining some face-to-face appointments and home visits. In many areas, they also set up “hot hubs” dedicated to seeing patients with confirmed or suspected COVID-19.
NHS Digital figures suggest GPs are running at around 80% the volume of daily patient contacts, compared to the same time last year. GPs are clear that they wish to transition back to face-to-face consultations. NHS Digital reported 20.1 million GP appointments in August alone, with 50% on the same day.
I don’t seek to minimise real concerns from patients who feel excluded and frustrated by reduced access to their GP, or others such as care home staff who have complained about reduced visits and call outs. But there will be trade-offs during a pandemic. Infection control and patient protection must come first.
What We Should Be Talking About
I have done my best to debunk some of the more pernicious and widespread myths circulating about COVID-19. I could have picked several more, and they share common roots: a distrust of government and its agencies; a mistrust of experts, experience and expertise; overconfidence and an over-reliance on information sources, used out of context, that confirm pre-existing biases; a perfectly valid view yet that restrictions and lockdowns may have gone too far, putting the economy, jobs and people with non-COVID conditions at risk.
In some cases, the sceptics stretch into the realms of conspiracy theories about hidden deep-state agendas, attempts to control the population, or steal data.
In reality, the expert scientific consensus among those with backgrounds in infectious diseases, outbreak medicine, public health or virology is nowhere near as fractured or polarised as sometimes portrayed.
There may be differences about how best to tackle the pandemic, or which countries have dealt with it best. But not about whether the Coronavirus is real, whether it makes people ill, kills them or puts health services under significant strain.
Let’s get serious about the mission, not the myths.
David Oliver is an NHS consultant working in geriatrics and acute internal medicine and a former national clinical director for older people, President of the British Geriatrics Society, Vice President of the Royal College of Physicians, and a visiting fellow at the King’s Fund. He writes a weekly column in the British Medical Journal.