Basic pandemic literacy

The level of spread via asymptomatic hosts is highly controversial still, and that is agreed to by the WHO. But even if it does spread in that way with any significance, as fatality rates are so low, particularly here, again it would not justify the panic merited by say diabetes or car accidents on the island – Pic by Shehan Gunasekara 

There was a strange press release from the medical fraternity. I am utterly baffled by its pervasive illogic. Let’s take a look.

The suggestion was that Lanka delayed action re the pandemic this time, and WHO says ‘over-reaction’ is better than ‘delayed action’. If indeed Hurricane Katrina is coming towards you, or you have already delayed key action for months, maybe. Otherwise, for leaders who have to balance social and economic needs, precipitous action usually is a sign of confusion. 

And having been alone in the world in keeping in place a 24/7 curfew in the spring for several months quite unnecessarily (given both the more than modest number of cases and certainly the nominal number of genuinely ascribable fatalities when that ‘curfew’ was not recommended by any medical best practice globally), thereby bringing the economy to the literal brink of insolvency, it is hard to argue that we haven’t already flirted with ‘over-reaction’.

As we write there are numerous ‘positive test results’ in Lanka, far fewer live actual ‘cases’ and virtually no ‘deaths’, so when the medical Cassandras speak ominously about ‘the present situation’ I am not quite sure what we are to be quaking from.

They say we may be on the verge of ‘community transmission’. We may be, and it may be inevitable, and we are yet to hear how these oracles would have us stave it off. Other countries have gotten there, and in Asia many of them have IFC (infection fatality rates) that are a fraction of the global average. Certainly, it is nothing to encourage or be reckless with, but it cannot be the sole consideration in running a country and an economy and safeguarding a way of life. And factually, currently, as per reports, this is still very cluster driven, amplified through the fish market network superspreader environment, not currently showcasing any rampant ‘sprouting’ of unconnected cases all over the island. And if we don’t find manageable solutions going forward that let life and liberty and economy and interaction proceed as optimally as they can within the boundaries of medical prudence (and this should be debated not just asserted), we cannot proceed, the virus wins. We are held hostage…to far from reliable PCR tests posing as arbiters of national wellbeing. And when there’s a next pathogen, is this the new playbook…stop the economy and paralyse our lives, and hope someone somewhere can pay for it?

The statement suggests C-19 spreads more rapidly, including via asymptomatic hosts. And it is mentioned that when it strikes hard, there is a need for ICU treatments for the patients suddenly that can overcrowd hospitals. The level of spread via asymptomatic hosts is highly controversial still, and that is agreed to by the WHO. But even if it does spread in that way with any significance, as fatality rates are so low, particularly here, again it would not justify the panic merited by say diabetes or car accidents on the island. “When it strikes hard,” is true of many serious illnesses. This doesn’t very often, so why throw that in for confusion?

We are then told we had “three COVID-19 related deaths in a short period…” Globally, statistically, not even a blip. Many of our 19 clearly had comorbidities and it is utterly unclear that they died ‘from’ rather than just ‘with’ C-19. One of these three was suffering from cirrhosis, and I continue to seek clarity re the other two – however one of them was tested after dying and only then did C-19 get confirmed, ergo they can hardly have been treated for it during their illness. Again, this seems more like panic mongering than medical testimony.

Nuwara Eliya closes ‘voluntarily’ and guidelines galore for Western Province

Adding to the bizarre brew, we learned on Thursday the 29th, that 30 people in Nuwara Eliya were ‘exposed’ to C-19, quote ‘in the entire district’ and therefore people were requested not to visit Nuwara Eliya, and for any sad souls who had legally and properly made such plans for the long weekend, all tourist attractions were being hereby closed.

I am unsure about the nature of this ‘exposure’ but 30 people in a district of 700 k plus, especially a green, verdant, windswept district, with ample open spaces and natural distancing opportunities galore, hardly seems a basis for this bizarre fetish to shut everything down and further impoverish all those depending on such business.

Again, published Government guidance is unanimous with that of the world’s medical guidance, thought it seems that we act as if we’re reading from a different hymnal. C-19 spreads person by person, through droplets primarily, and with limited aerosol transmission ‘possibly’ but in closed, poorly ventilated spaces, and usually requiring some sustained contact, not a ‘whiff’ from an incidental passerby. Fearing catching COVID outdoors is about as close to ‘superstition’ as you can get from all global medical findings.

To be even more cautious masks are being requested at least indoors or when close to others, though WHO guidance, and global guidance, has never been to stay five feet part apart ‘and’ wear a mask (actually, it was three feet anyway, from Ebola on), but if you cannot maintain that distance, then to err to caution, and use a mask. Ergo, our guidance is extremely cautious and conservative, and officials tells us that if we just do this, wash our hands, and stay attentive to symptoms, we simply cannot pass the virus on. I would trust that and be suspicious of a testing regime that suggests ‘results’ that run contrary to overwhelming global medical consensus, certainly before blowing our economy up again. 

Our behaviour does not synch with the above guidance either, with the past panic of one stray ‘positive test result’ of a person, requiring an entire building to be closed, disinfected, and lives and livelihoods shuttered, when we don’t even know if the test is accurate (also particularly as in 85% of the ‘cases’ the person is asymptomatic). Again, how would they be spreading it if wearing a mask, everyone washing hands, and keeping prudent distance?

The exceptions are the ‘superspreader’ environments (garment factories, congested markets as we’ve had this time, concerts, rallies, large events, etc.). So, there, we need extreme caution for sure. Not sure, again, how that vaguely translates to Nuwara Eliya further rattling Sri Lanka’s already fragile sense of ‘recovery’ and the welcome instinct of fellow citizens and residents trying to provide custom across the island. Because if we are 30 people of a ‘positive’ test away from a district shutdown, viruses being tenacious and prone to mutation, we will not win here. We have then set completely unrealistic and unsustainable standards for ourselves.

Hot on the heels of this, we hear essentially ‘business’ and ‘life’ in the Western Province is to be put on suspended animation even once out of the weekend curfew, the rationale being given is the relatively large number of cases in this province (or again ‘positive tests’). But the primary superspreader vector, post garment factory, Peliyagoda fish market is in Gampaha. So why is this surprising?

Also, ‘lockdown panic’ hit France with 32,000 such positive tests in a day as a benchmark; 500-600 a day here for a few days, adjusting for a 70% accuracy of these tests in key labs (as accepted in last week-end’s reporting), seems a strange basis to literally ‘freeze’ normal functioning of a crucially (to national GDP) needed district with a population of around six million. So, again, in any sane, rational percentage terms, if these were even mortality numbers in that range, it would not justify stopping life, much less they being just positive test results, which if even all of them become cases – would present us with a 95%+ rate of recovery by what we know globally).

I remain quite baffled by the hysterical frenzy. And in the hopes of helping us win a ‘winnable war’, one based on facts and deliverable achievements, rather than superstitious hobgoblins where the dire name ‘COVID’ dare not be spoken, and we are ready to unravel at the merest statistical whisper of it, here we go once more.

The virus

Corona viruses are among the viral agents of the common cold. So, start there, and please let it sink in. They are not UFO aliens from a dread pathogenic “no man’s land.” They cause largely benign, yearly pandemics of respiratory tract infections. Once more, please let’s let that simple observation, just sink in.

Coming to the current flashpoint, C-19 has a fatality rate which the CDC has variously pegged as .26|% (May) to more recently .65%, global studies come in around .2% and based on WHO estimates of global infection, .14%. So, I think our statement above factually stands. This is far from an unparalleled existential terror, and nowhere near the leading annual causes of mortality (60 million die per annum from various causes roughly).

Vulnerability: Age and comorbidities

An overwhelming majority of fatalities ‘linked’ to COVID, even if not ‘exclusively caused’ by COVID happen among the old and frail mostly with pre-existing conditions, and where below 65 almost always with those ‘accomplices’.

Lombardy in Italy, known for an elderly population, 95% of the fatalities included older patients with 1-3 existing morbidities, the mean age was 82. This is anyway close to the average life expectancy age in developed European countries.

The same data profile is found in the US and UK, indeed, basically everywhere. 

This is despite the loose characterisation of a ‘COVID death’. We saw it with diabetic heart patients and cirrhosis patients in Lanka who had COVID as an accompanying stressor or ailment, but it gets worse. In many jurisdictions, if you die from ‘cause x’ and after your death, they find you ‘test positive’ for C-19, you are tagged as a ‘COVID death’. This has happened to motorcycle deaths in the US and as one UK government insider put it, “It turns out you could have been tested positive in February, recovered, been hit by a bus in July and you’d be regarded as a COVID|death.”  Dr. Hendrik Streeck writing about Germany says: “In Heinsberg, for example, a 78-year-old man with previous illnesses died of heart failure, and that was without C-19 lung involvement. Since he was also infected, he ‘naturally’ appeared in the C-19 statistics.”

The US CDC guidelines (which have been ‘stoked’ by financial incentives from insurance) state, “It is important to emphasise that Coronavirus Disease 19 or COVID-19 should be reported for all decedents where the disease caused or is presumed to have caused or contributed to death.” 

Wow! ‘Presumed to have caused’ (who’s making these presumptions and on what basis?) or ‘contributed’ (how big a ‘contribution’ counts?).

Despite all this identification ‘mischief’, the age profile for fatality indicated stands, while one is left wondering about the actual ‘totals’ given all the above.

Even France and Germany with their current ‘reflexive’ (case number rather than mortality driven) announced lockdown, are keeping schools open. So at the very height of their panic, industry and schools are staying open, because not even the most crazed panic peddler can make a plausible case for children being substantively at risk or even in any demonstrable way being carriers of the virus.

Even the UK’s much touted ‘second wave’ has claimed lives of only 17 people under 40 (virtually all with pre-existing conditions). In the UK, 28 December to 16 October, post June more deaths to date from flu and pneumonia! In September in the UK, C-19 trailed in mortality terms prostate cancer, flu and pneumonia, other respiratory diseases, strokes and blood clots, lung cancer, heart disease and dementia in the UK. Why are those not equally epochal?

A brief ‘UK update’ as Boris Johnson’s newly announced ‘lockdown’ proposal for the UK is all in the news. Again, we need facts over hysteria. The BBC, which seems to trumpet such panic, let slip an ONS graph, showing flu/pneumonia death tolls in the eight years between 1993 and 2000 are still higher (by a fair bit) than ‘ascribed’ COVID deaths in the UK, which begs the question, how that data (lower death toll than a recent historical period) can rescue any argument for imposing greater restrictions when society continued to operate and flourish then.

Immunity

Between antibody studies, cross-immunisation with other corona strains, the so-called ‘second wave’ is a surge of cases with floundering relative hospitalisation and mortality statistics globally. Intensity has lessened as Farr’s law, a sturdy guidepost in virology, predicts. 

As of this writing, Sweden is 94 days+ with no lockdown or masks, and without any serious mortality numbers, declining trend lines all around. Asia and Africa continue to skate through overall, and Japan, Vietnam, South Korea, Singapore, Hong Kong, Taiwan, Cambodia, are mystifying outliers with exemplary results, some linked to policies (like contact tracing in South Korea) elsewhere to nothing really very much at all (like Japan).

Cross-reactive T-cells have been confirmed and validated in numerous papers. So ‘novel’ in the case of the coronavirus clearly does not mean ‘unique’.

When massive testing surges take place, there are inevitably ‘positive test’ surges in the wake of that, particularly when the bulk of these people are asymptomatic. These are being misclassified as ‘cases’, which once upon a time, in the quaint annals of yesteryear (as recently as 2019) meant someone sick with symptoms.

Only five cases of alleged ‘reinfections’ out of millions of ‘cases’ and these are not clear either. And it is completely unclear if this might be a subsequent strain or mutation. Anyway, it is so nominal, it isn’t worth really at present even exploring further.

As most everyone below 65, and particularly without pre-existing conditions are not at risk as demonstrated, let us let them take society forward rather than retarding and infantilising our collective immunity. 

Even the ‘excess mortality’ EuroMomo has finally seen across Europe (week 39 and 40 were normal, week 41 and 42 were very slight rises, week 43 is somewhat more pronounced) is virtually all in a few key countries and in the above 65 demographic once more!)

PCR tests and the ‘Case-demic’

PCR tests do not forecast accurately or effectively, as we’ve covered at length, the infectious power or lethality of what they are picking up. Only the daily evolution of fatalities gives us any credible output of how we’re really doing. For months and weeks, across Europe and even large parts of the US, there has been no sustained excess mortality attributable to C-19 as a pandemic; heartily true in Asia, Africa, certainly in Lanka. Positive test rates both have a technical false positive rate, and also, based on amplification settings, react to inactive viral fragments and potentially even other corona strains. 

In fact, globally, the daily addition to mortality from ‘COVID ascribed’ deaths since late May has never moved beyond fluctuating between 0 and 1%, contrasted with 12% to 15% and higher on a daily basis in mid-March. 

Ergo, looking manically at raw numbers of alleged ‘infections’ on a week to week basis out of context is deceptive and simply self-confounding if not downright dubious.

Lockdowns kill

Medical practitioners have said that if they were ‘prescribing’ lockdown, they would have to share side effects openly: and among these would be collateral health and medical damage from untreated or unscreened for other illnesses, educational and social erosion, community upheaval and economic meltdown. And then we’d say, “Are you okay” for that to be the case for an ‘experimental drug’ that was never sanctioned in any public health protocol until this year to tackle an ailment with a fatality rate of .14%, with mortality risk focused on those above 65 with pre-existing conditions? Shall we blow up the planet, our economy, and our society, especially in Lanka where we have to literally ‘strain’ to find 19 people we call C-19 mortalities when 12,000 pass away from various causes each month? It is hard to believe that any sane person would ask for that prescription to be filled. Vaccinations deferred, businesses wiped out, economic sectors collapsing, mental illness spiked, irrecoverable impact on children’s education, usurping of civil liberties, destroying social bonds, actions so extreme they have never been undertaken for any war, natural disaster, epidemic, pandemic, act of terrorism in anything akin to this sustained, ruinous, manner…to attempt to quell the ‘positive test results’ (which we can’t even bother to standardise or quality control around the world before paralysing life as we know it for), for a disease survived by over 99% of those under 70 who contract it. According to the CDC, even above 70, lethality is .054.

Great cities globally have become like ghost towns in the aftermath of this capitulation to insanity, as if a neutron bomb had been detonated there, and the ‘virus’ that created that dystopian hell, is our own blind, mindless, relentless, media infused panic. And so the real horror is mounting every day, looking around and seeing what we have wrought. 

As I wrote last week, we have done much better in Lanka, and should be avail of our success and advantages and build on our current, balanced, targeted approach, and not capitulate to ‘positive test’ mania.

It’s time

So we have to change the Lanka narrative, away from the silliness of ‘eradicating’ unconfirmed positive test results of a virus we have to yes medically address, but also evolve with and not cower from, and where real symptoms to address and not viral spooks are where we have to focus on.

Lanka’s life, its future, its development, its children, its enterprise, its people, its culture, its society, have survived more than this deranged ‘mental’ plague, and those aspirations and capabilities must resolutely take a stand for a much richer and larger future, rather than all public policy being perpetual statistical shadow boxing, an addled confusing of positive test results with cases with the ‘looming spectre’ of deaths – too many of us pixilated by a pathogen.