We have a fighting chance to recover in Lanka. C-19 related death rates are too mild to mention when normal mortality is about 12,000 a month, even with skewed death certificates. We are killing ourselves with two things: slavish adherence to PCR tests which now WHO has finally also officially indicated are not equivalent to ‘infection’ in and of themselves (why we don’t use the Antigen tests more comprehensively is far from clear, as they actually track ‘contagiousness’ not ‘presence’ of what could be viral debris), and secondly, pretending an asymptomatic person is the same risk as a symptomatic one – Pic by Shehan Gunasekara
Well, a so-called ‘leading’ Australian think tank has given Sri Lanka the status of ‘10th best’ for handling the COVID crisis. I cannot say I am impressed by their analysis, but not for reasons you might think.
On the other hand, we also read that ‘infected’ patients may have to spend two days at home before going to hospitals and treatment centres due to lack of availability here (already happening in Gampaha based on some reporting). Critics may cackle, saying how inconsistent that is with ‘10th best’ status.
Well, handling the crisis, and managing it, may be two different things. PCR tests, as WHO has now confessed (see my last article), or go online, cannot by themselves confirm ‘infection.’ Cycle Thresholds (Ct) matter (should be below 30 to correctly identify high viral load), prevalence matters (the lower it is, the higher the likelihood WHO says of ‘false positives’; low prevalence is considered 1%, we are below half of that while being strangely overcome with unwarranted alarmism), and then a slew of other diagnostic issues, including presence of symptoms (hinted at more obliquely, but clearly part of the clinical review) should be consulted in coming to a determination. Ergo, the sheer presence of a ‘positive’ PCR test is not conclusive. Yet we send asymptomatic (the bulk of our so called ‘infected’) and the symptomatic (those who actually require such attention), to the same quarantine strictures as if they are equivalent, and they manifestly are not. More on this to follow.
Back to the award. New Zealand is given first place, and Australia is ranked higher than Lanka. This is ridiculous, Lanka clearly should score higher than either or both, but then so should China, Singapore, Hong Kong, Japan, South Korea, Belarus, and depending on standards you apply much of Scandinavia. If ‘handling COVID’ simply means counting ‘cases’ (positive tests) and ‘deaths’ (far more relevant), without seeing at what cost to society or economy or functioning, then such ‘handling’ is irrelevant. And if you are a small country with far less travel, smaller population, isolated, anyway, C-19 is not going to land in the same way as in Mumbai or Lombardy or Brooklyn.
But beyond these variables clearly not consulted in looking at the actual ‘achievement’ (parts of Africa can easily match such stats if looked at in detachment, Seychelles and Mauritius among them), the problem is New Zealand is the last model Sri Lanka should follow!
Statistical footnote: of the two million or so ‘purported’ COVID deaths globally (despite how they are categorised in terms of COVID being a real ‘cause’ or just a ‘bystander’), about 1.3 million come from Europe and the US. All of Asia is about 360,000, in a region including both China and India population-wise!
Can anyone with a straight face tell me this is an epochal, once in a lifetime, world changing pathogen, for this region? And anyone who thinks this is due to masks in Asia, or social distancing, needs to get their eyes checked. Full-scale lockdowns have happened here in spasms yes but have never been flogged as the new reality.
Beware isolation perpetuated
India and Japan have a travel bubble between them, Lanka has tourists slowly trickling back, Maldives is open, Florida is open, and Australians can’t even fly to New Zealand! Some achievement.
No one can visit Australia, and even Australian returnees must pay for lockdown quarantine hotels for 14 days to come home! They are threatening a continuation of this farce until 2022. If so, let’s write off Australia from the world stage and off any laudatory lists. Moreover, a whiff of C-19, and Australian states mutate into police states, ghastly ones. And they have one third the cases of Lanka and three times the claimed deaths (though our death certificates seem to add in everyone who died from anything but also had a positive PCR test), and they have only three million more in population, so not a great benchmark for us.
New Zealand for a disease with a 99% global recovery rate below 60 locks down entirely if there is a single case, thinks they ‘might’ begin their vaccination program mid-2021, and entire sectors of its economy are verging on indefinite collapse. I warned against this in the unnecessary long months of ‘curfew’ here, and we too are facing extreme economic challenge and wide-scale hardship for the poor and lower middle class in particular. So, our models have to be open economies, or more open economies who managed the pandemic within the bands of normal annual mortality. New Zealand’s economy shrank at a record 12.2% in the June quarter for example. Becoming a client state of China, who is happy to step in (their own non-locked down economy is growing nicely), is already on the cards.
The asymptomatic myth and blunting corporate effectiveness
We have a fighting chance to recover in Lanka. C-19 related death rates are too mild to mention when normal mortality is about 12,000 a month, even with skewed death certificates. We are killing ourselves with two things: slavish adherence to PCR tests which now WHO has finally also officially indicated are not equivalent to ‘infection’ in and of themselves (why we don’t use the Antigen tests more comprehensively is far from clear, as they actually track ‘contagiousness’ not ‘presence’ of what could be viral debris), and secondly, pretending an asymptomatic person is the same risk as a symptomatic one.
On the latter, there are three major papers always referred to when making the case for asymptomatic spread (for example, a recent claim that asymptomatics are 75% as infectious as symptomatics in JAMA for example). All three are outlier papers, one from South Korea, two from far flung lands (which doesn’t invalidate the paper, but quality control is harder to ascertain).
The South Korean paper, with some 300 people involved, concludes ‘viral load’ is the same whether symptomatic or asymptomatic, but then argues that ‘viral load’ is not the same as transmissibility! In the conclusion it says therefore no conclusions re transmissibility can be reached on this basis! Not quite sure why it was undertaken then, or is ever cited?
The second paper, from Brunei, finds the symptomatic are roughly three times more infectious than ‘presymptomatic and asymptomatic’ added together! But why bundle the two? There is no controversy that those ‘pre-symptomatic’ are contagious, hence the efficacy of the Antigen test which is sensitive to this. This allows no conclusion, given that even the paper confesses ‘presymptomatic’ are considerably more contagious than ‘asymptomatic.’ The final is a modeling paper, which I will discount as it’s not empirical.
Against this are four recent studies/assessments, a 10-million-person Wuhan study finding not one instance of asymptomatic transmission, University of Florida the same result from their extensive sampling, the British Medical Journal saying it was not a major factor in dealing with C-19, and a JAMA meta-analysis of 77,000 where symptomatic household transmission was 18%, and asymptomatic was .7%, considered within the margin of error.
Therefore, the recent announcement in Lanka of a revision of protocols for dealing with those testing positive is disappointing. In one way, it’s progress, in that it says that if the lab result came from a lab with a Ct setting above 30 (arguably too high an amplification setting), a second test for antibodies will be done, to dial out the possibility that the test is picking up ‘leftovers.’
But wouldn’t it just be better to insist that no test with a Ct setting above 30 will be allowed? End of confusion, end of waiting period, end of yet another lab test. 27-30 settings show very few false positives, and usually don’t pick up ‘debris’ as per Harvard University, among other leading institutions.
And if you are asymptomatic and test positive, surely five to seven days of home isolation is it, as we don’t even know these people pose ‘any’ danger whatsoever. And five days is an established global standard. Why ship the asymptomatic, which on preponderance of evidence are only nominally if at all contagious, to Jaffna, destroying livelihoods for over two weeks, putting strain on businesses already running with barely sufficient staff, imposing stress and grief on families and impairing all kinds of personal needs…for an unsubstantiated myth, hyped by a rumour mill? If they are at home, what is the danger, if no symptoms, if general protocols are adhered to?
A CEO I spoke to recently mentioned how difficult it is to run a business on this basis. No one has an issue with treating the symptomatic, until 2020, that’s what medical care was for! But now, one PCR test, and a whole division can be shut down, which makes people wonder, ‘What are the guidelines for?’ If not meant to keep you safe in precisely such an instance, even if you encounter someone infected, why do we have them?
Beyond that, this leader pointed out, they have to reorient a whole work unit, or swap them out, or have two sets of teams ready in case of one stray, possibly false positive (unless we insist on Ct levels and use more Antigen tests which by being less ‘sensitive’ are more responsive to actual infectiousness), which could shut down a production line say, with all kinds of delays and economic repercussions. And then there is the ‘pariah factor’ where no one wishes to be around the individual afterwards. It is ruining lives, when 10 times as many deaths come from car accidents here in Lanka, based on ‘non-science’ verging on ‘nonsense.’
Five days of isolation to be safe for the asymptomatic, everyone else carry on, trust the guidelines, and have the fulfilment of the guidelines be where the attention of the authorities go…otherwise having such protective guidelines are an expensive ornamental extra with no meaning. And they are, overall, actually very sensible, and we should trust them and use them accordingly.
Stop voting for catastrophe
In 2006, the smallpox eradicator Donald Henderson wrote a sweeping, magisterial article warning how ‘not’ to handle infectious disease, painting a misguided doomsday scenario that is today’s ridiculous reality. His portrait of misguided tactics involved perpetuating travel restrictions, forced human separation, business and school closings, mask mandates (I kid you not!), limits on public gatherings, quarantines and the entire grotesque cavalcade of brutality we’ve all experienced under the guise of ‘public health’ all year. Elements of all of these are wise, and we have prudent expressions of many in Lanka today, far more sage and balanced than the antics found in other ‘lauded’ jurisdictions.
His argument was society has to stay solvent so medical professionals are supported, and can work, and to ensure they are working to sustain something that won’t just collapse after their tireless efforts bear fruit. Diseases are dealt with he said, one person at a time, not by grandiose central planning.
It is great news that we live in a country, which along with other sane spots overall, around the globe, allows for a fair bit of normal life and a slow but sure ‘reset’ of society. In too much of the world, in too much of the ‘advanced’ part of the world (Asia largely excepted, except insofar as the terror of travel and tourism), you see businesses shut down, demoralised people unable to move about, fights breaking out over masks, all of the arts suspended if not wrecked, ‘cowering’ is the national pastime, while unemployment surges.
And the mistake is to say all this due to ‘COVID.’ It is not, let’s just stop regurgitating that silliness. It is the ‘pandemic response’ NOT the pandemic. Sweden, Taipei and Atlanta have COVID too, but are not suffering from this slew of insanities. So when the parade of ills is brought before us: restaurants bankrupt, opioid deaths spiking, alcoholism on the rise, suicidal despair becoming a default setting, murder rates going up, vaccinations with unknown consequences being marketed while known and needed vaccinations are foregone along with cancer screenings, etc. and ad nauseum, remember this. It is ‘lockdown’ not C-19 that is the culprit, our deranged, diseased, human fascination with controlling that which we cannot control, have never controlled, and likely never will.
And this ‘playbook’ can never be repeated, no one could or would afford it, except the New Zealanders perhaps who may opt to be colonised as a way out. We have never seen anything like this mass stupidity in history, and it shows the downside of global, viral, campaigns of ‘mass appeal.’ We are selling fact-free, economic suicide and social meltdown the way we once marketed Blue Jeans.
When three of the world’s leading epidemiologists (representing Oxford, Harvard and Stanford) write The Great Barrington Declaration with close to 800,000 signatures, we cannot even have a mainstream debate, so terrified are we of looking in the mirror. Instead, we vilify and demonise and resort to the rhetorical tactics of Orwellian ‘thought police.’ Even WHO had been intimidated after saying ‘no asymptomatic spread’ to ‘well as best we know, from the data we’ve studied, but we don’t believe it’s the main driver.’ Media headline: ‘WHO reverses position.’ It did nothing of the sort, they stuck to their guns as above, but had to do a little tap dance along with it.
Vote for progress instead
Citizens in a democracy are entitled to berate their leaders, to ask more of them and from them. But I pray here in Lanka what we will not castigate our leaders over is having to make the silly ‘positive test’ case-demic disappear, when there is virtually no impact whatsoever on net mortality, which is the only real report card.
New Year didn’t create a swell in fatalities, Christmas didn’t bring it on, the elections didn’t bring it on, congregating for Ayurvedic syrup in Kegalle did not, despite teeming crowds with contaminated cloth masks being clung to totemically while particles swirl all around and through openings. If we were to somehow have one million ‘positive tests’ and keep chugging along with mild deaths ‘ascribed’ to COVID that are and are not based on respiratory illness, lower than most years’ dengue deaths, is that a disaster? Or is the real disaster, death by poverty, the collapse of the economy, depreciation of our currency, destruction of education, erosion of mental and emotional health, people foregoing operations because they can’t risk the PCR test, businesses that can’t be competitive because of capricious protocols, and tourists who don’t wish to be jabbed three times in seven days and kept away from the allure of interacting with Sri Lankans deflating our tourism rebound?
Again, balance is needed. The US seems the worst case. Even allowing for inaccuracies in testing and exigencies of how fatalities are classified, we have recovery rates from the US as per the CDC: 99.997% for 0-19 years, 99.98% for 20-49 years, 99.5% for 50-69 years, and 94.6% for 70+ years. Nursing homes are where most of the deaths, 200,000 of the US tally, comes from.
And if we stuck to medical wisdom honed over decades and longer, we would protect as best we can the most vulnerable, let this respiratory and flu-like illness, run its pandemic course, letting it become what it almost certainly will, endemic, as has happened dozens of times in the last 100 years. No planetary paralysis on any of those occasions, and so society moved on, we progressed, we invented, we built businesses, we travelled, we managed breakthroughs, we retarded poverty, we advanced education. In one year, we’ve dialled back everything. Hopefully not irretrievably, if we wake back up now.
So, before we look at everyone as a viral threat, ‘mask up’ and spray ourselves with sanitiser to the point that we retard our own immune responses, it may be time to wake up. Sweden demonstrated it. Pakistan refused to shut down and isn’t over-run. India reports 50% antibodies in Delhi and for its population, its deaths are less than those from air pollution. Lanka is winning! That’s the narrative. Let’s stop shooting ourselves in the foot with PCR tests and asymptomatic hobgoblins.
Okay, we were cautious, we were protective, we were humane. Now, time to be sane, logical, enterprising, disciplined, collaborative and decisive.
Let’s leave the Middle Ages of ‘lockdown’ and return as we have been here in Lanka, more and more, to the 21st century, and ignore the attempt of the failed ‘virus fighters’ to continually blame the populace rather than accept their own ignorance and impotence. We have great public servants here, and their valour and dedication is to be saluted. But of all the national champions of our wellbeing, we have to include everyone ready to rejoin the living. And on that front, we need everyone to be ‘symptomatic.’ The ‘symptoms’ are creative engagement, passion, renewed purpose, mutual support and compassion, doing what we say, finishing what we start, and carrying the country forward. In a difficult period, we were well looked after. Gift received, due thanks to our leaders. Now it’s time to give back, and the gift we have to offer, is our balance, our commitment to reality and our resolve.
Winston Churchill once wrote, ‘Nothing would be more fatal than for the Government of States to get into the hands of experts. Expert knowledge is limited knowledge and the unlimited ignorance of the plain man, who knows where it hurts, is a safer guide than any rigorous direction of a specialist.’ Yes, we live in a democracy not an iatocracy (a society governed by physicians). They can advise, then we all have to trust our own wisdom to decide, and to act.