Posts Tagged ‘covid-19’

“Covid 19: We need neither vaccine nor herd immunity”

May 28, 2020

Reblogging this article from https://milindwatve.home.blog/

Both interesting and a refreshing change from the usual.


Covid 19: We need neither vaccine nor herd immunity

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I had said in an earlier blog article that the SARS Cov-2 virus responsible for the current pandemic is likely to evolve rapidly towards reduced virulence. The reason why I expect this is that on the one hand, almost all countries are implementing strict quarantine measures for all detected positive cases. But on the other hand, we cannot afford to do mass testing, leading to many undetected asymptomatic cases roaming around and spreading the virus. The virus reaches huge populations and also has a high mutation rate, so all possible variants will keep on arising. A virulent strain is most likely to cause severe infection which will invite testing and ultimately quarantine. A mild variant, on the other hand is more likely to lead to asymptomatic or mild symptomatic infections which are more likely to escape screening followed by quarantine and therefore keep on spreading. In several generations of the virus, which is a short time for us, natural selection will favour the mild variants.

While all research on the virus is engaged in developing vaccine, studying pathogenic mechanisms or suggesting treatments, nobody seems to talk about evolution of the virus. This is for two reasons. One is that people in medicine are never trained to think of evolution. The other is that virulence is difficult to quantify. It is easier to sequence the virus, study its proteins, look for antibodies in the host etc. Researchers typically do what is easy to do rather than what is scientifically more relevant. Since one cannot measure a change in virulence easily, nobody will even talk about any hypothesis related to it. This is what I call “evidence bias” in science. If it is difficult to find evidence to either falsify or support a hypothesis, people will avoid talking about the hypothesis because it cannot make a paper. Whether the hypothesis is relevant to public health is not an important issue, whether you can publish a paper is.

But in the epidemiological trend at the global as well as the Indian scene, there are definite signs of reduction in virulence. Although the infection is growing, the death rate is consistently reducing with time. Look at the patterns. From mid-April, although the total number of new cases per day has been increasing, the total reported deaths per day is decreasing.

The same is happening in India too. In fact, the case fatality rate in India was always low and it is decreasing further, although the absolute number of deaths per day has not started decreasing yet.

Data from: https://ourworldindata.org/mortality-risk-covid

I plotted the time trend in the ratio of daily reported positive cases to daily reported deaths starting from the day the new death count exceeded 50. Although there are expected daily chance fluctuations, there is a clear decreasing trend.

Data from https://www.covid19india.org

Now if we make a simplistic assumption that the linear trend continues, then we can come out with a prediction that in India in about 35 days, Covid 19 will remain only as dangerous as any seasonal flu. The assumption of linearity is of course an oversimplification, the slope may not remain the same throughout. The second caveat is that case fatality rate cannot be exactly equated to mortality rate. In a growing epidemic, case fatality rate is an underestimate or mortality. But that need not affect the trend. The estimate of 35 days might be too optimistic. It may take somewhat longer. But the direction is assuring. Anecdotally I heard from some of my clinician friends that the proportion of patients needing critical care is already low.

The vaccine trial and mass production is going to take many months and may not immediately become available or affordable to the masses. For the huge population of India, acquiring herd immunity is a huge task and will not happen for a year or two. But much before either of the two becomes useful for public health, evolution would have taken care of the deadliness of the virus. We need to continue quarantine and good medical care of symptomatic cases, but not be fussy about the asymptomatic ones. Because they are going to be the saviours. Let us wait for a couple of months to see whether the prophecy turns out to be true qualitatively or quantitatively. If it does, it has a long term lesson for medicine. Virulence management strategies should become an integral part of public health planning. This is not the last time that a new virus arises. This will keep on happening. Understanding of evolutionary dynamics is certainly required to manage public health.


 

Globalism fail: A global pandemic is having to be handled nation by nation

April 20, 2020

“Globalism” is meaningless sanctimony without nations first taking care of themselves. In this Covid-19 crisis, there is no “globalised” solution and every nation is having to find its own way of handling the problem. There is a great deal of bilateral and even international cooperation, but every nation is then taking its own decisions for its own people. To be truly international, nations must first take care of themselves.

I have been waiting for the UN Security Council to pass a resolution banning the coronavirus. However such a resolution might well attract a veto from China.

The WHO preferred not to listen to warnings from Taiwan because they follow the Chinese line that Taiwan does not exist.

FT: The criticism by the World Medical Association … accusing it of “severely mismanaging and covering up the spread of the coronavirus”. The WMA said the WHO’s failure to heed Taiwan’s early warnings resulted in “errors that led to the world paying a high price” in the 2003 Sars outbreak and the coronavirus pandemic. …. Taiwan has accused the WHO of dismissing its early efforts to raise the red flag that the virus might spread among humans because of the organisation’s pro-China bias. It has been excluded from having “observer status” at the UN body’s annual meeting of decision makers since 2018. 

Shinzo Abe, the Japanese prime minister, was among those to call for an investigation into the WHO once the pandemic was under control. ….. Health officials in Taiwan said they alerted the WHO in late December about the risk of human-to-human transmission of the new virus but said its concerns were not passed on to other countries.

The EU is another organisation which promotes the “globalist” religion (provided the EU is first among equals). The reality is that the EU cannot take care of any member state which cannot take care of itself. The EU has proved itself impotent in time of crisis.

Forbes: Mauro Ferrari, head of the European Union’s top scientific research body, … resigned on Tuesday, effective immediately, citing a “political thunderstorm” in the European Commission in response to his plans to address the pandemic. ….. “I moved that the European Research Council should establish a special program directed at combating COVID-19,” he wrote, but that the plan was outright rejected by the European Commission, ……..
Ferrari said, in a two-page statement, printed in the Financial Times: “I have been extremely disappointed by the European response to COVID-19, for what pertains to the complete absence of coordination of health care policies among member states, the recurrent opposition to cohesive financial support initiatives, the pervasive one-sided border closures, and the marginal scale of synergistic scientific initiatives.”

However, the EU did express solidarity with Italy and Spain but had to apologise for being incapable of providing any help.

Guardian: ….. when Italy pleaded for fellow countries to send it medical equipment such as masks, France and Germany not only failed to respond, they placed export bans (since lifted) on the export of the kit Italian hospitals were crying out for. 

 ….. Another problem for Italy is that ….. it has to pay a higher rate of interest on the money the government borrows than is the case for Germany and, when the hospitals in the cities of Lombardy started to fill up with Covid-19 cases, this gap – or spread – started to widen. It was therefore deeply unhelpful for Christine Lagarde, the president of the ECB, to say that it was not the job of her institution to “close bond spreads”. …….. Last week’s virtual meeting of EU leaders was supposed to come up with a joint approach to the crisis but was instead a complete car crash.

Italy’s prime minister, Giuseppe Conte, said at the weekend: “If Europe does not rise to this unprecedented challenge, the whole European structure loses its raison d’être to the people. We are at a critical point in European history.”

The “Marshall plan” for the EU has been under discussion for over a month but the Commission cannot take their hands out of their pockets for fear of the virus.

Freedom of travel has been suspended in the EU. The EU regulations for reimbursements from airlines for cancelled flights are largely being ignored by EU member countries and their hard-hit airlines.

Of course, following Brexit, the EU has little sympathy to share with the UK.

India and other SE Asian countries have learnt to be very selective in listening to the WHO.


 

Has the world overreacted?

April 17, 2020

As countries now begin to, or plan to, relax their lockdowns and struggle to restart their economies, I have a niggling suspicion at the back of my brain that the world reaction may have involved more of panic and less of rationality. That the world may have overreacted in a fearful chain reaction may be understandable but was the chosen solution actually worse than the problem?

” ….. the spread of COVID-19 peaks after about 40 days and declines to almost zero after 70 days — no matter where it strikes, and no matter what measures governments impose to try to thwart it”.

This is from Prof Isaac Ben-Israel, head of the Security Studies program in Tel Aviv University, Chairman of the National Council for Research and Development and Head of Israel’s Space Agency.

A case perhaps of a kind of Mass hysteria?

A prominent Israeli mathematician, analyst and former general claims simple statistical analysis demonstrates that the spread of COVID-19 peaks after about 40 days and declines to almost zero after 70 days — no matter where it strikes, and no matter what measures governments impose to try to thwart it.

Prof Isaac Ben-Israel, head of the Security Studies program in Tel Aviv University and the chairman of the National Council for Research and Development, told Israel’s Channel 12 (Hebrew) Monday night that research he conducted with a fellow professor, analyzing the growth and decline of new cases in countries around the world, showed repeatedly that “there’s a set pattern” and “the numbers speak for themselves.”

……..

Asked to explain the phenomenon, Ben-Israel, who also heads Israel’s Space Agency, later said: “I have no explanation. There are all kinds of speculations. Maybe it’s related to climate, or the virus has a life-span of its own.” He said the policy of lockdowns and closures was a case of “mass hysteria.” Simple social distancing would be sufficient, he said. If the lockdowns instituted in Israel and elsewhere were not causing such immense economic havoc, there wouldn’t be a problem with them, he said. “But you shouldn’t be closing down the entire country when most of the population is not at high risk.”

Asked to explain why the virus had caused such a high death toll in countries such as Italy, he said the Italian health service was already overwhelmed. “It collapsed in 2017 because of the flu,” he said.


 

Fatality League: Without the 70+ deaths, Sweden would be doing very well

April 14, 2020

The pandemic is far from over, but as some countries contemplate or begin to relax their lockdowns, it is not too early to begin to look at some of the emerging data.

With its 10.1 million population Sweden has suffered over 1,000 deaths due to Covid-19. In the fatality league (deaths/million of population), Sweden has by far the worst numbers in Scandinavia and lies among the worst 10 globally (and in Europe) as of 14th April 2020. (Countries with fewer than 100 deaths are not included). Almost 90% of the fatalities in Sweden are of those over 70. Without these included, Sweden would have a fatality rate just one tenth of that observed.

I merely observe that in a mathematical model which gives little value to the lives of those over 70, Sweden would be doing very well indeed.

The questions are accumulating but any attempt at answers will have to wait at least a year.

Death League (as of 14th April 2020)

Some of the questions that will have to be addressed in Sweden at some time are:

  • Most countries have used “worst case” models (which are always ridiculously alarmist) but Sweden has used, it seems, “best case” models. Why?
  • Do the mathematical models give a lower “value” to the lives of the 70+?
  • Policy has been to restrict the movement of those over 70 to reduce load on the health service in case they are infected. However the infection carriers are the young and the mobile. Has the policy led to more of the 70+ being infected or less?
  • How much of the spread of infection was initiated/due to returning, asymptomatic tourists from the Alps who were neither tested nor quarantined?
  • Almost 90% of the dead in Sweden are 70+. Was this modeled at all?
  • How many of the 70+ were “prisoners” to infection in their care homes?
  • Was the main source of infection in the care homes through infected but asymptomatic staff?
  • Sweden has more than doubled Intensive Care Places in the last month. By establishing “priorities” for intensive care, Sweden has succeeded in ensuring that they have not been full to the limit. How many of the 70+ were denied Intensive Care due to the “priorities” established by the Social Welfare Board? (Priority is based on “expected life remaining”).
  • Was it optimal that unlike in other countries, leadership was abdicated by politicians in favour of the officials of the National Health Board.
  • …….
  • ….

 

 

In Sweden, coronavirus deaths are almost invisible among average daily deaths

April 12, 2020

In response to great demand Sweden’s Statistics Central Bureau (SCB) has published daily deaths (all causes) data for 2015 – 2020.

For the month of March 2020, the daily total deaths do not appear much different than the average for 2015-2019. The average daily death toll is about 250 (+/- 30). The coronavirus has been responsible (so far) for about 30 fatalities per day but there is some probable offset due to reduction of deaths from some other causes. During March there is no visible spike in total daily deaths that can be attributed to the coronavirus.

Daily Deaths March 2020 compared to average 2015-2019

We can never know what it would have been without a lockdown. What is visible during March is that with the voluntary lockdown in place, fatalities by all causes have not increased significantly.

In a few months, when the outbreak has been brought under control, I will not be surprised if we will be asking if the level of economic disruption was worth it.


 

Daily death curves

April 12, 2020

The Worldometers website is the most comprehensive and up-to-date site I have found. I believe the global data they display is about as good as can be for any public database. The John Hopkins dashboard is a lot slower and not as user friendly. I find the WHO site is not as useful as the Worldometers site.

Worldometers:

We collect and process data around the clock, 24 hours a day, 7 days a week. Multiple updates per minute are performed on average by our team of analysts and researchers who validate the data from an ever-growing list of over 5,000 sources under the constant solicitation of users who alert us as soon as an official announcement is made anywhere around the world.

Sources and Methods

Our sources include Official Websites of Ministries of Health or other Government Institutions and Government authorities’ social media accounts. Because national aggregates often lag behind the regional and local health departments’ data, an important part of our work consists in monitoring thousands of daily reports released by local authorities. Our multilingual team also monitors press briefings’ live streams throughout the day. Occasionally, we can use a selection of leading and trusted news wires with a proven history of accuracy in communicating the data reported by Governments in live press conferences before it is published on the Official Websites.

I think daily death curves for each country are a better guide to the state of the pandemic than the number of infections (which are contingent on the testing policy being followed).

In the progression of the coronavirus, it would seem that Italy lies about 9 days before Spain, 13 days before the UK and 17 days before the US.


 

India has learnt not to rely on the WHO

April 10, 2020

The WHO leadership is complicit in the suppression of news about the coronavirus. Its guilt will be judged by history. It was warned by Taiwan in December but could not pay attention to anything that might upset China. But it is not always wise even with its advice.

India has learnt over the years to sidestep the WHO when necessary.

So far India has reported just over 7,000 cases with 229 deaths attributed to covid-19 (10th April, 2020). With a population of over 1.3 billion the fatality rate at present is 0.18 per million of population. It is very early days to be sure but, so far, the fatality rate is long from what was, and still is, feared.

As the Indian Express reports:

… when it comes to key aspects of COVID management, the government has politely sidestepped the periodic “advice” from the WHO and, instead, leaned on the Indian Council of Medical Research (ICMR) and the experience of several state governments — from Kerala and Uttar Pradesh to Rajasthan and Maharashtra. …

Most recently, on April 3, the government’s advisory on the use of masks while stepping out of the house was at variance with that of the WHO, which said this should be only for those who are symptomatic, health workers, or caregivers to COVID patients.

That’s not the only point where the government veered off the WHO track.

  • On January 30, WHO Director General Tedros Adhanom Ghebreyesus said that WHO did not recommend travel restrictions to China — in fact, it was opposed to such an idea. This despite the fact that the same day, the WHO’s International Health Regulations Emergency Committee raised a global alert on the need for containment, surveillance, detection, isolation, and even contact tracing. By this time, India’s first advisory on avoiding non-essential travel to China dated January 25, was already in place.
  • Three days after the WHO statement, India advised citizens to refrain from travel to China, a step up from its earlier advisory.
  • On March 16, Ghebreyesus said that the WHO’s key message is “test test test”. On March 22, ICMR head Dr Balram Bhargava said: “There will be no indiscriminate testing. Isolation, Isolation, isolation.”
  • Hours later, India went into lockdown, starting with 75 districts and then, from midnight of March 24, the whole country. The decision was based on a paper by ICMR that quarantine is a more effective way of containing the virus than even airport screening.
  • The day after the lockdown began, WHO executive director Mike Ryan said: “Without implementing the necessary measures, without putting in place those protections, it’s going to be very difficult for the country to exit (the lockdown). And when they do, they have a resurgence and I think that’s the challenge now.”
  • WHO’s clinical care guidelines clearly lay down that there is “no current evidence to recommend any specific anti-COVID-19 treatment for patients”. India, nevertheless, first included two of its undertrial antivirals — lopinavir and ritonavir — in its clinical care guidelines for patients of the novel coronavirus disease, and then revised the management guidelines to replace the antivirals with a combination of hydroxychloroquine and the antibiotic azithromycin.

All the coronavirus solutions are going to be national, not global, solutions and I am quite sure that countries with effective measures will quickly inform other countries directly. They will not rely on a pampered and ineffective WHO leadership to do that.

Mumbai lockdown 9th April 2020

India has removed the ban on exports of hydroxylchloroquine to selected countries on humanitarian grounds and has sent supplies to, at least, USA, Israel, Brazil, Sri Lanka and a few others.


 

Whether for Haiti cholera, Ebola or the coronavirus, the WHO leadership failed

April 9, 2020

The WHO has many skilled, dedicated and hard working staff.

But the WHO leadership and the organisation are not fit for purpose.

After the Haiti earthquake it was poorly screened UN troops who took cholera into Haiti in 2010. But the UN and the WHO leadership were more concerned with appearing politically correct and with CYA than anything else.

NY Times (Dec 2016):

After six years and 10,000 deaths, the United Nations issued a carefully worded public apology on Thursday for its role in the 2010 cholera outbreak in Haiti and the widespread suffering it has caused since then.

The mea culpa, which Secretary General Ban Ki-moon delivered before the General Assembly, avoided any mention of who brought cholera to Haiti, even though the disease was not present in the country until United Nations peacekeepers arrived from Nepal, where an outbreak was underway. ……

One of the reasons the disease spread so widely, public health experts have said, is because it was allowed to; had there been a vigorous response in the first couple of years, it would have been far easier to contain, and fewer people would have died. The death toll stands at an estimated 10,000; some say it could be higher. ………

The WHO knew about the outbreak and the causes but was incapable of taking any actions which might have political implications.

The WHO was even worse with their “egregious failure” after the Ebola outbreak of 2013.

Reuters (Nov 2015):

The World Health Organization’s failure to sound the alarm until months into West Africa’s Ebola outbreak was an “egregious failure” which added to the enormous suffering and death toll, ……

The Ebola epidemic has killed at least 11,300 people in Guinea, Sierra Leone and Liberia since it began in December 2013. The crisis brought already weak health services to their knees and caused social and economic havoc.

“The most egregious failure was by WHO in the delay in sounding the alarm,” said Ashish K. Jha, HGHI’s director and a leading member of the panel. “People at WHO were aware that there was an Ebola outbreak that was getting out of control by spring, and yet it took until August to declare a public health emergency.” …..

And now with the coronavirus outbreak, the WHO leadership has failed again. Instead of preparing for a pandemic it has wasted time on the imaginary threats of climate change, on placating China and playing nice with celebrities.

There are three charges against WHO. First, it failed to prepare the world for a pandemic, spending the years since the Sars and ebola alarms talking more about climate change, obesity and tobacco, while others, including the Wellcome Trust and the Gates foundation, actually set up a coalition for epidemic preparedness innovation, and countries like Singapore and South Korea put in place measures to cope with an outbreak like SARS in the future.

Second, once the epidemic began in China, WHO downplayed its significance, tweeting as late as January 14 that “preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus”, when it had already been warned by the Taiwanese health authorities among others of strong evidence for medical staff in Wuhan becoming ill.

The Chinese government at this stage had known for weeks that the virus was spreading, probably person to person, yet WHO then sycophantically praised the Chinese government. “China is actually setting a new standard for outbreak response,” said WHO’s director-general, Tedros Adhanom Ghebreyesus, a former foreign minister of Ethiopia, a country run by a repressive regime heavily dependent on China. “China is really good at keeping people alive,” echoed the assistant director-general, Bruce Aylward, on 3 March.

On 29 March, a Hong Kong-based journalist asked Aylward to comment on Taiwan’s highly-successful efforts to defeat the virus. At first Aylward ignored the question, claiming not to have heard it. When the journalist offered to repeat it, strangely he said no, he would rather move on to another question. When she pressed, the call was mysteriously cut off. When the journalist called back and asked the question again, he answered a different question, talking about China, rather than Taiwan. The background here is that China is a big funder of WHO and insists that Taiwan be excluded from the organisation since it does not recognise Taiwan’s existence as a separate country. Taiwan banned travel from China very early in the pandemic.

The third charge against WHO is that it has failed before. When the ebola outbreak in West Africa that was to kill 11,000 people began in late 2013, on its own admission WHO hindered the fight against the virus, obsessed with not letting others find out what was happening. In April 2014, the charity Medecins Sans Frontieres announced that the outbreak was out of control. They were promptly slapped down by a WHO spokesman. Others tried again in June to alert WHO. It was not until August that WHO admitted the gravity of the situation.

Later WHO admitted its “initial response was slow and insufficient, we were not aggressive in alerting the world, our surge capacity was limited, we did not work effectively in coordination with other partners, there were shortcomings in risk communication.”

All of which is true again today.

The first case was in November 2019. By December the Chinese authorities knew but were suppressing the news. By end December Taiwan and others had warned the WHO about the outbreak. The pandemic was declared on 12th March 2020. The WHO will not live down this now infamous tweet on January 14th.

The Japanese Deputy Prime Minister recently suggested that the WHO change its name to the China Health Organisation.

The WHO suppresses information, and releases cherry-picked information, to suit what its leadership considers politically correct. Multilateral organisations such as the WHO (and even those of the UN and the EU) do not necessarily level up. They all too often sink to the lowest common level set by what is often compounded among the  worst members.

What is striking is that the global problem of the coronovirus has to find national – not globalised – solutions.


 

Swedish coronavirus policy least successful of the Nordic countries

April 8, 2020

Much as I admire Anders Tegnell (Sweden’s Chief epidemiologist) he appeared, at today’s press conference, to be brushing aside the differences between the Nordic countries a little too lightly. I am sure the health services have done a fantastic job. But, for whatever the reason, Sweden’s policy has so far resulted in many more fatalities (actual and per capita) than in the surrounding Nordic countries. The fatality rate is almost twice that of the next nearest Nordic country (Denmark). There is most likely a lapse of policy, rather than lack of equipment or failure of care, which lies behind this reality.

The reason is probably not unconnected with the overwhelming representation of the over-70’s (88% of all deaths in Sweden) among the fatalities.  (They are not particularly over-represented in the number of cases registered). It seems as if many of these older people were a “captive and doomed” population, stuck helplessly within their care homes – not protected in time from infection by the developing policy.

 


Note for reference:

In the Nordic countries the crude mortality rate (all causes) is between 7,000  and 8,000 per million of population every year. Sweden would normally see about 70,000 -80,000 deaths every year (all causes) compared to the 687 attributed so far to covid-19.

In Italy with a population of 60 million, there would be about 450,000 deaths due to all causes every year. The deaths attributed to covid-19 are currently about 17,500.


 

Have the old been sacrificed in Sweden?

April 8, 2020

We can never know what might have been.

But the aged in their care-homes did not go out and bring in the virus. They were infected by others. As of 7th April, 7,693 cases have been registered in Sweden and 591 deaths have been attributed to the coronavirus. Of these 2,807 cases (36% of total cases) and 519  deaths (88% of all deaths) were of people over 70 years old. Just in Stockholm’s care homes, 159 deaths have been registered. The major difference in deaths per capita between Sweden and the other Nordic countries is the much higher number of deaths among the old in Sweden.

It may well be that those infected mildly and showing no symptoms have been the main carriers of the virus. In one department at a major hospital more than half of all the employees were without symptoms but were infected with Covid-19.

Of course, there is a youth obsession in Sweden. Of course, those who are labeled “retired” have a lower value. Of course, the care-homes are a place for the old to be tucked away out of sight. Of course, there is a formal perception that with a lower “expected remaining life”, the old have a lower value to society and get a lower priority for care. It could have been worse, of course.

It may not have been intentional but the numbers say that in the fight against the coronavirus, the old have been sacrificed in Sweden.

As of 7th April 2020


Related:

When healthy and young has priority over sick and old


 


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