Case numbers are only half the story

We should focus on other factors related to Covid-19. Case numbers aren’t everything.

You may wonder, why you should read this — another article by an unkown person — about Covid-19. And yes, you’re right, I am nobody. My most compelling argument might be that I am unbiased: I don’t care about politics and I am appaled how Covid-19 has been politicised the world over. Research is what I do for a living and my job is to try and sort fact from fiction — particularly in science.

I am convinced that much went wrong scientifically in this crisis, specifically many countries overreacted (more on that below). And to that many will say: “but there seems to be consent in the scientific community, so we shouldn’t believe all these high-profile scientists?”. There are a few aspects to that: 1) Elements of the consent were right. B) But scientific consent does not equal truth. My favourite example is Ignaz Semmelweis, the father of Germ Theory who actually went mad, because the scientific consent was that he was wrong. There is also groupthink in science. 3) Most importantly, media (and social media ) do not seem to be capable of reporting with any nuance anymore and politicians are not capable of governing with nuance. Good scientists tend not to make absolut statements, but governments and media mostly just wanted to slap a one-off solution on Covid-19 and be done with it. Whereas the situation has been very much evolving. And 4) many other high-profile scientists with opposing opinions were literally censored in some cases.

With regards to Covid-19, I only look at the big picture, and I have to — no matter how tragic any individual death is — because proportionate and reasonable solutions can only be found, if we look at the greatest good for the greatest number of people. Evidence must be king.

So what I have done for this article, is to compile information and tried to make sense of it to understand what needs to happen differently in a similar health crisis. My main gripe is that we still keep hearing only about rising case numbers, when there is a bunch of other data that is much more relevant and useful — respectively will be useful in about a year’s time.

“Stopping” the virus was never an option

It was early on predicted, that a large proportion, maybe half, of the world population will be infected with Sars-Cov-2. This was based on the observed rates of infection. By now, we have evidence that there is some prior immunity, based simply on the fact that antibodies for Sars-1 and other coronviruses also neutralise Sars-Cov-2. This part is important to note, because any potential prior immunity by parts of the population were completely disregarded in the nightmare models that caused lockdowns in many countries. There is evidence that the virus behaves like any regular virus and infected people will have a regular immune response and will reach a more permanent immunity.

The second prediction was, that Covid-19 would not go away, but instead become milder and become part of our regular seasonal cold repertoire. Since those two predictions — i.e. large numbers of infections and the virus not disappearing — were never contested, even by people who were strongly against lockdowns, I will accept these predictions as “true”.

At some point, the narrative changed

Given how very rapidly the virus spread, there was an initial worry about overloading (often faltering) healthcare systems, which we saw illustrated with tragic images from Northern Italy, for example. So experts and governments naturally started looking at options how the spread of the virus could be slowed down. This became known as “flattening the curve”, and certain social distancing measures were implemented, people were asked to work from home, and large gatherings were banned. Some countries, like India, went into full-blown lockdown early on.

The idea of flattening the curve was a no-brainer to me personally. Of course we wanted to make sure that our health care systems stayed accessible to people who needed treatment, whether for Covid-19 or anything else. But at some point — in my opinion — the narrative started changing and the goal was no longer to flatten the curve, but to stop this virus completely. Which, we established above, was never going to be possible. It was not possible, because we could not lock up an entire global population for an indefinite amount of time, possibly years, until we’d have a vaccine.

There is evidence that the curves were flattening in many places due to social distancing, working from home, cancelling large events, before those places decided to go into lockdown. So the less draconian measures already showed effect, for example in London, Germany, or Switzerland. But some countries, the UK is a good example, then decided to go into lockdown based on numbers generated by models, rather than actual data and evidence (see video below). The lockdowns then certainly made that curve drop even faster, however, they also brought with them significant long-term issues that I will go into below, as well as a lack of strategies as to how to ease the lockdowns.

I am reposting a video here with Johan Giesecke, former state epidemiologist of Sweden, in which he sums up some of the above and also later points I will make

Case numbers are still rising

So, case numbers, R-values, death rates… what should we look at?

I generally found the R-values (reproduction rates of the virus) useful in conjunction with death rates. As everything, R-values were also controversial, because nobody could agree on how they should be calculated. But, dropping R-values together with certain “mild” Covid-19 measures, gave a good indication in many countries as to how the spread of the virus could be controlled, albeit often with a time-lag.

Today, case numbers are rising in certain places, yet death rates seem to be going down overall. There may be a number of explanations for that, for example that we’re getting much better at treating the disease. Case numbers are also rising due to increased testing. There are problems associated with how tests are conducted, for example, that tests even pick up dead virus debris and give a “positive” result for people who are not sick or contagious at all. I’ve explained that in a little more detail in a separate article. Timeliness can be another issue. When we see a rise in case numbers, as for example in Colorado some weeks ago that are accompanied with a statement like “this is a backlog we just processed”, we should realise that these numbers do not represent current data. While these are individual examples, we can assume that in most countries a mix of many factors play a role. I will elaborate some more on countries like the US below.

In terms of case numbers, a second rise was also to be expected in countries that had stricter lockdowns. As soon as people would go out again and mingle, infections would of course go up, because as mentioned above, the virus could not be eradicated anyway. This point may best be illustrated with data from Sweden, which did not have a strict lockdown, but instead voluntary social distancing and a ban of large gatherings, so people were exposed to the virus more than in other countries. And notably Sweden does not have rising case numbers anymore — in fact they’ve had a very sharp drop since end of June, but a steady drop in deaths already since April. The example mentioned above, Switzerland, has seen a small rise in case numbers since lockdowns have been eased and we shall see, if that leads to a rise in deaths again.

I like comparing Sweden and Switzerland, because they’re both well-off countries with an overall healthy population and an excellent health care system. According to Giesecke in the video above, we should see comparable death rates within a year’s time in most countries. So his theory would suggest that Sweden’s numbers will continue dropping and Switzerland would continue to see a rise again after easing lockdown, until the number of deaths are comparable per capita (adjusted for population age, overall health, and other factors) within about a year. There are also other, very believable voices who say that, unfortunately most patients dying of Covid-19 would have likely died within a year anyway, due to their underlying health issues. If that is indeed true, then we will know more within a year or two, when we can thoroughly analyse overall numbers of deaths and excess deaths for 2020.

The US: cities, comorbidities, health care underfunding, and a lack of trust

As of mid-July or so we are seeing increasing case numbers and growing death tolls in a number of states in the US, but not in others. I’ve considered it a huge problem early on, that Covid-19 measures were essentially taken globally, rather than looking at local data and finding solutions accordingly. Because the factors in the outbreak are so varied, this applies not just to the US, but many other countries that either took too strict or too lax measures.

I can maybe illustrate this with statistics in terms of “excess deaths”, i.e. the number of extra deaths that may be attributed to Covid-19, compared to a regular “baseline” of expected deaths at any given time. Both The Economist and the Financial Times are visualising this data on a continuous basis. Looking at those graphs, it’s very clear that large cities were a big issue. Clearly, the virus spread more easily there, it’s also been suggested again and again that bad air quality made Covid-19 outcomes worse. What would the US total numbers look like, if we took the densely populated epicentres of New York and New Jersey out of the picture? Deaths per 100,000 vary significantly per state. And should states with low numbers have held off on lockdowns and waited, because clearly some could do with stricter measures now (later on in the crisis), whereas the whole of the US is now at a stage of easing restrictions.

Other than that I cannot further comment on those graphs, because only in about a year can we calculate whether these excess deaths were at all statistically significant. For example, if the above is true and a majority of Covid-19 fatalities would have died within a year anyway, we might see a dearth of deaths compared to the baseline later on. However, be aware, we are also expecting a rise in deaths due to reasons directly induced by lockdowns. I will elaborate more below, but let’s just say, people crunching these numbers in a year’s time will have their work cut out.

Apart from air pollution, underlying health issues (comorbidities) were a confirmed factor in Covid deaths. Overall, Americans as a whole suffer much from exactly the type of diseases that make people vulnerable, for example diabetes (as do Brazilians, with Brazil being another country not doing well right now), hypertension (which kills nearly half a million American per year as a primary or contributory factor) and cardiovascular diseases, which already the number one cause of death in the US. Furthermore, health outcomes are strongly linked to wealth and so it is no surprise that we see increased deaths in poorer communities and urban areas. And last but not least, the US health care system has been taking budget cuts for years. The TFA wrote an article in April 2019 about how much the health of Americans is put at risk due to chronic underfunding.

The importance of trust in a government during a crisis has been mentioned on numerous occasions as well, especially by historians. The US is particularly interesting to me, because as an outsider I find it absolutely amazing, that at country of over 300 million people is supposed to be divisible into two parties. But this is actually being done to Americans. Either party responds differently to the crisis, on TV channels you can only ever get one or the other opinion — but never both (because God forbid you formed your own!). The consequences are that wether it’s Trump, or would have been Clinton or Sanders: The other half of the country would not trust the government and its actions, especially young people. In 2019, trust in government was at an all time low in the US.

Even though trust globally went up somewhat in the first half of the corona crisis, it is interesting to note that the US has the highest discrepancy between trust in federal government (low) vs local government (high). On top of that you’re facing mistrust in any government at all, for example in Texas, which just happens to be another state with a rising death toll. What’s my point? Local measures for local needs.

Did we talk ourselves into a crisis?

So, case numbers do not equal deaths, the virus could be getting milder (this might or might not already be happening), it was never the case that we could stop the virus. Did we talk ourselves into a crisis, when someone somewhere decided that flattening the curve was supposed to mean eradicating the disease?

I am overall worried how eager we all seem to be really scared and to go insane. I know people first-hand who quarantined all their food deliveries for weeks, before they would touch the packages. I’ve seen parents tell seriously traumatising things to their children, while I was out on a hike or a run. And I’m reading stories of Covid patients being treated like lepers or HIV patients in the 80s in countries like India. How has that kind of behaviour ever help anyone — whether you’re an individual or we’re a society? I don’t want to be harsh, but death is the one unavoidable part of our lives and we simply have to learn to deal with it better. And instead of going into a panic, we can take reasonable steps to protect ourselves — if you are genuinely afraid for your life because of Covid-19, please take responsibility and stay home. Do not go out and treat others like criminals. Again, your individual pain is not irrelevant, but do not forget that globally about 60 million people die every year from all kinds of illness and disease.

In terms of scientists and media, I started to get worried about a weird group pressure effect, when I first noted high-profile scientists being censored. Then we even had the WHO retract statements, for example about their data showing that asymptomatic infections were very rare. And this is true people, hardly any viral infection goes down without symptoms. It’s much more likely that you had just a slightly scratchy throat and then forgot about it, when you talked to your doctor, and so it seemed as if you didn’t have symptoms. What the WHO correctly said, was that people could be presymptomatic and spread the virus. But I guess that important distinction of words was too much to handle for many. It’s because of information overload. Every bit of news and research gets hyped up, before anyone has even vetted the information for accuracy. Point in case, the horror story of the 200 Koreans who supposedly got reinfected with the virus, after they already had the disease. The explanation of it, due to how testing works, gained far less attention than the panicmongering.

Similarly, every article with good news comes with a big warning and finger wagging of “don’t you dare thinking this is getting better. You must stay scared!”. In my personal opinion, I often find explanations and reasons are sought at any cost to keep us in fear of this virus. The headlines of antibodies lasting only a few months in our bodies are bigger than the headlines that many of us have an underlying immunity, and that there seems to be strong T-cell immunity against the virus. The incessant reporting on case numbers outweighs the fact that a majority of people has a mild course of the disease and that millions of people have already recovered.

Sorry, not to be pessimistic (which I am though), but watch/read the Handmaid’s Tale and see for yourselves how this kind of scaremongering is used to force a horrendous political system onto people. We’re not quite there yet, you say? First off, I’m pretty sure that constitutionally there is no precedent for preventively locking up a global population so they might not get sick. And then just think about the contact-tracing apps many governments want to implement. this is all just creeping up on us. And if dystopian fiction is not your thing, just look back at history and how these kinds of tactics have been used over and over. Again, I never said that no action at all should have been taken. I believe that it was probably right to have stricter measures in a city like New York, but the measures should have been lifted earlier, as I said, the disease will not be erradicated. Some US states and many European countries would not have needed a lockdown. I strongly believe the Swedish model will ultimately be proven to be the sanest.

The consequences of lockdowns will be devastating

It’s may be easier for some to forget what happened to us over the past half year, now that most lockdowns are being eased. Many may even want to see stricter measures again, due to rising case numbers. But the lockdowns will have serious long-term consequences.

Some studies say that lockdowns had a relatively small effect on the overall curbing of the virus spread. Other studies say other things, because of course, the lockdowns made the curve drop immediately. If we’re to believe Giesecke above, then whatever measures we took, just delayed the infection of many people more or less absuptely. Flattening the curve, by the way, refers to a rising curve flattening off to either stay stable or fall again. It does not mean a flat line at 0 on a graph’s y-axis. I cannot say it often enough: The virus will not be eradicated. But overall working from home, the cancellation of large events, and social distancing were effective by themselves in flattening the curve. The lockdowns added little.

So let’s come back to numbers and the big picture. I am truly sorry for everyone who lost a friend or family member to Covid-19. But please do not tell me that you think the number of deaths justifies 40 million unemployed people in the US alone? The major economic downturn we’ve slid into, brings a host of serious problems. There will be further cuts to health care systems, and as always, probably education. School closures were the biggest sham of this whole exercise, because Sars-Cov-2 has barely been an issue for children and young people. It is estimated that 10 million children might never return to school again as a direct consequence of the lockdowns.

And even those who kept their jobs, will feel the effects for years to come, including worse health when they’re older. So we’ve just ourselves up for a devastating outcome in a future health crisis, because we have just created a generation of sicker people. In Europe, the lockdowns are estimated to increase overall poverty and inequality significantly. As always, the consequences are much harsher on the poorer and less educated. As a logical consequence, it’s also been suggested early on that lockdowns could be significantly more devesating than the virus itself in developing countries.

We will have increased inequality issues not just due to poverty and education (and with that often ethnicity), but also gender. Domestic violence went up and it’s suggested that women would have been set back more by lockdowns, because they were expected to take care of the children (the age old issue of unpaid care), while the men just worked from home.

Potentially 250,000 additional people could become homeless due to harsh Covid-19 measures, adding to an already growing population of homeless. Again, that’s just in the US, I cannot even fathom what these numbers will look like globally. And we will see a longer term increase in other deaths, as lockdowns have increased mental health problems, diseases went undiagnosed, treatments were missed, to the point where it’s been described as mass casualty incident.

As a society, I believe, we will suffer much more from the consequences of the lockdowns, than any individuals are now suffering from the loss of a loved on. But yes, I cannot put a price tag on it.

What can and should have been done instead?

We had the evidence early on, that mostly older people were at risk — we had that data from the outbreak in China, before the disease even reached the West. As Sweden now says, if they had put together comprehensive measures to protect their elderly population more (particularly care homes) they would have done a lot better. People at risk and with relevant comorbidities should have been protected, but could have also taken responsibility to protect themselves (as many have, I’m sure). Lockdown of a healthy population, particularly the closing of schools, has even been shown not to be a very effective measure. Social distancing and the ban of large events were, however.

Right now we can stop focussing on the by-itself useless number of cases and look at other, relevant data. Scientists, media, and governments could also stop making big announcements, when information is in fact not proven or in the worst case pure speculation. Local measures should be implemented according to local needs. And finally: accept that we will not erradicate this disease, that there will be some deaths, and that overall we’ve done a good job at flattening the curve. In many ways, the Covid-19 measures went too far, and in other ways not far enough. We must simply do better and do it in a more nuanced way next time.

While I look at all the information neutrally, you can see that I have used it to form an opinion. You’re very welcome to disagree, but if you write a comment please respect that I have put quite some thought into this and I would hope you put thought into your comment.

I am a scientist and writer. I aim to be a voice of reason and facts in this distorted world in which opinions are considered truth.

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