Posts Tagged ‘covid-19’

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.


At least 44 vaccines under Phase 1 -3 trials

September 1, 2020

There may never be a vaccine.

A vaccine may apparently be developed but long term effects will be unknown.

The most plausible scenario is that there may be promising vaccine available for mass usage, and with a reasonable level of safety, in the summer of 2021.

RAPS has an illuminating post detailing the various vaccines under trial and their status:

Researchers worldwide are working around the clock to find a vaccine against SARS-CoV-2, the virus causing the COVID-19 pandemic. Experts estimate that a fast-tracked vaccine development process could speed a successful candidate to market in approximately 12-18 months – if the process goes smoothly from conception to market availability.

To date, just one coronavirus vaccine has been approved. Sputnik V – formerly known as Gam-COVID-Vac and developed by the Gamaleya Research Institute in Moscow – was approved by the Ministry of Health of the Russian Federation on 11 August. ………. 

The pandemic has created unprecedented public/private partnerships. Operation Warp Speed (OWS) is a collaboration of several US federal government departments including Health and Human Services and its subagencies, Agriculture, Energy and Veterans Affairs and the private sector. Within OWS, the US National Institutes of Health (NIH) has partnered with more than 18 biopharmaceutical companies to accelerate development of drug and vaccine candidates for COVID-19 (ACTIV). The COVID-19 Prevention Trials Network (COVPN) has also been established, which combines clinical trial networks funded by the National Institute of Allergy and Infectious Diseases (NIAID): the HIV Vaccine Trials Network (HVTN), HIV Prevention Trials Network (HPTN), Infectious Diseases Clinical Research Consortium (IDCRC), and the AIDS Clinical Trials Group.

The COVAX initiative, part of the World Health Organization’s (WHO) Access to COVID-19 Tools (ACT) Accelerator, is being spearheaded by the Coalition for Epidemic Preparedness Innovations (CEPI); Gavi, the Vaccine Alliance; and WHO. The goal is to work with vaccine manufacturers to offer low-cost COVID-19 vaccines to countries. Currently, CEPI’s candidates from companies Inovio, Moderna, CureVac, Institut Pasteur/Merck/Themis, AstraZeneca/University of Oxford, Novavax, University of Hong Kong, Clover Biopharmaceuticals, and University of Queensland/CSL are part of the COVAX initiative. There are further candidates being evaluated in the COVAX Facility from the United States and internationally.

The US government has chosen three vaccine candidates to fund for Phase 3 trials under Operation Warp Speed: Moderna’s mRNA-1273, The University of Oxford and AstraZeneca’s AZD1222, and Pfizer and BioNTech’s BNT162. Members of ACTIV have suggested  developing safe controlled human infection models (CHIMs) for human trials could take 1-2 years. A sponsor would need to provide data from placebo-controlled trials indicating their vaccine is at least 50% effective against COVID-19 in order to be authorized for use, according to FDA guidance issued and effective 30 June. 

The 44 candidates ( as of 31st August 2020) are:

AAVCOVID, Ad26.COV2-S, Ad5-nCoV, AdCOVID, Adenovirus-based vaccine, AdimrSC-2f, Adjuvant recombinant vaccine candidate, AZD1222/Covishield, Bacillus Calmette-Guerin (BCG) live-attenuated vaccine, bacTRL-Spike, BBIBP-CorV, BNT162, ChAd-SARS-CoV-2-S, CoronaVac, COVAX-19, Covaxin, gp96-based vaccine, GRAd-COV2, GRAd-COV2, HaloVax, HDT-301, Ii-Key peptide COVID-19 vaccine, Inactivated vaccine, INO-4800, LineaDNA, LUNAR-COV19, Molecular clamp vaccine, mRNA lipid nanoparticle (mRNA-LNP) vaccine, mRNA-1273, mRNA-based vaccine, mRNA-based vaccine, NVX-CoV2373, PittCoVacc, Plant-based adjutant COVID-19 vaccine candidate, Protein subunit vaccine, Recombinant vaccine 1, Recombinant vaccine 2, SCB-2019, Self-amplifying RNA vaccine, Sputnik V, T-COVIDTM, V590, V591, ZyCoV-D

Covid candidate vaccines (pdf)


 

Has “flattening the curve” maximized the number of Wuhan virus deaths?

July 22, 2020

I am beginning to think that the international lockdowns may have been a colossal mistake.

The primary objective of “flattening the curve” was to protect health services, not to minimize deaths.

In theory, flattening the curve should have given the same number of deaths but over a longer period of time. In practice, the flattened curve has kept the pandemic alive for much longer than necessary. The lockdowns have ensured that no general immunity has been achieved anywhere. The total number of deaths could well have been lower with a more intense but short-lived pandemic.

 

“Flattening the curve” Theory

“Flattening the curve” Actual?

The assumption that the curve can be flattened without affecting the area under the curve is speculative and unjustified. The two curves cannot be equated. The reality is that extending the tail of the curve by attempting to flatten the peak may have done more damage than good.

Have the lockdowns actually saved any lives?

Or have they extended the pandemic such that more lives have been lost than if there had been no lockdowns. And at the cost of a global economic shutdown. Fewer lives lost per day but for a very, very long time as opposed to many lives lost per day over a much shorter period of time.

Flattening the curve may well have maximized the number of deaths.

The Chief Minister of Karnataka State in India actually made some sense yesterday when he said:

“There will be no lockdown in Bengaluru from tomorrow. However, I humbly request the people of Karnataka — with folded hands — to wear masks and to practice social distancing. This is the only way to combat COVID-19, at least till a vaccine is found,  …….. People can resume work and businesses as usual, outside containment zones. A stable economy is essential for the state to combat the coronavirus pandemic effectively.” 

Indeed. Protecting a health service in a collapsed economy is not possible.


 

So what exactly have the lockdowns achieved?

July 20, 2020

The Wuhan virus continues to lay waste.

Cases are on the rise again.

Deaths are also rising globally.

The pandemic is now expected to continue into 2021.

There will be no reliable vaccine at least until spring 2021.

So, what exactly have the lockdowns and economic disruption achieved?

If anything?

But one thing is certain. The lockdowns have extended the life of the pandemic.

Without any lockdowns there may well have been a sharper peak.

But it could possibly all have been over by now.

The WHO is clueless. It went from “no person-to-person transmission” to “transmission by fluids only” and is now on to “air-borne transmission”.

Alarmist models don’t make for settled science.


 

 

 

Covid puts ethics under pressure in Sweden

July 18, 2020

The Wuhan virus pandemic is bringing many ethical questions about the treatment of the aged into stark relief.

90% of all deaths in Sweden due to the Wuhan virus have been of those over 70 years. I have been less than impressed by the Government and the National Board of Health and Welfare (Socialstyrelsen) in Sweden. Their “remaining useful life” criterion is rational but hypocritical in trying to maintain the pretense of it not being age discrimination. They have effectively removed those over 70 from their definition of the herd to be protected. Even the trade unions were extremely concerned about protective equipment for their members working in the care sector. They threatened to strike at some care homes. I suppose that very few inmates of the care homes are active trade union members.

Suspected cases in care homes were usually kept away from the health care system and its facilities. The health system was under stress but never overwhelmed. Isolating those over 70 certainly helped reduce the pressure on the health services, but did not protect the over 70s from themselves being infected in their care “prisons”. In most cases the inmates were infected by their carers. However, unlike the inmates, the carers had recourse to the hospitals. The isolation also eliminated – probably as intended –  any chance of the +70s participating in any herd immunity that may develop. In the fight against the Wuhan virus, “Official Sweden” (from government to bureaucrats), has taken the position that the over 70s are not part of the herd and are expendable.

Take this ethical question:

When an 80+ year old in a care home contracts a treatable condition (bacterial pneumonia for example), but is misdiagnosed (assumed) to have the Wuhan virus and, without any further testing, is put on “palliative” care (morphine) leading inevitably to death, is it 

    1. unfortunate accident? or
    2. humane care?, or
    3. negligence?, or
    4. incompetence?, or
    5. euthanasia?, or
    6. justifiable manslaughter?, or
    7. murder?

“Official Sweden” has generally taken the comfortable position that such cases  – and there are more than a few – are all “unfortunate accidents”. I would put it less complacently at 3 on the list above or even higher.

The nice thing about “unfortunate accidents” is that nobody is accountable and nobody needs to take any responsibility.


 

All the Chinese viruses from the Spanish flu to the Wuhan coronavirus

July 10, 2020

This is the Wuhan virus and it did come from China. 

Trying to be politically correct is more misleading and probably the cause of more disinformation and self-delusion than any other. Political correctness applied to the scientific process is particularly destructive and gives us the burgeoning levels of fake science. Results are determined before the investigations have begun. For the WHO it is servility to Chinese interests which has prevented the Wuhan coronavirus from being named the Wuhan virus.

It now seems highly probable that even the Spanish flu of 1918 originated from China.

National Geographic:

 The deadly “Spanish flu” claimed more lives than World War I, which ended the same year the pandemic struck. Now, new research is placing the flu’s emergence in a forgotten episode of World War I: the shipment of Chinese laborers across Canada in sealed train cars.

Historian Mark Humphries of Canada’s Memorial University of Newfoundland says that newly unearthed records confirm that one of the side stories of the war—the mobilization of 96,000 Chinese laborers to work behind the British and French lines on World War I’s Western Front—may have been the source of the pandemic. …..

…. The 1918 flu pandemic struck in three waves across the globe, starting in the spring of that year, and is tied to a strain of H1N1 influenza ancestral to ones still virulent today.

There is little doubt that the current pandemic originated from Wuhan though, every so often, some journalist or “scientist” who is part of the China lobby will cast doubt on that. 

RealClearScience:

The Asian Flu in 1956 killed between one and four million people worldwide. SARS in 2002 infected 8,098 and killed 774 in seventeen counties. H7N9 emerged ten years later to strike at least 1,223 people and kill four out of every ten of them. Now, the milder, yet more infectious COVID-19 has sickened more than 70,000 across the globe, resulting in 1,771 deaths.
All of these outbreaks originated in China, but why? Why is China such a hotspot for novel diseases?

“It’s not a big mystery why this is happening… lots of concentrated population, with intimate contact with lots of species of animals that are potential reservoirs, and they don’t have great hygiene required. It’s a recipe for spitting out these kinds of viruses,” Dr. Steven Novella recently opined on an episode of the Skeptics’ Guide to the Universe.

South Central China is a noted “mixing vessel” for viruses, Dr. Peter Daszak, President of EcoHealth Alliance, told PBS in 2016. There’s lots of livestock farming, particularly poultry and pigs, with limited sanitation and lax oversight. Farmers often bring their livestock to “wet markets” where they can come into contact with all sorts of exotic animals. The various birds, mammals, and reptiles host viruses that can jump species and rapidly mutate, even potentially infecting humans. Experts are pretty sure this is precisely what happened with the current COVID-19 coronavirus, which is why, on January 30th, China issued a temporary ban on the trade of wild animals. ………

….. China is also notorious for its misinformation, secrecy, and censorship, which raises the chances that new diseases will fester and spread. Back in early January, Chinese government officials told the public that the new infection’s spread had been effectively halted. This was not true. At the same time, the authoritarian regime bullied health experts who attempted to sound alarm. The young doctor Li Wenliang attempted to warn others about the new coronavirus. He was ‘rewarded’ with a threatening reprimand by police. Li subsequently caught COVID-19 and succumbed to the disease the first week of February.

It may be called the Covid-19 virus but it is the Wuhan coronavirus pandemic


 

The great success and the great betrayal of the Swedish coronavirus strategy

July 3, 2020

The Swedish lockdown has been more voluntary than enforced. The over 70’s were told to quarantine themselves to protect the health system. Since the compliance with the voluntary social distancing requirements has been quite high, the spread of infection has not been much worse than in many countries enforcing very strict lockdowns. In total number of deaths due to the Chinese virus, Sweden sticks out among its Scandinavian neighbors who enforced much stricter lockdowns. But Sweden is not an outlier among other European countries. Economically, Sweden will probably be among the countries which recover fastest.

The Swedish strategy has been both a great success and a great failure. The numbers tell the tale.

source: worldometers

There is no right or wrong to the various strategies applied by different countries. Decisions have probably been made in good faith though these have been dominated by the culture of fear and risk aversion that permeates the world today. The fear of alarmist, imaginary crises has meant the world was totally unprepared for a real crisis. The impotence of a politicized WHO and the duplicity of a terrified Chinese bureaucracy has not helped. The stupidity of relying on imperfect and alarmist mathematical models was very evident.

But diving into the Swedish statistics also shows great successes among some very great betrayals.

Only 10% of the deaths have been of those under 70. Based on the National Board of Health and Welfare (Socialstyrelsen) criterion of “expected remaining life”, the loss of expected remaining life has been kept to a minimum. The 90% of deaths of those above 70 do not contribute much to “expected remaining life”. Among the “productive” population the loss of life has been kept down to about 50/million of population. That is the great success. 

Also among the successes have been:

  • intensive care places were more than doubled in a very short time
  • intensive care places were never overwhelmed
  • restarting the economy is well under way, and
  • herd immunity may not yet have been achieved but the risk of infection to the general population under 70 is greatly reduced. (Effectively, Swedish policy excludes the +70s from the herd).

But the cost has been the betrayal of the elderly. The unvoiced, undercurrent of opinion is that “but they were going to die soon anyway”. Care homes became virtual prisons for their inmates. Following the Socialstyrelsen’s publishing of their criteria for prioritizing lives based on “expected remaining life”, there were cases of those infected in care homes being denied oxygen and respirators. There have been cases where they have been put directly onto palliative care (sometimes a euphemism for a self-fulfilling, end-of-life care). The Swedish government through up its hands and abdicated its responsibilities to the bureaucracy of the Public Health Agency (Folkhälsomyndigheten) and of the National Board of Health and Welfare (Socialstyrelsen). The Public Health Agency were, I think the heroes, at least for honesty and fidelity and for stepping-up, if not always for compassion. The Health Services were also among the heroes. The bureaucrats of the Socialstyrelsen were hypocritical, mealy-mouthed and less than impressive. The reality, which is the opposite of what they often voiced, is that the elderly are second, or even third, class citizens in Sweden. The Swedish herd has protected itself by excluding the elderly from the herd.

I am over 70 and may be a trifle biased. But the villains of this pandemic internationally are the Chinese bureaucracy, the Alarmist Brigade and the WHO. Within Sweden, the villains are the government and the National Board of Health and Welfare (Socialstyrelsen).

And even if herd immunity is achieved, the over 70’s will remain at great risk until such time as a vaccine is developed. Every herd protects itself by sacrificing the weak and the sick. And the old.


 

“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

Posted on

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.


 


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