Pandemic seasonal cheer

We have to calm down and not impose ridiculous standards on ourselves. It is a ‘virus’ and will circulate – Pic by Shehan Gunasekara

Thursday, 24 December 2020 

Dr. Waqar Rashid, Consulting Neurologist and MS specialist writes poignantly: “We appear to be attempting to stop all transmission of a respiratory virus that is already widespread. We are doing it with draconian measures which have little or no evidence of net benefit, and we are doing it in mid-winter. I have never seen anything like it.” Indeed, neither has anyone else. 

 

If there were a Lanka version of the above, it would read: “We are attempting to stop all transmission of a respiratory virus that has barely spread though our panic suggests it has infiltrated all our lives. In fact, prevalence here has not even reached half of 1% (still less than .005%). We are doing it with erratic measures that are frequently revised, rendering guidelines that are meant to keep us safe, moot. Despite our dressing up mortality statistics with the most tenuous cases where C-19 had any role at all in the death, our death tally continues to limp along at numbers so objectively unremarkable that they ought to make the most paranoid person blush. So, our actions have no evidence of net benefit other than further damaging an already besieged economy and thereby inflicting further suffering on our people and it seems no amount of lack of evidence will deter us from this fevered course.”

The funny thing is, as I am at pains to keep pointing out, in the COVID wars Lanka is winning! Yet for some reason we wish to continue a narrative at odds with some of the least worrying and actually most encouraging stats on the planet relative to COVID-19. 

While other Asian countries which clearly show even lower death stats (for example, Taiwan, Hong Kong, Singapore, Vietnam) scrupulously count as COVID deaths only those deaths clearly caused by respiratory distress flowing from pneumonia that was instigated by COVID-19, in our case, by contrast, we flash headlines about a 39-year-old female who recently succumbed, and then we find her cause of death was ‘disseminated tuberculosis, sepsis and multi-organ failure along with diabetes and then COVID pneumonia’ included on the roster. I don’t know about you but reading that lineup does not particularly instil in me a terror of COVID as a pernicious predator that is cutting down citizens at whim. 

On that same date (19 December) we had an 88-year-old female put on the COVID death ledger who we read had hypertensive heart disease and was chronically bedridden following brain infarction and then there’s a mention of COVID chest infection. A 77-year-old male is listed who had diabetes, hypertension, dyslipidemia, ischemic heart disease and then COVID pneumonia is listed. You would be hard pressed not to conclude that while some form of pneumonia may well have weakened their state, that is not what caused their demise or instigated the chain of events that led to it. 

Unterrifying as our death stats are (roughly 145,000 COVID ascribed deaths in India, 8,900 in Pakistan, 7,100 in Bangladesh, 1,700 in Nepal and only 176 in Lanka and this leaves out any consideration of the truly large numbers ascribed to COVID in Europe and the US), one has to wonder what our stats would be if we applied the same discipline as some of the other Asian countries in sifting between deaths ‘from’ as opposed to deaths ‘with’ COVID. 

Keep in mind again, just as examples, France at its height had over 30,000 plus positive test cases per day, Greece, a relative success as I’ve mentioned before, close to 100 deaths recently on a single day, and it remains overall a success given recurring mortality numbers in various parts of the world. We have to calm down and not impose ridiculous standards on ourselves. It is a ‘virus’ and will circulate. While staying prudent and vigilant, this indeed for Sri Lanka should be a season of relatively good cheer and comparative jubilation on this front!  

But what if it spreads?

The argument seems to be that if we don’t keep destabilising our economy, alarming people with shifting goal posts – allegedly to keep this dread scourge from pervading all of our lives – things might spiral out of control. I want to make three controversial statements that, on the facts, are actually uncontroversial and easy to defend. 

1) It doesn’t really matter if it spreads if we will take a few simple measures, and with those taken, it may be better if it does. 

2) The lockdowns haven’t worked and don’t work except to cripple the economy, and the sooner we can completely get past our fetish for them, the better. 

3) Mask wearing essentially doesn’t work, so we’ve already experienced what life and virus spread would be like if we weren’t using them. So, there isn’t much to fear if that were reversed.

 

Let it spread

Let’s start here. Remember, outside those who are 65 and older, and those with serious comorbidities, there is a 99% recovery rate globally. Ergo, who cares if this spreads outside that demographic? Can we keep repeating this awareness please, until it is tattooed into our consciousness? So, for the elderly, we usually are careful in the winter during flu and influenza season in particular, as we know a cold can be lethal, infections can persist, and medical issues can become chronic. For those with multiple comorbidities, we can exercise greater care, keep them from superspreader environments, have people be particularly attentive re hygiene around them, and if the vaccines seem ‘safe’ after some rounds of application, these are the folks who should get them.

What we don’t want is mindless panic like that being spewed in the UK re the ‘mutant’ varietal that has now plunged London into ‘Tier 4’ lockdown while people try desperately to flee over Christmas to escape this sudden edict. The COVID-19 Genomics UK consortium has confirmed this ‘new’ mutation has actually been around since September, and it is neither more lethal nor less amenable to vaccination. In fact, though touted to be more infectious, even on that front, the evidence is scarce. As Sharon Peacock, COG Director pointed out, “We are still dealing with very thin evidence at the moment about this variant.”

Dr. Maria van Kerkhove, Head of Emerging Diseases at WHO, has confirmed this ‘strain’ has been circulating for months! The main evidence that the variant transmits more readily seems to be a recent surge in London and the South East. But these types of spikes are typical for December, and though this month is predictably the busiest month for hospital admissions for respiratory disease in the UK, the hospitals there report being quieter this year than last year!

So, let this mildly lethal pathogen spread, as we have to, and if feasible and where applicable, via vaccine and otherwise via basic immunology from the overwhelming majority not at risk, let’s develop immunity, or else we’ll be cowering forever. For the first time in centuries due to the capsizing of logic and clarity, large parts of Europe will be forbidden from celebrating Christmas together – on no good evidence whatsoever, but a governmental shroud thrown over gross incompetence and inconsistency.

Not wishing to emulate that here and having had multiple clusters and more recently, allegations of people ‘traveling’ causing infection and the Western Province being a seething petri dish of infection (these last two are factually rubbish), we have virtually no cases by any global standards (half of 1% prevalence would put us at 105,000 cases). And if our hospitals get full, it is a choice, as we send the vast majority of asymptomatic cases for the same treatment as those needing medical attention. That is a choice, and not a wise one.

 

A review of the deadliness 

There was a recent assertion that COVID-19 is about ‘three times’ more deadly than the flu. Not really, except above the age of 70. Hospital mortality rate for C-19 has come down dramatically from the spring, since we’ve learned more about treating it. The flu mortality rate is also tempered by annual vaccinations. 

Sweden, that bloody disruptor, showcases no excess mortality between July 2019 and July 2020. There was a 1% mortality rise in the above 80. So how can a country that took such mild precautionary measures not have deaths higher than normal? This suggests elsewhere either there was a misguided ascription of deaths to COVID when other causes were primarily responsible and possibly the ‘dry tinder’ or mortality displacement of a build-up of a frail, vulnerable elderly population after a very mild flu season (2019). Despite still only light measures compared to other countries, even re the autumnal ‘surge,’ ICU admissions re COVID have been falling in Sweden since end of November. 

And re the flu, Dr. John Ioannidis’ paper on behalf of WHO, looking at 61 studies around the world of serological analysis to calculate IFR (infection fatality rate rather than ‘case’ fatality rate which can be spurious), gives us globally an IFR of .05% for healthy under-70’s. Compared to that, the IFR of the 2016-17 flu epidemic in the US, for example to take a robust comparison case, gives us an IFR between .1% and .2%.

 

Lockdowns did nothing for us

In Sri Lanka, we imposed ‘curfew’ not just ‘lockdown’ initially, and we did it when there was no real spike in cases or mortality. This left us in the curious position of having no curve to really flatten. Since then, we have really had a spate of clusters.

However, there are a plethora of studies re the global efficacy of ‘lockdown’ and the portrait they paint is not a pretty one. So here we go:

• EClinical Medicine 25 (2020), country-level analysis found full lockdowns and widespread C-19 testing were not associated with reductions in critical cases or mortality.
• 23 June 2020, Sage Preprint, official data from Germany’s RKI agency suggested that the spread of the coronavirus in Germany receded autonomously before any shutdown interventions could have become effective. 
• 8 August 2020, Cornell University pre-print, showed infections were in decline before full UK lockdown (24 March 2020), and infections in Sweden, with no lockdown, started to decline only a day or so later.
• 16 April 2020, Professor Ben Israel’s analysis of countries around the globe, showed that rapid rise in infections reaches a peak in six weeks and declines from the 8th week, regardless of response policies.
• 1 May 2020, Thomas Meunier, MedRxiv Pre-print, shows across multiple countries, comparing trajectory of the epidemic before and after lockdown, no discontinuity in the growth rate, doubling time, and reproduction number trends.
• 28 September 2020, Med Rxiv Pre-print, multiple authors, concludes ‘…most of the slowing and reversal of COVID-19 mortality (looking at 11 European countries) is explained by the build-up of herd immunity.’ 
• 2 August 2020, SSRN working paper, comparing weekly mortality in 24 European countries, the paper found ‘that more severe lockdown policies have not been associated with lower mortality. In other words, the lockdowns have not worked as intended.’
• 15 September 2020, Belarus remains another outlier. Mass events have continued, schools are open, country’s death rate is among the lowest in Europe…just over 700 deaths in a population of 9.5 million with 73,000 confirmed cases (again compare stats with Lanka!).
• US States with fewest coronavirus restrictions, 6 October 2020, WalletHub, the study reveals no relationship in stringency levels as relating to death rates, but only between stringency rates and unemployment. 
• The Taiwanese miracle, 2 November 2020, endogenous factors rather than political response predominate. They did ‘everything wrong’ as per the ‘playbook’ but have the best public health results of any country in the world. 

 

Ergo, by overwhelming data, ‘lockdowns’ have had little to no impact on mortality. Ergo, our fascination with them, with the collateral economic damage caused, has to be relinquished. They do not stave off COVID deaths (few enough as those are), and they have no net benefit to overall mortality. But they are a shattering impact on the economic livelihood and wherewithal of a nation, crippling by paralysis, where we are ‘ordering’ people into bankruptcy for nothing, other than silly superstition from a ‘penal remedy’ never before 2020 a part of any public health prescription.

 

Unmasking

In very congested environments, where ‘macro’ particles can also be hacked, or coughed, or sneezed, yes there can be value. Wearing them outdoors, when safe distance is easy, is not only silly, it’s dangerous in terms of being able to breathe and the quality of oxygen supply, and the danger of unduly breathing in your own waste (CO2), which we are not designed to imbibe.

Let’s just go to manufacturers for validation. Here is the ‘warning’ on the box of a large-scale US manufacturer of cloth masks and I quote: “WARNING: This product is an ear loop mask. This product is not a respirator and will not provide any protection against COVID-19 (coronavirus) or other viruses or contaminants.” Further down on the box: “Wearing an ear loop mask does not reduce the risk of contracting any disease or infection. User is solely responsible for the selection of appropriate personal protective equipment for the setting and application. Change immediately if contaminated.”

The legalities of not ‘confessing’ that in the US are overwhelming, so the truth will be out. California has been locked down for weeks, mask mandates galore and still double the hospitalisation rate as Florida which has theme parks open, no capacity restrictions for restaurants, and most counties without mask mandates. So how is this objectively possible? Some of the best public health stats world-wide come from Denmark and Norway, which were more ‘shut down’ than Sweden, but do not enforce public mask wearing. The Norwegian government flatly says they have studied masks and they don’t work.

Coming back to Florida, masks are a ‘county’ issue there. Three counties allowed the mandates to expire by 10/23. If you review all 67 counties in Florida, the counties without mask mandates clearly have measurably lower case rates and lower case growth!

The ‘rationale’ is simple, cloth masks cannot stop infitesimally small airborne aerosols and droplets, there is a gap between face and mask, and eyes are exposed. Even surgical masks are designed to protect against respiratory not viral droplets. Only respirators, face fitted and sealed with their own oxygen circulation provide meaningful viral protection, and these are not advised to be worn for more than two hours at a time and need to be scrupulously sanitised. For an illness 99% recover from anyway, this clearly seems much ado about less than a little something.  

And we are only fretting due to the unsubstantiated hobgoblin of ‘asymptomatic spread’ which a 10 million strong recent study out of Wuhan (published in Nature magazine) was unable to find one instance of, and a JAMA meta-analysis of 77,000 people, found transmissibility to be close to 18% indoors for the symptomatic, and .7% for the asymptomatic, which reads almost as a rounding error.

 

The mutant

A new ‘mutant’ strain of COVID has thrown the UK and travel to and from into disarray. But evidence shows its rapid spread has also coincided with a drop in death rates - suggesting it may be less fatal.

Dr. Paul Tambyah, President-elect of the International Society of Infectious Diseases, said: “Maybe that’s a good thing to have a virus that is more infectious but less deadly.” The top infectious disease expert said most viruses tend to become less harmful as they mutate.

Dr. Tambyah, who is also a Senior Consultant at the National University of Singapore, added: “It is in the virus’ interest to infect more people but not to kill them because a virus depends on the host for food and for shelter.”

To show how media hysteria can be selectively fostered, please note, scientists discovered the mutation as early as February and it has circulated in Europe and the Americas, as per WHO, who has also said there is no evidence to mutation has led to more severe disease.

The UK’s Professor Nick Loman from Birmingham University said there wasn’t any significant association with survival rates and the length of hospital stays for people who presented with that mutation after extensive assessment. With a 99% recovery rate below the age of 70, if less virulent, this clearly is not much of an issue. The greater transmissibility while asserted, is currently also just conjecture.

 

Economic cheer

Sri Lanka’s resilience during the harrowing three plus decades of the civil war was remarkable. The rebound of communities after the tsunami was beyond inspiring. Even after the Easter bombing, the hospitality sector and tourism by December of the same year were almost on par with the year prior. This was to be the year of growth and sustained breakthrough.

And then came COVID, and we were blessedly insulated to a large extent, by being in an immunological corridor that continues to confound the modelers and extrapolators (Asia has 60% of the world’s population, and only 19% of the ‘ascribed’ global COVID mortality, despite China and India being in our collation). Among South Asia, again, we had trifling statistics, and so we should be parlaying this, and the wonderful work of our leaders and public health and medical professionals to have a ‘positive’ economic surge.

Despite tragic ‘magical thinking’ that purported to claim that months of total shutdown for an already indebted nation wouldn’t leave us with the piper to pay, multiple downgrades, missing import income, missing tourism income, foreign remittances not incoming, leave us with an acute need for innovative, disciplined, focused, action in every sector of the economy. And that means we need the stability and clarity and confidence to invest and move forward, and not be fearing every ‘positive test surge’ from somewhere, will have us in full-fledged retreat again.

It’s a virus, not the Black Death or a rampant plague. Since lockdowns don’t work, we’ve experienced the virus anyway. Since masks don’t really work, we’ve already experienced the virus on that front. We need to follow real science and open schools, UNICEF has been horrified that governments keep shutting schools as a first step rather than last resort, though children clearly are at less than nominal risk and seem not to transmit (Taiwan, Sweden, Switzerland, all have showcased that).

So could we gather our fabled resolve? Could our leaders rally that serendipitous resilience? During this season of cheer and joy and mercy, could we decide with the American President FDR speaking in the midst of the Great Depression, “The only thing we have to fear is fear itself.” This virus does not merit our meltdown. Let’s face the facts, they are extremely friendly! And let’s let this ‘resplendent isle’ fully shine this season and beyond!