New paradigms needed

Before the next “test-demic” surge and the next almost inevitable temporary peak of death from this or that leads us to destroy all the momentum we next build up, or the next pathogen has us scampering for the covers and locking our lives away, perhaps we can insist on the application of the precautionary principle, and make sure we find smarter ways to balance both perils and possibilities – Pic by Shehan Gunasekara

As we navigate through the pandemic that we refuse to let become endemic, there are alarm bells that ring, and cognitive dissonance galore.

First, we were spooked by numbers of “positive tests” (posing as cases) that grew dramatically. I have flagged this before, but our testing quadrupled from early April to mid/late May as well. While “positivity percentages” certainly increased, some of the shocking increase came here, as it had in so many jurisdictions globally, when there was a massive increase in testing.

Second, we are told some of these in recent weeks were already in quarantine and their results were being added in.  Then, WHO, updating their guidance at the end of 2020, clarified that the lower the amplification (Ct) setting PCR wise, the more likely we were finding infectiousness rather than viral debris or strands. Globally, that means below 30, CDC in the US now alighting on 27 to check for post-vaccination reinfection. I keep asking, do we have a national standard, is it being enforced? WHO says every PCR test should have the Ct setting identified. We live in reliance on this being the case.

WHO also indicates that false positives are an issue, and so the PCR test is one piece in the diagnostic puzzle, and other indicators (symptoms perhaps?) must be consulted. Surely, each lab has some “false positive” percentage identified? Some time back, in the national press, that was indicated to be 30%. Then incidence was very low, and there is an indirect relationship between spread and false positives, as incidence of infection goes down, false positives go up. 

And the Ct settings reinforce the false positives. At 33, numerous studies indicate already an 80% false positive, above 35, almost 100%! And because PCR anyway does not distinguish between live virus and dead, while infectiousness for COVID is 7 days, the PCR detects non-viable (non-infectious) SARS-CoV-2 for up to 34 days. So, even without the Ct setting, there is an intrinsic, built in tilt towards false positives! Without addressing this, we are magnifying potential distortion.

In fact, globally, Ct settings at the height of the “pandemic” (test-demic?), were as high as 45. Dr. Michael Mina, epidemiologist at the Harvard T.H. Chan School of Public Health called such settings “absolutely insane.” At that magnification, he points out, you may be looking at a single RNA molecule, whereas “when people are sick and contagious, they literally can have 1,000,000,000,000x that number.”

And as Dr. Peter McCullough, one of the world’s leading cardiologists and specialists in COVID early clinical care, and author of the only two peer reviewed papers globally on COVID treatment, pointed out, when we had him presenting to policy makers here, “If it’s asymptomatic, in other words, no symptoms, it’s almost always a false positive.”

A 10 million strong study in Wuhan found chances of asymptomatics being infectious and spreading infection as basically nil. In this extensive study, not one person in close contact with an asymptomatic individual tested positive. That was the case even in the minority of cases where asymptomatic individuals had some live virus, the viral load was just too low for transmission. As the authors noted, “In the present study, virus culture was carried out on samples from asymptomatic positive cases and found no viable SARS-CoV-2 virus. All close contacts of the asymptomatic positive cases tested negative…”

Additional studies testify to this, in JAMA, the scientific journal Nature, New England Journal of Medicine, and more. As the British Medical Journal concluded: “Searching for people who are asymptomatic yet infectious is like searching for needles that appear and reappear transiently in haystacks, particularly when rates are falling.”

So, we also need to know the percentage of those testing “positive” who are asymptomatic. When we found in Mumbai, that was close to 85%, researchers were sure the Indian surge would plateau, and was as much a “positive test outbreak” as a viral outbreak. Not to say there wasn’t a devastating toll, but nothing close to the optics. Especially not in a country where 3,200 die daily between TB and diarrhoea…one might argue, that’s a more terrifying recurring pandemic!

When the US changed its national guidelines to a Ct setting below 30 in most States, well ahead of any vaccination benefit (January on), numbers started plummeting. The only two things that had changed, was an outbreak of early treatment protocols in key states and rationalising the setting. 

So, without this information, we are firing blind, especially with the sudden multiplying of test volume, which was going to inevitably correspond to spikes, in addition to actual greater infection in key clusters and locales.

Then, we have no idea of actual deaths. For months, we have been given “aggregate” deaths of multiple weeks, some going back a month or more. And there were a list of comorbidities, which begs the question of who died “from” COVID, rather than COVID being an accomplice, or even a bystander? We simply don’t know. Happily, the protocol has now shifted to reporting deaths in the last 24-48 hours, however the “comorbidity” list is gone (earlier listed as among “causes of death”, and so “COVID related” deaths in the small print, becomes “COVID deaths” now in the headline). 

This is not unique to Sri Lanka. In the UK, trying to compare COVID mortalities with adverse effects from the vaccines, they decided in June to compare against those death certificates that “only” had COVID listed. And from the 127,000 “ascribed” deaths, they found about 3,500, that were canonically, cleanly “from” COVID. 

In a June COVID 19 Situation Report prepared for the Health Ministry here, among the listed deaths, roughly 83%-85% were indicated to be “with” substantial comorbidities. So, could we say, from our death total, say 15-17% are actual COVID fatalities, and for the others, the presence of COVID was either incidental, or if no COVID, some other respiratory illness, pneumonia or influenza or something else would have availed of their weakened immune system? Again, we can suspect, but we don’t know. But asserting these as “COVID deaths” and making sweeping statements, or shutting down the country, its economy and untold livelihoods, on so gossamer an analysis is unfortunate.

The global median age of COVID deaths seems to be inching up, around 73 in the US, above 80 in Canada, about 82 globally. So, some of our stats, of 20-year-olds and 39-year-old fatalities are simply implausible on the global data. Unless Sri Lanka is uniquely vulnerable at younger ages, these are very likely victims of these abundant comorbidities with a positive PCR test. Applying Occam’s Razor, going with that which bends likelihood the least and is the simplest, suggests this is again conflating “with” and “from”, generating panic detached from reality.

Against the suggestion that children do die from COVID, for example, Johns Hopkins released research showing that “not one healthy child” has died of COVID in the US! All who have, a very small number happily, had serious comorbidities. And as we’ve been at pains to point out, happily early treatments exist and can be deployed. It’s outrageous these aren’t on public health protocols everywhere anyway.

Working in Zimbabwe, having helped to drive down daily deaths from 70 to close to 1-2 using such treatment protocols, Dr. Jackie Stone calls the avoidance of preventive, early treatment, primarily from long vetted, off label, repurposed drugs (the mainstay of medicine in the developing world), a form of “passive genocide”.

The modelling distortion

Were we in a situation akin to India or other true surges, there would be an “exponential” increase in cases and deaths, and this would continue for weeks. So yes, we got to 4,000 “positive tests”, but it fell off there, well before any travel restrictions could have been the source of the change. Thereafter it seesawed between 3,000 and 2,000, number of tests fluctuated, we don’t know the applied PCR protocols, but no assertion of “impending doom” having been narrowly averted by economic self-destruction is justified on these numbers. 

Ditto, on the death front, taking aggregates out, “exponential” would mean it kept multiplying, and then perhaps after a few weeks of travel restrictions, there was a flattening, and then a downward move. Nothing like that is in evidence.

Statisticians keep trying to defend the global lockdown religion, a fact-free, life-leeching, penal approach, not on any public health guideline, opposed by WHO up to 2020, still not its proposed primary remedy, opposed in the US, before Fauci the fickle was seduced by whatever malevolence this trove of emails seems to suggest. So, with no new research, no new science, centuries of public health wisdom, of not “locking up the healthy” to protect the very small number that are vulnerable to this highly age-stratified illness, was thrown overboard.

One attempt in Lanka can be to wonder at the lack of impact on excess mortality, which is really what matters, despite temporarily swelling “positive tests”. But the disconnect between a high number of positive tests and deaths is currently observed in the UK, was evident in April in Sweden where positive tests (hence they’ve discontinued use of PCR) increased, and deaths kept plummeting (as they focused on protecting and treating and vaccinating the vulnerable). Singapore had the migrant worker surges, and a recent uptick, but deaths are less than 40. This “disconnect” is not unique.

Another attempt is to posit the ridiculous IHME model and say that’s where we were headed, and if we didn’t get there, that means shutting everyone away from the outdoors (when there is no outdoor transmission recorded, and exercise, sunshine and fresh air are tonics and enemies of viruses) was inevitable. 

Only IHME, like all the modelling, has been persistently wrong. The 4,000 deaths a day forecast for the UK in October had to be hastily withdrawn. The SAGE 90,000 deaths in Sweden if they didn’t lock down, were absurdly off, when Sweden then barely had 13,000 deaths and an average year for mortality, below average in 2021, with the mildest restrictions, almost all voluntary. Florida was to be teeming with deaths. Instead, open a year, with music festivals, open schools, people from other States moving there in droves. We were told Georgia was undertaking an experiment in “human sacrifice.” Except they are flourishing. Texas was walking into the “jaws of the beast” and Biden called it “Neanderthal behaviour”. More than three months later, with plummeting deaths, fully open Texas, with only about 35% vaccination is smiling as the real Neanderthals are revealed.

The situation is dynamic, more people recover and become immune, many aren’t at risk and shrug off the infection, vaccinations take place, and on the lockdown theology, as soon as you open, with any contact with the outside world, or a seasonal airborne surge, back we go. Let us follow the mortality needle, not error-riddled modelling “experts” like Michael Osterholm, who predicted for the US in January, the worst months were ahead, and reset that failed prediction for every futile variant that came to fizzle out there.

Misuse of the precautionary principle

Professor of Medicine, Stanford University, Jay Bhattacharya, explains that when preventive action to mitigate an unknown danger is marshalled, it must weigh up the costs with the same level of precaution as is applied to mitigating the challenge.

And in the case of COVID, long after the fears of a world ravaging pathogen had faded, and we are facing a disease largely of danger to the elderly and those with pre-existing conditions, the skyrocketing costs continue to be summarily ignored.

Every one of the following assumptions turned out be wrong: two to three out of a hundred infected people will die (actually 0.15% based on global IFR seroprevalence reported from Stanford, on the WHO website as well, peer reviewed); the disease is spread primarily by droplets (it’s not, it’s airborne); and on surfaces (CDC reports about 1 in 10,000 have been infected from touching a surface); no  immunity after infection (repeatedly confirmed including recently to last several years if not a lifetime); and everyone, no matter what age is equally at risk of hospitalisation and death (99% recovery rate below 60 with no comorbidities, 95% above 75 without serious comorbidities even), and there is no way to treat it (early treatment can reduce hospitalisation and risk of death by 85%+, amply documented, and so even if more get infected than we fear, we can improve their prospects significantly).

Despite all of these having quickly revealed themselves to be ill-founded, lockdowns premised on this (though this was never utilised since the Middle Ages), are still inflicted with ever greater rigor. Worship inhibited, businesses shattered, economic sectors undermined, music and artistic expression silenced, life plans aborted, on the faux claim that “millions” will die otherwise. And we have living proof from open jurisdictions without this folderol to prove they won’t.

But what Professor Bhattacharya is pointing out, is that the vast harms “from” locking ourselves in against the grain of all public health guidance should also have been considered using the same precautionary principle…and even today, we dare not even assess the impact we have wrought locally or globally (remember, while it’s fashionable to say only the Spanish Flu was a real pandemic of this magnitude, age and population adjusted, both the 1957 Asian Flu and 1968 Hong Kong Flu, were arguably more lethal, and they did not track normal mortality).

And the need to lash out at any epidemiologists who raise questions about the virulence of the virus or economists who flag collateral harms, shows how unsound these propositions are. The learning is, the costs of the precaution must be as proactively and transparently assessed alongside the risks of foregoing the precaution or creating a more sane version of it (protect the vulnerable, treat preventively and early as it’s a coronavirus not a visitation from Mars).

Before the next “test-demic” surge and the next almost inevitable temporary peak of death from this or that leads us to destroy all the momentum we next build up, or the next pathogen has us scampering for the covers and locking our lives away, perhaps we can insist on the application of the precautionary principle, and make sure we find smarter ways to balance both perils and possibilities.

Heave-ho

Lord Sumption, former Supreme Court Justice in the UK, was bristling at Boris Johnson’s extending their lockdown yet again on no more than scant evidence, alas more intemperate “modelling”. The PM described it as “one last heave”.

And Lord Sumption points out the pernicious folly of this approach. We began with three weeks to flatten the curve, another surge, another shutdown. Can we imagine if citizens had been told, “We’ve dealt with pathogens before, but with no confirmation our direst fears are likely, we invite 69 weeks of paralysis, economic meltdown, and micromanagement of your lives.” We rather suspect, outcomes would have been vastly different.

The only thing the modellers got right was that you would have to “keep” people locked in, or else the virus would bounce right back. Of course, they ignored natural immunity, and Farr’s Law which says whatever you do, viruses get more infectious and less lethal (they need living hosts) and taper off. We have interfered with this, and leading epidemiologists suggest, this is actually driving the variants. Those variants though, Dr. Michael Yeadon, former Chief Science Officer of Pfizer assures us, are only 0.3% different from the mothership. The immune system can readily deal with them, and again, he urges, focus not on swelling positive tests, but mortality.

Lord Sumption reminds us that the entire global strategy, now that we know lethality, is excessively risk averse. COVID is here to stay, it has to become endemic. The madness must end, whereby we wire everything in life through one virus. The risk of illness is part of life. Suppress that entirely, and you are suppressing life, and that becomes more lethal than any pathogen. As Oxford Professor John Bell points out, if our strategy is to bolt down a rabbit hole at every surge or new viral strain that seems menacing, we are going spend a very long time underground.

Again, we never adopted this “terrorise ourselves into immobility” in the face of war, or terrorism, or tsunami. Anyone, anyone, explain why it’s merited now. The only reason to treat healthy and unhealthy the same, a true scandal, is that it makes it easier to police. But “easier” is not leadership.

Different groups face radically different risk levels, based on age, health, clinical vulnerabilities, type of work, vaccination status (more about symptom suppression at present). So, risk assessments have to be tailored, and treatment and care has to adapt.

And crucially, public health simply is not the only relevant consideration. We all have to safeguard “lives” and not just biologically. If all the gates of returning us to normal functioning are clinical, then we are in dire straits. No weight is given to education or a viable future for the young, our jobs, mental and emotional wellbeing, culture, relationships, sporting events, our celebrations and worship. We have here anyway a minimal risk of death. The greater risk is sacrificing, pointlessly, everything that brings viability as well as joy into our lives.

The cessation of our ways of living is not an appropriate response to a respiratory virus that has not led to excess mortality in Lanka, and globally, has largely led to deaths of people in their 80s and older. And freezing life for all, has at best negligible impact on viral spread.

So real respect for life demands defiance of the “sick” suggestion that loving life is shown by calling off life, instead of doing what works. Letting people live and build natural immunity, treating those with symptoms, safeguarding the vulnerable, and keeping Sri Lanka solvent and hopefully back to flourishing again.