Covid-19 Diary : Sunday 21 February, 2021

 

Sunday saw 57,198 new Covid cases in the US.  A week ago, last Sunday saw 66,777 new cases.  So, a 14% drop over last Sunday, and while that is a smaller drop than has been the case for most of the last almost six weeks, it is still a substantial drop, and the (happy!) mystery of falling new case numbers continues.

There is one explanation out there that I’m hesitant to accept, because it suffers from the weakness of being very difficult to prove, and also equally difficult to disprove.

The explanation is that we have now reached “herd immunity” and so the virus spread rate is dropping, due to its inability to find new people to infect who don’t already have immunity, either acquired from a past Covid infection, vaccination, or immunity as a result of some other similar past infection.

Before I critique this, let’s allow it to be expressed by a proponent – this Wall St Journal article is a good expression of the concept.

But is it really a convincing article?  Six things immediately leap out upon reading the article.

The first is there are no sources given for nearly all the claims made.  That’s not to say the sources don’t exist – they probably do.  But it makes it much harder to understand the writer’s reasoning and agree or critique his interpretation of the sources.  It silences a discussion/dialog rather than encourages one.  Why is the writer not enabling an open full discussion?

The second is the claim “15% of Americans have received the vaccine”, which is a distortion of the underlying truth, and clearly intended to support his herd immunity claim.  The reality is better stated “50 million vaccinations have been given, mainly with people receiving the first of two doses, and in some cases, people have now had both doses”.  Remember you need both doses for full immunity to kick in, and remember also that most of the doses given are in the last 3 – 4 weeks, the period during which immunity is building rather than already at high levels.  The writer by careful wording and implication makes it seem as if 15% of the country have now developed vaccine-based immunity.  That is totally wrong, and if he is wrong about that, what else is he wrong about?  If he misunderstands how vaccines work, what else is he misunderstanding; or if he is lying, what else is he lying about?  My confidence in the writer and his honest assessment of the situation is shattered by this.

Incidentally, he doubles-down on this error by then quoting how many more people will be vaccinated by the end of March.  What is the relevance of future vaccination trends in terms of explaining the huge drop in cases in the past?  None, whatsoever.  He is trying to further strengthen a weak or erroneous point with irrelevant “supporting data”, which implies he is doing this because there is nothing stronger in terms of real data to offer.

The third is his introduction of suggestions of various other forms of immunity mysteriously appearing, his ignoring of the possibility of past-infection immunity being short-lived, and his ignoring the present and likely future virus mutations that seem to evade presently acquired immunity.  He is greatly overstating the case for acquired immunity, and without that, his argument is greatly weakened.

The fourth is that his numbers for hidden/undetected cases of the virus are much higher than are traditionally given by other sources.  The generally accepted number is that detected and officially counted cases are slightly more than half of all cases – here’s one of many sources to support that.  He is suggesting that only 15% of cases are detected and officially counted.  In other words, instead of saying that for every recorded case, there is one more unrecorded case, he is saying that for every recorded case, there are six more unrecorded cases.  That’s a huge difference.  The evidence for his claim, not given in the article, is awkward, empirical, and not broadly accepted.

The fifth thing is he cites irrelevant unrelated evidence to “prove” his claims for long-lived immunity by referring to the Spanish ‘flu from 1918.  That was a totally different type of virus, and may have created totally different immunity.

The sixth thing is his citing of what seem to be exact numbers.  He says

About 1 in 600 Americans has died of Covid-19, which translates to a population fatality rate of about 0.15%. The Covid-19 infection fatality rate is about 0.23%. These numbers indicate that roughly two-thirds of the U.S. population has had the infection.

That sounds very scientific, and a “clincher” for his argument.  But you’ll note he gives no source for his claim that the Covid infection fatality rate is 0.23%.  It seems to come from this paper from a somewhat controversial researcher.  The problem is the writer is using a circular self-confirming argument.  The assumptions about disease prevalence in creating a 0.23% infection fatality rate are then used to “prove” the assumption of the disease’s prevalence.

Ultimately, like all good fortune tellers, he ends with a prediction that is hard to disprove.  His prediction – the virus will be “mostly gone” by the end of April is vague.  What does “mostly gone” mean?

As for me, I’m in a quandary.  I see and accept the data in front of us all – the plunge in new infection numbers.  But I don’t see any credible explanations – it is too soon for vaccinations to have any impact, and there’s been little or no change in social distancing and mask wearing in January and February compared to November and December, and the weather is also not very different.  As for herd immunity, it wouldn’t work this way – it wouldn’t suddenly switch from a steep upwards rate to a steep downwards rate.  It would slowly reduce its climb, level out, then slowly start to drop.

Something obviously is causing this drop.  But if it truly is herd immunity, that is not necessarily cause for celebration.  It is cause for puzzlement, and ongoing concern for all of us who have not yet been vaccinated or recently suffered from the virus.  Herd immunity is a concept of value for an entire country, but not for the individuals within it.  It is sort of like the statistic “the average American family has 2.5 children”.  If that statement were literally true, there would be lots of “half people” everywhere.

One possible explanation has been suggested, probably tongue-in-cheek.  The use of ivermectin has skyrocketed in the last few months (discussed further here).

Talking now about ivermectin, I tried, but abjectly failed, to engage a husband and wife pair of doctors on Twitter in a dialog about ivermectin.  They follow me on Twitter and read my articles, and so I was astonished when out of nowhere, they said (I’ll show their comments in brown)

I’ve been asked multiple times why we don’t use #Ivermectin for #COVID19.

Well, for one NO data to support it AND the drug maker Merck says it DOES NOT WORK. If the drug maker says it doesn’t work and there is no data…There is no reason to use it. #FactsMatter

This quickly resulted in a response from another user (and reader, I’ll use blue)

But what about https://ivmmeta.com

For sure, hasty comments limited to 280 characters and a messy way of matching comments to responses do not make for a scholarly dialog.  But what followed became more and more distressing, progressively revealing a totally illogical refusal by these two doctors to consider any possibility or any proof of ivermectin’s effectiveness.

As for the response back to the doctors, ivmmeta.com is a site that compiles a list of articles about IVM, and provides some basic and utterly persuasive analysis of the studies’ findings and ivermectin’s effectiveness.

The doctors’ reply was strange

Im just wondering why this is not published in a respected peer reviewed journal if it is legitimate?!?!

This response not only misunderstands the nature of the ivmmeta site (which has 27 peer-reviewed articles listed on it) but also implies the data on the site is not legitimate.

This received at least two replies (mine in green), it is difficult to follow the interlinking comments, and not all comments from all participants are shown below

One explanation is institutional bias favoring exciting *new* (and profitable) drugs and against boring old ones.

If you understood this website, you’d realize this is a summary of studies, not a study itself.

This caused the two doctors to say

But for COVID the main drug we use is steroids which is old and cheap. We dont have any magic bullet for this virus . Honestly if there was a drug that worked we would all be using it…

I replied

There are many drugs showing beneficial outcomes. The two stars are HCQ and IVM. Here’s the most recent peer reviewed IVM study, by the way. Why are you not following this more closely? How many of your patients are you killing?

I also asked the question

How many dozens of peer reviewed studies are there supporting steroid use? I’m all in favor of it, just curious to see what level of evidentiary support there is for drugs you’ll accept compared to those you refuse.

The answer to that was “the Meduri protocol” with no link or further reference.

They failed to appreciate the irony of their comments about steroid use being the main drug used.  Presumably they did not know that originally the medical “establishment” argued against steroid use for treating Covid, and it was largely as a result of the impassioned advocacy of one doctor that this slowly changed.  That one doctor is now engaged in a similar quest to get ivermectin accepted….

Meantime, the doctors sort of replied to my comment about the most recent peer reviewed IVM study by saying

The data is reviewed monthly by a group of infectious disease and ICU docs. There is just no good evidence that any of this stiff works. Otherwise we would be using it. Its unfortunate you think of medicine and healthcare the way you do, our only goal is to help.

“There is just no good evidence” is a crazy thing to say, ignoring the 62 studies earlier offered up to them, and the specific study I’d just linked to.

I returned back to the “no good evidence” and the earlier reference to peer reviewed studies and said

You talk about wanting only peer reviewed studies for IVM. According to this page, there are 27 peer reviewed studies, all positive. Where is the “no good evidence” you refer to? There is none – only positive evidence.

At this point, I was starting to feel a sense of disbelief.  Two doctors were claiming, in spite of being offered 62 articles, 27 of them peer reviewed, that there is “no good evidence” for using ivermectin.  How can they be so blind to the facts in front of them?

Another Twitter member helpfully referred to two recent double blind randomized controlled trials, one of which was written up in a publication by The Lancet, once one of the three or so most prestigious medical journals in the world.

Another Twitter member posted

There is overwhelming data to support #Ivermectin. Beware the know it all who stops reading. Start here, and start saving lives:

To which the doctors replied

Im happy to look at any data in a peer reviewed journal confirming that this drug a viable option for covid.

You might noticed we’re back to the “show me a peer-reviewed journal study” line, even though they have been shown studies in 27 peer reviewed journals including ones as prestigious as The Lancet.

The other Twitter user referred them again to the list of studies.

Next, these two people said

Ivermectin has not been associated with lower mortality or higher recovery. Most of what you sent are “pre prints” so conclusions are not finalized. Not saying the drug doesn’t have potential, It just hasn’t been definitely proven to be effective.

This needs to be better studied. If you follow treatment protocols, much has changed as we learned more over the last few months, but we did it based on evidence not anecdotes. We still have much to learn about COVID and immunology in general.

This is a combination of nonsense (“not been associated with lower mortality or higher recovery” – in fact the studies suggest 89% reduction in mortality) and arrogant non-wisdom “needs to be better studied…  based on evidence not anecdotes”.  While they are dismissing 62 studies and 89% reduction in mortality as needing better studies and evidence, people are dying.

I replied

Absolute nonsense! Did you forget people are dying? Half a million so far. Here’s a drug that is cheap, safe, and probably amazingly effective, and which as 62 all-positive studies so far. Compare that to approved remdesivir – 8 studies, mixed results.

This caused the following patronizing response

Show me just one peer reviewed article published in a respected medical journal that backs up this claim. It does not exist. But I appreciate your enthusiasm to help with this pandemic.

I said

I’ve sent you links to 27 such articles, plus another 35 articles of various types. How much more does it take to open your eyes?

Their reply

You have not. Find one, just one article published in a respected medical journal. Ive been looking, it does not exist.

Note how they are now demanding peer reviewed studies in “respected” medical journals (but apparently The Lancet does not meet their doubtless impossible to satisfy requirements).  I asked

Please advise why each of the 27 publications with peer reviewed articles are not considered “respected medical journals”.

The truth, of course, is they probably haven’t looked at anything in any of the links at all, and never will.  And as if to confirm that, their next message

This is a dead end conversation. If you don’t know, then I can’t help you. Have a good day.

And my response

It is not only a dead end conversation, but if I were your patient, I might now be dead. Do you tell your patients “ignore the 62 articles, ignore the countries that have approved IVM, go home, do nothing, and quietly die”.

Nothing further has been heard from these two doctors.

I grew up in a world where Dr Finlay (in Britain/Scotland), Dr Kildare and Marcus Welby (in the US) were role models for my view of doctors as being caring, kind, and omniscient.  Now we have doctors who refuse to look at evidence in support of a cheap safe effective drug, and would rather let their patients dieI cannot comprehend how such people can practice medicine and look at themselves in the mirror each day.

Nowhere in this exchange was any reason not to prescribe IVM given by these two doctors; no cautionary tales, no studies that showed negative effects.  Some of the other contributors in the exchange were doctors saying “use this, it works for us”.

These two doctors are boasting how they tell their patients not to take IVM, and in doing so, increase their risk of dying nine-fold.  For what reason?  For what offsetting good purpose?

At what point does this become medical malpractice?

Current Numbers

Tennessee dropped back to 46th place with Iowa now appearing in the five worst affected states.  MS and RI swapped places in the death list.

There was no change in rankings in the minor country list or the major country case rate list, in the death rate list, the Czech Republic moved up one and the UK moved down one.

US Best and Worst States

Rank Cases/Million Deaths/Million
A week ago Now A week ago Now
1 Best HI (18,968) HI (19,192) HI (301) HI (304)
2 VT (21,919) VT (23,226) VT (303) VT (316)
3 ME ME AK AK
4 OR (35,631) OR (36,232) ME (483) ME (490)
5 WA (43,493) WA (44,254) OR (507) OR (511)
47 TN (110,909) IA (113,936) RI (2,162) MS (2,202)
48 UT (112,695) UT (114,392) MS (2,171) RI (2,243)
49 RI (114,051) RI MA (2,246) MA (2,296)
50 SD SD NY (2,368) NY (2,417)
51 Worst ND (129,382) ND (130,274) NJ (2,528) NJ (2,573)

 

Top Case Rates Minor Countries (cases per million)

Rank One Week Ago Today
1 Andorra (135,799) Andorra (138,328)
2 Gibraltar (125,249) Gibraltar (125,516)
3 Montenegro Montenegro
4 San Marino San Marino
5 Slovenia Slovenia
6 Luxembourg Luxembourg
7 Israel Israel
8 Panama Panama
9 Lithuania Lithuania
10 Aruba (67,479) Aruba (71,681)

 

Top Case Rates Major Countries (cases per million)

Rank One Week Ago Today
1 Czech Republic (101,480) Czech Republic (107,553)
2 USA (85,070) USA (86,577)
3 Portugal (77,201) Portugal (78,362)
4 Spain (65,347) Spain
5 Belgium (63,429) Belgium
6 Sweden  (60,010) Sweden
7 Netherlands (59,987) Netherlands (61,578)
8 UK (59,289) UK (60,420)
9 France France (55,153
10 Brazil Brazil
11 Italy (45,060) Italy (46,507)
12 Argentina (44,568) Argentina (45,408)

 

Top Death Rate Major Countries (deaths per million)

Rank One Week Ago Today
1 Belgium (1,862) Belgium (1,883)
2 UK (1,720) Czech Republic (1,792)
3 Czech Republic (1,692) UK (1,770)
4 Italy (1,549) Italy (1,585)
5 Portugal (1,505) Portugal (1,568)
6 USA (1,497) USA (1,538)
7 Spain (1,384) Spain (1,435)
8 Mexico (1,339) Mexico (1,385)
9 Peru (1,314) Peru (1,356)
10 France (1,252) France (1,290)

I Am Not a Doctor, But….

On Thursday I chronicled how our “experts” are making a mess of testing, and how regrettable/harmful this is.  Here’s an interesting piece that further explains how essential it is to have readily available and fast testing.

At present it seems the worst of the Covid experience might be behind us, and perhaps we can shift our focus now to how soon it will be before life returns to something close to normal.

But…..  Just when you are starting to think happy thoughts, there’s this – a new type of bird flu that can be passed to humans.  It is way too soon to urgently replenish your stocks of masks and toilet paper, but it is a reminder of other risks just below the surface of our lives and may suddenly become huge distorting factors, too.

Vaccine News

While Canada’s case and death rates are massively below ours in the US, its vaccination strategy has some astonishing and unforced errors, in particular its early decision to place “all their eggs in one basket” and contract with a single source for vaccines – and of all choices to make, a Chinese source, which eventually gave up and failed to develop a vaccine at all.

One thing our previous administration did so well was signing up with multiple vaccine developers for an over-supply of vaccines, meaning that whichever vaccines were first to be approved, we’d be in a good position for supply.  Canada, not so much.

Timings And Numbers

The US continues to lead most of the rest of the world in its rate of administering vaccinations, and the slowing down this last week is probably weather related.  We’re not so sure why Britain’s vaccination rate has also stumbled.

Do you remember, in the early days of the outbreak, how various “experts” were projecting the future of the pandemic.  We were being told at one point to expect millions of deaths in the US, then we were told to expect less than 75,000, and now the reality is we’re climbing up above half a million, so far.  The experts – not individuals, but lavishly funded teams of “experts” – first guessed way too high, then way too low.

One expert however has consistently offered up accurate predictions.  The thing is, he isn’t an “expert” per se at all, just a guy in Santa Clara, living with his parents, and working on predictions in his spare time.

This is yet another area where the “experts” have totally failed us.

Talking about predictions, the TSA have been consulting their own crystal ball, and seem to be expecting positive growth in air travel numbers.  They are seeking to hire 6,000 new airport security officers in time for the summer.

Please stay happy and healthy; all going well, I’ll be back again on Thursday.

Please click here for a listing of all our Covid-19 articles.

 

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