13 October 2020
One of the biggest drawbacks in the efforts of the global community to fight this pandemic is how to an extent tools for number crunching, modelling and assessments of predictive analytics actually threw off a straight forward narrative of science. A narrative that said that this novel corona virus, SARS CoV2 was deadlier than the ordinary flu, which was seasonal, deadlier than the swine flu perhaps, but still one that was going to afflict certain categories of people based on age, on metabolic status and chronic conditions, and gender more severely than othershttps://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us-previous.html. The initial assessment that upto 98% of the affected would either be unaffected or just singed by it, and a further 2% may pay the price by way of death, is something that did weigh heavily upon planners and government bureaucracies as they factored this Pandemic in 2020 and mounted what can only be called a disproportionate response.
People who compare this with the Spanish Flu pandemic a century back, do not give credence to how societies have evolved, nation states have used the tremendous growth and technological advancements available a century later to mount such a response as they have- ordering people to shelter at home, amongst others. Yet the human tendency to indulge in nit picking will never cease to be an object of wonderment, for if any evidence were needed to show how humans lose objectivity, it is this ability to pry into pet peeves and create artifices that simply indulge prejudices preexisting!
We see a opinion in The Hindu where the sub headline says that Covid19 is different from Spanish Flu, https://www.thehindu.com/opinion/lead/pandemics-and-the-collective-consciousness/article32828839.ece because its economic and political consequences far outweigh the disease effect on humans. I can say, that this is clear case of conflating, because, simply put it is too early to know the full extent of how Covid19 has medical consequences in those who recover from it. Early trends evidence that people suffer from ‘brain fog’ a sense of disorientation, from depression, from physical debilitation like respiratory weakness, heart weakness, nerves and other neurological complications, and even metabolic weakness of liver, kidney functions. We are still fathoming out the full pathological spectrum from initial Influenza Like Syndrome, to Cytokine Storm, to Bradykinin Storm, to Hyaluronic Acid Soup that creates a gell-O like layer over the alveolar surfaceshttps://www.studyfinds.org/covid-filling-patients-lungs-with-liquid-jelly/, all of which in bits and pieces create a Multi Organ System Failure, which forms the clinical picture of the acute setting of this viral infection. We know that inflammation of heart, lung and liver tissue could well explain some of the after effects, besides cerebral tissue effects that could explain the neurological symptoms observed in survivors. Even without these, at approximately 40 million cases and 1.25 million deaths, in 2020, Covid19 is actually a health crises, as every other response that has been mounted by governments has been to mitigate this problem.
Another artifice is how people compare Sweden with rest of the world, little realising that Sweden did bring into effect ways and means to lower the chances of gatherings in public spaces and offices from word go. Already a country that was hypo dense and with a culture where people were acutely sensitive to physical spacing, Sweden did undertake these measures:
1.Children >16 were switched to online learning from schools and universities
2.Gatherings of upto 50 people only were permitted, rest were banned even outdoors
3.Elderly >70 were asked to self isolate
4.People were asked to work from home by choice
5.Schools, child care, gyms, bars and restaurants did stay open with restrictions to reduce the number and mixing of individuals
https://www.economist.com/europe/2020/10/10/how-sweden-hopes-to-prevent-a-second-wave-of-covid-19?fsrc=scn/tw/te/bl/ed/europesoddmanouthowswedenhopestopreventasecondwaveofcovid19europe So we did see a reduction in footfalls for public transport, work spaces and parks, a drop upto 30%, with great emphasis on ‘physical distancing’ and handwashing, but no masks were insisted or advised in Dr Tegnell’s policy which aimed for Herd Immunity. Sweden has failed not just the elderly in care homes, but it also failed her ethnic minorities from Syria and Somalia, who took the brunt of the first wave in terms of casualties. Dr Tegnell then reviewed the policy and banned public funerals, prayer services, and he is consistently indicating a willingness to review his advise after acknowledging that only a maximum of 20% of Swedes could be exposed to the SARS CoV2 virus in first six months, by which time the first wave in Sweden got over. Now for the second wave, Dr Tegnell has placed a policy of strict 7 day quarantine for those who were close contacts/living with a Covid19 patient, that too with a fifth day test which if negative could end the self isolation. Further all contacts are advised to self isolate and work from home for 14 days, during which to test if they are symptomatic, and avoid the elderly for this fortnight. All this is not Voodoo but science applied more specifically because Sweden has the resources. Even here let us note that unlike USA where all contacts are advised to test, Sweden advocates testing only symptomatic, so automatically the daily hundreds that Sweden now reports as cases are clearly a fraction of the perhaps thousands who are actually positive cases, especially when we see evidence that asymptomatic cases from amongst contacts could be as high as 60-70%. Current indications are that Sweden has a second wave underway, with 07 October 2020 recording 831 cases, a clear surge from 07 September 2020 which recorded 185 cases. Daily mortality has been less than 10 since July, and closer to the under 5 figures for majority of this extended period. Sweden stands in global rankings at 44, which is primarily based on total infections recorded so far, which stands at 98451 today. ( There is a lag in updation of figures by nearly a week now)
If one wished to compare Sweden, then the exact opposite of Sweden is not USA or India, which is what people from these countries do, but New Zealand, as one that embraced a complete lockdown. Mind you New Zealand and Sweden are still countries that do not advise masks for general public, but New Zealand’s interventions were far more severe and its policy mindset was an exact opposite, where PM Jacinda Ardern publicly stated that she wanted to crush the disease in that island nation. So New Zealand stayed at home for months. It has reimposed restrictions in Auckland thereafter, it looks at infection rates and calibrates the reopening of the economy. So where does New Zealand stand as far as Covid19 is concerned? It is 159 in global ranking, with just 1872 cases. It has total of 25 deaths so far. Of course, its economy suffered a severe contraction, but in a larger picture where globally every economy is under contraction, the price for a low Covid19 disease burden could well pay itself in more than one way! Of course, the Kiwi policy would come into rough weather, if the vaccines don’t fetch up, because even New Zealand will need to open up to tourism and international business which are its main folios, in an irreversible manner, going forward. The danger of just quarantining incoming humans was revealed in the case of an Indian who tested positive for Covid19 well after his strict four weeks quarantine was over.
So just as Sweden got trumped by asymptomatic carriers, New Zealand too could face problems from a disease that is still unpredictable in its clinical course. Yet we see clearly as a comparison between Sweden and New Zealand, two apples, that there is none, Sweden loses massively in terms of the Covid19 load because, even now in the month of September she lost more individuals to Covid19 that the Kiwis have for the entire year, not to mention her number of ‘symptomatic cases’!
So is there a third model? Actually there are many other models, which are dynamic responses from Asian countries like Japan, South Korea, Taiwan, Singapore and Vietnam.
Take Vietnam as a country that had very selective phases of lock down in selective areas, but with universal mask wearing rule. Vietnam is ranked at 165, below New Zealand, with a population 15 times as New Zealand and being next door neighbour with a international highway to China-the epicentre of the pandemic, which was open trans-border till mid March! 1110 cases, 35 deaths, and an economy that is now receiving bulk of the decoupling that is taking place from American, Taiwanese and Japanese companies!
If one takes Japan, a country with a mask culture due to pollen allergy co existent with the late winter and spring season there, Japan too never locked down. Being one of the densest populations in the world, Japan emphasised masks and hand hygiene, with excellent contact tracing including retrospective contact tracing, testing only those suspected of developing Covid19, it stands at 89347 cases and 1629 deaths with global ranking of 46, below Sweden. Japan was initially slow screening passengers from China with only thermal scanners, not insisting on quarantine for inbound, until the evidence of asymptomatic and first few days of infectivity even in symptomatic came about.
So the comparison to Sweden’s very limited non pharmaceutical interventions avoiding a full lockdown should truly be Taiwan. That too because, Taiwan is a model for universal mask wearing, something which Dr Tegnell still insists is not a necessary implement to prevent infection amongst general public.Taiwan at 174 in global ranking, with 529 cases and 7 deaths shows how Sweden model plus mask could have achieved far stellar results in terms of the Covid19 disease burden without subjecting the economy to any measures that curtailed its functioning, in the manner of rest of western Europe and including China, India, South Africa, Brazil, Russia!
Today Sweden stands worse off than Norway, Denmark, Finland, Switzerland, her immediate neighbourhood, only better off than Netherlands and Belgium. There is science and resource matrix behind Sweden’s calculus, no doubt, even though there is a perplexing void of not implementing universal masking.
We must see evidence for what it is, in a scientific and critical manner, and as we do so, we will unravel a larger failure of our collective leadership, which makes this Pandemic even at this stage, a very human tragedy…
(To be concluded)
indiarubberman.com 