When it comes to Covid19, some scientists and academics are not living up to the expected standards of known facts, free enquiry and open discussion…
The serology tests today being demanded by experts as necessary to track the mystery resurgence of COVID19 have been banned by the Ministry of Health.
Simon Thornley, epidemiologist with the Covid Plan B group, has criticised health commentators as hypocritical in calling for serology testing to track the source of the current outbreak and assess its prevalence in the community.
Thornley said the Covid Plan B group has been calling for serology testing back in April, but by the end of that month the Ministry of Health had specifically banned the importation and sale of serology tests.
In reply to an Official Information Request the Ministry of Health said serology testing would not be conducted because even that test would underestimate the level of virus prevalence. See: https://www.covidplanb.co.nz/epidemiology/nz-govt-confirms-it-wont-test-for-virus-prevalence/
“The one test that would really tell us how the virus is moving through the community has been banned in New Zealand. Companies selling the test were called and told to stop.”
“When we called for the testing, we were criticised by the Government-favoured health commentators. Five months later, these same people are suggesting tests, conveniently forgetting they initially said they weren’t necessary.”
Thornley said that now the Government’s own favoured experts were agreeing with Covid Plan B, it could no longer resist conducting serology tests.
He predicted that based on overseas tests, the number of people who had already contracted Covid-19 would be many times the number of tested cases.
Contact: Simon Thornley, 021 299 1752
The Covid-19 Science and Policy Symposium was held on 17 August 2020. The event took place as a Zoom webinar, bringing together nine international and national experts to analyse the latest science and New Zealand’s response to the virus.
Watch the presentations here.
Dr David Katz, Medical Doctor and Preventative Medicine Specialist, New York.
- New Zealand is taking the “hiding” option. If there is no exposure, there can be no immunity. Gain herd immunity in a controlled way using voluntary measures based on personal health indicators.
Dr Jay Bhattacharya, Medical Doctor and Professor of Medicine, Stanford University
- Lockdowns only delay the impact. Flatten the curve was an approach that spread out over time the number of people infected. Strong economies improve health, and the reverse is also true. Estimates NZ lockdown set NZ back 7 years in economic value, equal to one life year (reducing life expectancy from 82 to 81). Covid will not be eradicated.
Dr Byram Bridle, Viral Immunologist, The University of Guelph.
- Provided a short summary of how immune systems work. Scientists are making unrealistic promises, and in some cases what constitutes a “successful” vaccine is being redefined. It takes 10 years to make a safe vaccine and 4 years is the quickest on record. There is no shortcut to safety. Testing will be problematic as the epidemic abates. Vaccines don’t work well in the elderly. Bridle is working on a ‘plug and play’ vaccine for future coronaviruses, so we are not caught out again.
Prof. Sunetra Gupta, Professor of Theoretical Epidemiology, University of Oxford.
- Addresses the three myths of covid19: She says we can’t keep it out, it’s nothing like the threat to each of that we first feared, and that we can get herd immunity and are close to it. There is natural resistance to Covid19 from previous infections. Costs of lockdowns are delayed but more costs Advocates a careful form of the Swedish model. Accuses developed world of abandoning its ‘social contract’ with the developing world, by closing down borders, trade and interaction.
Dr Simon Thornley, Senior Lecturer in Epidemiology at the University of Auckland
- The mean age of Covid-related deaths is similar to life expectancy – indicating Covid is affecting those who may have otherwise died from other illnesses. No research can find benefits from or a disease response to lockdowns. Estimates from other studies of the economic costs from lockdown compared to QALYs is that New Zealand is that costs outweighed benefits by 95:1. Switching from level 2 to level 4 had a very subtle effect on case numbers and probably saved one life in the very elderly population.
Prof Ananish Chaudhuri, Professor of Experimental Economics, The University of Auckland
- The costs of lockdown are not being adequately counted or assessed. Borrowing will have very severe long-term consequences, especially for small nations and those enfeebled by the retardation of their economy. Capital flight will become a big problem if and when borrowed money need to be repaid. Inflationary impact will be destabilising. Tourism and education are big holes in our economy. Explains why people wedded to lockdown approach find it hard to change position.
Dr Grant Morris, Associate Professor of Law, Victoria University of Wellington
- Ran through the various laws implicated in government regulation and actions in response to Covid19. Main theme was that although Government must justify its reasoning for decisions made under existing laws, or for new laws, it is sovereign – so can make any rule it decides. Calls for more considered and patient decision-making by Government so rights and freedoms are not abandoned.
Ben smith, PH.D – Data Scientist
- Runs through a model designed to assess the infection risk posed by allowing people from other countries into New Zealand based on the covid19 status of the home country, and the rules they adhere to in NZ. Shows that NZ can allow people in from countries with zero infections, as the risk is about equal to that in New Zealand.
Dr Carlo Caduff, Associate Professor of Global Health and Social Medicine, Kings College London.
- Covid statistics are very unreliable, and gathered on a different basis between countries – so not comparable. Yet countries appear to be competing for the best statistics, rather than sharing discoveries, or comparing on more humane values. Moralistic judgement and nationalism in interpreting statistics has also been evident.
By Ananish Chaudhuri and Simon Thornley
The authors are members of the Department of Economics and School of Population Health respectively at the University of Auckland. The views expressed are their own.
During the Vietnam war, the well-known (and Kiwi-born) journalist Peter Arnett is supposed to have quoted a US Major as saying “We had to destroy the village in order to save it.”
Regardless of whether anyone actually said this or not, we cannot help reflecting on the idea behind this as we go into yet another lock-down.
Back in March, when we entered our first lock-down, the evidence was not so clear. Reasonable people could have disagreed about the sagacity of the lock-down. Some of us did but on the whole most were willing to abide by the government’s decision.
But the evidence is clear now. Lock downs are not a panacea. There is, at best, weak if any correlation between lock downs and the spread of the disease. At best, they merely postpone the spread of the infection.
When the Swedish authorities said this, the rest of the world sneered at them.
Now, there is increasing recognition that maybe the Swedes did get it right. Certainly not all of it; they did experience a failure to protect the frail and elderly. But, on balance, it appears they will emerge from the pandemic stronger than their neighbours and that in the current globalized world, lock downs are not and cannot be a sustainable solution.
A recent report from the Productivity Commission now provides support for this Swedish view by asking questions about the relative costs and benefits of prolonging our earlier lock down. The conclusion: the costs conservatively outweighed the benefits of an extended lockdown by 95:1.
And the Swedish approach has been reiterated by Camilla Stoltenberg, Director General of the Norwegian Institute of Public Health; that Norway could have handled the disease without locking down.
There is no vaccine and if there is one, it is still some time away. The fastest vaccine ever developed, for mumps, took four years. In any event, even with a vaccine there is no way of guaranteeing that every Kiwi will take it. In fact, unless we keep our borders closed forever, we need everyone else in the world to take the vaccine too. Diseases we thought had been eliminated, like measles, have made a come-back.
Consequently, in an earlier article we pointed out that elimination is not and never was a realistic strategy and suggested ways of moving forward and resuming normalcy including opening our borders.
It was certainly inevitable that the disease would recur. What was not inevitable was the steps we took along the way and the economic and social costs of those steps.
Did we really need to spend the time, effort and resources to force people into quarantine? Could we not trust them to self-isolate like we did earlier with prosecution of violators? Like Sweden, New Zealand is a high trust society. Why does our government have such little faith in its citizens? Why does it claim for its police the right to enter people’s home without warrants to enforce quarantine?
And if a government does not trust its citizens, then why and how long should the citizens continue to trust the government?
Even with preponderance of evidence that lock downs are mostly useless, our government has responded to an outbreak with another lock down. The initial rationale for a lockdown was protecting our hospitals, but now with cases linked to only one household, the threshold for pulling the lockdown trigger has dropped considerably.
Is this really sustainable: To lurch from one from lock down to another with breaks in between?
Yes, resuming normal life will lead to more cases and there will be more deaths due to Covid-19; just as there will be more deaths from auto accidents, flu, pneumonia, respiratory illnesses, loneliness and self-harm. We also now appreciate that the age distribution of deaths from Covid-19 is indistinguishable from background mortality.
Maybe we need to better confront the idea of our own mortality. Such a conversation is topical given the upcoming referendum on euthanasia.
If we could shut down all motorized vehicles, then the reduction in pollution will save many lives that are lost from respiratory illnesses. But, no one suggests that since this is not a realistic proposition. Instead, we set emissions standards in such a way that the social benefit of driving or flying is equal to or higher than the social cost.
Contrary to the culture of fear besetting us, Covid-19 is hardly the threat it has been made out to be. Both the case fatality ratio (number of deaths divided by the number of reported cases) and the infection fatality ratio (number of deaths divided by the number of people potentially infected) is relatively low and much lower than say Ebola or other corona viruses such as Middle Eastern Respiratory Syndrome (MERS) or Severe Acute Respiratory Syndrome (SARS). It is now clear that lockdowns are a blunt instrument that is disproportionate to the threat posed by this virus.
Most New Zealanders believe now that we are in an exalted position on the Covid road. We are world leaders who have beaten a deadly virus thanks to a tough lockdown. Our only threat now remains from overseas travelers who are quarantined at the border. We are now a Covid-19 free paradise. We can stay this way until a promising vaccine from Oxford comes our way. Surely, this is a matter of holding on for a few more months, and then we can put this whole episode behind us and get on with life.
I would like to believe this story, since my life would be much simpler if I followed the official line. But as an epidemiologist, I’m taught to question and to examine the evidence independently. There are a number of assumptions in this story we have been told. Let’s examine them one by one.
The first is that we are dealing with a deadly virus. Early on in the pandemic, it was possible to believe this, as we had only genetic tests of the virus available. The ratio of people who had died with Covid-19 divided by people who tested positive was 3.4%. This is about seven times the usual estimates of fatality from seasonal influenza (<0.5%).
High fatality rates were projected on a grand scale by modelers. These high rates lead to astronomical predictions of death and destruction which justified severe lockdowns.
Throwing the kitchen sink at such a deadly threat made sense. Just as with swine flu in 2009, however, it was soon found that other evidence, such as antibodies detected in blood, showed a totally different pattern. This occurred in 2009 when antibodies were discovered in about one in four of the New Zealand population. The clamour to eliminate the virus lost its legs.
Early in the epidemic, other researchers overseas were pointing to similar evidence. Professor Mikko Paunio, for example, an epidemiologist from Finland, early in the epidemic showed that 27/1000 blood donors had antibodies to the virus in Copenhagen, Denmark. This proportion extrapolated to over a million Danes having seen and recovered from the virus, compared to many fewer ‘official’ cases. The revised fatality rate was 0.13% – nothing to get excited over.
Now, we even have the Center of Disease Control in the US using 0.65% as a working estimate. This is derived from a summary paper which averaged the results of 26 individual studies. This revised figure is in the scale of severe influenza, and scales down the threat of the virus to just above that of seasonal influenza. These estimates don’t take into account more information about T-cells which now show an even wider exposure to the virus than from antibodies alone. This means that even these revised estimates are very conservative and should be lower still.
In New Zealand, it is clear from looking only at cases, that risk of fatality is higher for older people (Table). People aged over 90 years have not fared well after infection, but conversely, we have now had no deaths from the virus in people aged under 59 years.
Table. Covid-19 cases in New Zealand, by clinical status and age group (at 20 July 2020).
|Age Group (years)||Active||Recovered||Deceased||Case fatality ratio* (%)||Total|
|0 to 9||1||37||0||0||38|
|10 to 19||0||122||0||0||122|
|20 to 29||8||365||0||0||373|
|30 to 39||9||239||0||0||248|
|40 to 49||1||221||0||0||222|
|50 to 59||3||247||0||0||250|
|60 to 69||2||177||3||1.67||182|
|70 to 79||2||71||7||8.97||80|
|80 to 89||0||23||7||23.3||30|
|90 or more||0||4||5||55.6||9|
*The ratio of deceased PCR test-positive cases divided by the sum of both deceased and recovered. The infection fatality ratio is likely to be much lower owing to serology and T-cells pointing to more widespread infection compared to PCR test-positive cases only. 95% confidence intervals calculated by exact binomial method. CI: confidence interval.
It is also clear that around the world the average age of death of Covid-19 patients is near that of the average life expectancy of that country. This is also clear for New Zealand (figure 1), where the shape of the age distribution of Covid-19 deaths closely approximates the spread of deaths over the same period the year before. A formal test for differences in counts between these data sources shows no evidence of difference. It is very difficult to argue from this plot, that Covid-19 is shortening life spans.
Figure 1. Counts of NZ deaths March to May 2019 (black line), compared to counts of deaths from Covid-19 (red line, right vertical axis), by age category.
Although commentators are lampooning Sweden and their Covid-19 death rates, it is clear that countries with harsh lockdowns, such as Peru have higher rates of Covid-19 deaths than Sweden. Belgium, UK and Spain, all locked down but suffered higher rates of Covid-19 deaths than the comparatively liberal Swedes. Just what explains the difference between these country’s rates of Covid deaths is still unclear, but much is likely to be explained by differences in recording of deaths, demographic differences and population density. We now know that national lockdowns during the epidemic are not associated with an expected reduction in Covid-19 deaths.
Despite the avalanche of evidence coming from overseas, the New Zealand Ministry of Health has clearly stated that it has little interest in serology and is not planning a serosurvey. This strongly indicates that an updating of the fatality of the virus is unlikely in New Zealand, at least in official circles.
Where does this leave New Zealand? Our borders remain closed and both political parties are doubling down on this action. In contrast, other countries including the vast majority of Europe, Iceland, China, and the UK are opening up their borders. Iceland has had its borders largely opened, albeit with virus screening, since June 15 with no evidence of a further outbreak (figure 2). It is clear that these governments have learned from new information, reassessed the risk posed by the virus to their populations, including their immune status.
Evidence of widespread immunity, both in the form of antibodies and T cells is growing. In New Zealand, our politicians and health leaders have little interest in investigating this important issue. A vaccine is simply not a realistic proposition for at least another four years, if not ten. Our tourist economy and borders simply cannot wait this long. We will be held hostage to a story associated with the virus that is well past its “used by” date.
Figure 2. Covid-19 epidemic curve from Iceland, with border opening occurring in mid June. Red line indicates average trend.
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.
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.
By Ananish Chaudhuri, Simon Thornley, Michael Jackson.
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.
Drs Michael Jackson and Simon Thornley
A recent article in a New Zealand newspaper claims that Sweden’s approach to managing the Covid pandemic means that “56,000 more people may yet die”. We believe the article is misleading because:
- The author assumes an ‘infection fatality proportion’ (IFP) of 1% and states it’s the “current best estimate”. This estimate is derived from seroprevalence studies from just two countries (France and Spain – both with high per capita death rates). But, the Centre for Disease Control’s (CDC) recent best estimate is 0.26% (four times lower). A summary of studies (19 May) by Professor John Ioannidis that included studies from Asia, Europe, and North and South America derived an estimate of between 0.02% to 0.40%. This mirrors the IFR provided by the Centre for Evidence-Based Medicine at Oxford University. We believe the use of a high IFP is misleading as it produces an estimate that wasn’t based on current best estimates.
- The author does not include any commentary about the recent identification of cross-reactive T-cells. The paper’s findings (published May 14 and before the author’s article was published) indicate between 40-60% of a population may not even be susceptible to Covid-19 due to prior exposure to other coronaviruses that cause the common cold. This has important implications, as it lowers the number of people susceptible to infection. More recently (we acknowledge after the article was published), one of the world’s most influential neuroscientists and statisticians, Professor Karl Friston (University College London) said the figure could be as high as 80%. The inclusion of this information would have allowed for the re-calculation of an estimated fatality rate and provided the reader with further information about the uncertainty of the author’s predictions.
- The author assumes that 60% of a population needs to be have been infected or vaccinated to achieve herd immunity. But some are calculating it at 40% based on Sweden-specific data, not generic inputs. Also, the 60% figure is based on modelling, rather than measured seroprevalence. Given the previous data about T cell immunity and cross-reactivity of other antibodies, the true population immunity is likely to be much higher than seroprevalence surveys indicate. Again, this paints a more negative picture and doesn’t present the reader with a balanced view.
- The author states “After completing this article, a new study has reported that the proportion of people in Stockholm with antibodies to Covid-19 is only 7.3 per 100 people”. But an internet search will tell that the 7.3% figure “reflects the state of the epidemic earlier in April”. That’s a whole month before the article was written and when the total number of deaths in Sweden was around 1000. Sweden’s Public Health Agency estimates the figure would now be about 20% but this isn’t mentioned by the author.
- The author does not attempt to consider how his prediction of 56,000 extra deaths matches actual recorded data and trends for Covid-19 in Sweden (figure). With 4,874 deaths currently, and a clear downward trend (also evident when the author published his article), the author’s prediction is unrealistic.
Figure. Covid-19 daily mortality in Sweden (16/6/2020). Line indicates trend.
- The author claims that Sweden’s economy hasn’t fared any better than its neighbours, despite its more relaxed approach. Again, this is misleading. While this may be true for Denmark and Norway (note Norway now say they could have achieved the same results without a lockdown), Sweden’s projected downturn (1% GDP) is less than Germany (6.5%), the Netherlands (6.8%), the EU as a whole (7.4%), Belgium (8%), France (8.2%), Croatia, (9.1%), Spain (9.4%), Italy (9.5%), Greece (9.7%) and the UK (up to 14%). For comparison, the New Zealand government is predicting a downturn of around 10%. You may also be surprised to hear Sweden’s economy actually grew in the first quarter of 2020 compared to declines across Europe. The UK’s economy, for example, contracted by 2% over the same period.
We are not, here, looking to justify of Sweden’s approach. Only time will tell if Sweden took the right one. We are simply asking that commentators present their work in a balanced, evidence-based way – one that draws the reader’s attention to the complexity and uncertainty in their projections. Figures like “60,000 deaths” are headline-grabbing but are based on incomplete and overly simplistic modelling. They are not ‘reasonable best estimates” based and clearly contradict observed trends.
In the response to Covid-19, it is easy to forget that our knowledge of the virus is provisional and still evolving. We have seen, for example, that the infection fatality rate, initially given as 3.4%, now with serology data has been dialled back considerably to between 0.02 to 0.40% which is in the range of severe influenza. This updated information brings an inevitable conflict with political decision making, in which actions are often justified at all costs.
We have now seen evidence of this, with the Medical Director of the Royal New Zealand College of General Practitioners, Dr Bryan Betty, stating that New Zealand was staring down the barrel of a “potential health system meltdown.” He continued: “We were literally one week away from that or we were going down a track of lockdown, which actually halted the spread of the coronavirus in New Zealand. You’ve got to remember that at that time we had exponential growth going on… [Our case numbers] were doubling every day.”
On the face of it, this sounds reasonable. We were looking down the barrel… Let’s pull out all the stops.
Several of Betty’s statements deserve scrutiny. The first is that numbers were doubling every day. They weren’t. In the days immediately before lockdown, numbers increased by 4 from 36 to 40 on the 24th of March, an 11% increase, the next day to 50 (25% increase), then level 4 was instituted. Only for one day did numbers at least double (23rd of March).
The statement that we were staring at a health system meltdown is exaggerated. During the so called “crisis”, hospitals had spare capacity. Hospitals were quiet, so quiet in fact, that specialists expressed concern about it. Intensive care units likewise. In fact, we now have the opposite problem with some primary care practitioners going broke owing to lack of demand and the costs of adapting to new service models. Patients with other conditions were clearly foregoing usual care.
The dire modelling, predicted, even with strong mitigation measures, never eventuated. If there is one thing this teaches us, it is that our understanding of the virus needs updating. The 80,000 predicted deaths are an overestimate of the observed mortality number by 3,400 times. In deciding policy responses, we desperately need to take account of the evolving nature of both the science and the available information rather than rely on outdated models.
A scientific approach involves learning from mistakes. The Norwegian Prime Minister, Erna Solberg admitted that she panicked into a decision to close schools and early childhood centres. Similarly, the Director General of Health in the Scandinavian country, Camilla Stoltenberg, stated that they could have achieved the same result by ‘not locking down’.
Here, we see both politicians and health officials learning from mistakes. Rather than being an admission of failure, it is a logical and healthy response to new information. This response contrasts strongly with some of New Zealand’s leaders.
We are rapidly learning that the threat posed by the virus is not as serious as we have been led to believe. New research shows that immunity is likely to be more widespread than we have previously appreciated. Immunity to this virus is also likely since other scientists have found cross-reactivity to other coronaviruses that cause the common cold. Many more of us are likely to have seen the virus than our case numbers indicate.
This new knowledge must lead to an update of policies for the country. We should continue to question whether it still makes sense for us to keep our borders firmly closed in the light of this new information. Serosurveys of New Zealanders would help us judge more accurately the degree of spread of the virus. If the virus has circulated to many more people than we think, and many more are protected than we previously believed, then we can have confidence to open our borders. Slovenia and Italy have already done this for several weeks and thus far they have not had second waves (figure).
Figure. Daily counts of Covid-19 cases for Slovenia and Italy, two European countries with open borders to European Union citizens.