COVID-19 POLICY COMPARISON: EAST – WEST, 100 – 1

Sputnik 1957 – Covid-19 2020

On October 4, 1957, the Russians shocked the World by shooting Sputnik 1 to orbit.  The consequences in the US at the time were not denials, lies or bombastic gestures.  Instead, Eisenhower declared three ”stark facts” the United States needed to confront:

  1. The Soviets had surpassed the Americas and ”the rest of the free world” in scientific and technological advancements in outer space.
  2. If the Soviets maintained that superiority, they might use it as a means to undermine the Americans prestige and leadership.
  3. If the Soviets became the first to achieve significantly-superior military capability in outer space and created an imbalance of power, they could pose a direct military threat to the US.

Eisenhower followed this statement by saying that the United States needed to meet these challenges with ”resourcefulness and vigor” [Wikipedia]. At that time the US woke up and rose up to the challenge. School curricula were revised, NASA was established, research investments were multiplied, President Kennedy announced the target of sending a man to the moon before 1970, and the US won the space race.

The superiority that the East Asian and Oceanic countries demonstrated 63 years later, in 2020, over the West (Europe and North America) in the management of the current Covid-19 pandemic is every bit as challenging as Sputnik 1 was 63 years ago, and so far the responses of the West have not been convincing.   If we [the West] harbour ambitions to regain any of our lost prestige and leadership – and even if we just want to protect the life, health and livelihood of our citizens – we should meet this challenge with at least equal ”resourcefulness and vigour”, because this time …  

… the West has failed monumentally

With four colleagues I wrote already on 3.4.2020 an article into the Finnish Journal, Suomen Kuvalehti demanding a policy to crunch the COVID-19-Pandemic.  Its subtitle was “Asia leads Europe 6 – 0”.  Six months later – is Asia holding to its lead?

Much more than holding to. The score is no more 6 – 0, it is now 100 – 1.  Plain and simple, the corona responses in Europe and North America have been failures.  After all the efforts, hard work of the health professionals, lockdowns, teleworking and remote schooling, how dear I be so blunt?  By comparing. A failure becomes manifest in comparison to a success. The overall population fatality rate (PFR) of COVID-19 in the East (China, South Korea, Japan, Malaysia, Taiwan, Vietnam, Singapore, New Zealand and Australia), is less than 1% of the COVID-19 PFR in the West (EU-Europe and North America).  Now, try to think of a developed country A with 100 times the infant mortality or traffic death rate of another developed country B.  Regardless of what the rates are in country B, country A cannot be a developed country. We are talking about a colossal failure in the most fundamental function of the society – to protect the life and health of its population. 

The overall failure of the West exhibits regional and local differences and includes temporary successes in places.  Still, only three countries of the West, Lithuania, Latvia and Slovakia, have so far outperformed the poorest performer of the East, Australia.  Decades ago the US led the science and knowledge of public health with CDC, NIEHS and FDA, its crown crown jevels and global authority.  Today US has no cohesive policy, leads in the total number of COVID-19 deaths, and ranks as number 8 in the highest COVID-19 deaths per million among the 215 countries and territories that we have data from [Worldometers, WHO].  Seven of the 25 countries with the highest COVID-19 deaths per million are EU member states.  

The comparison uncovers the fallacy of Western superiority.  All knowledge, medicine or equipment applied by the East has been available for the West as well.  As governments, administrations, societies, cultures and individuals we have proven ourselves incapable of applying the existing knowledge, documented experience, logical analysis, consistency and endurance, whenever their demands turn unpopular and go against the perceived rights for short term gratification amongst the most vocal interest groups. 

Our overarching values, pleasure and life

A wise man argued about 25 years ago, in a discussion about the [supposedly] changing societal values, that in fact all current Western cultures share two overarching values, the pursuit of PLEASURE and the protection of LIFE.  These values are so universally acknowledged that we jump for fear when facing anyone who rejects them [think of a terrorist who explodes herself in a marketplace full of shoppers and children].  He continued that many of the issues we are unable to solve or come to agreement about involve a conflict between these two values: among those abortion is a prime example, but, interestingly, also COVID-19 appears to be one. 

At first the COVID-19 policy in most countries prioritized the preservation of life.  When more people began to feel, however, that the restrictions could/would interfere with their own pursuits of financial, sexual, cultural, social, culinary, etc. pleasures, that these restrictions would not be lifted any time soon, and that their own lives might not be at risk, self declared rights for personal pleasures via personal choices took the lead.  Business, political and administrative leaders listened and agreed – the customers and the electorate are always right – right?  Nobody, of course, openly demands intentional sacrifice of lives [of others] for the pursuit of pleasure [for me].  Instead narratives emerged that focused on the needs of intelligent compromises, because we cannot close the societies, the loss of jobs would eventually cost more lives than corona (!), or less intelligent promises that you can, in fact, both ‘have your cake and eat it too’. 

Data and studies about both the 1918-19 Spanish Flu and the present Covid-19 pandemics demonstrate that these claims are wrong. If we target further ahead than a few coming weeks, the choice is not health or economy. They are inseparable, we either gain or lose both [for more information, read 1, 2, 3, 4, 5].  On April 20 I published my most read blog post so far, titled “Repelling the Corona Pandemic: It is not your money or your life but your money and your life” (in Finnish, sorry).

Are we approaching herd immunity …

The promise of both immediate lifting of restrictions and sustainable economic recovery in the midst of a raging pandemic, necessitates some factual, logical, intellectual and moral compromises.  Here in Finland (as well as dozens of other countries) many were led to believe, that the decline of the cases and deaths towards early summer had actually not taken place because of the restrictions, but instead, because the population was developing herd immunity or because the pandemic had run its course, fading away like they always do in the Spring. The time had arrived to reward ourselves, to have a party and to return to business as usual.  As only small percentages of the populations had actual serological signs of possible immunity, non-measurable or unproven immunity mechanisms, T cell and cross-reactivity with low risk endemic coronaviruses, were referred to as facts.  So far the most recent studies published in Nature conclude merely that the possible effects of pre-existing T cells on the SARS-CoV-2 infection should be carefully evaluated, and in Science that although it is plausible that T cell memory from earlier human coronavirus (HCoV) infections could contribute to COVID-19 outcomes, this is presently highly speculative.  There are no data to support a belief that antisera provided by individuals with confirmed infections of four endemic [and relatively harmless] HCoVs would be reactive against MERSCoV, SARSCoV or SARSCoV2

…or is SARS-CoV-2 losing its teeth?

Not surprisingly, when the restrictions were lifted in June … August (depending on the country), after a few weeks the cases began to pick up and increase exponentially, in places exceeding the levels observed in the Spring wave.  So much about the acquired herd immunity from non-observed Covid-19 infections, T cells and or cross reactions from endemic HCoV cases.  In spite of the increasing case numbers, however, mortality did not seem to be increasing respectively.  New explanations turned up: the virus had weakened and/or the treatments have improved drastically (health professionals’ favourite).  So we could, after all, stay relaxed even when the cases are again increasing exponentially – right?  Two facts make this conclusion illusionary.

First, we must differentiate between two terms, CFR and IFR.  Worldometers, Owid, ECDC, Johns Hopkins, WHO and others report daily and cumulative numbers of the observed [tested or otherwise diagnosed] COVID-19 cases.  These, however, are always underestimates of the contracted infections. In the Spring the real numbers of infections were in most countries much higher (in Spain 8 times higher) than the observed cases.  The coverage of testing has since grown much broader than it was in the spring (See table) and therefore many milder and non-symptomatic cases are presently identified, i.e., the numbers of the tested cases have since Spring been creeping closer towards the real numbers of infections. The table also demonstrates the strong linkage between the higher testing rate and smaller mortality rate. Still today, as in the Spring, the coverage of the testing varies greatly between countries.  Therefore, the case-fatality rate (CFR = number of Covid-19 deaths/diagnosed cases), as a valid indication of the risk, was rejected already in February…March.  For reasons, which include ignorance, comparisons of the CFR values between Spring and Autumn have recently appeared in the media as evidence that the virus has become weaker and/or the treatments more effective.  This remains an unfounded conclusion.  

Already in the Spring researchers and experts used different indirect methods to assess the actual infection-fatality rate (IFR = number of COVID-19 deaths/infected, including also unidentified infections). Not only were the COVID-19 cases underestimates (see above), but so were the COVID-19 deaths, and both to highly varying degrees.  The first robust and reliable population wide IFR estimates came from a few small towns in Northern Italy, Nembro and Castiglione d’Adda, where serological tests demonstrated that 60…70 % of the population had been infected, and a month later from Spain, where a nationwide population representative serological survey demonstrated that 5 % of the population had contacted the virus.  From these direct data supported by other indirect analyses the population wide infection fatality rate of Covid-19, the IFR, was established to be 0,7…1,4%. 

Second, in most countries the age profiles of the second wave cases have weighed heavily on adolescents who apparently trust that they would not personally be in danger.  COVID-19 appears in the current second wave to be less deadly much because its fatality for those below 30 years is only tiny fraction of the respective fatality for those above 70 years, i.e., IFR of 0,01…0,03% vs. 5…9%.  The fatality depends, indeed, so strongly on the age that all other risk factors, gender, blood group, underlying health condition and obesity pale in comparison.  There are no reasons to believe that the recent growth of the cases in the adolescents is not going to spread into the older age groups and eventually into the nursing homes, where the death toll will then surge.

And, indeed, computing case fatality data for the most recent weeks from Worldometers and Owid databases, the observed CFR is 1,8…2,1% for Spain and 1,8 % for the US.  Assuming that about half of all infections are presently identified and counted as cases, would yield an IFR of circa 1%, i.e., the virus has lost none of its fatality.

Sorry, No!

The conclusion that the virus has become weaker was based on two errors, first from ignoring that the CFR reduction from spring to fall is affected by the increased case identification (still below 100%), and secondly that, compared to Spring, in most countries a much higher proportion of the observed cases have recently occurred among adolescents with very low personal mortality risks.  In Finland since July 1st 40% of the observed new cases have occurred in the age group of 19-30, 31% in 31-50, but only 6% in the highest risk individuals older than 65 years. This age distribution, however, is creeping towards the older age groups.

In the beginning I noted the failure of the West in particular.  In most of East Asia, Australia and New Zealand the corona policies have preserved LIFE vastly more successfully than we here in the West.  Have they respectively failed in their pursuit of PLEASURE?  I see no indication of that, e.g., that the Australians, Taiwanese or New Zealanders would be less happy or more dissatisfied with their lives and governments than, say, the Britts, Spaniards or Americans.  I would certainly feel safer and enjoy my life more if I could go to dine in a restaurant, see a play in a theatre, my son’s new home in Helsinki, fly out to visit my daughters in Lombardia and Lyon or sister in Yorkshire in Europe where the COVID-19 cases would be under control and I would not be playing russian roulette with my life – the life of a 74 year old male with at least one extra risk factor.  I would certainly also spend more money on services, travel, culture and entertainment – the economy – in those conditions.

Vastaa

Täytä tietosi alle tai klikkaa kuvaketta kirjautuaksesi sisään:

WordPress.com-logo

Olet kommentoimassa WordPress.com -tilin nimissä. Log Out /  Muuta )

Google photo

Olet kommentoimassa Google -tilin nimissä. Log Out /  Muuta )

Twitter-kuva

Olet kommentoimassa Twitter -tilin nimissä. Log Out /  Muuta )

Facebook-kuva

Olet kommentoimassa Facebook -tilin nimissä. Log Out /  Muuta )

Muodostetaan yhteyttä palveluun %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.