It strikes me that a lot of people are arguing with each other about masks, and not always on a scientific basis but more on an emotional level, which frequently includes ad hominem attacks on those who hold opposing views.  

There’s a sense that people are demonising people each other: both those who believe masks should always be worn, and those who are not so sure that the given mask strategy works, or is thought out properly.

It might serve everyone well to consider what we know about masks and about Covid-19 at this point. I welcome the conversation on that. And I mean conversation. Repeating simple boiler plate such as “The science is settled” or, “stop being a mask Nazi” might be a sign that you should withdraw from the discussion and leave it to the adults.

Far more importantly, there’s the question of strategy. If we are to wear masks: for how long should we wear them, and where should we wear them?

It makes sense that masks can help to suppress the spread of Covid-19 but, as suppression doesn’t eradicate the virus, is it the wrong tactic at a national strategic level? Think about it, is discarding the masks (with obvious exceptions for when dealing with vulnerable people) and striving for herd immunity the most rational and safest strategy?

If visiting vulnerable elderly or people in a health care setting I’m all onboard for wearing a mask. That looks like good protocol and proper precaution to protect at-risk people, but, should we wear masks all the time everywhere?

What is the exit strategy for the mask and shutdown strategy? What does the mask and shutdown strategy achieve? What are the aims of the strategy? I have yet to hear a clear answer to that question.

Are we suppressing the spread of the virus in the hope that a vaccine will be developed before the virus spreads throughout the population? That seems to be the tacit understanding, but is it a scientifically rational approach? Is it taking too much of a risk? There are undeniable risks associated with the lockdown, and we need to look closely at what they are. The lockdown might kill more people than the virus would have. Let’s explore this.

How long will a vaccine take? Can anyone say how long it will take to develop a successful and fully tested vaccine? Even if we put all the sharpest minds in the world on the case, will a vaccine take 1 year, 2 years, 15 years? I haven’t even heard a hopeful projection. There may never be a vaccine. Bear in mind that there has not yet been a single fully successful vaccine for a coronavirus of any type. Are we to shut down until we die of old age?

So are we waiting for a vaccine before we can go back to normal? Could that be 2 or even 15 years? Vaccine development can take that long – and there are often very solid reasons for taking the time to approve vaccines as safe and effective.

If we rush a Covid-19 vaccine by taking shortcuts on testing, and it is given to everybody on the planet as Bill Gates has pushed for, what are the risks? The reason pharmaceutical products go through rigorous clinical trials, is that there are frequent and unpredictable side effects from the product. Double blind placebo controlled studies take time, but they are absolutely necessary, because they flag all (theoretically all that is) the dangers that the medicine presents.

What happens when clinical trials are inadequate? Think of the thalidomide scandal.

In order to hurry the process, what actuarial risks would we be happy to accommodate to get vaccination rolling? If everybody on the planet were to get a rushed vaccine surely some of the 7.5 billion people on the planet would die from side effects. In terms of risk management, can we place a number on what would be an acceptable death rate from vaccinations (or even chronic health side effects) to justify the program? Will the WHO, who have been so untrustworthy in this crisis so far, put a number on that? Assuming that it would mean saving lives from the Covid threat.

 

So is the suppression of the virus an unallied good? It depends on the trade off doesn’t it?

We were told that the lockdown was to buy time so that the health services would not be overrun with cases, and crash. This sounded like a reasonable temporary strategy because we had wild overestimations about how deadly and contagious the virus was. It is now very clear that Fergusson’s Imperial College model was wildly inaccurate. He overestimated the impact of the disease by a factor of at least 10.

How can I say that with confidence?  Well, because we have the example of a country who ignored Fergusson and did exactly what he warned us not to do. I invite you to look at the data for Sweden on the Covid Worldomoter. Look at their total deaths and look at the graph of their daily deaths. If Fergusson was right their total deaths would be 10 times as high as it is. Now look at the graph of daily Swedish Covid deaths and tell me; is that an epidemic that is out of control, or is it one that has passed? The graph clearly suggests that there was an early spike and that it is now passed.

When the strategy of Sweden is mentioned people frequently cite the lower death rate of its neighbouring Scandinavian countries, but these figures must be looked at in context. It is true that Denmark, Finland, and Norway have considerably lower Covid death rates, but does tell the whole story? Does it even tell us anything useful? There are problems with this comparison. The most obvious being that the pandemic is not over and the final death count is not in. Also there is the negative effects of the lockdown, and how long those negative effects will be imposed.

Stanford’s Prof Jay Battacharya, a leading expert on medicine, demography and economics of health and ageing, emphasises again and again that you must look at every policy decision in terms of trade-offs. If you close down an economy there are deaths; if you impose quarantined isolation there are deaths; if you curtail normal health service activity, there are deaths. Hasty policies have unintended consequences which you might not see right away, but which will be felt in a year’s time or more.  Economists know that every % reduction in economic activity leads to deaths. It is not a surprise that people live shorter lives in poorer countries.

Prof. Battacharya, also pointed out that the virus is not going to disappear just because of government policies. He says it is an illusion that “If we just shut down hard enough for long enough, the virus will go away”

New Zealand, which has been lauded as leaders in the fight, and was celebrating 100 days virus free has just discovered how right Prof Battacharya is. NZ’s economy relies substantially on tourism, with 20% of its economy being tourism. For the past 6 months that section of NZ workforce have been idle and it looks like all the pain was for naught. Maybe we should have another look at NZ in 6 months time to see how they have managed the pandemic, and how their economy is. It’s all about trade-offs.

Sweden achieved what seems to be herd immunity while keeping their children in school, keeping their economy open, allowing people to socialise and avoiding the kind of lockdown which most other countries adopted. Sweden had a very capable epidemiologist on their side, Anders Tegnell, who devised a strategy based on science, not superstition or reactionary panic.

Sweden’s Covid death graph suggests that the surge has passed. It looks like they achieved herd immunity, or will very soon, and it looks like their children didn’t suffer a half year of lost schooling. And here’s the home run, it looks like Sweden is the only country in Europe where elderly people can mix with young people and not be terrified out of their wits.

Tegnell wasn’t the only epidemiologist or virologist who advised herd immunity strategies. There were so many.

Here’s another perspective. Sunetra Gupta, an infectious disease epidemiologist and a professor of theoretical epidemiology at the University of Oxford, said that a virus could not be eradicated once it gets into a population. It will spread until the population has been sufficiently exposed and thereby builds herd immunity. This is obvious to anyone who has ever lived. We cannot isolate completely because we need food and other necessities, so there is some level of movement in every human society that is unavoidable. The virus is present and it will spread, that is as sure as night follows day.

So what are we doing? Are we just slowing the spread to prolong the pain? For all the economic and social impacts this incurs (including a rise in the number of deaths from other causes because of difficulty accessing healthcare in a lockdown) is this the best strategy.  Again look at Sweden’s Covid death graph. Look at the integral under the curve. No matter whether that graph was charted over three years or six months, the integral under the curve would not differ. In short, the total death count will be the same, as long as the health service is not overwhelmed, whether or not you flatten the curve.

That point bears repeating because people are prone to offering up the worst cases, such as Italy, as a counter to Sweden. Each country has its own particular infrastructural and demographic properties so comparing them is a complex (but possible) multifactorial operation.

As long as Sweden had capacity in their health system to deal with the demand for ICUs and other Covid treatment related infrastructure, their final Covid-19 death count would not be different even if they aggressively tried the never-ending suppression strategy. That was the thinking behind Tegnell’s Strategy.

What was Tegnell’s strategy for Sweden? I’ll summarise:

1. Protect and isolate the vulnerable and elderly. That was done on a voluntary basis by the way.
2. Allow the rest of the population, to whom the virus presents a very low threat to circulate freely and contract the virus. The virus is therefore spread throughout the population who build what is known as herd immunity.
3. Now allow life to return to normal for the elderly and those with underlying conditions. They are now at a much, much, lower risk from the virus, but can get visits from relatives and friends.  In Sweden’s strategy, healthy people when mixing with healthy people, should not wear masks.

Sweden did make errors in how they protected their vulnerable elderly populations in care homes, but back in May when this became clear their government responded with emergency measures and opened an inquiry to investigate what went wrong. This surge of nursing home deaths corresponded with the epidemic peak in Sweden.

A criminal inquiry was opened into a single home where a third of the elderly residents died from Covid and it appeared there was no protocol in place to stop cross contamination. This is a responsible science led response to a changing situation; compare it to Simon Harris’s response of refusing to open an inquiry into the care home scandal in Ireland.

Infectious medicine specialist, Professor Sucharit Bakdi, from the Johannes Gutenberg University of Mainz, who knows about infectious diseases, was highly critical of lockdown strategies. He said the lockdown response was ‘grotesque, absurd and very dangerous.’

He rightly points out that humans are social creatures and need company, and that older people die for want of company. We have seen older people grieving their spouses as the coffin was taken from the house, and worse being refused permission to see them before they died. Many were then not allowed to go the funeral. That level of isolation, given what we now know about the virus, doesn’t seem in the best interest of those we are meant to be protecting.

So what was the cost of our lockdown, which looks like it will continue with no end. What is the exit strategy? Can any spokesperson for our government give us a hint? Wouldn’t people like some sort of plan that can point to an objective that will end the on-off reactionary strategy of our government. To be honest, they seem clueless. They often admit they are clueless in fact.

 

Could we have created more problems with the lockdown than we have prevented with it?

For example, we don’t know yet how many diagnoses of cancer were missed because the entire health system was diverted to this Covid threat. Remember that the hospitals were underutilised during the pandemic, so there was no real reason to close down day-services and operating theatres. A delayed diagnosis is a higher chance of fatality, that’s a calculation we should all be conscious of. When stage 1 or 2 cancer develops to stage 3 cancer because it wasn’t treated or diagnosed, that’s a failing of the system that can kill.

Then there are deaths of despair – suicide, alcoholism, domestic abuse, sexual abuse. It’s frightening to think how these numbers have inflated because of the lockdown. Think of dysfunctional households with no release, where parents take to drinking heavily. It’s anecdotal, and reports I have heard are coming from single institutions rather than population wide analyses, but around the world clinicians are reporting dramatic spikes in all these domestic violence reports. Isn’t that a worrying problem?

How did we respond anyway? I would argue cluelessly and rudderlessly. Undoubtedly the scandalous strategy of sending sick elderly into the nursing homes was one of the biggest blunders so far.  It’s a mistake anyone could make in a panic, but I would like to see our government take responsibility for their part in it.

I am sceptical of the masks directive. I think it is the wrong strategy. I think sound science, which has been tested now, indicates this is so. I would be led by science and data, and not by superstition. Covering our faces and waiting for a miracle seems to be a hopeless strategy to me, especially when we can point to what seems to be a more successful strategy in countries like Sweden.

There are others who will disagree, and all discussions should be welcomed, based on an analysis of the facts. We should move forward relying on scientific analysis, and not fear.

 


 

Lorcán MacMathúna