Transcript: Mark Woolhouse
My conversation with the author of The Year the World Went Mad
In July of 2020, in The New Statesman, my guest on this week’s program wrote, “I fear that history will judge lockdown as a monumental mistake on a truly global scale.” At that time, there was surprisingly little debate over an unprecedented public health intervention. But that dialogue is starting to happen now, and my guest’s recent book is one reason why.
Mark Woolhouse is a professor of infectious disease epidemiology at the University of Edinburgh. He’s also the author of The Year the World Went Mad: A Scientific Memoir.
This is an edited transcript for paid subscribers. You can listen to the episode for free here.
TH: Mark, welcome to Lean Out.
MW: Thank you very much. Pleasure to be here.
TH: Really nice to have you on. Your book was a relief to read, for so many reasons. But in part because of how accessible it was to the public. How well written it was. It’s really one of the first books that I’ve seen airing debate on key issues of pandemic policy. Let’s start here: Take me back to January of 2020. You raised the alarm about this virus very early on. You’d been studying the emergence of new viruses for more than 20 years. What did you see in those first two months that others — particularly in government — did not see?
MW: For those of us who had been studying emerging viruses for many years, this was a straightforward issue. We were about to have a pandemic. We were very confident about this. There are several things that contribute to that. One of them is knowing how well it spreads. Epidemiologists use this complicated ratio — it’s not that complicated, really — the number of cases per case. Basically, if every case is generating more than one other case, you’ve got an exponential process. You’ve got the beginning of an epidemic. You’ve got a potential pandemic. And it was. And we could see that it was. We knew from the very early data from China that that was happening. And then, you also have a couple of other numbers that tell you how fast the epidemic is moving, and also how severe it is. This was a very difficult number to get early data on — how many of the people who were getting infected were not only getting sick, but sick enough to put them in hospital. And some of them actually died, of course. So we had not very good data on that. But certainly the data we had was absolutely enough to be calling the alarm at that very early stage in mid January.
TH: I want to focus on lockdowns today. You point out in the book that you won’t find the word “lockdown” in a textbook on public health published before 2020. Matt Ridley, writing in the forward to your book, points to the Italian lockdown as a turning point, with authorities realizing that it was a measure that could be palatable outside of China. Why do you think so many governments seized on lockdowns?
MW: This is quite a thought, isn’t it? We had, even before the pandemic, any number of plans from governments, from agencies, from international bodies, for how we would deal with the next pandemic. And nobody — absolutely nobody — in those plans had put lockdown. It wasn’t there. So we made this up from scratch. We have this imminent pandemic, and clearly the Chinese authorities, even if they didn’t say so directly, understood the seriousness of the situation from very early along. Because if you remember, they locked down the entire city of Wuhan. That’s a huge city, it’s well over 10 million population. They locked it down in late January. So, they knew how serious this was, and they knew what sort of measures would have to be taken to deal with it. But they hadn’t planned to do it. We hadn’t planned to do it. The World Health Organization didn’t have any plans to do it. But it was the first thing that we actually did. And it seemed to have an effect. It did actually eliminate the infection from Wuhan. And that encouraged particularly the World Health Organization to endorse this brand new, newly-invented intervention as the way that we should be dealing with Covid-19. And, not surprisingly, pretty much every government in the world — not quite every government, but most of them — latched on to it.
TH: You have talked about the period before lockdowns, and what could have been done in that lead-up. There wasn’t actually much done in the very beginning. Talk to me about that.
MW: Well, some very high-level analyses, retrospective analyses, of what went right and wrong in those early stages have called February 2020 as “the lost month,” the month where really nothing happened. The alarm had been called in January and the World Health Organization had, somewhat belated, in my view, declared that this was a “public health emergency of international concern.” That’s their phrase for a worrying outbreak. It’s not a full pandemic. They didn’t declare that until early March. And, in between that gap, we had this what was being described as a localized public health emergency growing into a pandemic, largely unseen, spreading around the world into Northern Italy, where you mentioned earlier, but many other European countries too. And America very definitely as well, at the same time, spreading all around the world. During that month of February, largely unseen until, by March, for most countries it was too late. The infection was well established in their populations. It was starting to spread locally. It was starting to take off in individual countries. And there we were. We had a pandemic.
Nothing much happened in February. When, in fact, it could have done, if we’d accepted what was coming. We could have done a lot more to prepare ourselves, both in terms of the actual implementations we would need. The basic things like masks for healthcare workers, tests, and so on. But also, of course, our planning. We could have, at that stage, planned not only that this is going to be a big event, but we might have realized, given what was happening in Wuhan, that if we weren’t careful we were going to end up in lockdown. I always saw those as twin hazards. I mean, clearly you don’t want a huge pandemic. Without question, you don’t want that. But also, really, do we want to go into lockdown? Could we not have used February to identify a better strategy, a better way of dealing with it? But we didn’t do that. And when the pandemic finally became so obvious that even the World Health Organization had to admit we were having one, lockdown became the preferred tool of choice. It was implemented in many states in America, most of the countries in Western Europe, and a lot around the world.
TH: Certainly here. You pointed out in The New Statesman, in July of 2020, that lockdowns are supposed to be a temporary measure. They’re not supposed to be a sustainable public health intervention. But many jurisdictions did not seem to have a speedy exit strategy. Our lockdowns in Ontario, for instance — where I am, in Toronto — lasted months. I was working in mainstream media during these lockdowns. I saw almost no public debate about the harms versus the benefits. You were a government advisor during the crisis. Was there an assessment of the potential harms of lockdowns on the economy, mental health, education, societal wellbeing, and the functioning of the healthcare systems?
MW: No. There wasn’t. And I really hope this is an issue that the inquiries … we’re having a big national inquiry into our pandemic response here in the UK. It’s begun already. I really hope that inquiry, and any that happen in America or Canada or anywhere else, really emphasize this point. We had these very detailed projections — they weren’t always right, but we had them — about how bad the epidemic would be in terms of its public health impact. We had all those and they kept coming all the way through the pandemic. Very, very detailed analyses of what the public health agencies and the national health systems could expect. But we had nothing equivalent for the harms that we might anticipate to the economy. And those aren’t, by the way, just the harms done to lockdown. I mean, the pandemic itself of course has huge impact on the economy. Even if you don’t try and fight it with lockdowns, it has an impact. We didn’t have any proper assessment of that. Nothing on the harms to education that would come from closing schools for a prolonged period of time. Nothing on the mental health impacts of something like lockdown, severe social distancing. No analysis of that. Interestingly, nothing on the impact of the reduced access to healthcare.
I don’t know how it was in Canada, but here in the UK we were effectively told in those early months of the pandemic, “Stay away from the health service if you possibly can. They’re concentrating on Covid.” And the result of that was that thousands of more deaths than usual occurred during that period in people’s homes. Quite clearly, those were very ill people who should have gone to hospital. And they didn’t. But we didn’t have any analysis of what sort of impact those would have. All the way through, this bias remained that we were looking at the public health harms caused by the virus, but not all that long list of harms caused by lockdown. So it was very, very difficult for anyone to come to a well-informed, evidence-based, rational decision about the right balance of how strict our response should be versus the very obvious harms that would be caused by the virus. How can we find that balance when we hadn’t done the work? We had only looked at one side of the equation.
TH: Another thing that really stood out from the book for me is in October of 2020, you co-wrote a report with your colleague Chris Robertson. And I want to ask you a little bit about its findings. In Scotland, how many deaths were caused by infections acquired after lockdowns were imposed?
MW: Most of them. Probably somewhere of the order of half to three quarters of the people who died during the first wave in Scotland — which killed thousands of people — they got their infections during lockdown. As you say, it wasn’t before the lockdown was implemented. Even allowing for the lag before people get ill enough to die. We allowed for all that. And it wasn’t after once we started to release it. It was during. Now, what that says to me is whether or not you are for or against lockdown as an appropriate intervention to deal with this sort of thing … And, as you said, I’m definitely not [for it]. But there are people in who still defend it, even to today. But it doesn’t matter whether you’re for or against it, it tells you that just having the lockdown by itself wasn’t enough. Because that’s most of the people who died; they got their infections during lockdown.
The key point is, of course, even by that early stage, we knew who these people were. It wasn’t everybody. It wasn’t that this virus was equally dangerous to every member of society. It absolutely wasn’t. We knew from very early on that elderly people — so, a 75-year-old or older was 10,000 times more likely to die from an infection with this virus as a school-aged child. 10,000 times. I mean, that’s an absolutely extraordinary difference. And what that tells you, surely, is whatever else you do, this is something that is very dangerous to over 75s. And once we established that there were other co-morbidities — things like diabetes, obesity, all sorts of immunocompromising conditions as well, we have a long list of them now … I think those [groups] needed an awful lot more attention than they got. There’s a couple of reasons why they didn’t get it. But one of them is because, somewhere along the line, we got the message that lockdown was the way to deal with this. And it simply wasn’t enough to protect the people who are most vulnerable to this virus.
TH: Those are astonishing numbers. And yet for many months in the media, when I was working, these numbers were not at the forefront. This understanding was not in the public. I want to talk about shielding in a moment, but first, let’s touch on school closures. This is a contentious issue now. But at the time, there was also not a lot of debate. You write in the book that “there was never any compelling evidence that school closures would have much public health benefit, but we did it anyway.” Why?Why do you think that is?
MW: The reason we did it is fairly easy to understand, at least in the UK context. Our preparedness planning for the next pandemic was based very much around pandemic influenza. Influenza is another kind of respiratory infection, obviously, and that has historically spread very well in schools. If you remember the swine flu pandemic back in 2009, 2010, that was largely driven by schools. The children were getting infected, spreading the virus among themselves, passing it on to their teachers and the parents. They were driving the epidemic.
Now, we knew from very early on that Covid-19 was very closely related to a different respiratory infection, the SARS coronavirus. Which, of course, did hit Canada. You had quite a significant outbreak there in Canada. And SARS was a real threat. The case fatality rate was far higher than it was for Covid-19. So it was a very dangerous virus. But they were very closely related.
SARS didn’t really affect children. During that whole worldwide SARS epidemic, the children were not particularly affected. There was never any evidence they were really contributing much to transmission. And it turned out, perhaps unsurprisingly, given how closely Covid-19 is related to SARS, that that was true of that virus too. And so children were not driving this pandemic. But we assumed that they were because we were thinking of flu. And they weren’t. There was never any evidence they were, because they weren’t. There was never any evidence that they were a particular danger from this virus, because they weren’t. Healthy children are in almost no danger from this virus. There have been some very ill, and indeed fatally-infected children, but they’ve always been, to the best of my knowledge, children that were already very, very poorly. Which is obviously extremely sad. But the epidemiology remains true that it’s not really a virus that’s spread among children, or is a threat to healthy children. And yet we closed schools. The irony is back in the swine flu pandemic in 2009, 2010 — which was a threat to children and killed many more than than Covid-19 did — we did keep schools open. It doesn’t make sense. It really doesn’t make sense.
TH: It’s a strange thing to have to think through. But, of course, so important as we begin to come out of this, and to take stock. One of the other things that I was struck by, reading your book — you argue that there was this dominant thinking, that no death from coronavirus is acceptable. Which made it impossible to tackle pandemic policy in a rational manner. And indeed, the reaction to lockdown criticism was a little on the hysterical side, accusing people of not taking the virus seriously, claiming skeptics just wanted to let the virus rip. You advocated for shielding of the vulnerable and the elderly. Walk us through what shielding looks like.
MW: Well, there’s quite a lot in that question. So can I just reinforce one of the introductory points you made? Which was about the difficulty of having a debate about the merits, or otherwise, of lockdown. In a very nice review of The Year the World Went Mad, in one of the leading newspapers in the UK, their science editor Tom Whipple wrote that it wasn’t possible to have the debate at the time because — his quotes — “supporting lockdown had become a test of virtue.” So, if you didn’t support lockdown, you were in some sense a bad person. I certainly got elements of this myself. I devoted my entire time during this pandemic to try to minimize the loss of life and reduce the collateral damage. I would never, ever recommend anything that I thought meant that more people would die. Good grief, far too many people died as it was. So there was just absolutely no question of that. But you’re quite right, the debate took that sort of flavour.
We talked earlier about the importance of protecting the vulnerable. We didn’t do it very well by lockdown, and we understand now why we didn’t. It’s actually very obvious. Anyone could have worked this out in the first place. The reason is that the people who are most vulnerable to this virus, as we’ve already said, are elderly, but they’re also frail. They’re often ill with other conditions. They’re not well. And these are people who cannot isolate themselves, which is what most of us were asked to do — stay in our homes. They need to interact with the healthcare system regularly. They need to interact with social carers. They need to interact with informal carers. It’s simply not possible for them to isolate themselves. As I say in my book, my own mother was in this position. She had regular daily carers that had to come in to look after her. There was no way around this.
So, those people could not isolate themselves in the way that we were all asked to. And the subsequent analysis has shown that actually a lot of them, that’s the route they got their infection — through their essential carers. So how do we stop this? It’s rather obvious, isn’t it? If the carers are the ones that inadvertently are transmitting infection to these very vulnerable individuals, we need to protect the carers. And we could do all sorts of things to make sure that they’re not infected. But one thing we could do easily to break the link is test the carers, and test them regularly. Even with what we started with, those rather cumbersome PCR tests that we all had to go to special places to get tested, and all this sort of thing. Before we could test ourselves in our own homes, which is much better. But even with the PCR test, we could have directed our resources to testing the people who were caring for what we already knew was the most vulnerable fraction in the community.
In addition to that, we didn’t go to the effort of saying to the carers, “Here are some proper medical-grade masks that you can have for free. Here is your advice; this is how you keep the people you are caring for safe. How you keep the people like my mother safe. This is how you do it.” Now, a lot of the care companies did this for themselves. But there wasn’t a coordinated, national effort to say that these are the sort of people that we really need to concentrate on, in order to protect the vulnerable. We never really had a joined-up strategy of that kind that put the focus where I think it should have been — on protecting those that were most likely to suffer very badly from this virus.
TH: What are the key differences between this strategy that you’re proposing and the Great Barrington Declaration?