Dr John Lee, a former professor of pathology and NHS consultant pathologist, has written another of his excellent articles for the Speccie. It is sadly paywalled, so by giving the article our ‘From Behind the Paywall’ treatment his arguments and assessment might reach a wider public.
The title of his article – “The way ‘Covid deaths’ are being counted is a national scandal” might indicate that this is yet another review of what the NHS, ONS and government have messed up. This mess is actually worse, as the subtitle explains: “We have no idea how many lives have really been lost to the disease”
Dr Lee starts with describing what pathologists do and why their role in medicine is so important:
“As a pathologist, I’m used to people thinking that my job mainly involves dealing with death. But nothing could be further from the truth. That is why I and many of my colleagues are so dismayed by changes introduced during the coronavirus epidemic which mean that pathology has not been able to play the role that it should have in helping to understand this new disease. […] There is my own speciality of histopathology, or cellular pathology. We are experts in analysing changes in the fabric of our bodies that result from disease. […] Every time a biopsy or surgical sample is taken, it comes to the histopathology lab to be examined. Histopathology is often regarded as a ‘gold standard’ for diagnosis of diseases that change tissue structure. A clinical examination or X-ray may suggest that a tumour or fibrosis of the lung, say, is present, but you need to examine a tissue sample microscopically to be sure that it’s really there, what type it is, and how advanced. Tissue can also be examined genetically to look for the presence of infectious agents or cellular receptors that may determine how deadly it is.” (paywalled link)
Dr Lee describes next why autopsies are important:
“Autopsy — auto opsis — literally means seeing for oneself. And the person doing the seeing should be clear-eyed — an independent specialist medical practitioner, with no emotional or professional vested interest in what happened to the patient. Autopsy studies typically show major discrepancies between actual findings and clinical diagnosis in a quarter to a third of cases. And in about a sixth of the cases, knowing about these hidden pathologies in life could have made differences to treatment that might have prevented death. In the UK in recent decades about one in six deaths have had an autopsy examination — a deceased person’s last gift to the living.
The results contribute to maintaining and improving care, verifying and upholding the standards of public health statistics, preventing diagnostic drift, and basically keeping medicine honest. And nowhere are autopsy studies more important than in the study of new diseases and new treatments.” (paywalled link)
And then Dr Lee comes to the crux of the matter -this is important to understand why the way in which CV-19 deaths are counted is a national scandal:
“Looking at the current crisis, the response so far has been very different. We are still struggling to understand coronavirus. I can think of no time in my medical career when it has been more important to have accurate diagnosis of a disease, and understanding of precisely why patients have died of it. Yet very early on in the epidemic, rules surrounding death certification were changed — in ways that make the statistics unreliable. Guidance was issued which tends to reduce, rather than increase, referrals for autopsy.” (paywalled link)
Doesn’t that look as if somehow actual, medically important facts about CV-19 should not ‘come out’, should not be investigated? Next:
“Normally, two doctors are needed to certify a death, one of whom has been treating the patient or who knows them and has seen them recently. That has changed. For Covid-19 only, the certification can be made by a single doctor, and there is no requirement for them to have examined, or even met, the patient. A video-link consultation in the four weeks prior to death is now felt to be sufficient for death to be attributed to Covid-19. For deaths in care homes the situation is even more extraordinary. Care home providers, most of whom are not medically trained, may make a statement to the effect that a patient has died of Covid-19. In the words of the Office for National Statistics, this ‘may or may not correspond to a medical diagnosis or test result, or be reflected in the death certification’.” (paywalled link)
We’ve talked about this, about the difference of ascertaining if someone died ‘of’ or ‘with’ the virus, and why this difference must surely have an impact on all those ‘death toll’ numbers, on the Lockdown, the statistics influencing the government’s decisions. Dr Lee explains the way this scandal came about:
“From 29 March the numbers of ‘Covid deaths’ have included all cases where Covid-19 was simply mentioned on the death certificate — irrespective of positive testing and whether or not it may have been incidental to, or directly responsible for, death. From 29 April the numbers include the care home cases simply considered likely to be Covid-19.
So at a time when accurate death statistics are more important than ever, the rules have been changed in ways that make them less reliable than ever. In what proportion of Covid-19 ‘mentions’ was the disease actually present? And in how many cases, if actually present, was Covid-19 responsible for death? Despite what you may have understood from the daily briefings, the shocking truth is that we just don’t know. How many of the excess deaths during the epidemic are due to Covid-19, and how many are due to our societal responses of healthcare reorganisation, lockdown and social distancing? Again, we don’t know. Despite claims that they’re all due to Covid-19, there’s strong evidence that many, perhaps even a majority, are the result of our responses rather than the disease itself.” (paywalled link)
If you think this is already sufficiently scandalous, there’s even more:
“It might have been possible to check these proportions by examining the deceased. But at a time when autopsies could have played a major role in helping us understanding this disease, advice was given which made such examinations less likely than might otherwise have been the case. The Chief Coroner issued guidance on 26 March which seemed designed to keep Covid-19 cases out of the coronial system: ‘The aim of the system should be that every death from Covid-19 which does not in law require referral to the coroner should be dealt with via the [death certification] process.’ And even guidance produced by the Royal College of Pathologists in February stated: ‘In general, if a death is believed to be due to confirmed Covid-19 infection, there is unlikely to be any need for a post-mortem examination to be conducted and the Medical Certificate of Cause of Death should be issued.’ (paywalled link)
Isn’t it as if those regulatory bodies who ought to have been most eager to examine this new virus, to find out how it works, blanketed any investigation by giving ‘guidance’ that somehow autopsies weren’t necessary in this pandemic. Why? Didn’t it matter? Dr Lee says next why it did and does:
“We need proper information to inform our responses to the virus, both clinical and societal. Instead, we have no idea how many of the deaths attributed to Covid-19 really were due to the disease. And we have no idea how many of the excess deaths were really due to Covid-19 or to the effects of lockdown. Officials should be releasing, as a matter of urgency, detailed information on the surge in deaths, both apparent Covid and non-Covid — particularly in care homes. How many are dying of Covid acquired in hospitals? Data presumably exists on this too, but is not released.” (paywalled link)
Ah – I can answer that one: it’s because of ‘patient confidentiality’ – something the government blithely disregards when it comes to their fabled ‘test-and-track’ app! Dr Lees’ concluding remarks emphasise why this is a national scandal
“The first rule in a pandemic should be to ensure transparency of information. Without it, errors can go undiscovered — and lives can be lost. We will never be able to find out for sure what this disease was like, or what it did in the early stages of the crisis.
One of the unappreciated tragedies of this epidemic so far is the huge lost opportunity to understand Covid-19 better. We like to beat ourselves up for having the worst Covid death toll in Europe — but we will never know, because we decided not to count properly. In a country that has always prided itself on the quality of its facts and figures, the missing Covid-19 data is a national scandal.” (paywalled link)
It is indeed a national scandal – even more so because these vital questions are being given scant regard in ‘Our MSM’. It is even more a national scandal because government seems to have been relying solely on the predictions and models of all those SAGE ‘experts’ without asking for any medical proof for these predictions which autopsies ought to have provided.
The greatest scandal is that all those medical governing bodies have thrown away vital opportunities to research CV-19 – as if it’s ok to accept all research that comes out of China, without the need for any independent research here in the UK.
And our ‘speaking truth to power’, scrutineering MSM …. remain silent.
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