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Why the scaremongering about COVID?
This week we were told that, in the UK at least, anyone who had a positive COVID test who then died – of anything – would be recorded as dying of COVID. No matter when they die.
Which means that someone could have been tested positive in March, with no symptoms of COVID at all, who then died in July. They would be recorded, in the official figures, as dying of COVID. Even if the were hit by a bus.
Even more weird is the fact that there does not seem to be any time limit to this. So, you could test positive in March 2020, then die in March 2040, and still be recorded as dying of COVID. I doubt this will happen, but it could.
To be honest I have known something very strange has been going on with the UK data for some time. In that, the UK has not provided any figures on how many people have recovered from COVID. In almost all countries, figures are provided on the total number of cased, the total number of deaths, the number of active cases and the number who have recovered.
In the US for example, there have been just over three and a half million cases, a hundred and forty thousand deaths and one point seven million people have officially recovered. In the UK, there have been nearly three hundred thousand cases, forty-five thousand deaths – and no recorded recoveries.
In short, in the UK, you cannot ever recover from COVID. Once you’ve got it, that’s it, you’ve got it. This anomaly has been reported on before. Here for instance, from the Guardian in June.
‘Britain is an outlier internationally in not reporting the number of people who have recovered from Covid-19 alongside statistics on deaths and numbers of identified cases.’ 1
However, it is not just the UK that is hyping up COVID deaths. A reader of my blog sent me an analysis of the WHO advice on death certification, which seems accurate. In his analysis:
If you die of anything and they suspect you might have it, with no tests and perhaps just because everyone else is assumed to have it, then COVID-19 goes on the death certificate as primary cause of death. Broadly speaking… unless the patient dies of something that is sudden and cannot be a long-term comorbidity.
If you have the same symptoms as flu or pneumonia you must be put down as COVID19 and not due to an influenza type illness.
Any certificates that are in any way erroneous with regard to the above must be recoded to conform.
Any COVID-19 codes that are wrong should not be fixed in any circumstances
To me looks like a recipe for systematic over inflation of death counts, designed to disallow or circumvent clinical judgement 2.
In the US Dr Scott Jensen, who is a physician, and a member of the Minnesota senate, has been notified by the board of medical practice in Minnesota that he is being investigated for public statements he has made.
Essentially, he is being accused of spreading misinformation about the completion of death certificates, and the overestimation of deaths from COVID-19. Also, that he has been comparing COVID-19 to influenza, in terms of how serious it is. This is considered ‘reckless advice’.
For pointing out the over-reporting of COVID-19 deaths and daring to claim that COVID-19 is no worse than a bad flu season, he could be struck off the medical register. You can see Dr Jensen discussing this YouTube 3.
For example, a few days ago, a new story hit the headlines in the UK, warning of hundreds of thousands of deaths this winter.
‘The UK could see about 120,000 new coronavirus deaths in a second wave of infections this winter, scientists say.
Asked to model a “reasonable” worst-case scenario, they suggest a range between 24,500 and 251,000 of virus-related deaths in hospitals alone, peaking in January and February.’ 4
Where did this come from? It was a model, using exactly the same assumptions as that created by Prof Neil Ferguson from Imperial College London in March. The one that warned of five hundred thousand deaths in the UK. Only out by a factor of ten. Probably far more, because many of the deaths recorded as due to COVID have been, simply, wrong.
How certain was their prediction of 120,000 deaths? Professor Stephen Holgate, who chaired the report then said. ‘vpn被封翻墙党该何去何从？App Store连接不上如何解决？(图 ...:2021-1-29 · 据悉，220.127.116.11是谷歌免费公用DNS。网友认为进行这一修改，可以解决一些服务商的DNS解析问题。此前，也有消息称，修改后，可加速应用下载。 2021年12月初，国家互联网信息办公室主任鲁炜在赴美国考察时，曾与苹果CEO蒂姆·库克会面。.’ A possibility… Perhaps it should be published in the Journal of possibility-based medicine. A journal where you simply make up facts, then see how many people run around in sheer terror.
What is now happening is extremely disturbing. COVID has certainly been a serious disease, but the flu epidemics of 1957 and 1967 were just as bad, if not worse, with regard to total fatalities. They were both over a million, and COVID has a long way to go to match that 5
In addition, in those epidemics far more younger people died. With COVID, if you are under fifteen, the chance of dying of COVID is around one in two million, which is three times less than the chance of being struck by lightning 6.
Across Europe, the excess in deaths has simply disappeared 7. There is no increased mortality anywhere to be seen. Whilst we are told about outbreaks of COVID deaths in various cities, the rate of new infection in these ‘outbreaks’ is less than one in a thousand. Which is not really an outbreak at all.
Despite this, mask wearing is to be mandatory. When COVID-19 took off, no-one was wearing a mask in my unit, unless they were helping a patient, and there was no social distancing between staff. Now the trust has decreed masks must be worn at all time, and social distancing is being ruthlessly enforced. A bell now rings, and we must wipe of all surfaces in front of us…
The reality is that COVID-19 has all but gone in the UK and Europe. The slow, but inexorable rise in deaths in the UK is being driven by the fact that anyone who has ever had a positive COVID-19 test, who dies, is recorded as dying of COVID.
Yet, as COVID-19 disappears, mask wearing and social distancing is being enforced as never before, and the prospect of a deadly second wave is being waved like a black shroud, with warnings of hundreds of thousands of deaths to come.
A biomedical scientist in the UK sent me an e-mail two days ago, about the testing they had done.
‘In the week 9th – 16th July we carried out 2800 PCR tests (across three different platforms: mainly on the Hologic Panther, but some on the Cepheid GeneXpert and Biomerieux BioFire) and had only 4 positives. These 4 positives were all patients who had previously tested positive. We had NO new cases, and after checking back a few weeks, the only positives we have had have been from repeat swabs from these same 4 patients – they were almost acting like QC samples to ensure that our tests were actually working properly!’
Two thousand eight hundred tests and none positive. This scientist contacted other laboratories, and they were seeing the same things. ‘I have contacted a couple of nearby NHS Pathology Labs and they reported the same findings as us: zero or near zero new cases for several weeks.’
Having published the guest article by ‘Bob’ there have been a lot of comments. I have not replied, as it was not my article. However, Bob has put together a kind of generic reply to people’s posts which I think may be useful and informative.
Hello Everybody – I wrote the article and have read your comments. First, I want to thank Dr. Kendrick for publishing my thoughts in his esteemed blog. I started following Dr. Kendrick’s blog around 2015 and am a devoted reader. My favorite single post is the one titled “Salt Is Good for You.”
I was introduced to the wonderful world of Vitamin D in 2010 when a physician directed me to the Vitamin D Council website, now defunct. John Cannell’s articles on influenza, and on autism, were compelling for me. I started taking 5000 IU per day in December 2010 (at age 60) and I noticed that I no longer got colds or influenza in the winter. Before 2010 I would get one or two colds every winter, with the usual sore-throat – head cold – chest congestion sequence. Since then I have had exactly 5 colds, all very mild. I now take a higher dose but I think people should look at the advice provided in the Grassrootshealth article and make up their own minds as to appropriate dose.
My article sketches out a theory that yields a series of hypotheses which can be tested. Thus, one notes a general pattern, and scratches one’s head over exceptions. Hence my discussion of Ecuador and South America.
I propose that an underlying difference in susceptibility to coronavirus arises from the fact that the New World was epidemiologically isolated from the rest of the world until about 500 years ago. Before then the indigenous populations of the New World and the Old World were exposed to and therefore developed adaptive mechanisms to ward off different groups of pathogens.
Several of you have pointed out that death rates from various countries are inconsistent with the sunshine theory. First, do not confuse cases with deaths. Case totals are the creatures of testing programs, which vary from place to place. Deaths are a much harder statistic.
That said, country-specific factors come into play. In comments, Andrew Larwood and Simon C pointed out Finland’s vitamin D supplementation program would reduce deaths. Their death rate per million is 59, which seems very low for a country in the winter at such a high latitude. Now I know why. Another factor may be fatty fish, a dietary source of Vitamin D, which is consumed in quantity in Scandinavia老王下载Håkan, your comment about Sweden is relevant.
Many people attribute the higher rate of Covid19 deaths to the lack of a lockdown. However, an equally good case can be made that the dark-skinned immigrant population in Sweden is more deficient in vitamin D and thus more susceptible to the illness. See this article by Dr. David Grimes where he notes that 1 percent of the Swedish population may be responsible for 40 percent of deaths: http://www.drdavidgrimes.com/2020/04/vitamin-d-and-immunity-important.html and this one: http://www.bmj.com/content/368/bmj.m1101/rr-10 If you have read Dr. Kendrick’s last blog post, “Distorting science in the COVID pandemic,” you would know that the very low death rate (7 per million) in Morocco may be due to their use of hydroxychloroquine to treat sick patients.
Does implementation of hydroxychloroquine treatment explain the abrupt decline of coronavirus deaths in the UAE on May 12? 打工信部和公安部旗号卖VPN 这家公司胆子有点大_新闻频道 ...:2021-7-8 · 打着工信部和公安部的旗号卖VPN，这家公司胆子有点大.6月30日， “著名记者冯诗林”还在新媒体平台“北京时间”上发布过一篇题为《VPN应用7月1日 ... If you look at the death rate graphs for a number of Muslim countries, there is a distinct uptick in cases at the end of May. Does this have something to do with Ramadan, which was April 23 to May 23 this year?
I was sent this piece on Vitamin D and COVID by a reader of this blog. I thought it was very good and asked them if they minded me posting it. They said fine, but they wish to remain anonymous. Not everyone likes the glare of publicity – with all the attending Trolling and insults that inevitably follow [you should read my in-box sometime].
Season, Latitude, and COVID-19 Severity
Here is a coronavirus puzzle for you to ponder. For context, let’s look at how many people have died of COVID-19 in the USA (as of mid-June). Websites give different totals, but it’s around 120,000, or about 360 per million of population. So how many died in Australia? 102. How many died in New Zealand? 22. In both countries, the death rate is 4 per million. That is an extraordinary contrast!
Wouldn’t public health officials like to know the cause of this difference? Are the Antipodeans that much better at hand-washing and social distancing than the people of New York, Italy or Great Britain? Do they share a highly-effective cure kept secret from the rest of the world? Or is there another reason for the disparity?
Unlike the USA and other countries where the disease has taken a huge toll, the coronavirus arrived in Australia and New Zealand in mid-summer. Most of the inhabitants of these two countries are descendants of pale-skinned British settlers (and convicts in the case of Australia). Yet at the same time the death rate in Great Britain, the homeland of their ancestors, is over 600 per million.
Actually, the division between countries with high death rates and low death rates is about the 37th parallel north. According to Wikipedia, the 37th parallel is the dividing line between greater than average and less than average sun exposure.
So it appears that people living south of the equator, and south of the 37th parallel north, experienced, in general, higher levels of sun exposure and lower death rates from the coronavirus than those in the northern hemisphere north of the of the 37th parallel.
This explains the very low death rates observed in Africa. Many experts have forecast that the coronavirus would take a heavy toll in Africa because of poor healthcare infrastructure in much of the continent. Yet this has not happened. For example, death rates in Ghana, Nigeria, Kenya, Ivory Coast, Togo, South Sudan, Niger and Burkina Faso are between 2 and 3 per million.
Virtually all of the continent is south of the 37th parallel north and sub-Saharan Africa is close to the Equator. It could be argued that the low death rate is an artifact of poor record keeping, but reasonably good data about another virus, Ebola, reached world attention, so high death rates from coronavirus would likely be evident.
The same is true in the Far East. Indonesia, Malaysia, Singapore and Sri Lanka are near the equator and have coronavirus death rates per million of 8, 4, 4, and 0.5. But this pattern breaks down when one looks at that most equatorial of nations, Ecuador.
Here the reported coronavirus death rate is about 223 per million. Other major countries of the South American continent, Brazil, Peru, Chile and Bolivia, have per million death rates of 208, 208, 176, and 54, which is quite a contrast to those seen in Africa and Southeast Asia. The disparity may arise from a greater susceptibility to the coronavirus among people with indigenous ancestry.
Support for this idea comes from the death rates in Argentina and Uruguay, which are 19 and 7, per million, respectively. Unlike the rest of South America, the populations of these two countries are very largely of European ancestry, mostly Spanish and Italian. Remember that while it was summer in Argentina and Uruguay, at the same time it was winter in Spain and Italy, where COVID-19 death tolls per million were 580 and 571, respectively.
Vitamin D3 is created in the skin by the ultraviolet light in sunlight. Before the advent of dietary supplements, sunlight was the only significant source of Vitamin D3. Fatty fish is a natural dietary source. Vitamin D3 is transformed inside the body to calcidiol, 25(OH)D3, which is not a vitamin, but a hormone.
However, the body also has an innate immune system that responds to the wide range of pathogens to which it is exposed every day. Recently it has been demonstrated that the innate immune system is the body’s principal defense against another viral disease – influenza. The annual wintertime outbreaks of influenza are triggered by declining levels of serum vitamin D in the host population. That is why influenza doesn’t occur in the summer and is very uncommon in the tropics.
For in-depth discussion of innate immunity, Vitamin D3 and influenza, read the paper in Virology Journal titled “On the Epidemiology of Influenza” by John Cannell, et. al., and his earlier paper “Epidemic Influenza and Vitamin D” published in the journal Epidemiology and Infection. Open access full text of both articles can be found on the internet on PubMed.
However, the COVID-19 coronavirus is not influenza, so the role of innate immunity and Vitamin D in the incidence and virulence of this disease must be established. Given the very recent emergence of COVID-19, it is understandable that not very much research on the role of Vitamin D has been published.
However, one key paper has come out, which has been summarized in the website Grassroothealth.net/blog/first-data-published-covid-19-severity-vitamin-d-levels/. The data are observational and the population of patients was 212, but the results are statistically significant. People with adequate levels of serum Vitamin D in their blood experienced mild bouts of COVID-19, while those with inadequate levels suffered ordinary, severe or critical cases. The chart in the article illustrates these data.
The results of this study are exactly consistent with the idea that sun exposure is inversely correlated with the virulence of COVID-19. When serum levels of Vitamin D are high, the disease is mild. When they are low, the disease is severe. Which then leads one to ask what are the specific effects of Vitamin D that reduce the severity of COVID-19 infection?
There are at least two. Severe cases can be complicated by what is called a “cytokine storm.” This is a severe over-reaction of the immune system that can be fatal. Vitamin D is known to prevent this condition (see the above-referenced articles by John Cannell). A second effect is related to the recent discovery that COVID-19 attacks blood vessels, in particular, the endothelium, which is the internal lining of vessels, causing widespread clotting1.
Research published in 2015 showed that Vitamin D3, in the form that is created in the skin by UV light or taken as a dietary supplement, has a direct, protective effect on the endothelium 2 Because Vitamin D3 lasts in the body only a day or so before it is processed into calcidiol, one needs a daily dose of sunshine or supplement to maintain the protective effect on blood vessels. It should be underscored that sunscreen blocks UV rays from reaching the skin and therefore diminishes the formation of Vitamin D. The skin pigment melanin is a natural sun screen and has a similar effect.
What does this mean for people who want to protect themselves from the malign effects of COVID-19? Vitamin D3 is not some untested off-label prescription drug or sketchy supplement: it is an essential hormone naturally produced in the human body by sunlight on the skin.
With enough sun, one’s body makes all that is necessary to counteract the virus. But modern lifestyles can make it impossible for many people to get sufficient daily sun exposure in the summer, and during Minnesota winters it is physically impossible because the sun is too low in the sky, not to mention that it is too cold to take off your clothes.
Therefore, one needs a program of supplementation with Vitamin D3, which is readily available over the counter. The question, of course, is how much. Grassrootshealth has devoted considerable study to finding the answer, a good discussion of which can be found here 3 The coronavirus statistics I used are from the site Worldometers 4
A few years ago, I wrote a book called Doctoring Data. This was an attempt to help people understand the background to the tidal wave of medical information that crashes over us each and every day. Information that is often completely contradictory ‘Coffee is good for you… no, wait it’s bad for you… no, wait, it’s good for you again,’ rpt. ad nauseam.
I also pointed out some of the tricks, games and manipulations that are used to make medications seem far more effective than they truly are, or vice-versa. This, I have to say, can be a very dispiriting world to enter. When I give talks on this subject, I often start with a few quotes.
For example, here is Dr Marcia Angell, who edited the New England Journal of Medicine for over twenty years, writing in 2009:
Have things got better? No, I believe that they have got worse – if that were, indeed, possible. I was sent the following e-mail recently, about a closed door, no recording discussion, under no-disclosure Chatham House rules, in May of this year:
“A secretly recorded meeting between the editors-in-chief of The Lancet and the New England Journal of Medicine reveal both men bemoaning the ‘criminal’ influence big pharma has on scientific research.
“According to Philippe Douste-Blazy, France’s former Health Minister and 2017 candidate for WHO Director, the leaked 2020 Chatham House closed-door discussion between the [editor-in-chiefs] – whose publications both retracted papers favorable to big pharma over fraudulent data.
“Now we are not going to be able to, basically, if this continues, publish any more clinical research data because the pharmaceutical companies are so financially powerful today, and are able to use such methodologies, as to have us accept papers which are apparently methodologically perfect, but which, in reality, manage to conclude what they want them to conclude,” said Lancet [editor-in-chief] Richard Horton.”
A YouTube video where this issue is discussed can be found here. It is in French, but there are English subtitles.
The New England Journal of Medicine, and the Lancet are the two most influential, most highly resourced journals in the world. If they no longer have the ability to detect what is essentially fraudulent research, then… Then what? Then what indeed?
In fact, things have generally taken a sharp turn for the worse since the COVID pandemic struck. New studies, new data, new information is arriving at breakneck speed, often with little or no effective review. What can you believe, who can you believe? Almost nothing would be the safest course of action.
One issue that has played out over the last few months, has stripped away any remaining vestiges of my trust in medical research. It concerns the anti-malarial drug hydroxychloroquine. You may well be aware that Donald Trump endorsed it – which presents a whole series of problems for many people.
However, before the pandemic hit, I was recommending to my local NHS trust that we should look to stock up on hydroxychloroquine. There had been a great deal of research over the years, strongly suggesting it could inhibit the entry of viruses into cells, and that it also interfered with viral replication once inside the cell.
This mechanism of action explains why it can help stop the malaria parasite from gaining entry into red blood cells. The science is complex, but many researchers felt there was good reason for thinking hydroxychloroquine may have some real, if not earth-shattering benefits, in COVID-19.
This idea was further reinforced by the knowledge that it has some effects on reducing the “cytokine storm” that is considered deadly with COVID. It is prescribed in rheumatoid arthritis to reduce the immune attack on joints.
The other reason for recommending hydroxychloroquine is that it is extremely safe. It is, for example, the most widely prescribed drug in India. Billions upon billions of doses have been prescribed. It is available over the counter in most countries. So I felt pretty comfortable in recommending that it could be tried. At worst, no harm would be done.
Then hydroxychloroquine became the centre of a worldwide storm. On one side, wearing the white hats, were the researchers who had used it early on, where it seemed to show some significant benefits. For example, Professor Didier Raoult in France:
“Jaouad Zemmouri, a Moroccan scientist, believes that 78% of Europe’s COVID-19 deaths could have been prevented if Europe had used hydroxychloroquine… “Morocco, with a population of 36 million, [roughly one-tenth that of the U.S.] has only 10,079 confirmed cases of Covid-19 and only 214 deaths.
“Professor Zemmourit believes that Morocco’s use of hydroxychloroquine has resulted in an 82.5% recovery rate from COVID-19 and only a 2.1% fatality rate – in those admitted to hospital.”
Just prior to this, a study was published in the Lancet, on May 22nd stating that hydroxychloroquine actually increased deaths. It then turned out that the data used could not be verified and was most likely made up. The authors had major conflicts of interest with pharmaceutical companies making anti-viral drugs. In early June, the entire article was retracted by Richard Horton, the Editor.
Then a UK study came out suggesting that hydroxychloroquine did not work at all. Discussing the results, Professor Martin Landray stated:
“This is not a treatment for COVID-19. It doesn’t work,” Martin Landray, an Oxford University professor who is co-leading the RECOVERY trial, told reporters. “This result should change medical practice worldwide. We can now stop using a drug that is useless.”
This study has since been heavily criticised by other researchers who state that the dose of hydroxychloroquine used was, potentially, toxic. It was also given far too late to have any positive effect. Many of the patients were already on ventilators.
Then, yesterday, I was sent a pre-proof copy of an article about to be published in the International Journal of Infectious Diseases which has found that hydroxychloroquine…
..“significantly” decreased the death rate of patients involved in the analysis. The study analyzed 2,541 patients hospitalized among the system’s six hospitals between March 10 and May 2 and found
13% of those treated with hydroxychloroquine died while
26% of those who did not receive the drug died.(ref)
When things get this messed up, I tend to look for the potential conflicts of interest. By which I mean, who stands to make money from slamming the use of hydroxychloroquine (which is a generic drug that has been around since 1934 and costs about £7 for a bottle of 60 tablets)?
In this case it is those companies who make the hugely expensive antiviral drugs such as Gilead Sciences’ Remdesvir – which costs $2,340 (£1877) for a typical 老王v p n安卓版 in the US. Second, the companies that are striving to get a vaccine to market. There are billions and billions of dollars at stake here.
In this world, cheap drugs e.g., hydroxychloroquine, don’t stand much chance. Neither do cheap vitamins, such as vitamin C and vitamin D. Do they have benefits for COVID-19 sufferers? I am sure that they do. Will such benefits be dismissed in studies that have been carefully manipulated to ensure that they do not work? Of course. Remember these words:
‘…pharmaceutical companies are so financially powerful today, and are able to use such methodologies, as to have us accept papers which are apparently methodologically perfect, but which, in reality, manage to conclude what they want them to conclude,” said Lancet [editor-in-chief] Richard Horton.’
Unless and until governments and medical bodies act decisively to permanently sever the financial ties between researchers and Big Pharma, these distortions and manipulation in the pursuit of Big Profit will continue.
Just please don’t hold your breath in anticipation.
It has been almost impossible to make any sense of the figures on COVID -19 deaths from around the world. They do say that the first casualty of war is truth. However, the enemy, in this case, does not much care what anyone says, so there is no point in lying to it.
All it wants to do is move from one host to another and propagate itself. Why does it wish to do this? We don’t really know, it just does. COVID -19 doesn’t do interviews, but we can guess that its mission is to completely dominate the world.
However, if you do try to compare lock down vs. no lock down, the COVID mortality figures appear incomprehensible. Belgium, for example, entered lockdown on the 18th of March, whilst Belarus did not lock down at all. Belgium has a population of 11.5 million, while Belarus has 9.5 million.
Belgium, as of the 22nd of June, had suffered 9,696 COVID related deaths.
Belarus, as of the 22nd of June, had suffered 346 COVID related deaths.
The death rate in Belgium, per million of population, is 847.
The death rate in Belarus, per million of population, is 36.
Which means that the death rate in Belgium is over twenty-three times as high as in Belarus. Yes, two European countries sitting at approximately the same latitude, both starting with the letter ‘B’, and they have a vastly different rate of death. What can we make of such statistics? The simple answer would be to say that I don’t believe the figures from Belarus.
Alternatively, you could say that you don’t believe the figures from Belgium either, because they have the highest death rate from COVID, per million, in the entire world. Why? Who knows? However, I would caution against dismissing figures that you don’t like, or don’t feel make sense.
In fact, the death rate in Japan is very nearly the same rate as the rate in New Zealand, which has had only twenty-two deaths, and has been lauded for its aggressive lockdown policy and low rate of deaths. The NZ death rate is 4.9 per million.
First, to provide some context. The most accurate figures to use, in studying the COVID epidemic, are excess deaths. That is deaths from all causes, over and above the average from the last few years. If, say, 10,000 people normally die in the first week in April, a figure of 15,000 deaths, in the same week this year, would represent 5,000 “excess” deaths.
If an elderly person goes downhill rapidly and dies in a care home, and they did not have a test, did they die of COVID, yes or no? Probably, possibly? Doctors in the UK have been advised to write yes, while in other countries they are more likely to write no. On the other hand, there are tales of doctors in the US being coached to write COVID on almost all death certificates, because the hospital is 老王app官方下载 if they do so.
Which means that relying purely on the statistics for COVID recorded deaths may be highly misleading. However, you can absolutely rely on the diagnosis of death. It is a tricky clinical condition to miss.
So, if you want the outcome that is the most reliable indicator that something truly significant is going on, you need to look at excess mortality rates. If they stay the same, you can be reassured nothing serious is happening. This is true however much the diagnosis of a single condition rises.
To provide this data, as close to real-time as possible, EuroMOMO (European mortality monitoring activity) was established. Currently, it monitors changes in overall mortality in 24 different European countries. England, Wales, Scotland and Northern Ireland are treated as separate countries. This becomes important.
EuroMOMO showed absolutely no change in mortality across all 25 countries until week eleven, the second week in March. It then rose rapidly, topping-out in week fourteen. By the end of May, everything had fallen back to normal. Which means the COVID mortality spike lasted ten weeks, from start to finish. Overall mortality rates are now lower than normal
It is fascinating that some countries showed a sharp rise in mortality, and some showed nothing. For example, Austria, Denmark, Finland and Germany – nothing. France, Belgium, Spain, the Netherlands, England – major spikes. Thirteen countries spiked, twelve did not.
Then, and here we get to the really weird part, is the data that was tucked away in a sub-section. A massive rise in mortality that was seen in only one country out of the twenty-five, and nowhere else. And a spike in the age group 15 to 44… one of age groups least vulnerable to COVID -19… and in England alone. Not in Scotland, Northern Ireland or Wales. It lasted five weeks and then disappeared.
Frustratingly, the figures on causes of death are not available – some types of death can take a long time to be recorded e.g. deaths from accidents, or suicides. So, were all the excess deaths from COVID, it seems unlikely as the total number of recorded deaths in this age group has been less than five hundred since the start of the epidemic and that is not going to create such a spike.
Might lockdown have, in some way, have caused it? Might the loneliness of it have caused a rise in suicides? Or a surge in drug overdoses? Or other reckless behaviour?
COVID – will lockdown lead to a major health disaster
[ This article was published in 老王vpm2.2.8下载安卓版 I feel I should mention that I have taken some criticism for writing articles for Russia Today, I have remained silent on the matter up to now.
However, I would like to point out that I tried to contact the BBC with regard to many of the issues I have been highlighting e.g. the COVID care home disaster in the UK – no interest. I tried to contact UK newspapers – no interest. And I have a good relationship with a lot of journalists.
As Toby Young made clear, they shadow banned an interview with Peter Hitchens entitled ‘Lockdown is a catastrophe.’ They also removed an interview with Nobel laureate Michael Levitt called ‘the case against lockdown.’
When I criticised the modelling of Imperial College, a huge number of replies came flooding in. They attacked me, but were highly supportive of the modelling, and the Government actions. These posts were from people who have never posted before, or since. Hired guns? I watched an interview where a representative of Facebook explained that they were shutting down any posts on Vitamin C and COVID-19. Calling it fake news. As if they had any idea of the science behind it.
Currently, if people wish to point an accusatory finger at news outlets for manipulating and censoring the news, the facts, the information flow, they need to turn their attention a little closer to home. The mainstream media seem to have become what they should never, ever, be. Cheerleaders for their Governments.
And no, no-one has paid a single rouble to write this little rant. I have never written anything that I do not believe to be true. More fool me, probably. So, I would like to say thank you to Russia Today for being willing to publish my, completely unedited, thoughts. ]
COVID – will lockdown lead to a major health disaster
I fear we may be heading for a post-lockdown health catastrophe that could mirror the disaster of the post-Soviet era.
The self-inflicted damage we’ve done to our economies in the name of combating COVID-19 may end up killing far more people than the virus itself. The economic collapse that followed the communist bloc’s break-up caused millions of deaths.
There has never been a situation to compare with what we have been living through these past weeks and months. Never in the history of the world have entire countries been locked down. Never have entire countries inflicted such enormous damage to their own economies and distorted their health systems away from all other activities, to deal with a virus.
Perhaps they were unaware that we do this all the time. It is why NICE – the UK’s National Institute for Health and Care Excellence – was established in 2000. It is what all healthcare systems are forced to do. No country can afford to throw unlimited resources at healthcare. We all must decide what we can, and cannot, afford to do. Tough decisions to make, but essential.
Perhaps I came at the lockdown from a different viewpoint from most other people. When the pandemic took off, I was analysing the impact of economic and social upheaval on mortality. I was looking specifically at the breakup of the Soviet Union, as I knew that there had been a massive health impact from the rapid and uncontrolled “transformation” from a socialist to a market-based system.
An exhaustive study by three Austrian academics of the fallout from the dissolution of the communist bloc demonstrates the economic devastation it wrought:
“The immediate economic consequences of transformation were significant falls in gross national product. For example, between 1990 and 1993, real 武雪梅：苹果下架VPN是法治的胜利 - huanqiu.com:2 天前 · 日前，苹果公司CEO蒂姆·库克回应苹果应用商店中国区将VPN下架一事说，我们在遵守当地法律的情况下在当地开展生意。一些网民将此事与去年苹果就是否协助执法人员“解锁”加州南部圣贝纳迪诺恐怖袭击案枪手之一所持的手机，与美国联邦机构对簿公堂、甚至要向总统陈情的事件对比展开热议。Ukraine -10 per cent, Russia -10.1 per cent and Tajikistan -12.2 per cent. The first ten years of transformation was a period of great social disruption and chaos. The introduction of a market system of exchange led to a severe decline in gross domestic product, contraction of the labour market, and unemployment leading tosocial malaise including a rising death and suicide rate.”
What was the true impact on health? My main research interest is in cardiovascular medicine, and I was focussed on deaths from coronary heart disease (CHD). In lay terms, this means deaths from heart attacks. I had just put together the graph below, using Lithuania 老王vpm2.2.8下载安卓版.
As you can see, there was a dramatic increase in CHD deaths in 1989, the year that the Berlin wall fell. Lithuanians commenced their singing revolution, and there were mass demonstrations for independence, along with significant social upheaval.
The Soviet tanks rolled in, stayed for a bit, then rolled back out again, without doing much. Meanwhile, the Lithuanian GDP fell through the floor, and the rate of CHD virtually doubled over the next three years. A great mountain of increased mortality which makes anything from COVID look like a speed bump.
Of course, there were things over and above economic woes going on in Lithuania. However, I know that economic worries, by themselves, can be deadly. Perhaps the single deadliest thing of all. For instance, a study in South Africa found that people with significant 老王v2.2.8下载 were thirteen times more likely to have a heart attack:
“People who reported significant financial stress were13 times more likely to have a heart attack than those who had minimal or no stress. Among those who experienced moderate work-related stress levels, the chances of having a heart attack were 5.6 times higher.”
Lithuania was not the only ex-Soviet country to see a massive increase in death. Not just from CHD, but in all-cause mortality. Here is a section of a report on the break-up:
“The transition to market economies in many post-communist societies of the former Soviet Union and other former eastern bloc countries in Europe has produced a ‘demographic collapse,’ Among the most serious findings is a four-year drop in life expectancy among Russian men since 1980, from 62 years to 58.
“There were also significant drops in life expectancy in Armenia, Belarus, Bulgaria, Latvia, Lithuania, and Romania. The immediate cause of the rising mortality is the ‘rise in self-destructive behaviour, especially among men.’ Old problems such as alcoholism have increased; drug misuse, a relatively new problem in the former communist bloc, has risen dramatically in recent years.” The report, Transition 1999, stated that suicide rates climbed steeply too, by 60% in Russia, 80% in Lithuania, and 95% in Latvia since 1989.
Behind the self-destructive behaviour, the authors say, were economic factors, including rising poverty rates, unemployment, financial insecurity, and corruption. Whereas only 4% of the population in the region had incomes equivalent to $4 (£2.50) a day or less in 1988, that figure had climbed to 32% by 1994.
“What we are arguing,” said Omar Noman, an economist for the development fund and one of the report’s contributors, “is that the transition to market economies [in the region] is the biggest … killer we have seen in the 20th century, if you take out famines and wars. The sudden shock and what it did to the system … has effectively meant that five million [Russian men’s] lives have been lost in the 1990s.”
Five million lives lost in Russia… alone. As I write this, we have reached a worldwide figure of slightly under four hundred thousand deaths from COVID, in total. COVID now seems to be on the way out, and we may never reach half a million deaths in total. The economic impact, however, is only just beginning.
Moving back to CHD again, what were the Russian figures for CHD deaths following transition? As with Lithuania, they are quite fascinating, and highly disturbing.
You may ask why there was a two-year time lag between CHD deaths between Lithuania and Russia. I think the answer is that when the Berlin wall came down in 1989, it triggered an immediate crisis in Lithuania. On the other hand, the rest of the Soviet Union limped on for a couple of years. In 1991 there was an attempted coup, which failed. However, this did signal the end, and the Soviet Union then rapidly broke up.
In late 1991, Russia became a separate country, under the leadership of Boris Yeltsin, and it quickly moved to a market-based economy. Some people became eye-wateringly rich – far more became extremely poor. This, the delayed break up, is almost certainly why the Russian death rate lags Lithuania by two years.
There is another important difference. Russia did not just have one CHD peak, but two. After rising, then rapidly falling, it changed direction and climbed back up again. Why the double peak?
I think this can be explained by the fact that, in August 1998, there was a massive banking collapse. It virtually wiped out the stock market and destroyed the value of the rouble. At the same time, unemployment skyrocketed and the savings of the common man were further obliterated. The recovery took years, as this report makes clear:
“The enormity of Russia’s financial collapse on Aug. 17, 1998 only really hit home with me the next day. “We are so f-cked,” George Kogan, one of Moscow’s most famous and longest serving equity salesmen, explained to me standing in the apartment of Simon Dunlop, one of Moscow’s most famous entrepreneurs. “The whole system has just crashed. It will take years for Russia to recover.” 5
Having seen the health impact of economic crashes, I hope you can now see why I was deeply concerned about lockdown. It was clear to me that this could mean massive financial hardship, and I feared that the deaths that followed could be catastrophic.
When our pandemic “experts” were putting together their models on death rate, did they take any of this into consideration? They did not. But what is the point of any model that does not even bother to consider the potential negative impact of what they are recommending?
As a doctor, if I were advising any form of medical treatment, I would be considered negligent if all I did was talk about the benefits. I need to inform the patient about potential downsides. The procedure may not work; you may get worse – and suchlike.
We were persuaded into lockdown with the promise that hundreds of thousands of lives could be saved in the UK – and millions worldwide. We were never warned about the many millions of lives that could – and, I fear, will – be lost as a consequence of lockdown. I consider that to be negligent. Especially as, in this case, the patient in question was the entire population of the Earth.
2 June 2020
You will have your head bashed in with everything written about, claimed about, and talked rubbish about COVID-19. What to believe, what not to believe? Is this some weird virus that kills people in a way never seen before? Why are children developing a strange widespread inflammatory condition that looks like Kawasaki’s disease? And suchlike.
What I am going to tell you here are my thoughts on what I have learned about COVID, incorporating a great deal of previous knowledge from clever people. This is not the Gospel according to Dr Kendrick, but I am going to present what I believe to be a coherent hypothesis about how COVID kills people. Everyone can feel free to attack it from all sides. [This is going to get quite technical at times].
The hypothesis here is that, the way the COVID kills people is, primarily, by damaging the endothelial cells that line all blood vessels, and also the lung endothelium facing the atmosphere.
This endothelial damage then triggers a widespread ‘inflammatory’ response that triggers the development of blood clots – not just in the lungs – but also everywhere else in the body. The endothelial damage is, in effect, the body attacking itself, through an immune response – the so-called ‘cytokine storm’. Some of the resulting clots that result are small, some big. This overall process is known as Disseminated Intravascular Coagulation (DIC).
DIC, by blocking and damaging a high percentage of small blood vessels in the lungs, hampers gas exchange, driving down oxygen levels, and can lead to death through oxygen desaturation.
Other organs can also become seriously damaged, because DIC can block up blood vessels anywhere in the body. Larger blood clots can cause strokes, heart attacks, kidney failure and suchlike. Clots forming in veins, in the legs, can break off and travel into the lungs where they create pulmonary embolism. Venous Thromboembolism (VTE) is a common cause of death.
Essentially, people die as a result of blood clots.
Diabetes and COVID
The probable reason why diabetes has been found to be an important risk factor for dying from COVID is that, in diabetes, hyperglycaemia (excessively high blood sugar level) specifically damages the glycocalyx (a protective glycoprotein layer covering all endothelial cells). This exposes the endothelial cells to greater damage and will lead to a greater and more widespread level of DIC1.
An additional problem with diabetes is that the glycocalyx layer is primarily where nitric oxide (NO) is synthesized. Nitric oxide is a potent anticoagulant factor and helps to protect endothelium from damage by Reactive Oxide Species (ROS) a.k.a. super-oxides.
COVID-19 does nothing unique – it just does more of it
The idea of a virus causing and inflammatory response, followed by DIC is not new. Influenza A has also been shown to do this. As highlighted in the article 手机上这么好用的功能 你用过吗？ - huanqiu.com:2021-9-30 · 十几年前，还是功能机的时代，相信很多人都会觉得用手机拍照、听歌以及上网都是很新奇的事情。然而，现在的手机拥有了越来越多新奇有趣的 ...
‘Influenza A virus (IAV) infects the respiratory tract in humans and causes significant morbidity and mortality worldwide each year. Aggressive inflammation, known as a cytokine storm, is thought to cause most of the damage in the lungs during IAV infection. Dysfunctional coagulation is a common complication in pathogenic influenza, manifested by lung endothelial activation, vascular leak, disseminated intravascular coagulation and pulmonary microembolism. Importantly, emerging evidence shows that an uncontrolled coagulation system, including both the cellular (endothelial cells and platelets) and protein (coagulation factors, anticoagulants and fibrinolysis proteases) components, contributes to the pathogenesis of influenza by augmenting viral replication and immune pathogenesis.’ 2
As you can see, this is much the same sequence of events as happens with COVID infection. The additional, major problem with COVID is that, because it enters cells through the ACE2 receptor, it specifically disables/damages this receptor.
This, in turn, blocks a key pathway pathway to NO synthesis. Instead of NO being synthesized, a ‘super-oxide’ is created, which causes more endothelial damage. In this way COVID has a dual damaging effect. There is less NO being made, with additional ‘super-oxide’ production. This effect was also seen with SARS 3.
Kawasaki’s and COVID
It seems that in the midst of COVID far more children are developing Kawasaki’s than has been seen before – although it remains very rare. This has led to the question, can COVID cause Kawasaki’s. I think this is almost certainly the case, because these conditions have very similar clinical manifestations.
Although the agent, or agents, that can cause Kawasaki’s have never been identified, Kawasaki’s disease is essentially a widespread vasculitis (damage/inflammation in blood vessels). It seems that an infective agent may alter endothelial cells in such a way that the body feels they are ‘alien’ and then decides to attack. A delayed immune response.
This delayed reaction is probably why the infective agent(s) causing Kawasaki’s have never been found. The agent causes the problem, then is gone, then the antibodies become active two or three weeks later.
In support of this concept, in Kawasaki’s Anti-Endothelial Cell Antibodies (AECA) can be detected 5. These almost certainly coordinate the immune attack on the endothelium, causing the secondary cytokine storm, and the other forms of organ damage that have also been seen in COVID.
In essence, the parallels between COVID and Kawasaki’s are very close, and both can be related directly to endothelial damage. So, I think it can probably be said that COVID does cause Kawasaki’s.
COVID as a form of viral sepsis?
Another way to look at this is as COVID as a form of viral sepsis. Sepsis is due to a bacterial infection, not viral infection. In sepsis, bacteria get into the bloodstream and multiply.
As they multiply, they secrete (waste product) ‘exotoxins’. These exotoxins strip off the glycocalyx and seriously damage the underlying endothelial cells. This, in turn leads to widespread clotting (DIC). As with COVID you end up with organ failure and death. There can also be loss of fingers, toes, entire limbs, due to the blockage of smaller blood vessels.
‘Deviations from normal endothelial barrier function can lead to or be caused by various internal or external stresses and pathologic conditions. Sepsis and septic shock, as recently redefined, are associated with pulmonary edema caused by increased permeability to proteins across pulmonary endothelial and epithelial barriers, and recovery from septic shock is associated with a reduction in edema, consistent with restoration of vascular function.’6
The treatment regime
Looked at in this way, the treatment regime for COVID (support treatment) should consists of three prongs
‘In April, blood clots emerged as one of the many mysterious symptoms attributed to COVID-19, a disease that had initially been thought to largely affect the lungs in the form of pneumonia. Quickly after came reports of young people dying due to coronavirus-related strokes. Next it was COVID toes — painful red or purple digits.
What do all of these symptoms have in common? An impairment in blood circulation. Add in the fact that 40% of deaths from COVID-19 are related to cardiovascular complications, and the disease starts to look like a vascular infection instead of a purely respiratory one.’ 7
In fact, COVID is both a respiratory and cardiovascular disease. However, I believe that its many manifestations, and the way that it kills people can be explained by the unifying observation that it damages endothelial cells.
Can Vitamin C be beneficial?
There have been many studies demonstrating the vitamin C can help to support nitric oxide synthesis and reduce super-oxide damage. As described below:
‘Circulating levels of vitamin C (ascorbate) are low in patients with sepsis. Parenteral administration of ascorbate raises plasma and tissue concentrations of the vitamin and may decrease morbidity. In animal models of sepsis, intravenous ascorbate injection increases survival and protects several microvascular functions, namely, capillary blood flow, microvascular permeability barrier, and arteriolar responsiveness to vasoconstrictors and vasodilators. The effects of parenteral ascorbate on microvascular function are both rapid and persistent. Ascorbate quickly accumulates in microvascular endothelial cells, scavenges reactive oxygen species, and acts through tetrahydrobiopterin to 工信部回应“整顿翻墙软件”：合法经营不受影响 ...- 新京报网:2021-7-25 · 新京报网以文字、图片、视频等全媒体形式，为用户提供全天候热点新闻，涵盖突发新闻、时事、财经、娱乐、体育，以及评论、杂志和博客等，新 ...A major reason for the long duration of the improvement in microvascular function is that cells retain high levels of ascorbate, which alter redox-sensitive signalling pathways to diminish septic induction of NADPH oxidase and inducible nitric oxide synthase. These observations are consistent with the hypothesis that microvascular function in sepsis may be improved by parenteral administration of ascorbate as an adjuvant therapy.’8
I am aware there have been many attacks on the use of Vitamin C in COVID with various experts stating that it does not protect against becoming infected with COVID, nor does it boost the immune system. However, that is completely beside the point, we are looking at endothelial damage here.
If it is true that COVID attacks and damages the endothelium – and the evidence seems strong that it does – we must protect it. Nitric oxide can do this, as can Vitamin C. Even if it does no good, vitamin C certainly does no harm. I would strongly support its use in COVID, even if the mainstream view is to dismiss it as nonsense.
COVID is a virus that, because it forces entry to cells through the ACE2 receptors, which are found in high concentration in both lung and circulatory endothelium, causes specific damage to these cells. Due to the addition, specific action of knocking out ACE2 receptors, NO synthesis is greatly reduced, and ROS/super/oxide compounds are formed. This greatly amplifies the endothelial damage.
This damage, and the resultant ‘cytokine storm’, leads on to DIC. This in turn causes deaths through organ failure and/or large blood clot formation which can block blood supply to the lungs, the heart, the brain, the kidneys etc.
Supportive treatment requires the use of agents that can increase NO/reduce ROS, slow or stop the cytokine storm, and anti-coagulants. Oxygen is required when there is significant lung damage.
[This article was first published on RT.com, and can be seen there at http://www.rt.com/op-ed/490006-death-certificates-COVID-19-do-not-trust/]
As a doctor working in the midst of the COVID chaos, I’ve seen people die and be listed as a victim of coronavirus without ever being tested for it. But unless we have accurate data, we won’t know which has killed more: the disease or the lockdown
I suppose most people would be somewhat surprised to know that the cause of death, as written on death certificates, is often little more than an educated guess. Most people die when they are old, often over eighty. A post-mortem is very rarely carried out.
Which means that, as a doctor, you have a think about the patient’s symptoms in the last two weeks of life or so. You go back over the notes to look for existing medical conditions. Previous stroke, diabetes, chronic obstructive pulmonary disease, angina, dementia and suchlike. Then you talk to the relatives and carers and try to find out what they saw. Did they struggle for breath, were they gradually going downhill, not eating or drinking?
If I saw them in the last two weeks of life, what do I think was the most likely cause of death? There are, of course, other factors. Did they fall, did they break a leg and have an operation – in which case a post-mortem would more likely be carried out to find out if the operation was a cause.
However, out in the community, death certification is certainly not an exact science. Never was, never will be. It’s true that things are somewhat more accurate in hospitals, where there are more tests and scans, and suchlike.
Then, along comes COVID-19, and many of the rules – such as they were – went straight out of the window. At one point, it was even suggested that relatives could fill in death certificates, if no-one else was available. Though I am not sure this ever happened,
What were we now supposed to do? If an elderly person died in a care home, or at home, did they die of COVID? Well, frankly, who knows? Especially if they didn’t have a test for COVID – which for several weeks was not even allowed. Only patients entering hospital were deemed worthy of a test. No-one else.
What advice was given? It varied throughout the country, and from coroner to coroner – and from day to day. Was every person in a care home now to be diagnosed as dying of COVID? Well, that was certainly the advice given in several parts of the UK.
Where I work, things were left more open. I discussed things with colleagues and there was very little consensus. I put COVID on a couple of certificates, and not on a couple of others. Based on how the person seemed to die.
It matters greatly for two main reasons. First, if we vastly overestimate deaths from COVID, we will greatly underestimate the harm caused by the lockdown. This issue was looked at in a recent article published in the BMJ, The British Medical Journal. It stated: vpn被封翻墙党该何去何从？App Store连接不上如何解决？(图 ...:2021-1-29 · 前几天，据《环球时报》英文网报道中国已经开始屏蔽外国VPN服务，此消息也引起了国内“翻墙党”的一片震动。日前，工信部通信发展司司长闻库在接受采访时也被问到了这一问题，他回应称在中国发展互联网一定要按照中国的法律法规来进行，一些不良信息应该按照中国法律进行管理。
“At a briefing hosted by the Science Media Centre on 12 May he explained that, over the past five weeks, care homes and other community settings had had to deal with a “staggering burden” of 30 000 more deaths than would normally be expected, as patients were moved out of hospitals that were anticipating high demand for beds.
“Of those 30 000, only 10 000 have had COVID-19 specified on the death certificate. While Spiegelhalter acknowledged that some of these ‘excess deaths’ might be the result of underdiagnosis, ‘the huge number of unexplained extra deaths in homes and care homes is extraordinary. When we look back . . . this rise in non-COVID extra deaths outside the hospital is something I hope will be given really severe attention.’
He added that many of these deaths would be among people ‘who may well have lived longer if they had managed to get to hospital.’”
What Speigelhalter is saying here is that people may well be dying ‘because of’ COVID, or rather, because of the lockdown. Because they are not going to hospital to be treated for conditions other than COVID. We know that A&E attendances have fallen by over fifty per-cent since lockdown. Admissions with chest pain have dropped by over fifty per-cent. Did these people just die at home?
From my own perspective, I have certainly found it extremely difficult to get elderly patients admitted to hospital. I recently managed with one old chap who was found to have sepsis, not COVID. Had he died in the Care Home; he would almost certainly have been diagnosed as “dying of COVID”.
The bottom line here is that, if we do not diagnose deaths accurately, we will never know how many died “of” COVID, or ‘because of’ the COVID lockdown. Those supporting lockdown, and advising Governments, can point to how deadly COVID was, and say we were right to do what we did. When it may have been that lockdown itself was just as deadly. Directing care away from everything else, to deal with a single condition. Keeping sick, ill, vulnerable people away from hospitals.
The other reason why having accurate statistics is vitally important is in planning for the future. We have to accurately know what happened this time, in order to plan for the next pandemic, which seems almost inevitable as the world grows more crowded. What are the benefits of lockdown, what are the harms? What should we do next time a deadly virus strikes?
If COVID killed 30,000, and lockdown killed the other 30,000, then the lockdown was a complete and utter waste of time. and should never happen again. The great fear is that this would be a message this Government does not want to hear – so they will do everything possible not to hear it.
It will be decreed that all the excess deaths we have seen this year were due to COVID. That escape route will be made far easier if no-one has any real idea who actually died of COVID, and who did not. Yes, the data on COVID deaths really matters.
The Mad Modellers of Lockdown
It appears we went into lockdown based on the modelling of one man – and his team. Neil Ferguson from Imperial College London. His workings predicted that, if nothing were done to prevent the spread of COVID, half a million people would die in the UK.
His prediction shaped the response of many countries around the world, definitely in the UK and the US. So, where did this half a million-figure come from? On a related note, the two million figure for the US is something which makes no sense at all.
This is because the US has five times the population of the UK. Thus, everything else being equal, in the US number should be two point five million. Even I can multiply 500,000 by five.
Getting back to Ferguson, and his model. So far, he has refused to release the data underpinning his model. Which, considering the impact it has had, is completely unacceptable. I think I would have given him a Chinese burn, at the very least, to get him to show me how he worked things out.
In truth, it is not exactly difficult to establish where this number came from. You can simply work backwards. There are sixty-six million six hundred thousand people living in the UK. If five hundred thousand die, that represents an infection fatality rate (IFR) of 0.75%. In other words, for every thousand people getting infected with COVID, seven and a half will die – on average.
Of course, there is an assumption built into the model that not everyone will get infected. Which is reasonable. There has been no pandemic in the history of the world where a bug managed to infect everyone – although it might be interesting to know why some people do not get infected, ever, when everyone around them is… This, I find, is the sort of question that never gets much looked at. Oh well.
Anyway, the Ferguson model predicts that eighty per cent of people could end up infected with COVID (which seems extraordinarily high and is simply a guess). That eighty per cent would happen if we all mingle and go to the pub, football matches, and suchlike. This increases the infection fatality rate (IFR) to 0.937% (0.75 ÷ 0.8). An IFR of 0.937% means that for every thousand people who get infected, nine and a half will die – on average.
The Ferguson team came up with an IFR of 0.9% (range 0.4 – 1.4), but I have no idea why it is not 0.937%. They talked about ‘mitigation’, but that didn’t seem to mean anything – it was just a fudge factor. Maybe they thought giving such a precise figure would look ridiculous when there are so many unknown variables flying about. True, but then again, I think the figures of 80% and 0.9 are simply wild guesses and look equally ridiculous.
The entire model can be seen in the original Ferguson model 1. By the way, I think I should mention that this paper was published on the 16th of March. Bear that date in mind.
So, that’s the model. Not very difficult really. Even though it is presented as some hugely complex mathematical monster, requiring the use of several super-computers running day and night to deal with the vast swathes of equations and data. Not so. You just need to do this:
66,600,000 x 0.009 x 0.8 = 500,000 (actually 479,520)
vpn被封翻墙党该何去何从？App Store连接不上如何解决？(图 ...:2021-1-29 · 前几天，据《环球时报》英文网报道中国已经开始屏蔽外国VPN服务，此消息也引起了国内“翻墙党”的一片震动。日前，工信部通信发展司司长闻库在接受采访时也被问到了这一问题，他回应称在中国发展互联网一定要按照中国的法律法规来进行，一些不良信息应该按照中国法律进行管理。 Michel de Montaigne
You may wonder what the difference is between Case Fatality Rate (CFR), which is often mentioned, and the Infection Fatality Rate (IFR) – which is rarely mentioned. At the moment the case fatality rate (CFR) in the UK is well over 10%. This is clearly much higher than any predicted IFR.
The reason for this massive difference is because, if you only test people who are very ill, who have arrived in hospital (the bad cases of COVID), you are only testing those who are most ill, and most likely to die. Which gives you this very high CFR.
During any epidemic the CFR will always be high at the start, then start to fall, as more and more people with milder and milder symptoms are tested. Or, you later find out how many were actually infected.
However, unless you test everyone in the community, even those with no symptoms, the CFR will always be larger than the IFR. I hope this is clear.
This is a long-winded way of saying that no-one had much of a clue what the COVID-19 IFR may be. In the UK this is still the case, because no-one has a clue as to how many people have actually been infected.
All is not lost though, you can try to make a best guess, and you can do this by looking at the population, or country, where the greatest percentage of the population has been tested. At present that country is Iceland, total population 366,130.
With regard to the CFR in Iceland, as of the 10th of May, fifty-four thousand tests had been done. There were 1,800 positive cases, and the total number of deaths was ten, with no deaths for the previous three weeks. This represents a case fatality rate of 0.55%.2
This figure is the absolute maximum CFR, because it has not changed since the 19th of April, and there were another twelve thousand tests during that time, with only twenty-two more positive cases.
What does this tell us about the IFR? Well, we know that IFR will always be lower than the CFR. However, even if we assume that the CFR and IFR in Iceland are the same (which is next to impossible) the maximum death rate, in the UK, based on those figures, would be
66,600,000 x 0.0055 x 0.8 = 293,600
As an aside in Iceland they randomly tested 848 children and found that the number infected was 0.00%. Some of those children must have been exposed to the virus, so viral exposure clearly does not even, always, lead to asymptomatic disease…
The 0.8 figure (80% of the population getting infected) still seems extraordinarily high to me, but I am willing to let it go. Even though it looks that the total number of people who may become infected is almost certainly far, far, less than 80%.
Leaving that issue aside, what is the next step in analysing the figures. It is to add in the fact that, at least, fifty per cent of people who become infected with Covid-19 are asymptomatic. So, using Iceland, the IFR can only be a half of the CFR. Which gives us this figure for the UK
66,600,000 x 0.0055 x 0.8 x 0.5 = 146,800
Anyway, as of today, that figure is a pretty reasonable estimate of the absolute maximum deaths we could have seen, in the UK, had we done nothing. One quarter of the Ferguson number.
Has the Ferguson number changed? Well, it has certainly wobbled about all over the place. On the 5th of April, Neil Ferguson made this prediction
‘LONDON (Reuters) – UK deaths from the coronavirus could rise to between about 7,000 and 20,000 under measures taken to slow the spread of the virus, Neil Ferguson, a professor at Imperial College in London who has helped shape the government’s response, said on Sunday.’ 4
As I write this, we have had just over 34,000 deaths under lockdown. So, not quite seven to twenty thousand. Undaunted, on the 28th of April Professor Ferguson changed his mind again, and then gave this warning:
‘100,000 could die of coronavirus this year if a gradual lockdown lift is implemented to just shield the elderly, warns epidemiologist Prof Neil Ferguson – as new analysis warns 60,000 are predicted to die by start of August.’3
“Five hundred thousand” changes to “seven to twenty thousand”, then becomes a “hundred thousand” or maybe “sixty thousand”. One two, miss a few, ninety-nine a hundred.
Yes, of course, we all know that Professor Ferguson was recently found to have been, repeatedly, visited by a young married lady. Thus, flouting the very lockdown rules that he had done so much to create. The words delicious, and irony, spring to mind. That, however enjoyable it may be as a Shakespearean tale, of a man laid low by hubris, is not the main point.
The main point is why the bloody hell, how the bloody hell, did this man – and his group – come to hold so much sway. His figures underpinning the original model could not be verified, because he would not release the source data. Even if the figures had been available for scrutiny they kept swinging wildly about the place and have already been proven to be blindingly inaccurate.
‘Paul the Octopus (26 January 2008 – 26 October 2010) was a common octopus used to predict the results of association football matches. Accurate predictions in the 2010 World Cup brought him worldwide attention as an animal oracle.’5
Instead, our Government just kept repeating the mantra. ‘工信部回应“禁用VPN”：清理对象是无资质者_央广网:2021-7-25 · 工信部回应“禁用VPN”：清理对象是无资质者 在国务院新闻办今日举行的发布会上，有记者问及“有地方出台规定，对违法违规利用VPN上网加强管理”一事，工信部信息通信发展司司长闻库表示，不了 …’ As if Science required a definite article. Here is ‘the science’, let me show it to you. Crikey, and here’s me, I thought science was a bunch of ideas, conjectures and hypotheses used to try and explain the physical world around us. Constantly under debate, always changing. Never certain.
But no, it turns out it is an actual thing. ‘The science’. Boris keeps it in number ten Downing Street, and they share a cup of tea in the afternoon, along with a few jammy dodgers. Luckily ‘The Science’ is immune to COVID, so social distancing is not required. The Science also, probably, moves in mysterious ways.
“The science moves in a mysterious way
Its wonders to perform
It plants its footsteps in the sea
And rides upon the storm”
To be a little more serious, what is the science that is leading them. Mathematical models? Models that change and swirl and have little basis in reality. Models used to create predictions. As a friend has remarked to me many times: “there are two types of prediction – lucky and lousy”.
Our lives, our economy, our health service, all those people no longer getting treatment for other conditions, the heart attack patients not turning up at hospital, the cancelled cancer treatments, thousands of small businesses sacrificed at the altar of a mathematical model created by the mad modellers of the lockdown. Our lives, in their hands.
I am doing my last Food Bank Show on Sunday 17th May, (tomorrow). Unless, the lockdown tightens up again – so who knows for sure.
I am hoping to talk about what I have learned about COVID. A tricky task as information floods in from all sides. What may work to protect people, what definitely doesn’t. Why the official responses are so slow. Anosmia (for example) is a very clear sign of infection with COVID, and is such an unusual sign that it can virtually be used to diagnose the disease. Yet, in the UK, the authorities are still refusing to add it to their ‘official’ signs and symptoms of COVID infection. They are so slow, and so conservative, that the entire pandemic may well be finished, and written about in history books, before they dare move from their laboriously constructed models. Ventilate very ill people. It turns out that ventilation may have made many people far worse. What drugs work? Let’s go back to the very same, very useless, antivirals and promote their use. Even if the trials have been equivocal at best, and completely useless, or damaging at worst. What about vitamins. The medical profession dismisses and decries vitamins as the work of the devil. The very idea that vitamin D and vitamin C may be beneficial…. This is utter nonsense. What about zinc, or magnesium… Again, dismissed.
They say of army generals that when a new war starts, they always fall back on the tactics of the last war fought. In a pandemic the experts fall back on the things they learned in the past. Our ‘experts’ are, essentially, a significant barrier to getting anything done. Especially looking at anything new, or different, that might work.
Experts getting in the way of new ideas was something noted many years ago by Professor David Sackett (one of the main founders of Evidence Based Medicine). As he wrote in 2000 in the BMJ in the article.
‘The sins of expertness and a proposal for redemption.’ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118019/
‘But there are still far more experts around than is healthy for the advancement of science. Because their voluntary retirement does not seem to be any more frequent in 2000 than it was in 1980, I repeat my proposal that the retirement of experts be made compulsory at the point of their academic promotion and tenure.’
I have nothing against knowledge and expertise, but the COVID pandemic has highlighted a significant issue. Namely that experts, are experts from the past, and about the past. When confronted with something new, they drag us back into what they know. A cavalry charge in a world armed with machine-guns. An outflanking manoeuvre when the enemy has spotter planes and bombers. Social isolation when we have no real idea how this virus spreads. Anyway, I hope it will be interesting.
Here is the link to the show
How to make a crisis far, far, worse
11th May 2020
I was asked by Russia Today to write an op-ed on what had been happening to me in my work over the last couple of months. It has appeared on their website 工信部回应“禁用VPN”：清理对象是无资质者_央广网:2021-7-25 · 工信部回应“禁用VPN”：清理对象是无资质者 在国务院新闻办今日举行的发布会上，有记者问及“有地方出台规定，对违法违规利用VPN上网加强管理”一事，工信部信息通信发展司司长闻库表示，不了 … This is what I wrote:
‘A slow and botched response’: how my eight weeks on the COVID-19 frontline taught me how the NHS made this crisis worse.
As with most people, COVID-19 seemed a long way away to me in January. I was working as a GP in out of hours cover, and in Intermediate Care. This means rehabilitating elderly people following accidents or illness, who need support and medical attention before going home.
All was calm at the start of the year. Yes, China was going into lock down, a few people had become trapped on cruise liners, posting interminable on-line videos. Would COVID come here, to the UK? The NHS was untroubled, slumbering.
I went skiing in France, in the Grand Massif, in the first week in March, when COVID still seemed a distant thing, unlikely to change my work, or my life. I suppose it was like sitting on a mountain, being told that a bank of snow was forming that might eventually form an avalanche and head my way. But when I looked out of the window, the sun was shining, the sky was blue. Nothing to see.
Then the cases in the UK started to rise. Suddenly, this was getting serious. What exactly was this disease? Was it like the flu, was it something else? As the avalanche began to rumble, hospital managers began charging about at high speed, bumping into each other and bellowing instructions – often directly contradictory. We had bronze meetings, then silver and gold meetings. The clipboards were all out.
Almost instantly things had gone from placid to panic, panic, panic. On the TV news, we could see hospitals were getting overwhelmed in Italy. The elderly were lying, dying, in corridors. Ventilators, we need ventilators. We need more capacity in the hospitals, we need beds. Like a slumbering beast, the NHS had awoken. More than a bit late.
Money started to get thrown around – as if money could suddenly make more beds in the hospital, or more staff, or create new nursing homes – or open those that had been shut. The bullying began. Of course, it wasn’t called bullying, but hospitals needed to be cleared out and nothing and no-one was going to get in the way. Edicts were handed down, orders barked.
In our little world, we were commanded to discharge our hospital patients as quickly as possible, to send them back to their families or their care homes. The two nursing homes where I look after patients, started to fill up with new patients from hospital, often COVID positive. Staff had no PPE; barrier nursing was impossible. Early warning signs. I made my concerns about this clear.
Essentially, there was a single objective for the NHS: Get the hospitals clear of patients. We absolutely had to have capacity. Social workers were told to find beds for patients in the community, no objections were allowed. Then lockdown happened, staff were going off sick all over the place, because someone in their household had symptoms of COVID.
However, if a member of staff developed symptoms – everyone else had to stay at work. Because… a virus at home was obviously completely different to a virus at work. At this time there was no swabbing, no testing, so no-one knew who was infected, and who was not.
All of a sudden, in early April, the elderly patients I was looking after started to die. One day, there were no cases, then, 24-hours later, we had many. The deaths were strange, quick. One nurse watched four patients develop exactly the same symptoms. A fall, then strange absences (short-term loss of consciousness), then their breathing rate going up and their oxygen levels falling. The patients were remarkably calm, not distressed. Then they died. Two before ambulances could even get to them.
More staff started to get symptoms, patients were getting symptoms, still no-one could get a test. The only people being tested were those, very ill, arriving at hospital. Why? What did it matter if they Covid, or not? They were ill, they needed the correct treatment for their symptoms.
All this time, our care home beds were being filled up with COVID positive patients (many having been discharged or turned away from hospitals), and patients who had not been tested, but could be infected. Here we were, with the elderly vulnerable, in our care. The absolutely most at-risk population. Piling them in. Every time I coughed, I wondered, have I got it? I started popping an oxygen monitor onto my finger on a regular basis. Was it dropping? What’s my temperature? What’s my pulse rate… luckily, nothing changed.
In out of hours care at the hospital, things had become very strange. Across the corridor, A&E staff were twiddling their thumbs. The number of patients arriving to see a doctor had fallen through the floor. Pods were created to see those patients who did arrive. Pod being a fancy name for a Portakabin with a non-closing door. What was our PPE? A surgical mask, non-fitted, gloves that split, and an almost immediately disintegrating plastic pinny.
But yes, this was all that was required, according to Public Health England. Until better PPE arrived, then suddenly that was what we required instead. Then it ran out, and we didn’t need better PPE anymore. Back to the disintegrating pinnies.
In the nursing homes and Intermediate Care, my objections to filling up beds with COVID positive patients was beginning to have some effect. Rather too late. Our rehab unit has beds for thirty patients; ten were COVID positive. Eight died, and seven staff were tested positive. On the positive side, moves were being made to clear the unit, to turn it green, free from COVID.
Then came the problem of death certification. What should I write? COVID, or not COVID? Who knew, because still no-one was being tested in nursing homes. Not patients, not staff. Pure guesswork. By this point, even the national news was recognising that Care Homes were the new front line of COVID. Further edicts rained down, four or five new protocols a day.
I believe it a terrible indictment of our system that it become obsessed by a target. One that ran roughshod over our duty of care for those in our care. The primary rule of medicine is Primum non nocere. Not primum nocere.
Post note: Since I wrote this article a few days ago, the Swedish Government has apologised for not protecting the elderly. Yes, the UK was not the only place where stupid things were done.
Sweden apologises for failing to protect older people
“We failed to protect our elderly. That’s really serious, and a failure for society as a whole.” Sweden’s government has apologised for not protecting older people, with 90% of the country’s COVID-19 deaths occurring in the over-70s.” http://www.theguardian.com/world/2020/may/10/coronavirus-latest-at-a-glance-may-10
Can we expect such an apology in the UK? Well, with all the airlines going bust, there may be more opportunity for squadrons of flying pigs to fill the air. The reality is that Sweden has grown-up politicians, who have grown-up ways of dealing with things – including that rarest of things… apologising. In the UK we still have a bunch of overgrown schoolboys in charge.
I will be appearing on a podcast tomorrow morning at 10am (Saturday, 2nd May 2020) UK time, talking about Covid and suchlike – and probably getting dragged off into other interesting areas, as usual. It is with Steve Bennett, a friend, and a man who is trying to promote the high fat low carb (primal) way of life. I fully support him in doing this. He is also putting a considerable amount of money into foodbanks in the UK, to help out those in need during the lockdown. I hope you may be able to watch at http://thefoodbankshow.com
COVID Update – Focus on Vitamin D
28th April 2020
I have found, I suspect like almost everyone else, that it is almost impossible to keep track of what is going on with COVID. Stories swirl and multiply, and almost everyone seems to be trying to get something out of it. People are claiming miracle cures and success – but it is difficult to verify any such claims.
The normal rules of research (flawed though they often are) have completely flown out of the window. It is like the wild west, with snake oil salesmen announcing wonderful products that not only cure COVID, but every other disease… I mean every other disease, known to man.
‘A vaccine you say sir, of course, I shall have one ready and done in four months, start to finish … safety sir, did you mention safety? No need for such things, vaccines are always safe, never caused anyone any harm. Never a single case of any problems.’
‘Narcolepsy sir… sounds like nonsense, never heard it. Guillain-Barré sir. My, we have been at the medical dictionary haven’t we? In my opinion, if you can’t spell it, you don’t need to worry about it. Sounds French to me anyway – and you can’t trust the French, can you?’
‘The WHO sir… what’s that you say? It may be that you can get infected twice. So how is any vaccine going to work. Well, I must say sir that vaccines are far more effective at creating immunity than getting the actual infection. Everyone knows that sir… what do you mean utter bollocks. I can tell you that a vaccine will always work, every time, guaranteed one hundred per cent effective, or your money back.’
‘Bill Gates is behind it all sir you say, pushing for mandatory vaccines for all diseases. You think it’s like something out of 1984. Well, Mr Gates is an expert in viruses sir, is he not…His operating system did allow a massive attack on IT systems in the NHS in 2017 sir. Now, if you will excuse me, I have more snake oil to sell… tatty bye sir, and good luck to you.’
‘Roll up, roll up.’
Which takes me to vitamin D. Which is my miracle cure for COVID.
I know that, in the West, the medical profession, hates vitamins with a passion. Those who promote vitamins are the very personification of woo, woo medicine. They have no proven beneficial effects they rant and on, and on. Insult and attack.
However, as I have been known to point out, the ‘vit’ in vitamin, stands for vital. As in, if you don’t take them, you die. So, they do kind of have important beneficial effects on the human body. Of course, I know the counter argument, which is not that vitamins are not necessary, of course they are, even doctors agree with that. The battle is about the optimal level for health.
We are told that almost everyone has sufficient vitamin intake from the food they eat, and that anything above that intake just creates expensive urine. In addition, some vitamins can be dangerous in excess. We have seen up to one death a year, in some cases.
Leaving the battles about vitamins to one side, what are the optimal levels of various vitamins? The answer is no-one really knows … for sure. The central problem here is that, when vitamins were first isolated, their deficiencies were creating major and obvious health problems. A lack of vitamin C caused scurvy – leading to death.
A lack of vitamin B1 a.k.a. thiamine led to Beriberi, with nerve and muscle damage and wasting and death. A severe lack of vitamin B12 lead to nerve damage, anaemia, weakness and death.
Looking specifically at vitamin D, the major and immediate health problem caused by a lack of vitamin D is on bones. Without vitamin D, calcium is not absorbed properly and the bones become thin and brittle. Children with low vitamin D develop rickets, bent bones that do not grow properly.
Once the level of vitamin D required to protect the bones was established, that was pretty much seen as job done. However, is it better for health to have higher levels. Can we be optimally healthy with, what many believe, to be a low vitamin D level?
More importantly right now, does a higher level of vitamin D enable you to fight off infections such as influenza and COVID? Of course, as I stated at the beginning, in the middle of the COVID maelstrom, people are claiming everything about everything.
So, I am going to take you back to 2008 to look at Virology Journal – yes, this is about as mainstream as you can possibly get in the world of virus research. The article was called ‘On the epidemiology of influenza.’ If you want to get your mind blown, read it 1.
It set out to answer seven questions:
Why is influenza both seasonal and ubiquitous and where is the virus between epidemics?
Why are the epidemics so explosive?
Why do epidemics end so abruptly?
What explains the frequent coincidental timing of epidemics in countries of similar latitudes?
Yes, I realise COVID is not Influenza, but past research on influenza is about as close as you can get. Cutting to the chase, of a very long article, the authors concluded the reason why flu was far more common in winter, is because people have much lower levels of Vitamin D.
These researchers then looked at what happened to people who took vitamin D supplements all year round. One group took placebo, one group took 800 international units (IU) a day – and one group took 800 IU per day but 2000 IU a day in the final year of the trial. Below is a graph of what they found.
To put this another way, of those 104 subjects who took 2,000 IU of vitamin D 老王下载day, only one got a cold or influenza in the entire year.
Perhaps more importantly, if you do get infected with influenza, vitamin D (especially D3) has a potent effect on protecting endothelial cells. And damage to endothelial cells appears to be a key mechanism by which COVID creates the most severe, and potentially fatal, symptoms. Here is a section from the paper ‘DietaryVitamin D and Its Metabolites Non-Genomically Stabilize the Endothelium.’
Our data suggests the presence of an alternative signaling modality by which D3 acts directly on endothelial cells to prevent vascular leak. The finding that D3 and its metabolites modulate endothelial stability may help explain the clinical correlations between low serum vitamin D levels and the many human diseases with well-described vascular dysfunction phenotypes.’ 2
In short, it seems Vitamin D stops you getting infected with viruses and, even if you do get infected, it helps to mitigate the worst effects. This could explain results from a, not yet published study, looking at the severity of COVID infections vs. the level of Vitamin D in the blood 3.
On the face of it, remarkable benefits. However, they fit with what is already known about the benefits of vitamin D on influenza.
I am not alone in being alarmed at the preponderance of deaths from COVID-19 among those with dark skin (UK government urged to investigate coronavirus deaths of BAME doctors, 10 April). While COVID-19 is likely to magnify the effect of social deprivation, I don’t think this is the whole story.
Vitamin D is needed for many reasons, including correct functioning of the immune system. It is converted to its active form by the action of sunlight on the skin. This is impeded by having dark skin and leads to low levels of vitamin D. Supplementing with vitamin D3 at 5000iu daily corrects this deficiency, and it is now an urgent need for all people with dark skin (and most with white). There is a reasonable chance that vitamin D replacement could help reduce the risk we are seeing playing out so tragically in the BAME community 4.
So, what do we know?
Dark skinned people are more likely to die from COVID
Dark skinned people are more likely to have low vitamin D levels 5
Vitamin D supplements protect against colds and flu – and hopefully COVID
Higher levels of Vitamin D should be able to mitigate the damage caused by COVID
The increased risks of low vitamin D levels on COVID seem dramatic, and the benefits of supplementation with vitamin D could be just as dramatic. I have been going out into the sun wherever possible in the last month. I take Vitamin D3 supplements 4,000 units a day. I strongly advise everyone else to do the same. It is snake oil, and it is free (if provided by the sun).
The only problem I see is that I cannot make any money out of this at all. Oh well. Perhaps I should claim to be making a vaccine, that could earn me billions.
Unfortunately, it seems that COVID-19 has infected everyone involved in healthcare management and turned their brains into useless mush.
Lockdown has two main purposes. One, to limit the spread of the virus. Two, and most important, to protect the elderly and infirm from infection – as these are the people most likely to become very ill, end up in hospital, and often die. [In my view, if we had any sense, we would lockdown/protect the elderly, and let everyone else get on with their lives].
However, the hospitals themselves have another policy. Which is to discharge the elderly unwell patients with COVID directly back into the community, and care homes. Where they can spread the virus widely amongst the most vulnerable.
This, believe it or not, is NHS policy. Still.
Yes, you did just read that. COVID-19 patients, even those with symptoms, are still to be discharged back home, or into care homes – unless unwell enough to require hospital care e.g. oxygen, fluids and suchlike. If this is not national policy, then the managers are telling me lies.
In fact, it does seem to be policy, although the guidance from the UK Government is virtually incomprehensible1. I have read it a few times and I fail to fully understand it – or partially understand it. I tried reading it upside down, and it made just about as much sense.
I now call care homes COVID incubators. Places where the disease can grow and multiply, happily finding new host after new host. Not so happily for the residents.
Equally, sending people home is further complete madness. Sending them home to somewhere that, very often, contains another elderly and frail person. Normally a husband or a wife. Did anyone think through the consequences of this? Clearly not. Do you think the other person in the house may be at risk? Really, you think. Surely not, knock me down with a feather…
If there is not another elderly partner in the house, there will usually be carers who come in to look after the freshly discharged COVID positive patients. These carers will have almost no protective equipment. Even if they do, they will be lifting and moving the patient around, washing them, taking them to the toilet… in very close proximity. The chances of getting infected are very, very, high.
These carers will then go and visit other elderly, vulnerable patients scattered around the community. They become the perfect vectors to spread the virus far and wide, amongst the exact group of people that we are trying to protect.
I have been doing a lot of jumping up and down about this over the last few days. The hospital trusts appear incapable of understanding the argument. ‘Clear the hospital, clear the hospital’… are the only words they seem capable of uttering.
The hospitals, I point out repeatedly, have been cleared. Wards are standing empty, corridors echoing. The first peak has also been passed – even if no-one dares admit it. So why are we continuing to fling COVID positive patients out into the community? Why? Why? Why?
‘工信部回应VPN指导意见:不会影响国内外用户正常使用 ...:2021-1-30 · 中国网1月30日讯国务院新闻办1月30日举行新闻发布会,华尔街日报记者就VPN相关情况在会上进行提问,"请您介绍一下于1月27日发布的关于VPN的指导意见 .... Squawk. ‘Because it is national policy’. Squawk. ‘Pieces of eight, pieces of eight.’
The entire nation has been locked down. Do not travel, stay two meters apart, do not go outside blah, blah. Meanwhile we have the perfect anti-lockdown policy in place for the very people we are mostly supposed to be protecting. There are two parallel universes here.
If you wanted to create a system most perfectly designed to spread COVID amongst the vulnerable elderly population, you may well have come up with the current one. Infect people with COVID in hospital, and then scatter them into care homes and the rest of the community. Making sure that you infect all the carers on the way.
As Albert Einstein said. ‘Two things are infinite, the universe and human stupidity… and I’m not so sure about the universe.’
However, it was very clear, very early on, that COVID was killing the elderly in far greater numbers than anyone else. In Italy, the early figures released revealed that the average age of death was seventy-nine. The figures were slightly higher in Germany, and around eighty years old in pretty much every other country.
In a world of uncertainty, one thing stood out. Which is that the unwell elderly were the ones who were most likely to die. Equally, they were the ones most likely to end up in hospital, potentially overwhelming the health services. As happened in Italy and Spain.
Ergo, you would think that someone, somewhere in the UK government, would have asked the obvious question. Where do we have the greatest concentrations of elderly, frail, people with multimorbidity? Could it possibly be that they are being looked after in care homes around the country?
Nursing homes, residential homes, care homes. They are all pretty much the same thing nowadays. Nursing homes tend to look after those with greater health needs, and they must have registered nurses looking after patients, but the distinctions have become blurred.
Many care homes are also specialised in looking after the elderly with dementia. In the UK, they are called EMI units [elderly mentally infirm]. These represent a particular problem in that residents tend to wander about from room to room.
So, in care homes we potentially had the perfect storm for the pandemic. They are full of elderly and infirm and highly vulnerable people. Environments where it is often impossible to isolate residents, and staff who have never been adequately trained in isolation measures. Equally, whilst relatives cannot visit hospitals, care homes have been continuing to allow them in.
It is not as if the warning signs were not there, flashing red.
What was the government’s strategy for dealing with nursing homes? It has been, up until the last couple of days, to make things even worse. The instructions from the Dept of Health have been to send patients diagnosed with COVID out of hospital, and back into care homes, with instructions to “barrier nurse” them, a term for a set of stringent infection control techniques. Care homes were informed that they could not refuse to take the residents back.
All of which means that the staff end up attempting to barrier nurse COVID positive patients with flimsy surgical masks, no eye protection, no gowns and gloves that, in my case, disintegrate rapidly and are almost completely useless. Until very recently, nursing home staff, in many homes, were told not to wear masks, and this was true even when there were COVID positive patients in the home.
The focus, the entire focus, has been to clear patients out of hospitals, waiting for the deluge of patients. This has been so effective that, in my area of Cheshire, the local hospitals have never been so empty.
There are wards with no patients in them. The shiny new Nightingale hospital in London, with four thousand beds, apparently had, so I am informed, just nineteen patients in it last weekend. Yet still the pressure still comes down: get patients out of hospital and back into care homes.
At the same time, all the effective personal protective equipment (PPE) has been directed to hospitals and hospital wards. Care homes have been almost unable to access anything. I scavenge what I can before I visit. I keep being told that things have improved. By those who haven’t seen a patient – or the inside of a care home – for years.
I have also watched patients go down very rapidly and die. COVID is a strange disease that kills people in a way that I have never witnessed before. In some cases, very quickly. I have tried to suggest that hospitals are the best place to look after potentially infectious people, not care homes. No-one has been interested.
Now, of course, the disaster is unfolding. The entirely predictable disaster. Here, from The Guardian:
‘Care home leaders have accused the government of vastly underestimating the deaths of elderly people from coronavirus, as they warned the disease may be circulating in more than 50% of nursing homes and mortality is significantly higher than official figures.
As I mentioned earlier, in one care home that I visit, they recently had eight deaths in seven days. Were these COVID deaths? Who knows for sure. No-one was tested. No-one is tested. The staff are not tested. I have patients who have died quickly. What do I put on the death certificate? COVID? Well I cannot, not really, because I have no idea if they had COVID or not.
It seems clear that many, many, COVID deaths in care homes will not even be registered as COVID deaths, so the figures are almost certainly worse here than are being reported.
I think we all recognise that the COVID pandemic has hit the country with great force, and that the Government has had to react at great speed. You can agree or disagree with some of the actions. However, one thing that stands out is that complete and utter abject failure to grasp the impact of COVID on care homes.
The actions taken, so far, have made the problem far, far, worse. All the thinking and resources have been directed to the NHS. Meanwhile, the residents and the staff of nursing homes have been, effectively, thrown in front of a bus. On Thursdays, while others have been clapping the NHS, I have been clapping for the unsung heroes of this epidemic. The care home staff.
A Good Cause
15th April 2020
I have known Steve Bennett for a few years now. He became a convert to the high fat low carb world (primal living and eating) and has set up Primal Living to promote this dietary message to the world, using his considerable financial muscle to do so.
In the midst of lockdown, he is running a series of youTUBE programmes, and interviews, discussing a number of topics, and from the resultant publicity he is hoping to gain donations to food banks – which are really struggling at the moment. He will match donations up to £100,000 to do this.
I hope you can watch some of the programmes. I hope you can donate, if you feel able. I am appearing on a couple of the shows. I think this is a very good cause. I support Steve Bennett and his team in the endeavour. Below is a slightly amended press release…
THE FOOD BANK SHOW – YouTube channel: The Primal Living.
Every morning thereafter, we will be broadcasting live on youTUBE providing food and health advice. Steve Bennett The Food Bank Show host will be joined by doctors, medical experts and chefs, many of whom contributed to his latest health book FAT and Furious. Together – they will be taking your questions from around the country and additionally during the shows we will video link to food banks across the UK and discover new ways we can all help offer support.
With fast food chains closed, we want to seize this opportunity to reshape the eating habits of our nation and improve everyone’s health and whilst we are doing this together – help feed those most in need during this crisis.
Join Steve and his family, as they put on a truly interactive show and please encourage everyone you care and love to join them too.
We aim to generate as many donations to the Food Banks as possible. Steve Bennett is going to match donations up to the first £100,000.
People can donate via a text or a justgiving page.
The show has 3 aims;
Help viewers learn about how to eat healthily
Raise money for foodbanks, with our partnership with the Trussell Trust
After keeping social distance and washing hands, the next best thing we can do to help our immune and defences is to be metabolically healthy, this will be discussed at detail in the shows.
Most vulnerable are those with metabolic syndrome. In Italy while the average age of death was 81, the average person who died suffered from 2.7 underlying chronic medical conditions. Including High blood pressure, cancer, diabetes. Lowering blood pressure, reversing diabetes, high sugar levels, can happen quickly with the right advice and that is the message the doctors will be promoting.
In Wuhan, more than 60% of people who died, or had serious complications had high blood pressure or type 2 diabetes.
UK over 60% adults are overweight or obese. Only 17.4% of American adults are metabolically healthy.
Contact the Show Writers Nick.Davies@primalliving.com or Poppy Hadkinson firstname.lastname@example.org
Jack Bennett Show Producer JB3015@bath.ac.uk
The Show Host Steve Bennett Steve@tggc.com
12th April 2020
Several politicians, including Keir Starmer, the opposition Labour Party leader, have been demanding to know the exit strategy for the lockdown. “We should know what that exit strategy is, when the restrictions might be lifted and what the plan is for economic recovery to protect those who have been hardest hit,” he said last week.
This is an entirely valid question, but the Government cannot have an exit strategy, unless they have an overall strategy. One follows directly from the other.
To eradicate the virus from the entire population by enforcing lockdown. Or to enforce lockdown until there is an effective treatment. Or to enforce lockdown until there is a vaccine. Or to enforce lockdown to slow the spread of the virus, so as to prevent the NHS from being overwhelmed.
Eradication is virtually impossible with such a highly infectious disease. Even if the UK was successful, if other countries were not, keeping Covid-19 out would require border closures for years, maybe decades. Endless checks on planes, boats, lorries, cars. Constant testing and restrictions. It is almost certain that the virus would still slip through. This does not seem a viable option.
What about finding an effective treatment? The chances are vanishingly small. Influenza, a very similar virus, has been around for decades, and no game changing medications have yet been found.
As for a vaccine? This solution is so distant that it does not really exist. It will be a minimum of eighteen months before an effective vaccine can be developed, then tested, then produced in sufficient quantities to be of any use. Waiting for eighteen months before releasing lockdown would be socially and economically impossible. We would be committing national suicide.
Ergo, there is only one overall strategy that can be followed. Control the spread to avoid overwhelming the NHS. This has never been made explicit, but the Government has, albeit indirectly, told us that this is exactly what they are doing.
In the last few days, a letter was sent to all households, signed by Prime Minister Boris Johnson, before he too succumbed to the disease. It was entitled “Coronavirus – stay at home; protect the NHS, save lives.” It contained this key passage:
“If too many people become seriously unwell at one time, the NHS will be unable to cope. This will cost lives. We must slow the spread of the disease, and reduce the number of people needing hospital treatment in order to save as many lives as possible.”
The key sentence is the first. If too many people become seriously unwell at one time.
This fits with the initial UK strategy. Contain, delay, research, mitigate. The UK has passed through “contain” and is now in “delay and mitigate”. Research sits in the background and may, or may not, provide a solution.
However, delay and mitigate doesn’t mean that people will not become infected and die. It just means that the NHS will not be overwhelmed by a massive wave of people getting ill at the same time. We are simply, it should be made clear, trying to control the “peak”, which now may likely be a series of “peaks”.
At present, ministers are not admitting this. They are presenting lock-down as a way of “beating this virus.” In order to enforce lockdown, they are haranguing and scaring the population into compliance.
Covid-19 is being presented as a deadly killer that does not discriminate. Young, old, we are all at risk of contracting this dreadful disease. Every night, the television news has story after story of young people who have been infected, and who have died. In fact, very, very few people under 20 have died so far. I believe it was five, at the end of last week.
There is hardly anything said about the fact that the average age of death is around eighty, that the vast, vast, majority of those dying are old (92% are aged over sixty) The great majority of them have several other serious medical conditions.
The reality is that for anyone younger than about sixty, Covid-19 is only slightly more dangerous than suffering from influenza. The infection fatality rate (IFR) currently stands at around 0.2% in those countries doing the most testing. This figure will inevitably fall, once we can identify those who were infected but had no symptoms.
By avoiding this more reassuring message, by frightening everyone into compliance, the Government has painted itself into a corner. How can they say to people that, last week you couldn’t drive two miles to walk in the countryside, or go to the beach, or go to a restaurant, or lie in a park sunbathing, in order to prevent the spread of this deadly killer disease …but this week you can?
Worse than that, when cases begin to rise again, about a month after lockdown is relaxed, we will all have to lock down again, to prevent the next surge? How will the public respond to this? I don’t know, but I expect that it is going to be extremely difficult, if not impossible, to force everyone back into lockdown again.
By this point, millions will have been financially crippled and will be desperate to work, if their jobs still exist. Thousands of businesses will have fallen over, bankrupt. Hundreds of thousands of operations, and cancer treatments, will have been postponed and cancelled. I have already warned that it’s possible, perhaps even likely, that many more people could as a result of the lockdown than will die from coronavirus.
That great harm is being done by it was made clear in an article last week in the Health Service Journal:
“NHS England analysts have been tasked with the challenging task of identifying patients who may not have the virus but may be at risk of significant harm or death because they are missing vital appointments or not attending emergency departments, with both the service and public so focused on covid-19.
“A senior NHS source familiar with the programme told HSJ: “There could be some very serious unintended consequences [to all the resources going into fighting coronavirus]. While there will be a lot of covid-19 fatalities, we could end up losing more ‘years of life’ because of fatalities relating to non-covid-19 health complications.”
It may well seem that all this suffering was…well, for what, exactly? To simply prevent a surge of cases. This government, all governments, must be honest about this and admit that in the longer term we cannot prevent almost everybody getting infected and acknowledge that a proportion of those infected will die.
When lockdown restrictions are lifted this does not mean that the virus has gone. It does not mean that people cannot infect each other. It does not mean we can simply carry on as before. It means that we have kept the first surge under control.
So, what is the exit strategy? The answer is that we don’t have one. We have a strategy of delay and mitigation which will continue until… when? Until everyone has been infected? Until we have an effective treatment? Until we have an effective vaccine? Until enough people have been infected that we have achieved herd immunity?
The Government must tell us the truth and be clear about what end point they are seeking to achieve. Only then can we have an exit strategy. One thing for sure is that this lockdown is not a way to defeat the virus.
A senior NHS source familiar with the programme told HSJ: “There could be some very serious unintended consequences [to all the resource going into fighting coronavirus]. While there will be a lot of covid-19 fatalities, we could end up losing more ‘years of life’ because of fatalities relating to non-covid-19 health complications.
“What we don’t want to do is take our eye off the ball in terms of all the core business and all the other healthcare issues the NHS normally attends to.
“People will be developing symptoms of serious but treatable diseases, babies will be born which need immunising, and people will be developing breast lumps and need mammograms.”…
Nuffield Trust deputy director of research Sarah Scobie said it was “a considerable worry that people are keeping away from routine and urgent health services, and also from emergency departments”.
She added: “The PHE (public health England) data suggests there could be significant problems already developing for heart disease related conditions patients, for example. Attendances relating to myocardial infarction at emergency departments have dropped right down, whereas ambulance calls in relation to chest pain have gone right [up].’
I suppose my first response would not be one of great surprise. In fact, it confirms what I have been saying for some time. When the great Swine Flu epidemic (that killed hardly anyone) created the last pandemic crisis in the UK, exactly the same thing happened. If, whatever you were suffering from, wasn’t Swine Flu, it didn’t seem to matter.
In my small part of the world a small but significant number of people were diagnosed with Swine Flu. This was done over the phone, by poorly trained operatives. These people were then prescribed the (almost entirely useless Tamiflu), they then died. It turned out that they had other conditions that could, and would, have been properly treated had we not been overcome by a massive over-reaction to Swine Flu. They died because of swine flu.
Last week, in Intermediate Care, we sent two patients into the local hospital who were seriously ill. They were both sent back almost immediately. They both died. Yes, they were ill, and may have died anyway. But I believe they should both have been admitted, and treated, and they could both still be alive. They died 老王下载 COVID.
Ambulance crews are under very heavy pressure not to admit anyone unless absolutely necessary. Some of those, not admitted, will die.
These people, all these people, are dying ‘because of’ COVID. Because of the fact that almost the entire focus of the NHS is now on COVID – to the virtual exclusion of anything else.
Our local hospital now has more empty beds than at any time in history. Elective surgery has stopped, to free up resources. There is enormous managerial pressure to clear more and more people out of hospital, out of Intermediate Care beds, back home with little support available. Some of them will die because of this.
My last blog focussed on the economic costs of the reaction to COVID. My argument was that economics, and health, do not exist in isolate bubbles. Harm to the economy will result in harm to health and vice-versa.
Equally, if you spend all your healthcare resources trying to treat one thing, everything else will suffer, because resources are not infinite. At present we have virtually shut down the NHS to deal with COVID.
I saw several patients yesterday while I was working in “out of hours”, who were not critically ill, but they were ill. Two of them, I felt, really needed to be followed up. A girl with weight loss over the last three months, a man with clear signs in his chest that could have been malignant.
They will not be followed up any time soon. If at all.
At present there is a lot of discussion about how we are categorising deaths from COVID. Anyone who dies, having been diagnosed with COVID, is considered to have died of COVID. Even if they died of something else. The died with COVID, not of COVID.
There is, I believe, an even greater immediate problem here. Which is those who are dying because of COVID. This is not just me saying this, this is NHS England:
“While there will be a lot of covid-19 fatalities, we could end up losing more ‘years of life’ because of fatalities relating to non-covid-19 health complications.”
‘The operation was a success, unfortunately the patient died.’
A Health Economic perspective on COVID-19
29th March 2020
The current COVID pandemic has brought a very thorny and difficult issue to the forefront. How much money should we, as a society, spend on keeping people healthy/alive? No-one has ever fully got to grips with this question, but it has never been more important than now.
The reason why I say this is that the US Govt has set aside two trillion dollars to deal with the crisis, in the UK it is over three hundred and fifty billion pounds, which is almost three times the current yearly budget for the entire NHS. Is this a price worth paying?
I know that some people will instantly dismiss such a question as being cold-hearted, and simply stupid. ‘打工信部和公安部旗号卖VPN 这家公司胆子有点大_新闻频道 ...:2021-7-8 · 打着工信部和公安部的旗号卖VPN，这家公司胆子有点大.6月30日， “著名记者冯诗林”还在新媒体平台“北京时间”上发布过一篇题为《VPN应用7月1日 ....’ Is an argument that I have heard many times, almost whenever health economics is discussed.
The counter argument is that – if funds are not limitless – then we should focus on doing things whereby we can do the most good (save the most lives) for the least possible amount of money. Or use the money we have, to save the most lives. In fact, this is why the National Institute for Health and Care Excellence (NICE) was established.
NICE reviews interventions and decides whether they provide value for money. The economic term for this is cost-effectiveness. This work is complex and often relies on assumptions that can be difficult to verify.
However, keeping this as simple as possible, NICE tries to compare healthcare interventions against each other by using a form of ‘currency’ called the cost per QALY. A QALY is a Quality Adjusted Life Year. One added year of the highest quality life would be one QALY.
People with conditions such as cancer, or severe heart disease, or who are suffering from chronic pain can be considered to have a quality of life less than one. For the sake of argument, we can say that their quality of life is 50%. Thus, one year of additional life gained for them, would have a value of 0.5 of a QALY.
It also needs to be borne in mind that not everything that is measured using a QALY, relates to saving, or extending, lifespan. For example, someone could have chronic hip pain, and a quality of life of 0.5. Then they have a hip replacement, and their pain goes away, their quality of life can improve from 0.5 to 1. If they live another twenty years, they will have gained 20 x 0.5 QALYs = 10 QALYs.
Obviously, things can get significantly more complicated than this, and the validity of the measured quality of life is a matter of considerable debate.
However, the fundamental question as always, comes down to the following. How much are we willing to pay for one QALY? [How much can you afford to pay for one QALY?] Not just the NHS, but the country as a whole? The current answer, in the UK, is that NICE will recommend funding medical interventions if they cost less than £30,000/QALY. Anything more than this is considered too expensive.
This figure is not set in stone and can vary depending on circumstances. Interventions for young children tend to get more spent per QALY, and powerful lobbying groups can bring pressure to bear on that figure.
However, the figure of £30,000 is generally accepted – if not widely publicised.
To put it in more stark terms. In order to spend three hundred and fifty billion pounds, we require a return on investment of eleven point six million QALYs. If not, NICE would reject it.
[For those who think this an impossible/inhuman calculation, you always have to consider how many other lives could be saved, how much other suffering, or death, could be prevented, by spending three hundred and fifty billion pounds in another way. Because that is what you are really trying to work out].
Are we likely to achieve this level of benefit? Of course, any attempt to model this requires several assumptions to be made. However, the model we can use in this case only has four variables, two of which are (pretty much) known. The variables are:
[In truth, average age of death is only needed to calculate the average reduction in life expectancy.]
Average age at death 78.5
Average reduction in life expectancy 3 years
Average quality of life of those who die 0.7
QALYs lost: 500,000 x 3 x 0.7 = 1,050,000
Using these figures, if we spend three hundred and fifty billion pounds – in the hope of reducing the ‘QALYs lost’ figure to zero, then each QALY will have cost £333,000. Which is more than eleven times the maximum cost that NICE will approve.
In fact, we do know two things with reasonable accuracy. First, we can be pretty certain about the average age of death, and we can also be fairly clear on the average quality of life of those who have died.
What is less certain is how many will die, and the average life expectancy of those who have died. At this point we need to look at the ‘variables’ in the model in a little more detail. This is UK only.
Number who may die
The 500,000 figure for possible deaths, that I used in the calculation above, is the absolute upper range of the numbers that have been proposed, and it comes from modelling that was developed by the Imperial College in London. Their modelling has been since used around the world to guide Government responses. 1
On the other hand, the UK Government has used an estimated 250,000, for the upper limit of deaths – if nothing is done to prevent spread. Other figures have been much lower, but I am going to use 500,000 as the maximum, and 250,000 as the ‘most likely number’ in this model.
My minimum figure will be 20,000, as this has recently been suggested by the same Imperial research group. It seems low.
Average age of death
In Italy – which has had the greatest number of deaths – the average age at death is 78.5. This is comparable with age of death in other countries. I am going to use this as a non-variable 2.
This is more complicated. Using Italy, again, the average life expectancy is 82.5 years (both men and women). However, if people die aged 78.5, this does not mean you have reduced life expectancy by 3 years.
The average life expectancy in Italy, at birth, is 82.5 years. However, once you reach 78.5, you can expect another eight or nine years of additional life. [You will have avoided car crashes, early cancer, suicide and suchlike which reduce the ‘average’ life expectancy of the entire population].
On the other hand, those who are dying of COVID have multiple medical conditions. On average they have three serious underlying problems such as: diabetes, COPD, heart disease, previous stroke, active cancer and suchlike.
Which means that these 78.5-year olds do not have a life expectancy of eight or nine years. It will be far less. How much less? This is virtually impossible to calculate. I am going to estimate a half – or 4.5 years (an average).
Again, this is difficult to establish. However, studies have been done to work out the ’reported’ quality of life in those with multimorbidity. Perhaps the most accurate figure I could find with that elderly people with three underlying serious health problems have a quality of life of 0.8.3
Using different figures in the model
Having put figures to the likely range of the variables, we can look at the cost per QALY in various scenarios. I am only going to look at three. ‘Best case’ ‘Most likely’ and ‘Least benefit.’
I am going to start by inputting the figures that would provide the greatest possible gain in QALYs. This is 500,000 deaths prevented, and an average gain in life expectancy of nine years [This assumes all 500,000 lives will be ‘saved’ with the actions taken]. Quality of life is kept constant at 0.8.
500,000 x 9 x 0.8 = 3,600,000 QALYs
Which gives a cost per QALY of £97,200 [£3,5Bn ÷ 3.6m]
We can then run the ‘most likely’ scenario, which is 250,000 deaths prevented, with an average gain in life expectancy 4.5 years.
250,000 x 4.5 x 0.8 = 900.000 QALYs
Which gives a cost per QALY of £388,888 [£3.5Bn ÷ 900K]
Finally, we can tun the ‘least benefit’ scenario, which is 20,000 deaths prevented, with an average gain in life expectancy of 3 years.
20,000 x 3 x 0.8 = 48,000 QALYs
Which give a cost per QALY of £7,291,666 [£3.5Bn ÷ 48K]
I fully recognise that looking at human life in from this purely economic perspective can seem harsh, almost inhumane. Can we really stand back and watch an elderly person ‘drown’ as their lungs fill up with fluid ‘Sorry, we are not spending money on more ventilators, because it is not cost-effective.’ Or suchlike.
However, there is also a health downside associated with our current approach. Many people are also going to suffer and die, because of the actions we are currently taking. On the BBC, a man with cancer was being interviewed. Due to the shutdown, his operation is being put back by several months – at least. Others with cancer will not be getting treatment. The level of worry and anxiety will be massive.
Hip replacements are also being postponed and other, hugely beneficial interventions are not being done. Those with heart disease and diabetes will not be treated. Elderly people, with no support, may simply die of starvation in their own homes. Jobs will be lost, companies are going bust, suicides will go up. Psychosocial stress will be immense.
In my role, working in Out of Hours, we are being asked to watch out for abuse in the home. Because we know that children will now be more at risk, trapped in their houses. Also, partners will suffer greater physical abuse, stuck in the home, unable to get out. Not much fun.
Which means that we are certainly not looking at a zero-sum game here, where every case of COVID prevented, or treated, is one less death. There is a health cost.
There is also the impact of economic damage, which can be immense. I studied what happened in Russia, following the breakup of the Soviet Union, and the economic and social chaos that ensued. There was a massive spike in premature deaths.
In men, life expectancy fell by almost seven years, over a two to three-year period. A seven-year loss of life expectancy in seventy million men, is forty-nine million QALYs worth. It is certainly a far greater health disaster than COVID can possibly create.4
In Lithuania, the impact of the break-up of the Soviet Union was also dramatic, and damaging. Below is a graph, looking purely at deaths from cardiovascular disease. As you can see, starting in 1989 (when the Berlin wall fell) there was an enormous spike, representing hundreds of thousands of premature deaths. These same spikes, in death and disease, were seen across most countries in the former Soviet Union. 5
These, the downsides, can be calculated, using the figure that is the opposite of the QALY, which is the DALY. The Disability Adjusted Life Year. Or, to put it another way, how much harm are you causing with your interventions? I am not doing this calculation here, because it would have about ten thousand variables and would take far too long.
Despite this, the message here is that severe damage to an economy does not simply affect bank balances, it can be deadly. If we look at the result of social deprivation in the UK, the effect is (potentially) immense
This was highlighted in a review by Michael Marmot, who studied two areas of Glasgow. Lenzie, which was rich, whilst the other area, Calton, was poor (socially deprived). The findings were stark:
…we can see this in Glasgow. When we published the report of the WHO Commission on Social Determinants of Health (CSDH) in 2008, I drew attention to stark inequalities in mortality between local areas of Glasgow: life expectancy of 54 for men in Calton, compared with 82 in Lenzie.’ 6
A twenty-eight-year difference in life expectancy between people living approximately five miles apart. The difference? Money.
Which means that I fear that we are taking actions that could, in the longer term, if we are not very careful, result in significantly more deaths than we are trying to prevent.
Even if we restrict the analysis purely to the cost per QALY and narrow the ‘health’ analysis purely to COVID, and deaths from COVID, it remains difficult to justify spending £350 billion pounds to control a single disease.
I know that many people will violently disagree with this analysis and will think I am some cold-hearted fiend. ‘People are dying, we must do absolutely everything we can. No matter how much it costs.’ ‘What would you say if it was your mother…’ and suchlike.
Well, I have spoking to my mother, who is 92. Her view is that she has lived long enough. She thinks the Government actions are a ridiculous over-reaction. She is going out shopping and chatting to friends… she will take no advice on the matter.
So, what would I do if it was my mother that is dying? I will say that she made her choice, and who am I to argue with it.
[5.7% were admitted with no symptoms at all – not clear what they came in with. Presumably admitted with something else, then developed the symptoms later]
What did they die of?
96.5% died of acute respiratory distress syndrome.
‘Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function.
ARDS typically occurs in people who are already critically ill or who have significant injuries. Severe shortness of breath — the main symptom of ARDS — usually develops within a few hours to a few days after the precipitating injury or infection.
Many people who develop ARDS don’t survive. The risk of death increases with age and severity of illness. Of the people who do survive ARDS, some recover completely while others experience lasting damage to their lungs.’1
Treatment is with oxygen and ventilation but has a low success rate in the very elderly.
There do not seem to have been any deaths below the age of thirty.
ACE-inhibitors and Angiotensin Receptor Blockers (ARBs)
There has been much debate as to whether or not ACE-inhibitors (angiotensin converting enzyme inhibitors) and ARBs may increase the risk of death [these drugs are widely used to lower blood pressure]. This is because COVID-19 appears to enter the body through ACE2 receptors – found in high concentrations in the lungs and can cause upset to the neurohormonal system where ACE, and ACE receptors, play an important role.
The data from Italy is that:
‘Before hospitalization, 36% of COVID-19 positive deceased patients followed ACE-inhibitor therapy and 16% angiotensin receptor blockers-ARBs therapy. This information can be underestimated because data on drug treatment before admission were not always described in the chart.’
That is 52% who were on one, or the other (it is very rare for anyone to be on both). That was clearly, as they state, an underestimate. Possibly a considerable underestimate.
Knowing this, it is important to know how many (elderly people) take either of these drugs, to see if there is a correlation between taking them and dying from COVID-19. The figures from Italy are not clear at all. However, the latest data on prevalence of high blood pressure in the adult Italian population was, around 52% (This is an absolute maximum).2
However, the number of people known to have had their high blood pressure recorded by their general practitioner is around 20% 3 . Which means that most people with high blood pressure are not treated with anything.
Bringing these figures together, it can be estimated that a maximum of 10% of the Italian population are taking antihypertensive medications. These figures may be a little out of date, and these data are not specifically for the age group of, around, 80 years of age. Here the figures on diagnosis of hypertension, and use of antihypertensives will probably be higher, possible double.
So, we can say that 10% of the adult population is treated for hypertension, and that this may be around 20% in those aged around 80. Taking the figures one step further, it is estimated that about 67% of those who take antihypertensive in Italy use ACE-inhibitors, or ARB. 4
Bringing all of these figures together, it is likely the average percentage of eighty-year olds taking an ACE, or ARB is
67% of 20% of 52%x 2 = 14.0%
Which means that amongst 80-year olds ~14% are taking one, or other, of these drugs.
I cannot say either of these figures in carved in stone and I believe 14% is probably a overestimate. I wish there were more fully accurate figures to be had. So, what does this mean?
It means that:
A (probable) maximum of 14% of the elderly population in Italy are taking ACE-inhibitors/ARBs
A minimum of 52% of people in Italy who are dying from COVID-19 are taking ACE-inhibitors/ARBs.
Which suggests you are four times as likely to die from COVID-19 if you are taking one of these drugs, prior to contracting the virus. This, of course, does not take into account confounding variables – many of which are currently unknown. By a confounder I mean that people taking these drugs may have more comorbidities, such as heart disease, diabetes etc.
However, it remains a very strong signal, and I do not think it can be ignored, particularly in the light of the knowledge that the COVID-19 virus has a significant impact on the ‘ACE system’.
On this basis I would strongly recommend that elderly people, with any comorbidity, who is taking an ACE-inhibitor/ARB should look to change their antihypertensive treatment to something else – whilst the threat from COVID-19 is high.
I should point out this runs contrary to the advice from the authors of a study in the European Heart Journal 20th March:
SARS-CoV2: should inhibitors of the renin–angiotensin system be withdrawn in patients with COVID-19?
‘In conclusion, based on currently available data and in view of the overwhelming evidence of mortality reduction in cardiovascular disease, ACE-I and ARB therapy should be maintained or initiated in patients with heart failure, hypertension, or myocardial infarction according to current guidelines as tolerated, irrespective of SARS-CoV2. Withdrawal of RAAS inhibition or preemptive switch to alternate drugs at this point seems not advisable, since it might even increase cardiovascular mortality in critically ill COVID-19 patients.’ http://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa235/5810479
It should be borne in mind though, that their advice does acknowledge that they had no evidence about the number of people who were taking ACE-inhibitors, or ARBs, who then died. The data from Italy came out a day after the EHJ article was published.
Of course, no-one can be certain about what exactly is happening. I cannot be certain, but the signal from Italy on ACE-inhibitors and ARBs, seems very strong, and concerning. Based on it, I think my advice would be to change medication, if possible.
Stating this, I am aware that most GPs will not change anything, unless they get instruction from the acknowledged experts. Unfortunately, this is likely to take far more time than many people actually have.
Dr Kendrick cannot provide individual patient advice over the Internet. UK General Medical Council regulations are clear that to do so would be a breach of medical standards that could result in disciplinary proceedings.
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