SOME DAYS Scotland is aiming for a ‘Zero Covid’ strategy. Some days it’s aiming to ‘eliminate’ the virus SARS-CoV-2.
And some days, it seems we have no plan at all.
Professor Devi Sridhar, a most trusted adviser to the Scottish Government, openly muses about ‘Zero Covid’, qualifying what she means in various ways. Recently she wrote that when she said we should strive for ‘Zero Covid’, she meant ‘endemic virus’. These are not the same things.
On the 10th March, Nicola Sturgeon stated in Parliament that we must ‘eliminate’ Covid. Someone needs to challenge her to define ‘eliminate’.
The first rule of the management of any project is: determine and define your aim. When the project might destroy all the economic and social structures of your nation, establishing a clear aim seems an important place to start.
Until 2020/21, ‘endemic’ status of viruses has always come about with time and gathering high enough levels of community immunity through exposure.
Take ‘Russian Flu’: in 1889/90 we suffered a grim and frightening pandemic. [Read ‘An Uncommon Cold’]. It is now widely postulated that this pandemic was in fact caused by a Coronavirus (named ‘OC43’) rather than a flu virus. It makes little difference: it is estimated to have killed 1 million people worldwide out of a population of only 1.5 billion. When people became ill with Russian Flu, they developed high fevers, fatigue and central nervous system dysfunction. It was an extremely unpleasant way to die and very contagious. But for others infected, no doubt, they experienced mild or even severe illness, and did not die but recovered with varying speed and success.
This virus spread through the population for some years, apparently originating in St Petersburg, causing less death as time went on, mutating and evolving until it caused only very minor symptoms in the vast majority of its hosts. It quickly came to an overall peaceful understanding with the collective human immune system.
Have we achieved ‘Zero Russian Flu’ 130 years later? No!
You have very likely been infected with Russian Flu, especially if it was indeed coronavirus OC43, which is still in circulation.
You probably caught this virus as a child and experienced very normal cold symptoms – your mummy and daddy would have wiped your snotty nose and sent you to school or took you to the playground with unsanitised hands. You would have sneezed on your playmates, coughed over your siblings, hugged your grandparents with your runny nose and sore throat, and yet probably still not made many or any of your beloveds around you ill. You might have passed on your Coronavirus to a couple of unfortunate friends or family members and they would have tutted and rolled their eyes and said something like: “I must have caught it from the baby”. What a nuisance! But no hand-wringing seemed necessary and no quarantine was required.
Do you remember when we used to live like that? Free to be ill. When personal minor malaise was not a matter of public concern or record.
We have lived this way in an environment of ‘Not-Zero Russian Flu’ for around the last 130 years. And have you ever wondered where Spanish Flu has gone? The answer is: nowhere. If we tested the population for Spanish Flu and Russian Flu, we might well find them.
There was never a vaccination programme for Russian Flu. This was unfortunate for those who died or suffered Long-Russian Flu of course, but the point is that it is not necessary for humans to interfere with a virus to force it to get to ‘endemic’ status. It will get there all by itself. Obviously, if you can immunise a population early when a new virus appears with a safe and effective vaccine, thereby saving lives, that’s wonderful. Safe and effective vaccines are truly a miracle! Especially for high-mortality diseases or diseases which disproportionately affect the young (neither of which characteristics applies to Covid).
But we are unlikely ever to achieve ‘Zero Covid’, either with an effective vaccine or without.
The trouble for Zero Covid proponents/fanatics is that to get to that point of endemicity (if that’s what they mean), SARS-CoV-2 has to be allowed to circulate in the population. It has to have the chance to reside in the non-vulnerable. We mustn’t constantly challenge it to mutate and evolve to become more transmissible – and yet that is what restricting human interaction during an epidemic does: it forces the virus to mutate and evolve to be better at jumping the enormous hurdle we call ‘social distancing’. It, like us, will do whatever it can to survive.
My personal deep discomfort about striving through dystopia towards the utopia of Zero Covid lies more in my knowledge that there is a general lack of understanding in Government of how statistics work and how the Laws of Mathematics prohibit Zero Covid ever being achievable with testing practices as they are currently. This lack of understanding seems, worryingly, to be coupled with a stubborn unwillingness to learn and determination to discredit all who question policy. I wrote about why Zero Covid and mass testing cannot co-exist here.
New Zealand is often referred to as being a ‘Zero Covid’ zone. But is it? Here is a graph of spring and summer infections there:
The reader can see this is not Zero, even if the numbers are small. There is Covid present, and there is good reason to think that, any reduction in cases due to vaccination notwithstanding, there will be a rise in cases this coming winter. It looks rather like the situation in Scotland over the summer. Our low Covid period was shorter, but we have different climates and likely have different susceptibility to the virus. And no doubt, New Zealand’s being at the end of the line of travel in global journeys will have affected its ability to isolate itself from Covid.
I note that no-one seems to question in New Zealand whether drawing out infections over a longer time period might not actually be counterproductive. Are they giving the virus more of a chance to adapt in an unnatural and unhelpful way for humans in order for it to overcome ‘social distancing’?
The New Zealand strategy is perhaps less Zero Covid, and more ‘Long-Term Low-Level Covid’. In any case, they locked down hard and early, have closed their borders as completely as possible, they enforce quarantine in ‘hotels’ for those unfortunates who test positive – and they still have Covid present in the population.
(New Zealand, since 1st October and to the time of writing, has carried out just under 675,000 tests, and found just under 550 positives from those tests – a 0.08% positive rate.)
What is the only way to achieve zero cases of Covid? It’s to do zero testing.
The Drowning in Data blog is an excellent place to go for analysis of Scottish Covid data. In recent work, the blogger has analysed the testing data to find the number of false positives nestled in the results. The method is all referenced and it is possible to check the calculations for yourself. Here community testing has been split in to true and false positives:
The Scottish Government simply must know this by now; the majority of positives are false. It has been told many times. I and others from Inform Scotland and other groups have reached out to them repeatedly and consistently, and they have access to plenty of advice. It is not possible that there are no advisers aware of the problems of mass screening. We can correct for false positives very easily by doing confirmatory testing. If we did this it would mean we can rely on the tests to give back only true positives in the vast majority of cases. That would be a start along the path to ‘eliminating’ Covid.
So let’s say we made that start. We would perhaps return a similar number of positive results to New Zealand.
But why would we choose to continue with mass testing at all? What’s it for? Is it a good strategy, or is it madness?
The vast majority of Covid deaths have occurred in hospitals in the second and third waves. They are not happening in the community. The horrifying turn in Covid deaths occurring at New Year was really quite extreme and unexpected (and did not follow an epidemic pattern) and hospital occupancy and ITU occupancy rose. But with large numbers of hospital acquired infections, as has been widely reported, and all patients in hospital being tested on admission and repeatedly during their stay (and false positives in hospital seemingly largely uncorrected for) the rise in occupancy and hospital deaths is not necessarily the picture the public might imagine.
The picture is not: person in community gets sick, goes to hospital for treatment and then ends up in ITU being cared for Covid there. What is often happening is: existing patients in hospitals are acquiring Covid-positive status and we are having outbreaks in care homes, even after vaccinations. As a group, hospital patients and care home residents are high-mortality, and are tested frequently. Why is it a surprise that many with a recent positive test are dying?
Testing a patient in hospital may lend some value in treatment or in isolation of that patient. But obsessive counting of them, the announcements of these statistics, and their being used as justification for lockdowns is now totally senseless in terms of informing the risk to the public as they are (prevented from) going about their daily business. Testing is doing nothing to mitigate risk, nor to inform.
Is the testing predicting Covid deaths? No longer! It used to, but the correlation has been lost. Is the testing predicting ITU occupancy? Again: no longer! This has implications for planning, presumably, but it also infers that testing is not particularly identifying the sickest patients. This is shown below – the correlation is gone, especially in recent weeks:
So, the testing in the community is not identifying those likely to get the most ill or die and it is not effectively preventing true outbreaks in hospitals or care homes.
But it is creating an impression in the public mind of a risk to them which simply no longer exists to the extent being implied. Rather than Zero Covid, we are generating a mirage of more Covid than really exists.
We will arrive at endemicity with SARS-CoV-2 in a time determined by the laws of Mathematics and Immunology, but what we are doing now is probably coercing SARS-CoV-2 to mutate to become more transmissible through social distancing. And we are doing so much testing in the community, where people do not die of Covid, that we distort the clinical picture: we are not identifying the most ill, and we are diluting the seriousness of Covid.
As long as we test, we will always find Covid. We will never reach the utopia of Zero Covid.
We do not need to.
Christine Padgham was a health physicist who now is analysing Scottish health trends following the Coronavirus crisis with the help of many other professionals, scientists and activists on the website InformScotland.uk – where she posts on a daily basis.
Image by elenabsl from Adobe Stock.