What should we do when we get another wave of Covid-19 cases?

Simon Thornley

15/5/2020

New Zealand has now progressively opened up, and we are now at level two. The next item to consider is what happens if we have another cluster of cases? What if the number of cases rises steeply? The government has stated that it has achieved ‘elimination’ of the virus, although there are dribs and drabs of new cases, mostly related to known sources. Recently, outbreaks occurred in Hokkaido, Japan, after lockdown was relaxed. The Northern Japanese island locked down for a second time in response to this second wave. Should we follow suit?

Our response depends on the answer to a number of questions. These include:

  • How effective are lockdowns?
  • How do similar viruses behave?
  • How widespread is immunity?
  • What are the risks to our health?

On the questions of the efficacy of lockdowns, there is likely to be ongoing squabbles, which will inevitably spill a lot of academic ink. We now have some compelling evidence that lockdowns in Europe were not especially effective. The trajectory of the epidemic was already declining in many countries when lockdowns were implemented, and the author of the article concluded that lockdowns were unlikely to have saved lives. Other evidence, such as a comparison of US States, that are either under lockdown or not reinforces this view. This analysis has now been subject to major revisions and re-analysis, but the conclusion remains the same – per capita cases and deaths from Covid-19 in each State are not materially different under either policy. The main factor linked to cases and deaths was testing rates. The more tests that were carried out by State, the more cases were found. Closer to home, our New Zealand – Australia comparison, in which New Zealand locked down harder and tighter than our cousins over the Tasman did not support the “hard lockdown” theory.

It is hard to believe with the Covid-19 blinkers on, but there are a number of other coronaviruses that have been circulating for many years that we pay little attention to. As well as the deadly SARS that has been eliminated, there are other coronaviruses that we have been living with for many years that have escaped our gaze. These latter examples are more similar to Covid-19 than SARS and MERS. These coronaviruses, including HCoV-229E, HCoV-HKU1 and HCoV-OC43 have a history of causing fatalities in resthome populations, like our new virus on the block. These viruses have now become endemic with winter seasonal peaks. With these similarities, it is likely that we will have to learn to live with future Covid-19 cases, particularly with winter around the corner.

The risk of future waves is likely to be related to the extent of our exposure to the virus. Tests of immunity in hard hit countries are returning immunity levels of about 5%, such as in Spain. Other tests of cell mediated immunity suggest higher real levels of immunity than those obtained from antibody tests alone. In Germany, 34% of antibody negative healthy donors showed markers of cellular immunity. In New Zealand, we don’t yet know our immune status, since we haven’t tested for it. With the comparative evidence that indicates that lockdowns are not especially effective, the fall in case numbers in New Zealand strongly indicates that widespread immunity is rising. The rise, fall and now low number of cases in China, with only smaller contained outbreaks after the initial peak, suggest that immunity is sustained, at least in the medium term.

We also need to consider how much of a threat the virus poses. In even hard hit countries, for the majority of working age people, the risk of death from the virus is about the same as a daily thirty kilometer trip by car. For those under the age of forty, the mortality risk is extremely low. We now know that hospitals in Australasia were never stretched, even at the epidemic’s peak. It simply makes little sense to squirrel children and working age people away, when the economic effects of lockdowns are ruinous.

The evidence that I see simply does not add up to an endorsement of further lockdowns. The elderly, particularly those who live in rest homes, deserve the greatest protection we can afford. For the rest of us, we can safely get on with our lives and progressively open up the country, even in the face of further cases.

Video: epidemiologist’s take on Covid-19

Dr. Simon Thornley

  • Deaths due to coronavirus have been exaggerated
  • Mean age of death – 80 years old

What you need to know about Covid19 serology

By Simon Thornley

19 May 2020

Why does New Zealand need a serosurvey?

New Zealand urgently needs to test for antibodies to Covid-19. The standard test for Covid-19 at present is a genetic test that only detects whether or not the virus is currently in the body. Serology is a test of a person’s immune response to the virus and persists long after the virus has disappeared. This test gives important information about who in the community has recovered from infection and is thus unlikely to get the infection and pass it on to others. The overwhelming picture from this information is that the virus is much more widespread than is shown from genetic test positive cases.

In the response to swine flu in 2009, a serosurvey provided crucial information to dial back the clamour to stamp out the virus, since that survey showed that the virus was much more widespread than initially thought. As a consequence, it also followed that the virus was much less deadly than initially believed.

We can now count a total of 18 regions or countries that have conducted serological surveys and reported results in English to determine the extent of population exposure to the virus (Table). The proportion of the population who were found to have positive Covid-19 antibodies ranged from between 0.5%  in Colorado to 25.9% in Northern France. In some studies, the rate of positivity increased substantially as the study progressed. Even in the low prevalence regions, these findings strongly indicate that the virus is widespread and unlikely to be amenable to an elimination strategy.

Table 1. Prevalence of positive antibody tests to Covid-19 in surveys from around the world.

Region, Country Sample size Prevalence (%)
Northern France 171 25.9%
Guilan, Iran 552 22.0%
Gangelt, Germany NA 14.0%
New York State, USA 15000 12.3%
Barcelona, Spain 578 11.2%
Wuhan, China 1402 10.0%
Aspen Colorado, USA 198 9.9%
Miami-Dade, USA 1400 6.0%
Switzerland, Geneva 760 5.5%
Los Angeles County, USA NA 4.1%
Finland 147 3.4%
Kobe, Japan 1000 3.3%
Moscow, Russia 1000 3.0%
Santa Clara, USA 3324 2.8%
Netherlands 7361 2.7%
Denmark 9496 1.7%
Colorado, USA 5455 0.5%

NA: not available.

What are antibodies?

Antibodies are like keys in a lock that the body makes in response to viruses and other bacteria. Antibodies only fit a specific virus or bacteria. The shape of the antibody locks on to the microbe so that the body’s immune system can more easily eliminate the virus. Once a high proportion of the community have antibodies to the virus, it becomes very difficult for the virus to spread throughout the community, since it is hard for the virus to find new susceptible people to spread to.

Antibody tests are generally not used to diagnose the infection, since there may be a delay of one to three weeks from the time of infectiousness with the virus to the time that antibodies are generated by the body. Genetic tests, such as PCR, are usually used for making the diagnosis as they are positive earlier in the course of the illness.

What sort of antibody tests are available for Covid-19?

An antibody test generally involves the collection of venous blood or a finger prick to collect capillary blood. A number of test kits have been authorised by the US Food and Drug Administration for use for Covid-19. The Center for Disease Control has developed a test which is reliable for detecting SARS-CoV-2. The test is claimed by the organisation to be 99% sensitive (low false-negative rate) and 96% specific (low false-positive rate).

At present, tests of immunity are mainly recommended for assessing the extent of infection, and what proportion of the population has had mild disease from the virus. Until more information comes to light, researchers are not certain that test-positive individuals are unable to be re-infected, although this is likely to be true.

Are there other types of immunity to Covid-19 apart from antibodies?

As well as using antibodies which come from “B” white blood cells, our immune system also has “T” cells that recognise the virus directly, without the need for antibodies. A recent study from Germany has demonstrated that 83% of genetic test positive Covid-19 cases tested positive for T cells that react to the virus. Also, 34% of healthy blood donors, who were test-negative for antibodies, had evidence of reactive T cells, but at lower levels than cases. It is likely that these T cells confer some immunity to the virus, but it is unclear to what extent such people are protected.

What is the NZ government experience of antibody tests?

A wide range are available, but none have been rigorously tested in New Zealand yet. In order to be confident that these tests are useful, media interviews suggest that the government requires local evidence of testing their accuracy, despite overseas studies showing excellent accuracy with some tests. A number of tests are now endorsed by regulatory agencies in the United States.

If someone tests positive for antibodies, does that prove immunity?

The long term immunity associated with Covid-19 antibodies is not known. It is likely that they confer partial immunity, as seen with other antibodies for coronaviruses. This depends on the dose and route of administration. For example, in an animal study, mice administered coronavirus in the nose maintained immunity for at least 12 months, however, those that had exposure to the virus by mouth had high levels of immunity at one months, but lower levels at 6 and 12 months.

Conclusion

New Zealand urgently needs to test for antibodies to determine community exposure to the virus. If antibody levels are high, then this suggests that the virus is widespread. This also means that the virus is much less deadly than we feared.

 

 

 

Mean age of Covid-19 death equal to average life expectancy

5 April 2020

Simon Thornley

To understand the risks of ending lockdown, it is useful to think of a worst-case scenario. What would happen if ending lockdown led to a fate like Spain, Italy and New York.

A well-known epidemiologist has calculated the answer. For individuals aged less than 65 years, even in ‘pandemic hotbeds’, the risk of dying during the outbreak in hard hit European countries, is about the same as that associated with driving a car between 15 and 100 kilometres per day, throughout the pandemic. For people aged forty or younger, the risk is almost zero. Females have a risk two to three times lower than for males. For people aged younger than 65 years, with no medical conditions, the risk of death is extremely low, with this group contributing only 1/100 of all Covid-19 deaths.

Underscoring the low risk of death, the authors of the study noted that the mean age of death is approximately equal to the average life expectancy at each center. The exact ages of cases are not given for New Zealand cases, but if these are fixed at their midpoint for those for whom only a decade is given, the mean age of death is 81.6 years. This very closely approximates New Zealand’s life expectancy of 82 years. Since the numbers are so close, it is very difficult to argue that the virus is causing early death. In fact, such a pattern is replicated in almost all countries heavily affected by Covid-19. The risk of death in people aged less than 65 years was at least 92% lower compared to their older counterparts in eleven hard hit Covid-19 regions.

This analysis must force us to ask difficult questions, such as if our population of working age are at so low risk, why are we locking down our entire population? If the risks posed by the virus are so low, what are the downsides of locking down? Why are we closing our borders, and devastating our economy due to such a threat? On the basis of such a threat, why are we so obsessed with eliminating the virus?

There are really two choices that continue to be open to us to contain the virus, in the case of increased spread. These two combinations are ongoing lockdowns, or opening up the majority of society, returning us to work and school and protecting the vulnerable. The question of the closure of our borders continues to loom, as we consider whether we can remain cut off from the rest of the world or we work toward a sort of Australasian bubble.

The lockdown affects people of all ages, taking children away from school and workers away from their jobs. In contrast, protecting the vulnerable largely means that people over working age, past their 65th birthday are vulnerable.

The toll is starting to mount. In Queenstown, 30% of the population faces unemployment. Now, more than 100,000 kiwis are looking for mortgage relief. The true magnitude of the effect of the lockdown will take some time to be realised.

At the same time that we are dialing back the real risks posed by the virus, the downsides of putting the country in handcuffs are becoming more apparent. We urgently need to get back to work and school and do our utmost to protect the vulnerable.

Covid-19: science should come first and policy second

1 May 2020

Simon Thornley

With much journalistic ink spilled over Covid-19 it is easy to forget that our policies of lockdown and social distancing are based on a belief about the lethality of the virus and its spread.  This belief comes from interpreting evidence. Currently, two main ideas predominate. Although the government has not stated it explicitly, their elimination policy now indicates that Covid-19 cases are contained, and that the virus can be put back in the box. This optimistic picture starkly contrasts with more convincing evidence from overseas that the virus is now well and truly out of the box, being now much more widespread than first thought. While this initially sounds terrible, it is instead good news, as it allows for a more relaxed stance toward the virus.

The government is now treating the disease in a similar fashion to how we have treated measles. Under this model, the vast majority of cases of infections have symptoms, the test is accurate, and we can contain the virus through contact tracing, quarantine and vaccination. This is a good model for infections that ‘declare themselves’ by causing unequivocal disease in cases and where vaccination is available.

The government has reused this model for Covid-19. Superficially, there is some justification, since community surveys of swab testing for coronavirus have all returned negative. The elimination strategy justifies harsh lockdowns which may be severe in the short term, but pay long term dividends. Under this model, the infection fatality proportion, that is the number of deaths divided by the number of people with infection, is (at the time of writing in NZ) 1.6%, well above seasonal flu (~0.1%), and justifies the ‘eliminate’ approach.

While this may sound attractive, several lines of evidence now indicate the virus often doesn’t ‘declare itself’ like measles, and is instead far more widespread than was initially thought. For example, in Iceland, a community survey of the population showed about 1% of the population tested positive for the virus from a nose swab, and about half showed no symptoms, despite the positive test results.

Information from antibody tests adds to the evidence that the virus has well and truly left the box and left its trail circulating in our bloodstream. After infection, the body mounts an immune response. After exposure, we produce antibodies as evidence that we have seen the virus. This blood test is quite different from the genetic nose swab that has so far dominated New Zealand’s ‘elimination’ thinking. The swab results only indicate the presence of the virus at the time the test was taken.

Antibodies give a contrasting picture from nose swab tests. Varying percentages of positive antibodies are reported, but the overwhelming picture is that many more people have recovered from the virus than has been appreciated. The percentage varies between 4% (Santa Clara, California) to 21% in New York city.

Why is this good news? Well, it indicates that exposure to the virus is about 50 to 85 times that observed from nose swab tests alone. In turn, this information dials back New Zealand fatality estimates to about 0.03% of all infected cases. This adjusted mortality rate is no greater than that for seasonal influenza. This is an important reality check on modelling figures which forecast carnage from Covid-19 equivalent to World War I deaths.

These antibody surveys are from overseas, and critics may argue that this does not apply to our New Zealand Covid-19 situation. Features of our Covid-19 cases, however, support the ‘out of the box’ idea. For example, in the recent measles outbreak, sourced from overseas, the majority of cases occurred in Auckland. For Covid-19, however, cases are much more dispersed around New Zealand, with 3% having no apparent link to overseas sources or other cases (44/1,461). In an effort to stamp the virus out, we will be hunting for needles in a very large haystack.

Since the disease is much more widespread than initially thought, then lockdowns are also unlikely to be effective at reducing spread. Recent evidence supports this idea. A comparison of US States showed that regions with social distancing were doing as well or even better on average for Covid-19 case or death rates than those that had a lockdown policy. Per capita cases and death rates were largely determined by a State’s population density – a factor New Zealand has on its side. While it is tempting to compare ourselves with New York, we have a population density more similar to Vermont, Arkansas, Oklahoma and Iowa. States with these population densities have death rates 95% lower than in New York, and are almost identical whether or not the State has locked down.

The government’s idea of a contained virus simply doesn’t gel with recent antibody surveys. The idea of elimination is scientifically unsound. The weight of evidence clearly illustrates that we are dealing with a virus that is more widespread and much less deadly than we feared. Evidence strongly supports us throwing off the lockdown shackles, safely returning to work and school, while doing our utmost to protect our most vulnerable in hospitals and rest homes.

 

Do the negative social and health implications of lockdown outweigh the benefits?

29 April 2020

Gerhard Sundborn, Senior Lecturer Population and Pacific Health, The University of Auckland.

With Covid-19 bearing down on New Zealand, and fears of an overloaded health system and a death toll numbering many tens of thousands, the Government moved swiftly to implement a national lockdown. The magnitude of this threat is now being questioned by many epidemiologists and statisticians, here and internationally.

Although the lockdown was administered with the best intentions at heart, we at Plan B propose that the stringent five-week lockdown went further than necessary. Consequently, there are real questions to be asked about whether the benefits of the lockdown justify the negative social and health impacts. There is also doubt as to whether draconian measures such as lockdowns are any more effective than less severe measures such as social distancing.

Impact on Health Care Services

A clinician at a local hospital explained that they have been temporarily closed during level 4 and have been working out of a sister hospital nearby for acute patients only. When their hospital re-opens, to clear the accumulated backlog of surgical procedures and investigations it may take at least one to two years’ work including weekends to get back on track.

There are many reports of similar occurrences where hospitals around the country have reduced their provision of standard care and have been eerily quiet only operating at 50% of their usual capacity. The level to which life-saving and prolonging treatment and surgery has been either cancelled and delayed for many conditions including cancers, heart disease, diabetes, fertility, joint surgery and more need to be considered when weighing up whether the lockdown has been justified or has caused more pain, suffering and death than it has prevented and how much longer this can last.

In a recent communication the medical director for the Cancer Society feared that up to 400 cancer related deaths could be seen due to significant delays in diagnostic and treatment procedures resulting from the lockdown. Overseas evidence has shown that only half as many cancer diagnoses have been made during lockdown than normally expected.

Adding to this dilemma is the bizarre situation that many general practice clinics find themselves in where they may be forced out of business due to spiralling costs and falling revenue. One clinic explained that there are significant costs placed on GP practices in acquiring the right supplies in preparation for Covid-19 as well as a significant reduction in business from the lockdown. People have delayed seeking medical advice for less urgent ailments which has meant reduced income. People have also not sought treatment for more serious conditions for fear of becoming infected if they leave the safety of their ‘home-bubble’.

Short-term health and social harms

Domestic Violence – A surge in domestic violence as a result of lockdown procedures has occurred. In the UK, calls to helplines for domestic abuse increased by 25%, visits to their associated websites increased by 150% and cases of actual abuse soared. In China’s Hubei province during February domestic violence reports to police tripled. Regrettably, we (New Zealand) hold the title of having the highest rate of domestic violence in the developed world, meaning that we are not immune to this second ‘silent casualty’. Police statistics showed that just three days into lockdown (Sunday 29th March) a 20% increase in reported cases of domestic violence. I am fearful to know what levels of domestic violence exist in our communities now – 5 weeks on. What do the victims – adults and children – go through and what impact will this have on their future? Added to this, some DHBs have reported rises in the number of drug and alcohol presentations to their Emergency Department and in cases of suicide.

Poverty – In the most recent Salvation Army Covid-19 Social Impact Report and Dashboard a number of measures are cause for concern, including the number of people and families that have become impoverished. The greatest increase was in the food security measure. In the third week of the lockdown, close to 6,000 food parcels were distributed. This is equivalent to what is usually distributed in one month.

Long-term health and social harms

Due to the impending economic downturn as a result of Covid-19, there are several negative health and social harms that are expected to continue over a number of years as a result of loss of jobs and higher poverty. The NZ treasury have predicted that unemployment rates could climb to twenty six percent.

At the individual level we expect increased:

  • Use of primary and secondary care health services
  • alcohol-related hospitalisation and death
  • levels of chronic ill-health
  • excess mortality from: circulatory disease; poor mental health; increased health harming behaviours; self-harm; and suicide

For families – studies have shown that following mass unemployment events there is likely to be increased:

  • levels of divorce,
  • conflict and domestic violence,
  • unwanted pregnancy,
  • levels of poorer spouse and child health,
  • levels of financial hardship affecting parenting,
  • strain of child mental health
  • levels in lower educational attainment1

For communities the experience of mass unemployment is likely to result in less social support networks and community participation, which add to a sense of grief, social isolation and a loss of community identity.

Level 2 Now

The negative implications from the lockdown on our lives as well as on the economy are causing damage that won’t be fully appreciated for years to come. This carnage is the result of business closures, job losses, rising unemployment and the stresses that go with it.

From a public health standpoint, we need to limit the social and health harms to our society, we need to move to ‘Level 2’ immediately. We will need to wrap stronger protection around hospitals as well as elderly care facilities and develop ways in which we can better support the elderly and people with underling health conditions who are living in homes with younger family members. These initiatives will need to be carefully thought out, developed and resourced appropriately. The vast majority of our population, including most working people, students and infants, face minimal risk from the virus and can safely resume normal life.

We need to get our society up and running again and open for business. Students need to be back at school and in tertiary education and all types of workplaces opened immediately.

The sooner the ‘lockdown’ can be lifted the more businesses and jobs that can be saved, the better us all. Unfortunately, the long-term impacts of the situation we find ourselves in will need to be worked off over many years and possibly decades by ourselves and our children and will shape our lives and society in ways that we are yet to fully appreciate.

Should kids go back to school?

25 April

Simon Thornley

The government is now cautiously opening schools, but many parents are reticent, fearing that their child will be exposed to the virus. Let’s take a look at we have learned about childrens’ risk of exposure to Covid-19 at school?

When thinking about the risk of death from Covid-19, it is important to appreciate that the risk is not the same for everyone. As our experience has made clear in the recent weeks, older people, living in resthomes are much higher risk of dying from the virus compared to all other groups. One’s risk of dying from the virus is about the same as our risk of dying that year given our age. This means that children of school age are extremely low risk for having severe complications from the virus.

In a systematic review of scientific studies relating to Covid-19 in children, the authors concluded that children had a much milder response to the virus than for adults. Of three children that required intensive care, all had severe underlying conditions. In one case-series in China, 90% of test-positive cases had no symptoms attributable to the virus. Of all children, infants are more likely to have severe complications.

One possible objection to returning to school is that adults could catch the infection from children. While this is possible, an analysis of cases from Shenzhen, China, shows that attack rates are higher in older adults and the majority of transmission occurs among household contacts. Modellers have concluded that school closures are unlikely to be an effective strategy for halting Covid-19. New Zealand has had a cluster of about 92 students at Marist College in Mount Albert, Auckland. The first identified case was a teacher and 12 students have subsequently tested positive. The majority of cases have been adults and at the time of writing, 79 cases had recovered.

In New Zealand, there is little evidence of risk from spread of infection in children. According to the Ministry of Health, at the time of writing, there were 18/344 or 5% of New Zealand’s active cases in people    under the age of 20 years. Overseas data shows that immunity to the virus is building in populations that have been tested. It is very sensible for the government to open schools. I believe that this will help build higher levels of immunity in children to act as barriers for the spread to elderly and those with pre-existing medical conditions. These people are the ones we really want to protect from the virus.

Should New Zealand be eliminating coronavirus?

24 April.

Simon Thornley

The Government and its health advisers are taking an increasingly hardline against coronavirus, stating that it will be eliminated from our shores. It certainly is desirable, but is it realistic?

New Zealand is one of the only countries in the world to attempt this. Almost alone, we have shifted from agreeing with the international approach of flattening the curve to the objective of either eliminating or eradicating the virus. The latest claim, or clarification, is that the Government’s intention is ‘zero spread’ rather than ‘zero virus’.

We need to consider that the only means of achieving even zero spread are tough social restrictions, only ending when a vaccine is invented and most of the population is vaccinated. Let’s be clear – that means a form of very restricted activity for at least a year.

The Government contends that these are needed because our population is vulnerable to the virus, so the spread must be stopped. It paints a picture that the virus is contained by the current public health measures as well as lockdown, and we are effectively leaping on and isolating each new case.

Evidence emerging in the rest of the world, however, is that this picture of a lockdown-halted virus amongst a defenseless population is inaccurate.

Serological tests from samples of people in New York, Germany and California, in contrast, show that between 4 to 15 per cent of the population have seen the virus, recovered from it, and are now immune. This is a much larger proportion of the population than we have seen from positive swab tests of the virus.

This has important implications. First, it shows that the mortality of the virus is much lower than previously appreciated. Also, it demonstrates why a suppression strategy is better than elimination. China, which is trying to eliminate the virus, is now experiencing a resurgence in cases. The cat is well and truly out of the bag.

To boot, recent analysis from the US shows that lockdowns are not effective in reducing Covid-19 deaths, comparing states with such a policy to those without. The data shows that the strongest factor determining a State’s Covid-19 deaths is population density. The lower it is, the lower the death rate. This is a key factor in New Zealand’s favour.

In New Zealand, until we have some data on existing immunity, we just cannot tell how realistic elimination is. That’s without considering whether the goal is desirable or the means worth the cost.

We are betting the house on something that overseas data is showing to be an increasingly remote possibility. Perhaps the rest of the world knows something we don’t?

No One Has A Monopoly On Being Right

As a scientist I am trained to think critically, to evaluate evidence, and ask questions – lots and lots of questions. That’s my job. In March 2020 the World Health Organization predicted that 3.6% of those infected with COVID-19 would die. New Zealand’s own modelling predicted 80,000 Kiwis would die. These numbers seemed extraordinary to me. If they were accurate the impact of COVID-19 would be enormous. But, as I delved deeper, I began to question the accuracy of the predictions. At the time, the infection fatality rate was calculated as the number of COVID-19 deaths divided by the number of confirmed infections. As a scientist, that seemed overly simplistic. Surely many more people would have caught COVID-19 than had been officially tested? If correct, that would lower the predicted fatality rate dramatically. So I began to do what I’m trained to do: think critically, evaluate evidence and ask questions.

What I found was analysis and perspectives I had not been exposed to in New Zealand. John Ioannidis, Professor at Stanford University, and one of the world’s leading physician-scientists, was particularly vocal. The data collected on how many people had been infected (and used to model the fatality rate) were “utterly unreliable”. Not only was there no reliable evidence for “draconian countermeasures” like lockdowns, but if enacted, the measures would themselves lead to significant long-term social and health harm. His concerns were echoed by Sucharit Bhakdi (Professor Emeritus, Johannes Gutenberg-Universität Mainz, Germany) as well as many other eminent epidemiologists around the world. Why had I not heard these different arguments and perspectives in New Zealand? Where was the balanced debate?

On 31 March Dr Simon Thornley, an epidemiologist at the University of Auckland, published an article entitled “Do the consequences of this lockdown really match the threat?” His questions and concerns about the data resonated with me. It turned out I wasn’t alone. Simon received emails from across New Zealand with similar and related concerns. What impact would the lockdown have on mental health, rates of suicide, long-term unemployment, and poverty? What were the legal and ethical ramifications? The list of questions went on.

Last week our cross-disciplinary group of academics published COVID Plan B. Our aim is to get those different arguments and perspectives heard, expand debate and provide a pathway out of lockdown. We want to help New Zealand navigate its way through this pandemic in a way that mitigates its impact on all kiwis. But, while we have received considerable positive support from concerned members of the public, we have also received criticism because of our desire to widen the debate. We have been criticised, for example, for not focusing enough on the elderly or vulnerable. You may wish to read point’s 2 and 4 of Plan B to learn otherwise. To offer a different perspective is apparently now to be ‘contrarians’: people to be dismissed as outside the scientific consensus. I assume, by association, that Professor Ioannidis and those many eminent epidemiologist are also ‘contrarians’? As Michael Crichton (MD Harvard and author) says…“the work of science has nothing to do with consensus. Consensus is the business of politics… invoked only in situations where the science is not solid enough”. Some commentators and scientists have even suggested that we should remain silent and toe the line. This attempt to stifle debate and marginalise those who offer a different perspective on one of the most important issues of our time is deeply worrying and has more in common with political activism than science.

We must never stop interrogating and adapting our COVID-19 strategy. We should, at all times, be open to new analysis, different perspectives and vigorous debate, however uncomfortable that makes us. Different perspectives should be welcomed, not castigated. There can be few decisions in history that would not have benefitted from different perspectives and wider input. No one is well-served by groupthink. As Galileo said “In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual.”

Dr Michael Jackson is a postdoctoral research at Victoria University of Wellington.

Counting the hidden costs of staying home to save lives

Gerhard Sundborn, Senior Lecturer Population and Pacific Health, the University of Auckland, urges us to consider that while staying home may be saving some lives, it is causing death and devastation to many more.

On Thursday 26th March in response to Covid-19, in an unprecedented action, our government enacted a state of emergency to lock our country down to prevent a purported

The modelling that generated these frightening statistics is questionable. When we look at the actual number of infections of covid-19 in New Zealand in proportion to those deaths ‘possibly’ related to covid-19 it is apparent that this modelling was incredibly misleading. Renowned Stanford University epidemiologist Professor John Ioannidis raised the notion that much of the debate and statistics around covid-19 is a “once-in-a-century evidence fiasco.”

Deaths during the 4-week lockdown
Covid-19 ‘related’ 13 deaths
All other causes 2,688 deaths

After 28 days, 12 elderly people have sadly died in their 70s, 80s and 90s. It has not been established if they died with Covid-19 or from the virus.  Although these deaths are undoubtedly sad, when viewed from the perspective of ‘years of life lost’, this is nothing like a wartime tragedy as modellers have made it out to be.

On average our country has had one Covid-19 related death every two and a half days.

Meanwhile, by comparison, across the country, two hundred and forty New Zealanders die every two and a half days from less publicised but equally tragic health conditions such as: heart disease, cancers, suicide, diabetes, pneumonia, respiratory infections, the flu and old age. Over the four week ‘lockdown’ period to date approximately 2,688 New Zealanders have died from other causes.

Like the twelve Covid-19 related deaths, these 2,688 non-Covid related deaths are not merely statistics. They are individuals – our mothers, fathers, grandparents, children, brothers, sisters and friends. Each loss of life is heartbreaking for those left behind.

Regrettably, the strict conditions imposed during this ‘lockdown’ has meant that for those 2,688 + 12 individuals who have departed – children have not been able to farewell dying parents in hospitals, dying people have not been surrounded by their loved ones during their final days, and funerals have taken place in empty funeral halls with no more than a lonesome widow by the departed one’s casket. These unconscionable conditions are outlined on a pandemic response funeral management plan prescribed by our Ministry of Health and based on a scenario that 32,000 deaths had occurred, which was last updated in 2012.

Within our Tongan community, a friend explained that already his family has endured these restrictions in the passing of four family members on separate occasions since the lockdown began. No doubt, for the close family and friends of each of the 2,688 and 12 deaths during this period – additional stress, depression, and grief is likely to be experienced long into the future as a consequence of not being able to celebrate their loved one’s life with the dignity and respect deserved. Where is the dignity and humanity afforded to anyone or family in such circumstances?

Dr Elana Curtis, Associate Professor in Māori Health has described similar experiences in her Māori community and speaks to the “terror being unleashed on my people”, specifically relating to tangi.

A workmate explained to me her frustrations with this ‘lockdown’ as her first grandchild was expected and she was primed to support her daughter during such a special time. These plans had been derailed. The emotional anguish was clear and understandably so.

My grandmother is 93 and lives in a retirement village close by. Her memory is vague these days and she is thought to have a mild case of Alzheimer’s dementia. She has been accustomed to seeing her family every day or two, does not like to socialise with others and is becoming increasingly agitated, lonely, and confused. She often asks why we have not visited and has spoken of ‘what is the use of being around if I can’t see my family’ even going as far as saying she should end it all. Along with this, our team has received reports of increased rates of suicides from District Health Board members. It was distressing to hear of the 93-year-old man from the Kapiti Coast who developed panic attacks and eventually died as a result of social isolation measures, rather than from the virus. My fear is that my grandmother is giving up and may well die of loneliness and despair before we can see her again, hold her hand, comfort her with idle chat over a cup of tea, a smile or a hug.

The question must be asked how many more of these ‘silent casualties’ is the lockdown responsible for?

While these are anecdotes, our team has received e-mails from District Health Board members who state that suicides have increased during the lockdown. As Treasury forecasts increasing unemployment of up to 26%, this is not unexpected, since evidence shows that suicide risk triples in frequency during similar circumstances.

These silent deaths and silent tragedies combine with growing evidence that the health risk of the pandemic has been exaggerated, to suggest that staying home is saving some lives but taking others.