Two Ministers and a Virus

A brief personal history of COVID-19 and some practical advice on how people can protect themselves from future rounds of infection.

A friend recently sent me a screenshot of a message from Owen Paterson, the former Secretary of State for the Environment, and asked, “Remember this?”

The message was from February 2020 and in it Owen said he had discussed my paper with Matt Hancock, the Secretary of State for Health and Social Care, and impressed upon the minister the importance of what I was saying. I’d been asked to give Hancock an outsider’s perspective on the imminent coronavirus pandemic and I had raised three concerns the government needed to consider as the pandemic unfolded.

The first was reinfection – prior experience of coronaviruses suggested we would not be able to build long-term immunity to infection and that the government was wrong to rely on herd immunity, the approach outlined in the 2011 Pandemic Preparedness Strategy.

Herd or community immunity is used to define a state in which the majority of a population are protected from infection by prior vaccination or infection. This means the minority of the population who cannot achieve vaccine- or infection-induced immunity, predominantly the immunocompromised and infants, are protected because the relevant pathogen then has a more limited number of hosts to infect in the general population. In this scenario, the exposure risk for the unprotected members of the population is greatly reduced. There are real public health and clinical consequences of a failure to achieve herd immunity, particularly for vulnerable populations, which is why there are still millions of people shielding around the world – almost four years on from the emergence of this virus.

The second concern flagged in my paper was long-term health impacts of infection. Researchers in the field believe coronaviruses are responsible for neurological and other sequelae, and it was already known that many survivors of the SARS pandemic of 2002-2003 suffered a range of chronic health issues.

My third concern was viral persistence – coronavirus researchers have long believed that this type of virus is somehow capable of persisting in the human body in a low-replication state. This paper by Dr Marc Desforges et al sets out some of the hypotheses and evidence. This is one of a number of studies that have since established viral, protein or RNA persistence as a phenomenon of at least some SARS-CoV-2 infections. The long-term health implications of this are currently unknown.

I later co-authored this paper with Dr Desforges, Dr Deepti Gurdasani, and Dr Anthony Leonardi, and we set out the things we might expect to see in the medium- and long-term if SARS-CoV-2 became established in the human population. We started work on it in summer 2020 and it was eventually published in 2021. It’s interesting to see how many of the risks we anticipated have come to pass.

Hancock was supposed to phone me to discuss my concerns on Saturday 29 February 2020, but never did, and I was eventually told the government didn’t agree with my assessment and believed herd immunity could be achieved and that infection would clear after a short illness in most people. I knew then that Britain and, by inference, most of the world would not have an effective response to the new virus. It’s interesting to see many of the figures involved in the response at the time now say more should have been done to contain and eliminate the virus, which was what I’d recommended.

As an aside, the 2011 UK pandemic strategy told public bodies to prepare for “210,000 – 315,000 additional deaths, possibly over as little as a 15 week period and perhaps half of these over three weeks at the height of the outbreak,” which gives an idea of the scale of loss the government is prepared to tolerate and suggests those responsible for developing the strategy had no idea of the impact of human suffering and healthcare collapse involved in such rapid and high mortality.

After Hancock rejected my concerns, I became quite active in public health, trying to get the Department for Education to introduce ventilation and filtration in schools, starting the John Snow Memorandum with Dr Gurdasani, leading the vaccines-plus initiative, and contributing to the Delphi consensus on ending the pandemic. I’ve since become involved in the John Snow Project, which is an initiative paid for and run by volunteers, many of whom are frontline healthcare workers who’ve cared for patients throughout the pandemic. Free of political interference or funding conflicts, the objective of the organization is to provide impartial expert analysis of public health policy and the science behind the SARS-CoV-2 pandemic.

I stopped commenting publicly on COVID-19 in September 2021, but maintained my involvement in a number of scientific and clinical groups and have stayed current on the research relating to the long-term harm being done by SARS-CoV-2 infection. As we face yet another wave of infections, new variants, and growing concerns about the long-term impacts of COVID-19, I urge people to take steps to protect themselves from infection.

Vaccines are an essential tool, but the evidence shows they are not enough on their own. Many public health agencies are now warning about the cumulative risks of re-infection and advise people to take a multi-layered approach to reducing risk, including respirator masks, ventilation and filtration. But the advice is delivered very quietly and most people are unaware of the risks of repeat COVID-19 infection. This first-person account of Long COVID developed after vaccinations and multiple mild infections is a stark illustration of how ineffective public health communication is leading people to stumble into life changing harm.

It's been bizarre watching public health agencies whisper sensible advice, while their high-profile leaders continue to propagate a ‘don’t look up’ message. Frankly it is getting beyond a joke when Dr Mandy Cohen, the director of the US CDC, refuses to recommend respirator masks and clean air as means for people to protect themselves against COVID-19 infection. Even the basic advice on vaccines is logically flawed. How is a doctor or nurse practitioner meant to advise a patient on whether it is wise to wait for updated vaccines without knowing the relative protection offered by each vaccine against the new circulating variants? People deserve better from their public health agencies and Dr Cohen’s message is part of the reason I’m writing this piece today. It’s not good public health advice and is out of line with what other US and international agencies recommend.

I’m not going to resume my commentary on COVID-19 because it took a toll on my health. I was too invested in trying to stop the unfolding harm and ended up suffering. I also found myself on far-right anti-lockdown and antivaxx lists online, which wasn’t fun. I just can’t remain silent in the face of such poor public health advice, as the world faces yet another wave of infections, which is why I’ve returned to the subject today.

If you want to stay current on the latest developments in SARS-CoV-2 research and policy, follow the John Snow Project on Twitter or check out the website.

Click here for practical advice on reducing your risk of infection.

Wishing you the very best until next time.