Dialling out the drama

Tuesday, 26 January 2021 00:50 -     - {{hitsCtrl.values.hits}}

Sri Lanka has opened, and if we can evolve in our protocols, and escape the PCR trap (which will inhibit our tourism, our lives, our planning, everything) now that WHO has further paved the way, if we can refuse “Covidian drama” and get our thrills there from Shakespeare and Oscar Wilde and their kin, if we can decide “enough is enough” and we are invited to outgrow the panic, and vote for solvency, sanity, and renewed success through our policies and actions, we can not only benefit ourselves, but be a beacon besides

Sri Lanka has to beware, moving mindfully and prudently forward, not to be waylaid by COVID “superstition” of which too much is afoot these days. 

It is a serious virus, and it is being effectively managed here, and on the other side of hysteria, we can say so confidently, based on very low related mortality by any global standard (and even there, many being called “COVID deaths” are not actually dying due to respiratory illness, so COVID was a bystander, or perhaps at most, a cohort to the primary illness, as pneumonia, influenza and their ilk so often are), and the relatively low prevalence in society (less than half of one percent of the population) even if every one of the “positive tests” were accurate, which they almost certainly are not. 

WHO to the rescue!

After months of these same points being hammered home by scientists across the globe, some pilloried for being “naysayers” to the orthodoxy, WHO has updated its guidance (almost a year late, but better late than never). The audience for this encyclical, published on the 20th of January is indicated as “laboratory professionals and users of IVDs.” Lankan professionals, take note!

Let us let WHO speak for itself for a bit, lest there be suspicion of our taking literary liberties here:

“The cycle threshold (Ct) needed to detect virus is inversely proportional to the patient’s viral load.” (English translation: lower the Ct setting, the more likely you are actually detecting “live” virus and contagiousness). 

“WHO reminds IVD users that disease prevalence alters the predictive value of test results, as disease prevalence decreases, the risk of false positive increases. This means that the probability that a person who has a positive result (SARS-CoV-2 detected) is truly infected with SARS-CoV-2 decreases as prevalence decreases, irrespective of the claimed specificity.” (English translation: when you have low prevalence, 1% is considered that by the way and we are well below that here, the impact of every false positive is magnified statistically, making “positives” increasingly dubious).

“Most PCR assays are indicated as an aid for diagnosis; therefore, health care providers must consider any result in combination with timing of sampling, specimen type, assay specifics, clinical observations, patient history, confirmed status of any contacts, and epidemiological information.” (English translation: the test by itself is not a diagnosis and has to be treated as one “input” among the other factors listed).

So: Breaking news! PCR tests are not, as per the WHO, proof of infection, and therefore flashing aggregate numbers is distorting as any confirmation of the spread of the illness. Ergo, automatically shipping people off to hospitals who have no symptoms is counter-productive, and not in synch with WHO guidelines.

The original Ct limits of 37-45 that were set are demonstrably absurd. Epidemiologists are converging on below 33, 30-27 being most accurately predictive based on viral load according to Harvard University’s Michael Mina.

Sri Lankan laboratories need to publish their FPR (False Positive Ratios), and as is now being urged by the WHO, also their Ct settings. Only then can we possibly sift the results. 


Silly drama, panic and media frenzy

Dr. David Katz of Yale points out that literally “epidemiology” is a study of impact on human populations. So, epidemiologically, when C-19 emerges, you respect the contagion and the challenge it poses, but rightfully disdain and resent the silly drama associated with it, the gorging on panic, and the media feeding frenzy. 

Unencumbered data showed this illness targets primarily those at or past life expectancy and is significantly more lethal to the elderly with comorbidities. Without panic pyrotechnics, protecting the vulnerable, and letting others develop immunity once this became clear (way back in April 2020), would have been the sane, dispassionate response.

But a new field emerged, says Dr. Katz: COVIDramademiology! And this really merits a post-mortem. Dr. Katz says this has been “rampant and diverse, ranging from inadvertent to cleverly crafted in increments of sound bite and clickbait.” 

Let’s take an example. Suppose you saw a headline, “Nearly 3 million die in the United States.” It’s horrifying. But if you realise the context is annual mortality, it’s the annual expectation, mostly from old age. Despite the “biological survival” at all costs mantra, we are all mortal. In a US population of 330 million, annual mortality is just under 1% therefore, a natural cycle of life.

We know deaths “from” and “with” COVID are dubiously tagged in the US. Moreover, reports from hospitals indicate that many in hospitals listed as “COVID patients” are being treated for other diseases, but just happened to test positive on being admitted. 650,000 people die of heart disease in the US each year (COVID deaths with comorbidities which could include gunshot wounds and poisoning, are showing as 400,000). Why are the annual heart attack rates not as tragic? And then we could go on to cancer and diabetes and more.

Perhaps we say these others are not “contagious.” Well, we are talking about impact, not mechanism, and for those outside the vulnerable demographic, the “contagiousness” is largely irrelevant due to immune response, but all are candidates for cancer by contrast.

If every death is truly a tragedy, how about the 1,800 a day from heart disease in the US? Countries around the world are guilty of the same blinkers. Car accidents could be flashed in Colombo with similar impact. It’s a choice re communication we’re making, otherwise it’s just hypocrisy.

We know that flu deaths have virtually “disappeared” from the catalogue, at least 100,000 lower than a severe flu season. So, clearly some of the “COVID deaths” would have been attributed to deaths by flu, along with an array of other viral infections that seem to have gone into hiding. Why would there have been no drama in that data or world-stopping agitation as in this case? Why calamity if by COVID, ho hum if by flu?

Suppose we take a cancer comparison says Dr. Katz. In the US, roughly 1,600 die from cancer daily. Suppose we “cured” cancer. So now more of these people live longer, their hearts wear out, and they die of heart disease instead. So now heart disease daily deaths climb to 2200 from 1800. We could flash the headline: “Heart Disease deaths Soar!” Perfectly true, and completely misleading.

Context is needed, and where people don’t see reality comporting to “dire” data, they start to doubt the overall narrative. So desperate sadness and an exaggerated helplessness battle anger and perhaps extreme denial.

Perhaps a proper autopsy of national responses is merited. Might calling people to civic cooperation rather than provoking mindless dread have worked better? Lest there be any nuance in “lockdown and mask” even if it doesn’t seem to work, the narrative and messaging was to bombard people with COVID deaths, as if no one was dying from lockdowns or deferred care or any other cause or would die from poverty or depression. Seasonal variations in hospital quotas were rarely, if ever, mentioned in reporting, and indefinite relegation of autonomous human beings to virtually enslaved troglodytes was somehow going to flourish as a replicable or even sustainable playbook?

Those mutants

Since discussing the inescapable reality here of differentiated risk was too much for us, we went from tackling a serious challenge to cringing helplessly before an alleged apocalypse. Instead, people needed to be recruited and empowered and asked to protect the vulnerable and to keep society functioning and solvent for everyone. 

The mutant strains (though viruses naturally mutate and so believing these are new invading alien hordes is silly), were engendered in part by our drawing out the crisis, and not trusting our immune systems to do what they have naturally done for billions of years as we’ve co-evolved with viruses. 

As Dr. Katz says, “Pathogens and our immune systems are opposing sides in an arms race.” So, random mutation deals arms to both, but vastly expedited to the virus. The more viral generations, the more populated hosts, the more likelihood of “advantageous mutation” (which usually means decreasing virulence, as viruses require living hosts to perpetuate). When dealing with an airborne pathogen that can take refuge in animal reservoirs (or can circulate in closed environments, or even “appears” as we learned recently, on a ship where everyone tested negative when they set sail and all but four were infected in a few weeks), you need “risk-stratified exposure.” 

Despite our refusing to accept it now, lest the coffers of pharmaceutical companies not bulge with such abandon, “herd immunity” is simply how pandemics end, a combination of natural exposure and vaccination when available. Our “lock it down” mania gave the virus far more time than required for innumerable mutations. So, here we are! We have aided and abetted viral spread. So, we can keep evading reality, and think some jab will give us reprieve. It may, but we’re hopefully not planning planetary, social and cultural Armageddon next time…so it would behoove us to learn some lessons this time.

Overstated impact

And despite all our attempts at “control,” we have a haphazard record before us. By way of demonstration, the Swiss in panic recently have gone for a month and a half lockdown. And to show up the silly panic that spurred it, the 2020 figures from the Federal Statistical Office were recently published. No mass death, and in no single age category, over the last 11 years, was 2020 at the top of the mortality league table! From 0 to 60, in Switzerland 2020 had an extraordinarily low number of deaths. Even between the 70- to 79-year-old category, it was number 6, and still only 5th place in the 80 to 89 category! Above 90, 2nd place. A Swiss doctor writing in “Bon pour la Tete” suggested a 79-year-old wanting to maximise his chance of surviving another year would, on that basis, choose 2020 over 2015, 2013, 2012, 2011 or 2010!

Of course, officials may be seeking to congratulate themselves on their success for this, except for the fact that infections were falling sharply in Spring ahead of the measures imposed, this happened again almost concurrently in the Fall, and already in the same week it seems hospital admissions were decreasing sharply to keep company with the panicked proclamation. So, if you want to pick the “wrong time” to shut down, these officials seem to have it pegged! This also coincided with the peer reviewed paper by Stanford University’s Dr. Eran Bendavid and Professor John Ioannidis, that showed no connection between positive health outcomes and lockdowns, replicating the findings of almost 30 other studies, arriving at the same results. 

German author and philosopher Ludwig Hasler bemoans the state of Swiss caprice: “…while the young are neither allowed to love nor suffer; no drama, no freedom – just security.” And that “security” is largely a phantom because of so many secondary impacts and collateral damage.

And then there are the Indians

For a time, the evangel was that Indian COVID cases were going to overtake and overwhelm that country. I have pointed out that in terms of mortality stats as a percentage of population, India is nowhere near panic territory, and all of South Asia seems to be in a rather charmed immunological corridor for various reasons.

An author pointed out that while India has the highest number of COVID cases after the US (or rather “positive tests” posing as cases as the US PCR protocols are absurd in many States re amplification thresholds), on the “optics” both are contrasted with say Australia as a poster child for success. However, lift the hood, and it’s a little different. 

First, Australia is sparsely populated, is an island, and slammed shut its borders, denying its own citizens access to their country. Residents cannot leave. There aren’t sufficient quarantine facilities for returning travellers about 11 months into the pandemic. People are stranded without income, separated from families, so this does not fill me with a sense of exemplary handling. I’d be happier today in Stockholm and am very happy in Sri Lanka.

India used Antigen tests (which detect contagiousness) wisely to prioritise the most contagious to take the steam out of its summer surge. Lockdowns are largely lifted, and early treatment protocols are being used very successfully. The US standard of care by comparison, has little to offer until you are gasping for breath almost. The drugs used successfully in India and other jurisdictions were politicised or suppressed in richer countries as there’s no money to be made from them, and the respective medical professions are clearly over-regulated. And if anyone says “safety” they should be made to wash their mouth out when they in the next breath say “vaccine” (which bypassed all past standards for safety trials).

Treatments like Ivermectin are being increasingly studied. A study in Odisha found a 73% reduction in C-19 among frontline workers, and a meta-analysis of randomised trials sponsored by WHO, found a 75% reduction in mortality with favourable clinical recovery and reduced hospitalisation. As a further sign of progress re India, apparently 80% of the “live cases” in Mumbai are asymptomatic, and if we can start calling those “positive tests” not actual cases, we will be even more heartened.

And now the Germans!

The Weimar District Court in Germany has pronounced the Government’s social distancing rules to be “unconstitutional.” This is further inducement to operate on clarity and data, not superstition and panic. German courts are not usually prone to delusional risk taking.

A man was ordered to pay a fine for celebrating his birthday with seven other people, from eight households, six guests too many! I hope these officials don’t ever drop into a Sri Lankan wedding, though I applaud the latter (with medical prudence) and decry the German scaremongering. 

The Court pointed out the state has to provide “precision in legislation.” Laws cannot impose across-the-board regulations. Bravo! Why not? Because it is a license for authorities to act on their whim, and that is not what democratic free societies are constituted for. 

While the Federal Infection Protection Act in Germany (IPA), allows temporary isolation or contaminated areas to be closed off, it does not envisage a general ban on contact extending to healthy people (again “asymptomatic” contagiousness has no demonstrated medical credibility, studies from Wuhan to Florida recently demonstrated that).

A counterargument was legislators could have imposed expanded restrictions for an “unprecedented event” that was not envisaged when the laws were written. However, in 2013 a risk assessment had been done by the Robert Koch Institute concerning a potential virus caused, wait for it, by a “SARS-type virus” which described a scenario of 7.5 million dead over three years and looked at anti-epidemic measures. The Court said with this “conditionally probable” scenario having been considered, if the government was not prepared for the pandemic, they cannot now close gaps in legislation as they see fit.

The Court also points out the data does not support a claim of an epidemic situation in Germany, numbers fell in Spring, and are not surging now. The Court found the lockdown came late and was generally ineffective! Even at the height of the crisis, at least 40% of ICU beds were available at all times! It gets “better” or “worse” depending on your perspective. Taking data from 421 clinics, the Court noted the first half of 2020 had lower severe acute respiratory infections as compared to 2019! The same for ICU and respirator cases.

The judge says in a damning summary: “A general ban on contacts is a severe intervention in civic rights. It is one of the fundamental liberties of the individual in a free society to determine…with whom (on presumption of consent) and under what circumstances he or she will make contact.” He continues, “Never before in Germany has the state come up with the idea of imposing such measures to counter an epidemic.” Even the risk analysis earlier alluded to does not consider anything so invasive. 

The judge also says a fundamental freedom is to decide what risks to take. “A citizen’s choice of visiting a café or a bar in the evening and running the risk of a respiratory infection for the sake of social interaction and pleasure in life or exercising caution because she has a weakened immune system...” must stay entrusted to them. Note the judge has not succumbed to the “COVID is radioactive” idiocy, ‘tis a virus.

Living beyond the drama

That German judge is onto something, citing also profit losses directly, indirectly, wage and salary losses, bankruptcies and destruction of livelihood and those costs to society.

Lanka has opened, and if we can evolve in our protocols, and escape the PCR trap (which will inhibit our tourism, our lives, our planning, everything) now that WHO has further paved the way, if we can refuse “Covidian drama” and get our thrills there from Shakespeare and Oscar Wilde and their kin, if we can decide “enough is enough” and we are invited to outgrow the panic, and vote for solvency, sanity, and renewed success through our policies and actions, we can not only benefit ourselves, but be a beacon besides.

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