Summarized Covid article from Peter Burrows elburropete@gmail.com 11/26/20
A Sensible and Compassionate Anti-COVID Strategy 10/9/20 By Jay Bhattacharya, Professor of Medicine at Stanford University. The following is from an article featured in the October 2020 edition of Imprimis, a publication of Hillsdale College. The article was adapted from an October 9, 2020, panel presentation in Omaha, Nebraska. It has been edited for brevity with key points emphasized by Peter Burrows.
My goal today is, first, to present the facts about how deadly COVID-19 actually is; second, to present the facts about who is at risk from COVID; third, to present some facts about how deadly the widespread lockdowns have been; and fourth, to recommend a shift in public policy.
1. The COVID-19 Fatality Rate - In discussing the deadliness of COVID, we need to distinguish COVID cases from COVID infections. In early March, the case fatality rate in the U.S. was roughly three percent—nearly three out of every hundred people who were identified as “cases” of COVID in early March died from it. Today, the fatality rate is less than one half of one percent. --when the World Health Organization said in early March that three percent of people who get COVID die from it, they were wrong --. The COVID fatality rate is much closer to 0.2 or 0.3 percent. The reason for the highly inaccurate early estimates is simple: in early March, we were not identifying most of the people who had been infected by COVID.
“Case fatality rate” is computed by dividing the number of deaths by the number of confirmed cases. To obtain an accurate COVID fatality rate, the number in the denominator should be the number of people who have been infected, the number of people who have actually had the disease—rather than the number of confirmed cases. In March, only the small fraction of those who got sick and went to the hospital were identified as cases. But the majority who are infected have very mild symptoms or no symptoms at all. These people weren’t identified in the early days, which resulted in a highly misleading fatality rate (that continues to drive) public policy ---because the perception of too many people about COVID is frozen in the misleading data from March.
So how do we get an accurate fatality rate? To use a technical term, we test for seroprevalence: how many people have evidence in their bloodstream of having had COVID. -- Someone who is infected with COVID and then clears it will be immune from it, but it won’t still be living in them. What we need to test for, then, are antibodies or other evidence that someone has had COVID. And even antibodies fade over time, so testing for them still results in an underestimate of total infections.
Seroprevalence is what I worked on in the early days of the epidemic. In April, I ran a series of studies to see how many people in California’s Santa Clara County, where I live, had been infected. At the time, there were about 1,000 COVID cases that had been identified in the county, but our antibody tests found that 50,000 people had been infected—i.e., there were 50 times more infections than identified cases. This was enormously important, because it meant that the fatality rate was not three percent, but closer to 0.2 percent; not three in 100, but two in 1,000. ---there are now 82 similar seroprevalence studies from around the world, and the median result of these 82 studies is a fatality rate of about 0.2 percent—exactly what we found.
In some places the fatality rate was higher: in New York City it was more like 0.5 percent. In other places it was lower: the rate in Idaho was 0.13 percent. What this variation shows is that the fatality rate is not simply a function of how deadly a virus is. It is also a function of who gets infected and of the quality of the health care system. ---But the bottom line is that the COVID fatality rate is in the neighborhood of 0.2 percent.
2. Who Is at Risk? The single most important fact about the COVID pandemic—in terms of deciding how to respond to it on both an individual and a governmental basis—is that it is not equally dangerous for everybody. This became clear very early on, but our public health messaging failed to get this fact out to the public. There is a thousand-fold difference between the mortality rate in older people, 70 and up, and the mortality rate in children-- the fact is that for young children, this disease is less dangerous than the seasonal flu. This year, in the United States, more children have died from the seasonal flu than from COVID by a factor of two or three.
Whereas COVID is not deadly for children, for older people it is much more deadly than the seasonal flu. If you look at studies worldwide, the COVID fatality rate for people 70 and up is about four percent—four in 100 among those 70 and older, as opposed to two in 1,000 in the overall population --- this huge difference between the danger of COVID to the young and the danger of COVID to the old is the most important fact about the virus. Yet it has not been sufficiently emphasized in public health messaging or taken into account by most policymakers.
3. Deadliness of the Lockdowns --- lockdowns have never before been tried as a method of disease control. The initial rationale for lockdowns was that slowing the spread of the disease would prevent hospitals from being overwhelmed. It became clear before long that this was not a worry: hospitals were never at risk of being overwhelmed. Yet the lockdowns were kept in place, and this is turning out to have deadly effects.
4. Where to Go from Here - Last week I met with two other epidemiologists—Dr. Sunetra Gupta of Oxford University and Dr. Martin Kulldorff of Harvard University—in Great Barrington, Massachusetts. The three of us come from very different disciplinary backgrounds and from very different parts of the political spectrum. Yet we arrived at the same view: the widespread lockdown policy has been a devastating public health mistake. In response, we wrote and issued the Great Barrington Declaration, which can be viewed—along with explanatory videos, answers to FAQs a list of co-signers, etc.—online at www.gbdeclaration.org. The Declaration reads:
As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies --- Current lockdown policies are producing devastating effects on short and long-term public health --e.g., lower childhood vaccination rates, fewer cancer screenings, and deteriorating mental health—leading to greater excess mortality in years to come ---
Keeping students out of school is a grave injustice. Our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza.
As immunity builds in the population, the risk of infection to all—including the vulnerable—falls. We know that all populations will eventually reach herd immunity—i.e., the point at which the rate of new infections is stable—and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.
The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.
Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19, e.g., nursing homes should use staff with acquired immunity and perform frequent testing of staff and visitors. ---Retired people living at home should have groceries and other essentials delivered -- When possible, they should meet family members outside rather than inside---
Those who are not vulnerable should immediately be allowed to resume life as normal (and follow) simple hygiene measures, such as hand washing and staying home when sick. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sports, and other cultural activities should resume.
---My final point is about science. When scientists have spoken up against the lockdown policy, there has been enormous pushback: “You’re endangering lives.” --- science can’t do its job (when) anyone who challenges the status quo gets shut down or cancelled. To date, the Great Barrington Declaration has been signed by over 43,000 medical and public health scientists and medical practitioners.It does not represent a “fringe” view within the scientific community.