Flawed ‘insider’s’ account of the covid-19 pandemic

Prof Mark Woolhouse’s main contention is that the UK’s Covid-19 lockdowns were mistakes. This is underlined in Viscount Ridley’s foreword, which enthuses that in addressing the defence of there being no alternative to lockdown, “Mark demolishes this in devastating and relentless fashion…” arguing that shielding the elderly and cocooning the vulnerable were superior strategies. Woolhouse’s demolition is indeed “devastating and relentless”, and he supplies genuinely useful and insightful analyses into Covid-19 being essentially a disease of old age; the folly of school closures; deficiencies in the response to Covid-19; and other well-argued points.

But undermining Woolhouse’s anti-lockdown arguments in a singularly “devastating and relentless” fashion is his own admission that: “At the SPI-M [SAGE’s modelling sub-committee] on the morning of 23 March [2020] I supported the committee’s recommendation of an immediate national lockdown.” Yet he told the Daily Telegraph in February 2022: “We knew from February [2020], never mind March, that the lockdown would not solve the problem. It would simply delay it.” And even knowing “that the lockdown would not solve the problem” Woolhouse nevertheless supported its establishment because “there was no other option on the table”. But other options, surely, must have occurred to – as Ridley avers – “one of the world’s most distinguished epidemiologists”. He could have advocated waiting for more accurate data to emerge. Or, since Woolhouse had “been studying the emergence of new viruses for more than 20 years, I knew what to look out for”, why didn’t he take the opportunity to deploy, as Prof Simon N Wood did, “a Bayesian inverse problem approach applied to UK data on first-wave Covid-19 deaths,” finding that “the disease duration distribution suggests that fatal infections were in decline before full UK lockdown” (Biometrics; 2022: 78: 1127–1140).

Given Woolhouse’s support of a lockdown he knew would fail; given his “devastating and relentless” demolition of that very strategy; and given that the Scottish Covid-19 Inquiry is underway, could one speculate that self-justification – rarely the best course of action after a calamity – played a motivating role in this “scientific memoir”? With this perspective, Dr Dorothy H Crawford’s assessment at the front of the book that it comprises a “unique record of the pandemic year” is true; and emblematic of its uniqueness is the author’s skill at holding cards to his chest to avoid spilling beans. Thus, the flyleaf assures readers that in “this astonishing account, Mark Woolhouse shares his story as an insider…”, but flicking through the index raised the suspicion that “this astonishing account” might reveal astonishingly little. For example, our insider is Professor of Infectious Disease Epidemiology at the University of Edinburgh and a Scottish Government advisor during the Covid-19 pandemic. Another insider, and Scotland’s best-known face and voice of Covid-19 advice, was National Clinical Director Prof Jason Leitch… who isn’t mentioned. Why not? Readers might have been interested in the extent to which two high-profile colleagues agreed/disagreed on policy issues.

Similarly, Ridley’s foreword is striking for what it omits. Thus, having written scathingly in May 2020 on how it had become commonplace for epidemiologists, inter alia, “to cite the output of mathematical models as if it was ‘evidence,’ [and asking].… Did we base one of the biggest peacetime policy decisions on crude mathematical guesswork?”, Ridley’s avoidance of the “m” word contrasts with Woolhouse’s chapter endorsing the value of modelling.

Woolhouse reminds us how his expertise helped address the 2009 swine flu pandemic. So he must have read Dame Deirdre Hine’s 2010 independent review of the UK’s response where she notes that a number of interviewees were concerned that “SAGE advice focused on the academic scientific viewpoint – the modelling activity – to the exclusion of views from those involved in operational epidemiology, such as people dealing directly with clinical cases, who arguably were better able to understand the virulence of the epidemic.” Such concerns were seemingly forgotten by Woolhouse who criticises Covid-19 scientific advisory committees “dominated by clinicians and public health specialists who weren’t looking at the bigger picture…” (page 256).

The bibliography has a slovenly approach to citation: Incomplete references; absent websites; and clumsy constructions – “I and 12 colleagues” – abound. Woolhouse asserts that respiratory viruses are transmitted when we “exhale, cough, sneeze or vocalise” ignoring the well-documented role of hands (see, for example, N Leung’s evidence in Nature Reviews Microbiology, 2021; 19: 528-545), and his claim that there is “surprisingly little data on the transmission of respiratory viruses between humans” fails to acknowledge substantial pioneering work undertaken by, for example, Sir Christopher Andrewes and Dr David Tyrrell at Salisbury’s Common Cold Unit, where human volunteer trials began in July 1946, and Prof Caroline Breese Hall into agents like respiratory syncytial virus in the 1970s.

Perhaps the Scottish Covid-19 Inquiry will enable Prof Woolhouse to clarify his role in the Covid-19 pandemic beyond what readers are given access to in this book.