In a previous post, I summarised some of the existing evidence on the risk/reward of COVID-19 lockdowns (and mask wearing). In that post, I also highlighted how the collection of scientific evidence during the pandemic remains poor; instead of gold-standard robust Randomised Control Trial evidence, we are instead relying on evidence of an incredibly poor quality (expert opinions, unvalidated computational models and case studies).

Professor Carl Heneghan (from the University of Oxford's Centre for Evidence Based Medicine), recently summarised this brilliantly at an Irish Parliamentary committee when another witness cited the example of Vietnam:

Often, people try to make points and look for evidence. For instance, the committee just heard about Vietnam. It is a classic fallacy. The median age in Vietnam is 30.5 years. The temperature and humidity are radically different from here. We do not even know whether people in Vietnam have pre-existing infections, cross-reactively, from SARS-CoV-1, of which it had outbreaks. With these issues, people say "here is the evidence and because they did that, we are going to do this". I find that very difficult to understand from an evidence-based perspective.

In lieu of Randomised Control Trial evidence, observational data from the University of Oxford highlighted that, as lockdown stringency increases, so do excess deaths and so does economic decline. We also now see evidence of the underlying harms; including domestic abuse, substance abuse, depression, suicide, poverty, hunger, heart attacks, strokes, lack of schooling, poor nutrition and lack of physical exercise.

This post isn't a recital of such evidence, but instead I wish to describe how my own experience in Sweden differs from that described in the British or American media.

The Swedish Experience

Media both in Britain and the US leads us to believe that the Swedish people regret not going into lockdown and have now imposed social distancing measures to an extent to bring the virus under control. Having spent some time recently in Sweden, this could not be further from the truth.

On arrival to Stockholm's Arlanda airport, there was a solitary small sign about COVID-19 on a door to the train station under the airport, informing tourists of a web address to get updates on Swedish policy.

Mask wearing is simply non-existent. In Stockholm, I only noticed one individual wearing a face mask in a crowded shopping centre. I never saw anyone wearing a mask on public transport.

That is not to say public debate on mask wearing does not exist, but instead that it is far more grounded in reality within Sweden. When mask wearing comes up in discussion, Swedes will be well versed in the arguments within their own national debate. They will be able to cite the risks of cross-infection, improper wearing and the lack of scientific evidence on them. Given how informed Swedes are on this matter, they see mask wearing for what it is - a ritualistic behaviour without grounding in true scientific understanding.

Social distancing simply does not exist either, I was able to greet friends by hugging them and people did not turn into screaming hyenas if you came within 2 meters of their physical presence.

Schools were never prematurely closed in Sweden, and as they re-open after the summer holidays, parents have no fear as they are armed with the truth on the risk to children and transmission within schools.

When I was asked of the situation in Britain, and told of how people were shamed for failing to socially distance or wear a mask, the person I was speaking to looked down pitifully and said "they're scared". This speaks volumes as to the Swedish approach towards the pandemic and goes someway to describing why Sweden's Chief Epidemiologist, Anders Tegnell, when asked to defend his strategy simply urged people to judge him in a year instead of jumping to defend himself. Swedes do not feel they have any need to defend their approach to anyone else, indeed, their dominant emotion to the rest of the world, in lockdown, is one of pity.

The experience I witnessed in Sweden seemed so completely different to that described to me through the media. One person even said to me that it must be analogous to the experience of leaving North Korea.

Dominic Sandbrook has since documented his own experience in a Daily Mail column: "No lockdown, no masks, no hysteria... no problem: Sweden didn't go into a corona coma - and it's living in glorious normality."

Speaking Out

Evidence-based medicine pyramid - Quality of evidence represented by each level of the pyramid, with quality increasing from bottom to top. For example; Randomised Control Trials are of significantly higher quality than Expert Opinion, but there are far less Randomised Control Trials than Expert Opinions.

Evidence-Based Medicine tells us that systematic reviews of Randomised Control Trial evidence is the most robust form of evidence towards interventions. Expert opinion is the worst form of evidence.

We most however understand that when the media reports predictions and politicians make decisions, the pyramid of evidence based medicine is inverted. Expert Opinion (in the form of talking heads) is wrongly treated as the best form of evidence.

Towards the start of this post, I quoted Professor Carl Heneghan on the flaws in a significant amount of what is claimed to be scientific. Recently, Professor Peter Horby has also began to speak out on the lack of evidence in relation to policy on face masks.

Professor Horby is one of the two chief investigators of the RECOVERY trial. This groundbreaking trial allowed the UK and the NHS to find the only known life-saving treatment to COVID-19, dexamethasone, which is now widely used and available around the world at low-cost in a generic form. From this one discovery alone, 650,000 lives will be saved over the course of 6 months, meaning he has saved more lives around the world during the pandemic than anyone else. It accordingly follows, that when he is speaking out on the lack of evidence around interventions for COVID-19, it is a good idea to listen to him - indeed, he has recently begun to speak out on the harms of evidence-thin blanket statements on face coverings:

We are increasingly beginning to see that politicians recognise that lockdown measures were a mistake. Sherelle Jacobs recently wrote in The Telegraph that "Europe is at last waking up to its lockdown folly", citing numerous European leaders who are quietly getting their populations accustomed to the idea that lockdown policies were a grave mistake.

As expert opinion from reputable scientists begins to truly follow the science, we must be aware that those who have so far led us down a road of pseudo-science and misinformation will do all they can within academia to attempt to warp scientific truth to match their viewpoints. We must be ready to defend honest scientists and provide them the means to speak out.

Fear is a powerful tool, in Britain we have even seen examples of malicious "lockdown fundamentalists" laying lethal traps in the countryside to kill those who wished to take exercise in the open-country during the peak of the pandemic (an activity that is/was fully lawful).

Be in no doubt, such malicious actors will now attempt to silence academics and doctors who call for scientific research, debate and rational policy using any means possible. We must be ready to defend them.