COVID Wisdom From Ireland: No Blarney Here!
I have already reported on the bracing insights of Canadian doctors and health care professionals in challenging the “COVID orthodoxy” that is so gossamer and flimsy in terms of actual data or even coherence, it fails to hold together when not just being generically asserted. Then, came the Belgian medical professionals, full of uncharacteristic impatience for the silly, spurious, incongruent claims being made. And there have been many other such outbreaks of sanity and wisdom from other quarters.
Well, Irish physicians and public health officials have just issued their jeremiad. It is powerful, focused, factual, compelling, and I am hard put not to just point to it, exclaim enthusiastically, and put my feet up and just cheer.
Alas, it seems when confronting willful insanity, stoked by media madness, and underwritten by desperate or despotic governments, completely at sea, and now perhaps shell-shocked as they see neither history, nor facts, nor their constituents in retrospect, will be kind to them, you have to continue to gear up. For otherwise, they just bunker down, regurgitate the pieties of the pandemic field manual, and re-enlist for another bout of delusional forecasting.
Flatten the Curve
The Irish experts admit, as perhaps we all must, that bereft of benchmarks, and uncertain of magnitude, a few week attempt to “flatten the curve,” whereby the period the pandemic would be experienced could be spread out, and thereby allow public health resources to be amassed and marshaled, made some sense. The grave, grotesque, lurch from there to “eradication” is what has caused today’s cataclysm. The Irish experts believe, factually, the virus is moving into an “endemic” phase (and was there really by end summer), and now our attention has to shift to the following:
- Ongoing C-19 mortality,
- The unsustainable interruption in our ability to provide routine and acute health services,
- Not sacrificing liberty on the altar of necessity, when it is clear health systems are not being overloaded,
- Balancing C-19 with other health care and social demands, not “crowning” it, quite unjustifiably, as a unique threat.
Since much has been learned since March 2020, predicting the populations most at risk has not only become much clearer but been clearly reconfirmed (above 65 with pre-existing conditions by a wide margin). The behavioral differences between this virus and influenza are clearer. Infection fatality rates have been indicated globally at 0.14%, Ireland concludes 0.23% across all groups and jurisdictions. Seasonality, viral dynamics, limitations of track and trace, and the distortions of mass PCR testing, are all being thrown into ever sharper relief.
One clear conclusion is that “lockdown” (that penal system interloper that has infested our responses) offers disproportionate costs for what are in fact negative results in terms of health, economic and societal damage. Its upside, seems elusive, and certainly not anywhere near on par with the demerits.
- Current mortality is within the envelope of previous challenging respiratory seasons (2000, 2015, 2018) as per the Irish and overall European experience.
- Hospital and ICU beds are under no more than comparable stress to previous winters.
- “Lockdown” was ruled out in the 2019 WHO and Irish pandemic guidelines, and we have now proven how accurate those concerns were insofar as actually mitigating morbidity and mortality.
- After a virus is roaming through a population, “test and trace” declines in value. Hence until 2019, WHO did not recommend it, for this very reason. In nursing homes, or for workers and residents in key risk environments, preferably using rapid Antigen testing, such “assessment” will likely have an ongoing role. Weaning ourselves off the PCR test fixation is key. Testing has to come back in line with clinical case evaluation, as heretofore has always been the case.
Lockdown Value: The Irish Perspective
As I have highlighted before, Lancet published a major study over the summer concluding
“Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people.”
Numerous preprint research papers fortify this, concluding at most a
“minimal beneficial effect on mortality outcomes.”
Since the downside of “locking down” economically, socially and the clear collateral health damage is so evident, this lack of dramatic upside is a real concern. Sweden, for example, following 2019 guidelines, rather than this absurd 2020 penal confection, will have essentially “normal” excess mortality, somewhat exacerbated by their nursing home debacle, and on the heels of two of the least severe flu seasons for them in 2018 and 2017, but otherwise nothing untoward. And while as per “modeling” 80,000 people should be dead there, happily the numbers are between 6–7k, even accounting for everything. They have had a slight recent “case surge” (nothing akin to the UK or France or Germany frankly), but mortality is still extremely mild, as the graph below shows.
Similarly, the Irish specialists indicate Ireland, regardless of lockdown interventions, shows no excess mortality against prior years, even if you zoom in on the first five months of the year. Even the peak month of April has a similar rate to January 2017 or 2018. By contrast we know lockdown seriously undermines breast, cervical, skin cancer and gastrointestinal cancer screening, leads to reduced referrals for malignancies like lung cancer, amplifies mental health issues in the old and the young, as well as, of course, igniting a pervasive economic catastrophe in all its manifestations.
However, as the paper points out, it is hard to extrapolate the full mortality “collateral impact” from these other causes from 2020 to the years ahead. In the UK, close to 75% of elective care has been postponed. The best estimate is that were this activity to be cancelled entirely, there would be an estimated 185,000 additional deaths. This does not account for impacts re health checks, non-urgent primary care (dental and GP), community services compromised, and screening and vaccination programs deferred.
And as the sad impact of C-19 hits most acutely those who are at or just beyond life-expectancy, the “lockdown-induced” deaths or health impacts are likely to include those well below their life expectancy. So “life years lost” could far exceed any foreseeable number saved (based on data rather than models).
Striking data from Public Health England is cited by the Irish experts, which details mortality trends for the months leading up to November 2020. Essentially no excess mortality occurred in the “hospital or care home” setting. Excess death, for many months now, has been concentrated in the “home” or “other places”, ergo driven by the negative effects of the lockdown mania either currently, or the ripple effects of the earlier shutdowns now coming home to roost.
Excess death has shifted from the more aged groups which COVID targets and has concentrated in the 14–44 and 45–64 age ranges, with no increasing finding of COVID as an illness in these demographics. This again, makes the case above.
Impact on Other Illnesses
The world’s greatest killer is cardiovascular disease, and fatal events are crucially linked to speed of access to proper care. Out of hospital cardiac arrest has ballooned in the UK by 56% just from 1st February to 14th May 2020 versus 2019. Another study cited by the Irish specialists testifies,
“Death in the home included 35% excess cardiovascular deaths,”
and they provide further citations of excess cardiovascular deaths in the community. Just by itself, these could potentially substantially exceed the C-19 impacts long-term.
Studies on impacts via cancer screening indicate about 9,000 deaths for six months of disruption, and how will that continue to roll over? As per the Irish Cancer Society’s assessments in July 2020, the cancer deaths will likely easily outdo COVID impact.
There is then the impact on mental health and emotional well-being, palpable though harder to quantify, except via “suicides” and “overdoses” indirectly perhaps, which continue to increase and have become more acute since “lockdown” mania. One clear finding is the duration of enforced isolation and loneliness is a clear predictor of future mental health problems.
French Health Minister, Olivier Veran, recently said
“The mental health of the French significantly deteriorated between late September and early November…”
Clearly the mental health of the political leaders of France had already plummeted perilously when they decided to fulfil that wry definition of insanity: Do whatever doesn’t work ‘harder’ expecting different results.
The socio-economic distress is heightened, of course, for the poor and vulnerable with skyrocketing unemployment (one study cited* shows that a 1% increase in unemployment tends to correspond with a 3.3% increase in drug-related deaths).
So we must return to the twin facets of any “bull’s eye” here: Keep the curve as flat as possible while allowing life to flourish as normally as possible. Either in exchange for the other on any sustained basis, must be treated with extreme suspicion.
Those PCR Tests!
We have done a tour of this carnage already. A positive PCR test is NOT a “case”. If you apply a standard false positive rate (hovering close to 4% in the UK as per the Irish doctors) in a low virus prevalence situation, say 2% or so as they cite, then as per the tests, it would show about 5% false positives! As prevalence goes down, false positives go up! Moreover, PCR tests cannot distinguish infectious “live” virus from residual “dead” virus or fragments from a past or other infection. Therefore, citing these results as “cases” are meaningless insofar as medical status relating to real contagiousness or transmissibility.
As PCR tests “amplify” genetic material, the cycle thresholds or “Ct value” matters immensely, as at higher amplification, the likelihood of “live” infection falls off drastically. Ideally the threshold should be below 35 cycles. And this is absurdly not standardized.
The Irish specialists summarize a litany of PCR concerns:
- Non-standardized specimen collection techniques
- No gold standard test yet identified
- Different tests used in different labs with no standardized, acceptable Ct values
- Inconsistent quality assurance programs
- False positives
- Identification of irrelevant dead viral genetic material which can persist for months after infection
- Potential contamination of specimens
That this would not be addressed “before” we blew up the planet and decided to “implode” as a functioning domestic and global society beggars the imagination so far as to be horrifying. Anyone testing positive on a >35 Ct value, should get several rapid Antigen tests to verify, before life and limb are no longer at their own discretion!
Might We Go With the Evidence?
So, crystallizing their prescriptions:
- “Hard”, invasive “lockdown” to be taken away as a mitigation measure, and it can be tossed on the heap of “disastrous non-solutions”. Evidence-based epidemic management, “WHO 2019” as the Swedes essentially practiced can return to the fore.
- Premise “public health” solutions to things that actually promote health! “Lockdown” does not do so, as detailed and catalogued above. This is perversely in practice, a dysfunctional, cyclical, way to maximize harm to the viability of a thriving human society. “Waiting for a vaccine” doesn’t solve the problem, as this cannot, simply cannot, be in the playbook for future challenges. Once more, say it with me, economic bankruptcy is NOT a medical strategy!
- Create an updated epidemic/pandemic action plan for each locale and have it ready to mobilize for future challenges. “Go home and lock the door” should not be its distillation.
- There should be immediate, fast-tracked, threshold based, data driven, not PCR test paralyzed, set of proposals for creating sustainable reopening in education, tourism, travel, hospitality, recreation, sports, and more.
- Some consideration has to be given to the physical and mental impact of our current mitigation efforts and the need for providing resources to address those, so when we “open,” people actually step into the breach, head out, stay prudent and vigilant, but also exercise initiative and engage in a way that allows for a real rebound.
- Create sane, portable, applicable, approaches to protecting the most vulnerable, yet also protecting a measure of autonomy and dignity for them, so their “care” is not tantamount to enforced persecution.
- Create education about “positive tests” versus “cases” versus “deaths” and the impact of false positives and high Ct values, and create some global “gold standard” and quality control, as we have across the board otherwise, medically and in virtually every other field in which we have lives and even livelihoods at stake.
- Focus on rapid antigen (saliva sample) tests for those dealing with high risk groups (nursing homes), in settings where there is a larger concentration of people and, say, for situations like practical provisions for arriving and departing passengers at airports.
- Masks may have a role, but it’s primarily where physical distancing cannot be managed. There, they can be meaningfully utilized. However, a recent peer reviewed study emerging from Denmark, does cast even this assumption, or rather presumption, into greater doubt, and deserves a robust exploration and expanded follow up.
- Restoration of cancer screenings and diagnostic services to pre-2020 levels.
- Key elective medical services to be restored (cardiac screening, joint replacement surgery, cataract surgery).
- Getting timing and logistics for a safe implementation of a vaccine as it becomes available, along with increasing, as a preventive “panic” measure, the number of hospital and ICU beds.
- Create legislative oversight for some of the most critical decisions that will be influencing generations.
- Get rid of the daily raw case numbers being flashed with agitated portents of doom. Fewer briefings, better data, real Q&A, focused on context and perspective.
- The Irish experts indicate, “We are deeply concerned by the absence of balance and debate in our media.” Too many voices are smothered, or side-lined, we need the widest possible consideration of creative alternatives.
- Replace fear as the default setting and aim to focus on risk in specific population groups, aim for achievable goals and milestones.
- Most critically, C-19 cannot compulsively remain the sole focus of the entire health sector, when the entirety, the full range of public health is pleading for, and deserves, our renewed, concerted attention.
And Then, a Perspective From Ohio?
After reveling in the wisdom, sanity and sense of the Irish doctors and public health specialists who have issued this challenge to insanity, perhaps we could build on their insights by heading across the pond. Dr. David Katz of Yale, has argued, akin to The Great Barrington Declaration, from the outset on the need for “Total Harm Minimization” and focusing on the relative risks to various populations, and not having a “one size fits all” virological approach to a pathogen that clearly does not have a “one size fits all” immunological risk across various age and comorbidity profiles.
Recently, Dr. Katz reports going on a “live” speaking engagement to Ohio, and being shocked, in a hall full of highly educated people, scientists and Ph.Ds., to find no “distancing” (social or otherwise), no mask wearing, despite these being well informed, wellness enthusiasts. And he was shocked to hear of similar behavior from colleagues from Washington State, Oklahoma, from the Hasidic Jewish community and more.
As he explored this, he found lack of trust in public pronouncements was certainly a source of the reaction (perhaps not a shock, given the lack of debate and transparency re the imposition of the penal fact-free stupidity of capricious, well-nigh reflexive “lockdowns”). He got an earful as he says about
“blunt instrument of government action and the general opacity in policy making that denies the public access to the data on which their elected officials were basing their decisions.”
And if the decisions flowed transparently from the facts, why would that be the case? Just a scintilla of common sense tells you there is something to hide, some charade. Otherwise why not blow the data trumpets, and then take your bows as you show your stripes as social saviors rather than fleeing from any challenge or suggestion by arguing, desperately, hysterically that it’s “anti-science?”
If that were remotely true, let’s get all those tenured signatories to Great Barrington and others who have exposed PCR testing debacles, or who question the “masking” literature, to be flailed in an open debate. Except for the fact, most of these people are immensely credible and believable, come from the leading universities, and can’t be swatted away.
I cannot agree though with Dr. Katz when he claims “open it all” is just the natural counterpart to the “shut it all down” so called “favored public health action.” If you lie to people about WMD, they want to invade Iraq. If you lie about being attacked by Vietnam, they support (initially) a military response. So, if you lie to people about millions of deaths and Spanish Flu 2.0 coming to your doorstep, and then conflate “cases” with actual mortality, and claim our discovered “penal” liberator, lockdown — never recognized or advocated by WHO or anyone through 2019 — surpasses all the public health, epidemiological wisdom of past pandemics and ages, then yes you will get bizarre reactions.
If Lockdown was such a stirring discovery, could we ask for the argument, research, or other demonstration that established that? Surely, we deserve more than just the bald, bold asserting that the collateral damage caused and being caused daily is not what it appears to be? Namely, the most grotesque miscalculation in history, where media porn colluding with power mania from our ruling junta, and gullibility from too many in the public who capsized their common sense, have made for tragic bedfellows.
So “open everything up” or “keep it open” is NOT a reaction Dr. Katz, it’s the world we had, it’s the world anyone would expect, and never has a reaction to a pandemic been so intrinsically inimical to it. Nor have we ever seen a pandemic response that exalts one danger — especially one so statistically tame in terms of demonstrated lethality (as Dr. Katz has brilliantly demonstrated himself through dispassionate analysis) — above every other value and concern in existence.
And the question is “by what right” does someone demand you shut your business, or put a “nappy” on your face, or avoid those you love, or avoid potentially life-saving screening, or postpone dreams and plans possibly built up over a life-time to possibly “save” someone from an illness 99% recover from (outside the most vulnerable profile, and 96% from the vulnerable profile taking quite conservative figures)?
Why does your fear of death, statistically irrational or otherwise, take precedence over someone else’s mental health, or their child’s education and the quality of life that flows from that, from the anguish of suicides and domestic abuse, from the devastation of poverty and literal starvation?
And to stoke those fires, we have to obtusely ignore the fact that this pathogen requires some sustained close quarter transmissibility. Ignoring that, we must implicitly and quite irrationally assert it might now infiltrate pores somehow and lay humanity to waste? When a normal, recurring influenza season can lead to 650,000 to 750,000 deaths year on year, before we even get to other mortality drivers, what is triggering our exaggerated panic?
No, if we showed the same passion for sanctity of life across the board, it would be far more credible: by addressing air pollution, and the garbage put in food that kills us, or a plethora of other risk factors, or outlawed all “extreme” sports, or kept cars from being able to drive above a certain speed limit, or were (and thank God we aren’t) a massively prophylactic culture in which “life” is not yours to live or lose, but is there to be inhibited and obligated.
Then perhaps the Ohio audience and others like them, might consider it plausible that this really has to do with “life.” Might we then be as compassionate over the person who loses a loved one from COVID and someone who cannot visit someone they desperately love in a care home literally “dying” of isolation, or who realizes that delayed care cost the life of a family member from cancer, or mourns the suicide of someone whose business was literally “ordered” to fail, all this so a median level influenza mortality season with a “brand name” would not shatter our perceived peace?
Like the Irish specialists, like Dr. Katz through his wonderful work, these Ohio attendees were expressing the civilizational imperative of being unimpressed by blarney. Clearly, on that front and in that conviction and commitment, given the stakes, we should join them.
Hollingsworth, Alex, Christopher, J Ruhm, and Kosali Simon (2017). “Macroeconomic Conditions and Opioid Abuse.”