Criticism of the lockdown

by Daphna Whitmore

Since I wrote Corona fevers and the madness of models, criticising the lockdown in New Zealand, there have been many comments and some objections to the article. Some of these have been discussed in other forums but here I will try to respond to a few of the main objections that have been raised.

1. That the lockdown was necessary and it saved many lives in New Zealand. 

I argued against a draconian lockdown as an unproven measure that has significant harm associated with it. There are principles at stake which have largely been ignored by people who are terrified and believe the “more action the better”. The principle of first do no harm is particularly important when applying a treatment or action to a whole group of people, rather than focusing efforts on those who are at risk.

There is also the principle of taking an evidence-based approach. Actions should be proportionate and based on good evidence.  Quarantining healthy people on this scale is new, and it has not been effective on a smaller scale with other contagious infections. For instance, prior to a vaccine, polio was an annual epidemic and quarantine measures did not succeed in preventing its spread.

Social distancing measures are not proven, but are lower cost measures that are worth trialing. That is not to say they are ineffective, just not proven yet. Maybe it will be possible as the pandemic subsides to work out which were effective, which were not and which measures were harmful. Handwashing so far is the only proven measure, but others may be shown to be effective over time.

Thirdly, there is the principle of consent to the action or treatment. That applies at an individual and collective level.

As much as we are told “we are all in this together”, that is simply a slogan. The truth is that COVID affects some groups more than others and the measures governments are taking against it affect some groups more than others.

2. Opposing a lockdown is putting the economy before lives. This is about saving lives vs the economy, the economy can be fixed later.

It is glaringly obvious that there is already an impact on the economy. Whether it turns into a slowdown, a recession, or perhaps a deep depression time will tell. One thing is certain, an abrupt stop to production in one-third of the world will have repercussions.

Oxfam has warned in a report on 8 April that the economic fallout from the COVID pandemic could push half a billion more people into poverty. This is about lives. There are already tens of thousands of New Zealanders losing their jobs. In the United States there are 6 million jobs lost. In Europe a similar picture of economic carnage is emerging.

There is also mounting evidence that the single focus on COVID has been to the detriment of other areas of healthcare. For instance, in Britain there are typically 30,000 new cancer diagnoses in April, now it is likely to be less than 5,000 says Professor Karol Sikora, Chief Medical Officer of the Rutherford Cancer Centres.

He is concerned:

Coronavirus will steal the headlines, but cancer kills 450 people a day in the UK – there is no peak and the numbers aren’t coming down. Unless we act urgently, that number will rise. A group of oncologists, including myself, estimate that 60,000 cancer patients could die because of a lack of treatment or diagnosis.

Despite lockdowns being imposed across the globe there is no evidence that they are effective, especially not in the long run, and certainly not against a contagious respiratory virus that is circulating in every continent. Lockdowns may slow the spread but they cannot be maintained without severe economic repercussions which will hurt the poor and many millions in the Third World.

3. New Zealand will be the first country in the world to eliminate COVID-19

The aim of the government just prior to the lockdown was to flatten the curve by introducing social distancing measures. This plan made sense, so the health system would not be overloaded and that deaths from lack of care could be avoided. Within days of the lockdown the government was talking about eliminating COVID, and keeping New Zealand’s borders shut indefinitely. This has enormous implications.

On 20 April after 4 weeks of hard lockdown the Prime Minister revealed she was abandoning the strategy of eliminating COVID-19. It was carefully packaged in an upbeat message and the move away from elimination went unnoticed by the reporters at the press conference. She said “elimination doesn’t mean zero cases, it means zero tolerance for cases. It means when a case emerges, and it will, we test, we contact trace, we isolate, and we do that every single time with the ambition that when we see Covid-19, we eliminate it.”

In a paper published mid-April 2020 by Gluckman and Bardsley they defined the strategy: ” Elimination as used by the WHO means essentially no new cases appearing in a region (e.g. New Zealand) whereas eradication is a term used to mean global elimination.” They acknowledged that it is likely there will be managed outbreaks, not elimination, in New Zealand.

4. We can protect people and keep the borders closed until a vaccine is available.

The elimination strategy is predicated on a perpetually closed border. The economic fallout will be significant.  It will wipe out most of the tourism industry which in 2019 had total earnings of $40.9 billion and was the biggest export industry, contributing 21% of foreign exchange earnings.

It also has civil liberties implications and will constrain international study, sports, and many other engagements that were taken for granted previously.

5. This is a pandemic of epic proportions. This is not just the flu. The ordinary flu does not overwhelm hospitals and cause so many deaths.

This is a different virus to the influenza virus. However the flu does sometimes overwhelm busy under-resourced hospitals, and most years there are reports of stressed and worn-out medics. One billion people get seasonal influenza most years. Typically 230,000 to 650,000 die from regular seasonal influenza despite there being vaccines.

It is true that in some areas the illness from COVID has been acute with large clustering and a wave of tens of thousands of cases. The north of Italy, London and New York City have been badly affected with high death rates.

New York City, Long Island and New Jersey account for more than half the US deaths from COVID. The rest of the US has not had similar peaks in deaths. Similarly, just three cities in Italy account for about a quarter of their deaths. Southern Italy was spared the wave of deaths seen in the North.

Professor John Ioannidis from Stamford University, in an interview on 17 April, pointed to the spread in hospitals as a key problem. With no vaccine, COVID spread in busy hospitals like Queens in NY where the sick infect each other and staff. The staff then go on to infect other patients within the hospital. In  Italy, Spain and the US, where excess deaths have been seen, there have been massive infections of medical personnel. In Italy 14,000 clinicians were infected. Hospitals are the worst place for people to go with viral infections and people should have been kept away unless they really needed medical attention. Ioannidis believes fear and panic sent people to hospitals in northern Italy and Spain and worsened the problem.

In contrast to the surge in NYC, the majority of hospitals in the US are not anywhere near capacity. Even in London they are two-thirds full and the specially built Nightingale hospital, which has 4000 beds, have had just 19 patients at the time of writing.

6. The mathematical models informing the decision to lockdown are based on sound and rigorous scientific studies.

For over three months COVID has been spreading across the globe, for the first two months it was barely noticed. Public health people were concerned particularly when the Imperial College report from Britain suggested there could be 40 million deaths across the world, 500,000 deaths in Britain, and two million deaths in the United States. The death toll is now nearing 200,000. This is very far from the original apocalyptic estimates.

The author of the Imperial College report, Neil Fergusson, has a history of extreme overestimations. In 2005 he claimed that bird flu could kill up to 200 million people. However, in the end, from 2003 and 2009 only 282 people died worldwide from bird flu.

Fergusson on 22 March 2020 admitted that his model (which predicted 500,000 deaths in Britain) used influenza measures extrapolated to the COVID epidemic. This is astounding considering the differences between the infections.  Influenza affects many children and they are the primary spreaders of the infection. In contrast, COVID  is rarely dangerous for children and mostly kills elderly people or people with diabetes or high blood pressure.

In New Zealand modelling done for the government by Nick Wilson at Otago University also predicted dire results with  3.32 million New Zealanders becoming sick and 27,600 dying. Another model, also for the government, was done by Shaun Hendy and he predicted 80,000 COVID deaths. Now the death toll from COVID in New Zealand is 18, all elderly with other health issues. No matter how successful someone believes a four-week lockdown has been it cannot be credibly argued that 79,982 lives were saved as a result. A report put out by Tailrisk economics in Wellington was very critical of the modelling. The whole report is worth reading but it is damning to see the most glaring errors made:

The Ministry engaged the Otago University’s Covid-19 Research Group to model the impact if efforts to eliminate the Covid-19 virus failed. The research group used a simple online calculator, but failed to use a key feature of the model that allows for contact tracing, testing and isolation. This implied that the Ministry was abandoning its trace, test and isolate strategy. This has the effect of blowing out the numbers, and was largely responsible for the estimates of between 8600 and 14,400 deaths if the initial eradication policies failed. These numbers may have played a role in the Government adopting a tough lockdown policy. The same model, configured with effective tracing and isolation, and some other plausible assumptions, generated about 160 deaths.

Would a lockdown have gone ahead on the basis of a potential of 160 deaths? Over $20 billion has been spent by the government extending financial support to businesses to stave off economic collapse. It is mind-boggling.

In the US predictions of deaths got scaled down from 2 million to 60,000. That is a vast difference.  The figure of 60,000 is the same as the influenza deaths for this winter in the US and is probably too conservative as COVID deaths in the US will likely be higher than that. The original modelling, done by the Institute for Health Metrics and Evaluation (IHME) in the US, even explicitly accounted for the effect of lockdowns but was still out by hundreds of millions. The journal The Annals of Internal Medicine noted that these are statistical models with no epidemiologic basis and raise concerns about the validity and usefulness of the projections for policymakers. “That the IHME model keeps changing is evidence of its lack of reliability as a predictive tool,” said epidemiologist Ruth Etzioni of the Fred Hutchinson Cancer Center, home to several of the researchers who created the model, and who has served on a search committee for IHME. “That it is being used for policy decisions and its results interpreted wrongly is a travesty unfolding before our eyes.”

Alex Berenson a former New York Times reporter has been very critical of the models by the IHME.  He pointed out, their projections were wrong on the day they published and that the model was about a third off.
The lockdown has been a crude instrument to apply to everyone, including the young and healthy, whereas COVID does not affect everyone equally. For the vast majority of people under the age of 65 COVID poses little risk. Healthy adults who are aged under 65 in Europe amounted to just 0.5% of all deaths. In the US  the under-65 year age group amounted to  1% of the deaths.

The argument has been that the lockdown prevented the spread of infections, illnesses, and deaths. Still, a third of the workforce in NZ continued going to work, and households still had someone shopping at busy supermarkets, and at the end of the five-week lockdown we will again resume more interactions.

The case rates in New Zealand have diminished to just 3 to 5 most days this week, so clearly the spread has been brought under control. However, the question is what next? We cannot stay at home, at some point we need to reconnect with society. If it is possible to control any further spread, and assuming there hasn’t already been significant earlier infection, then New Zealand may have few outbreaks, but we will be very exposed as a population without immunity. That means the vulnerable population is still unprotected.

It can also be argued that a severe lockdown is not necessarily better than less draconian social distancing. Australia has not shutdown workplaces on the whole, and many shops, even barbers, are still open. Likewise, Germany did not stop production work.

What has been shown is that protecting the elderly should be the focus. Stringent infection control and hygiene measures paramount in hospitals and rest homes. It is also important people do not go to the hospital if they have COVID unless they are in need of hospital treatment.

For people who believe that lockdowns were a proportionate measure for COVID how do they reconcile that we do not lockdown to stop influenza deaths? The rates are similar to COVID, and much worse for infants and children. Should all countries shutdown in influenza season? Are infants not worth saving? If lockdown is an effective method of eradicating contagious novel viruses surely we should? The flu vaccine is often ineffective, particularly among the elderly who don’t have the same immune response, so that’s not an argument against perpetual lockdowns.

7. The  mortality rate may well be quite low, but it does not really matter. What matters is the reproduction number. We are looking at a situation of exponential increase.

It is true that COVID is a highly contagious virus. While initial estimates for R0 were in the ~2.5 range, more recent estimates suggest it’s in the 3 to 5 range, and some individuals really do seem to be super-spreaders.

The Imperial College said COVID would double every 3 days and projected it would do so until it reached a 93% infection rate globally. They used that assumption to get to their model where 7 billion people get infected.
The problem with their first assumption was exponential growth.  That’s because exponential models are only exponential for a brief period of time then some variable comes in and alters the curve; that is what always happens.  So handwashing could change the curve, or some other measure. The Imperial College report did not account for improved hospital capacity, which was a huge oversight as China had built a huge new hospital in ten days, and similar measures have been seen elsewhere.

Antibody testing around the world is showing that there was widespread infection before the lockdowns.  Studies in Santa Clara County, in LA County, in Massachusetts and in Denmark have very similar results. The accuracy of these early antibody tests have been questioned but they do accord with testing of the virus – that many people have the infection with no or few symptoms and have recovered without knowing they were infected.

While probably not reliable enough for individuals to use, antibody tests are valuable for research purposes. In the journal Nature Jayanta Bhattacharya, a health economist at Stanford University in California and a co-author of the study in Santa Clara, noted: “This is a really inexpensive way to get an incredible amount of information.”

Peter Goetsche, who is a leading figure in evidence-based medicine, pointed out that the coronavirus doesn’t seem to be more deadly than influenza and measles (death rate only 0.16%, based on testing Danish blood donors bit.ly/3b8UJj5). But the risk of dying of a virus infection depends on the infectious dose, which is higher in settings with overcrowding.

8. Lockdowns save lives and those countries that have not locked down soon enough will have huge death tolls.

Quarantining healthy people on this scale is new, and it has not been effective on a smaller scale with other contagious infections such as polio which was an annual epidemic despite quarantine measures before the invention of the vaccine. In many countries lockdowns are seen as effective measures because they are extreme, but in some the rate of transmission was already dropping before the lockdown, such as in Germany.

The graph below shows that the rate of transmission was under 1 in Germany well before the lockdown was imposed. Major events of 1000 people and schools and restaurants closed and a full lockdown occured 23 March.

It could be that lockdowns early on are effective, but it would be hard to argue that Germany’s lockdown has produced significant results, especially when weighed against the economic hardship that its poorest citizens will now face.

9. Well, Sweden didn’t lockdown and it was a terrible mistake.

Sweden has been criticised by the supporters of lockdowns. Sweden has not imposed a lockdown or strict social-distancing policies. It encouraged its citizens to voluntarily socially distance and recommended that people work from home, wash their hands regularly, and avoid non-essential travel. It has stopped travel from outside of Europe. Schools for under-16s have stayed open along with bars, restaurants, gyms, and most businesses. Gatherings of more than 50 people are banned and older people have been advised to avoid social contact. It is similar to Level 2 in New Zealand. Most of the deaths have been in rest homes and while it may change, at present there is no sign of excess mortality compared to other years.

Sweden all type mortality peak months:
March 2020: 8284 deaths (1-15 April 2020: 4713 deaths)
March 2018: 9437 deaths
January 2017: 9282 deaths
Many months at 8600-8800 deaths
Swedish Statistics website + UNdata statistics website

The number of person-years lost was very small and their health system has not come near to be overwhelmed.

No country in Europe has been able to slow down the spread considerably.

In an article in the journal Nature Anders Tegnell, Sweden’s head epidemiologist, explained:

We aim to flatten the curve, slowing down the spread as much as possible — otherwise the health-care system and society are at risk of collapse. This is not a disease that can be stopped or eradicated, at least until a working vaccine is produced. We have to find long-term solutions that keep the distribution of infections at a decent level. What every country is trying to do is to keep people apart, using the measures we have and the traditions we have to implement those measures. And that’s why we ended up doing slightly different things.

In many countries the reasonable campaign to flatten the curve turned into a panic based on grossly inaccurate predictions. There is no argument that some densely-populated cities have experienced sharp peaks in cases and thousands of deaths.  Without an effective treatment or vaccine, the elderly will remain at risk until there are more healthy people with immunity in the community. Hospitals in the epidemic hotspots have been busy but after the experience seen in Italy preparations were made to avoid that in Britain, the US and other countries. The Telegraph reported on 14 April “Few patients were treated at new overflow facility as intensive care capacity at existing London hospitals never went above 80 percent”.

I will finish with a quote from John Ioannidis as he has been a great defender of reason and science:

That the scientists who made the apocalyptic predictions were profoundly wrong is not evidence against science. They were working under extremely stressful conditions with limited evidence and the default option is to assume the worst in a stressful situation. Science got it right eventually and pretty quickly under a situation of panic and chaos. The power of science is its ability to self-correct. Science is the best thing we have as humans to guide us, we just need better and more accurate science.

The full interview with John Ioannadis 17 April:

Also worth checking out is Radio New Zealand’s interview with Michael Levitt rnz.co.nz/…/no-evidenc

New Zealand scientist in Britain Professor Gary McLean comments on Levitt’s interview: rnz.co.nz/audio/player?a

Tailrisk report on the modelling used to inform the COVID response: http://www.tailrisk.co.nz/documents/Corona.pdf

18 comments

  1. “As of today, Sweden has now confirmed 192 deaths per million residents, far beyond the 144 per million recorded in the United States, or the 174 per million in Switzerland. (Source accessed on April 22nd, 2020)”
    And you write Sweden “1-15 April 2020: 4713 deaths” which is 314 per day. However Sweden now has 2152 deaths from Covid-19, I estimate up 1000 in 9 or 10 days, so about 100 per day. In other words the total death rate is up over 30% over that period due to Covid-19.

    https://www.naturalnews.com/2020-04-22-china-locks-down-city-of-11-million-sweden-death-rate-surges.html

    https://www.worldometers.info/coronavirus/country/sweden/

    • The graph above shows that Sweden sits in the middle of Europe in the charts of deaths. Without a lockdown Sweden is doing better than Britain and other countries. They didn’t protect their rest homes properly and this is where the deaths are occurring in the main and it is a mistake they have acknowledged. Most countries made that mistake. COVID is deadly for elderly people and very mild for healthy people under 65. That’s why a sledgehammer hard lockdown is not appropriate.

  2. What is the conclusion of this analysis? You seem to be saying 1) the virus IFR is no greater than flu (unproven I think) and 2) we dont mitigate or contain for that, so the containment response especially lockdowns of any degree was an unnecessary and panic response.

    So what should governments have done? Nothing, wash our hands and just let the virus work its way through and let hospitals handle any severe cases? It’s no worse than flu so forget all the fuss, right?

    • Good question, I didn’t really spell out a conclusion in this piece as in the original article (3 April) I had said: “The decision to lockdown the country was made without adequate information. Getting out of this mess will be much harder than rushing off the cliff was. The lockdown should be lifted and the type of stringent measures that have worked in Asia applied here. The sooner the better because the cure is already worse than the disease.”

      Stringent measures that don’t come at a huge cost are warranted. There are measures that are proven like quarantine the sick, supply ample PPE for medical staff, provide paid sick leave as needed to keep unwell people away from well people. Ensure the elderly are the focus as they are the group most at risk, along with some other groups with health problems that make them vulnerable. The largest number of deaths in most parts of the world are in rest homes. We should be looking closely at protecting those places.

      There are also sensible measures being used such as establising separate hospitals for COVID, triage patients in community clinics outside waiting rooms so they don’t spread to others at clinics. Many such measures help and are proven. The thing about all those measures is they have little collateral damage. The full lockdown we had in NZ has had huge collateral damage.

      There are other measures which come at a modest cost which are also worth doing and probably have considerable effect such as stopping big events, maybe shutting borders – though that is debatable, especially in Europe where it has already spread.

      All the numbers – from the PCR tests of current infections to the antibody tests showing previous infections – point to COVID being very widespread and therefore the IFR is much lower than the case fatality rate, which is typical and not surprising. It looks like it will be in the ballpark of influenza. Even if it turned out to be twice as virulent as influenza (which is not the direction the antibody tests suggest) does shutting down a third of the world seem like a proportionate or even an effective response?

      The lockdowns have some terrible ‘side effects’ The NYT reported on 22 April: ” Already, 135 million people had been facing acute food shortages, but now with the pandemic, 130 million more could go hungry in 2020, said Arif Husain, chief economist at the World Food Program, a United Nations agency. Altogether, an estimated 265 million people could be pushed to the brink of starvation by year’s end.”

      Just how sharp the economic downturn will be as a result of these lockdowns remains to be seen. That is your area of expertise Michael and your analysis of the fallout will be valuable.

      Further: I have just gone to your blog page and seen you have already written several meaty pieces which I will read. Cheers.

    • I had read that criticism of the Santa Clara study that’s why I wrote “The accuracy of these early antibody tests have been questioned but they do accord with testing of the virus – that many people have the infection with no or few symptoms and have recovered without knowing they were infected.” There are the other antibody studies that I’ve quoted which show similar trends and it is in line with the PCR tests, so the picture is emerging of an IFR under 1% and widespread unnoticed infection and recovery. There are several other antibody studies recently published which I didn’t mention including a NY study of pregnant women which showed 15% had COVID without knowing; tests of pupils and teachers at a French high school showed 25%; a CA company found 10%.

      I haven’t read about the Bali experience. Some suggest that COVID emerged as early as September last year, so there would have been plenty of time for it to spread in a small place like Bali. Lots of social settings that would be ideal for super spreaders too. I have wondered whether COVID has been in NZ earlier in the year. Why would it not? We had 20,000 people arriving daily, 500 flights a day into Auckland airport alone, lots of contact with China before the flights were stopped early February, and still lots of visitors from Europe coming here for a summer holiday. I hope antibody tests are done here before long. Also, Christchurch is a sister city with Wuhan.

  3. DH wrote

    “ Even in London (hospitals) are two-thirds full and the specially built Nightingale hospital, which has 4000 beds, have had just 19 patients at the time of writing.”

    Lack of planning, due to Tory measures which split the running of hospitals in London between 5 semi-independent Health Trusts and drove Nurses out of the NHS.
    Rather than being 2/3rds full, there was a shortage of beds before the pandemic began.
    The Trusts reacted to it by expanding the number of wards they have dealing with Covid patients.
    Meanwhile the government launched the Nightingale intitative and found it didn’t enough nurses and doctors needed to run it. So It’s now asking each Trust to provide the staff from their own rosters.

    The fact the hospitals are coping is down to the lockdown.
    If it’s relaxed too soon, the demand for beds will surge.

    To illustrate the difference between the strategies of the UK and NZ governments:-
    As of April 27th, the UK has a death rate for Covid-19 of 305 per million population– the 5th highest of any major country. This equates to ; 20,732 deaths , almost 10% of the world total (and that doesn’t include the figure from care homes)

    New Zealand’s figures are 4 per million and 19 deaths.

    The ireason for the difference is that Boris Johnson’s government didn’t introduce a lockdwon and rigorous testing & tracking soon enough Now they’re trying to catch-up.

    New Zealand is in a far better position to end its lockdown without a surge in new cases.

    • If lockdowns are the key to an effective strategy how do you explain Belgium? They locked down early and have the highest death toll per 1m population.

      • Belgium’s lockdown wasn’t that strict at first– for instance, schools and sports venues were only shut on the recommendation of City Mayors until mid-March.
        It’s also more honest about its mortality figures, which include deaths in retirement homes (half of the total)
        Many other countries, including the UK, under-reported this issue, until very recently .

  4. DH
    “The author of the Imperial College report, Neil Fergusson, has a history of extreme overestimations. In 2005 he claimed that bird flu could kill up to 200 million people. However, in the end, from 2003 and 2009 only 282 people died worldwide from bird flu.”

    Fergusson’s estimate was based on the possible evolution of H5N1 strain of bird flu, which has yet to achieve human-human transmission. However it would only take a few mutations for it to be capable of that.

    Sars-cov2 has done it. The fact that it’s less deadly is counter balanced by its high transmission rate.
    It appears to have both a high rates of cryptic transmission and mutation.
    So predicting the possible number of deaths from those so far is a risky business.

    Better to err on the side of caution.

    • You say it would only take a few mutations to make H5N1 achieve human-human transmission. The more relevant question is what are the conditions that would make such a mutation be selected? Filthy cramped cages of birds and other animals will give rise to virulent strains but you need similar human conditions to make such strains successful in humans. WWI in the trenches were ideal for a pathogen that was so deadly your host didn’t need to walk about to spread it, there was someone right nearby who was malnourished and susceptible. Then you add being wounded into the mix, transport infected wounded men to army hospitals, then on to ships and off they go. Conditions don’t exist like that now, except perhaps some of the worst refugee camps. Lockdowns are not the answer, ending the internment of refugees is.

      • I doubt whether viral mutations are “selected” by social conditions.
        Once they’ve entered the human population, they can just spread by close contact.
        e.g shingles in old people’s homes.

        The most lethal ones tend to die out quickly because they kill the host.
        Covid-19 isn’t that lethal, but can spread via “cryptic transmission”.
        It could be genetics that decides whether it kills people.

        During the “Spanish flu” (H1N1) epidemic many of the victims died from secondary infections.
        This was certainly due to conditions in the trenches and on troop ships.

        Similarly, there are Covid hotspots caused by unsafe working conditions
        e.g. in US meatpacking towns.
        However it initially spread amongst a very different demographic .
        – people attending international conferences, going to ski resorts and attending sports events!
        After 3,000 Atlético Madrid supporters travelled to a Champions league tie in Liverpool in March, the number of cases rose from 6 to 262 within 3 weeks.

        These are arguments for imposing an early lockdown.
        This doesn’t mean that economies can be shut down indefinitely, they clearly can’t.
        But production should only resume in safe conditions, monitored by the unions.
        If not, workers should walk.
        People before profit!

  5. The CDC has revised its flu death estimates, it’s basically been exaggerating them to promote the flu vaccine and COVID-19 has caught this out.
    https://blogs.scientificamerican.com/observations/comparing-covid-19-deaths-to-flu-deaths-is-like-comparing-apples-to-oranges/

    In line with that, the Cochrane Collaboration (the epitome of evidence-based medicine) has published a new letter about how much we don’t know about flu mortality and whether the flu vaccine works.
    https://community.cochrane.org/news/why-have-three-long-running-cochrane-reviews-influenza-vaccines-been-stabilised

    “More recently, the US Centers for Disease Control and Prevention (CDC) have proposed estimates of impact ranging between 3,000 and 49,000 yearly deaths. When actual death certificates are tallied, influenza deaths on average are little more than 1,000 yearly. So, the actual threat is unknown (but likely to be small) and so is the estimation of the impact of vaccination.

    The uncertainty over the aetiology of ILI, its capricious nature and the weak correlation between immunity and protection, point to possible causal or concurrent factors in the genesis of both ILI and influenza. In other words, virus positivity may only be one of the factors necessary for a case of influenza or ILI to manifest itself.

    We await to see whether anyone has the interest or the courage to develop effective ways to control upper respiratory viral syndromes. Meanwhile our reviews will remain as a testimonial to the scientific failure of industry and governments to address the most important clinical outcomes for patients.”

    • Thanks for those links. The new Cochrane review is interesting and is in line with what Peter Goetsche has been saying for some time, before he was dumped from Cochrane.

      It’s hard to get a clear picture of how prevalent influenza is in NZ despite quite a lot of monitoring. ESR says around 35 die from it and there are on average just under 800 cases a year. ESR would be going by confirmed cases whereas public health people like Michael Baker use a broader definition.

      Michael Baker has defined influenza as “probably New Zealand’s deadliest infectious disease. More than 200,000 New Zealanders contract the flu each year. Of these, it’s estimated that 400-500 people will die either directly or indirectly from its effects. In the key 65-79-year age group, men are twice as likely to die from the flu as women, and Māori are 3.6 times more likely to die than those of other ethnicities. Those living in the most deprived 20% of neighbourhoods are 1.8 times as likely to die compared with those living in the wealthiest areas.”

      “…Many regions are reporting mainly single-figure mortality rates from this year’s flu season, but only a small proportion (an estimated one in 23) of deaths caused directly or indirectly by the flu virus are recognised and recorded on death certificates. Michael Baker puts the blame on our system of recording mortalities. These tend to prioritise one cause of death. If there is an underlying condition that is fatally aggravated by the virus – and once you get to 65, says Baker, half the population has an underlying condition of some sort – it is that condition, rather than flu, that is recorded.

      “So, the underlying cause of death might be coronary disease or prostate cancer, but if we had stopped the influenza circulating you might have had another five years.” https://www.noted.co.nz/health/health-health/influenza-nz-evolving-threat

      So there’s the whole dying with and dying from debate. Many frail elderly people die with several pathogens present. The ambiguity around influenza being a factor or the cause in deaths of susceptible people is very similar to the debate around covid being a trigger or the cause of death in elderly in resthomes etc.

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