- The many months of often draconian response elsewhere is far worse than the threat
Friends here are two articles re-posted in their entirety that appeared in The Spectator UK. We do this for key articles to facilitate learning, and any commentary we can impart, and because in the current climate who knows how long the internet gods will allow revealing but contra one-world-government doctrine to be accessed. They may over look our humble offerings (like the search-engines do anyway). Bold our emphasis.
How dangerous is Covid? A Swedish doctor’s perspective
spectator.co.uk/article/how-dangerous-is-covid-a-swedish-doctor-s-perspective/amp
Sebastian Rushworth 11 Aug 2020, 9:08am
I want to preface this article by stating that it is entirely anecdotal and based on my experience working as a doctor in the emergency room of one of the big hospitals in Stockholm, and on living as a citizen in Sweden. As many people know, Sweden is perhaps the country that has taken the most relaxed attitude towards the Covid pandemic. Unlike other countries, Sweden never went into complete lockdown. Non-essential businesses have remained open, people have continued to go to cafés and restaurants, children have remained in school, and very few people have bothered with face masks in public.
Covid hit Stockholm like a storm in mid-March. One day I was seeing people with appendicitis and kidney stones, the normal things you see in the emergency room. The next day all those patients were gone and the only thing coming into the hospital was Covid. Practically everyone who was tested had Covid, regardless of their presenting symptoms. People came in with a nosebleed and they had Covid. They came in with stomach pain and they had Covid.
Then, after a few months, all the Covid patients disappeared. It is now four months since the start of the pandemic, and I haven’t seen a single Covid patient in over a month. When I do test someone because they have a cough or a fever, the test invariably comes back negative. At the peak three months back, a hundred people were dying a day of Covid in Sweden, a country with a population of ten million. We are now down to around five people dying per day in the whole country, and that number continues to drop. Since people generally die around three weeks after infection, that suggests virtually no one is now being infected. If we assume around 0.5 per cent of those infected die (which I think is very generous, more on that later) that means three weeks back 1,000 people were getting infected per day in the whole country, which works out to a daily risk per person of getting infected of 1 in 10,000. And remember, the risk of dying is at the very most 1 in 200 if you actually do get infected. And that was three weeks ago. Basically, Covid is in all practical senses over and done with in Sweden. After four months.
In total Covid has killed under 6,000 people in a country of ten million. A country with an annual death rate of around 100,000 people. That makes Covid a mere blip in terms of its effect on mortality.
That is why it is nonsensical to compare Covid to other major pandemics, like the 1918 pandemic that killed tens of millions of people. Covid will never even come close to those numbers. And yet many countries have shut down their entire economies, stopped children going to school, and made large portions of their population unemployed in order to deal with this disease.
The media have been proclaiming that only a small percentage of the population have antibodies, and therefore it is impossible that herd immunity has developed. Well, if herd immunity hasn’t developed, where are all the sick people? Why has the rate of infection dropped so precipitously? Considering that most people in Sweden are leading their lives normally now, not socially distancing, not wearing masks, there should still be high rates of infection.
The reason we test for antibodies is because it is easy and cheap. Antibodies are in fact not the body’s main defence against virus infections. T-cells are. But T-cells are harder to measure than antibodies, so we don’t really do it clinically. It is quite possible to have T-cells that are specific for Covid and thereby make you immune to the disease, without having any antibodies. Personally, I think this is what has happened. Everybody who works in the emergency room where I work has had the antibody test. Very few actually have antibodies. This is in spite of being exposed to huge numbers of infected people, including at the beginning of the pandemic, before we realised how widespread Covid was, and when no one was wearing protective equipment.
I am not denying that Covid is awful for the people who do get really sick or for the families of the people who die, just as it is awful for the families of people who die of cancer, influenza, or an opioid overdose. But the size of the response in most of the world (not including Sweden) has been totally disproportionate to the size of the threat.
Sweden ripped the metaphorical band-aid off quickly and got the epidemic over and done with in a short amount of time, while the rest of the world has chosen to try to peel the band-aid off slowly. At present that means Sweden has one of the highest total death rates in the world. But Covid is over in Sweden. People have gone back to their normal lives and barely anyone is getting infected anymore. I am willing to bet that the countries that have shut down completely will see rates spike when they open up. If that is the case, then there won’t have been any point in shutting down in the first place, because all those countries are going to end up with the same number of dead at the end of the day anyway. Shutting down completely in order to decrease the total number of deaths only makes sense if you are willing to stay shut down until a vaccine is available. That could take years. No country is willing to wait that long.
Covid has at present killed less than 6,000 in Sweden. It is very unlikely that the number of dead will go above 7,000. In an average year 700 people die of influenza in Sweden. Does that mean Covid is ten times worse than influenza? No, because influenza has been around for centuries while Covid is completely new. In an average influenza year most people already have some level of immunity because they’ve been infected with a similar strain previously, or because they’re vaccinated. So it is quite possible, or in fact likely, that the case fatality rate for Covid is the same as for influenza, or only slightly higher, and that the entire difference we have seen is due to the complete lack of any immunity in the population at the start of this pandemic.
This conclusion makes sense of the Swedish fatality numbers – if we’ve reached a point where there is hardly any active infection going on anymore in Sweden, in spite of the fact that there is barely any social distancing happening, then that suggests at least 50 per cent of the population has been infected already and has developed immunity, which is five million people. This number is perfectly reasonable if we assume a reproductive number for the virus of two: If each person infects two new people within a five day period, and you start out with just one infected person in the country, then you will reach a point where several million are infected in just four months. If only 6,000 are dead out of five million infected, that works out to a case fatality rate of 0.12 per cent, roughly the same as regular old influenza, which no one is the least bit frightened of, and which we don’t shut down our societies for.
Sebastian Rushworth is a junior doctor in Stockholm, who studied medicine at the Karolinska Institute. This article originally appeared on his personal website.
The dangers of a Covid ‘elimination’ policy
Spectator.co.uk/article/the-dangers-of-a-covid-elimination-policy
September 22, 2020
It’s understandable that, in a crisis, politicians reach for wartime metaphors – but they don’t always fit. There was the ‘war on terror’. Now we have politicians talking about the need to vanquish Covid-19. This is about more than language. There’s a big difference between a Covid-19 eradication strategy and one that seeks to find a way to live with this virus, in the way we learned to live with Swine Flu (or, as it’s now called, flu.)
The Prime Minister is leading by example. Addressing a committee of conservative MPs on Thursday, he said: ‘We have to make sure that we defeat the disease by the means we have set out.’ Later he said: ‘We must, must defeat this disease.’
And last week, the Leader of the Opposition, Sir Keir Starmer, told the PM that, among other things, he should ‘Get on with defeating this virus.’
Are they aiming for elimination? If so, it’s a new strategy – and a worrying sign of mission creep. Back in March, we were all requested to ‘buy time’ for the NHS to stop hospitals being overwhelmed by a sudden surge in cases. The idea back then, in so far as it could be divined, seemed to be that we would temporarily ‘protect the NHS’, then get used to living with the virus once the acute danger had passed. But over the last few months, while the science has become clearer, the politics has changed. Preventing a surge of deaths seems to have morphed into minimising the number of cases in all age groups, which is a completely different proposition.
Of course, it can be good to have ambition and aim high. President Kennedy’s rallying call to land men on the moon and bring them safely back galvanised great things. But as the saying goes, ‘You should be careful of your ambitions, because you might achieve them.’ Having unattainable ambitions can be expensive, harmful, and, when pursued on a political scale, cause untold misery, as we all know from the disheartening historical litany of failed utopias.
In this case, it’s clearly going to be easier to control people than to control coronavirus, and, with depressing predictability, that’s what governments around the world (with honourable exceptions such as Sweden) are setting about doing. So it makes good sense to examine what, exactly, we can mean by ‘defeating’ a virus.
There is only one example of a human viral disease where ‘defeat’ has been comprehensively achieved, and that is smallpox. In its day, which was not that long ago, smallpox was a horrible disease. In 1950, it was still killing over a million people every year in India alone. In 1967, it still menaced three fifths of the world’s population, killed one in five of those infected, and left many more scarred for life or blinded. It was a prime candidate for medical intervention.
How did we succeed with smallpox, and could there be lessons for coronavirus? Although smallpox virus can enter through skin abrasions when people are in close contact, the most important means of transmission was the respiratory route: inhaling the virus in crowded conditions. Smallpox infected cells in the lung and then spread around the body, infecting many organs. These included the skin, where it produced the pox pustules in a characteristic centrifugal distribution, i.e. mainly affecting the face and extremities, allowing it to be clinically distinguished from chickenpox, which mainly affects the trunk and face.
The ability to clinically distinguish smallpox from other diseases was vital in helping to eradicate it from the world, allowing index cases to be isolated. And, crucially, it was not infectious until the patient started to develop symptoms – by which point they were usually sufficiently ill to be in bed, thus minimising transmission. There were hardly any asymptomatic infections. Very helpfully, smallpox had a typical incubation period of about 12 days – meaning that once an index case was identified, almost two weeks were available for tracing contacts and isolating them until they could be shown to be non-infectious.
There’s more. Vaccination against smallpox was known to be safe and very effective, and had been applied with increasing reach since the end of the eighteenth century. Smallpox was a stable DNA virus with only two types (major and minor), which looked exactly the same and responded identically to vaccination. And there was no animal reservoir for smallpox: it infected only humans.
These key features, combined with the awfulness of the disease, led to the motivation to eradicate it from the globe, and also aided our ability to do so, since eradication means that recognition, isolation and elimination of the disease much reach the furthest, poorest, least technologically advanced corners of the planet to be successful. Smallpox became extinct in the wild in 1979, and marked a genuine victory for humanity and ‘defeat’ for the virus.
However, the lessons for Covid that governments should be learning are almost entirely reciprocal. SARS-Cov-2 is a highly mutable RNA virus that spreads on the wind, like all successful respiratory infections, much more effectively than smallpox. There are animal reservoirs, a very high proportion of asymptomatic cases, and huge differences in disease severity in different segments of the population.
There are no clinically-defining features sufficiently specific to be useful in case isolation, and a relatively short incubation period of about five days on average, making case isolation virtually impossible and massively disruptive if it were pursued with vigour. The reliance on testing to identify cases, requiring massive resources, and generating severe problems of its own on any reasonable assumptions about accuracy and sensitivity, means that it’s difficult to know what the burden of serious and mild disease is, even in developed countries throwing everything they have at it.
Also, there’s no vaccine. Despite much current optimism, coronaviruses have staunchly resisted attempts at vaccine development before. Even if a reasonably effective vaccine is found, its benefits may well be short-lived – the mutability of the virus means Covid may mutate away from control.
So where does this comparison leave us with Covid? Recognition is difficult, isolation very difficult and comes at enormous societal cost. Which is why elimination is, almost certainly, impossible.
This means we must learn to live with Covid. ‘Defeat’ of the virus is a false and dangerous ambition. The very large proportion of the population for whom Covid represents a small new risk should allowed to get on with their lives normally. The proportion for whom Covid represents a larger risk should be presented with the information, encouraged to make their own risk assessments, and helped to take avoidance action (if that is what they wish to do: some may prefer to keep seeing and hugging their family and regard Covid as one of the many viruses that human-to-human contact can bring).
What’s more, once a nation decides to live with a virus, relatively asymptomatic spread of the virus among large sections of the population is a good thing because it speeds our progress towards collective immunity – which is where, irrespective of what governments do, we will end up in equilibrium with the virus. Through vaccination or infection, this is how viruses dwindle. The main differences between countries will be in the size of the own goals that their responses cause in the meantime.
Ironically, there’s a lesson here from the only other human viral disease that we have nearly ‘defeated’: polio. Polio has been knocked down by over 99 per cent by a vaccine using a live, but weakened form of the virus. This is taken by mouth, replicates in the gut, and is excreted in the faeces. In most parts of the world this means that the virus then spreads effectively in the community: so asymptomatic spread to those not formally given a dose of the vaccine has actually been essential to the success of the program.
The fatality rates from Covid do not bear comparison with great scourges of the past like smallpox and plague, so coercion in the name of ‘defeat’ for the virus not justifiable, as well as not being realistic. An unrealistic ambition of ‘defeat’ for the virus might sound good in speeches, but it would be unachievable as a policy – and the pursuit of this policy, with the suppression measures it would bring, would cause harm. The Prime Minister should choose his words carefully, and his Covid policy more carefully still.
The Spectator
Dr John Lee
