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The Corona Files: Can we trust our leaders in this crisis?

[This post got a bit longer than planned and you might not have the time to read the whole post, but I can promise you that it is worth it, because there is some amazing and unheard of news towards the end of it!]

After more than a month in “lockdown”, with a significantly changed infection rate and considering what is happening in other countries, it is now time to think about the trust we can or should have in the politicians in Ireland to do the right thing.

While the picture here is by far not as shocking as in the USA, where Trump suggested to put UV light “inside people” to kill the virus or maybe to inject disinfectant (www.youtube.com/watch?v=33QdTOyXz3w) so that the virus dies, we still need to keep a close eye on what is done with our lives and to us by the people who are in power.

Because I do believe that we are dealing with a virus, a virus that is more dangerous than other viruses (I will write another time about THAT discussion and the Conspiracy Theories that are connected to it.), I do think that the soft-ish lockdown that we were put under, was the right thing to do.

But I am wondering of the people in charge are the right ones to get us out again.

Who is in charge?

First let’s have a look at the power structure in Ireland to see who is really in charge right now.

It seems that the following people and organisations/forums are on this list: Taoiseach Leo Varadkar, Health Minister Simon Harris, National Public Health Emergency Team (NPHET), Chief Medical Officer Tony Holohan and maybe also Professor Philip Nolan, who is leading the modelling team.

This is an interesting list for many reasons:
The majority of people on it are seemingly un-elected and are employees or subcontractors of the Department of Health. It seems to be really difficult to find out who is part of the NPHET (I wasn’t able to!) and the NPHET doesn’t release any minutes of their meetings anymore. But it seems that the two elected politicians (Don’t worry, I will come to that!), Varadkar and Harris, leave ALL or nearly all decisions to the NPHET. Alan Kelly, the Labour leader, has some justified concerns about NPHET: www.thejournal.ie/taoiseach-nphet-alan-kelly-5082184-Apr2020/

In a setup like this, there is a huge risk that experts are experts ONLY in their area, but don’t really see/understand or want to care about any other aspects of their decisions. You probably know the saying, to a man with a hammer, everything looks like a nail!

Because a modeller cares very much about his models and a Chief Medical Officer cares very much about the medical aspects of this pandemic, they definitely have to be PART of the advisory group, but after that should it not be the elected politicians that carry the responsibility and also then make the decisions and announce the decisions?

Yes (I am getting to that now!), I am fully aware that neither Harris nor Varadkar are confirmed in their roles after the recent election. And strictly speaking, they lost the election and would have to get re-elected or re-appointed before they are confirmed in their roles. However, they are – according to the Irish Constitution – rightly and correctly continuing in their roles until a new Taoiseach is elected and a new Minister of Health has been appointed.

On the way into the lockdown, I think they did do the right thing and performed well. But a critic could say that the getting into a lockdown is easy and you can’t do much wrong, the way out of the lockdown is MUCH more complicated and requires completely different leadership.

I am not convinced that the people in power are the right ones to get us out of the lockdown. The Chief Medical Officer will be judged by the only statistic he focuses on on a daily basis: Number of newly infected and number of deaths. The Modelling expert, only looks at the virus reproduction number R (and surprisingly for an expert he seemingly doesn’t understand that R0 and R are not the same!! R0 is the max reproduction number and R or Reff is the REAL reproduction number. Prof Nolan got it wrong here www.gov.ie/en/publication/ea86cc-covid-19-modelling-data-thursday-16-april-2020/). And if you are judged by ONE specific result or number, then naturally you only focus on that one single issue and tend to loose sight of any other issues.

So who will look at the other effects and impacts? There are social, mental, economic, educational and political impacts as well.

This is the sphere were politicians need to make decisions, but to do that, they might have to tell the medics and modellers that they appreciate their advise but might choose not to follow it for now and do we think Varadkar and Harris would do that? I don’t think Harris would and I am not too sure about Varadkar.

NO politician anywhere in Europe or even worldwide KNOWS what to do in the current situation, so we can’t be tooo harsh with our judgement. No medic or modeller really has reliable and 100% correct data! Apart from the number of deaths, everything else is pure guess work. We have NO idea how many people have been infected. We don’t even know exactly how the infections happen and why some people have a weak reaction and others have a strong reaction to an infection. So all the people in power are totally winging it! Not only in Ireland, but worldwide.

So what can be done? In my opinion, we should watch closely what is happening in other countries. Austria, Germany, Denmark and Czech (and a few more) are starting to ease the restrictions and our politicians should look at that to 50% and listen to the experts with the other 50%.

But this expert forum has to change now! Medics and modellers are still needed, but in addition we need to add people that know about mental health, that are experts in education and in economy. The expert group that will ADVISE our politicians (not lead instead of the politicians) has to spread wider and cover more bases.

How come I dare to say that? Do I think that all the deaths are not real? Do I think that we are over the hospital emergency?
No, I do not think that at all! What our health care workers experience is definitely real and we definitely need to continue the work on easing the pressure they are under.

But we also need to be aware that Covid-19 is not the only health issue in this country. There are people avoiding hospitals that urgently should be seen and possibly operated. And we need to take into account that there is NO good justification for some of the restrictions and the renewed clamping down that gardai have announced for this coming weekend. There is a good justification for the physical distance, but NOT for the 2km radius for exercise and also not for the travel limitations (as long as you continue to keep the physical distance wherever you go to).

And if business life doesn’t continue in some shape of form, we will NOT be able to pay for the out of work aid that is being paid at the moment and we will NOT even be able to keep financing the hospitals. Heck, we were not able to finance hospitals sufficiently to avoid overcrowding when the economy was going well, so how can it be possible when the economy has stopped?

I am NOT talking about a “getting back to normality”, but I am talking about moving out of emergency shutdown mode into a emergency handling mode in the same way as these other European countries do it.

And YES, it could happen that we will get back into lockdown mode again for another 2 weeks or so. Maybe even a few times. And that is absolutely ok, but we now need to work on a plan for getting out and I am not sure we can trust the people who are currently in charge to have the ability to do that in a reasonable way.


I should mention something else as well and I have to admit that it influenced my opinion a good bit. It is a very important aspect and maybe I should put up a separate post about this, because it is VERY surprising:

The deaths that we are currently experiencing is the only reliable number. We don’t know in a lot of cases if a death was caused by Covid-19 or not and for the dead person or his/her family it is not even relevant. But we know that these deaths are real! The ridiculous and brutal restriction to just 10 family member at a funeral, no matter how big the church or funeral venue is is also real and there is not the slightest justification for it. Thanks NPHET for one of exceptionally nonsensical rules!
But I discovered something else this week and I have not found ANYBODY writing or talking about it!!

There is a European Project that has the cute name “EuroMOMO”, but is not cute at all. EuroMOMO is a European mortality monitoring activity, so they cound the number of deaths that happen in Europe. And the goal of EuroMOMO is to detect and measure excess deaths related to seasonal influenza, pandemics and other public health threats.

So, the 24 participating countries report their number of deaths to EuroMOMO and EuroMOMO creates graphics and reports to show if and to what degree the deaths in a certain period of time are above or below the “normal” death rate. In normal years the deaths that are above the normal death rate are considered as influenza deaths if they happen between October and May. EuroMOMO has a lot of graphs and stats on their website, but the most relevant is the Z-scores by country and you should have a look at that here www.euromomo.eu/graphs-and-maps/#z-scores-by-country

The results are shown on a time graph and the Z-score shows by how much the current number of deaths varies from the normal number of deaths. In Belgium, France, Italy, Netherlands, Spain and UK you see a significant peak. That shows that they are having significant more deaths than in normal years.

But now check Ireland! And you will be surprised to see that Ireland has LESS deaths in this Covid-19 period than it would be normal this time of the year. LESS!!!

I have no idea why that is, maybe it is because there are less other hospital operations. Maybe because there are less accidents because people stay at home. Maybe the fact that people avoid going to hospital if they have some other issues, keeps them alive longer? I have no clue! It also doesn’t mean – and I repeat that on purpose again – that Covid-19 is not happening or that it is harmless or that it is just like a normal flu. NO! That is all nonsense! And the numbers in other countries clearly show that. But if our excess mortality at the moment is lower than normal, then maybe the 1014 deaths (as of yesterday) are at least in Ireland, just normality. And if that is the case then we have to continue keeping the virus under control by keeping a physical distance, but we have to wonder if the current lockdown is justified in its current form!

Soooo, can we trust the people in charge? What do you think?

The Corona Files: Get me out of here!

In Ireland, restrictions of public life started on 13 March, so we are one month into it and last Friday it was announced that the lockdown will continue for at least another 3.5 weeks until 05 May.

So it is much too early to pain for a “back to normality”, we need a lot of patience, but at the same time, it is the right time to think (or learn) about how we will be able to get out of this lockdown situation again.

There are a lot of people that think that as long as we are patient and stay away from other people, the virus will disappear again and we can go back to normality. However, this is a highly unlikely scenario!! The Coronavirus will be with us for a long long time and can (and probably will) flare up again and again.

If you think this through, then there is no straight forward and simple way to lift the lockdown. Not on 05 May and not on 05 June or 05 July unless something else happens.

The job description of a of an efficient virus includes the requirement “must spread…ideally like wildfire”. And in that respect the Coronavirus is a very efficient virus. Not as efficient as measles, but doing a good job nevertheless.

Virus Reproduction numbers are essential

The efficiency is expressed through the “max speed of spread” or reproduction number, which is called R0 (R Zero). For measles this is around 15 and for the Coronavirus it is up to 3, for the influenza virus (flu) it is around 1.3. That means that one infected person will infect 15 others for measles and 3 others for the Coronavirus. 15 is crazy, but even 3 (or on some areas around 2.2) is exponential spread. So to reign it in the effective reproduction or Reff (R effective) has to be brought down to 1 or better below one. That would mean then that one infected person will infect just one other person or maybe even less than one person. At that point the spread is linear or is decreasing (when smaller than 1).

In Ireland we have the advantage that the country is quite small and this combined with relatively fast action that was taken, we are allegedly at the point where Reff is at around 1. I say “allegedly” because I think that the numbers of infected people are MUCH underestimated in Ireland due to the low number of tests that have been carried out. But lets hope that we are actually close to 1.

At that point, the virus is far from being gone. It is just more under control and therefore it is expected that the hospitals will be able to deal with virus patients better.

So what Reff doe the authorities aim for? The simple and complicated answer is “as low as possible”. But be aware that it is unlikely to be Zero, because the Coronavirus is devious and smart. It is hiding its presence for 5-14 days and only after that you will get symptoms. During these 5-14 days a carrier can infect a LOT of people.

With R0 being around 3, ONE single carrier could easily infect all his/her social contacts in a week and for a busy person that could amount to 3-4 per day. So in, let’s say 10 days ONE single highly socially active person could infect 20-30 people and BOOM there is a new cluster that can lead to another wildfire-like spread.

How to lift the lockdown?

If we lifted the lockdown completely, we could be back in a uncontrollable situation within 1-2 weeks. So we can’t do it that way. In Austria they are talking about lifting the limitations for smaller shops and trades people on 14 April and then for hairdressers (WHY them!?) on 01 May and then for the first few pubs and restaurants in mid May. Schools will still stay closed at that time. This is just an idea, a concept that might get changed faster than you can read this blog post, but it shows what we also might have to do.

What do we want to achieve?

That is an important question! The virus can be stopped by only one thing according to virologists and that is a high enough immunity in the population so that it can’t spread anymore. In virology terms, this is called “herd immunity”. This term got a bad meaning because the UK tried to wait for natural “herd immunity” at the outbreak of Covid-19 and now many think that “herd immunity” doesn’t work. This is totally incorrect. Herd immunity is not the same as letting the virus go rampant. Herd immunity just describes that 60-70% of the herd (or population) reached immunity. This can be achieved in two ways: Either they get immunity because they were infected, got through the infection and are now immune OR because they were vaccinated.

The natural immunity is still not certain for the Coronavirus. A trial was done with 5 monkeys that showed that after an infection and going through Covid-19 the monkeys got immune and didn’t show any symptoms when they were re-infected afterwards. But monkeys are only similar not identical to human beings, so more tests are needed to be absolutely certain. The indications are good though. The second problem is that we have no clue yet how long the immunity will last. Some viruses (chicken pox) will be kept away because our body will develop immunity forever, but with other viruses, the immunity is time limited. And with a bad ass Coronavirus, it is POSSIBLE that the immunity will only last a few weeks or months or maybe one or two years. We have no clue yet about that!

What do we need to reach herd immunity?

If we need 60% of the population to have survived Covid-19, we need a LOT more infected people than we have at the moment. Right now, there are around 9000 people tested and found infected in Ireland. IT is assumed that in countries with a high test rate around 80% had the virus and didn’t show any or no severe symptoms, so in a best case scenario the 9000 are our 20% and then we would have had a total of around 45,000 people that were infected and survived and now might have immunity. Because the test rate in Ireland is super low, let’s be generous and let’s assume that we actually have only 10% of detected cases. Then the total immunity level in Ireland after Covid-19 would be around 90,000. This is a immunity level of measly 1.8%!!

So to achieve herd immunity (60%) we need to get another 2.79 million people infected. :-O Imagine! And this has to happen soo slow that the Intensive Care Units will not get overwhelmed again. So maybe at a rate of 90,000 every 1.5 months (at the moment we might have 90,000 in one month with catastrophic consequences for ICUs). With this infection rate, it could take 31 *1.5= 46.5 months (!) to reach herd immunity!

Luckily there is an expectation that in a best case scenario we will have a vaccine in about 12-18 months. So we wouldn’t have to go through the whole infection process of 46.5 months, but would only have to do it for around 18 months. Still in these 18 months we would have to continue protect (=shelter) the high-risk groups and we would have to control the planned infection process constantly and be prepared to shut down life again as soon as it threatens to get out of control.

You can see that this is not an easy situation and that we will be dealing with that WELL after 05 May. This is a bit of a grim prospect, right!?

It will be interesting to see IF Austria will go through with their plan and it will also be interesting to keep a close eye on Denmark and other countries.

I expect that the lifting of the lockdown will have to be a very careful gradual lifting ALL the time being prepared to go into full shut down mode again if needed.

Smart Distancing + Tracing App

An alternative possibility would be to move from Social Distancing to Smart Distancing, in this case we would stay away from people that could be infected and we would continue to quarantine them for 2 weeks as soon as they get some symptoms. We would still need to cocoon the high risk group and couldn’t go back to normal international travel and large events (concerts, football matches, olympic games etc.). And we also would have to combine that with a HOPEFULLY anonymous contact tracing app that would tell you when you had contact with someone who is infected and once you had contact, you would have to self-quarantine immediately (and the app information would have to be proof to your employer that you will have to stay at home for 2 weeks). We also would need LOTS of antibody tests so that people with Coronavirus antibodies would be allowed to freely move around again without having to quarantine.

I am not a modeller or epidemiologist, so all the “models” I described above are very much simplified, but it shows that the Social Distancing and “Stay at home” measures are 100% required to protect the health care system at the moment, but they are not an ideal approach to reach a form of “normality” again.

What do you think about Smart Distancing and a Corona tracing app? If antibody tests are available, you might have to check yourself every two weeks or so. Would you be ok with that? And what if the app was NOT anonymised? Like in China now, the authorities would be able to trace EVERY move you make. Would you consider using the app still?

 
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