The BMJ: Should countries aim for elimination in the covid-19 pandemic?

We go head to head in the BMJ on the goal of eliminating Covid19.

We would all like to eradicate covid-19 from the globe. However, closer scrutiny shows that the odds are heavily stacked against this as a sustainable, cost effective, long term strategy. New Zealand’s apparent three month success has recently been broken by a cluster with no known link to overseas travel. Ongoing lockdowns have now occurred in Auckland, and the country is still focusing on elimination.

https://www.bmj.com/content/370/bmj.m3410

 

UK Sage Group scientist says lockdowns a mistake

While New Zealand commentators remain enamoured with lockdown, the rest of the world is thinking again…

A member of the UK’s Sage group advising the government says lockdowns were a mistake.

https://www.express.co.uk/life-style/health/1320428/Coronavirus-news-lockdown-mistake-second-wave-Boris-Johnson

Masks only useful in confined spaces

Media Release

14 August 2020

Epidemiologist Simon Thornley has reassured people that there has been no new information that concludes masks are warranted against COVID19.

“The trials are clear; there is no statistically useful safety gain in wearing a mask, although low quality observational studies show an advantage to wearing one in confined spaces.”

Thornley says he was moved to clarify the science because people advocating masks were claiming ‘things had changed’, leading to an increase in public mask-wearing since Wednesday.

“Nothing in medical science has changed since Ashley Bloomfield first told us months ago that there was no advantage to masks. What has changed is social and political advantage in advocating masks, and that’s not science.

“I will not be wearing a mask without symptoms, but anyone with compromised health could choose to carry a mask to wear in places like public transport.”

Thornley urged all public communicators, including media, to reference the latest science on masks so people could decide for themselves (see below).

On Monday, the Covid Plan B group is live streaming a COVID-19 Science and Policy Symposium, featuring international experts analysing the New Zealand situation. Find out more here.

ENDS

The Science on masks

A trial in Australia showed that in households exposed to children with respiratory symptoms and fever, there was no difference in outcome between households that wore either surgical or P2 masks with controls who did not wear masks. The incidence of laboratory confirmed infections were twice as high in the mask wearing groups compared to controls, but the difference was not statistically significant.1 About 50% of patients reported problems with the masks, and by day five, only 30% of participants were compliant with the mask use.

A larger trial in Thailand that compared control, to handwashing, and handwashing and surgical masks in households with influenza-like illness showed no difference between the three groups, in terms of reducing the incidence of secondary transmission from primary cases.2

Meta-analyses of observational studies have reported benefits of reductions in risk of using masks.3 A case-control study of H1N1 transmission following a prolonged flight between China and the US showed a very strong association between mask use and protection from infection. None of the 9 cases wore masks, compared to 47% (15/32) of control passengers.4

The World Health Organisation5 only recommends masks when individuals have symptoms compatible with Covid-19. In populations such as those with a high prevalence of Covid, immunocompromised patients or times where high population density cannot be avoided, such as mass gatherings, public transportation (including aeroplanes), masks are considered useful for ‘source control’, rather than ‘protection’.

References

  1. MacIntyre CR, Cauchemez S, Dwyer DE, et al. Face mask use and control of respiratory virus transmission in households. Emerging infectious diseases 2009;15(2):233.
  2. Simmerman JM, Suntarattiwong P, Levy J, et al. Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand. Influenza and other respiratory viruses 2011;5(4):256-67.
  3. Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. The Lancet 2020;395(10242):1973-87. doi: https://doi.org/10.1016/S0140-6736(20)31142-9
  4. Zhang L, Peng Z, Ou J, et al. Protection by face masks against influenza A(H1N1)pdm09 virus on trans-Pacific passenger aircraft, 2009. Emerging infectious diseases 2013;19(9):1403-10. doi: 10.3201/eid1909.121765
  5. Organization WH. Advice on the use of masks in the context of COVID-19: interim guidance, 5 June 2020: World Health Organization, 2020.

Suicides and other costs from lockdown

22 April 2020: Gerhard Sundborn, Senior Lecturer at the University of Auckland, says the Plan B group is receiving information from across New Zealand indicating the real human tragedy of lockdown is greater than the lives which may have been saved.

In a post to the Covid Plan B website, Sundborn says one piece of information from inside a district Health Board has heightened fears that suicides may have increased.

“A person in a top level DHB position has told us that the number of suicides in that region has risen, although the information is unobtainable under current rules empowering CEOs.

“Whether or not the report is accurate, the stress of lockdown-induced events will be taking a terrible toll on people and families.

“The elderly are alone, the sick are not seeking help, the newly unemployed are afraid, and people with mental health issues are without a network or health facilities to help.

“Strict conditions during the lockdown has meant families have not been able to farewell the more than 2600 other people who died this past month – that has exacerbated their grief.”

“As these tragic experiences grow, devastating families and communities, this will become a silent ‘counter-epidemic’ to Covid-19.”

Last week, think tank Koi Tū: Centre for Informed Futures, founded by former Chief Science Advisor to the Prime Minister Sir Peter Gluckman, released a report predicting that rates of depression, anxiety and suicide will increase because of the pandemic.

Similarly, one of New Zealand’s leading suicide prevention centres, The Taranaki Retreat, has said there is a link between the lockdown and an increased suicide risk.

The police have admitted there is an increased risk of self-harm incidents but say there is no evidence yet.

“The 13 coronavirus related deaths in New Zealand are undeniably sad. However, throughout the lockdown period, an additional 2,688 people have died from less publicised yet equally terrible illnesses.

“Staying home may be saving some lives, but it is also taking others.”

/ENDS

Contact: Gerhard Sundborn 021 100 3989

Chaudhuri: unseen costs of covid-19 not being counted

Media Statement: April 15 2020

University of Auckland Economist Dr Ananish Chaudhuri says the immediate emotional power of people dying with the disease could lead New Zealand into an extension of the Covid-19 lockdown with dire consequences, including more deaths.

Chaudhuri, who is currently Visiting Professor of Public Policy, at Harvard Kennedy School, says people over-estimate the costs of immediate and visible dangers, which clouds judgement and calculations of the unseen costs arising from their reaction.

“Extension of the lockdown would aim to save a more certain number of lives now, for an unknown number of lives we will lose over time due to health and economic impacts.

“People have tried to claim that extending the current lockdown is a choice between saving lives and losing money, but it’s not. It’s a choice between losing lives now but losing lives later – and possibly a greater number and a greater variety of otherwise healthy people later.”

“Unemployment is not just a number; there are human health and fatality costs. When unemployment goes up the life expectancy of those people goes down. Furthermore, there are devastating consequences for communities from high unemployment – depression, poverty, violence, falling education.”

Chaudhuri points to research showing that the immediate aftermath of the 911 attacks was an estimated 1500 additional deaths on the road, from people driving rather than flying. It arose because in an environment surrounded by concerns over terrorism, people judged they were more likely to die of terrorism than a traffic accident, or even of the more likely event of respiratory illness or heart attack.

“The problem is that we pay more attention to, and value higher, things happening right in front of us – but we don’t pay attention to, or value, even larger things that happen less visibly or more slowly.”

Chaudhuri says an error is being made by those who differentiate between objectives of suppression, eradication, or mitigation.

“It’s a continuum between doing nothing and doing everything – and there’s different costs along that continuum.  The challenge is to correctly perceive and calculate those costs.” Chaudhuri says.

/ends

Contact: Ananish Chaudhuri / 021-258-1525

RNZ: Coronavirus: Academics want much looser rules after lockdown

https://www.rnz.co.nz/national/programmes/morningreport/audio/2018742542/coronavirus-academics-want-much-looser-rules-after-lockdown

 

Plan B in 3 minutes

South Korea shows the way out

South Korea’s policy of testing, tracing and treating without lockdowns has been widely lauded. Some attribute this to South Korea’s having dealt with previous epidemics such as Sars and Mers. At the roots of South Korea’s success against Covid-19 are a well-funded and efficient system of delivering public services.

https://www.theguardian.com/commentisfree/2020/apr/11/south-korea-beating-coronavirus-citizens-state-testing

Virus response impacts women: UN

Global economic hardship, 1.52 billion students at home, growth in domestic violence and healthcare workers and systems harmed: vicious side-effects for women the United Nations warns.

https://www.theguardian.com/world/2020/apr/11/un-coronavirus-pandemic-gender-inequalities-women