A Covid Recap

One purpose of this blog is for me to be able to pin down what I was thinking on particular subjects at particular times in order to spot patterns of inattention or self-deception.  I have enjoyed occasionally finding myself to have been prescient on certain things as they developed.  I have benefitted from finding myself to have been . . . well any number of things on other topics.  Slow, too trusting of emerging data, not trusting enough of new data, overly-skeptical, insufficiently skeptical, too reliant on rules of thumb, etc.  

While I have been commenting on Covid-19 over the past couple of years (all posts here), I have reiterated the constant refrain, “We really don’t know what is going on with Covid-19.”  A refrain nearly as true today as back on February 27, 2020 in my first post commenting on the experience of Taiwan with Covid-19.  In that post there is another theme which has also been consistent across these two years - Only when we ensure the free flow of information in a democracy can we construct a healthy society.  

To counter and control a viral epidemic, both government and civil society need sufficient information. The characteristics of a democratic society are openness and transparency, which promise the public access to information. On the other hand, a democratic government also has to take responsibility for communicating with people because leaders are accountable to the public. Only when we ensure the free flow of information in a democracy can we construct a healthy society. Besides its strong public health infrastructure, Taiwan proves that the democratic strategy is successful in curbing the spread of the new coronavirus – which is why Taiwan is outperforming its authoritarian neighbor, China.

Most of my posting has been about new data, new research, skepticism of some of the public health conclusions drawn, comparisons between countries, and criticism of the mainstream media for inaccurate, simply false, or manipulative reporting.

Most of those issues are still present but in much clearer form than they were at the beginning.

I thought now, when perhaps we are finally turning the corner and reverting to what we should have been doing all along, might be a good time to gather my thoughts and impressions as a synthesis of these two years.  What do we think we now know to be usefully true that was not known with confidence at the beginning?

In the beginning there was the word and the word was Covid-19 or Wuflu or Wuhan virus, etc.  In other words, from the very beginning this pandemic has been politicized when it did not need to have been and should not have been.  That complicates things significantly.

So what do we know now about the beginning?

Origins of the virus

From the very beginning, there has been bad reporting.  News of the virus was presented by China, and taken as an article of faith by US mainstream media, as a zoonotic virus where transmission occurred from animal to human in the Wuhan wet markets.  This was the first of many narratives which ended up collapsing despite desperate efforts by Fauci, mainstream media, and various governmental agencies to keep it on life support.  

We don’t know how the virus first jumped to humans.  The wet market hypothesis remains a viable, but seemingly unlikely, hypothesis.  The alternative hypothesis, that the virus was developed under American auspices via funding from the National Institute of Health through research conducted at the Wuhan Institute of Virology is now accepted as an alternately plausible explanation.

There was massive institutional resistance to this conclusion up until 6-12 months ago when the Government, Fauci, and the mainstream media finally gave way to a tidal wave of new evidence suggesting that this was a lab escape not a zoonotic origin.

I noted this on October 21, 2021 in Snoopy brings down the Red Barron. 

We are left with the remarkable scenario that the single senior official who most likely created Covid-19 was also the one put in charge of responding to the pandemic he created.  Also, he was in charge of investigating whether he himself had committed any wrong-doings.  Remarkable.

Of note was the fact that of the 27 scientists who had denounced the hypothesis that the China virus came from the bio-weapon lab in Wuhan, 26 had links to that lab.  One of the long list of critical pieces of information not investigated by our mainstream media (MSM).

John Tierney was already on top of this in the summer of 2021 when he published The Panic Pandemic, Fearmongering from journalists, scientists, and politicians did more harm than the virus. 

Estimate -  My estimate is that there is a 70% probability that this was a lab escape.  I also am willing to go with 70% for the idea that the mutated virus which escaped was from an American supported line of research.  Distinctly possible that it might have been a parallel Chinese line of research but we have a lot of documentation on our research which puts it in the lead.  

Early evidence of the virus

Since it was first reported by China in December 2019, there have been claims of the earlier presence of Covid-19 outside of China.  I seem to recall China actually pushing this idea for a while.  

I was open to this idea as well.  In late 2019 I was working closely with a client who, though American, was China born and closely integrated into the American Chinese community and who periodically travelled to China.  She was deeply ill over a couple of months with a bad barking cough.  At the time it seemed just a bad and persisting respiratory illness.  With the confirmation of a new and highly contagious virus out of China in December 2019, I held the suspicion that perhaps that was what had been afflicting my client.

But since then, though there have been many claims, I have not yet seen much compelling evidence of an earlier presence in the US than that of the first confirmed case on January 21, 2020 in a traveler who had returned from Wuhan on January 15th.  

But it is possible there might have been earlier cases based on this information from Roger Pielke.

In 2016, at 1:15:50 of video linked, Peter Daszak describes research done by Chinese colleagues to increase the pathogenicity of SAR-like viruses ("you insert the spike protein") from bats to produce viruses that "really do look like killers"https://t.co/rMVVSHBisa pic.twitter.com/JH1Tam9lgE

— Roger Pielke Jr. (@RogerPielkeJr) June 9, 2021

We know the Covid research was being done as early as 2016.  Was it far enough along?  I doubt it.  Were there earlier escapes from WVI?  That is a distinct possibility but I doubt there were any accidental releases which took hold.

Estimate – I think the best information is that the first case was in the US on January 21st 2020 and there were no earlier cases here.  I would put that estimate as high as 80% and it would be higher except that we don’t know what we don’t know.  Much of the most important information on the early spread is in China and we don’t have access to that information.  Or confidence in that information either.

Early spread of the virus outside of China 

Here the story gets very complicated.  We know (reasonably confidently) the first case in the US.  But much of the early concern was centered in countries like Italy where it seemed to be sweeping like a wildfire through the population with very high death counts, especially among the elderly.  

The Italian government recently lowered their estimated Covid-19 death count by nearly 90%.  I understand the revision was driven by a retroactive estimation based on the distinction between dying from and dying with Covid-19.

This introduces one of our most dramatic public health failures of the whole pandemic which has been present from the start.  Across most countries, there has been a major failure to adequately define Covid-19, deaths from Covid-19 versus deaths with Covid-19, failure to define degrees of severity (hospitalization, ICU, ventilation), failure to define asymptomatic Covid-19, etc.  In most countries, the data is abysmal.  The US not excepted.

Estimate - I think that the actual pathway of contagion won’t be known for a good while, perhaps ever.  Since airports were not locked down for a month or two after Covid-19 had been identified, there was a shotgun blast salting the world with possible transmission sources.  The actual pathways and volumes would have been highly contingent on particular circumstances.

Initial pandemic response plans

Fortunately, the World Health Organization (WHO), the Center for Disease Control (CDC), and most developed countries had well developed plans on how to respond to an emergent pandemic.

Unfortunately, for reasons yet unknown, we discarded those pre-existing evidence-based plans.

Both the CDC and WHO plans acknowledged the lessons learnt from past epidemics.

That it is important to address both treatment of disease along with prevention of disease.

That population masking is at best marginal in its effectiveness and mostly ineffective when considered at a population level.

That population lockdowns are ineffective at stopping contagion.

That strategies should be narrowly targeted at those most vulnerable.

Again, this was research conducted before 2019 and prior to Covid=19.  This was known, researched, and documented policy.

While details about every pandemic are unique, especially in terms of who might be the vulnerable population, the broad lessons have been pretty clear.  These were deeply researched and broadly supported conclusions by multiple committees of credentialled experts in many countries.  This was the established baseline of knowledge.

And in the very early days, there seemed to be some awareness of that pre-existing knowledge.  As countries shutdown air travel from China it seemed in most cases not to be part of a general shut down but an intentional effort to slow the initial transmission.  In other words, it was a delaying tactic, not a strategy.  

The US instituted its ban on air travel from China on January 31st despite strong domestic political opposition and criticism.  This was the same day WHO declared a Global Health Emergency based on 200 deaths in Wuhan.  

Estimate – Travel restrictions were only ever a stopgap to buy everyone time to prepare for Covid-19.  Recalling that very little was yet known about the nature and progression of the disease with any confidence.  I am guessing that the travel restrictions probably bought us 2 weeks to two months of slowed transmission.  My estimate is only at 50% confidence that we obtained as much as two months of delayed transmission.

Early US pandemic responses

From January 31st, 2020 to December 11th, 2020 was a critical window in terms of our response.  December 11th was the first Emergency Use Authorization (EUA) of the Pfizer mRNA vaccine.  While the mRNA was relatively novel in terms of vaccines, the technique itself was reasonably familiar and there was much earlier work done on other Covid related diseases, MERS and SARS.  

In those ten months, something happened and I don’t know what it was or the mechanics by which it occurred.

We focused on vaccines to the exclusion of treatments was one trend which emerged during those ten months.  

The other trend was the apparent but not explicit adoption of a Zero Covid policy.  We sought to stop Covid rather than manage and treat it.

This latter was perhaps the more devastating decision.  Some countries such as Australia and New Zealand have been explicit about this decision.  In most other countries, including the US, it has been implicit.

From my perspective this decision, whether emergent or planned, was a major and negative detour away from better outcomes.  And it reflects to some degree a bifurcation of expectations among experts at the beginning.

Early on, there were one set of experts who argued that, while Covid-19 was unknown and unfamiliar and that though we had to be cautious, this wasn’t a great emergency.  This wasn’t Ebola, or the Black Death or the Spanish Flu.  We needed to execute our existing pandemic plans but not go haywire.

The other camp, from their actions, advocated going haywire.  They threw out the rule book, endorsed masking, lockdowns, and mandated vaccination.  

This makes sense when dealing with a high transmission, high virality virus.  The Black Death (a bacterium Yersinia pestis spread via rats) had high rates of transmission and a high rate of lethality.  These kinds of pandemics will scythe a population down.  There are few treatments and no way to effectively reduce transmission (at least at that time).  The only advantage is that such plagues are self-correcting.  They tend to recur over time but in each subsequent wave, they are usually less lethal.  It is a basic evolutionary issue.  If Yersinia pestis killed all hosts, it would end its own line.

Which is why most plagues, of whatever origin, always eventually attenuate, becoming less lethal at the least, even if they become more transmissible.  That end state where there is a balance between spread and reduced lethality is known as being endemic.  Host and virus are in an infinite dance of evolution with one another.  

So the early question when Covid-19 popped up was whether we were facing a plague like the Black Death with high mortality and high transmission or whether we were facing a virus which would be endemic. 

Initially stories and data out of China created an impression of Black Plague.  There were videos of people simply collapsing in death as they walked the streets of Wuhan.  Videos of families being welded shut into their apartments.  

But once it began to spread in the US, early data was already mixed.  It seemed moderately infectious but low lethality.  Still very much a problem, but also certainly no Black Death scenario.

So what happened?  Why did we effectively fall into a Zero Covid strategy?  I don’t know.  We might not know for a long time.  My guess is that at least the CDC, and almost certainly politicians as well, were highly incented to be seen to be doing something.  A crash program on vaccine development was one step in the right direction given these incentives but that could not be counted on to deliver something within a year

We should have been rigorously scanning and exploring treatments to deal with those who had already contracted Covid-19.  Instead, most of the emphasis was on developing a vaccine which would immunize people to Covid-19 and arrest transmission.  In addition, what little structured work being done on treatment was at the state level and was routinely mired in political controversy.

Ivermectin was an example.  Does it provide either prophylactic protection or symptom reduction?  I don’t know.  I see some very strong research from overseas that indicates a strong effect.  Most US research does not.  Other developed country research seems a mixed bag.  

For the duration of 2020, if Trump suggested a possible treatment, it was de facto condemned in the MSM, academia, and the research establishment.  Regardless of the much more positive findings overseas.  Across the board, it is not clear to me which of dozens of possible treatments work to what degree.  I am confident that some do because that is the past pattern in epidemics.  But which ones?  I have little confidence in knowing which are effective.  

And mostly that is due to the politicization of the pandemic rather than the actual research.  

The net result has been that from mid-2020 till today, our official policy seems to be Zero-Covid.  Instead of slow the spread, “Fifteen days to flatten the curve”, we seem to have defaulted to a maximalist “We will stop Covid”.  

Zero-Covid is the wrong strategy for what will be an endemic disease.  

Estimate – I have a 90% confidence we will eventually come to the realization that Zero-Covid and its associated policies were the wrong decision and that we suffered excess and avoidable deaths by pursuing such a strategy.  Not just Covid deaths but the associated deaths from lockdowns.  It is very striking that countries (and states) with the harshest lockdowns also seem to show no reduction in their all-causes mortality rates.  Indeed, a good number seem to be seeing increases in all-causes mortality, suggesting that the negative health consequences of the lockdowns exceed any benefits in death from Covid reductions.

TBC