Covid +1

It was exactly one year ago that news was first coming out of China that a SARS like virus was spreading in Wuhan.

It has been quite a year since then.

We can all attest to it. We have lived it.

However, Wuhan and China, despite being the original epicenter of the pandemic, have fared much better than almost anywhere else. This is without a vaccine or other high tech therapeutic treatments that were developed in the United States such as Remdesivir and monoclonal antibody treatments.

For example, compare the scenes in Wuhan (a city larger than New York City) with Times Square on New Year's Eve.

Wuhan, China on New Year's Eve

You can view a video from Wuhan here.

Times Square in New York City on New Year's Eve at 11pm

Is it just a coincidence that the virus emanated from China and yet a good part of the rest of the world is living under this scourge while China is getting richer and richer?

Did the virus come from bats in a wet market or are we dealing with something else?

https://nypost.com/2021/01/02/growing-body-of-evidence-shows-covid-19-leaked-from-chinese-lab-us-official/

It is also interesting to look at the number of confirmed cases and deaths that have come from Asia and Africa compared to Europe, North America and South America.

Confirmed Cases per Million

Deaths per Million

What explains this? Is there a genetic component here? Is it culture? Diet? Underlying health effects? The extensive use of HCQ to prevent and treat malaria in Asia and Africa? Testing? Is it just differences in reporting?

How could a virus that is deemed so contagious that we are told we have to lockdown our lives not have the same affect on humans who live in some of the densest population centers on earth?

Source: https://www.reddit.com/r/MapPorn/duplicates/9tvsa0/population_density_of_the_world/

We seem to be missing something.

In many places it seems that lockdowns actually result in increasing cases.

Take a look at California which currently has no indoor or outdoor dining, stores are limited to 20% of capacity and all major gathering venues (zoos, museums, theme parks, sports) are totally closed. The Rose Bowl game actually had to be moved to Texas. The San Francisco 49ers played today's home game in Glendale, Arizona.

Here is the Google Mobility Index for Los Angeles County. The baseline used here is the median value for the period January 3- February 6, 2020.

Source: https://www.gstatic.com/covid19/mobility/2020-12-29_US_California_Mobility_Report_en.pdf

Here it is for San Francisco County.

Source: https://www.gstatic.com/covid19/mobility/2020-12-29_US_California_Mobility_Report_en.pdf

There is massive testing and contact tracing going on in California and there is as much mask usage there as anywhere in the world.

The decline in cases in the last week of 2020 appears primarily to have been due to reduced testing during the holidays.

Once upon a time we would have looked at this data and concluded that there must be a flaw in our approach. Something we are doing (lockdown, masks etc) must not be working. That is no longer the case. We now just double down and blame people for not doing what they are told even when they are doing it.

If you look at a graphic of all states together you see that most states peaked in mid-November and started declining. This is irrespective of lockdowns or mask mandates.

Source: https://coronavirus.jhu.edu/data/new-cases-50-states

For example, look at the Upper Midwest states which were heavily impacted with Covid cases in the Fall.

All rose and fell together even with vastly different public heath policies (South Dakota very few restrictions, Minnesota with a great deal more). Cases spiked and cases declined at the same time and with essentially the same rhythm.

Look at Minnesota and Iowa. In October, Wallet Hub ranked Iowa as the #5 on a list of having the least restrictive Covid restrictions in place. Minnesota was #32. South Dakota was #1, North Dakota #9.

A friend and BeeLine reader recently sent me a blog post from Dr. Malcom Kendrick on Covid entitled "What is left to say". Kendrick is a Scottish physician and has a lot of great insights on Covid. It is well worth the read.

Kendrick writes that we are almost one year into Covid and most of us are caught between two warring camps.

The ‘COVID19 is the most terrible infection ever, and we must do everything in our power to stop it, whatever the cost’ banner.

Or the ‘What on earth are we doing? This is no worse than a bad flu, and we are destroying the world economy, stripping away basic human rights and killing more people than we are saving’ banner.

Between these two, main, completely incompatible positions, lies the truth. It is in pretty poor shape. It has been crushed, and bent out of shape, smashed, and left as a broken heap in the corner. I search where I can, to find the fragments, in an attempt to bring together a picture that makes some kind of sense.

We don't know whether the PCR tests to diagnose Covid are accurate and helpful or are actually falsely hyping the threat.

Did someone die of Covid or merely with Covid? Are we overestimating or underestimating deaths from the disease? 

At Covid+1 it seems we should know more.

What does Dr. Kendrick know right now?

So, what do I know? I know that COVID19 exists – or I am as certain of this as I can be. Was it a natural mutation from a bat, or was it created in a laboratory? Well, I suppose it doesn’t really matter. It’s here, and there is no chance that any Government, anywhere, would ever admit responsibility for creating the damned thing. So, we will never know. If you asked me to bet, I would say it was created in a lab, then escaped by accident.

Is it deadlier than influenza? Well, it is certainly deadlier than some strains of influenza. Indeed, most strains. However, Spanish flu was estimated to have killed fifty million, when the world’s population was about a fifth of what it is now. So, COVID19 is definitely less deadly than that one. About as deadly as the influenzas of 1957 and 1967. Probably.

Will it mutate into something worse? Who knows.

Will the current vaccines work on mutated strains? Who knows.

Can it be transmitted by asymptomatic carriers? Who knows. 

How effective are the current vaccines going to be? Who knows.

That is a lot of "who knows" one year into this.

And North America and Europe are betting big time that vaccines are the only way forward. This is the case even when we really don't know how effective they will be or the longer term side effects that the new messenger RNA vaccines may have on the people who take them.

You undoubtedly have seen the headlines that the Pfizer and Moderna mRNA vaccines are said to be 95% effective.

However, do you know what that means?

Let's put it in context thanks to an excellent summary of the vaccine trial data by Dr. Zoe Harcomb, PhD  that I found interesting.

Ideally, you want an antiviral vaccine to do two things.

1. Reduce the likelihood you will get severely ill and have to be hospitalized

2. Prevent infection and interrupt disease transmission

You might be surprised that neither of these are the stated objectives in any of the Covid vaccines.

They merely were focused on the detection of a positive test and at least one symptom of Covid and the comparison between those who took the vaccine and those who took the placebo.

In the Pfizer test there were about 18,000 in each arm of the testing (vaccine and placebo). Very few of those in the trials were over the age of 70 or had severe comorbidities.

Among the 18,000 who got the vaccine, 8 later tested positive for Covid and had at least one symptom. Among the placebo group, 162 tested positive at some point. The vaccine efficacy was stated to be 95% because 8/162=.05. This is where the 95% efficacy numbers came from.

However, Dr. Harcomb observes there is another way to look at this.

The tiny number of people who tested positive is striking. The revised Pfizer numbers could also be reported as 99.9% of people in the vaccine group and 99.1% of people in the placebo group didn’t test positive.

You wonder how is it that millions of people in Wuhan were celebrating on New Year's Eve without one vaccination among any of them?

Does that have something to do with a natural human immune system?

Look at the Pfizer test results again. Over 36,000 people were in the vaccine trials. Only 170 tested positive at some point in both of the groups. 99.5% of the overall test group never tested positive.

Based on the data, 154 possible infections were avoided but it took 18,000 vaccines to accomplish that compared to the placebo.

The Number Needed to Treat (NNT) is an important measure of the value of an intervention. The NNT is the number of patients, on average, who would need to receive experimental treatment (instead of control treatment) for one additional patient to not have the study outcome.

It is a simple way to contextualize the risk/benefit relationship of a treatment alternative. The ideal NNT would be 1 meaning that a single intervention would produce a corresponding positive health outcome. As the NNT increases it is possible that the risk of the intervention might outweigh the benefits. 

The NNT for the Pfizer vaccine is 119 based on the test data. That is a very high number of necessary treatment interventions to avoid one case. Perhaps we will find that it is lower than that as we gain more experience with it. However, we might also find that it carries more risks (or benefits) than the original testing showed.

Here are some NNT's for some other common treatments for comparison.

Wearing compression stockings post-surgery to avoid a serious blood clot is a 7 (for every seven who wear the stockings one deep vein thrombosis will be avoided)

Antibiotics to cure conjunctivitis within 10 days is a 12 (11 would get better on their own without needed)

Taking a statin to prevent a heart attack within five years is 60.

If all 119 vaccinations required to avoid that one Covid positive test are completely harmless the benefit clearly outweighs the risk. However, if there are significant side effects the calculus might change.

The risk profile might also depend on the individual. The benefit might outweigh any risk for an 80 year old in a nursing home or an ICU nurse who treats Covid patients every day.

However, it might be different for a 30 year old stay-at-home mom, a 40 year old male triathlete or a 16-year old high school student.

It is important to know your situation and the real facts rather than rely on "public service" announcements telling you to get vaccinated as soon as you are able.

Dr. Harcomb concludes this way.

If you stopped 100 intelligent people in the street and asked them what 90% vaccine efficacy means, they will likely say that it means 90% of people vaccinated won’t get the virus. The fact is that 99% of people who were given the placebo didn’t get the virus. The intelligent person in the street won’t realise that it means approximately 100 people need to be vaccinated to avoid 1 case. They might think those vaccinated won’t have a bad outcome and can no longer transmit the virus. They probably won’t realise that the trials were not even designed to test these key issues. 

What has Dr. Kendrick learned and where does he see this going now that we are at Covid +1?

So, again, what have I learned about COVID19? I learned that all Governments are floundering about, all claiming to have exerted some sort of control over this disease and ignoring all evidence to the contrary. In truth, they have achieved nothing. As restrictions and lockdowns have become more severe, in many cases the number of infections has simply risen and risen, completely unaffected by anything that has been done.

The official solution is, of course, more restrictions. ‘We just haven’t restricted people enough!’ Sigh. When something doesn’t work, the answer is not to keep doing it with even greater fervour. The real answer is to stop doing it and try something else instead. 

If I were to recommend actions. I would recommend that we stop testing – unless someone is admitted to hospital and is seriously ill. Mass testing is simply causing mass panic and achieves absolutely nothing. At great cost. We should also just get on with our lives as before. We should just vaccinate those at greatest risk of dying, the elderly and vulnerable, and put this rather embarrassing episode of mad banner waving behind us.

Hopefully, in time, we will learn something. Which is that we should not, ever, run about panicking, following the madly waved banners… ever again. However, I suspect that we will. This pandemic is going to be a model for all mass panicking stupidity in the future. Because to do otherwise, would be to admit that we made a pig’s ear of it this time. Far too many powerful reputations at stake to allow that.

I would hope we are in a better place this year than we were last year.

Yes, ignorance is bliss and there was a lot of ignorance to make us blissful last year.

 I would like to think we are in a better place now that we are at Covid+1.

Then again, as Dr. Kendrick correctly states....who knows?