Covid Plan B

24/08/2021

Introduction

18 months on from the world’s fearful response to the arrival of SARS-CoV-2, we provide an alternative to New Zealand’s elimination strategy to one of ‘living with covid-19’. We are now back in level four lockdown indefinitely with escalating PCR positive ‘cases’. We urgently need to reassess New Zealand’s elimination strategy and whether it makes sense given the new information.

The revised strategy takes account of five major developments over the period:

• The infection is far less threatening than originally forecast by authorities, including New Zealand, when they proposed lockdowns and other restrictions. Data from the WHO, CDC and other peer-reviewed studies show the median infection fatality ratio (IFR) is ~0.23%, not the projected 3.6%. The condition is therefore more akin to pandemics in 1957 and 1967 than influenza in 1918. Asymptomatic individuals do not spread the infection, removing the key idea underpinning lockdowns. Long-term health effects (“long covid”) have not proven any different to or more prevalent that those experienced in the recovery period from existing circulating pathogens.
• Questions still remain about the accuracy of the polymerase chain reaction (PCR) test used to diagnose ‘covid-19 cases’. The virus remains yet to be isolated, the sequence of the virus was generated in silico (stitched together from computer databases) and many people who test positive are asymptomatic. In addition, the clinical symptoms associated with covid-19 are not unique.
• It is clear that the average age of death with covid-19 is about the same as our life expectancy (~82 years). Older people are much more likely to die of covid than younger ones.
• Very rapid development of vaccines and dissemination of these in New Zealand. The vaccines show some evidence of reducing PCR positive cases, but not of prolonging overall survival or reducing transmission. In many countries now with highly vaccinated populations, there are increasing numbers of breakthrough cases. It is now obvious that vaccines will not stop the spread of the condition long term. In addition, clear evidence shows a major increase in post-vaccination deaths and serious injuries.
• Early treatment protocols are showing promise in the early treatment of cases otherwise destined to be hospitalised.
• New Zealand’s very low incidence of covid-19, with the apparent absence of community transmission for many months, whereas covid-19 cases occur freely throughout the rest of the world. Now, we are faced with yet another lockdown and an increase in case numbers.

The vaunted elimination objective makes re-engagement impossible without an improved vaccine administered as often as necessary to most of the population.

New Zealand cannot sustain economically or socially the years of border closure, threat of lockdowns, social disruption and government debt, needed to reach this position, if it can be reached at all. We believe, frankly, this to be a utopian pipe dream, but necessitating dystopian government dictates. The fabric of our society will be rent – then restitched to what?

We propose an approach that slowly and carefully manages our entry back into a world where covid-19 exists, and where it can exist in New Zealand without causing unacceptable harm.

Guiding Principles

The risks of mortality following covid-19 infection have been grossly exaggerated. As observed in other pandemics, a high degree of ascertainment bias has occurred that has further exaggerated the importance of this condition in the minds of scientists, decision makers and politicians. This has led to an over prioritisation of the illness above many other health issues. In turn, this exaggerated threat has led to mortality and morbidity from other diseases due to the imposition of lockdowns and disruption of usual medical care.

The economic effects of lockdowns and border closures, leading to unemployment and poverty will lead to further health deterioration that is out of proportion to the threat of covid-19. Consistent evidence also highlights that lockdowns do not limit the spread of infection.

Now, it is important to note that hospital treatment for covid-19 patients has improved considerably during the course of the pandemic and that hospital mortality has declined. Potential treatments are also available to reduce morbidity and mortality include the use of both the micronutrient vitamin D and anti-parasitic and anti-viral drug ivermectin. It is also clear that metabolic disease is an important contributor to death with covid-19, and it also raises risk of death from other diseases. Addressing dietary risks related to metabolic disease is also worthwhile to reduce potential harm from covid-19, such as reducing sugar intake.

These guidelines were inspired from those produced by the group who published pandata.org.

Ongoing pursuit of elimination is risky

New Zealand is the only country in the world now continuing to attempt to eliminate cases. Many countries that were attempting to eliminate covid-19 have now given up, such as Singapore, UK and Australia. It is a dead-end strategy which will leave New Zealand isolated and vulnerable, in a (possibly) covid-free bubble. Even if elimination is possible and the reward warrants the financial and social cost, cases will still exist throughout the rest of the world – endemic for the foreseeable future (hundreds of years). To keep it out, New Zealand will need to retain covid-19 border testing indefinitely. Similarly, lockdowns and tracing and testing have no time limit.

There are three ends to the elimination strategy:

1. A cataclysmic failure at the border, such as the beginnings of which we are now seeing, or a winter-resurgence within the country, in which infection sweeps quickly through the population. Lockdowns would, like the US and UK, not protect us.
2. The infection becomes endemic with low levels of circulation and winter peaks, like the varieties of influenza and coronaviruses that circulate. This is likely to take many years. New Zealand would need to decide a point at which it could open.
3. Future vaccines may be developed to completely interrupt transmission of covid-19. The development of the currently available partially effective vaccines has been the quickest ever, and faster than we imagined. We do not yet have evidence that the current vaccines reduce viral transmission through a population. Given performance to date, this evidence might one day eventuate. But the rest of the world is not trying to eliminate covid-19 and appears satisfied with the imperfect protection of the current vaccines. That makes it uncertain whether there will be a commercial incentive to ever invent such a comprehensively protective vaccine, since the existing ones are not as effective as required to maintain population elimination.

Our belief is that none of these exits from the elimination strategy are palatable.

Instead, New Zealand should prepare for, and carefully manage, the inevitable introduction of covid-19 to New Zealand.

Frequently asked questions

Do new variants and strains (lineage B 1.1.7 or delta) pose an increased risk of harm?

Every virus is thought to have thousands of variants. There are over 100,000 alleged variants for covid-19. The fact that there are new strains is not important. What’s important is their effect. With the UK strain, the claim is it transmits easier. We haven’t yet seen any convincing evidence that new strains are more dangerous.

Has there been increased overall mortality as a result of covid-19?

Yes, there has been increased overall mortality in some countries, but not all. Many countries, such as Malaysia, Cyprus, Costa Rica, Uruguay, Japan, Singapore, Denmark, Finland, Ireland, Luxembourg and Malta have not. Excess death is also statistically associated with the period after lockdowns in between country comparisons and between US states. Since the average age of death is close to our life expectancy in almost every country, much of the excess mortality is likely to be related to displaced mortality, and light influenza seasons in recent years, leaving a high number of people who are frail and elderly. It is also clear that some of the excess mortality was due to responses to covid-19, such as abandoning non-invasive ventilation for intubation and mechanical ventilation and prematurely sending infectious patients from hospital to rest homes. Hospital mortality in New York has now dropped by 70% since the beginning of the pandemic.

Does evidence support the wearing of masks to prevent infection?

The best evidence from a randomised controlled trial, the Danish mask study, couldn’t find any evidence to support mask use, particularly cloth ones, to protect the wearer. That also indicates that they are not preventing transmission. And asymptomatic people are unlikely to transmit the infection anyway.

What is the extent of the economic recession?

Globally, the World Bank is saying we are now facing the greatest recession since World War 2, demand in food banks in New Zealand has doubled or trebled and we have now thrown more than 50,000 adults in New Zealand into the dole queue, since March, when lockdowns and border closures began.

The health effects from the widespread panic over covid-19 has also produced many mental problems. For example, there has been an increase in children hospitalised for eating disorders both here in Auckland and in Melbourne. In the UK, mental health scores have deteriorated.

Does asymptomatic spread occur?

A mass testing study in Wuhan, a city of 10 million residents, identified 300 asymptomatic cases, with no evidence of spread of infection from them.

Are you just scientific outliers?

We might seem a minority in New Zealand, but our approach is the same as the Great Barrington Declaration, a view on covid-19 signed internationally by 15,000 medical and public health scientists and almost 44,000 medical practitioners.  The counter viewpoint signed by supporters of lockdowns only mustered ~4,200 signatories.

The Plan

Brief guide

1. Offer enhanced protection and treatment for covid-19 to vulnerable people.
2. End mass testing, contact tracing, quarantine and lockdowns.
3. Vaccination should be voluntary and with informed consent and transparency of both efficacy and safety data.

Healthcare recommendations

1. Since approximately half of fatalities worldwide with covid-19 have occurred in people living in rest homes, this should be the focus of protection. Effort should be given to protecting those who are at high risk of fatality from covid-19, which are individuals aged greater than seventy-five years, particularly those living in supported residential care, and those with metabolic health conditions, such as diabetes, obesity and cardiovascular disease. Measures to protect these people could include regular testing of health workers with respiratory symptoms, who have a high level of exposure to vulnerable people. Strong exclusion policies for workers with respiratory symptoms are important. Ensure people with covid-19 are not in contact with vulnerable people during their infectious period. Other measures include:
   1. Minimise the number of nursing home staff a resident is exposed to.
   2. Provide outdoor areas for socialisation of rest home residents where transmission of the infection is likely to be lower.
   3. Enforce strict exclusion policies related to workers or visitors with any respiratory symptoms.
   4. Encourage supplementation of vitamin D and sun exposure for vulnerable people, since trial evidence supports the use of this micronutrient to prevent intensive care admission in hospitalized patients.
2. End mass testing for the infection and contact tracing. The test should be only used within a clinical context of a characteristic clinical picture, compatible with a lower respiratory infection within hospitalised individuals.
3. Increase capacity in hospitals and intensive care units to cope with seasonal demands of respiratory illnesses, including covid-19. As stated, early treatment on diagnosis promises to reduce admissions
4. Cases should only include those who test PCR positive, at a limited cycle threshold value, with compatible symptoms of a respiratory infection.
5. Deaths from covid-19 should include only those who fulfil the criteria of being an active covid-19 case temporally related to their death, with no other likely competing cause.
6. Eliminate mask wearing in the community, since evidence does not support their use to prevent infection in the community.
7. Vaccination should be entirely voluntary with informed consent of the risks and benefits as more information about their efficacy and side effects come to hand. Vaccination for children of school age should be withdrawn since they are not at appreciable risk of covid fatality. Dangers of exposure to the vaccine, particularly to pregnant women, should be made clear and Ministry of Health information updated accordingly. Vaccination passports or any form of discrimination based on vaccination status should be abandoned, since the vaccines do not convincingly reduce SARS-CoV-2 transmission.
8. Consider the routine use of vitamin D and ivermectin in the treatment of hospitalised covid-19 infection.

Societal recommendations

1. Abandon the use of either regional or national lockdowns to contain viral spread, since they are unnecessary, economically disastrous and ineffective.
2. Schools, childcare centres and universities should not be subject to restrictions and face-to-face learning should have no restriction since children are at extremely low risk for covid fatality.
3. End all restrictions on businesses.
4. Undergo a phased re-introduction of normal travel across New Zealand’s border. At first, a risk-based approach may be undertaken, as shown in the following web app and accompanying paper, which has been published in the New Zealand Medical Journal. This strategy indicates a method for opening NZ’s border, based on the estimated prevalence of covid-19 infection in the country of the traveller’s origin. This would enable travellers to come from several countries immediately who have a very low prevalence of covid-19. New Zealand should then aim to end travel restrictions completely, should this initial strategy be successfully enacted. In support of such a stance, the European CDC, for example, has now recommended the dropping of covid-19 testing and quarantine across borders.
5. End the covid-19 elimination strategy in New Zealand. With cases widespread globally, it is clear that such a strategy is neither sustainable nor beneficial from a perspective which considers both the costs and benefits of such a strategy to New Zealand. Eventually, infection is likely to become endemic and part of the usual seasonal respiratory illnesses that affect New Zealanders every year.

Simon Thornley

6/7/2021

We have recently been told that “Life’s not going to go back to 2019 any time soon.” and that we need at least 83% of us vaccinated for measures such as lockdowns and quarantines to be a thing of the past. Other experts said these estimates were “plausible”. In fact, the figure might be as high as 97%. Before we abandon any dream of returning to normal, let us consider the broader issue of how much certainty we can place in these pronouncements, and whether we should now be putting our skeptical spectacles on.

These days it is easy to live under the illusion that specialists in any field have it all together. The other day my oven started burning food that I thought was put in to keep warm. I assumed the thermostat was broken, I ordered and installed another, but the problem persisted. I couldn’t work out what was wrong. I finally gave up and called a very good appliance repairer, who within ten minutes had found the short and the oven now works almost as good as new. The same generally happens when I bring my car in for a service. Whatever wasn’t working, now is and the problem is solved. Even I can now repair a computer that gives me the blue screen of death and fails to boot. The Windows recovery USB is a beautiful thing and is worth looking-up if you haven’t discovered it yet.

All of this creates the false impression that we live in a world of certainty and that experts can solve any problem. This assumption is safe when it comes to human designed machines and usually there is either an expert somewhere or a youtube™ video ready to give you advice about how to fix something that is broken. Such advice is often built on a profound and subtle understanding of how a machine normally works, how to distinguish normal from abnormal behaviour, and replace the faulty part in question.

The same is not true, however, for my chosen specialty. Epidemiology is fraught with uncertainty as we often have competing information from different areas and we need to decide which evidence is most important and most reliable. About covid, for example, we have seen this in action. We are still told to wear masks on public transport in New Zealand. Mask proponents will use this observational study to justify their use to prevent infection, whereas people opposed to their use may point to trials such as this one. Now both parties have evidence to fall back on and justify their viewpoints. The question is then now “which evidence is superior?” Conventionally, trials, such as the DANMASK one is generally considered better evidence than observational ones, since all other differences, other than the one under study (masks or no masks) are cancelled out by design. Instead, observational studies cancel out other factors through statistical means, which are clunky and we can only account for what we know, whereas the trial rather miraculously accounts for what we don’t know.

This is all old news. Science writer Gary Taubes pointed to this many years ago in a seminal article, asking the question of whether epidemiology had faced its limits? Taubes made the relatively straightforward observation that studies purporting to answer the same question in epidemiology often came to diametrically opposed conclusions, so it was hard to know where the true answer lay. Examples in the recent past include the questioning of the belief that saturated fat is the cause of heart disease. This has been dogma for many years, and now the lack of statistical evidence in support of the hypothesis is starting to more than raise eyebrows. Sugar intake, traditionally thought to be healthy, is now considered a prime suspect, taking the place of the formerly guilty animal fat.

This should now give us pause for thought as the country is given no letup in the torrent of bad news that seems to stream from authority on the covid-19 path. Although, I acknowledge there are different views of covid-19 and those who think it is terrible will point to scenes of overwhelmed hospitals in India and other places, there are also many reasons to be optimistic. We now have much data about the fatality ratio of the virus, and it is now in the region of 0.15%, not far off seasonal influenza (0.1%). The fear created by the spread of the latest ‘delta variant’ shows a case-fatality of only 0.1% in UK data. This is even with systematic exaggeration of death reporting which we are now only just appreciating. Deaths rates from covid-19 have dropped precipitously in many hospitals.

In perhaps the most sinister twist, we have our medical council stating that we may only discuss  evidence-based information about the COVID-19 vaccine if it aligns with government issued information, implying that any other information is anti-vaccine and not acceptable. This is despite new information leading to 18 countries withdrawing the AstraZeneca vaccine in order to protect their populations. The assertion that we are being told the “Whole Truth” is starting to now feel rather hollow. The recent case-series of cases of myocarditis and the rapid increase in reports of post-vaccine death in the US demands a cautious approach.

Te Pūnaha Matatini’s latest headline grabbing piece is based on another complex model that paints us all in a corner until we are all vaccinated. Even children, who have almost zero risk from covid-19 are targeted for the jab. Reading the document, I can’t help but yawn. The underlying assumptions are that we have no background immunity, it is only achieved through either infection or vaccination. It is also clear that the only goal is to defeat covid-19. Nothing else matters. There is not one mention of vaccine adverse effects – these are of no interest on the road to zero covid. It is almost as if this group is living in a parallel universe where the only concern is defeating the virus. This group who gave us visions of mass death that prompted lockdowns does not discuss the issue of pre-existing immunity from other coronaviruses that provide protection to SARS-CoV-2. Other modelers are drawing attention to this as a major reason for exaggerated death estimates early in the covid-19 saga.

The importance of the defeating covid-19 must be balanced against the growing evidence of harm from the vaccine and from restrictive measures. It is almost as if reports of vaccine harm don’t exist to the mathematical modellers. Physicians calling for the withdrawal of the vaccine stating there is “more than enough evidence on the Yellow Card system [UK vaccine side effects reporting system] to declare the COVID-19 vaccines unsafe for use in humans” must be deluded. The rate of 1/50,000 covid-19 vaccinees dying and the 1/70 having adverse effects reported after the vaccine must simply be co-incidence. These admonitions   along with the recent finding of strong cross-reactive immunity to SARS-CoV-2 in children hasn’t seemed to have dampened the Ministry of Health’s enthusiasm to vaccinate this age group.

In a recent telephone call from Professor Michael Baker, I was told that the average number of years of life lost from covid-19 was sixteen. I asked him what the average age of death from covid-19 was in this country? He couldn’t tell me. He asked me what that I thought that figure was. I responded that it was similar to our life expectancy: about 82 years. The same is true overseas. The combination of an average of 16 years of life lost and average age of death from covid-19 logically means somehow the virus is targeting people who would have otherwise lived to 98 years. This seemed implausible to me. Professor Baker agreed with me, however, Nevertheless, one week later he made the same claims about average life years lost. During that lecture he dismissed everything I’d said during the covid-19 saga as “misinformation” and accused me of “cherry picking” data. I had the same conversation with a stuff.co.nz reporter about one week later. Whatever else covid-19 is doing, we should not simply assume it be prioritised above all other concerns. We need to face the vaccine and the virus with our eyes open. From these data, it is not overall reducing our life expectancy.

It is a positive sign that Singapore, UK, and now Australia have recently announced that they have abandoned ‘zero covid’ as unsustainable, in favour of living with the virus and eventually returning to normality, albeit with vaccination. We urgently need to remember that the pretense of ‘one source of truth’ is anti-scientific, and that good science demands freedom to raise and debate uncomfortable evidence.