Geneva, 5 December, 2020

We all have a bit of the “don’t mess with me” mentality. We are intolerant of people in our space or causing us the slightest inconvenience. We get stroppy; some more than others. Political parties feed off “don’t mess with me;” some more than others. However, if it serves a greater good, we tolerate being messed with; some more than others. What has surprised me is how the pandemic has brought out the “don’t mss with me” in so many people who seem unable to comprehend that the greater good of an effective public health approach must engender collective measures. The lockdowns and other social distancing measures are seen as an attack by government on individual freedoms, a personal affront and, it follows, ineffective.

In the COVID Chronicles 6, I described the no-nonsense, calm approach of the Swiss to the main issue for all of us: that is, the big balance that weighs an effective public health response against the social and economic impact of lockdown and other social distancing measures. Quite a contrast to the political and “don’t mess with me” argy-bargy in the UK about how, where and when anti-COVID-19 measures should be imposed. If I could show that the first UK lockdown avoided two million COVID-19 cases with their inevitable burden on the health services and 70,000 deaths, would the on-going imposition of lockdown and / or other social distancing measures be more digestible and less contentious? Could we not work towards a cooler judgement of weather such measures are “worth it”? You may well wonder how I’ve arrived at these figures. With some trepidation…. here goes….!

Above are the UK stats for COVID-19 cases and deaths per day according to Johns Hopkins (who collate each countries own reported stats.) To date, the UK has reported a total of 1,633,744 COVID-19 cases and 58,545 related deaths largely distributed between two peaks. Similarly, other western Europe countries, Australia and Canada show two peaks. Current declining cases and deaths are due to re-imposition of a variety of measures all of which curtail our lives to an extent.

Given the graphs for the global cases and deaths per day (see below,) it would be reasonable to assume that in the UK, without the first lockdown beginning in March, the epidemic curve for daily cases would have continued to rise through April and beyond. The curve for daily deaths would have risen but disproportionally less so for reasons that remain unclear. The same assumption could be made for other countries with two peaks.

In the UK, the first peak of cases per day is on 10 April and the second on 17 November. This gives a “inter-peak” period of 191 days. A line drawn between the first and second peaks of these curves would represent a minimum of cases and deaths without the first lockdown. If we assume that the below-the-line average for those 191 inter-peak days would have been around 1,200 cases per day and around 400 deaths per day, we arrive at 2,292,000 cases and 76,4000 deaths. Therefore, the minimum number of cases and deaths avoided in this 191 day period are given by the 2,292,000 cases and 76,4000 deaths minus the reported 1,303,000 cases  and 42,000 deaths respectively for the same period. This gives us 989,000 cases avoided and 34,400 deaths avoided. The same calculation can be made for any other country showing two peaks.

But, of course, epidemic stats follow curves and not straight lines. This means that the reality of what would have happened over the 191 day inter-peak period without lockdown would have been represented by a curve in the form of one bigger peak. We will never know the full height or width of this bigger peak. Nevertheless, the figure of the below-the-line cases and deaths avoided as calculated above must represent only a fraction of the cases and deaths that would have been. In reality, double this would be a good shot. Maybe we’re looking at two million cases and 70,000 deaths avoided by the first lockdown? So there!

Politely worded disagreements based on existing data and reasonable assumptions are welcome. 

The COVID Chronicles could also chronicle the more bizarre opinions I’ve read about anti-COVID-19 measures. How about this one? In several locations in nearby France: “Slaves and their children are masked and vaccinated!”

Geneva, 30 November, 2020

There is quite a COVID-19 storm brewing on the other side of the planet. The 53-strong Pakistan cricket squad flew into Christchurch, New Zealand for a series of international matches. Whilst doing time in their isolation facility, six of the visitors have tested positive. They were caught on CCTV breaking distancing protocols by givin’ the tea bags heaps outside their own single rooms. They are being threatened with a return flight having not bowled a single ball. There is outrage on both sides. Former Pakistan fast bowler Shoaib Akhtar youtubed “I want to give a message to New Zealand cricket board that this is not a club team, it’s Pakistan national cricket team. We don’t need you. You are talking about Pakistan – the greatest country on the planet – so behave yourself…. Be careful next time.” Well, that’s telling ‘em! New Zealand has shone bright throughout the COVID-19 pandemic by being one of the few countries to have controlled transmission of the virus. Since mid-May, they have had only a scattering of cases exclusively among isolated international arrivals. So I am totally baffled as to why – just in the name of sport – this number of people are permitted to enter NZ from a country with patchy public health infrastructure that is reporting nearly four thousand cases per day and rising. Yes, indeed! Be careful next time!

The international news is currently dominated by COVID-19 vaccines and pre-christmas relaxation of social distancing measures. The debate about the origin of the virus in Wuhan, China seems to be on a back burner. It (the debate) will come back at some stage.

Italy was the first European country to be hit hard by the pandemic. As lawyers place the best understanding of facts in the context of law, so science places new findings in the context of the best understanding of facts. Enter a study that drew brief attention in April but is now published for review. Giovanni Apalone and colleagues have reported that people in northern Italy were exposed to the virus responsible for COVID-19 as early as September 2019. More than a little surprising! If true, emergence of the virus in Italy predates the presumed beginning of the Wuhan outbreak by at least two months. These findings do not fit easily into “the context of the best understanding of facts.” Can this really be correct? Can this be explained by laboratory error or – somehow unlikely – are we looking at fabrication of facts? The scientific community seems to be doing the stunned mullet on this one. As I said in the Lockdown Diary on 12 April, getting to the bottom of the origins of the virus in and its spread outside China will require a neutral stance, a ton of diplomacy, the best of science, the coolest of heads and time. In all things COVID-19 – related, there’s a message here for trigger-happy journalists, political opportunists, social media cheap-shots, conspiracy theorists, antivaxers and Dunning-Kruger positives. Good science takes time and the truth will out in good time.

Living in Switzerland can lack excitement. Everyone here just gets on with things in a democratic no-fuss way. For the expat, the Swiss respect for law and order brings advantages beyond living in a clean, safe and exceptionally beautiful country. The weekend before this second lockdown, my wife and I rented a campervan and spent an autumnal rainy weekend near the charming town of Interlaken. When the clouds cleared, the Alps towered above us. The lakeside camp site was immaculate.

It was also very, very quiet. No wonder given the site’s rules that constitute local by-law. I just love it… especially indeed the prohibition whatsoever of any particularly annoying games and the like!

So, despite clocking up some of the worst COVID-19 stats per capita in Europe, the Swiss have dealt with the pandemic in their own way. The first lockdown was accepted. To my knowledge, there was little disagreement; we saw no anti-lockdown demonstrations. With the current resurgence, the national authorities have decided that a second lockdown must be avoided. They have imposed a rule on the number of people who can meet socially, made masks mandatory in any enclosed public space and appealed to the weight of citizens own responsibility. This approach seems to be respected and, looking at the stats, effective. The feeling is that, yes, worrying and inconvenient as it all is, we are in safe hands.

And here are the safe hands. The ultimate decision-making body in Switzerland is the elected seven-member Federal Council. (Note: they are hardly household names.) Each member is responsible for one ministry and decisions are usually arrived at by consensus. The Council’s Presidency rotates on a yearly basis. That’s right, there is no Head of State in the usual sense. It’s not a political system that naturally selects the alpha male personality and to cite the late Ruth Bader Ginsberg, “Wherever decisions are made, there has to be women.” I have the utmost respect for this system. It means that the Swiss response to the COVID-19 pandemic has not become mired by party politics or yobbobabbled into wibblewobbleland by one clueless male leader as we’ve seen elsewhere (well… in the US.)

The sudden spike in cases here in Geneva four weeks ago meant “non-essential” businesses in town have closed temporarily; a measure permitted by the Federal Council. Whilst those affected are obviously unhappy, they accept this has to be done. A local feature in this week’s Tribune de Geneve is that a rugby team (I didn’t know they had one!) is helping out by doing the shopping for the elderly.

The other day, I heard about a Swiss couple who had concerns about their apparently normal and happy five year-old boy because he had never uttered a word. They took the boy to a paediatrician who, after a battery of sophisticated tests, asked him directly why he had never spoken. “Because,” replied the boy “Until now, everything has been perfectly satisfactory!”

Geneva, 23 November, 2020

In 1797, an English physician named Edward Jenner reflected on the widespread observation that milkmaids were generally immune to smallpox. He undertook an inoculation or “variolation” (later to be termed  “vaccination”) from a cowpox pustule on a milkmaid’s hand into the arm of a young boy called Phipps (the son of Jenner’s gardener.) This prevented Phipps from contracting smallpox later when Jenner exposed him on multiple occasions to the much-feared disease. The experiment proved successful in a further 23 cases. And all this with no understanding of microbes! Jenner sent a paper to the Royal Society that was never published. But word was out. 

The practice spread rapidly around the world despite criticism that included sanitary, religious, scientific, and political objections. By 1802, an active Anti-vaccine Society stoked fears – rational and irrational – about the smallpox vaccination. The UK government would later pass the Vaccination Act of 1853 making compulsory the vaccination of children aged less than three months; this spawned the Anti Compulsory Vaccination League. Serious outbreaks of smallpox in the USA toward the end of the 19^th century were tackled by vaccination campaigns that were in turn opposed by activists. The Anti-Vaccination Society of America was founded in 1879. Needless to say, a global coordinated vaccination campaign eventually allowed the World Health Organisation to declare the eradication of smallpox in 1980. 

The Financial Times reported last week that on the day that Pfizer and BioNTech announced the development of a vaccine that effectively protects against COVID-19, shares in Pfizer rose by 7% and Pfizer’s Chief Executive, Albert Bourla, sold US$5.6 million of his own stock. In trying to understand whether this was legal, whether this indicated Mr Bourla’s lack of faith in the product or whether he was expecting imminent emergence of competition – that would then drop the value of Pfizer’s shares – I found myself sliding down a rabbit hole into the kaleido-warren of high finance.

It’s obvious where I’m going with this. In the months to come, the world news in relation to the COVID-19 pandemic will be dominated by the development, production, distribution, administration and effect of the vaccine and opposition to it. This media hot topic will inevitably coincide with and be linked to an ever-increasing number of COVID-19 cases in the USA and how the outcome of the extraordinary election there plays out.

The bases of reservations about or total opposition to COVID-19 vaccines are many and varied. The vaccine is not safe. The vaccine is not needed. The vaccine is not effective. The whole exercise is too expensive. You can’t trust doctors and scientists. Vaccination is one big scam run by pharmaceutical companies. Vaccination should not be compulsory. Governments can’t be trusted. The WHO is corrupt. Vaccination is not natural. Vaccination runs against God’s order. Vaccination is the means for governments to insert microchips into our bodies. There are others more competent than me WHO have ready answers to all the above. 

The voices of those against the vaccine will become all the more powerful via blogs, on-line news and social media. Disinformation and conspiracy theories spread and can take on a life of their own and so become credible. Here we arrive at what I want to say in this blog. Be very careful with respect to what you read, hear and believe about COVID-19 vaccines. Knowing about the Dunning-Kruger effect may help you.

We all like to read stuff that resonates with what we already believe but most of us have the capacity to put our own beliefs into question when presented with reasonable counter-arguments. The Dunning-Kruger effect is when people with low ability tend overestimate their ability. Thus, some people may believe they are superior because they are unable to recognise their lack of ability. Dunning summed it up as “If you’re incompetent, you can’t know you’re incompetent … The skills you need to produce a right answer are exactly the skills you need to recognize what a right answer is.” It follows that intelligent people have the ability to question whether they have the right answer. Those who do NOT ask themselves whether they have the right answer are susceptible to having their self-overestimation reinforced by interacting with others who also have not asked themselves whether they have the right answer. Think extremist politics, devotion to ultra-religious creeds, biker gangs etc. (If you’ve read this far you are probably not subject to the Dunning-Kruger effect!) It goes without saying that the internet in all its forms unleashes one great accelerator of the Dunning-Kruger effect. In relation to the subject at hand, it potentially allows equal voice to the leading public health scientists of the day and Elvis-says-NO-to-vaccines. This is just one example of what Barack Obama recently referred to as “truth decay.”

Duh!

Donald Trump blasted his way into the MMR vaccine / autism debate. On 4 September 2014, he tweeted “So many people who have children with autism have thanked me – amazing response. They know far better than fudged up reports!” Just before the 2016 US election, I flew to my hometown, Norwich, in the UK. I jumped into a taxi. The driver seemed like a nice guy. We got talking. It was soon apparent that he admired Mr Trump. The soon-to-be-President Elect’s intelligence was, apparently, evident by what he had to say about vaccines. I nodded. The subject turned to Brexit. Unsurprisingly, my driver was all for it. Fair enough. Just before we got to my destination, he said, “I see it like this… Britain ruled the world before we were part of the European Union. Britain won’t rule the world again until we leave the European Union!” I paid my fare and got out of the taxi. I stood by the roadside, stunned. How, I asked myself, do people come up with ideas like that and feel comfortable voicing them to strangers? I know now: the Dunning-Kruger effect.