La (A) View from Wales

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In April 2010, one of us wrote a short retrospective on the H1N1 / 09 pandemic (“Swine Flu”), for the newly relaunched “Public Health Today”, under the direction of another of us, entitled “The modelers not public health “. the doctors had guided in the planning of the flu ”. His sentiments were echoed in the swine flu pandemic report for the UK cabinet office of Dame Deirdre Hine, former CMO Wales, which found the UK government relied too heavily on “modeling evidence”. That Cabinet Office report went on to recommend that “the Government Office of Science, working with key government departments, should enable key ministers and senior officials to understand the strengths and limitations of probable scientific advice available as part of their general induction. Such training must then be strengthened in the event of any emergency. ”Thus, the report recognizes that the mathematical and academic nature of mathematical modeling can be attractive to troubled politicians and officials who aspire to” follow the science. ” , but warns against considering mathematical modelers as “court astrologers.” Public health today, a few years later, was gone and with it, in the management of the COVID-19 pandemic, this particular lesson was forgotten .

Indeed, “court astrologers” have been ubiquitous in the COVID 19 pandemic since Imperial College London’s implausible predictions in March 2020, the most recent example of its long history, have led directly to near-simultaneous blockades in the UK, France and the US.

Meanwhile, on March 24, 2020, in a letter to the Western Mail, “the national newspaper of Wales”, entitled “Social distancing will really work,” one of us wrote,

“This new virus will continue to circulate until we all have it or vaccines or effective treatments are available, both solutions perhaps years later. The spacing simply makes the virus spin slower and the pandemic lasts longer. Distance also means less wealth and resilience to fight it ”.

Earlier, on February 28, another of us had written in a BMJ editorial,

“Given the lessons of 2009 – which taught us that the containment of a globally spread disease was useless … once the disease is recognized as a global pandemic, nations, trade and healthcare can enter in a much more rational phase with resources aimed at those most in need. We should plan on the assumption that most of the population can contract the virus … “

Why risk-based approaches, or “targeted protection” as some have defined them, were not followed; neither in Wales nor elsewhere? Part of the explanation was the dominance of mathematical modeling in the scientific advice mechanism. Welsh ministers, like many politicians and journalists, have internalized the widely popular idea of ​​the effective reproductive rate (R.T.) as a sort of epidemic volume control that responds with small increases / decreases to their “cautious” changes, a picture that completely ignores the determining role of social networks in epidemic models. The Welsh Government Technical Advisory Committee (TAC) is chaired by the Chief Scientific Advisor, not the Chief Medical Officer and despite a number of members, who are experts in all aspects of the infection, it has been suggested, in private, that they are the model makers mathematicians who dominated the agenda. Certainly the TAC results, available online, are consistent with this explanation, for example, a document showing that the Welsh government’s two-week October firebreak was “successful”. In this article, arcane math is used to claim success, while, from a simple look at the observed incidence of COVID, it would be difficult to conclude other than that any effect was marginal at best.

While such comprehensive approaches to pandemic management were used, the loss of attention to risk meant that preventable infections remained unprevented, as evidenced by the high death rates where the infection was acquired in hospital or care facilities. and the percentage of nursing home cases linked to hospital discharges. Field data to guide such approaches was available at the start of the pandemic from the “OpenSAFELY”, “ISARIC” and RCGP Research and Surveillance Center projects, not to mention timely documents from China. Public Health Wales subsequently made important contributions to this work with its studies on hospital discharge and the community screening project in Merthyr Tydfil. Empirical data from field surveys could be used in the same way to establish what works in protecting the most vulnerable and to assess whether some of the Welsh government’s more unique decisions (closure of selected supermarket aisles, pubs that are banned from selling alcohol, night club vaccination passports) have been / are of no benefit.

Finally, the Wellbeing of Future Generations Act, some of Wales’ most forward-looking laws, have singularly failed to translate into any kind of systematic assessment of the downsides of global “blocking” approaches; negative aspects that are most likely to impact only those future generations whose interests the act seeks to protect.

What room was there for an independent position in Wales, given the high level of economic and social interaction with England? It has been done. Wales refused to support DH claims in England that BSE could not be transmitted to humans, chose to wait before undertaking smallpox vaccination of healthcare workers, due to the high levels of documented side effects in the United States, before the Iraq war and during the 2009 Swine Flu Pandemic, Wales chose to use the usual health care providers, bypassed in England by the costly, centralized and often ineffective “Influenza Line” (national service for pandemic flu). The scope of leadership is, however, limited, but should that mean that the letters to the Welsh ministers, from our side, suggesting what more focused approaches might look like in practice simply went unanswered?

So this is definitely not the seen from Wales but it is a view and a view of four of us who have spent much of our senior careers in epidemiology and communicable disease control. So, whatever form the public inquiry of Wales takes, we would like to see our views, particularly regarding the need to use real-world surveillance and investigation, including the downsides of the interventions, considered and this time, lessons practices learned and remembered.

Roland Salmon
previously, Director, Communicable Disease Surveillance Center, Public Health of Wales

Meirion Evans
previously, Consultant Epidemiologist, Public Health Wales

Stefano Palmer
Emeritus Professor of Public Health, Cardiff University

John Watkins
Professor and Consultant Epidemiologist, Cardiff University

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