Public Health vs Panic

Last year the World Health Organisation’s Global Influenza Programme published Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza.  Coronavirus is not an influenza but it is a respiratory virus with similar genetic material, similar transmission with epidemic/pandemic potential and similar human illness, so this document is highly relevant to the Covid-19 pandemic.

The document “provides recommendations for the use of NPIs in future influenza epidemics and pandemics based on existing guidance documents and the latest scientific literature. The specific recommendations are based on a systematic review of the evidence on the effectiveness of NPIs….”.

Table 1 on page 3 (Recommendations on the use of NPIs by severity level) includes this section:

WHO NPIs 2019

It is a 91 page document providing a lot of useful information about what is recommended and what is not recommended, and why.  Yet it appears to have become redundant.  Is evidence really driving policy on this pandemic?

When China locked down Hubei Province in January, they stopped public transport, created road blocks, ordered everyone to wear a mask and to stay inside.  World Health Organisation called it “unprecedented in public health history” (although I don’t think so because China have locked down communities with dubious success and significant societal disruption in previous pandemics such as SARS).  Yet lockdown has become standard public health practice across the globe in the six months following.

China also censored and “disappeared” people who said the wrong thing about the outbreak.  Video footage of Indian police beating tuk tuk drivers and street vendors violently for committing the crime of being outside is etched in my brain.  Police killings in the favellas of Brazil’s cities have risen by 30%, with one headline stating “instead of doctors to help us, they send the police to kill us”.

Between February to May UK hospitals saw 5,000 less admissions due to heart attack than the expected number.  Many of these will be pushing up excess deaths data which were initially promoted as “even more Covid-19” but appear now, to be deaths caused by health care inaccessibility.  Great Ormond St Hospital for Sick Children in London reported a rise in badly abused babies from an average 0.67 cases per month in the preceding three years, to 10 per month during lockdown, which is a rise of 1493%.  It is thought that as people are not accessing health services, the figures for non-life-threatening abuse are likely extremely high.  Impoverished nations fare even worse, with food and shelter cut to millions as daily incomes are no longer available.  Programs addressing the three big killers, TB, AIDS and Malaria have lost many years of progress.  WHO and UNICEF report “an alarming decline” in the number of children being vaccinated.

Britain and America are currently in the throes of “Face Mask Wars” as mandatory face masks enter into law.  One camp are planning anti-mask rallies and the other are demanding police action against bare faces.  There is a science behind the use or otherwise of face masks which relates to the size of the holes in the material compared to the size of virus particles, as well as considerations like ensuring you have the right fit, how to wear it properly, when and how to change it, how to dispose of it safely.  The WHO NPI document, based on the science of how they work, recommends use of face masks in quite specific situations.  The document is referring specifically to medical masks, but in 2020 promotion of cloth masks appeared from the need to reserve medical mask supplies for the places where they are actually needed.  However a recent study trialing cloth masks against medical masks found that penetration of cloth masks by particles was almost 97%, they retain moisture and have poor filtration, therefore likely increasing the risk of infection.

Page 47 of the WHO document states “Home quarantine of exposed individuals to reduce transmission is not recommended because there is no obvious rationale for this measure, and there would be considerable difficulties in implementing it“.  Australia have resources to accommodate and support people in enforced quarantine and as WHO’s evidence discusses, studies have shown that a majority of Australians say they would comply with quarantine, although willingness is affected by individual circumstances.  In countries where poverty consumes life, quarantine is a completely unreasonable and lethal measure.  There are places in our world now where, if you stay at home you will die of hunger but if you go outside you face a high risk of violence by the authorities, who have zero public health training or insight.

Today it was reported that Public Health England, whose role is to lead the pandemic response and includes counting and reporting Covid-19 deaths, are not only counting those who die with a current Coronavirus infection but also anyone who ever had a Coronavirus infection who subsequently recovered completely before dying of another cause.  One plausible guess for why such a bungle could happen is an overburdening of services trying to implement unrealistic measures and consequently working in chaos.

One calming piece of news is that another study has supported the findings about T-cell immunity. T-cell immunity doesn’t show up on antibody tests, but has been found to play a significant protective role in Covid-19 infections.  If your T cells are in good shape and have some memory of other Coronavirus exposures (eg those responsible for some common colds), they will likely put up a good fight.  This explains the mysteries around why most infections are either asymptomatic or sub-clinical and the confusing reports around antibody tests.

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