What the latest science says about New Zealand’s Covid-19 policy

Simon Thornley, Gerhard Sundborn

4 July 2020

With a smattering of new cases emerging from returnees in hotels prompting both sides of the house to double down on our tight quarantine the key question is coming into focus: where does our nation go from here?

Sir Peter Gluckman, Rob Fyfe and Helen Clark have recommended starting to reopen our borders. On the other hand, both Dr Ashley Bloomfield and PM Jacinda Ardern have talked about being prepared for further lockdown-like restrictions, with tight border control. Victoria, a state with similar characteristics to New Zealand, has had a recent spike of cases and has decided to enforce local lockdowns, which is a worrying prospect. Which road is best? To open up or to hunker down? Can science help us with this decision?

The latest information on the virus can help us decide which of the Covid-19 roads is best. Its relevance is underlined by the fact it also helps explain why some of the predictions about the fatalities from the virus in New Zealand were 500 to 3,600 times greater than what is happening.

The assumption until now has been that we were all sitting ducks and that we were — and remain — completely at the mercy of the virus. And that assumption underlies the current anxiety about reopening without an effective vaccine to protect us.

The latest science reveals the battle our bodies have had with this virus —and it indicates we are not as defenseless as we might think. Our blood has two major weapons in the fight against viruses:  B and T cells, which together are called lymphocytes or pus cells. B cells are like missile factories, making antibodies that lock onto free virus in the body. Most tests to see if anyone has been exposed to the virus look for these antibody B cells.

T cells are more like hitmen who destroy host cells already infected with the virus. T cells are less commonly considered in testing for previous exposure. A feature of Covid-19 is that levels of both these cells (lymphocytes) are unusually low in severe cases most likely because they have been working overtime to fight infection.

A recent study out of the Karolinska Institute in Sweden confirms this idea. A team of researchers tested the blood of 203 people, some of whom had had Covid-19 (by genetic test), looking for evidence that the immune system of these subjects had seen the virus. Among healthy blood donors, who had never tested positive for Covid-19, the researchers found that 4/31 (13%) had antibodies but 9/31 (29%) had positive T cell responses to the virus. That indicates that many more people had been exposed to the virus (and not fallen ill) than indicated by B cell tests alone.

In family members of people with Covid-19, 17/28 (60%) had positive antibodies (B cells), but almost all (26/28; 93%) had positive T cell tests. Almost all genetic test positive cases of Covid-19 had both immune markers. Some may debate the importance of the T cell tests and whether they confer immunity. The researchers are guarded, but indicate that such responses are similar to the immune response of vaccines for other viruses.

What relevance does this knowledge have to us here in New Zealand, considering who to let in and out of the border? As indicated above, it explains why modelling of Covid-19 was so staggeringly inaccurate. Many more of us than we ever knew have microscopic missiles and hitmen in our system on our side. This helps explain why the predicted flood of cases to our intensive care wards and hospitals never eventuated. And this helps us be more realistic about the risk posed by the virus.

What else can we learn from this study? A critical question now is how immune is our population? We have previously summarised the rates of Covid-19 antibodies measured in populations around the world ranges from 0.5 to 26%. The Swedish researchers have shown that the proportion of people in the general population who are likely to be protected from Covid-19 is actually about three times the proportion who have Covid-19 antibodies. This would mean that likely protection from the virus is far more widespread than the antibody surveys indicate. In New Zealand, we are still waiting for any results from antibody tests. The media has reported that tests have been carried out but no data is being made available. Surely the results of this study, even if preliminary, are of critical importance?

So, how does this help us address the border question? If we really want to know what our risk is posed by the virus, we need to take a keen interest in our population’s immune status, as the Swedes have done. The findings of the Covid-19 virus in France and Spain well before the ‘official epidemic’ hit means that many of us have likely encountered the virus before without even knowing it.

Now, in many countries, deaths with the virus are waning, even if in some countries, cases are increasing. The lack of large second waves as Europe is progressively opening up gives us some confidence that immunity to the virus is much more widespread than we initially thought. The debate about our supposed exalted status having ‘eliminated’ the virus is becoming less relevant as evidence accumulates that many of us have already seen the virus, become immune and moved on.

Some commentators have highlighted the paradox of being a Covid-free cul-de-sac. It is our view that we need to adjust to living with the virus and accept that further cases are likely to occur. If our level of natural protection is much higher than thought we need to urgently reconsider whether the elimination strategy, its implications for further lockdown, and an unknowable period of continued border closure, is really worth the financial pain it will continue to inflict. And let’s not forget Covid-19 is not entirely unique. We already accept the risks of living with a number of coronaviruses that have similar characteristics to Covid-19, including: HKU1, 229E, OC43 and NL63.

Benefits of lockdown are “illusory”: researchers

Take-down of the Flaxman et al. (2020) claim that interventions saved lives. 

The illusory effects of non-pharmaceutical interventions on COVID-19 in Europe

Flaxman et al. (Nature, 8 June 2020, https://doi.org/10.1038/s41586-020-2405-7, 2020) infer that non-pharmaceutical interventions conducted by several European countries considerably reduced effective reproduction numbers and saved millions of lives. We show that their method is ill-conceived and that the alleged effects are artefacts. Moreover, we demonstrate that the United Kingdom’s lockdown was both superfluous and ineffective.

https://advance.sagepub.com/articles/Comment_on_Flaxman_et_al_2020_The_illusory_effects_of_non-pharmaceutical_interventions_on_COVID-19_in_Europe/12479987

How did it come to this (Covid over-reaction)?

Dr. Carlo Caduff, King’s College of London, delivers a thoughtful critique of the social, political and ideaological drivers behind the panicked response, and the almost deliberate ignoring of facts.

We urgently need to look beyond the virus if we want to understand the real seriousness of what is happening today. How did we end up in this strange space of thinking, acting and feeling that has normalized extremes and that is based on the assumption that biological life is an absolute value separate from politics? Never has it been more important to insist that another politics of life is possible.

https://evidencenotfear.com/wp-content/uploads/2020/06/Carlo-Caduff-What_Went_Wrong_With_Corona.pdf

Vaccine researchers say sorry: no vaccine in time to make a difference

The implications of this statement by vaccine researchers are profound.

They say that a vaccine for Covid19 won’t be found in time to make a difference to the natural outcome of the pandemic.

So is NZ still planning to wait?

 

It typically takes a minimum of 10 years for a vaccine to complete the three consecutive phases of the clinical research pipeline. This is because of the scope and length of the experiments, the need to critically assess the results at each stage and the mountains of paperwork that are involved.

 

We contend that a safe and effective vaccine against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which is the causative agent of coronavirus disease COVID-19, most likely cannot be made available to the public in time to make a substantial difference to the natural outcome of this pandemic. People often cling to hope even when prospects of success are low. However, this can have negative consequences if that hope is not realized.

 

https://theconversation.com/fast-covid-19-vaccine-timelines-are-unrealistic-and-put-the-integrity-of-scientists-at-risk-139824

Covid19 response may kill more in India than the virus

Mob mentality that feeds hysteria

By Bharat Dogra 

 

The situation is much more serious in developing countries like India where a large percentage of people lead a precarious life even in normal times and hardly have any savings to fall back upon in distress situations like those created by prolonged lockdowns.

“[The] aim should be to protect the risk groups, without endangering the availability of medical care and the health of the whole population, as is unfortunately occurring.” One of the reasons why evidence- based response could not become effective has been because the voice of some very senior scientists like Dr. Sucharit Bhakdi, who challenged draconian measures and exaggerated response at an early stage, did not get the desired attention.

Why new Covid19 cases is not a “surge”

https://www.orlandomedicalnews.com/article/3545/letter-to-the-editor-why-increasing-number-of-cases-of-covid-19-is-not-bad-news

Letter to the Editor: Why Increasing Number of Cases of COVID-19 is NOT Bad News

By JOHN T. LITTELL, MD

Several times a day, on every possible news outlet, we are bombarded with updates as to the new number of “cases” of COVID-19 in the U.S. and elsewhere.  News analysts then use these numbers to justify criticisms of those who dare to reject the CDC’s recommendations with regards to mask wearing and social distancing.   It is imperative that all Americans  – and especially those in the medical profession – understand the actual definition of a “case” of COVID -19 so as to make informed decisions as to how to live our lives.

Older Americans remember all too well the dread they experienced when a family member was diagnosed with a “case” of scarlet fever, diphtheria, whooping cough (pertussis), or polio.  During my career in family medicine, including several years as an Army physician, I have cared for patients with chickenpox, shingles, Lyme disease as well as measles, tuberculosis, malaria, and AIDS.   The “case definition” established for all of these diseases by the CDC requires the presence of signs and symptoms of that disease.  In other words, each case involved a SICK patient.  Laboratory studies may be performed to “confirm” a diagnosis, but are not sufficient in the absence of clinical symptoms.

Having now been privileged to care for sick patients with COVID-19, both in and out of the hospital setting, I am happy to see the number of these sick patients dwindle almost to zero in my community – while the “case numbers” for COVID-19 continue to go up.  Why is that?

In marked contrast to measles, shingles, and other infectious disease, “cases” of COVID-19 do NOT require the presence of ANY symptoms whatsoever.   Health departments are encouraging everyone and anyone to come in for testing, and each positive test is reported as yet another “new” case of COVID-19!

On April 5, 2020, a small number of state epidemiologists (Council of State and Territorial Epidemiologists (CSTE) Technical Supplement: Interim-20-ID-01) came up with a “surveillance” case definition for COVID-19.  At the time, there was uncertainty as to whether or not completely asymptomatic persons could transmit COVID-19 sufficiently enough to infect and cause disease in others. (This notion has never been proven and, in fact,  has recently been discounted – cfr “ A Study on the Infectivity of Asymptomatic SARS-CoV-2 Carriers,  Ming Fao et al, Respir Med, 2020 Aug – available online through PubMed 2020 May 13, as well as recent reports from the WHO itself).   The CSTF thereby justified the unconventional case definition for COVID-19, adding  “CSTE realizes that field investigations will involve evaluations of persons with no symptoms and these individuals will need to be counted as cases.”

Hence, anyone who has a positive PCR test (the nasal swab, PCR test for COVID Antigen or Nucleic Acid) or serological test (blood test for antibodies –IgG and/or IgM) would be classified as a “case” – even in the absence of symptoms.   In our hospitals at this time, there are hundreds of former nursing home residents sitting in “COVID” units who are in their usual state of good health, banned from returning to their former nursing home residences simply because they have TESTED Positive for COVID-19 during mass testing programs in the nursing homes.

The presence of a positive lab test for COVID-19 in a person who has never been sick is actually GOOD news for that person and for the rest of us.  The positive test indicates that this person has likely mounted an adequate immune response to a small dose of COVID-19 to whom he or she was exposed – naturally (hence, no need for a vaccine vs. COVID-19).

It is important as well to understand that the presence of lab testing is not the ONLY criterion that the  the CDC uses to established a diagnosis of COVID-19.  The presence of only 1 or 2 flu-like symptoms (fever,chills, cough, sore throat,  shortness of breath)  – in the absence of another proven cause (e.g., influenza, bacterial pneumonia) is SUFFICIENT to give a diagnosis of COVID-19 – as long as the patient also meets certain “epidemiological linkage” criteria as follows:

“In a person with clinically compatible symptoms,   [a “case” will be reported if that person had] one or more of the following exposures in the 14 days before onset of symptoms: travel to or residence in an area with sustained, ongoing community transmission of SARS-CoV-2; close contact (10 minutes or longer, within a 6 foot distance) with a person diagnosed with COVID-19; or member of a risk cohort as defined by public health authorities during an outbreak.”  Note that the definition of a “risk cohort” includes age > 70 or living in a nursing home or similar facility.

So, in essence, any person with an influenza- like illness (ILI) could be considered a “case” of COVID-19,  even WITHOUT confirmatory lab testing.  The CDC has even advised to consider any deaths from pneumonia or ILI as “Covid-related” deaths – unless the physician or medical examiner establishes another infectious agent as the cause of illness.

Now perhaps you see why the increasing number of cases, and even deaths, due to COVID-19 is fraught with misinterpretation and is NOT in any way a measure of the ACTUAL morbidity and mortality FROM COVID-19.   My patients who insist upon wearing masks, gloves and social distancing are citing these misleading statistics as justification for their decisions (and, of course, that they are following the “CDC guidelines”).  I simply advise them, “COVID-19 is NOT in the atmosphere around us; it resides in the respiratory tracts of infected individuals and can only be transmitted to others by sick, infected persons after prolonged contact with others”.

So you may ask – why are we continuing to report increasing numbers of cases of COVID as though it were BAD news for America? Rather than as GOOD news, i.e, that the thousands of healthy Americans testing positive  (also known as  “asymptomatic”)  are indicative of the presence of herd immunity – protecting themselves and many of us from potential future assaults by variants of COVID?

Why did we as a society stop sending our children to schools and camps and sports activities?  Why did we stop going to work and church and public parks and beaches?  Why did we insist that healthy persons “stay at home” – rather than observing the evidence-based, medically prudent method of identifying those who were sick and isolating them from the rest of the population –   advising the sick to “stay at home” and allowing the rest of society to function normally?  And, while we witnessed the gatherings of protestors in recent days with little concerns for COVID-19 spread among these asymptomatic persons, most certainly many are hoping  that the increasing “case” numbers for COVID-19 will discourage folks from coming to any more rallies for certain candidates for political office.

Fear is a powerful weapon.  FDR famously broadcast to Americans in 1933 that “We have nothing to fear, but fear itself”.  I would argue that we have to fear those who would have us remain fearful and servile and willing to surrender basic freedoms without justification.

John Thomas Littell, MD, is a board-certified family physician. After earning his MD from George Washington University, he served in the US Army, receiving the Meritorious Service Medal for his work in quality improvement, and also served with the National Health Service Corps in Montana. During his eighteen years in Kissimmee, FL, Dr Littell has served on the faculty of the UCF School of Medicine, President of the County Medical Society, and Chief of Staff at the Florida Hospital. He currently resides with his wife, Kathleen, and family in Ocala, Florida, where he remains very active as a family physician with practices both in Kissimmee and Ocala. To learn more, visit johnlittellmd.com

Are we being kind to the Cook Islands over Covid-19?

By Gerhard Sundborn

The Cook Islands is almost as much a part of New Zealand as the North or South Island. Like Niue and Tokelau, all Cook Islanders hold New Zealand citizenship. The Cooks is home to 17,500 people of whom about 2,500 (15%) are either expat Kiwis or Aussies who have moved to the Cooks to work in the tourism industry and live a lifestyle we have all dreamt of, a never-ending summer on a tropical paradise.

Tourism accounts for nearly 70% of the Cook Islands economy with most of the 170,000 tourists coming from either New Zealand or Australia each year.

In response to Covid-19 on March 13th the Cook Islands closed its border to all direct flights from all countries except for New Zealand as well as cruise ships, and yachts. Since then New Zealand has remained their only gateway to the outside world. Here in New Zealand, our borders closed nearly a week later on March 19th. The Cook Islands have successfully prevented an outbreak of covid-19 and remain one of only 17 countries in the world to remain free of the virus.

Having engaged in extensive testing for the virus to date there has not been one positive case. The level of testing for the virus in the Cook Islands (7% of total population) is 3.5x greater than for New Zealand (2%). The measures taken by the Cook Islands have been well-planned, executed and successful.

Recently, there has been a call for New Zealand to open a ‘Pacific Bubble’ with Covid-free Pacific nations or a ‘NZ-Cook Islands Bubble’. This has been supported by the Cooks’ Prime Minister Henry Puna. He also described the economic hurt that his country is experiencing since tourism has dried-up. In a statement, Puna appealed for kindness, explaining, “New Zealand and the Cook Islands are family. During difficult times, families look out for one another. These are those times. That’s all we’re asking from New Zealand. Look out for your family.” Unfortunately, this appeal has landed on deaf ears with our Prime Minister Jacinda Ardern more interested in engaging with Australia around talks of a ‘Trans-Tasman Bubble’. This has now been ruled out by Australia for the foreseeable future.

The logic behind our Prime Minister’s keenness to establish a travel bubble with Australia who continue to have new cases, yet reluctance to engage with the Cook Islands who have remained Covid-free, is confusing, frustrating and smacks of prejudice.

The health risk to New Zealand posed by opening our border to the Cook Islands is tiny, and the risk to the Cooks is also small. Considering this I believe that Ardern should embrace kindness and open our border immediately between the two countries. In times of ‘kindness’, it is vital that we throw our Pacific family an economic lifeline.

Learn to live with virus: NY Times

Around the world, governments that had appeared to tame the coronavirus are adjusting to the reality that the disease is here to stay. But in a shift away from damaging nationwide lockdowns, they are looking for targeted ways to find and stop outbreaks before they become third or fourth waves.

https://www.nytimes.com/2020/06/24/world/europe/countries-reopening-coronavirus.html

Covid-19 elimination impossible, so time for New Zealand to change direction

By Ananish Chaudhuri, Simon Thornley, Michael Jackson.

20/6/2020

877 words

The recent fiasco that allowed people to leave quarantine without testing, risking spread of Covid-19, highlights how nebulous the government’s claim of total elimination always was. The government, in projecting thousands of deaths that never eventuated, has continued with a story that the virus can be eliminated if we all play our part. The façade of a watertight border has been shattered, and the government broke its own quarantine rules. We urgently need to reconsider whether an ‘elimination at all costs’ strategy makes sense, as many other countries are moving on and opening up their borders.

Like other coronaviruses, Covid-19 is here to stay and a vaccine will be a long time coming. Studies show that respiratory viruses are ubiquitous. Over two years, in a cohort of 214 people who were sampled every week in New York, 70% had at least one positive test for a respiratory virus, with the vast majority having few symptoms of infection.

And even if we do get a vaccine, its efficacy is far from guaranteed. Vaccines against seasonal flu are often ineffective since we are often vaccinating against last year’s strain while the virus has already mutated.

Vaccines need to be thoroughly tested before they are offered to the populace. The usual process is to go through three phases of clinical trials. At present, only one vaccine is in phase 2, where safety and dose information is tested in a large group. The critical phase of testing efficacy (phase 3) is the most time-consuming step and often takes years. With the virus now waning in many countries, demonstrating the effectiveness of the vaccine will be difficult, since exposure to the virus will be rare. The sooner we face up to this fact, the better off we will all be. Sooner or later, we will have more cases; at least ripples, if not a wave. We will need to learn to tolerate further cases.

However, based on what we know about the virus at this point, there is no reason to panic. First, contrary to what was claimed earlier, the infection fatality rate of Covid-19 is around 0.25 percent. Many people who contract the virus show few symptoms and the age distribution of fatality with the virus is similar to day-to-day life. Serological tests are telling us that a much larger proportion of the population has immunity against the virus. Even in those who test negative, a high proportion are showing other signs of immunity, through a separate cell-mediated pathway. With more of us already protected, it is harder for the virus to spread.

Second, the most at risk are the elderly, especially those who are frail with other illnesses. This does not mean that we should be willing to sacrifice our parents and grandparents. It simply means that we need to exercise greater caution around the elderly, particularly those in care homes and in hospitals. The majority of deaths with Covid-19 have been in rest homes. Conversely, this also means that we don’t need to worry too much about the young and the healthy. Children especially seem virtually immune to the disease.

Third, countries all around the world have started opening up. Slovenia has opened its border with Italy, the hardest hit country. The government of Slovenia has declared the epidemic over and is now rather prioritising economic recovery. Across Europe countries are moving to open up their borders, as their governments reassess the risk posed by the virus.

Given this, it seems bizarre that our border is still tightly closed, even with our Pacific neighbours including Cook Islands, a state that is associated with New Zealand. The Cook Islands earns 80% of its revenue from tourism mostly from New Zealanders who holiday there.

Lockdowns are not and never were a panacea. There is very little evidence that lockdowns mitigate the spread. The theory indicates that they slow cases down, rather than reduce overall numbers. Our firm lockdown will cause a significant economic misery with public debt climbing to more than 50% of our GDP in about 2 years’ time. Unemployment will increase sharply and it is well documented that higher unemployment lowers life expectancy, not to mention potential self-harm.

Current predictions are for a 15.8% drop in GDP in the second quarter of the year, suggesting that the Finance Minister’s suggestion of a 4.8% drop during the budget presentation was underestimated.

Behind the scenes, lockdowns, here and elsewhere, are causing havoc. The evidence is emerging gradually. Required tests and surgeries have been postponed and vaccinations have been delayed. Both lives and livelihoods have taken a hit. Around the world, about 80 million children have not been vaccinated leading to a sharp increase in measles, diphtheria and cholera.

It is now time to take stock. The government has broken its own rules to eliminate the virus. Simultaneously, Covid-19 is not as dangerous as it was first thought to be. Serology tests overseas clearly show that the virus has got to many more people than appreciated. We urgently need to assess our own population’s susceptibility to the virus, as we reconsider the border question. It is time for recalibration of the threat, and to prioritise flattening the economic recession curve, rather than doubling down on a fragile and myopic vision of elimination.

Stanford study reveals why COVID19 forecasts failed

…models failed when they used more speculation and theoretical assumptions and tried to predict long-term outcomes, e.g. using early SIR-based models to predict what would happen in the entire season. However, even forecasting built directly on data alone fared badly. E.g., the IHME failed to yield accurate predictions or accurate estimates of uncertainty. Even for short-term forecasting when the epidemic wave has waned, models presented confusingly diverse predictions with huge uncertainty.

 

…epidemic forecasting continued to thrive, perhaps because vastly erroneous predictions typically lacked serious consequences. Actually, erroneous predictions may have been even useful. A wrong, doomsday prediction may incentivize people towards better personal hygiene. Problems starts when public leaders take (wrong) predictions too seriously, considering them crystal balls without understanding their uncertainty and the assumptions made.

https://forecasters.org/blog/2020/06/14/forecasting-for-covid-19-has-failed/