Erasmus : The key question to ask in the current Corona Virus [CoVid 19] crisis is "Why we are doing this?". The usual answer is of course that we seek to save lives. So the community response has been to “stop” the spread of the infection. Unfortunately, any doctor within ounce of sense or reason can instantly see why this would fail. The corona virus is a respiratory virus. It is a very infectious respiratory virus.
And the new variants are more infectious still. Australia won the quarantine war and limited its cases. Most of the world did not. And where the world succeeded at first, they then failed to control the newer variants from escalating into an epidemic.
Kinkajou: What is at stake?
Dr Xxxxx : Well, initially we thought that 5% of the population could die. In country the size of Australia- 25 Million people that means that potentially 1.25 million people could be killed by the Corona Virus CoVid 19.
Erasmus : But not everyone will catch this virus.
Dr Xxxxx : Ok. So let’s assume that 1/3 of the population will catch CoVid before the epidemic peters out. A conservative assumption. That then translates into 400 000 people dying of CoVid in Australia in the epidemic, with a long term trickle of cases as the epidemic turns into a chronic smoldering infestation- but hopefully to be controlled by new vaccines or drugs as humanity “finds a cure”.
Kinkajou: I don’t think we’re close to controlling the infection are we.
Dr Xxxxx : No Australia is a bit atypical. It has had 8000 confirmed cases and about 100 deaths as at 2nd July 2020. A death rate of 1.25%. We did successfully quarantine the disease.
The world in general failed to stop the spread of Covid. The world has had 10.7 million cases and 516k deaths: a rate of 5.3% as at 2nd July 2020.
More currently: as at 4th June 2021
Now the world has a population of about 7 Billion. Yet the world has experienced the number of CoVid deaths that we were initially fearful of seeing in Australia. The population of the world being 280 times larger than Australia. So in effect we are dealing with a disease with a purported death rate of 5%, which is producing cases at a rate a fraction of what we were expecting as at 2nd July 2020.
Erasmus : WTF? As I have said, I think - much of the case diagnosis rate is based on PCR technology , not serology, so there is a substantial built-in bias in the numbers. We are underdiagnosing cases and distorting death statistics to make them look worse.
Kinkajou: Maybe we’re just successful at stopping the spread of the virus.
Ebola is a very different virus.
It has a very high mortality rate.
Dr Xxxxx : You may as well try to stop the spread of a puff of smoke or to stand on the beach and command the waves to turn back. It is not possible to stop the spread of the infection. I will repeat it is not possible to stop the spread of the infection. I think most sensible doctors accepted this fact of life. They saw that at this point of our knowledge and technology, all we could really do is to change a fast epidemic with 5% mortality to a slow smoldering chronic infestation with a death rate of 5%, and maybe in the bargain we could save a few more lives if our medical facilities were not overwhelmed. The critical resource was deemed to be the access to ventilators.
Dr Xxxxx : So the rationale for the doctors in the early phase of the illness was to spread out the case load impacting on intensive care facilities. If we can slow the infection down, over a period of time a larger number of people would be able to access intensive care/ventilator support. This would save lives.
This seemed especially necessary since the death rate from viral infection has consistently appeared to be of the order of 5%. That is 5% of the people who are infected with the coronavirus, will die.
Erasmus : The figures we are seeing worldwide are not demonstrating anything like the tidal wave of death that we were bracing ourselves for.
Dr Xxxxx : Yes. There seems to be some fault in this reasoning. The statistics are not showing the anticipated population impact on the world, though subsets (displayed prominently by the news media) are pointing to 5% death rates. Note- much of the case diagnosis rate is based on PCR technology , not serology, so there is a substantial built-in bias in the numbers.
The death rate amidst the elderly is definitely high and very age dependent, no matter what diagnostic technology you may use.
But there is more evidence of discordancy.
Over the last 4 months, we have seen a number of instances where pockets of infection with coronavirus have failed to produce the implied death rate. There is the case of the community in Australia and Southeast Asia, where the infected person isolated by PCR testing, appeared to be the last person in the community who had caught the infection. Serology revealed that the rest of the community was immune, but there had been no recorded deaths.
Madonna said she had the Corona Virus : evidence via Serology Testing, not PCR testing.
Madonna has twittered that her serology for coronavirus shows that she has HAD the infection but does not have it now. She relates that there was an unusual infection in her road touring group. It becomes obvious that the entire group would have been exposed. No recorded deaths occurred. Note that a 5% death rate means that one in 20 people in a group would be expected to die if that group were infected with the coronavirus.
Kinkajou: Isn’t Germany doing a lot of serology as part of their CoVid? Any Information from there?
Dr Xxxxx : You are well informed my young friend.
There is the example of the factory in Germany where there were 900 employees of whom 700 were identified by serology as having caught the infection. No deaths occurred.
The problem here is that the experience of the spread of the infection suggests that the death rate is not 5% as has been suggested.
In Germany, community studies are showing that between 2 to 14% of the community has experienced a CoVid infection. Statistics show that there have been approximately 10,000 deaths amongst a confirmed case load of approximately 200,000 cases. This gives a death rate of approximately 5%, the figure which is commonly presented from caseload data. However the general population is approximately 84 million. If even only 1% of the population is positive for coronavirus serology suggesting that it has experienced asymptomatic CoVid infection, the death rate now effectively becomes 1%. If 10% of the population is positive for coronavirus serology, this suggests that the death rate is now .1%.
Now comes the crunch. Every month > 0.1 % of the population of the world and any country in the world will die. At this rate of death, we will run out of people in the world in about 80 years. In short, in a world population of 7 billion, 7 million people will die of "natural” causes monthly. In a country like Australia, population 25 million, 25 000 people will die monthly. (Divide by 1000 gives an easy rough translation between population and monthly death rate.
CoVid has caused deaths worldwide, even now well short of the monthly world mortality statistics.
Erasmus : Again WTF? Why are we destroying the world economy to save a death quota equivalent to about 2 days death from natural causes in the world?
The destruction of the world: as seen by history.
Kinkajou: A good question. It still comes back to saving lives.
There is another point of view to consider though, not just focussed on death. We need to consider disability. CoVid-19 causes substantial "disability" as well. It matters less if 5% of the population dies than if 5% of the population is crippled. CoVid causes substantial lung scarring and can spread throughout the body especially in the older patients causing stroke , heart attacks and cardiomyopathy.
5% of people dying is a lot less a problem than having 5% of people continuing to live but needing extensive expensive care to keep them alive or to enable to achieve their ADL- activities of daily living.
This is an issue difficult to consider early during the pandemic due to lack of statistics, and becoming hard to assess later in the pandemic as new drugs such as remdesivir became generally available and medical care optomised to enable us to better treat the illness. Our treatments have altered our statistics making our initial basis for decisions irrelevant.
In the new world order, maybe the question we should be asking is not how many are dying but how many are crippled or disabled as a result of the infection.
Erasmus : Even though the doctors never said it would be possible. What is your take on our justification for trying to suppress CoVid Dr Xxxxx?
Dr Xxxxx : Remember 0.1% of the population dies of “natural” causes each month. For a death rate of 5% of the population, a rate which is 50 times the average monthly mortality figures, I would propose that it is probably worthwhile trying to intervene in the infection spread process. For a death rate of .1% of the population, if this were spread out over a few months it would cause only a very minor blip in the population death statistics – compatible with the usual increase death from the winter flu season. For a death rate of 1/14 of 0.1%, we should probably not bother doing anything more than we might for a bad flu season.
However, if we consider disability, our actions would needs default to reducing infection by any means possible. A 0.1% additional disability rate is likely to become a long-term and significant issue.
Old age: a major disease mortality risk factor.
Now remember it is not possible to reduce the number of people infected. The virus is highly contagious. It will spread easily and infect people easily. Remember the goal we have written down initially. That is, we will try to slow down the spread of the infection to minimise the load on intensive care facilities and to maximize people’s survival from the use of intensive care facilities.
The unwritten and unknown real goal should actually have been to reduce the number of long term lung cripples or people affected by CoVid related disablement. The cost of looking after old and sick people is high enough, but the cost of looking after crippled and disabled definitely supports " do whatever you can to limit the infection until other more effective strategies emerge".
For a death rate of .1% of the population, maybe extreme quarantine measures are not worthwhile. Yes, people are dying. Yes, this is a sad event. Yes, it will happen no matter what we do. Essentially our community interventions may spread out the community infection process over time, but in the end the coronavirus pandemic will end when enough of the community is immune to make it difficult for the virus to spread from person to person. So for a death rate of .1% of the population, all interventions will still guarantee a death rate of .1% of the population. In short, lockdown is not a useful process to change the statistics of coronavirus infection.
All our activities and interventions seem focused on taking the patients out of intensive care. However, we are putting the economy in intensive care instead. And in the final analysis, the death rate and the number of people dying will probably be largely the same.
However, the long term numbers of people getting care is a much more important driver for CoVid decisions- if we can create a path to more effective disease control such as vaccination. Measures which would change death but more importantly also change disablement.
To make a balanced decision it is important to consider the health of the entire country. To delay the deaths of a few, (especially where most deaths- 80% - are in the older age groups most at risk of dying anyway), is to endanger the economic and social health of the entire country.
Considering delaying or preventing Disability is a much more significant consideration.
Dr AXxxxx : Lockdown/ Economic Damage and Disability both would reduce the country’s capacity in future to cope with economic stress or other problems. They would reduce the country’s capacity to cope with conflict. They would reduce the country’s capacity to make strategic economic decisions. They reduce the development of new families and new social networks. It abandons social investment and social programs in favour of just stuffing them into new “isolated” accommodation – in Australia anyway.
Erasmus : So the question behaves asking what have we achieved? What should we be doing?
Dr AXxxxx : I fear about the long term consequences of these decisions. The world economy will be in recovery mode for up to 5-10 years. A war could not have caused as much devastation.
Kinkajou: Yes. Strangely, wars tend to stimulate economies by focusing all economic activity on “production’. If it were not for the destructiveness of war and the direction of resources to economically useful production, war would in fact be a very positive economic event.
Though Australia did very well literally printing money to support "jobkeeper" payments to businesses in jeopardy allowing them to survive the lockdown crisis. The long term social and business damage is a fraction of what could have occurred without targeted government policies focussed on allowing businesses wholly dependent on cash flow to survive financial hardship.
Dr AXxxxx : So there may be two issues arising long term: economic production loss and the vaccination program to come. CENSORED.
The news from a little german Town.
NEWS ITEM: excerpt
How many people have really been infected by the coronavirus?
In one German town a preliminary answer is in: about 14%.
The municipality of Gangelt, near the border with the Netherlands, was hard hit by covid-19 after a February carnival celebration drew thousands to the town, turning it into an accidental petri dish.
The survey in Germany was carried out by virologist Hendrik Streeck and several others at the University Hospital in Bonn, who say they approached about 1,000 residents of Gangelt to give blood, have their throats swabbed, and fill out a survey.
They found that 2% of residents were actively infected by the coronavirus and a total of 14% had antibodies, indicating a prior infection. This group of people, they say, “can no longer be infected with CoVid 19.”
In short, one in seven (14%) have been infected and are therefore “immune.” Many of those people would have had no symptoms at all.
Here's why the true infection rate in a region matters: the bigger it is, the less pain still lies ahead. Eventually, when enough people are immune—maybe half to three-quarters of us—the virus won’t be able to spread further, a concept called herd immunity.
From the result of their blood survey, the German team estimated the death rate in the municipality at 0.37% overall, a figure significantly lower than what’s shown on a dashboard maintained by Johns Hopkins, where the death rate in Germany among reported cases is 2%. (The death rate for seasonal influenza is about 0.1 %.)
The authors explain that the difference in the calculations boils down to how many people are actually infected but haven’t been counted because they have mild or no symptoms.
Virologist Hendrik Streeck had argued even before the study that the virus is less serious than feared and that the effects of long shutdowns may be just as bad if not worse than the damage the virus could do.
Note- much of the case diagnosis rate is based on PCR technology , not serology, so there is a substantial built-in bias in the numbers.
The front line in the USA for COVID / Corona Virus.
AND IN THE USA
Early results from US hospitals are already circulating among some experts, who think these data will get us “closer to the truth” about how far the infection has spread in US cities. “If you see 11% positive in your health-care workers, that means infection rates probably aren’t higher than that in your city,” he says.
CDC officials said data provided by states most closely tracking the occupations of people with the virus suggest that healthcare workers account for about 11% of all Covid-19 infections.
A California serology study of 3300 people released last week in a preprint also drew strong criticisms. The lead authors of the study, Jay Bhattacharya and Eran Bendavid, who study health policy at Stanford University, worked with colleagues to recruit the residents of Santa Clara County through ads on Facebook. Fifty antibody tests were positive—about 1.5%. But after adjusting the statistics to better reflect the county’s demographics, the researchers concluded that between 2.49% and 4.16% of the county’s residents had likely been infected. That suggests, they say, that the real number of infections was as many as 80,000. That’s more than 50 times as many as viral gene tests had confirmed and implies a low fatality rate—a reason to consider whether strict lockdowns are worthwhile, argue Bendavid and co-author John Ioannidis, who studies public health at Stanford.
A small study in the Boston suburb of Chelsea has found the highest prevalence of antibodies so far. Prompted by the striking number of COVID-19 patients from Chelsea colleagues had seen, Massachusetts General Hospital pathologists John Iafrate and Vivek Naranbhai quickly organized a local serology survey.
Within 2 days, they collected blood samples from 200 passersby on a street corner. That evening, they processed the samples—and shared the results with a reporter from The Boston Globe. Sixty-three were positive—31.5%. The result carries several large caveats. The team used a test whose maker, BioMedomics, says it has a specificity of only about 90%, though Iafrate says MGH’s own validation tests found a specificity of higher than 99.5%. And pedestrians on a single corner “aren’t a representative sample” of the town, Naranbhai acknowledges.