Alexander Mercouris weighs both sides of the debate between lockdown and herd immunity and examines claims that Covid-19 is over-hyped and is really just like the flu.
By Alexander Mercouris
Special to Consortium News
The year 2020 has been witness to many forecasts and prophecies. Of only one can we be sure that it will indisputably be proved to be true: 2020 will be remembered as the year a micro-organism, the virus strain SARS-CoV-2, had a tremendous impact on human society.
Given this tremendous impact it seems to me that it would be useful at this stage in the pandemic, when its initial period has passed, to sum up what is known about the effect of the virus and the illness – Covid-19 – which it causes. I say this because it remains a remarkable fact that months after the virus implanted itself to such devastating effect, there continues to be much confusion about it, which in turn confuses much of the discussion about how to respond to it.
The Virus and the Illness
Firstly, it is important to distinguish between the virus itself – the coronavirus known as SARS-CoV-2 – and the illness – Covid-19 – which the virus causes. Unfortunately this important distinction is rarely made or explained, so that many people in my experience do not understand it, and are not aware of it.
It is possible for an individual to be infected by the SARS-CoV-2 virus without becoming ill (by which I mean feeling unwell and showing symptoms of illness) with the illness known as Covid-19. The fact that individuals who become infected with the SARS-CoV-19 but who do not become ill with Covid-19 are typically referred to as “asymptomatic cases” – as if they are somehow ill but in some invisible way – makes the confusion about this fact greater. This in turn leads to a misunderstanding of how dangerous an illness Covid-19 is.
Prevalence of the Virus
The proportion of those infected with the SARS-CoV-2 virus who do not become ill with Covid-19 is presently unknown. Estimates I have seen range from 25 percent to as many as 90 percent.
In Russia, where testing has been very extensive (4.1 million tests up to May 3 in a country with a total population of 144.5 million, with numbers of tests currently in a range of 120,000 and 180,000 a day) the percentage of persons detected in a typical day who are infected with the SARS-CoV-2 virus, but who are not ill with Covid-19, is in the range of 40-50 percent. Many of these persons do eventually fall ill with Covid-19, so the actual percentage infected who do not become ill with Covid-19 is lower.
Russian test results argue against the theory, which has become an article of faith for some people, that a large part of the population is infected.
Over the course of a 24-hour period ending on April 26, the Russian authorities carried out 138,000 tests for the SARS-CoV-2 virus. These tests identified 6,198 persons (4.5 percent of the total tested) who were infected with the SARS-CoV-2 virus, of whom 2,693 (1.95 percent of the total tested) showed no sign of being ill with Covid-19.
Russian testing, like testing in every other country, is not random but is focused on those believed to be most likely to be infected. That makes it likely that the percentage of the Russian population infected by the SARS-CoV-2 virus, but not ill with Covid-19, is currently less than the 2 percent, which is being picked up by current tests.
On May 2 Sergey Sobyanin, the mayor of Moscow, estimated that the total percentage of Moscow’s population infected by SARS-CoV-2 was no more than 2 percent. Moscow is by a very substantial margin the most heavily infected region at this stage of the pandemic in Russia. The percentage of people infected by the SARS-CoV-2 virus would be expected to be high there. In the rest of Russia the percentage likely to be infected at this stage of the epidemic is probably much smaller.
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It is likely that the percentage of persons infected in other countries, such as the United States and Britain, is higher than in Russia. However test results in most countries, including the most badly affected, suggest that even in these countries at this stage of the epidemic the percentage of the population which is infected is in still only in single figures.
The widespread belief that “most” people have already been infected, or that there are tens or even hundreds of millions of undetected “asymptomatic cases” is therefore almost certainly wrong.
Various studies or ‘surveys’ which claim the opposite turn out on examination to be based either on unreliable mathematical models or on results obtained from test samples which are too small.
A good example of a study based on an unreliable mathematical model was a study, briefly endorsed by the Swedish Public Health Authority, which claimed that by May 1 up to a third of the population of Stockholm would be infected by the SARS-CoV-2 virus. This study was withdrawn the day after it was published when it turned out that it was based on an error.
A good example of a ‘survey’ based on an excessively small sample was a Stanford University survey which claimed that fifty to eighty-five times more people in California’s Santa Clara County had become infected with the SARS-CoV-2 virus than had been officially confirmed by the local authorities on the basis of testing. The sample upon which this survey was based was however small and far from random, being on the contrary small, unrepresentative and self-selected.
A more recent survey in Germany, which claims that the infection rate there may be ten times greater than the official rate, also seems to be based upon a small and unrepresentative sample.
The Stanford University survey, and possibly the German survey also, moreover appear to rely on antibody tests, whose reliability is still in issue.
The Illness is not Flu
Contrary to repeated claims, Covid-19 is not flu, and its symptoms do not resemble flu.
Several people I know claim to have contracted it. They describe headaches and fevers, a continuous and prolonged dry cough, loss of the senses of smell and taste, a sensation of severe tightness of the chest, and a shortage of breath, which can last for days.
The last is especially frightening, with one person (an athletic young woman of 30) comparing it to the shortness of breath experienced following a marathon race, only this time lasting for days. Obviously this is an exaggeration, but one which conveys the extreme discomfort Covid-19 causes.
In addition several people have described to alternating periods of remission and of acute illness, which has been both disorientating and exceptionally debilitating.
In every case the illness lasted longer than 14 days. In every case moreover the British National Health Service assessed the illness as “mild”, and not deserving of treatment, and the subjects were not even tested.
In severe cases (not directly described to me) there is acute respiratory collapse, with the lungs unable to provide oxygen to the blood, causing danger to life. In some cases this can happen without the person affected noticing that they are no longer breathing properly, and are becoming dangerously short of oxygen.
It is now clear that alongside these classic symptoms of Covid-19, the SARS-CoV-2 virus can also cause damage to the brain and to the central nervous system.
No Effective Drugs
Contrary to numerous claims no drug treatments have so far proved effective. Claims made on behalf of hydroxychloroquine have not been borne out by test results, with a U.S. test reporting no benefits, and a Brazilian test reporting danger to patients when hydroxychloroquine was prescribed in high doses.
Claims continue to be made on behalf of remdesivir. However whilst it seems remdesivir may help Covid-19 patients already in recovery, there is no evidence it helps Covid-19 patients who are critically ill, or that it prevents deaths.
Covid-19 poses significantly higher risks to older people with weaker immune systems and to individuals with underlying health conditions. Those who downplay its dangers typically make much of this. However any disease would normally be expected to pose higher risks to those who are already old or ill, though there are exceptions, of which the most famous is Spanish flu.
Contagiousness of the Virus
The SARS-CoV-2 virus is highly contagious. Carriers are at greatest risk of spreading the infection some days after they become infected but before they become ill, and also – and most especially – in the first days of illness, when the main symptom is a dry cough.
It seems that in around 95 percent of cases the virus is spread when water droplets carrying the virus are coughed or sneezed out by a carrier, and then breathed in by a passerby.
The SARS-CoV-2 virus can survive for short periods outside the human body, though the time period in which it is able to do so varies according to the atmospheric temperature or the particular surface on which it settles. Its survival rate appears to fall sharply when the atmospheric temperature is high, or when it settles on certain organic materials, such as wood or paper.
This has led to claims that the SARS-CoV-2 virus cannot survive or spread in the summer or in hot climates, supposedly reducing the need for social distancing during the warm summer months and in countries with hot climates.
“The widespread belief that ‘most’ people have already been infected, or that there are tens or even hundreds of millions of undetected ‘asymptomatic cases’ is therefore almost certainly wrong.”
There may be some truth to these claims. It is important to say however that as of the time of writing they are unproven. The most important means of transmitting the SARS-CoV-2 virus is through the breathing in of water droplets breathed out by a carrier. It is not obvious how a high temperature affects this. There are in fact contrary claims that warm climates and high temperatures have no effect at all on rates of infection or on virulence. As it happens, one of the worst affected countries – Ecuador – has a relatively warm climate.
Arguments Leading to an Underestimate
of the Dangers of the Illness
Though it is no longer seriously arguable that Covid-19 is lethal to some people and that the SARS-CoV-2 virus which causes it can spread rapidly through human populations, there continues to be bitter dispute, especially on social media, as to exactly how dangerous it is.
There is a significant and vocal community on social media who insist that Covid-19 is not really dangerous at all save to those who are old or seriously ill, and who are likely to die shortly anyway. Typically such people claim Covid-19 is no more dangerous than seasonal flu, and claim that the restrictions on movement which have been imposed to contain its spread are counterproductive and unnecessary. Often they persist in referring to Covid-19 as “flu”, presumably in order to emphasise their rejection of the claims about its dangers. They also typically complain that the restrictions on movement, if made mandatory, are violations of human rights.
Those who make these claims tend in my experience to add together the number of people infected with the SARS-CoV-2 virus with the number of people ill with Covid-19, treating them as if they were all ill with Covid-19. Needless to say this results in a serious underestimate of the percentage of those ill with Covid-19 who die from the disease.
They then typically compound this error by accepting the exaggerated claims about the numbers of so-called “asymptomatic cases” – that is to say of people who are infected by the SARS-CoV-2 virus but who are not ill with Covid-19 – which regularly get made. This of course results in their underestimating the percentage of cases of Covid-19 which end in death even further. These errors are then further compounded by a further tendency to explain away Covid-19 deaths as the deaths of old or unhealthy people, who supposedly were on the brink of dying anyway, and whose deaths were not therefore supposedly caused by Covid-19.
At the end of this flawed process the percentage of deaths from Covid-19 which it produced is insignificantly small, resulting in an extreme underestimate of the lethality of the illness.
In reality the true measure of the lethality of a disease is how many people die who are ill with it, not how many people die out of the total number of people who may notionally have become infected by the micro-organism which causes it.
As for the claim that most of those who die from Covid-19 are old or unhealthy, that is undoubtedly true. However I am unable to see the relevance of this point. In any epidemic with very few exceptions (Spanish flu being one) it is precisely those with weakened immune systems because they are old or unhealthy who are most likely to die. The fact that they are old or unhealthy does not mean that Covid-19 did not cause their death.
Risk of Death from the Illness
The risk of death from any disease will vary considerably depending on a host of factors, of which one of the most important is access to proper health care. At this stage in the Covid-19 pandemic it is impossible to set a precise number on the chances of death of anyone who falls ill with it. All that can be said with any certainty is that as the pandemic has expanded the percentage of those who have been reported ill with Covid-19 who eventually die has steadily increased.
On January 29 the WHO’s estimate of the mortality rate was 2 percent. On March 3 that estimate had grown to 3.5 percent. As of April 29 there were 225,615 deaths out of 3,188,596 reported cases, which is a death rate of 7 percent of those who are reported to have fallen ill.
A mortality rate of 7 percent for Covid-19 is almost certainly too high. It does not take into account the many undetected cases of Covid-19, of which most end in recoveries. However there are also many unreported deaths from Covid-19, and at this stage in the pandemic there is insufficient knowledge of either figure to make it possible to set one off against the other in order to arrive at a final outcome.
“There is a significant and vocal community on social media who insist that Covid-19 is not really dangerous at all save to those who are old or seriously ill, and who are likely to die shortly anyway.”
A reasonable guess consistent with the information available might be a mortality rate of 2 to 5 percent, falling lower, perhaps much lower, in wealthier countries with advanced healthcare systems, and rising higher, perhaps much higher, in poorer countries without advanced healthcare systems and lacking the means to enforce social distancing.
These estimates can be compared with mortality rates normal for typical seasonal flu, which in the United States is estimated to have a death rate of between 0.1 and 0.2 percent.
Clearly Covid-19 is an order of magnitude more dangerous than seasonal flu, with a mortality rate probably exceeding that of the 1918 second wave of Spanish flu, which is estimated to have been between 2 and 2.5 percent of cases globally.
That Covid-19 is a dangerous disease, with a risk of death that is an order of magnitude greater than that from seasonal flu, is borne out by general mortality statistics, which are now starting to trickle out from richer countries for the period since the pandemic started.
In the United Kingdom, where standards of record keeping are high, the Office for National Statistics registered 18,516 deaths in the week ending April 10, which is roughly 8,000 more than would be expected in that week in a typical year. In the previous week ending April 3 the Office of National Statistics registered 16,387 deaths, which is roughly 6,000 more than would be expected in that week in a typical year.
Inevitably the figures from the Office for National Statistics – which suggest a significantly higher death rate from Covid-19 than the official figures of deaths from Covid-19 published by the British government suggest – have been the object of intense discussion.
Though there were 6,000 more deaths than usual in the United Kingdom in the week ending April 3, Covid-19 was only cited in death certificates for roughly half of these deaths. This has led some to claim that many of these deaths were caused not by Covid-19 but by illness or psychological stress caused by the lockdown, which had been imposed on British society by the British government the week before in order to slow the spread of infection by the SARS-CoV-2 virus.
I have no doubt that the great majority of these deaths – probably nearly all of them – were caused by Covid-19.
It is inherently unlikely that the lockdown as opposed to Covid-19 was in and of itself causing large numbers of deaths so soon after it was imposed. There is in fact no evidence as of the time of writing that the lockdown has caused any statistically measurable increase in deaths at all. All claims to the contrary so far are pure guesses.
The purpose of death certificates in the United Kingdom is not to identify the cause of death; it is to confirm officially that someone has died. Only very rarely, for example where there are grounds for suspicion that a death might not have a natural cause, would there be an enquiry as to the cause of death, requiring in most such cases an autopsy and a coroner’s inquest.
In the first two weeks of April testing rates for the SARS-CoV-2 virus in the United Kingdom were very low, whilst a doctor signing a death certificate would be unlikely to identify Covid-19 as the cause of death in the absence of a positive test. It is not therefore surprising that Covid-19 was not identified as the cause of death on the death certificate in a large number of these cases. That is almost certainly the reason why thousands of deaths caused by Covid-19 in the first two weeks of April were not reported as such, and are not reported as such by the Office for National Statistics.
Italy has followed a similar pattern. ISTAT, Italy’s Statistical Service, has reported that in the five week period from Feb. 21, when the first Covid-19 death in Italy was reported, to March 31, Italy’s nationwide death rate was 39 percent higher than the average of the previous five years. The total number of “excess deaths” in Italy in this five-week period was 23,354. The Italian authorities registered Covid-19 as the cause of death in 13,710 of these.
In Lombardy, Italy’s hardest hit region, deaths were up 186 percent overall, with numbers of deaths up 568 percent in Bergamo, 391 percent in Cremona, 370 percent in Lodi and 93 percent in Milan.
Following a discussion very similar to the one in Britain, ISTAT has speculated that the cause of death for the 11,600 “excess deaths” where the cause of death has not been identified is either Covid-19 or other conditions which went untreated because of the collapse of the local health systems under the pressure of the pandemic.
That the cause of death in the great majority of these unaccounted cases was Covid-19 is however strongly indicated by comparing numbers of deaths in cities in Italian regions less affected than Lombardy by the Covid-19 pandemic. Rome and Palermo, despite being also in lockdown, had 9 percent fewer deaths during this same five week period than the average of the previous five years.
Whilst a breakdown of the health system in Lombardy may have accounted for some of the “excess deaths,” it is unlikely that it caused a significant number of them, whilst the fall in the death rates in Rome and Palermo suggests that a lockdown, instead of causing more deaths by inducing illness or psychological stress, actually reduces deaths overall.
In summary, results of testing call into question the theory of widespread SARS-CoV-2 virus infections. Whilst there is no doubt that many infections go undetected, the best evidence suggests that percentage of the human population which is currently infected with the SARS-CoV-2 virus is still in single figures. The WHO estimates the percentage to be around 2 percent, which corresponds with the test results.
The test results also suggest that in the majority of cases persons infected by the SARS-CoV-2 virus will eventually become ill with Covid-19. Though it is still impossible to say with any certainty what percentage will do so, it is certainly higher than 50 percent. A range of 60-70 percent seems most likely.
Moreover recorded death rates show that a significant percentage of those who fall ill with Covid-19, especially if they are unhealthy or old, are likely to die. A reasonable estimate puts the mortality rate at 2 to 5 percent, though it is likely to go either higher or lower depending on the quality of healthcare provided.
The danger the SARS-CoV-2 virus poses is not therefore being exaggerated. On the contrary, the danger is very real. Where a government loses control of the spread of the infection, as has happened in Britain and Italy and in parts of the United States such as New York, the death rate will spiral upwards, and will result in a major upward jump in mortality figures.
The comparison which some still make with seasonal flu is therefore not merely wrong; it is wrong by orders of magnitude and is seriously misleading. It is wrong to make it, and it should not be made.
Crisis in Health Systems
Unfortunately, in the absence of effective drug based treatments for Covid-19, modern medicine is severely constrained in what it can do.
A BBC article dated April 29 discussing the outcomes of British hospital treatments for Covid-19 patients draws a dark picture. Out of 17,000 patients hospitalised up to that date, 49 percent have recovered, 33 percent have died, and 17 percent were still being treated. Amongst patients in intensive care the death rate was 45 percent, and 31 percent in general wards.
The article quotes Professor Calum Semple, Professor of Child Health and Outbreak Medicine at the University of Liverpool, as saying:
“The crude case fatality rate for people who are admitted to hospital with severe Covid-19 is 35% to 40%, which is similar to that for people admitted to hospital with Ebola. People need to hear this and get it into their heads… this is an incredibly dangerous disease.”
The BBC article only discusses outcomes for Covid-19 patients admitted to hospital. British practice has been to admit to hospital only those Covid-19 patients who are severely ill. The large majority of people ill with Covid-19 in Britain are not hospitalised because their condition is assessed as “mild”and they are assumed to be able to recover by themselves without needing treatment.
The advice given to them by the British National Health Service is to self isolate, take paracetamol if suffering from bad headache, and only request treatment if their condition seriously deteriorates. Most, though far from all, do in fact eventually recover without treatment. In the early stages of the pandemic such “mild” cases were not tested in Britain.
Other countries such as China, Germany and Russia have taken a completely different approach. They advise their citizens to contact their health authorities immediately in order to request and receive medical treatment as soon as they experience even the mildest symptoms of Covid-19. Testing is automatic.
The much lower death rates and much higher recovery rates from Covid-19 in these countries suggests that this is the more correct approach.
Challenge to Governments
The high potential death rate from Covid-19, the contagiousness of the SARS-CoV-2 virus, the absence of a vaccine to limit its spread, and the difficulty in providing effective treatment for Covid-19 in the absence of effective drug treatments, poses unprecedented challenges to governments.
No government I know of has ignored the pandemic entirely, or has failed to take at least some measures to contain it. Even the secretive and self-absorbed government of North Korea has spoken at the highest level of “the virus epidemic that broke out at the end of last year [which] has rapidly expanded worldwide and has become a great disaster threatening the whole mankind, regardless of borders and continents.”
In Belarus, whose President Alexander Lukashenko has repeatedly made public statements which appear to deny the seriousness of the pandemic, the reality on the ground (as confirmed to me by eyewitnesses) is of social distancing and of increasing involvement by Russia to help stem the spread of the pandemic. In Brazil President Jair Bolsonaro’s efforts to sabotage his own government’s response to the pandemic, have left him politically isolated, with the nation’s response to the pandemic taken over at provincial level by the regional governors.
In the absence of a vaccine or drug treatments, the way governments have attempted to contain the pandemic is by breaking the chain of infection. This has involved encouraging or imposing social distancing, so that carriers infected with the SARS-CoV-2 virus do not infect others. The intention is that this will reduce the number of infections, causing over time the spread of the disease to fall to manageable levels, or to stop entirely.
There is no doubt that action taken by governments along these lines has had some effect in slowing the spread of the pandemic. Slower rates of infection have in turn led to fewer cases of Covid-19 than would otherwise have been the case. That in turn has resulted in fewer deaths.
This has further in turn had the paradoxical but unsurprising effect that those who deny the danger of Covid-19 are able to point to the reduced number of deaths as “evidence” that the government actions which brought it about are unnecessary.
Imperial College Study
At this point something should be said about the much misreported March 16 Imperial College study. Since this study has been widely credited with influencing a change in U.S. and British government policies in favour of lockdowns, it has unsurprisingly become the target of relentless attack by those who deny that Covid-19 poses any special danger and who oppose lockdowns. In particular a claim supposedly made by the study, that there might be as many as 510,000 deaths from Covid-19 in the United Kingdom, is continuously cited as proof that the study was wildly wrong and alarmist
The figure of 510,000 possible deaths from Covid-19 in the United Kingdom appears in one paragraph on pages 6 and 7 of the study, which reads as follows:
“In the (unlikely) absence of any control measures or spontaneous changes in individual behaviour, we would expect a peak in mortality (daily deaths) to occur after approximately 3 months (Figure 1A). In such scenarios, given an estimated R0 of 2.4, we predict 81% of GB and US populations would be infected over the course of the epidemic. Epidemic timings are approximate given the limitations of surveillance data in both countries: The epidemic is predicted to be broader in the US than in GB and to peak slightly later. This is due to the larger geographic scale of the US, resulting in more distinct localised epidemics across states (Figure 1B) than seen across GB. The higher peak in mortality in GB is due to the smaller size of the country and its older population compared with the US. In total, in an unmitigated epidemic, we would predict approximately 510,000 deaths in GB and 2.2 million in the US, not accounting for the potential negative effects of health systems being overwhelmed on mortality.”
The figures of 510,000 deaths in the United Kingdom and 2.2 million deaths in the United States are predictions of what would happen in “…..the (unlikely) absence of any control measures or spontaneous changes in individual behaviour…”
“Control measures” have of course been imposed in both the United Kingdom and the United States – in fact they were already substantially in place when the study was being written – so, as the study correctly predicted, the eventual number of deaths is going to be well below these figures. Critics of the study disregard this fact, being perhaps unaware of what the study actually says, and cite the figure of 510,000 deaths out of context.
In fact a more valid criticism of the Imperial College study is that it was overly optimistic. It assumed that illness with Covid-19 confers future immunity, at least in the same disease cycle – an assumption which some are now doubting – and it appears if anything to have underestimated the mortality rate from Covid-19.
For the record, I doubt that this study had anything like the influence on government policy, whether in Britain or in the United States, that is claimed for it. In Britain at least what caused government policy to change was, I am sure, not this study but a sense of gathering crisis on the front lines in Britain’s already desperately overstretched hospitals.
As for the salacious reporting by sections of the British media which has led recently to the resignation of Professor Neil Ferguson, one of the co-authors of the Imperial College study, from his membership of the British governments Scientific Advisory Group for Emergencies (SAGE), is of course completely irrelevant to an assessment of the study itself.
Whilst social distancing is the common denominator of the policies of all governments as they try to stem the spread of the pandemic, at least in Europe and North America, there continue to be important differences in the way governments conduct these policies.
Mitigation versus Suppression
The Imperial College study divides policy responses by governments between strategies of “mitigation” and of “suppression”.
In broad outline, a mitigation strategy accepts that the SARS-CoV-2 is here to stay, and is now a permanent presence in human society. It seeks however, by encouraging social distancing, to slow the spread of the Covid-19 pandemic so as not to overwhelm health systems with a sudden flood of Covid-19 cases (this is called “flattening the curve”). It prioritises protection for that part of society, essentially the unhealthy and the elderly, which is most at risk.
Ultimately, it aims to contain the danger from Covid-19 by building up resistance within the human population to the effects of the SARS-CoV-2 virus, by allowing and even discreetly encouraging widespread infection.
This way of building up resistance through widespread infection is often referred to as achieving “herd immunity”, though governments which practice the mitigation strategy tend to avoid public use of the term and sometimes deny that it is their objective.
Since the ultimate objective of mitigation strategies is to achieve herd immunity, whether this objective is admitted or not, social distancing tends to be encouraged rather than enforced, and is less rigorous, whilst mass testing for the presence of the SARS-CoV-2 virus does not happen, since it is deemed unnecessary.
The country in the West most identified with the mitigation strategy is Sweden, though it was also the strategy followed for a time by Britain.
A suppression strategy by contrast aims to extinguish the presence of the SARS-CoV-2 virus in human society, by enforcing rigorous social distancing through legally enforced lockdowns to stop its spread, and by mass testing to determine its presence and to identify and isolate its carriers.
The country most identified with the suppression strategy, and where so far it has been implemented most thoroughly and most successfully, is China, though most European governments, including eventually the British government, have adopted it also.
In the United States policy seems to have been less coherent, with a bewildering mix of these two policies being followed by different states, and with the federal government oscillating between the two.
Each of these strategies has its critics, with those who dispute or play down the danger from Covid-19 obviously preferring the mitigation strategy, whilst denouncing the suppression strategy in often fiery terms.
Problems of Mitigation
At this still early stage in the pandemic it is impossible to say with any certainty which strategy is better. What I would say, and what has been confirmed to me by reports I have heard coming from both Sweden and Britain, is that the mitigation strategy draws heavily on previously drawn up plans to deal with a worldwide flu pandemic similar to the 1918 Spanish flu. SARS-CoV-2 is however a coronavirus not a flu virus. It is far from clear that plans designed to respond to a flu pandemic are therefore of much relevance in dealing with the current pandemic.
This goes to the heart of the generally unannounced objective of the mitigation strategy, namely achieving herd immunity.
Whilst it seems that human populations build up resistance rapidly to flu virus, so that herd immunity can be achieved within a relatively short time (eg. within a single flu season), it is far from clear that the same is equally true for a coronavirus such as SARS-CoV-2. Evidence is slight and conflicting, and is the subject of differing interpretations, though the current predominant view seems to be that infection does create resistance, so that someone who has been ill with Covid-19 is unlikely to fall ill with Covid-19 a second time within a short time period. However resistance may only be short term.
“In the United States policy seems to have been less coherent, with a bewildering mix of these two policies being followed by different states, and with the federal government oscillating between the two.”
More critically, a mitigation strategy aiming for herd immunity achieved through the controlled spread of the SARS-CoV-2 virus looks like a strategy based on an assumption of the risk to life drawn from the death rate in a flu pandemic. Covid-19 has however turned out to be many orders of magnitude more dangerous than all but Spanish flu, without there being either a vaccine or treatments available which exist to treat and reduce the effect of even the most dangerous flu, such as Spanish flu.
This has resulted in critics of the mitigation strategy complaining that in the absence of a vaccine and effective treatments it takes unacceptable risks with human life, so that it is ultimately unethical.
Countries which have followed the mitigation strategy, whether continuously or for only a certain period, such as Sweden and Britain, have in fact registered many more deaths from Covid-19 than have their comparators, which have pursued suppression strategies. In the case of Sweden the most appropriate comparators are the other countries of Scandinavia, with which Sweden shares many similarities, and in the case of Britain they are the two other big countries of northwest Europe, Germany and France.
As of May 6 Sweden (population 10.23 million) has had three times the number of reported Covid-19 deaths (2,854) as the rest of Scandinavia (population 16.7 million) combined (964). The individual breakdowns are Denmark (population 5.8 million) 246, Norway (population 5.37 million) 215 and Finland (population 5.5 million) 246).
Britain (population 67.88 million), which followed a mitigation strategy until shifting to a suppression strategy in late March, has reported as of May 6 almost as many Covid-19 deaths (29,427) as Germany (population 83 million) and France (67 million) combined (32,524). In reality, since reported British figures for Covid-19 deaths are known to be incomplete and a severe underestimate, the total number of deaths in Britain from Covid-19 is much greater than the combined total of Germany and France.
Though the greater number of deaths in countries which have pursued mitigation strategies may be difficult to justify morally, a case might still be made for them if they do eventually result in these countries achieving herd immunity more quickly.
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However, beyond the questions of whether herd immunity is even achievable, or whether it lasts for a sufficiently long period of time to be desirable or sustainable, a further argument against the mitigation strategy is that it is based not only on a serious underestimate of the danger of Covid-19, but that it also seriously overestimates the general prevalence of the SARS-CoV-2 virus.
If the percentage of individuals infected with the SARS-CoV-2 virus is still in single figures, as it probably still is in both Sweden and Britain, then waiting until herd immunity is achieved would be tantamount to waiting indefinitely. The paradoxical effect of the social distancing measures would in that case be to delay achieving herd immunity even more, though the risk of a massive surge in Covid-19 deaths and of overwhelmed health systems makes it impossible to do away with them.
As it is in both Sweden and Britain the health systems are already under severe stress. Some reports are circulating that some Swedish hospitals are making contingency plans to refuse intensive care to patients with a ’biological age’ of 80 or over and to patients over 60 with underlying health conditions. In Britain there are reports of a health system racked with equipment shortages with staff frightened to provide treatment to Covid-19 patients because they feel insufficiently protected.
At that point the country pursuing the mitigation strategy becomes trapped in a prison it cannot escape, forced to maintain social distancing indefinitely until such time as a vaccine appears.
In practice no Western government would allow itself to become trapped in such a position. As the possible problems with the mitigation strategy became increasingly clear the British government abandoned it in late March, using the Imperial College study as its excuse for doing so, though by this point the SARS-CoV-2 virus had gained a substantial presence in the country, a fact which explains Britain’s high Covid-19 death rate.
In Sweden the reputations of too many important people are bound up with the country’s mitigation strategy for it to be openly abandoned. However, restrictions have been quietly tightened throughout April. The fact that Sweden is unable to ditch publicly its mitigation strategy is however no doubt the reason why some of the more optimistic claims about the prevalence of the SARS-CoV-2 virus and the imminence of herd immunity come from there.
Criticisms of Suppression
The alternative suppression strategy however also has its critics, with numerous complaints about its devastating effect on the economy, and of the psychological stress it causes to a population in lockdown, which allegedly does more harm to health than the SARS-CoV-2 virus.
The most passionate criticism of the suppression strategy however comes from those who say that it infringes civil liberties and human rights. This has led to some extremely bitter exchanges between supporters and opponents of the suppression strategy, including an especially fraught one over whether it would be acceptable during a lockdown to remove by force suspected virus carriers from their families and homes, something which happened during the lockdowns in Wuhan and elsewhere in Hubei province in China.
Human Rights and Lockdowns – An Attack on Civil Liberties?
Human rights are ultimately a form of legal rights, so any discussion of whether lockdowns infringe civil liberties and human rights ought logically, at least in my opinion, to proceed from human rights law. In Europe (which for this purpose includes Britain, Turkey and Russia) human rights law is enshrined in the European Convention on Human Rights (ECHR), which many European states have incorporated into their domestic law.
When looked at in this way, it is clear that the civil liberties and human rights which critics feel are being infringed by the lockdowns are those which are set out in ECHR Article 5 (freedom and security of the person) and in ECHR Article 8 (right to a private life). However ECHR Article 5(1)(e) specifically allows for detention “…..for the prevention of the spreading of infectious diseases….”, whilst ECHR Article 8(2) permits interference by the state in a person’s private life “…..for the protection of health….”.
A particular subset of the human rights arguments against the lockdowns is that whilst it may be appropriate to detain or quarantine ill people, it is oppressive to detain or quarantine healthy ones.
However ECHR Article 5(1)(e) does not require that the persons detained for the purpose of “[preventing] the spreading of infectious diseases” should be ill, but rather that their detention should be “lawful” through being necessary to “[prevent] the spreading of infectious diseases”.
“It is far from clear that plans designed to respond to a flu pandemic are therefore of much relevance in dealing with the current pandemic.”
The purpose of the lockdowns is to limit the spread of Covid-19. It is this purpose which makes them lawful within the terms of ECHR Article 5(1)(e). It would therefore make no sense to make exceptions of people who believe themselves to be healthy and well and to exclude them from the lockdowns when it is known that some of the carriers who are most likely to spread the SARS-CoV-2 virus may not be ill with Covid-19 and may actually be, healthy and well. Doing so would not only defeat the whole purpose of the lockdowns. Such exceptions might also render the lockdowns unlawful since they would in that case no longer be fulfilling the purpose set out in ECHR Article 5(1)(e).
The lockdowns do not therefore seem to me to infringe human rights in and of themselves. Arguments that they infringe civil liberties and human rights seem to be wrong.
It is important to say however that lockdowns must be introduced and applied lawfully, and that proportionality is always central to human rights law. ECHR Articles 5 and 8 would no doubt be infringed if proportionality were lost, for example if the lockdowns are persisted in after the disease has been suppressed, or are introduced or enforced in an arbitrary and inconsistent way without proper law or due process, or are being used for purposes other than “preventing the spreading of an infectious disease” and “protecting health”. However that does not seem to be the case at the moment.
On the specific issue of separating a virus carrier from his or her home or family, it seems to me that, subject always to the overriding principle of proportionality, ECHR Article 5(1)(e) expressly allows for it. To my knowledge involuntary removal from home and family happens regularly in the United Kingdom in cases of individuals who suffer from severe mental illness, and who are deemed to be dangerous either to themselves or to others.
In every such case there must however be a reference to the court to confirm the proportionality and lawfulness of the removal and in order to meet the requirements for a decision on such a matter by the court, as set out in ECHR Article 5(4) and in ECHR Article 6(1). If the court decides that the removal was unlawful because it was done inappropriately or disproportionately, compensation should be paid (ECHR Article 5(5)).
I am no expert in U.S. human rights law, but I doubt that in practice the principles followed in applying human rights law in the U.S. differ significantly from those in Europe.
In summary, though I do not doubt the sincerity of those who say that human rights and civil liberties are being infringed by the lockdowns, human rights law, at least in Europe, does not seem to to me to support their claims.
Risks of Abuse of Power
This subject cannot however simply be left there. Though critics of the lockdowns and of the suppression strategy are wrong to say that the lockdowns in and of themselves are oppressive and infringe civil liberties and human rights, they are certainly right that they can never be accepted as normal, and that the governments which are imposing them have a long history of bad faith, of abuse of power and of infringing civil liberties and human rights. It would be a foolish and potentially tragic mistake to give these governments unqualified trust as they exercise the powers the lockdowns give them.
That however seems to me an argument of the need for continued strong political engagement to hold governments accountable, not for doing away with lockdowns which during a time of pandemic are saving lives.
Issues of Economics and Well-Being During Lockdowns
The other commonly made criticisms of the suppression strategy can be quickly dealt with.
There is no evidence the lockdowns are causing more deaths than they prevent, or that they make the population, which is subject to the lockdown, less healthy than at a time of pandemic it otherwise would be.
The data from Italy shows a 9 percent fall in absolute numbers of deaths as compared with the average of the previous five years in Rome and Palermo (cities where the number of reported Covid-19 cases was small) during March, despite being in lockdown.
Apparently Germany, where strong preventative measures, including lockdowns and thorough testing, have succeeded in keeping the number of deaths from Covid-19 low (7,392 as of May 8), there is no increase in deaths that can be attributed to the lockdowns as opposed to Covid-19. According to the German news magazine ZEIT, from the end of March to the beginning of April 2020, only slightly more people died in Germany than on average over the previous four years, excepting 2018, which had relatively high numbers due to a wave of influenza.
By contrast, countries which have moved too quickly to ease lockdowns have seen rises in infections and deaths. Iran saw a doubling of the infection rate in the four days to May 7 to 1,680, the highest number since April 11, after its lockdown was eased.
The evidence seems clear: lockdowns do not cause deaths. Instead at a time of pandemic they save lives.
As for the economic arguments against the lockdowns, these in my opinion tend to lose sight of the fact that during a life threatening pandemic of the sort currently being experienced normal economic life is impossible, irrespective of whether there is a lockdown or not. There can obviously be no normal economic activity happening if thousands of people are falling ill and dying because of an epidemic disease every day.
Sweden, which has followed a mitigation strategy instead of a suppression strategy, looks set to experience an economic downturn this year every bit as severe as those of its Scandinavian neighbours, who opted for lockdowns.
Suppression and Lockdown: More than the West can Bear?
In my opinion a far more valid criticism of the suppression strategy than those which are commonly made against it is that it demands a mobilisation of resources and a level of endurance and self-discipline within society which is no longer achievable in Western countries.
Amidst all the attention given to lockdowns, it is consistently overlooked that a lockdown is only a part of a successful suppression strategy. Such a strategy, if it is to be effective, also requires, alongside a lockdown, massive and carefully planned and targeted testing in order to track down and isolate carriers so that it can be fully effective.
In Europe, only Germany and Russia have conducted testing in anything like that manner and on anything like that scale. In the United Kingdom, where the British government set itself a target of 100,000 tests by the end of April, testing continues to be a shameful debacle, and has fallen back far below this figure.
In the absence of a sufficient level of mass testing Western governments have proved unable to chart a clear and structured course out of the lockdowns.
“The evidence seems clear: lockdowns do not cause deaths. Instead at a time of pandemic they save lives.”
Whilst in theory the lockdowns could be kept going until all transmission of the SARS-CoV-2 virus fully and finally stopped, in practice the time needed to achieve that outcome is far longer than Western societies seem able to bear. The result is that governments in Europe and the United States, worried about the state of their economies and sensing the restiveness of a part of their populations, have rushed to ease the lockdowns at the first sign of a decline in total numbers of deaths and cases.
That in turn means that lockdowns are being eased across Europe and North America whilst the SARS-CoV-2 virus is still circulating, with no means (in the absence of adequate testing) to keep track of it and to identify and isolate its carriers. [On Sunday British Prime Minister Boris Johnson said anyone who could not work from home should return to work, effectively ending a six-week lockdown. The “Stay at Home” slogan has been replaced with “Stay Alert”.]
The risk is that this will lead to a further upward spike of deaths and cases, requiring renewed lockdowns, leading to a debilitating cycle of recurring easing and lockdown, which could ultimately do more damage to the fabric of Western society and to its morale than the thorough and consistent application of a suppression strategy would ever do.
Inevitable End of The Pandemic
Having said this, the pandemic will ultimately end, as all pandemics eventually do. Either the SARS-CoV-2 virus will lose its virulence, or the much touted herd immunity will be achieved, or an effective vaccine will be developed.
According to the WHO there are as many as seventy possible vaccines under trial, and though development of a successful vaccine is not guaranteed, and may take years, evolutionary changes in the SARS-CoV-2 vaccine, unlike in flu virus, have been relatively slight, which gives good grounds for hope that before long an effective vaccine will be developed.
Even if none of these hopes come true, it is a certainty that modern medicine and modern science, which is learning more about the SARS-CoV-2 virus every day, will before long come up with effective treatments for the Covid-19 disease which it causes. Already there are early signs that improvements in treatment of Covid-19 patients in hospitals are causing death rates in the richer countries to fall.
In the meantime, and for all its many undoubted flaws, the WHO continues to fulfil an essential role as a coordinating body and as an information exchange, ensuring that best practices and proper treatments, including vaccines and drugs treatments, are rapidly made known and distributed to health workers around the world.
Whilst the end of the pandemic is an eventual certainty, its end is being unnecessarily delayed by partisan infighting and by the confused response to it. The muddle about which approach to follow – the mitigation strategy or the suppression strategy – shows that this confusion exists at the political level more than at the scientific and medical one.
The onset of the pandemic has inevitably led to a rash of quotes and misquotes from Albert Camus’s famous 1947 novel The Plague. Strangely these have not included what I suspect was for Camus the single most important quote of all, attributed to the humble but heroic civil servant Joseph Grand: “There is a plague and we must fight it. I only wish everything were as simple”.
That is the clarity and singleness of purpose which dealing with a pandemic demands, and which is currently missing, but which I have no doubt will eventually be found.
Alexander Mercouris is a political commentator and editor of The Duran.
The views expressed are solely those of the author and may or may not reflect those of Consortium News.
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