One of the most reputed publications in the annals of medicine, “The Lancet” recently published a controversial study based on Surgisphere data, that demonstrated enhanced death rates in COVID-19 patients being administered with the drug Hydroxychloroquine. Touted indiscriminately and inanely by President Donald Trump as a “miracle drug” against the COVID-19 pandemic, the use and the unfortunate, abuse, of the drug had stirred a disproportionate amount of global interest. The Lancet study however, led to the World Health Organisation (WHO) issuing directives to terminate global trials of Hydroxychloroquine for Covid-19 in May, based on the study’s startlingly adverse findings. However, the proof in this instance, was not to be found in the pudding. The study was hastily retracted post a Guardian investigation where researchers unearthed damning inconsistencies in its data, courtesy a database owned by Surgisphere. The New England Journal of Medicine also retracted a study with findings based on Surgisphere data and a third paper involving Surgipshere and Desai – the author or co-author of all three studies – holding forth on the impact of the drug ivermectin on Covid-19 patients, was excised from the website SSRN, a repository for scientific papers.
Richard Charles Horton is the editor-in-chief of The Lancet, and an honorary professor at the London School of Hygiene and Tropical Medicine, University College London, and the University of Oslo. In his newly published book titled, “The COVID-19: What’s Gone Wrong and How To Stop it Happening Again”, this much acclaimed and respected man of medicine tries to pry open the scientific and political causes behind the viral spread of this dangerous pandemic before dissecting its potential socio-economic consequences. However, the lofty title belies the content that succeeds it. Although thought provoking and deeply introspective in some parts and a fount of good advice in some others, “The COVID-19 Catastrophe” is frankly speaking, a disappointment. The greatest let-down of the book lies in its treatment of China. In the diverse continuum of rich conspiracy theories, astringent, albeit methodically researched criticisms and everything in between, China’s role in the entire pandemic, has at best been, suspect, and at worst, downright complicit. However, Mr. Horton seems to eat out of this behemoth’s hands. All that China receives from this expert of medicine is a mild rebuke instead of even a reluctant rap on its condescending knuckles.
As Mr. Horton himself informs his readers, China made a capital hash of handling the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV-1), when it first reared its ugly head in 2002-03. The former Prime Minister of Norway Gro Harlem Brundtland, who was heading the WHO at that time, was extremely critical regarding China’s efforts (or rather a complete absence of them to reign in the epidemic and to share information with the rest of the world). Mr. Horton, however, asserts quite ebulliently, that China has learnt its lessons and has done an exemplary job in so far as reigning in COVID-19 is concerned. “After enduring the global opprobrium following its handling of SARS, Chinese leaders invested heavily in their universities, and specifically in their capacities for scientific, technical and medical research. Confronted by a new virus, Chinese scientists were ready, equipped and swung quickly into action. They reported the first 41 cases of COVID-19 in The Lancet on 24 January. The Chinese team was led by Bin Cao, a professor in the Department of Pulmonary and Critical Care Medicine at the China–Japan Friendship Hospital in Beijing. He assembled groups in Wuhan and Beijing which began to put together the epidemiological, clinical, laboratory and radiological data from this initial group of patients. Bin Cao and his colleagues provided the first case descriptions of symptoms and signs for COVID-19, an essential and urgent resource for doctors around the world facing patients with an unfamiliar type of pneumonia. They made the connection between the illness and exposure to the live-animal market. They described how a third of patients had to be admitted to intensive care. They calculated the average time from the onset of symptoms to ICU admission (10.5 days). They showed that patients often had blood profiles that revealed serious cardiac, renal and liver injuries. Chest computed tomography produced images that were abnormal in every case. One pattern of investigation was particularly disturbing – elevated levels of cytokines that constituted a ‘cytokine storm’. The Chinese team described how some patients needed invasive mechanical ventilation and a special means to oxygenate blood when the lungs failed – a technique called extracorporeal membrane oxygenation. They also described how 15 per cent of the patients admitted to hospital had died. The contrast between this impressive response and China’s pitiful efforts during SARS in 2002–3 illustrates the remarkable scientific renaissance that had taken place in the country in just two decades. Bin Cao’s team was not only able to gather state-of-the-art data on these early patients but also encouraged to write up their work, publish it free from censorship in foreign English-language medical journals, and make their findings available to others – all within weeks of the first reports of the new disease. The cultural, as well as the scientific, shift that had taken place in China was monumental”.
The only feeble complaint against China takes the form of a reproduction of a letter from an anonymous writer who prefers to address herself as Moon, that bemoans the appalling situation in Wuhan as a result of the virus running amok. Whilst a gleeful China is the recipient of such a warm Panglossian warmth, the United Kingdom received a stinging rebuke – and deservingly so. At the onset of the pandemic, the UK Government was being advised by a group of scientists, who upon hindsight, turned out to be so ill-advised about the very pandemic regarding which their advice was urgently sought. This resulted in both the administering and the administered running around like headless chickens. This should not have been the case. The extent of preparedness in the United Kingdom ought to have been much higher. “Exercise Cygnus” a scenario planning for a pandemic influenza outbreak took place in the UK as long back as in October 2016. “Pandemic influenza is top of the UK government’s National Risk Register. A pandemic is deemed the most severe civil emergency risk to our society. The same is true for most Western democracies. The result of Cygnus was a stark warning: UK preparedness was ‘currently not sufficient to cope with the extreme demands of a severe epidemic.”
In early March, Prime Minister Boris Johnson chaired COBRA, the civil contingencies committee that is convened to handle issues of national emergency. “After that meeting, he agreed that COVID-19 presented ‘a significant challenge’. ‘But we are well-prepared,’ he said. Was Johnson aware of Exercise Cygnus and its clear conclusion in 2016 that the UK was most definitely not well-prepared? If he was, he lied to the public. If he was not, then he is surely guilty of misconduct in public office. Remember: a pandemic is top of the UK’s National Risk Register. A prime minister should reasonably be expected to understand the capability of his country to address the most severe civil emergency risk. The best that Prime Minster Johnson could do was advise handwashing. He was still arguing that the UK ‘remains extremely well-prepared’ on 3 March. On ITV’s This Morning he said, ‘Perhaps you could sort of take it on the chin, take it all in one go and allow the disease, as it were, to move through the population without really taking as many draconian measures. I think we need to strike a balance.’ He displayed his own disregard for the risks of infection by regularly shaking hands with those he met – and bragging about it afterwards. Herd immunity.”
‘Is the government’s objective to suppress infection or to manage the infection?’, asked Sir David King at the first press conference of a newly formed Independent Scientific Advisory Group for Emergencies (SAGE), held in May.
Mr. Horton is also scathing in his indictment of the United States. He illustrates the inexplicable and jaw dropping shenanigans of President Donald Trump from expressing denuded denials about the seriousness of the pandemic to cutting off all funds to the WHO. In fact, he reproduces Trump’s speech in full, wherein he makes the incredulous decision to deprive the WHO of all funding. The WHO itself has been a peculiar study in contrast. From issuing perplexing guidelines on asymptomatic patients, before retracting them to introduce an even more bewildering element of pre-symptomatic patients to the COVID-19, confounding mix, to halting drug trials based on suspect data, it can be safely said that neither the WHO nor its Director General Dr Tedros Adhanom Ghebreyesus have covered themselves with glory.
The most interesting part of Mr. Horton’s book deals with the unfortunate, yet unavoidable socio-economic and civic chasms formed as a result of the pandemic and the disturbing results such divisions have produced. Quoting from the works of Michel Foucault, Slavoj Zizek, Samantha Brooks, Jacques Ellul and Didier Fassin, Mr. Horton bemoans a loss of empathy and an alarming rise of divisive politics that could have undesirable societal ramifications. Mr. Horton employs a very interesting metaphor “panopticonisation of society” to describe the various contact tracing apps that are making the rounds, and which inadvertently might possess an element of intrusion into the most private lives and details of its users. However, Mr. Horton offers five sagely conditions complying with which such apps may turn out to be beneficial.
- Commitment by the government to universality, and inalienability – privacy protection must be accorded to everyone;
- Indivisibility – our rights are interdependent. It is not for the state to determine which rights it will and will not guarantee;
- Equality and Non-Discrimination – all human beings are equal in their dignity;
- Transparency – Governments must be open about information and their decision making
On the whole “The CovID-19 Catastrophe” falls short of what it actually could have been considering the wisdom and versatility of the author.