Archive for the ‘Health’ Category

Sweden’s non-strategy has failed dismally to “flatten the curve”

December 12, 2020

I take skepticism to be the most important characteristic of any scientific inquiry. All “experts”, and especially media proclaimed experts, need to be met with a high degree of skepticism. “Experts” have a high level of knowledge, but only of what is known and what is known may not be very much. The inherent paradox is that it is the “experts” who need to be challenged the most, but can only be challenged by other experts. But the very clear lesson that can be learnt is that little “experts” are dangerous.

In Sweden, the media made an epidemiologist from the Public Health Agency (Anders Tegnell of Folkhälsomyndigheten – FHM) into some kind of a superhero in March. The government abdicated its responsibilities and left the stage free for “experts”. The media hype converted FHM’s limited position that face-masks were of most use within health care into a belief that face-masks were counter-productive in general use. “Flattening the curve” was the slogan being touted by everyone (including me). But epidemiology is more art than science. We know a lot about viruses but we knew very little about how humans behave and how the coronavirus spreads. The WHO was an unmitigated disaster as they tried to hide any information that was critical of China. (Someday China will need to be held accountable and take some responsibility for having failed to contain, and allowing the spread of, the virus). The government (and the Public Health Agency) proved to be utterly incompetent in predicting the behaviour of the young (who were not at great risk) and the effects on the old (>80% of fatalities).

Of course, almost every country has failed to flatten the curve. The Swedish non-strategy has also failed.

The diagram below needs little comment. The top curves were what we were shown everyday in March and April by FHM about what the strategy (or non-strategy) would achieve. The bottom curve is the actual burden on the health services in terms of the number of admitted Covid-19 patients in hospital (excluding intensive care places which are 70% full).

“Flattening the curve” has become a nonsense slogan.

Flattening the curve didn’t work

FDA panel recommends approval of Pfizer vaccine, 17 to 4. But why did 4 oppose?

December 11, 2020

As expected, the FDA’s independent vaccine advisory committee recommended approval of the Pfizer vaccine yesterday, “17 to 4 in favor of recommending the drug for emergency use for people aged 16 years and older, with one of the members withholding”.

CBS News

A federal advisory panel on Thursday recommended the emergency use of Pfizer’s COVID-19 vaccine. The Food and Drug Administration is expected to approve the drug, kicking off a massive nationwide operation to get nearly 3 million doses of the vaccine to hospitals and drug stores across the country. The experts voted 17 to 4 in favor of recommending the drug for emergency use for people aged 16 years and older, with one of the members withholding. Health care workers and nursing home residents will be among the first to get the vaccine.  …….. Clinical trials showed the Pfizer vaccine was nearly 95% effective for adults 18 to 64 and was just as effective for people of all ethnicities. However, some groups — people with weak immune systems, individuals with severe allergic reactions, and pregnant women — could be restricted from getting the shot. However, British health officials on Wednesday warned that people with a history of “significant” allergic reactions to vaccines, medicine, or food should not be given Pfizer’s vaccine. Hahn said the FDA is working closely with its partners in the U.K. to understand what happened with the allergic reactions. “We study the data very carefully to say who should not receive the vaccine and these are the things the FDA does to ensure the safety and effectiveness” of the drug, Hahn said Thursday.

The advisory committee’s recommendation will probably lead to FDA approval by the weekend. The consensus is that the vaccine is safe and 95% effective. The Covid-19 pandemic is clearly out of control and there is a fear – quite justified – that without widespread acceptance of the vaccines the pandemic may continue unchecked. The Spanish flu pandemic (1918 – 21) lasted almost 3 years without any vaccine. Even with widespread and effective vaccination against Covid-19, this pandemic is set to last for at least two years until Spring 2022. Currently there is a widespread, global “information campaign” in favour of vaccination. Sometimes the simplistic and unnuanced messages are, I think, counter-productive. The WHO and UN information programs, in particular, talk down to the “great unwashed” and come close to being brainwashing attempts.

It can be expected that all members of an expert panel on vaccines will generally be in favour of vaccines. A key question then is why 4 of the expert panel did not recommend approval. In the current climate the dissenting expert views are of special importance. Unfortunately there is not much reporting of their views (with some exceptions).

The WSJ has some details:

Archana Chatterjee, dean of the Chicago Medical School at Rosalind Franklin University of Science and Medicine, said she dissented from the recommendation vote because there isn’t enough data justifying including 16 and 17 year olds in an emergency authorization. …. Oveta Fuller, a virologist at the University of Michigan Medical School, also dissented, saying in an interview that she would like to see at least two more months of data on trial participants that could help determine whether the vaccine reduces transmission.

The issue of using placebos in double-blinded trials for some patients and denying such patients vaccines came up (of effectively using humans as guinea-pigs). This is not really an ethical question at all, though the medical profession assuages its conscience by presenting it as such.

……. Doran Fink, deputy clinical director of the FDA’s division of vaccines, said further evaluation of the vaccine after its release will be necessary to see if its benefits continue to outweigh its risk, and whether any labeling changes will be required. Dr. Fink also addressed one major topic that has been in question—whether patients in the Pfizer trial who were randomly assigned to placebo should automatically be switched over and get the vaccine. FDA staffers told the committee they shouldn’t.

Steven Goodman, a Stanford University School of Medicine dean and epidemiologist, described that choice in testimony before the panel as an “ethical dilemma” in which both answers—getting vaccines to placebo patients and developing long-term safety and effectiveness—are right, and neither is unethical. ….. Marion Gruber, director of the FDA’s office of vaccines (and no relation to Bill Gruber), said she is concerned that if there is an unblinding of patients, that might limit the ability of the study to gather enough data about the vaccine’s safety.

Of course, there is no ethical dilemma. It is a simple case of the one being over-ruled by the many. Those patients involved in trials who get placebos instead of the vaccines are effectively human guinea-pigs whose health (and lives) are being adventured, without their knowledge, “for the common good”. Guinea-pigs (human or not) are not required to be told, or to understand, their fate. Their role is only to be counted in the appropriate column.

Throughout human history “the few” have always been sacrificed for “the many”. That, after all, is the essence of democracy. The reality is that the health of those receiving placebos in a vaccine trial is always subordinated to the results of the trial.


FDA briefing says Pfizer vaccine safe and effective

December 9, 2020

The FDA briefing reckons the Pfizer vaccine is safe and effective. (An expected conclusion and the EU will soon follow suit). The trial had around 44,000 participants.

The FDA’s independent vaccine advisory committee meets on Thursday, 10th December to consider emergency use of Pfizer’s coronavirus vaccine.

During the trial, one participant receiving the vaccine had a severe Covid-19 infection while three receiving placebos were severely infected. Four people in the placebo group died during the trial and two died in the vaccine group. None of the deaths are ascribed to the vaccine.

Antibodies are produced within 10 days.

How long immunity may last is not known. The meeting is expected to focus on safety aspects.


Efficacy Summary
In the final efficacy analysis, among participants without evidence of SARS-CoV-2 infection before and during vaccination regimen, vaccine efficacy (VE) for the first primary endpoint against confirmed COVID-19 occurring at least 7 days after Dose 2 was 95.0%, with 8 COVID-19 cases in the BNT162b2 group compared to 162 COVID-19 cases in the placebo group. The 95% credible interval for the VE was 90.3% to 97.6%, indicating that the true VE is at least 90.3% with a 97.5% probability given the available data. For the second primary endpoint, VE against confirmed COVID-19 occurring at least 7 days after Dose 2 in participants with and without evidence of SARS-CoV-2 infection before and during vaccination regimen was 94.6%, with 9 and 169 cases in the BNT162b2 and placebo groups respectively. The 95% credible interval for the VE was 89.9% to 97.3%, indicating that the true VE is at least 89.9% with a 97.5% probability given the available data.

The AstraZeneca/Oxford vaccine and the Moderna vaccines will also soon get approval. Of course the AstraZeneca vaccine costs only about 10% of the cost of the Pfizer vaccine (excluding the storage and logistic costs) and – in the long run – may generate greater revenues if the vaccination becomes a recurring event. My guess is that the costs of the Pfizer vaccine are too high to be sustainable.


Vaccine races

December 4, 2020

Long-term effects can only show up in the long-term. The UK has won the Pfizer race but Russia and China already won their own races. The EU and the US are just slow (but claim credit for a prudence that is not possible). They are both so heavily invested that they cannot not approve. In fact, the world needs the vaccination initiatives to proceed with all speed, no matter the immunization conferred. Deployment of their own vaccines has started in Russia and China and the Pfizer vaccine will start being deployed in the UK next week. Other countries will follow – have no choice but to follow. The low cost vaccine is the Astrazeneca / Oxford vaccine which is probably 2 months away. Some few countries will deploy the Chinese and Russian vaccines. 2021 is vaccination year. It remains to be seen if this succeeds in preventing another Covid-19 spike in spring 2021.

Long-term effects are unknown but unlikely. The period of conferred immunization is unknown and will come out in the wash.


Vaccination priorities – Get the spreaders first

November 25, 2020

My perception is that the main spreaders of Covid-19 are those between 20 and about 40 years old. Among this group there are some super-spreaders. It is said that the 80/20 rule applies and around 20% of those infected have infected the other 80%. The most number of deaths are among the old (>70) and especially the old in care homes (>80). The highest risk of death is for those having other complicating conditions.

Most countries seem to be setting vaccination priorities as follows:

  1. health care workers
  2. elderly people
  3. people with complicating conditions
  4. general population over 15 years old

It seems to me that the priority should be, after protecting health and care home workers, to vaccinate those between 20 and 40 years old. The old do not spread the virus and their mobility is so limited that infection is always brought in to them. Those in care homes have no mobility to speak of. Their best protection is if those taking care of them are vaccinated and if all their visitors are vaccinated rather than in being vaccinated themselves. Moreover it is the 20 – 60 year old who keep the economies going.

It is a question of attack or defense. Availability of vaccines gives the possibility of attack. Do you put armour on those inside the besieged castle or do you put a stop to the marauding invaders as they get off their boats?  To put an end to the pandemic needs that the spreaders be stopped rather than putting armour on the besieged. After a year of cowering in our homes it is time to go on the offensive. It seems that the priorities for vaccination should be:

  1. health care and care home workers
  2. all between 20 and 40 years old
  3. those with complicating conditions of whatever age
  4. the general population between 40 and 70
  5. the population over 70

Of course this will not be politically correct, and since I am over 70 this would push me down the vaccination priority list. But it will be rational and much more effective in ending the pandemic.


Vaccine worship is almost as bad as anti-vax

October 18, 2020

Anti-vax may be utterly stupid but vaccine worship is not far behind.

Let us not forget the public health fiasco with swine influenza vaccine and narcolepsy. In October 2009, Sweden’s public health services carried out a mass vaccination program against swine influenza. Six million doses of GlaxoSmithKline’s H1N1 influenza vaccine Pandemrix were administered. The vaccine was approved for use by the European Commission in September 2009, upon the recommendations of the European Medicines Agency. By August 2010, both the Swedish Medical Products Agency (MPA) and the Finnish National Institute for Health and Welfare (THL) launched investigations regarding the development of narcolepsy as a side effect.

An increased risk of narcolepsy was found following vaccination with Pandemrix, a monovalent 2009 H1N1 influenza vaccine that was used in several European countries during the H1N1 influenza pandemic. This risk was initially found in Finland, and then other European countries also detected an association.

CDC

Today over 400 people of those vaccinated in Sweden suffer from narcolepsy.

Narcolepsy is a central nervous system disorder characterized by excessive daytime sleepiness (EDS) and abnormal manifestations of rapid eye movement (REM) sleep. This disorder is caused by the brain’s inability to regulate sleep-wake cycles normally. The condition is incurable and life long. Some treatments can help to alleviate symptoms. 

It is the same “experts” and institutions who decided on mass use of Pandemrix who are now inventing public health strategies for Covid-19. Meanwhile a vaccine for the coronavirus is still in its early stages of development and clinical trials. Some of these “expert” strategies are just fairy tales and fantasy.

Vaccinations generally work. Particular vaccinations sometimes don’t. Whether any particular vaccine against Covid-19 will work remains to be seen. The experience with other coronaviruses provides no track record which inspires great confidence.

I get worried when people say they believe in science. To be scientific is to be skeptical. If some science has to be believed in, then whatever it is that has to be believed, is not science.


“What the pandemic has taught us about science” – Matt Ridley

October 14, 2020

Matt Ridley’s article in the Rational Optimist expresses much of my frustration with gullible journalists and the opportunism of the scientific fraternity (where over half are bean counters or clerks and don’t do any science) to exploit every funding opportunity. The money being thrown at Covid-19 research is far too tempting to expect that the charlatans will stay away. More than three hundred different projects being funded for developing a vaccine suggests that either we are so clueless that 300 different paths need to be pursued or that we have a number of fake projects being funded. I am not impressed when projects are funded to “study” how long the virus remains viable on mobile phones as opposed to plastic bags, or when the number of authors on Covid-19 papers are counted and “analysed”.

As Matt Ridley writes:

“…. peer review is often perfunctory rather than thorough; often exploited by chums to help each other; and frequently used by gatekeepers to exclude and extinguish legitimate minority scientific opinions in a field”.

His article is re-blogged here.

What the pandemic has taught us about science – Matt Ridley

The scientific method remains the best way to solve many problems, but bias, overconfidence and politics can sometimes lead scientists astray.

The Covid-19 pandemic has stretched the bond between the public and the scientific profession as never before. Scientists have been revealed to be neither omniscient demigods whose opinions automatically outweigh all political disagreement, nor unscrupulous fraudsters pursuing a political agenda under a cloak of impartiality. Somewhere between the two lies the truth: Science is a flawed and all too human affair, but it can generate timeless truths, and reliable practical guidance, in a way that other approaches cannot.

In a lecture at Cornell University in 1964, the physicist Richard Feynman defined the scientific method. First, you guess, he said, to a ripple of laughter. Then you compute the consequences of your guess. Then you compare those consequences with the evidence from observations or experiments. “If [your guess] disagrees with experiment, it’s wrong. In that simple statement is the key to science. It does not make a difference how beautiful the guess is, how smart you are, who made the guess or what his name is…it’s wrong.”

So when people started falling ill last winter with a respiratory illness, some scientists guessed that a novel coronavirus was responsible. The evidence proved them right. Some guessed it had come from an animal sold in the Wuhan wildlife market. The evidence proved them wrong. Some guessed vaccines could be developed that would prevent infection. The jury is still out.

Seeing science as a game of guess-and-test clarifies what has been happening these past months. Science is not about pronouncing with certainty on the known facts of the world; it is about exploring the unknown by testing guesses, some of which prove wrong.

Bad practice can corrupt all stages of the process. Some scientists fall so in love with their guesses that they fail to test them against evidence. They just compute the consequences and stop there. Mathematical models are elaborate, formal guesses, and there has been a disturbing tendency in recent years to describe their output with words like data, result or outcome. They are nothing of the sort.

An epidemiological model developed last March at Imperial College London was treated by politicians as hard evidence that without lockdowns, the pandemic could kill 2.2 million Americans, 510,000 Britons and 96,000 Swedes. The Swedes tested the model against the real world and found it wanting: They decided to forgo a lockdown, and fewer than 6,000 have died there.

In general, science is much better at telling you about the past and the present than the future. As Philip Tetlock of the University of Pennsylvania and others have shown, forecasting economic, meteorological or epidemiological events more than a short time ahead continues to prove frustratingly hard, and experts are sometimes worse at it than amateurs, because they overemphasize their pet causal theories.

A second mistake is to gather flawed data. On May 22, the respected medical journals the Lancet and the New England Journal of Medicine published a study based on the medical records of 96,000 patients from 671 hospitals around the world that appeared to disprove the guess that the drug hydroxychloroquine could cure Covid-19. The study caused the World Health Organization to halt trials of the drug.

It then emerged, however, that the database came from Surgisphere, a small company with little track record, few employees and no independent scientific board. When challenged, Surgisphere failed to produce the raw data. The papers were retracted with abject apologies from the journals. Nor has hydroxychloroquine since been proven to work. Uncertainty about it persists.

A third problem is that data can be trustworthy but inadequate. Evidence-based medicine teaches doctors to fully trust only science based on the gold standard of randomized controlled trials. But there have been no randomized controlled trials on the wearing of masks to prevent the spread of respiratory diseases (though one is now under way in Denmark). In the West, unlike in Asia, there were months of disagreement this year about the value of masks, culminating in the somewhat desperate argument of mask foes that people might behave too complacently when wearing them. The scientific consensus is that the evidence is good enough and the inconvenience small enough that we need not wait for absolute certainty before advising people to wear masks.

This is an inverted form of the so-called precautionary principle, which holds that uncertainty about possible hazards is a strong reason to limit or ban new technologies. But the principle cuts both ways. If a course of action is known to be safe and cheap and might help to prevent or cure diseases—like wearing a face mask or taking vitamin D supplements, in the case of Covid-19—then uncertainty is no excuse for not trying it.

A fourth mistake is to gather data that are compatible with your guess but to ignore data that contest it. This is known as confirmation bias. You should test the proposition that all swans are white by looking for black ones, not by finding more white ones. Yet scientists “believe” in their guesses, so they often accumulate evidence compatible with them but discount as aberrations evidence that would falsify them—saying, for example, that black swans in Australia don’t count.

Advocates of competing theories are apt to see the same data in different ways. Last January, Chinese scientists published a genome sequence known as RaTG13 from the virus most closely related to the one that causes Covid-19, isolated from a horseshoe bat in 2013. But there are questions surrounding the data. When the sequence was published, the researchers made no reference to the previous name given to the sample or to the outbreak of illness in 2012 that led to the investigation of the mine where the bat lived. It emerged only in July that the sample had been sequenced in 2017-2018 instead of post-Covid, as originally claimed.

These anomalies have led some scientists, including Dr. Li-Meng Yan, who recently left the University of Hong Kong School of Public Health and is a strong critic of the Chinese government, to claim that the bat virus genome sequence was fabricated to distract attention from the truth that the SARS-CoV-2 virus was actually manufactured from other viruses in a laboratory. These scientists continue to seek evidence, such as a lack of expected bacterial DNA in the supposedly fecal sample, that casts doubt on the official story.

By contrast, Dr. Kristian Andersen of Scripps Research in California has looked at the same confused announcements and stated that he does not “believe that any type of laboratory-based scenario is plausible.” Having checked the raw data, he has “no concerns about the overall quality of [the genome of] RaTG13.”

Given that Dr. Andersen’s standing in the scientific world is higher than Dr. Yan’s, much of the media treats Dr. Yan as a crank or conspiracy theorist. Even many of those who think a laboratory leak of the virus causing Covid-19 is possible or likely do not go so far as to claim that a bat virus sequence was fabricated as a distraction. But it is likely that all sides in this debate are succumbing to confirmation bias to some extent, seeking evidence that is compatible with their preferred theory and discounting contradictory evidence.

Dr. Andersen, for instance, has argued that although the virus causing Covid-19 has a “high affinity” for human cell receptors, “computational analyses predict that the interaction is not ideal” and is different from that of SARS, which is “strong evidence that SARS-CoV-2 is not the product of purposeful manipulation.” Yet, even if he is right, many of those who agree the virus is natural would not see this evidence as a slam dunk.

As this example illustrates, one of the hardest questions a science commentator faces is when to take a heretic seriously. It’s tempting for established scientists to use arguments from authority to dismiss reasonable challenges, but not every maverick is a new Galileo. As the astronomer Carl Sagan once put it, “Too much openness and you accept every notion, idea and hypothesis—which is tantamount to knowing nothing. Too much skepticism—especially rejection of new ideas before they are adequately tested—and you’re not only unpleasantly grumpy, but also closed to the advance of science.” In other words, as some wit once put it, don’t be so open-minded that your brains fall out.

Peer review is supposed to be the device that guides us away from unreliable heretics. A scientific result is only reliable when reputable scholars have given it their approval. Dr. Yan’s report has not been peer reviewed. But in recent years, peer review’s reputation has been tarnished by a series of scandals. The Surgisphere study was peer reviewed, as was the study by Dr. Andrew Wakefield, hero of the anti-vaccine movement, claiming that the MMR vaccine (for measles, mumps and rubella) caused autism. Investigations show that peer review is often perfunctory rather than thorough; often exploited by chums to help each other; and frequently used by gatekeepers to exclude and extinguish legitimate minority scientific opinions in a field.

Herbert Ayres, an expert in operations research, summarized the problem well several decades ago: “As a referee of a paper that threatens to disrupt his life, [a professor] is in a conflict-of-interest position, pure and simple. Unless we’re convinced that he, we, and all our friends who referee have integrity in the upper fifth percentile of those who have so far qualified for sainthood, it is beyond naive to believe that censorship does not occur.” Rosalyn Yalow, winner of the Nobel Prize in medicine, was fond of displaying the letter she received in 1955 from the Journal of Clinical Investigation noting that the reviewers were “particularly emphatic in rejecting” her paper.

The health of science depends on tolerating, even encouraging, at least some disagreement. In practice, science is prevented from turning into religion not by asking scientists to challenge their own theories but by getting them to challenge each other, sometimes with gusto. Where science becomes political, as in climate change and Covid-19, this diversity of opinion is sometimes extinguished in the pursuit of a consensus to present to a politician or a press conference, and to deny the oxygen of publicity to cranks. This year has driven home as never before the message that there is no such thing as “the science”; there are different scientific views on how to suppress the virus.

Anthony Fauci, the chief scientific adviser in the U.S., was adamant in the spring that a lockdown was necessary and continues to defend the policy. His equivalent in Sweden, Anders Tegnell, by contrast, had insisted that his country would not impose a formal lockdown and would keep borders, schools, restaurants and fitness centers open while encouraging voluntary social distancing. At first, Dr. Tegnell’s experiment looked foolish as Sweden’s case load increased. Now, with cases low and the Swedish economy in much better health than other countries, he looks wise. Both are good scientists looking at similar evidence, but they came to different conclusions.

Having proved a guess right, scientists must then repeat the experiment. Here too there are problems. A replication crisis has shocked psychology and medicine in recent years, with many scientific conclusions proving impossible to replicate because they were rushed into print with “publication bias” in favor of marginally and accidentally significant results. As the psychologist Stuart Ritchie of Kings College London argues in his new book, “Science Fictions: Exposing Fraud, Bias, Negligence and Hype in Science,” unreliable and even fraudulent papers are now known to lie behind some influential theories.

For example, “priming”—the phenomenon by which people can be induced to behave differently by suggestive words or stimuli—was until recently thought to be a firmly established fact, but studies consistently fail to replicate it. In the famous 1971 Stanford prison experiment, taught to generations of psychology students, role-playing volunteers supposedly chose to behave sadistically toward “prisoners.” Tapes have revealed that the “guards” were actually instructed to behave that way. A widely believed study, subject of a hugely popular TED talk, showing that “power posing” gives you a hormonal boost, cannot be replicated. And a much-publicized discovery that ocean acidification alters fish behavior turned out to be bunk.

Prof. Ritchie argues that the way scientists are funded, published and promoted is corrupting: “Peer review is far from the guarantee of reliability it is cracked up to be, while the system of publication that’s supposed to be a crucial strength of science has become its Achilles heel.” He says that we have “ended up with a scientific system that doesn’t just overlook our human foibles but amplifies them.”

At times, people with great expertise have been humiliated during this pandemic by the way the virus has defied their predictions. Feynman also said: “Science is the belief in the ignorance of experts.” But a theoretical physicist can afford such a view; it is not much comfort to an ordinary person trying to stay safe during the pandemic or a politician looking for advice on how to prevent the spread of the virus. Organized science is indeed able to distill sufficient expertise out of debate in such a way as to solve practical problems. It does so imperfectly, and with wrong turns, but it still does so.

How should the public begin to make sense of the flurry of sometimes contradictory scientific views generated by the Covid-19 crisis? There is no shortcut. The only way to be absolutely sure that one scientific pronouncement is reliable and another is not is to examine the evidence yourself. Relying on the reputation of the scientist, or the reporter reporting it, is the way that many of us go, and is better than nothing, but it is not infallible. If in doubt, do your homework.


Sweden: Covid 19 deaths no longer stick out.

October 12, 2020

 As schools and colleges have opened and partying has resumed, the number of infections have been rising.

However the deaths attributed to Covid-19 no longer stick out of the average of deaths/day (all causes).


Courage! Science (and bean-counters) cannot control the pandemic

October 7, 2020

Ten months on and I keep hearing the inane slogan “Follow the science”. But the best medical advice is floundering and is still no more than the basic common sense advice of “avoid being infected”. The simple reality is that the best our current science has to offer was unable to prevent the pandemic and is unable to curtail it or bring it under control. The Covid-19 virus cannot, at least for now, be eradicated.

While the medical fraternity is doing great things in treating those infected and is expending enormous money and energy in finding a vaccine, the epidemiological fraternity has failed spectacularly in both preventing the pandemic and in controlling or curtailing the pandemic. But more damaging is the illusion they promote that they are in control. Pretending you can when you cannot is bordering on gross negligence. Essentially they have nothing more to offer than the best advice available at the time of the Black Death almost 700 years ago.

I begin to suspect that epidemiology is more about bean-counting than about science. The political process which has relied on these bean-counters has vacillated between cowardice and courage.


100 years after the Spanish flu, virology still has far to go

October 4, 2020

Medical science does wonders. From amazing surgical procedures to an incredible variety of drugs and a fantastic array of tools and equipment, medicine, as it is practiced today, is light years ahead of where it was in 1918 at the time of the Spanish flu. Yet, medical science has not been capable of quickly defeating the current Wuhan virus pandemic. Health care has improved beyond recognition. Compared to 100 years ago, health services can deploy a bewildering variety of drugs and equipment and therapies to treat the infected.

The effects of the current pandemic are most often compared with the effects of the Spanish flu in 1918. The flu virus was identified in 1933 and the first flu vaccine came out in 1942. However, even today the flu vaccine is thought to be effective only in a little over 50% of cases. It is estimated that the Spanish flu, over a period of 3 years killed between 25 and 39 million people and that about 500 million were infected when the global population was only about 1,800 million. Today with a global population of 7, 200 million it is estimated that at least 35 million have been infected and, so far, over 1 million are thought to have died. The pandemic has lasted 6 months and is still ongoing. The virus was identified very quickly – perhaps one month – but only after the data repressed by the Chinese government and the WHO – leaked out.

The hunt for a vaccine is only 6 months old. There are at least 300 groups actively searching for one. Around 30 proposed vaccines have entered some kind of clinical trials. Estimates of when a vaccine could be readily available range from 6 months to 2 years to never. Money is being thrown at vaccine development at unprecedented levels. Certainly some of the groups chasing a vaccine have zero chance of success but cannot resist the temptation of huge amounts of easy money.

But virology is far from a settled science. In fact, there is still debate on whether a virus is living or not. That there are 300 different groups seeking a vaccine is, itself, evidence of 300 different opinions. During the past 6 months a bewildering variety of suggestions have been made for prophylactics, remedies and cures. Every single one has come from a “medical specialist”. The best advice is still “avoid infection” (by social distancing and masks which may or may not work), and hope. There are no preventive drugs and there are no cures (beyond treating symptoms). If and when vaccines are found, they will vary in how effective they are. Estimates of how expensive a vaccine may be range from 30$ to 300$ per dose for either a one-dose or a two-dose vaccine, with immunity available for periods ranging from 3 months to 1 year after vaccination.

Everyday new “experts” are trotted out on TV. But the science is not settled and there are no experts. The simple reality is that compared to 100 years ago, this pandemic has medical science just as stymied as the Spanish flu did – but at a very much higher level of knowledge.



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