Covid Plan B
A New Zealand household case of the UK variant triggered another short lockdown in New Zealand. This will have prompted many of us to wonder “when will covid end?” The answer requires considering that we won’t eliminate the virus, and nor do we need to.
I was recently invited by a Canadian group to debate the motion that all countries should aim for “zero covid”. My opponent, health economist, Dr Stephen Duckett waxed lyrical about the virtues of the zero covid, since he was at liberty to attend the Australian Open tennis tournament.
He talked about the relative freedom of elimination compared to the UK and US which were enduring constant restrictions and high rates of infection. The podcast was freshly posted when Victoria went back into lockdown, as did the chances of Stephen seeing Novac Djokovic play live. I briefly felt self-satisfied that it wasn’t New Zealand, but within days it was. Auckland was back into level 3.
People may rightly hope that vaccines will be the answer. After two doses, the Pfizer vaccine was claimed to reduce infection rates by 95%, with 8/21,720 cases in the vaccinated and 162/21,728 in the placebo. The rate at which these vaccines has been developed is a testament to human determination and skill.
However, we must also ask, why do most vaccines take ten years to develop and have we cut any corners? It is now clear that we simply do not know what the long-term benefits and safety profile of the vaccine will be. In South Africa, a trial of the once claimed 70% effective Oxford-AstraZeneca vaccine was rendered ineffective due to the emergence of the new variant with 19/748 in the vaccinated group infected, compared to 20/714 in the placebo.
Unanswered questions now are how effective the Pfizer vaccine is in the elderly, since in those aged 75 years or more there was only a total of five cases, with all occurring in the placebo group. While this is promising, it would be useful to have more definitive evidence about the elderly, since they are the target population for preventing fatalities from covid. There is little evidence on the ability of the vaccine to prevent their hospitalisation and death, which are surely the events we are hoping to prevent.
Since respiratory viruses frequently mutate, vaccine efficacy is unlikely to persist. We have seen this already with the Oxford vaccine, and the covid-19 end game remains unclear. As we’ve experienced, long periods without a community case are inevitably punctuated by community spread from the virus. As others have stated, it is a “tricky virus”. Indeed SARS-CoV-2 has been found in cats and dogs. The latest case indicates the limits of human understanding of transmission as we scratch our head about the source.
With all this uncertainty, unexpected good news has emerged, but you are unlikely to read about it in the newspaper. Hospital mortality in New York has dropped by a staggering 70%, comparing rates in March 2020 to August of the same year. While this suggests the introduction of new treatments, it is actually likely to be the opposite, in that less aggressive use of ventilators were likely to have improved survival in hard hit areas. Doctors in Toronto, like the public, were gripped with fear, initially quick to reach for the endotracheal tube, and have now realized the virus is not as deadly as they feared and become less trigger happy in reaching for the ventilator. The same pattern is replicated in both Italy and the UK. The finding of widespread covid-19 positive antibodies in Italy in September 2019 and a positive waste water test in Barcelona in March 2019, support the conclusion that it has been the response to the virus that has led to spikes in fatality.
What does this mean? We have all been gripped with fear from the virus. The government, as well as some doctors, have assumed that extreme caution will inevitably guide the best response. I believe this is well intentioned. However, this has led to preventable fatalities in some intensive care units, and to extreme public policy responses, that have prioritized the battle with this virus over all other health concerns.
Intensive care doctors had to learn that being cautious did not necessarily save lives, and instead led to harm. We need to learn the same about lockdowns and vaccines instead of naturally acquired immunity.
The concerns of livelihoods from small businesses, fiscal responsibility and mounting government debt have fallen into the background. Civil liberties and our way of life have faced the greatest restrictions since World War 2. Like doctors, our public policy makers need to dial back the fear, and contain the unintended consequences created by unnecessary, myopic, and destructive goals, such as the pursuit of national elimination of SARS-CoV-2.
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