Covid-19: Building Trust In Data
Previously published on A-Citizen.com
It is probably fitting that the first post on A Citizen concerns Covid-19, and in particular, the significant impact data has had on our lives. Many parts of the world are currently contending with the second wave of the virus, as predicted. A spate of countries in Europe, including Belgium, France, Spain and the UK, have instituted harsh lockdown measures to mitigate against future infections and deaths, with many becoming even stricter as the festive period nears and cases appear to be rising.
Given the various measures applied since the beginning of the year, lockdown fatigue is palpable and exacerbated by a growing frustration around the social and financial costs of repeatedly pressing pause on our lives and the economy. Few could have grasped just how powerful the government could be until this crisis struck, and the speed with which many liberties we take for granted have been dispensed with.
An interesting divide has sprung up in reaction to these lockdowns, which could be loosely described as a struggle between individualist and collectivist attitudes. You disapprove of lockdowns and want to get back to normal life? You’re selfish, prioritise money over health, and most likely belong to a low-risk group anyway. You’ll support strict lockdowns until Covid-19 is no longer a threat? You’re one of the sheep whose complacency is feeding the increasingly destructive tyranny of government. As is often the case, the truth lies somewhere in between but unfortunately, reaching any kind of consensus has been significantly hindered by the way information around Covid-19 has been disseminated. As will be touched on in other posts, the flow of information is crucial to a healthy, functioning society but Covid-19 has suffered from unclear, inconsistent data, and in many instances, stifled debate.
How do we measure data?
A key issue is the trust people have in the data upon which crucial decisions have been taken. As many might remember, initial modelling of Covid-19 by Professor Neil Ferguson, working out of Imperial College London, predicted millions of Covid-19 related deaths. This instilled justifiable fear into the citizenry and governments alike on how best to tackle this unfamiliar virus. However, it was not the first time Professor Ferguson had wildly overshot projected deaths, having done so for earlier foot-and-mouth and swine flu breakouts. When the deadliness of the virus turned out to be much less than anticipated — with Sweden acting as a helpful case study of what could happen in the absence of a lockdown — it emboldened people to be even more critical of the first lockdowns and the negatives associated with them. This, in spite of the fact that thousands of lives had been lost to Covid-19 and scientists were still trying to understand exactly how the virus spread.
Since then there have been, and remain, very valid questions around the information relating to the virus. What exactly constitutes a reported case of Covid-19? How reliable is testing today? What proportion of cases result in hospitalisations? Or long covid? And most importantly, how exactly are deaths attributed to Covid-19? Some countries are more forthcoming with such data than others but when the consequences of a lockdown impact so many areas of our lives, people understandably want to have more confidence in the data.
PCR tests have been determined by some studies to result in unusually high false positives — in November, for example, the Lisbon Court of Appeal ruled the tests to be unreliable based on publications in the Oxford Academic and The Lancet, the latter a reputed medical journal that had been the subject of controversy only a few months prior, due to data inconsistencies around hydroxychloroquine. With regard to death rates, and as accessible via the UK’s Office for National Statistics, counted deaths consist of individuals who “tested positive for Covid-19 at the time of death”, or where “ a positive test result for Covid-19 was not received but Covid-19 is mentioned on their death certificate”. Meanwhile in April, it was reported by Reuters that Belgium was counting deaths in what seemed to be a somewhat arbitrary manner:
“ so far reported 41,889 confirmed cases and 6,262 deaths, but 52% of those fatalities are in nursing homes. Of these, only 4.5% are confirmed to have had COVID-19, with the rest just suspected cases.”
Whilst Belgium has since revised its figures to be more accurate, it isn’t exactly clear to what extent the parameters for attributing deaths have changed. In addition, it would be interesting to know how the remaining 48% of deaths had been counted in Belgium by April.
More recently, the UK was thrown into a second lockdown in November, based on alarming projections of up to 4,000 daily Covid-19 deaths — projections that were later quietly revised down by the government. This was caught by the media, resulting in a mini-scandal but interestingly, no revision to the decision to enter a lockdown. A less severe tier system, which had been in place before the lockdown, was acknowledged to have been working. Perhaps it was not working fast enough but no matter, a further dent in public trust had been made.
The medicine of Covid-19
Another area which has been muddied is that of the medicine capable of combatting Covid-19. At the onset of the pandemic, chloroquine and a closely related drug, hydroxychloroquine, were swiftly identified as a cost-effective method of treating early-detected cases. This was likely informed by a 2005 study published in the Virology Journal, titled “Chloroquine is a potent inhibitor of SARS coronavirus infection and spread” — this study is also archived in the US National Library of Medicine. Dr Didier Raoult, a controversial French physician and microbiologist specialised in infectious diseases, also claimed he had experienced significant success in treating Covid-19 with chloroquine. Furthermore, leading pharmaceutical companies, such as Bayer, Novartis, Sanofi and Mylan, committed to donating millions of doses of chloroquine to assist in the fight against Covid-19.
However, hydroxychloroquine quickly fell out of favour as a potential solution to the pandemic. It is certainly understandable to have been cautious about any drug suggested to cure Covid-19, and to insist on trials to measure effectiveness and side-effects. Instead, the subsequent hysteria around how dangerous the drug is raised many eyebrows, given that chloroquine is decades old, widely used to treat a host of diseases including malaria and lupus, and is even described as safe for pregnant and breastfeeding women to take. Nevertheless, doctors espousing its success in treating Covid-19 were ridiculed, with any discussion of the drug being labelled as dangerous ‘misinformation’ — disturbingly, many have since been the subject of disciplinary action and dismissal, with Dr Raoult awaiting a disciplinary hearing in the New Year.
A number of papers discrediting chloroquine were also published, although two reputed journals later retracted particularly influential papers which had contributed to the World Health Organisation halting its medical trials of hydroxychloroquine altogether: the Lancet (already cited above) and the New England Journal of Medicine. They did so at the request of the papers’ authors, after errors were spotted in the reports and the company which had provided the underlying data refused to share it for further scrutiny via peer review, citing privacy reasons.
In August 2020, Dr Steven Hatfill, an American virologist, wrote in RealClearPolitics that:
“there are now 53 studies that show positive results of hydroxychloroquine in COVID infections. There are 14 global studies that show neutral or negative results — and 10 of them were of patients in very late stages of COVID-19, where no antiviral drug can be expected to have much effect.”
Meanwhile, Dr Harvey Risch, an epidemiologist at Yale University, had written in Newsweek:
“I am usually accustomed to advocating for positions within the mainstream of medicine, so have been flummoxed to find that, in the midst of a crisis, I am fighting for a treatment that the data fully support but which, for reasons having nothing to do with a correct understanding of the science, has been pushed to the sidelines. As a result, tens of thousands of patients with COVID-19 are dying unnecessarily. Fortunately, the situation can be reversed easily and quickly.”
For those who are interested, Dr Risch also gave an interview in August 2020, addressing the alleged side-effects of hydroxychloroquine related to the heart, concluding that these did not pose a serious risk.
However cynical it might be, two factors are likely to have had an effect on the lack of receptiveness to hydroxychloroquine as a potential treatment for Covid-19. Firstly, US President Donald Trump had lauded the drug as a miracle cure early on, and as a highly controversial figure, he has been opposed at almost every juncture, even at the expense of objectivity and common sense.
From a financial standpoint, chloroquine is off-patent and very cheap. In contrast, big pharma has made a significantly larger amount of money through the research grants, upfront payments and future revenue associated with developing and ultimately selling millions of doses of vaccines to countries around the world. By August, circa 11 billion US dollars of funding had been committed to 8 pharmaceutical companies through the US government’s Operation Warpspeed alone. Meanwhile in April, it had been estimated that a course of treatment could cost as little as $1 for hydroxychloroquine, or $0.31 for chloroquine, to produce. This month, it was revealed that vaccine prices negotiated by the Belgian government ranged from €1.78 (Astrazeneca-Oxford) to €12 (Pfizer-BioNTech) and €18 (Moderna) per dose, with a number of the vaccines requiring more than one dose.
This is not to say that vaccines do not have a part to play in combatting Covid-19 but if non-scientific factors have in fact inhibited the use of a potentially life-saving drug, a grave disservice has been done, both in terms of lives lost and livelihoods destroyed.
The verdict on lockdowns
For full disclosure, I think strict lockdowns have exhausted their usefulness and are increasingly unjustified in the face of what we know about Covid-19, and the costs to society. This is in part informed by the opinion that an effective drug has been available from the very onset of the pandemic. Otherwise, it would indeed make a lot of sense to apply restrictions that slow the spread of the disease and ease the strain on our health services — but even then, only for a limited period as stressed by Dr David Nabarro of the World Health Organisation:
“We really do appeal to all world leaders, stop using lockdown as your primary method of control…Lockdowns have just one consequence that you must never ever belittle, and that is making poor people an awful lot poorer.”
Interestingly, the Great Barrington Declaration, authored by epidemiologists from the world’s leading academic institutions (Dr Sunetra Gupta of Oxford University, Dr Martin Kulldorff at Harvard and Dr Jay Bhattacharya of Stanford University) avoids the economy vs health argument altogether, arguing that lockdowns are detrimental to public health as a whole. It proposes ‘targeted protection’ of vulnerable groups instead, highlighting the irony that generalised lockdowns have often done little to prevent the failure in protecting high-risk groups, whilst the majority of the population experiences a high recovery rate in relation to Covid-19 — consider for example needless deaths experienced in New York care homes, or shortcomings in relation to the elderly, admitted to by the Swedish government. Other health issues sidelined during the pandemic include undetected cancers, postponed procedures and mental health issues resulting in heightened suicide rates — not to mention the rise in domestic and child abuse, associated with victims being confined for long periods with their abusers. The true impact of these occurrences will likely only be clear once Covid-19 has been overcome and a detailed post-mortem can be carried out.
Nevertheless, it is interesting how little coverage the Declaration, supported by thousands of medical practitioners around the world, has received; at one point, the Declaration’s Twitter account was even suspended but has since been reinstated. One may disagree with some of the authors’ positions but these professionals are hardly ‘quacks’ and it is strange that such experienced experts are sidelined from the debate, given the likelihood that they might improve the public policy response.
Handling this health crisis is no easy task for any government but given each of the issues discussed above, it is no wonder that a significant number of people have come to regard the handling of Covid-19 with distrust, even though the virus is very real and should be taken seriously. This has created fertile ground for suspicion around new data, the motivation behind lockdowns and the medicine of Covid-19 — based on past experience, a healthy dose of questioning might not be unwarranted. Looking forward, it will be very interesting to see how the ground-breaking advances in vaccines developed by Pfizer-BioNTech, Moderna and Astrazeneca-Oxford University will inform lockdown policy in the short to mid-term future.