[ExI] this makes a lotta sense to me

[spike at rainier66.com]

Someone sent me this link.  It is long, but I ended up reading it all.  It's
a transcript of a seminar and deals with some of our local case stuff.
spike

 


A Sensible and Compassionate Anti-COVID Strategy


Jay Bhattacharya
Stanford University

  _____  

Jay Bhattacharya is a Professor of Medicine at Stanford University, where he
received both an M.D. and a Ph.D. in economics. He is also a research
associate at the National Bureau of Economics Research, a senior fellow at
the Stanford Institute for Economic Policy Research and at the Freeman
Spogli Institute for International Studies, and director of the Stanford
Center on the Demography and Economics of Health and Aging. A co-author of
the Great Barrington Declaration, his research has been published in
economics, statistics, legal, medical, public health, and health policy
journals.

  _____  

My goal today is, first, to present the facts about how deadly COVID-19
actually is; second, to present the facts about who is at risk from COVID;
third, to present some facts about how deadly the widespread lockdowns have
been; and fourth, to recommend a shift in public policy.

1. The COVID-19 Fatality Rate

In discussing the deadliness of COVID, we need to distinguish COVID cases
from COVID infections. A lot of fear and confusion has resulted from failing
to understand the difference.

We have heard much this year about the "case fatality rate" of COVID. In
early March, the case fatality rate in the U.S. was roughly three
percent-nearly three out of every hundred people who were identified as
"cases" of COVID in early March died from it. Compare that to today, when
the fatality rate of COVID is known to be less than one half of one percent.

In other words, when the World Health Organization said back in early March
that three percent of people who get COVID die from it, they were wrong by
at least one order of magnitude. The COVID fatality rate is much closer to
0.2 or 0.3 percent. The reason for the highly inaccurate early estimates is
simple: in early March, we were not identifying most of the people who had
been infected by COVID.

"Case fatality rate" is computed by dividing the number of deaths by the
total number of confirmed cases. But to obtain an accurate COVID fatality
rate, the number in the denominator should be the number of people who have
been infected-the number of people who have actually had the disease-rather
than the number of confirmed cases.

In March, only the small fraction of infected people who got sick and went
to the hospital were identified as cases. But the majority of people who are
infected by COVID have very mild symptoms or no symptoms at all. These
people weren't identified in the early days, which resulted in a highly
misleading fatality rate. And that is what drove public policy. Even worse,
it continues to sow fear and panic, because the perception of too many
people about COVID is frozen in the misleading data from March.

So how do we get an accurate fatality rate? To use a technical term, we test
for seroprevalence-in other words, we test to find out how many people have
evidence in their bloodstream of having had COVID.

This is easy with some viruses. Anyone who has had chickenpox, for instance,
still has that virus living in them-it stays in the body forever. COVID, on
the other hand, like other coronaviruses, doesn't stay in the body. Someone
who is infected with COVID and then clears it will be immune from it, but it
won't still be living in them.

What we need to test for, then, are antibodies or other evidence that
someone has had COVID. And even antibodies fade over time, so testing for
them still results in an underestimate of total infections.

Seroprevalence is what I worked on in the early days of the epidemic. In
April, I ran a series of studies, using antibody tests, to see how many
people in California's Santa Clara County, where I live, had been infected.
At the time, there were about 1,000 COVID cases that had been identified in
the county, but our antibody tests found that 50,000 people had been
infected-i.e., there were 50 times more infections than identified cases.
This was enormously important, because it meant that the fatality rate was
not three percent, but closer to 0.2 percent; not three in 100, but two in
1,000.

When it came out, this Santa Clara study was controversial. But science is
like that, and the way science tests controversial studies is to see if they
can be replicated. And indeed, there are now 82 similar seroprevalence
studies from around the world, and the median result of these 82 studies is
a fatality rate of about 0.2 percent-exactly what we found in Santa Clara
County.

In some places, of course, the fatality rate was higher: in New York City it
was more like 0.5 percent. In other places it was lower: the rate in Idaho
was 0.13 percent. What this variation shows is that the fatality rate is not
simply a function of how deadly a virus is. It is also a function of who
gets infected and of the quality of the health care system. In the early
days of the virus, our health care systems managed COVID poorly. Part of
this was due to ignorance: we pursued very aggressive treatments, for
instance, such as the use of ventilators, that in retrospect might have been
counterproductive. And part of it was due to negligence: in some places, we
needlessly allowed a lot of people in nursing homes to get infected.

But the bottom line is that the COVID fatality rate is in the neighborhood
of 0.2 percent.

2. Who Is at Risk?

The single most important fact about the COVID pandemic-in terms of deciding
how to respond to it on both an individual and a governmental basis-is that
it is not equally dangerous for everybody. This became clear very early on,
but for some reason our public health messaging failed to get this fact out
to the public.

It still seems to be a common perception that COVID is equally dangerous to
everybody, but this couldn't be further from the truth. There is a
thousand-fold difference between the mortality rate in older people, 70 and
up, and the mortality rate in children. In some sense, this is a great
blessing. If it was a disease that killed children preferentially, I for one
would react very differently. But the fact is that for young children, this
disease is less dangerous than the seasonal flu. This year, in the United
States, more children have died from the seasonal flu than from COVID by a
factor of two or three.

Whereas COVID is not deadly for children, for older people it is much more
deadly than the seasonal flu. If you look at studies worldwide, the COVID
fatality rate for people 70 and up is about four percent-four in 100 among
those 70 and older, as opposed to two in 1,000 in the overall population.

Again, this huge difference between the danger of COVID to the young and the
danger of COVID to the old is the most important fact about the virus. Yet
it has not been sufficiently emphasized in public health messaging or taken
into account by most policymakers.

3. Deadliness of the Lockdowns

The widespread lockdowns that have been adopted in response to COVID are
unprecedented-lockdowns have never before been tried as a method of disease
control. Nor were these lockdowns part of the original plan. The initial
rationale for lockdowns was that slowing the spread of the disease would
prevent hospitals from being overwhelmed. It became clear before long that
this was not a worry: in the U.S. and in most of the world, hospitals were
never at risk of being overwhelmed. Yet the lockdowns were kept in place,
and this is turning out to have deadly effects.

Those who dare to talk about the tremendous economic harms that have
followed from the lockdowns are accused of heartlessness. Economic
considerations are nothing compared to saving lives, they are told. So I'm
not going to talk about the economic effects-I'm going to talk about the
deadly effects on health, beginning with the fact that the U.N. has
estimated that 130 million additional people will starve this year as a
result of the economic damage resulting from the lockdowns.

In the last 20 years we've lifted one billion people worldwide out of
poverty. This year we are reversing that progress to the extent-it bears
repeating-that an estimated 130 million more people will starve.

Another result of the lockdowns is that people stopped bringing their
children in for immunizations against diseases like diphtheria, pertussis
(whooping cough), and polio, because they had been led to fear COVID more
than they feared these more deadly diseases. This wasn't only true in the
U.S. Eighty million children worldwide are now at risk of these diseases. We
had made substantial progress in slowing them down, but now they are going
to come back.

Large numbers of Americans, even though they had cancer and needed
chemotherapy, didn't come in for treatment because they were more afraid of
COVID than cancer. Others have skipped recommended cancer screenings. We're
going to see a rise in cancer and cancer death rates as a consequence.
Indeed, this is already starting to show up in the data. We're also going to
see a higher number of deaths from diabetes due to people missing their
diabetic monitoring.

Mental health problems are in a way the most shocking thing. In June of this
year, a CDC survey found that one in four young adults between 18 and 24 had
seriously considered suicide. Human beings are not, after all, designed to
live alone. We're meant to be in company with one another. It is
unsurprising that the lockdowns have had the psychological effects that
they've had, especially among young adults and children, who have been
denied much-needed socialization.

In effect, what we've been doing is requiring young people to bear the
burden of controlling a disease from which they face little to no risk. This
is entirely backward from the right approach.

4. Where to Go from Here

Last week I met with two other epidemiologists-Dr. Sunetra Gupta of Oxford
University and Dr. Martin Kulldorff of Harvard University-in Great
Barrington, Massachusetts. The three of us come from very different
disciplinary backgrounds and from very different parts of the political
spectrum. Yet we had arrived at the same view-the view that the widespread
lockdown policy has been a devastating public health mistake. In response,
we wrote and issued the Great Barrington Declaration, which can be
viewed-along with explanatory videos, answers to frequently asked questions,
a list of co-signers, etc.-online at  <https://gbdeclaration.org/>
www.gbdeclaration.org.

The Declaration reads:

As infectious disease epidemiologists and public health scientists we have
grave concerns about the damaging physical and mental health impacts of the
prevailing COVID-19 policies, and recommend an approach we call Focused
Protection.

Coming from both the left and right, and around the world, we have devoted
our careers to protecting people. Current lockdown policies are producing
devastating effects on short and long-term public health. The results (to
name a few) include lower childhood vaccination rates, worsening
cardiovascular disease outcomes, fewer cancer screenings, and deteriorating
mental health-leading to greater excess mortality in years to come, with the
working class and younger members of society carrying the heaviest burden.
Keeping students out of school is a grave injustice.

Keeping these measures in place until a vaccine is available will cause
irreparable damage, with the underprivileged disproportionately harmed.

Fortunately, our understanding of the virus is growing. We know that
vulnerability to death from COVID-19 is more than a thousand-fold higher in
the old and infirm than the young. Indeed, for children, COVID-19 is less
dangerous than many other harms, including influenza.

As immunity builds in the population, the risk of infection to all-including
the vulnerable-falls. We know that all populations will eventually reach
herd immunity-i.e., the point at which the rate of new infections is
stable-and that this can be assisted by (but is not dependent upon) a
vaccine. Our goal should therefore be to minimize mortality and social harm
until we reach herd immunity.

The most compassionate approach that balances the risks and benefits of
reaching herd immunity, is to allow those who are at minimal risk of death
to live their lives normally to build up immunity to the virus through
natural infection, while better protecting those who are at highest risk. We
call this Focused Protection.

Adopting measures to protect the vulnerable should be the central aim of
public health responses to COVID-19. By way of example, nursing homes should
use staff with acquired immunity and perform frequent PCR testing of other
staff and all visitors. Staff rotation should be minimized. Retired people
living at home should have groceries and other essentials delivered to their
home. When possible, they should meet family members outside rather than
inside. A comprehensive and detailed list of measures, including approaches
to multi-generational households, can be implemented, and is well within the
scope and capability of public health professionals.

Those who are not vulnerable should immediately be allowed to resume life as
normal. Simple hygiene measures, such as hand washing and staying home when
sick should be practiced by everyone to reduce the herd immunity threshold.
Schools and universities should be open for in-person teaching.
Extracurricular activities, such as sports, should be resumed. Young
low-risk adults should work normally, rather than from home. Restaurants and
other businesses should open. Arts, music, sports, and other cultural
activities should resume. People who are more at risk may participate if
they wish, while society as a whole enjoys the protection conferred upon the
vulnerable by those who have built up herd immunity.

***

I should say something in conclusion about the idea of herd immunity, which
some people mischaracterize as a strategy of letting people die. First, herd
immunity is not a strategy-it is a biological fact that applies to most
infectious diseases. Even when we come up with a vaccine, we will be relying
on herd immunity as an end-point for this epidemic. The vaccine will help,
but herd immunity is what will bring it to an end. And second, our strategy
is not to let people die, but to protect the vulnerable. We know the people
who are vulnerable, and we know the people who are not vulnerable. To
continue to act as if we do not know these things makes no sense.

My final point is about science. When scientists have spoken up against the
lockdown policy, there has been enormous pushback: "You're endangering
lives." Science cannot operate in an environment like that. I don't know all
the answers to COVID; no one does. Science ought to be able to clarify the
answers. But science can't do its job in an environment where anyone who
challenges the status quo gets shut down or cancelled.

To date, the Great Barrington Declaration has been signed by over 43,000
medical and public health scientists and medical practitioners. The
Declaration thus does not represent a fringe view within the scientific
community. This is a central part of the scientific debate, and it belongs
in the debate. Members of the general public can also sign the Declaration.

Together, I think we can get on the other side of this pandemic. But we have
to fight back. We're at a place where our civilization is at risk, where the
bonds that unite us are at risk of being torn. We shouldn't be afraid. We
should respond to the COVID virus rationally: protect the vulnerable, treat
the people who get infected compassionately, develop a vaccine. And while
doing these things we should bring back the civilization that we had so that
the cure does not end up being worse than the disease. 

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://lists.extropy.org/pipermail/extropy-chat/attachments/20201102/0493c6d8/attachment-0001.htm>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image001.jpg
Type: image/jpeg
Size: 5134 bytes
Desc: not available
URL: <http://lists.extropy.org/pipermail/extropy-chat/attachments/20201102/0493c6d8/attachment-0001.jpg>