COVID logic vs the public health army

“There are two schools of thought… Science stands for healthy scepticism… asking for better evidence… Then you have a second school of thought that is public health… it has the stance that we have a crisis, we are like an army, the platoon must do this or that. Anyone who leaves the platoon must be shot down.”

I like the way John Ioannidis has characterised the COVID public health response. The science and scepticism approach has been overridden by the public health army approach, which has little need for evidence. I recommend his presentation in this video, which is the source of the above quote.

The two schools of thought might explain the “you are better than this” responses I sometimes get on Twitter when I raise concerns that the public health policy seems detached from the scientific and logical reality. I hope it’s because they want me in their army. I hope it’s not because they have given up seeking the truth. 

For some reason, I have a brain that can’t stop trying to seek out contradictions and the underlying logic that makes sense of the world. Scientific scepticism seems hard-wired. For example, when I look at Australia’s superannuation system, logic forces me to conclude that the system as a whole makes funding retirement harder, not easier. So I say we should dismantle it altogether.

I predicted that house prices in Australia would rise in May last year and people scoffed. Someone told me I should hand back my degrees. But the underlying logic I saw was correct (or at least useful for prediction).

Being right when the mob is wrong is, unfortunately, never popular.

In fact, a good rule of thumb is that there is no new information when someone says something popular. There is a huge amount of information when someone risks their reputation to say something. This is why John Ioannidis remains one of the few experts whose words contain actual information. He risks his reputation to say them.

This blog post is about the scientific and sceptical school of thought on COVID policy. It provides a glimpse of the contradictions and the underlying logic I see at play. Some of my previous thoughts and comments on COVID policy can be found here.

Seeking logic and evidence

Vaccines are the path

The current marching song is that vaccines are the path to freedom. Recently promoted by the Grattan Institute, an 80% vaccination target gets discussed as the key to returning to normal life.

There are two problems with this. First, getting 80% of adults vaccinated is quite difficult and has only been achieved in a small number of places.

Second, highly vaccinated places are getting COVID, some more than at any time before (e.g., Iceland, Israel, San Francisco, with surely more to come). While vaccines appear to be reducing mortality rates from COVID, differentiating the effect of the vaccination from the effect of previous population exposure is quite a challenge.

It seems to only make sense to vaccinate the elderly given the risk relativities and the limited effect on transmission.

Blaming one side of politics or the other for the “botched vaccine rollout” looks like nonsense to me when the experience elsewhere is that the level of vaccination is not having a major effect on subsequent virus waves.

Masks work

The only problem with this idea is that you cannot see it in the population-level data. In fact, you cannot even see much evidence that masks work in surgical theatres. Here is a thread containing many studies showing they don't. 

Masks have become political symbols. And people love it.

The seasonal resurgence of COVID across the US despite vaccination and masking is quickly turning into a political problem to be manoeuvred around, not a health issue. Yet more signs that COVID policy is not health-driven.

Vaccine passports

Another chant I hear is that vaccine passports are necessary. But if vaccines work, we do not need a vaccine passport. The vaccinated are not at risk and their presence in the population reduces virus spread regardless. If vaccines do not work, then a vaccine passport is not stopping the virus from circulating and spreading amongst the vaccinated.

Notably, the recent data shows that vaccines wear off and vaccinated people get COVID at quite a high rate compared to unvaccinated (perhaps as much as 80% after six months) and are likely to transmit at a similar rate. This is why vaccine boosters are being planned. 

I cannot see how the current crop of vaccines gets anywhere near a reasonable benchmark for restricting movement. Most people when pushed seem happy that vaccine passports would be used as an incentive to get vaccinated rather than as a direct health measure. 

R0 talk and “exponential” threats

Despite a high reproduction rate and infectiousness, many COVID Delta waves have fallen off dramatically with relatively low infections (e.g. India). R0 does not seem to give any indication of the final size of an outbreak. 

Another big unknown in the modelling is the degree of prior immunity in terms of the variation in COVID waves over time and between regions (such as if previous local viruses conferred some protection in the population), and in terms of potential for reinfection.

Lockdown cost-benefit

The lack of discussion about costs and benefits from masks and lockdowns is mass willful blindness. When an attempt is made, or some concession is made that the approach of evaluating costs and benefits is sound, usually another panicked argument is substituted instead.

Way back in the early days of COVID we saw some appalling attempts at cost-benefit analysis. One was out by a factor of 1,000! You could not be more wrong if you tried. Despite this, these same people are pretending to have been right all along and are still being taken seriously by the media.

That basket case Sweden

Sweden had a roughly 5% increase in total deaths in 2020 with no vaccine and no lockdowns (98,000 against ~93,000 expected deaths). For context, total deaths increased 5% in Australia from 2015 to 2017 (144,000 compared to 137,000 due to a 1.5% increase followed by a 3.5% increase). 

Sweden saw no increase in deaths in any age group under 50 years.

When faced with these facts some say Sweden did reduce mobility voluntarily and that made the difference. But this merely implies that compulsory masks and mass lockdowns are not necessary and do not make a difference. You cannot have it both ways.

Kids and vaccines

Plenty of medical experts and ethicists warn about the risks of vaccinating children. They are rightly cautious. If one death per million from the AZ vaccine applied to Australian children that would kill 7 kids if they were all vaccinated. How many would it save? Given the low risk of COVID in children that number seems to be roughly 14 to 20. Are you happy with that trade-off?

This paper estimates the likely range of vaccine-related deaths if 80% of 18-59 year olds are vaccinated at 17 to 153. Given how little vaccines seem to stop virus transmission these risks need to be carefully assessed. 

Suicides

A concern of mine has been that lockdowns would result in a rise in suicides. Thankfully that has not happened, but that does not mean there is no harm from lockdowns. U.S. data is showing a 50% rise in emergency department visits by teenage girls involving suspected suicide attempts.

The material prepared for quarantining households is predicated on the fact that forcing people to stay in their homes for weeks on end will lead to people bashing each other. Recent surveys of domestic violence care agencies suggest this has been the case. 

Surveys show huge increases in depressive symptoms during lockdowns. These human well-being costs are real. 

Media reporting for the army

I want to also demonstrate how easily the media falls into line with the public health army.

You may have seen the below chart showing that death from the AZ vaccine is less likely than being killed by a lightning strike in any year. Did you ever question it?

I did not at first either. But once your logical mind is brought into action you have to ask some questions. This is a classic example of the media picking and choosing “facts” and repeating them until they become the truth. Here’s the AMA President repeating it. Expect to hear it in casual conversation.

But there are two problems with this “fact”. First, the AZ vaccine has seen 7 deaths in Australia from roughly 7 million doses, so that risk is closer to double the 0.5 per million presented. Much more for all side-effects. Second, a risk of 0.4 per million for lightning strikes implies about 10 lightning strike deaths in Australia per year. But in reality, it is usually less than 2 (average of 1.9 for the past decade). So this is overestimated by a factor of five. 

These two corrections mean that the AZ vaccine is ten times more likely to kill you than lightning. This “fact” is off by a factor of ten. The vaccine risk is still low. But this is hugely misleading and certainly is not going to promote trust in authorities when the error becomes more widely known. 

Do you think the author of the original article presenting this “fact”, or the editors at The Conversation, actually care? Nope. 

I have been reliably informed that someone with a keen eye for statistics approached the author to request they update the chart with more accurate statistics (their original lightning strike stats were simply lifted from here). But no. No action. The editors prefer to keep the wrong statistic on this hugely important topic rather than issue a small correction. Off by a factor of ten is totally acceptable as long as you are marching with the public health army. 

And what of the risk of people dying with COVID? Why not put that on the chart and make a decent comparison. There has been almost no attempt at putting COVID risk in context in the media. 

Perhaps the reason is that the data doesn’t sing to the public health army marching song. Take the Swedish data again. For ages 0-19 the risk of dying from COVID after 18 months of community transmission including two waves of infections, mostly with no vaccine, masks or lockdown, was 3.7 per million (9 deaths out of 2.4 million population). On an annual basis that is 2.5 per million. If we partition the data to account for co-morbidities, a healthy young person’s risk of COVID death gets much lower. Lower than the one in a million risk from the AZ vaccine? Probably not. But not a big difference, and certainly not enough difference to warrant the calls for rushing to vaccinate children. 

Another place the media seems to be wrong is the story that vaccines produce better immunity than recovering from COVID. You might have heard this or seen a tweet like this.

So let us check the source of this claim. Nope. The study has no comparison between recovery-induced immunity and vaccine-induced immunity. It does show that some well-known immune responses do wane over time after infection. But this natural immune response may still be more persistent than the response from vaccines. However different evidence would be needed to establish the relativities. That doesn't stop the authors from making this claim, which is strange considering that one of the findings is that there is a subpopulation of people with a super strong and persistent immune response. Could they be simply chanting the public health army marching song?

Predictions

All of this has been a long-winded way of saying that a lot of what you hear about COVID and vaccines and the effect of our policy choices is incomplete, misleading, or plain old wrong. The one part that does make sense is quickly getting vaccines to the elderly—the overwhelming evidence for this conclusion is why every place is doing it regardless of differing views on masks, lockdowns, vaccine passports or border controls. In my view, vaccinating the elderly is one of the few policy actions the evidence favours. 

The rest of the actions only make sense if you are in the business of marching a public health army and don’t care where that army is going or how many of its own it loses along the way. Lockdowns cost a huge amount of lives, masks don't do anything at a population level, and vaccine passports make no sense given the type of vaccinations available. 

If the underlying logic of COVID I have identified is roughly true, then I should be able to make some predictions. Here are some. 

1. There will be a time in the next two years when Australia has a much bigger COVID outbreak than any yet despite being hugely vaccinated.

 Depending on the political fallout from 2021 we may even collectively take no action. No masks. No lockdowns. No border closures. 

2. Australia will see a year with a 7% increase in all-cause deaths (about 10,000) in the next decade and no one will notice. 

Given the ageing population and the normal variation in deaths each year, this makes sense. I’m actually being intentionally bold on this prediction. Realistically a 5% increase (7,000 extra deaths), or 134 extra deaths per week, is more likely to be observed. 

3. Vaccine passports of some sort will be enacted against all evidence. 

They will be cheered by the mainstream media as they justify all the terrible policies the public health army has forced onto us so far. No one will care that the vaccines wear off or that the vaccinated transmit the virus to a similar extent after six months or so. The public health army will march on from the vaccine race song to the vaccine passport song, to whatever else keeps the marching going. 


How the analysis looks to me

There is a spoof viking show called Norsemen on Netflix. In it, the characters talk about customs of life and death in a hilarious matter-of-fact way. I feel like I am living in a spoof Netflix show. The wonks are arguing the finer points of how to skin a virgin alive to please the gods while I stand by looking at the evidence that suggests rejecting the premise altogether. If only our policy choices today were a laughing matter.