On the same Monday in June, two studies emerged challenging most of what everyone thinks we know about the battle against the deadly pandemic SARS-CoV-2 coronavirus, and both suggest a fundamental frailty in the way humans think:
We are prejudiced by a desire to believe in human dominion over nature.
That fundamental belief, the studies suggest, might have prejudiced conclusions that non-pharmaceutical efforts to contain the pandemic have been successful even though the evidence doesn’t appear to support that conclusion.
After modeling real-world data from 40 countries, professor Harald Walach from the Poznan University of Medical Sciences in Poland and German health consultant Stefan Hockertz concluded that little of what has been done to battle the disease to date has proven truly effective and some actions might have made things worse.
“Interestingly, none of the variables that code for the preparedness of the medical system, for health status or other population parameters were predictive (of lower death rates),” they wrote. “Of the public health variables, only border closure had the potential of preventing cases and none were predictors for preventing deaths. School closures, likely as a proxy for social distancing, was associated with increased deaths.
“The pandemic seems to run its autonomous course and only border closure has the potential to prevent cases. None of them contributes to preventing deaths.”
The study was published on the preprint server MedRxiv and has not been peer-reviewed. The authors appeared to concede that, but they weren’t pulling any punches.
“It is interesting to observe that closure of schools emerges as a strong positive predictor for the number of deaths, i.e. school closures are associated with more deaths,” they wrote. “This could be an indicator for strong social distancing rules in a country which might be counterproductive in preventing deaths, as social distance for very ill and presumably also very old patients, might enhance anxiety and stress and could then become a nocebo.
“It could also reflect the fact that countries which saw a rising tendency of deaths closed schools as an emergency measure, and hence school closure is an indicator of fear in a country. But considering the prevention of deaths, none of the public health measures studied are associated with the prevention of deaths.”
Out of the mainstream
Conceding that their work “contradict(s) new modeling data using time series models that report clear evidence for the effectiveness of non-pharmaceutical interventions,” they took direct aim at those findings.
“The major shortfall of these models is that they ignore the most likely reason why we find the data we find: immunity in the population and neglecting the strength of
natural immunity,” they write. “Thus, a new reliability study of such models shows that they are crucially dependent on assumptions, parameters assumed and the time point at which they capture data. If the wrong assumption about a potential resistance against an infection in a population is made, the results are far off from true values.”
Walach and Hockertz are not alone in this thinking. Another study new on the MedRxiv server Monday also concluded that while actions taken to slow the spread of the disease appear to have reduced demand for space in intensive-care units “none of the proposed mitigation strategies reduces the predicted total number of deaths below 200,000. Surprisingly, some interventions such as school closures were predicted to increase the projected total number of deaths.”
A team of researchers from the University of Edinburgh reached those conclusions after investigating the United Kingdom’s response to the pandemic as guided by the advice of the country’s Imperial College against the subsequent trajectory of the disease.
Like Walach and Hockertz, the Edinburgh group led by Professor Ken Rice, an astrophysicist who specializes in modeling, concluded that closing schools actually increased the number of deaths, but the Edinburgh scientists didn’t stop there.
“We confirm that adding school and university closures to case isolation, household quarantine, and social distancing of those over 70 would lead to more deaths when compared to the equivalent scenario without school and university closures,” they write. “Similarly, adding general social distancing to a case isolation and household quarantine scenario was also projected to increase the total number of deaths.
Though this conclusion might at first appear counter-intuitive, the logic is sound. As with all viruses, SARS-CoV-2 needs new hosts to infect in order keep spreading. The fewer people it is capable of infecting, the harder it for the disease to travel through a population.
Thus if a large number of young people are infected and subsequently develop antibodies to ward off future infections, the virus has an increasingly harder time finding hosts and the spread of the disease slows.
“The qualitative explanation for this is that within all mitigation scenarios in the model, the epidemic ends with herd immunity with a large fraction of the population infected,” the Edinburgh researchers wrote. “Strategies which minimize deaths involve having the
infected fraction primarily in the low-risk younger age groups. These strategies are different from those aimed at reducing the ICU burden.”
Younger people – for reasons still not fully clear – have far better odds of beating SARS-CoV-2 than old people. Some do get very sick from COVID-19 – the disease caused by the coronavirus – but overall death rates are relatively low.
The age gap
The U.S. Centers for Disease Control (CDC) currently estimates a COVID-19 case fatality rate of 0.05 percent for those age 49 and under. It rises to 0.2 percent for those age 49 to 64 and climbs to a deadly 1.3 percent for those 65 and older.
When the data is further broken down, it lays things out even more clearly. The CDC charts a COVID-19 death rate that starts at 3.5 deaths per 100,000 for those aged 5 to 17 and climbs steadily to 535.2 deaths per 100,000 for those age 85 and older.
The chart reflects that those 50 to 64 years old are dying at a rate almost five times greater than those age 18 to 29, and by age 65, the death rate for the 65-and-older group is approaching 10 times that of those under 30.
A 2009, peer-reviewed meta-analysis of studies of the common flu published in the journal Epidemiology reported that most estimates for that disease “fell in the range of 5 to 50 deaths per 100,000,” but as with COVID-19 “rose monotonically with age, from approximately one death per 100,000 symptomatic cases in children to approximately 1,000 deaths per 100,000 symptomatic cases in the elderly, although with substantial variation in the estimates within each age group.”
Other than trying to protect the most vulnerable while growing herd immunity among the less vulnerable, both studies suggest there is not a whole lot that humans can do to change the course of the COVID-19 at this time.
“…The image that emerges from the data and the attempt to understand their relationship through modeling is that of a largely autonomous development,” Walach and Hockertz write. “It affects mainly the elderly. Smoking is somewhat protective and border closures is associated with a lower number of cases. But other measures – closing of schools and lockdown of whole countries – do not contribute to a reduced number of cases or deaths.”
The data does indicate, they add, that if suspected cases are tracked and traced fast enough – as in Taiwan and Hong Kong – “containment is possible….(but) once infections
are in the vulnerable segments of a population, like in hospitals or homes for the elderly,
political actions like school closures or country lockdowns do not prevent deaths.
“If anything, social distancing seems to be harmful. What might be useful but cannot be seen in our coarse-grained data are special protective measures geared to protect these vulnerable populations, such as protective masks for personnel and visitors in hospitals and old people’s homes, or the wearing of face masks in places with bad ventilation and close proximity of people.”
They admit it’s nice to believe the existing public health measures work, but argue the data just doesn’t support that conclusion.
“…We have pointed out that the peak of the cases had been reached in Wuhan already on January 26th, only three days after the city lockdown,” they write. “This was surely too short to be an effect of public health measures as cases manifest with a delay of at least five and rather more days. And a careful analysis shows that, if one uses realistic retrodiction (back-tracking of time) of cases, then effects of public health measures cannot be seen.”
The Edinburgh study gives more credit to the interventions but concludes that when they are relaxed – which must inevitably be done since governments can’t hold people in lockdown forever – anything that has been gained by the lock down is lost and maybe worse.
The consequence of some interventions, they warn, is that they suppress “the first wave so that a second wave, occurring after the interventions have lifted, then leads to a total number of deaths that exceeds the total for the equivalent scenario without this additional intervention.”
Both studies argue for protecting the elderly and others most vulnerable while growing herd immunity among younger citizens. If they are right, the U.S. might now be accidentally engaged in this practice given the Black Lives Matter protests that have drawn together large numbers of primarily young demonstrators.
As of this time, there have been no reports of deadly disease outbreaks tied to those protests, but there is no way of knowing how many people might have been infected who are asymptomatic and presymptomatic and destined to show up infections counts in the days ahead.
The Swedes, who have taken a beating for a more liberal response to dealing with the pandemic, generally followed the model suggested in the studies, but did a terrible job of protecting the elderly.
Swedish national epidemiologist Anders Tegnell described it as a weakness of the nation’s elderly care.
The Swedish death rate of 507 per 100,0000, according to the Worldometer COVID-19 tracker, is far higher than that of its Scandanavian neighbors, but less than that of Italy (573/100,000) and Spain (606/100,000) – two countries that engaged in onerous lockdowns.
Sweden’s rate is less than a third that of New York (1,607/100,000) and near a third of that of New Jersey (1,467/100,000). A number of studies have flagged population density as a possible contributing factor there, but the latest studies point to age being a bigger issue.
“Since being elderly is a risk factor for many diseases, and eventually death, and cannot be changed, political actions in future pandemics would likely need to focus on protecting these members of society first,” Walach and Hockertz written. “Apparently, closing schools and locking down countries is not the right method to prevent
The study is sure to be controversial.
Back in March, Dr. David Katz – a specialist in preventative medicine and public health, and the founding director of Yale University’s Yale-Griffin Prevention Research Center – wrote an op-ed for the New York Times (NYT) suggesting that idea.
Not long after, Katz appeared on CNN where NYT Science and Health writer Donald McNeil called the op-end “an extremely dangerous way of thinking” and “demanded the doctor “take that paper back and apologize for it because I think it provided a scientific underpinning for (President) Donald Trump to say things like the cure is worse than the disease.
McNeil called for a lengthy lockdown to save lives, arguing “we’re not going to be able to think about our 401Ks or take retirement at the time we want to. We’re going to have to think about getting enough calories, for perhaps the next year until a vaccine is here.”
McNeil seemed wholly unaware of economic realities. And a year-long down lockdown seems even more unrealistic now and then.
After a lockdown of only a couple months, the country has been split by the biggest protests since the Vietnam War as Americans, largely the young, demand racial justice, a noble goal no one is quite sure how to achieve in a society that has become only more tribal in the past decade.
“Currently there is no guidance for what comes after ‘flattening the curve,'” he writes. “It delays but does not prevent – a spike in hospital need and mortality, unless maintained until a vaccine is available.
“‘Everybody back to the world now’ means a high, unacceptable rate of severe infection and death among those at elevated risk.
“‘Hunker in a bunker until there’s a vaccine’ ignores the potentially massive adverse health effects of social determinants of health as lives, livelihoods, goods, services, and supply chains are disrupted and degraded.”
He has been criticized as putting economics ahead of health, but the two new studies would suggest the equation is not that simple.