Review

Confessions of an Epidemiologist

Photo: www.vperemen.com, CC BY-SA 4.0

This is the book every lockdown sceptic has been waiting for, and I place myself firmly in that camp. But to my fellow sceptics, I would brace for some disappointment. While author Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, has come out of the pandemic closet and declared himself to be a lockdown sceptic, he takes some time to get there. At times the reader may be forgiven for wondering if, after all, this was the book that they meant to order. His scepticism extends no further. Nevertheless, it should be noted that this book was published before Professor Woolhouse revealed that pressure had been put on him by Messrs Whitty and Vallance, respectively the chief medical officer and chief scientist, to modify his views on social media. The author had tried to reassure the public about the likely extent of deaths from COVID-19, but this was contrary to the UK government’s narrative. None of this is mentioned in the book.

However, it is a good book. It is very readable and, as the author is one of the world’s leading epidemiologists and eminently qualified, it is incredibly informative. Look no further if you want easy-to-understand, lay explanations of concepts that became household words during the pandemic, such as the ‘R’ number, ‘generation time,’ and ‘infection fatality rate.’ Other technical aspects of the pandemic and epidemiology are likewise explained with clarity and few people will come away from the book without being better informed than they were prior to picking it up.

I detected the author’s pain in his writing. Pain at his part in the mistakes that were made (he states clearly that he was one of the people officially supporting immediate and full economic lockdown on March 23, 2020). Pain at some of the criticism and hate mail he received when he began to make it clear that the measures introduced to manage the pandemic may have been excessive. He apologises to his daughter in the dedication for this generation letting hers down. As someone who condemned the lockdown from the outset, I feel no vicarious responsibility. Moreover, he should have tried being critical of the lockdown early in 2020 when, for example, calls were made to my university to have me dismissed and I was mobbed on social media.

Woolhouse explains the essential problem was with the modelling—the so-called ‘science’—that was so influential on UK government planning and implementation of measures. The models were not ‘segmented’ which means that they treated the population as a homogeneous mass. In other words, a newborn baby was considered at as much risk of becoming infected with and dying of COVID-19 as someone in their sixties; in reality, the difference in risk is around three orders of magnitude. This led to a one-size-fits-all approach which, while intended to reduce risk equally across the demographic board, simply inflicted equal and entirely pointless misery on younger and economically active people. This approach, according to the author, was also partly implemented due to an exaggerated level of risk aversion and, while he does not say it, I will: the UK government did absolutely nothing to mitigate that, even justifying the use of the ‘virtuous lie’ to cajole the population into lockdown and to keep it there for the best part of two years.

One excellent point is made related to closing borders and restricting entry to people from certain countries—so-called ‘red list’ countries—which had not previously struck me. For example, Ireland closed its borders to people entering from Brazil, where levels of COVID-19 were high, yet continued to allow visitors from the UK, where, by comparison, COVID-19 levels were low. But there is little logic to this approach as, notwithstanding the relative levels of COVID-19 in the two countries, very few people from Brazil enter Ireland annually whereas millions of people from the UK do. In other words, Ireland was at greater risk of COVID-19 spreading by allowing people from the UK to enter than from Brazil. In any case, according to the author, the COVID-19 gate had been closed long after the coronavirus had bolted. Border closings, when implemented, were probably pointless.

Clearly, the author finds it hard to let go of his part in the disastrous and multi-faceted decision that was lockdown. He refers copiously to how this was a public-health emergency, the serious and fatal nature of the virus, and how it cannot be likened to a dose of influenza, mostly without qualification. I found this unsatisfactory. It was evident from the infection-and-death profile emerging from Wuhan—which I had just left after a prolonged stay in November and December 2019—that the young were barely at risk of either and that the infection fatality rate seemed low. Clearly those figures had to be seen through a lens that filtered out Chinese government lies. Nevertheless, that general pattern has been substantiated. 

The notion of the public-health emergency led to vast amounts of spending on, for example, the white elephantine Nightingale hospitals in the UK. These were designed to take the pressure off the National Health Service by providing specific and specialised intensive care for people with COVID-19. In fact, they were barely used. One of my colleagues, head of the British Intensive Care Nursing Society, reported nightly on BBC news against the backdrop of an empty Nightingale hospital.

The claim that COVID-19 is not like the ‘flu is made several times before the author offers an explanation. The explanation is based around the longer time it takes for an infection to become apparent for ‘flu than COVID (the generation time). But the fact is that the order of magnitude of COVID deaths in 2020-2021 (once deaths ‘with’ as opposed to ‘of’ are accounted for) is of the same order of magnitude as the deaths from ‘flu in the 2013-2014 pandemic, which was in the tens of thousands. The fact that COVID-19 deaths were skewed towards older people is juxtaposed by the author to ‘flu deaths but I found this disingenuous as ‘flu deaths are likewise skewed towards older people. I was unsure what point Woolhouse was trying to make.

I undoubtedly come across as more critical of the book than I really am. But I maintain the position that lockdown was never an approach that should have been implemented. I would hold that view even if lockdown was a measure that was considered, based on evidence, effective. The cost to personal liberty was too great ever to contemplate and that was compounded in the UK by the fact that the costs of lockdown were never estimated prior to implementation. We witnessed a prolonged curtailment to basic freedoms assumed under common law of freedom of movement, freedom of association, and freedom of speech. But Woolhouse does not address this fundamental aspect of lockdown and the government’s attempt to control the COVID-19 narrative. In fact, while he clearly comes out as lockdown sceptical, it is not entirely clear why.

In addition to the author, there is a dramatis personae of the usual suspects who were vocal during the pandemic. But it is notable who gets mentioned and who does not. My cousin by marriage Dame Anne Glover gets a mention in her capacity at the time of the pandemic as president of the Royal Society of Edinburgh. But she simply held the party line on COVID-19. Viscount Ridley, who was a longer-standing lockdown sceptic than the author and provided a foreword, is mentioned along with an international roll of honour of eminent epidemiologists, including the author’s own wife. I was interested, but not disappointed, that the vocal and photogenic but medically unqualified Professor Devi Sridhar, chair of global public health at the author’s own university was not referred to. But I was astonished that Lord Jonathan Sumption, who presented the legal and moral case against lockdown, was also omitted. Another major omission was lockdown sceptic supreme Toby Young, who played no part in Woolhouse’s proceedings.Without doubt this book is a must read of the pandemic aftermath and will enter the canon along with tomes such as Viral by Chan and Ridley (reviewed in Salisbury Review passim). I sincerely hope that the process of writing it was therapeutic for the author.

Roger Watson is a British academic and former professor of nursing at the University of Hull. He is the editor-in-chief of Nurse Education in Practice and an Editorial Board Member of the WikiJournal of Medicine. He was the founding chair of the Lancet Commission on Nursing, and a founding member of the Global Advisory Group for the Future of Nursing. In 2020, Watson was elected vice president of the National Conference of University Professors. In 2022, Watson was elected president of the National Conference of University Professors.

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