Rembrandt van Rijn Student at a table by candlelight c.1642
We would by now have expected the narrative surrounding COVID19 to be simpler to understand, but it’s not. We may understand much more about the disease and everything that has to do with it, but we’re finding there is so much that has been left unsaid, not discussed, neglected.
The discussion has been stuck in an All Else Being Equal (Ceteris Paribus) mode, but all things do not remain equal. It’s not even as if you get rid of the disease, all your problems go away. Not only do various COVID measures inflict huge damage on economies, on people’s jobs and incomes, they also cause entire new sets of health problems.
Epidemiologists and virologists are not equipped for such massive problems. They may be able to say the odd wise word in their field -and even that will be 90% rear-view mirror stuff, because they must compare what they see to what happened in the past-, but the disease doesn’t only affect their field. It affects many fields they have no knowledge of.
Their ideas are then taken on board by economists, not exactly the most scientific of sciences, and off go the government policies. But that was 6-7 months ago, and we learned so much since, right? By now we have involved for instance mental health experts on a large scale, right? Yeah, sure.
The point is, you can’t force lockdowns, masks etc. onto people, without looking at what the consequences of that will be. Because all things do not remain equal for 6-7 months.
A nice example comes from a July 2020 study published in the Lancet, which indicates that “..the number of smokers in a population was correlated with a 3% decrease in covid deaths.. Wow, that’s great. Let’s get everybody smoking, said … nobody. But if your sole focus is COVID19, and for many governments it is, why not? That’s of course because smoking is one thing people recognize as “bad”. But how about other things, that are not?
That same Lancet study, as interpreted by a Sebastian Rushworth MD, also says there is no proof that lockdowns work:
The factors that most strongly predicted the number of people who died of covid in a country were rate of obesity, average age, and level of income disparity. Each percentage point increase in the rate of obesity resulted in a 12% increase in covid deaths. Each additional average year of age in the population increased covid deaths by 10% . On the opposite end of the spectrum, each point in the direction of greater equality on the gini-coefficient (a scale used to determine how evenly resources are distributed across a population) resulted in a 12% decrease in covid deaths. All these results were statistically significant.
Another factor that had an effect that was significant, but more weakly so, was smoking. Each percentage point increase in the number of smokers in a population was correlated with a 3% decrease in covid deaths. Ok, let’s get to the most important thing, which the authors seem to have tried to hide, because they make so little mention of it. Lockdown and covid deaths. The authors found no correlation whatsoever between severity of lockdown and number of covid deaths. And they didn’t find any correlation between border closures and covid deaths either. And there was no correlation between mass testing and covid deaths either, for that matter. Basically, nothing that various world governments have done to combat covid seems to have had any effect whatsoever on the number of deaths.
Which is intriguing, because countries like France, Belgium, Netherlands appear to have had spectacular success with their recent new lockdowns.
Problem is, you can’t lock down countries and people forever. And if the coronavirus has become endemic in the population, the “success” would seem to be inevitably short-lived. In the Netherlands just now, numbers were announced that already are 15% or so up from the 24 hours before. What if a lockdown is not the answer, or not anymore at least? I don’t have the impression that there is a Plan B.
But it would appear to be useful to by now stop throwing all “cases” on one heap, and find a better definition, for instance “positive PCR tests”. Or even “positive PCR tests that require medical attention.” And you will also have to define much better who requires that attention, and who dies. If you’re talking, say 90%, only about people who are either very old and/or have severe underlying conditions, maybe a general lockdown is not your thing.
Maybe you should aim to protect these vulnerable groups, and leave the rest alone. Maybe obese people, who are very much at risk, should be locked down, but not their fit and slimmer neighbors. Maybe you should ban food that causes obesity and diabetes, maybe you should hand out Vitamin D to everybody. Maybe you should simply accept that some people are going to die of the disease.
Whatever else you do, maybe you should prepare for the risk that the virus is endemic, and it’s here to stay. And then take it from there. Because, for one thing, it’s not all that obvious, it’s all still riddled with misconceptions. Renowned medical site medrxiv.org has this:
Close contact with children may provide cross-reactive immunity to SARs-CoV-2 due to more frequent prior coryzal infections from seasonal coronaviruses. Alternatively, close contact with children may increase risk of SARs-CoV-2 infection. We investigated whether risk of infection with SARs-CoV-2 and severe outcomes differed between adults living with and without children.
This is the first population-based study to investigate whether the risk of recorded SARS-CoV-2 infection and severe outcomes from COVID-19 differ between adults living in households with and without school-aged children during the UK pandemic. Our findings show that for adults living with children there is no evidence of an increased risk of severe COVID-19 outcomes although there may be a slightly increased risk of recorded SARS-CoV-2 infection for working-age adults living with children aged 12 to 18 years.
Working-age adults living with children 0 to 11 years have a lower risk of death from COVID-19 compared to adults living without children, with the effect size being comparable to their lower risk of death from any cause. We observed no consistent changes in risk of recorded SARS-CoV-2 infection and severe outcomes from COVID-19 comparing periods before and after school closure. [..] Our results demonstrate no evidence of serious harms from COVID-19 to adults in close contact with children, compared to those living in households without children. This has implications for determining the benefit-harm balance of children attending school in the COVID-19 pandemic.
And yesterday we had this from Reuters: “Anxiety, depression and insomnia were most common among recovered COVID-19 patients…and the researchers also found significantly higher risks of dementia…”
One of the Automatic Earth’s in-house doctors, Doc Robinson, rightly said qualifying insomnia as a mental illness is a very broad stroke. Whereas my attention was drawn to this line:
“.. people with a pre-existing mental illness were 65% more likely to be diagnosed with COVID-19..”
How does that work? Why would you be 65% more likely to catch COVID, or be diagnosed with it, if you’re already depressed? Depressed people are more likely to attend Trump rallies? Or Biden celebrations?
Many COVID-19 survivors are likely to be at greater risk of developing mental illness, psychiatrists said on Monday, after a large study found 20% of those infected with the coronavirus are diagnosed with a psychiatric disorder within 90 days. Anxiety, depression and insomnia were most common among recovered COVID-19 patients in the study who developed mental health problems, and the researchers also found significantly higher risks of dementia, a brain impairment condition. “People have been worried that COVID-19 survivors will be at greater risk of mental health problems, and our findings … show this to be likely,” said Paul Harrison, a professor of psychiatry at Britain’s Oxford University.
[..] The study also found that people with a pre-existing mental illness were 65% more likely to be diagnosed with COVID-19 than those without. Mental health specialists not directly involved with the study said its findings add to growing evidence that COVID-19 can affect the brain and mind, increasing the risk of a range of psychiatric illnesses. “This is likely due to a combination of the psychological stressors associated with this particular pandemic and the physical effects of the illness,” said Michael Bloomfield, a consultant psychiatrist at University College London.
As I said two days ago: “Just lovely! If you catch COVID, you get mental health issues. And if you go into lockdown so you don’t catch COVID….you also get mental health issues.”
Children hardest hit by Covid-19 measures have regressed during the pandemic, with some who were potty-trained pre-lockdown reverting to nappies and dummies, and others forgetting basic numbers or how to use a knife and fork, according to the schools watchdog Ofsted. Older children have lost physical fitness as well as reading and writing skills, and some are showing signs of mental distress, which can be seen in an increase in eating disorders and self-harm, according to Ofsted’s chief inspector, Amanda Spielman. [..]
The findings, based on 900 visits to schools and social care settings by Ofsted inspectors since schools fully reopened in September, paint a worrying picture of the impact of the pandemic on children at every stage of the education system in England. While children with good support structures have coped well, those whose parents were unable to work flexibly and have therefore been less available to help have lost out most. Children with special educational needs and disabilities have been “seriously affected” across all age groups, both in their care and education, losing vital support including speech and language services.
Lockdowns are based on pretending we can make time stand still. That, like in one of those slick videos, everything else stops moving while you can walk around it. All Else Being Equal. It never is, not for 6-7 months. And that the first lockdown didn’t work, at least not for long, should perhaps be a lesson. Maybe you should look for answers elsewhere. Because the damage just goes on, economically, psychologically, physically.
I’m not pretending I have the answers. I do have questions though. While the situation reminds me of Sisyphus, forced by Zeus to roll a boulder up a hill for eternity. Every time he nears the top of the hill, the boulder rolls back down.
We need to find a balance between the threat of COVID19 and the threat of everything else, very much including those things that are caused by our approach to COVID.
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