COVID Wisdom From Ireland: No Blarney Here!

The pandemic playbook gets clearer

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A social distance warning on the entrance gates to Ormeau Park in South Belfast (Photo by K. Mitch Hodge on Unsplash)

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:

  • 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.
  • 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.

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Swedish excess mortality based on reported mortality figures

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.

“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.

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.

  • 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

Might We Go With the Evidence?

So, crystallizing their prescriptions:

  1. 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!
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. Restoration of cancer screenings and diagnostic services to pre-2020 levels.
  10. Key elective medical services to be restored (cardiac screening, joint replacement surgery, cataract surgery).
  11. 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.
  12. Create legislative oversight for some of the most critical decisions that will be influencing generations.
  13. 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.
  14. 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.
  15. Replace fear as the default setting and aim to focus on risk in specific population groups, aim for achievable goals and milestones.
  16. 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.

“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?”

Global consultant, 30 years experience spanning Americas, Europe, Asia, Australia, Middle East. Bridging from human dynamics to real world results.

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