CLINICAL MATTERS
As the most recent wave of Covid-19 infections begins to subside, it is instructive to review how the battle against the virus was won and how misinformation continues to cause a lot of harm. This latest spike in cases was not an exception to the continued confusion sown by some self-proclaimed experts. Despite legitimate health experts and officials from the Department of Health stating that healthcare utilization was low and that there was no need to resort to new restrictions, some independent pandemic analysts of dubious expertise persisted in their panic mongering by citing flawed metrics and brazenly contradicting official government assessments and advice. Their unscientific reports were carried by sensationalist media outlets and unfortunately led to some local governments unnecessarily reinstating pandemic restrictions. Some schools even reverted to online classes in a knee-jerk response to this bad advice.
I remember early in the pandemic when some of these same characters were mocking our pandemic response. There was a lot of nitpicking as daily case counts were plagued with multiple backlogs, even as laboratories scrambled to get certified to test Covid-19 and RT-PCR reagents were in short supply. Thanks to the early lockdown, exponential growth in the first year of the pandemic was averted, saving hundreds of thousands of lives. I recall many amateur know-it-alls on social media stating that we hadn’t flattened the curve when we hit a “whopping” 800 average daily cases in June 2020. Looking back at the big picture with more than three years of data behind us, we very clearly flattened the curve against all odds in 2020 with the lockdowns and our minimum public health standards.
The exponential spread of Covid-19 in 2020 was controlled despite not doing blanket “mass testing” that was being ignorantly demanded by many amateur pundits without a valid scientific basis. Mass testing has since been shown to have a miniscule impact on transmission while being extremely resource intensive and inefficient. A frequent rejoinder to this lack of blanket testing has been, “Well, we missed a lot of cases without mass testing, right?” Nearly all the countries in the world missed cases, especially in the first year, but there are scientific remedies to assessing the impact. One way to do this is by looking at excess deaths compared to the most recent pre-pandemic years. Testing won’t affect this number since nearly all deaths get recorded, regardless of cause. Using this data, we can capture and approximate possible missed deaths from Covid-19. For 2020, the number of excess deaths was negative 40,000. This means that there were fewer deaths than expected compared to the prepandemic years. How is this possible? It seems the lockdowns worked better than expected and saved a lot of people not just from Covid-19 but also from other communicable diseases prevalent in our country, such as tuberculosis and pneumonia. When people stayed home, they not only avoided Covid-19 but other deadly respiratory illnesses as well.
Unfortunately, the following year (2021), excess deaths did shoot up compared to previous prepandemic years. While some of these excess deaths were indeed from Covid-19, the majority of excess deaths was found to be from other causes, particularly chronic diseases like heart disease and cancer. This was not unexpected since many people missed their clinic visits for management of their chronic illnesses, as well as opportunities for early detection of cancers and other diseases. The lockdowns also cratered our economy and depleted government coffers. The big takeaway for 2021 is that while lockdowns save lives at the start of a pandemic, these are not sustainable and they come at great cost. With this in mind, the government started transitioning from blanket community quarantines to the more focused and granular alert level system. This allowed us to gradually restart the economy and minimize scarring from recession. When the Covid-19 vaccines finally arrived in March of 2021, we were on our way to recovery.
Nowadays, deaths from Covid are very low, thanks to vaccines even in the midst of a rise in cases. Our economy is one of the fastest growing in the world and we are getting back on our feet. When panic mongers without any accountability recklessly recommend bringing back restrictions despite low deaths and low hospital occupancy and some policy makers believe them, it causes a lot of harm. These undisciplined hacks do not take into account how things have changed and how much those restrictions cost us, especially the continuing impact of suboptimal online education on our children.
In infectious diseases, we have the concept of stewardship where we use our strongest antibiotics for very bad infections, but for less severe infections a more targeted antibiotic with less side effects and collateral damage will suffice. This analogy applies to Covid-19 restrictions as well. Covid-19 is no longer the killer it once was. We know how to prevent it and we know how to treat it. There is no longer any need for draconian measures when less harmful interventions work just fine.
Vulnerable people should continue to use all means of protection against it, including masks and updated boosters since they still have a significant residual risk of severe disease. Several hundred thousand doses of bivalent Covid-19 vaccines are expected to arrive soon. The elderly, immunocompromised patients and healthcare workers will be prioritized for these limited shots. For the nonvulnerable who are fully vaccinated and boosted, Covid-19 has been transformed into a disease closer to the flu or the common cold. Continuing to use masks voluntarily to protect others doesn’t hurt though. Masks also protect against other respiratory illnesses so there is value in continuing to use them.
As we exit the pandemic, it is important to listen to the health authorities and legitimate experts and not to the people who have been wrong so many times throughout the pandemic. If we had followed the advice of these charlatans, we would have had so many more deaths and our economy would have been in ruins. There is a reason we follow the science. It works.