Covid Excess Deaths: East Asia in context – These charts show excess pandemic mortality so far for a wide range of countries, geographically themed. The charts are structured to emphasise deaths in 2022 and 2021, and to facilitate comparative analysis between regions. (General mortality data is lacking for Africa and South Asia.)

The first chart shows Australasia and East Asia, with Scandinavia providing context. (While Malaysia and Indonesia are missing because of a lack of supplied data, indications are that Malaysia’s excess death profile might be an average of those of Philippines and Thailand. Indonesia is more speculative, though estimates from The Economist and WHO suggest that Indonesia has suffered worse than the United States, maybe worse than Brazil, and certainly – unlike USA and Brazil – with the vast majority of its deaths in the 12 months to June 2022.)

From New Zealand’s point of view, the 2022 ‘performance’ is comparable with Australia and most of Scandinavia; New Zealand was much better in 2021 though. The worst performers in these regions over the last 12 months have been much of East Asia, Finland and Norway. Japan is most like New Zealand, with its worst half-year to date being the most recent one, suggesting that much of Japan’s and New Zealand’s eventual covid stories are yet to be told.

Philippines needs a special mention. It’s a country with a substantial demographic and labour force connection to New Zealand; it’s also comparable in terms of the severity of its top-down anti-covid public health mandates. On Al Jazeera News today, one item indicated that Philippines has been in shutdown for two years, featuring a succession of lockdowns which are just now ending. (See links to Al Jazeera stories at the end of this commentary.) Of most significance was that children there are only now returning to school after a two-year closure; and that the costs of this lost education may prove to be huge.

We should also note that the 2,300 excess deaths per million in the last 18 months in Philippines is in a country with a young population, making Philippines’ experience somewhat different to that of East Europe. (For East Europe, see final chart below; one similarity though is that both Philippines and East Europe are exporters of young labour.)

This next chart, to the same scale as the first one, allows for comparisons to be made with West Europe and North America. Greece is the country here which is most like Philippines in the earlier chart, having a substantial majority of its deaths in 2021 and 2022 following an apparently successful 2020. Greece is also a country that New Zealanders connect with, yet is almost never mentioned by New Zealand’s epidemiologists.

Germany, Austria, and Netherlands are not too flash either, having more than half of their excess deaths in 2021 and 2022. Spain, France and the United Kingdom have done significantly better than these from 2021, having done worse in 2020.

The next chart, on an extended scale, shows the Americas (with South Africa). Canada shows a ‘performance’ comparable with Ireland and Scandinavia. United States looks much like Latin America. Three countries which did pretty well in 2020 did poorly in 2021 and 2022: Uruguay, Paraguay, and Cuba. (Cuba’s actual numbers for 2022 are highly speculative.) In many ways these ‘Latin’ countries are like Philippines, in culture, demography, socioeconomic circumstance, and in economic proximity to the United States. Though only Cuba has been like Philippines epidemiologically, with the majority of its deaths being in late 2021. Both countries actively fought-off the virus for a long time, only ‘surrendering’ to it after a year-and-a-half (or so).

The final chart, on an extra-extended scale, shows the underacknowledged epicentre of the covid pandemic, East Europe. In all countries in East Europe, we see that the first wave of the pandemic (February to July 2020) was fended-off successfully, I understand through government mandates. The crisis came late in 2020 as the perpetuation of these mandates became untenable. East European populations were substantially less able to cope, owing to both economic and immunological weakness, than were West European populations.

On both sides of Europe, covid’s initial hit was during a shoulder season, neither winter nor summer. East Europe has the look of a region with a substantial general-immunity deficit in the autumn of 2020. Most countries in the region now appear to have restored general-immunity, but at great cost. For the most recent period (shown in black), February to July 2022, New Zealand falls between Hungary and Romania. Some countries in this region have lower recent excess mortality rates than New Zealand; this was especially true in July.

East Europe has an unusual demography, dominated by older people, as the region bleeds its younger population to West Europe. East Europe was already in dire straits before Covid19 hit. Indeed, it has been becoming the Dixieland of the European Union. We ignore East Europe’s stresses at our peril; those stresses are the crucible of world wars.

(A note about Russia and Ukraine. Russia’s reported deaths have dropped dramatically since it invaded Ukraine; before this year, Russia’s aggregate mortality data could be trusted. And Ukraine’s last reported aggregate of monthly deaths was in January.)

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

Al Jazeera news links:

https://www.aljazeera.com/news/2022/8/22/philippine-schools-reopen-after-one-of-worlds-longest-shutdowns

https://www.aljazeera.com/news/2021/8/21/philippines-eases-lockdown-amid-record-covid-19-infections

The chart above shows New Zealand’s aggregate weekly deaths from 2015. The normal winter experience is obvious, with 2015 to 2019 influenza peaks mainly in July and August, though in late June in 2019.

New Zealand is different from most European countries in that it has significantly faster population growth. (Although Scandinavian population growth is above average for Europe.) Thus, I have plotted a ‘black line’ to show normality; what mortality would have been like in New Zealand in 2022 had there been no covid pandemic, and no other unusual events impacting on mortality. (Note the dark blue segment that shows the 2019 Christchurch Mosque murders.)

(Note that New Zealand has a rising mortality trend, regardless of covid, due to: a rising population, an aging population; and also possibly due to increases in other ‘lifestyle’ chronic health problems such as diabetes. In Eastern Europe, where Covid19 has had its biggest demographic impact, the first of these three factors did not apply; so its projected mortality, had Covid19 not happened, was essentially the same as its actual 2015-19 mortality. That probably means that covid’s impact there was overstated, given East Europe’s increasing paucity of young people due to emigration and low birth rates, and its increasing recent exposure to chronic ‘lifestyle’ conditions. Demographics were dynamic long before Covid19 struck.)

While its not clear yet whether 2022 peak mortality will be as much above normal as it was in the 2017 influenza season, the important information shown is the extent to which mortality in New Zealand has been above normal since February. There was no simple mortality wave during and immediately after the March Omicron-covid wave. Rather, what we are seeing is a process in which many people who might otherwise have died in 2020 or 2021 have instead died in 2022, nudged in many cases by a covid or similar infection.

This next chart compares New Zealand with Finland, in the period from March 2021. This is excess deaths, not aggregate deaths; that is, this chart only shows deaths above the relevant ‘black lines’.

The first thing to note is that, for these countries each with about five million people, there is a degree of random ‘noise’ in the variation of weekly deaths. Having noted that, the most prominent feature of the chart is Finland’s long period of excess deaths in 2021 and early 2022. (Finland’s apparent mortality lull in the peak winter months is misleading; these are seasonal peak mortality months, so the extent that the deaths last winter were above normal was ameliorated by the high normal for that time. To some extent, covid deaths replaced influenza deaths.)

Finland is a country that took substantial public health measures to combat Covid19, so the deaths in 2021 can be to a large extent understood as postponed covid deaths. Except that very few of these excess deaths, especially in the third quarter of 2021, were actually diagnosed as covid deaths. The lack of diagnosis of covid may have been due to a lack of testing, on the supposition that the pandemic was over. Or it could be due to high rates of death from covid but not of covid; ie deaths arising from the massive disruption to normal life due to the public health measures, or from lower levels of general immunity to respiratory infections on account of distancing, masking and reduced contact with travellers.

I think it would be fair to hypothesise that the persistently high rate of excess deaths in New Zealand in 2022 suggests that New Zealand is now experiencing something akin to what Finland was experiencing in its last autumn and winter.

The above chart shows Sweden and France. These are the two countries in North/West Europe which least show the Finland mortality pattern, and are almost certainly the countries which retained and then attained the highest levels of general immunity. In Sweden’s case it was due to a public health approach that emphasised private responsibility over public mandates. In France’s case, the stronger public mandates did not linger on beyond the emergency periods.

Both countries had significant Covid19 mortality in 2020; they were hit full-on by the first and second waves. But both seem to have suffered only minimal amounts of waning general immunity as the pandemic progressed; and both suffered much less covid mortality in late 2020 than many other countries (with the USA coming mostly to mind).

The final chart shows Germany and Denmark. Both of these had low levels of pandemic mortality in 2020, due to substantial mandated public health measures; much lower excess mortality than Sweden and France in 2020. But both also show the Finland pattern in late 2021, and in 2022 to date.

Another point of interest is to see how swiftly the arrival of the Omicron strain in Denmark curtailed winter deaths there. Omicron arrived just as the Delta-covid wave was peaking; whereas in Germany the delta-wave had peaked a month earlier. We may note that all five European countries shown here suffered substantial Delta-covid mortality around November-December, although Sweden much less than the others. This was almost certainly due to waning immunity from vaccinations, and the public health authorities being initially slow to understand the issue, and slow to make booster vaccinations available.

In Germany in particular, we see a substantial summer-wave of pandemic mortality in 2022. There is a clear pattern. Countries which tied down their populations the most in 2020 are experiencing these significant late bouts of pandemic mortality.

All this suggests that New Zealand still has a long way to go to return to some kind of demographic normality. This coming summer, excess pandemic (or post-pandemic) deaths, if they happen, will be exposed for all to see, because they will not be mixed in with deaths from ‘winter viruses’.

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

New Zealand has had the worst reported mortality rate for Covid19 in the world for the last two weeks, according to the international data. And by a significant margin. But you wouldn’t know it from the media. ‘Underwhelming’ is an overstatement. The best I could find was this from Reuters nearly two weeks ago. New Zealand COVID death rate at record levels, 22 July 2022.

From worldometer weekly trends, the comparable number to the 151 given by Reutersis 271, that’s 54 deaths per million people in the week to 1 August 2022. The top five countries (all attending the Commonwealth Games) are:

• New Zealand, 54 deaths per million
• Barbados, 33 deaths per million
• Isle of Man, 35 deaths per million
• (New Zealand revised, 33 deaths per million)
• Bermuda, 32 deaths per million
• Australia, 27 deaths per million

These are the data published on Monday 1 August. This screenshot shows the same table on Friday 22 July.

We should note that all these countries other than New Zealand and Australia have populations less than 300,000 people. (Barbados’s population is 5.75% of New Zealand’s.) For very small countries, just one death has a big impact on the death rate. Unlike these little countries, New Zealand has been in the ‘top ten’ in the world for published covid deaths continuously, for several months.)

For a few days, the people at Worldometer struggled to work out New Zealand’s new reporting system. But they eventually decided that the original measure – deaths within 28 days of a positive test for Covid19 – was both the most comparable with other countries, and the most indicative as a measure of when the deaths occurred.

(The statistic above for ‘New Zealand revised’ is the new number favoured by the Ministry of Health. It’s not shown on Worldometer, and shown here only for comparison. This number – people who would not have died had they not had Covid19 – includes a few people who tested positive more than 28 days before their deaths.)

For the last few months, New Zealand has consistently had double Australia’s weekly Covid19 death rate. Both countries saw substantial increases in Covid19 deaths last month.

Why is this news not being reported by the traditional mainstream media? It’s more than the combined total of deaths in the 2011 Christchurch earthquake and the 2019 Christchurch Mosque tragedy. They were news.

A quick snapshot of other information, not easily accessible, about those who died with Covid19 in the last week:

• 86% of the deaths with covid in the last week were neither Māori, nor Pacific, nor Asian. Thus, mostly Pakeha.
• 83% of the deaths were people aged over 70 (ie all eligible – in principle though maybe not in practice – for four vaccination shots).
• 79% had had vaccination ‘boosters’ (though, for the vast majority of these, their immunity will have waned to minimal levels)

Good news for me on the personal front. I got my second vaccine booster yesterday, and without the intervention of petty bureaucracy to prevent me from doing so. (Refer: Answers Please? Tribulations af Getting a Covid19 Vaccine ‘2nd Booster’.) I’ll never know whether the first pharmacy simply had a wrong interpretation of the rules, or whether the Ministry of Health computer system was tweaked on Friday to fix the petty anomaly that I mentioned.)

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

I try to write about general issues of importance, in a general – indeed global – context. This time I will write just about me.

I am the same age as Phil Goff, Mayor of Auckland. And I want to be appropriately protected from Covid19. I have had three shots of the Pfizer Covid19 vaccine. My most recent vaccination – the so-called booster – was on the first of February this year. On 27 June I enquired about getting another ‘booster’ shot on Tuesday 28 June, before going away ‘on holiday’ on 30 June. I was not allowed to, because of a set of rules that have never been adequately explained. (RNZ‘s Kathryn Ryan tried to ask an expert on 13 July, but gave up in frustration.) The best I could do was to get a vaccination booking at my local Health Centre, for Wednesday 3 August.

(Between 28 June and 3 August, about 700 people in New Zealand will have died with Covid19. The substantial majority of these are Pakeha aged over 70 who received a booster vaccination ahead of the March wave of Covid19, and who have died (or will soon die) of Covid19. How many of these are dying for want of a vaccine booster?A rhetorical question. But the answer will be that at least one of these would have had a booster had they been allowed.)

I am classed as being in the ‘vulnerable age group’. Now, I’m not ‘very old’. But if I was the same age as Joe Biden, or even Jimmy Carter, I would also have been refused. I’ll bet that Jimmy Carter faced no impediments in getting a fourth vaccination shot. But Jim Bolger will have had to wait.

Anyway, I continue to be one of the dwindling number of people who has yet to get Covid19. Today, I asked if I could get my vaccination booking brought forward to Monday 1 August. “No”, they said, “we only do Covid19 vaccinations on Wednesdays and Thursdays”.

So I went to the local shopping mall. At the first pharmacy, I asked if I could come in for a vaccine on Monday 1 August? They said I could ‘walk-in’ any time from Tuesday 2 August. Why not Monday I asked; after-all Monday will be six months since my previous shot. They said I had to wait six months plus one day!! I asked why the Ministry of Health (MoH) requires that I wait that extra day. They had no answer.

So I went to another pharmacy and asked the same question. They said that “I could try coming in on Monday”, and that they can sometimes override the MoH computer. It was a roundabout way of confirming that I am meant to wait ‘six months plus one day’. I further questioned the Ministry of Health’s reason for this extra day’s wait, but the pharmacist had no explanation. He did say, though, to come in on Monday 1 August, implying that he would be able to do the system override.

At first impression, this situation – the needlessly long six-month wait – is a case of ‘bureaucracy gone mad’, killing a significant number of New Zealanders. And, regardless of the answer to that question, why must I wait that extra day beyond the six months?

MoH: Please just answer – not necessarily to me personally, but preferably to this publisher – these three questions? [Reminder: I got my third ‘first booster shot ‘ on 1 February 2022.]

• What is the medical reason why I cannot get my Covid19 ‘second booster’ on Friday 29 July?
• Why was I told by a health professional that I will not be allowed to get my Covid19 ‘second booster’ on Monday 1 August?
• Given the large number of people who become eligible for another vaccination in August, when and how will you tell the vaccination-willing New Zealand public that the rule is that they must wait ‘six months plus one day’?

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

West Europe

The first three charts (above) show three of the larger Western European countries: Germany, France, Spain. (Italy shows a similar picture.)

The most important data item is ‘excess deaths’. (In the case of France and Spain, the last few weeks of this data have been ‘topped up’ using estimates from The Economist, published by Our World in Data. Germany’s data is complete to the end of June, though most countries which release their mortality data promptly do subsequently revise their recent numbers, usually upwards.) For the pandemic as a whole, Germany has ‘lost’ 1530 per million of its population, including 197pm in the first half of this year.

In Germany, we clearly see the ‘Omicron death wave’ in March 2022, a common but by no means universal feature of country charts of this type. Reported covid cases clearly correlate with excess deaths in that month. We are also seeing the same June/July wave in Germany – in its summer – as we are seeing (in winter) in New Zealand. And, there is a clear June/July death wave to match Germany’s ‘case wave’. (Germany’s two worst death waves were in December 2020 [original Wuhan variant] and November 2021 [Delta variant].)

France shows many of the same recent patterns as Germany, though with only about half the severity. Two important differences are that the late 2020 wave came a month earlier in France, indicating that this late 2020 resurgence in Europe was probably driven by tourists from North America; covid levels in the summer of 2020 were much higher in the USA than in Europe.

Overall, France ‘lost’ 1740 per million of its population, including 240pm in the first half of this year. Certainly, France has the look of a more immune population than Germany. And it’s starting to show once again in the French Caribbean; throughout the pandemic, French people – relatively well-adapted to covid – have been conspicuous spreaders of covid through France’s extant empire.

As with Germany, deaths in the present wave do not show up markedly, yet, in the official death statistics; they only show up in excess deaths, meaning many people who have died in this wave have not been acknowledged as covid deaths.

Spain, while much more like France than Germany, still conforms with the general 2022 pattern for Western Europe. While case numbers appear lower in Spain than France, deaths are similar. Overall, Spain ‘lost’ 2570 per million of its population, including 286pm in the first half of this year. Spain looks to be well up the immunity gradient, like France; more so than Germany. This means that I would predict that Germany will have more excess deaths per million in the second half of this year than France and Spain.

We should note the importance of this concept of ‘immunity gradient’. New Zealand (like the much of the Western Pacific region) has a low place on the immunity gradient. This gradient means that countries like France and Spain will be among the most dangerous for New Zealand tourists to visit, at least with respect to catching Covid19. (New Zealand sports teams in Europe this year will be particularly vulnerable to covid, though these younger and fitter sportspeople will generally get through the illness quite quickly. So far, while significant numbers of elite sportspeople from New Zealand have caught covid overseas, almost none seem to have had disabling forms of the illness.)

Thanks to its place on the immunity gradient, in Spain “the pandemic has felt like an afterthought as Spaniards reverted to their usual beach holidays and eagerly welcomed tourists.” Deep in a Covid wave, Europe counts cases and carries on (22 July, NZ Herald courtesy of NY Times).

We should also note that the Scandinavian countries other than Sweden have charts that are similar to the Germany chart; except that their tolls in the first half of the pandemic so far were lower than Germany’s.

East Europe

Here I include charts for Czechia and Hungary, noting that other neighbouring countries – especially Poland and Slovakia – show similar patterns. (The Balkan countries and the former Soviet Union countries are more complex, and will not be further mentioned here.)

The first and most important things to note are that Czechia and Hungary successfully suppressed Covid19 until September 2020; they were significantly more successful than even Germany, in this respect. The pattern then shows a particularly severe winter of 2020/21; in two or three waves, though the troughs of these waves were probably overstated.

The key issue here is that countries in these temperate latitudes – and North Europe is the best set of test cases – suffer significant winter seasonal epidemics in three or four winters out of five. The timings of these regular epidemics of excess deaths vary; February tends to be worst. This makes it very hard to determine a winter normal for these countries.

In the winters of 2020/21 and 2021/22, covid has to a large extent displaced influenza and other seasonal cullers. Thus, in the peak influenza months, excess deaths from Covid19 may fall. Rather covid has displaced these other illnesses as the principal seasonal culler. That’s why covid deaths are best understood in the context of the fatal illnesses that covid is displacing. (See these charts on Evening Report.)

Czechia ‘lost’ 4480 per million of its population, including 234pm in the first half of this year. Hungary ‘lost’ 4500 per million of its population, including 292pm in the first half of this year. Overall, both countries have lost nearly one in every 200 of their populations, so far. (One in 200 of the world’s population would be 39 million people.)

So far, these Eastern European countries have incurred double the mortality of the major western countries noted here. But they suffered much less in the first six months of the pandemic, and they have seen significantly fewer deaths in the last couple of months. They also suffered surprisingly little in July-September 2021, the Delta wave that was then washing through the whole world.

These countries appear to have suffered a calamitous shift down the immunity gradient during 2020, and then paid the full price. Thus, by mid-2021, they shifted up the immunity gradient; or at least the ‘natural immunity gradient’. With waning vaccination immunity, and lower rates of vaccination, these eastern countries suffered in the late months of 2021 (October and November).

From the abovementioned New York Times article: “Other parts of Europe were even more hands-off [this year]. In the Czech Republic, where there are no restrictions at all, including in hospitals, the virus is running rampant, and officials openly predict an increasing spike in cases.” While Czechia is a place to watch, I suspect that any uptick in covid there will be less than the present covid spike in Germany. Either way, like France and Spain, Czechia and Hungary are presumably dangerous countries for New Zealanders to visit at present.

New Zealand and Sweden

These two countries are widely regarded as the developed capitalist countries which represent the opposite ends of the 2020 ‘stringency spectrum’. Sweden’s public health scientists emphasised the importance of population natural immunity as the key to good public health outcomes. New Zealand was the poster-child for interventionist mandates with the aim of creating maximum distance between the coronavirus and the people. New Zealand and Australia took more cues than Europe from those East Asian countries which were at the frontline of the successful suppression of the more lethal (though less transmissible) SARS1 coronavirus.

Sweden ‘lost’ 1210 per million of its population, including 128pm in the first half of this year. New Zealand ‘lost’ minus 220 per million of its population, though plus 272pm in the first half of this year.

Looking backwards, New Zealand has ‘done best’, though its excess deaths this year are comparable to all the other countries mentioned here (except Sweden which has done the best of the developed capitalist countries this year).

What matters, clearly, is the next phase of the pandemic. New Zealand is clearly, at present, well down the immunity gradient. New Zealand remains very vulnerable to international visitors bringing new strains of respiratory (and maybe some non-respiratory) pathogens.

The charts suggest that Spain, France, Czechia, Hungary and Sweden will have comparatively low excess mortality in the coming year and a half. My sense is that Germany will have higher ongoing mortality rates than these neighbours and near-neighbours.

My concern is for New Zealand, ‘going forward’, and with those other western Pacific countries that have taken bigger covid tolls in 2022 than in the previous two years combined. A particular point to note is that the next wave – the coming summer wave (or late spring) wave – will have a higher excess death toll than the present wave.

We see that, in many countries, Covid19 remains much more than a ‘winter’ illness. New Zealand at present is still seeing (at least in the early winter) rising covid-deaths offset by lower than normal non-covid winter deaths. When New Zealand gets to the late-spring or summer, there will be no such offset. Rather, in November or December, New Zealand could suffer a covid death spike similar to those this year faced by South Korea and Taiwan.

In terms of published data, New Zealand had the most covid deaths in the world last week. For some reason this known fact did not make the headlines. (This week New Zealand has been overtaken by Martinique and Anguilla, pointing to a new Caribbean covid wave. Just now is the peak of European and North American tourism into the Caribbean holiday destinations.) Further, while published cases and deaths have held steady in New Zealand over the last week, hospitalisations are rising again in the most recent data. It is possible that New Zealand will suffer over 800pm excess deaths in the second half of 2022; that’s another 4,000 people.

Below is the screenshot from Worldometer from Friday 22 July, showing New Zealand in its place at the top of the table for reported Covid19 deaths. The table is sorted by deaths per million people in each country’s population.

Context of the Immunity Gradient

Johan Anderberg, in The Herd, cites Hungary and Poland – and Spain and France – as being among “countries that had shutdown playgrounds, forced children to wear facemasks, closed schools, fined citizens for hanging out on the beach, and surveilled parks with drones” (p.298). And he includes Germany, Czechia and Hungary “among countries that hadn’t been affected in the spring and thus lacked immunity” as having problematic experiences at the end on 2020 (p.292). Hungary, “where Viktor Orbán had invoked the threat of the virus to strengthen his power”, gets a special mention for the initial strength of its anti-covid response (p.260).

Re the matter of children, on RNZ today I heard a news report about this story: Likely cause of mystery child hepatitis outbreak found. This story provides significant counter-evidence against requiring younger children to isolate and wear facemasks. Presumably, adenoviruses have been in short supply in New Zealand too, especially given the prolonged closures of New Zealand’s international borders.

It’s more important than ever that the blindspots in New Zealand’s official covid narrative are exposed. Many countries desperately need a scientific scrutiny of facts, and not just a lazy presumption that a few overexposed experts are presenting all the known facts to the New Zealand public; all the facts about New Zealanders’ – and other peoples of the Western Pacific – changing vulnerability to Covid19 and other infectious diseases.

Instead, the latest reporting of Covid19 [RNZ] is substantially downplaying deaths, with no daily death total given in the press release, and no further mentions of people dying ‘with covid’. If the reporting had been done the same as last week, there would have been a record high daily death total of 40. Even under the new tighter definition, the latest daily covid death toll is 29, also close to the daily record.

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

Analysis and opinion by Keith Rankin.

Professor Michael Baker: “Societies who are using masks are doing very well, like South Korea, Japan. … And when we look at the countries which are succeeding, they are mask-using societies.” From COVID-19: Epidemiologist Michael Baker calls for Government to ‘step in now’ as cases rise, Newshub Nation, 9 July 2022.

New Zealanders, and many others, are at present immunity-compromised. Influenzas and ‘common colds’ are being experienced more severely than usual; and we are seriously short of data about cases of these illnesses, and deaths of people with these illnesses.

Omicron covid – the Delta-slayer – remains very prevalent as we move into the second half of this year. While Omicron may be called an ‘uncommon cold’, it is likely to eventually join up with the other human ‘cold’ coronaviruses, including the ‘Russian flu’ pandemic coronavirus (early 1890s) which continued to circulate as a cold virus at least until 2020.

With most of the New Zealand population not yet legally eligible for a winter booster covid vaccine, including most of New Zealand’s older population, our main defence this season is to wear facemasks in indoor environments.

There is little doubt that facemask wearing is helpful during epidemic phases of respiratory infections. But wearing masks is not costless. As occurs with other barrier methods which separate people from exposure to viruses, the lack of day-to-day exposure to other people’s exhaled air compromises our immunity to these viruses. Human coronaviruses have been long-known to be associated with rapidly waning immunity. That’s why it has been usual for many people to get colds several times a year, especially in winter.

Professor Michael Baker has long been an uncritical advocate for the use of facemasks as a defence from epidemic respiratory infection. So much so that, as a public expert, in my opinion, he has become economical with the truth.

The charts above plot Covid19 mortality following the brutal wave in the northern winter of 2020/21. (This brutality – particularly marked in Eastern Europe – would appear to be linked to compromised immunity.)

The first chart above contrasts excess (mainly covid) mortality between South Korea (cited as a compliant facemask-wearing country) and Sweden, which represents the opposite extreme re the use of facemasks. The second chart shows Austria and Norway, closer than Sweden to the European norm, but which largely dropped the use of facemasks after March 2022.

The South Korea data shows a bigger gap – than Sweden – between recorded covid deaths and ‘excess deaths’, the latter being the correct best measure of covid epidemic mortality. Second, the Korean mortality rate was significantly higher than the Swedish rate for the majority of 2021. Third, South Korea has not ‘done very well this year’! But Sweden has done very well this year.

Looking at the Norway/Austria chart, we see that Sweden performed significantly better than both Austria and Norway, in 2021 and 2022. (The exceptional month was January 2022, where Sweden’s later ‘delta-wave’ coincided with its incipient ‘omicron-wave’. We note that, in the March 2022 Omicron-peak, Sweden’s epidemic death was virtually non-existent, unlike the other three countries shown.

The suggestion is that only Sweden’s population was not immunity-compromised. And that the most mask-wearing of these countries – South Korea – was the most immunity compromised. With vaccines having been available since early 2021, the extent of vaccine-enhanced immunity was substantially a political decision. None of these four countries are known as being vaccine-averse.

Singapore and Taiwan

Above I compare Korea/Sweden with Singapore and Taiwan.

We see that these two ‘model’ Asian countries have bigger gaps (than Sweden) between actual mortality and reported covid mortality. (At least, unlike most Asian countries, these countries do count total mortality.)

Singapore, one of Michael Baker’s “mask-using societies”, clearly had a bad experience late in 2021; significantly worse then than South Korea.

Taiwan is particularly interesting; this was just about everyone’s pandemic-exemplar country in 2020. But we don’t hear it cited much any more. Of all countries in the world with a population above half-a-million (and maybe of all countries which count their deaths), Taiwan has had the highest reported Covid19 mortality in the world in the May/June 2022 period. (Taking the second quarter as a whole, Taiwan roughly ties with New Zealand for that dubious honour.) It continues to be the only country with more than half-a-million people which has more deaths than New Zealand, using a seven-day daily rolling average. The key difference this week is that New Zealand’s toll is waxing, whereas Taiwan’s is now waning.

Japan? Japan, by the way, has had very low levels of Covid19 mortality overall. But its biggest mortality peak by far was in February/March this year. We should be careful in making assumptions about the extent to which Japanese people have worn facemasks throughout the pandemic. (I know that facemasks were widely worn, especially by young people, when I was there in April 2014. I sensed that they were much less common in 2019, when the Rugby World Cup was held.) Japan never had a facemask mandate in 2021, though masks were strongly encouraged during the Olympic Games. My sense is that older Japanese people carry high levels of general immunity; indeed higher than South Korea.

Who knows what has happened in China this year?

An Experiment needs a Control

I will finish with these quotes from The Herd (2022), by Johan Anderberg:

“For every decade that passed after the Industrial Revolution, we made it easier for new infections to spread. … We kept moving into increasingly crowded cities, travelled between them, and forced our way further and further into what had once been wilderness.” [p.41]

“The countries of the world had initiated a large-scale experiment by closing down their societies. The Swedes became the control group.” [p.239] Good experimental scientists refer to the control group, rather than ignoring it when the control group performs better than the ‘treated’ group.

In the grand 2020 narrative, we did upset the “delicate balance” [p95] of modern metropolitan life by imposing protracted barrier mandates, with facemasks taking full prominence in 2021. People in New Zealand’s South Island were forced to wear facemasks in 2021 when, for most of the year, there were zero active cases of Covid19 there.

The evidence is coming in that we have been through an unfortunate and ill-monitored experiment.

The political response to the 2020 pandemic is not the only example of our cavalier lack of unawareness. We have also experimented in shovelling massive amounts of waste-carbon into our life-giving atmosphere. This has been a long-running experiment without as much as a control.

*******

 Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

In a recent article (Weekend Herald, April 16) John Roughan wrote that the covid-19 pandemic has been an anticlimax in Aotearoa New Zealand.

Surprisingly, he acknowledges covid-19 has killed about 25 million people worldwide, so hopefully he was referring to New Zealand’s 600 deaths. He goes on to ask how many lives we in New Zealand have saved and states that it’s “not the 80,000 based on modelling from the Imperial College London that panicked governments everywhere in March 2020”.

I beg to differ. It is because governments panicked everywhere that the number of deaths so far is “only” about 25 million.

A recent comprehensive assessment of the covid-19 infection fatality proportion — the proportion of people infected with covid-19 who die from the infection — found that in April 2020, before most governments had “panicked”, the infection fatality proportion was 1.5 percent or more in numerous high-income countries. Included were Japan, Belgium, Denmark, Germany, Greece, Italy, Portugal, Spain, Switzerland and the UK.

Without stringent public health measures, covid-19 is likely to have spread through the entire population, and an infection fatality proportion of 1.5 percent multiplied by 5 million (New Zealanders) equals 75,000.

That’s close to the estimated 80,000 New Zealand lives likely to have been saved because our “panicking” government, like many others, introduced restrictive public health measures.

Public health successes are invisible
What Roughan fails to appreciate is that public health successes are invisible. Unlike deaths, you cannot see people not dying.

Without the initial public health measures and then the rapid development and deployment of highly effective vaccines (unconscionably largely to high-income countries) there would have been far more deaths.

Roughan asks “is this a pandemic?” He states that 25 million covid deaths are only 0.3 percent of the world’s population (“only” 16,000 New Zealand deaths).

How many deaths make a pandemic? In 2020, covid-19 was the number one killer in the UK, responsible for causing about one in 10 deaths in every age group, with each person who died losing on average about 10 years of life expectancy.

In the US, more than 150,000 children have lost a primary or secondary caregiver to covid-19.

So, has our pandemic response been proportionate?

Stringent public health measures were highly effective pre-omicron, but are unsustainable long term.

New Zealand is incredibly fortunate
We are incredibly fortunate that highly effective vaccines were developed so rapidly.

Even the less severe omicron variant is a major killer of unvaccinated people, as demonstrated in Hong Kong, where the equivalent of 6000 New Zealanders have been killed by omicron in the past couple of months, due to low vaccination rates.

Unfortunately, despite our high vaccination rates, we are unlikely to be out of the woods, and it is likely a new covid-19 variant will be back to bite us. The only certainty is that the next variant will need to be even more contagious to overtake omicron.

As long as covid-19 passes to a new host before killing you, there is no selection advantage to a less fatal variant. We are just lucky that omicron was less virulent than delta.

Pandemics over the centuries have often taken several generations to change from being mass killers to causing the equivalent of a common cold.

What response will we accept as proportionate to shorten this process with covid-19 without millions of additional deaths?

As immunity from vaccination or infection wanes, we will need updated vaccines to prevent regular major disruptions to society.

A sustainable proportionate response
Unlike the flu, which has a natural R-value of less than two (one person on average infects fewer than two others), omicron appears to have an R-value of at least 10. That means in the time it takes flu to go from infecting one person to two, to four, to eight people, omicron (without a proportionate response) could go from infecting one to 10 to 100 to 1000 people.

There is no way that endemic covid will be as manageable as endemic flu.

The only sustainable proportionate response to covid-19 is for New Zealanders to embrace universal vaccination.

It is likely that vaccine passes will be required again if we want to live more normally and for society to thrive. It cannot be difficult to make the use of vaccine passes more seamless.

Almost every financial transaction today is electronic and it must be possible to link transactions to valid vaccine passes when required.

Almost 1 million eligible New Zealanders haven’t had their third vaccine dose, yet few are anti-vaccination.

Rather, thanks to vaccination and other public health measures, the pandemic has been an anticlimax for many New Zealanders and the third dose has not been a priority.

As already demonstrated, for the vast majority of New Zealanders, a vaccine pass is sufficient to make vaccination a priority.

Professor Rod Jackson is an epidemiologist with the University of Auckland. This article was originally published by The New Zealand Herald. Republished with the author’s permission.

Article by AsiaPacificReport.nz

The first chart shows the three largest western countries: United States, United Kingdom, and Germany. The solid line plots represent quarterly average rates of excess death. It is clear that the United Kingdom copped Covid19 very early and very hard. The mid-June peak represents the period from mid-March to mid-June. It is important, however, to acknowledge the rapid fall in British deaths, after that peak. The United States had a much lower peak, and, for that same period, Germany hardly registers. The main issue here was the different abilities to protect the population aged over 80 from the ravages of the pandemic.

For Europe’s second wave, which represented the United States’ third wave, Germany was nearly as badly affected as United Kingdom; and slightly earlier, reflecting the continental European event that was most likely caused by late-summer tourism from the United States. (The later second peak in the United Kingdom reflects the Christmas New Year holidays; likewise, the United States whose peak was slightly earlier due to thanksgiving.)

The impact of the Delta variant barely shows on this chart, though we should note that Delta became predominant in the United Kingdom by 1 June (75% of cases), and by 1 July (just over 50% of cases) for Germany and the United States. The United Kingdom has lower deaths than the others in the most recent mortality data, probably due to more vaccinations, and despite rather than because of Delta.

The filled dots represent overall excess deaths, commencing with 24 May 2020, based on an assumption that the pandemic (outside of China) started to register in the death statistics from around 24 February 2020. And the unfilled dots represent annual average excess deaths; the first unfilled blue dot represents average excess mortality in the United States from mid-January 2020 to mid-January 2021.

We see that annual pandemic excess mortality is easily highest in the United States, due to its prolonged period of high Covid19 infection and death.

While overall excess deaths remain higher in United Kingdom than Germany, we see that annual excess deaths are now lower in the United Kingdom than Germany. Indeed Germany’s 2021 Covid19 outbreak, which roughly coincides in time with India’s big outbreak, is considerably more fatal than Germany’s first wave a year earlier. Germany’s 2020 outbreak – as shown through available excess death data – is too soon to be indicative of Delta.

The second chart, of the same type, shows Sweden and New Zealand. It uses the same scale as the previous chart. The timing of Sweden’s first peak is the same as that for the United Kingdom, though deaths in Sweden were fewer, more confined to the oldest age group. Covid19 had no direct impact on excess deaths in New Zealand. Sweden’s second peak, while lower than Germany’s, was identically timed. It would appear to be derivative from the wave of covid cases that first appeared in Europe’s prime tourist destinations around August 2020.

While Sweden continues to have more excess deaths than New Zealand over the whole pandemic period, this has not been true for annual excess deaths for the year to the end of June 2021. Projecting these data forward, it is quite plausible that Sweden’s overall pandemic-period mortality impact may prove to be less than New Zealand’s by December 2022.

Some of New Zealand’s excess deaths may be indirectly related to Covid19. We might also note that New Zealand has some unusual demographics which may be showing an overstatement of excess deaths. Sweden, on the other hand, a neutral country in World War Two, almost certainly shows a more conventional population pyramid, at least for people aged over 60.

New Zealand and Sweden represent opposite ends of the policy spectrum, when it comes to addressing Covid19. The ideal policy is probably to take the best of both country’s approaches. There is no doubt that Sweden’s initial strongly non-interventionist approach was a failure; in particular in its initial refusal to test for Covid19 except for people already hospitalised, and in its unwillingness to at least have a ‘circuit-breaker lockdown’. However Sweden paid much more attention to the need to have a well-immunised population, with immunisation coming from a mix of natural and artificial (ie vaccination) means. Sweden, with much higher vaccination rates than New Zealand, falls considerably short of United Kingdom vaccination levels.

The final chart shows quarterly excess mortality for people aged 65-to-74 (my age group) for six countries, including New Zealand. In principle this age group catches a mix of those who are older and hence more vulnerable and those who mix and mingle in the community. This is the classic ‘boomer’ age group. For the countries given, New Zealand has the third highest boomer excess mortality, after Spain and Austria. We note that Austria was affected by the same early summer third wave of Covid19 that affected Germany. And we note that Spain, while never coming close to its original peak mortality, has been largely living with Covid19 ever since then.

Two of the other three countries – Sweden and Denmark – have had consistently negative excess mortality for the boomer age group in 2021. Further, for this age group, excess mortality has been higher in New Zealand than in Sweden for the last twelve months. While New Zealand may have a faster growing age 65-74 cohort than Sweden, Sweden has a considerably lower base mortality for this age cohort (ie Sweden has a higher life expectancy than New Zealand). So, the two sources of possible bias in the data somewhat cancel out. Denmark, which had a bigger per capita caseload than Sweden in their second covid waves, has consistently lower excess mortality for 65-74 year-olds than either New Zealand or Sweden. And Denmark was more adversely affected by World War Two than was Sweden. Denmark’s demographic idiosyncrasies for births in the years 1940 to 1955 are likely to be few; or at least something of an average between Sweden’s and New Zealand’s.

Finally, the United Kingdom, the only one of the six countries whose shown Covid19 death rates could have been influenced by Delta, had the lowest incidence of boomer deaths in the three months to mid-July 2021. This most likely reflects the prolonged (albeit easing) England lockdown, and will probably not be sustained. (I am guessing that we will see quarterly excess deaths in England hover at around plus five percent for the remainder of the year.)

______________

Keith Rankin, trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

contact: keith at rankin dot nz

It’s a known known that the late Donald Rumsfeld’s principal legacy to the world is the following quote:

“As we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don’t know we don’t know.”

I might say that there are also unknown knowns, nuggets of truth buried in archives and barely read books and articles.

When it comes to known unknowns, there are two basic types. The first are questions posed for which we do not yet have any plausible answers. This could be due to technical (eg measurement) difficulties, or economic difficulties (the expected cost of finding answers being too high). The other type is because at least some people don’t want the questions answered (and may even place embargos on finding answers), or because the possible answers simply do not fit the prevailing filter through which the questions are framed in public discourse.

Re unknown unknowns there are also multiple categories. First there are cases where questions have never had reason to be posed, cases beyond the prevailing human imagination. These are genuine unknown unknowns; things that are true but that none of us had the capacity to imagine. I can offer no present examples. A past example is the electric light bulb, which could not have been imagined even by Julius Caesar. (Although the light bulb could have been imagined well before it happened; for example, after the scientific work of Michael Faraday.)

Then there are questions of wilful blindness, questions which verge on the final category of known unknowns. Third are the black swans, events that happen ‘out of the blue’ or ‘out of left-field’; but which were predictable ‘with hindsight’! Black swans represent something akin to wilful blindness; they are events that were genuinely unexpected, and for which the precise form of their manifestation could never have been predicted. Covid19 is a black swan. (Note that ‘black swan’ is an unfortunately ironic term. It was either first coined – as a metaphor – by someone who did not know that black swan birds exist, and are the normal type of swan in some parts of the world, including ours. Or it was coined because the ‘coiner’ believed that, for almost everybody except themself, actual black swans were unknown. In reality, black swans are not black swans, and they have been known in Europe since the seventeenth century. Nor are the black-white swans I saw on the island of Chiloe; I was not expecting to see them, but one reason people travel is to discover things that other people already know.)

(That the Taliban would rule over the whole of Afghanistan as soon as July 2021 was a black swan as recently as June 2021. It was not conceived of as even a possibility, except – maybe – by the Taliban themselves.)

Related to these unknowns are the unseen – or ignored – red flags. It is missed red flags that create black swans, such as Covid19. And – I would argue – our failure to adopt joined-up-scientific thinking re the known facts about Covid19 and related viral diseases, means that there are more black swans lurking. The most important red flag that I would mention in this case, is the present apparent loss of natural immunity to respiratory viruses; loss of what I will call ‘community respiratory viral immunity’ (CRVI). CRVI is not a binary concept; it’s a level of community immunity that, like the economy, has for the most part grown over time. Natural variation of immunity rises (or diminishes) through the changes in the pathogenic environment, rather than through interventions such as vaccination. (The economic growth analogy of a temporary loss of community immunity is a recession.)

The problem in New Zealand at present is epitomised by the way we report about ‘Delta’, a highly transmissible variant of the SARS-COV2 virus that causes Covid19; this ‘comms’ problem is perpetrated in particular by our technocrats, our bureaucrats, our ‘policrats’ (narrative-framing politicians), and our mediacrats.

Before discussing this further, I need to emphasise that New Zealand’s present ‘Level 4 lockdown’ is absolutely the correct emergency policy measure for the present outbreak in New Zealand of Covid19.

The Delta-Bogey and the Missing Science and CW2 (Covid-War 2)

The dominant narrative in Aotearoa New Zealand is that Covid19 – which we (the New Zealand ‘team of five million’) defeated in battle in 2020 – has morphed, like some demon – into Delta. And that Delta is a seriously mean beast. In creating Demon Delta, we implicitly treat its predecessors as comparatively harmless. Yet by far the majority of Covid19 deaths in the world have been caused by non-Delta variants. (If this latest outbreak had been identified as non-Delta, we should have been more – not less – alarmed; it would probably have come from South America, where Covid19 has most affected, and where Delta has been least present.) In this narrative, populations have four weapons at their disposal: macro barrier methods (lockdowns and quarantines), micro barrier methods (hygiene practices, including facemask wearing), contact tracing, and ‘silver bullet’ vaccinations. (By ‘silver bullet’ vaccinations, we mean that – after a course of vaccinations – a person may be classified as ‘immunised’; this is how we understand, for example, measles vaccinations.)

In this narrative, the implicit counterfactual is that the adverse consequences of a Delta outbreak are much greater than of an outbreak of the South American versions of Covid19, or of the original Wuhan version. While we have heard much about the greater transmissibility of Delta, I have heard of no scientific studies that compare Delta and non-Delta strains in fully comparable populations. (All scientific pharmaceutical trials require that drugs be tested alongside ‘control’ treatments.)

This predominant narrative may be called Hypothesis One.

There is a second obvious hypothesis (Hypothesis Two): that (i) Delta is substantially the same as previous versions of Covid19, though just enough more transmissible to displace other variants in circulation in the same environments (like grey squirrels displacing red squirrels), and (ii) from late 2020 – and especially in 2021 – populations have reduced CRVI (community respiratory viral immunity). (There is another possibility, an in-between hypothesis, that Delta is significantly more harmful than other variants, and that its impact is exacerbated through many current host populations having reduced CRVI.)

An extension of Hypothesis Two is that immunisation by vaccination may not be permanent. (It is a known known that measles immunisation is permanent, but that immunisation against influenza is temporary.)

In summary, Hypothesis One is that the major problem leading to ongoing mortality and morbidity is the more aggressive behaviour of the enemy (of Delta). Hypothesis Two is that the major problem leading to ongoing mortality and morbidity is the reduced CRVI of the population.

The counterfactual to the first hypothesis is that the Covid19 pandemic would be in its endgame, were it not for Delta. The counterfactual to the second hypothesis is that the outcome of New Zealand’s August 2021 outbreak of Covid19 (and recent Asian outbreaks) would be much the same – serious – whether or not this was the Delta strain. Both hypotheses predict that – without appropriate policy responses – there will be problematic levels of mortality and illness.

Policy Implications

Both hypotheses require policies of ’emergency lockdown’ and, if available, ‘vaccination’. (Fortunately, we do have available effective vaccinations which target the SARS-COV2 virus; had these vaccinations proven to be ineffective, then we would further emphasise ’emergency immunity management’ policies such as lockdowns.

There are two important policy differences, however, depending on which hypothesis is more true. The first policy difference relates to how populations should behave outside of periods of emergency lockdown. The second is about the ongoing vaccination programme.

In Hypothesis One, Delta is the problem, and success is the ‘elimination’ of SARS-COV2 (whereby SARS-COV2 goes to the same place that SARS-COV1 – in 2003 – went to), aided by the immunisation by vaccination of the population.

In Hypothesis Two, reduced CRVI is the problem, and success is a level of community immunity that would tolerate SARS-COV2 circulating in future as another seasonal ‘common cold’ coronavirus. And success means adopting practices – including regular vaccinations – that extend CRVI levels in the population. (The good news here is that regular Covid19 vaccinations should reduce illness from other endemic viruses by facilitating high CRVI levels. Good for labour productivity as well as for general wellness.)

CRVI

What exactly is community respiratory viral immunity? It’s probably not quantifiable as a precise metric, but is a real-world parameter that rises or falls under different conditions; and it’s a community attribute that, ideally, should be optimised but not necessarily maximised.

The key idea is that it is a measure of general immunity to an important class of pathogenic diseases, and not immunity to a specific respiratory virus. And it should be understood as a population measure, rather than a measure of an individual person’s immunity.

CRVI increases with exposure to respiratory viruses in aggressive or attenuated form. It relates to what might be called the ‘common’ classes of community viruses: influenzas, coronaviruses, rhinoviruses, and other similar viruses such as respiratory syncytial virus (RSV).

Novel viruses (such as coronavirus SARS-COV2) can be classed as ‘aggressive’ (mainly because they are unknown to our immune systems), though some may be more aggressive than others (eg SARS-COV1 was more lethal than SARS-COV2). Attenuated viruses can be classed as those which have evolved to be less aggressive, forming equilibriums with populations with given levels of community immunity. And the label ‘attenuated’ can be used to describe the deactivated viral sequences that constitute the active ingredients of our vaccines. Vaccination against community viruses is a relatively recent episode in the wider history of vaccination; until 2020, only influenza vaccinations were in place for this viral class, and even they are comparatively recent (ie, in practice, influenza vaccinations are twentyfirst century interventions).

Over the history of humanity, CRVI has increased, and necessarily so. As more community viruses circulate within human populations (ie become endemic to humans) – typically viruses passed to humans from other species for which they were already endemic – then CRVI levels increase due to accumulated exposure to ever-greater-numbers of these virus species. Thus, in 2019, CRVI levels in human populations throughout the world were probably at the highest level that they had ever been in human history. Indeed, the main driver of rising CRVI levels in recent decades has been the decreasing cost and increasing convenience of international air travel. Another important driver has been the introduction of annual influenza vaccinations.

CRVI levels are generally higher in urban populations, and highest of all in the world’s metropolitan cities; cities which are both densely populated and within close reach to international airports. One of the most important unknown knowns (or at least ‘little known’ knowns) in this regard is the difference in community immunity levels between different homeplaces of young men called into the United States’ military in 1917, the year that a new H1N1 influenza virus started to circulate in the United States. The weaker – indeed ‘weedier’ – city boys proved to be significantly more resistant to the virus than the muscular young men from the farms and the provincial towns. (Refer to The Pandemic Century (2019), by Mark Honigsbaum.)

An important feature of CRVI is that it wanes when not fortified by ongoing exposure to community viruses. CRVI is nuanced, in that if fortified mainly by rhinoviruses in one year, then populations become a little more susceptible to serious illnesses from influenza viruses in the following year. Nevertheless, exposure to one class of community viruses probably gives some degree of resistance to other classes of community viruses.

So, under Hypothesis Two, in early 2020, global population CRVI levels were very high. The result was that Covid19 illness – caused by the then novel coronavirus SARS-COV2 – was resisted by the younger infected population, including the middle-aged-populations which represented the majority of airline passengers. Thus the major health consequences were faced by the older and comorbid populations who were less able to mount the requisite immunity responses.

However – and under Hypothesis Two – the important but not understood story of 2020 was the unusually rapid waning of CRVI levels in (now largely physically disconnected) human populations. This waning was a result of restrictive behaviours, mandated and unmandated. Restrictive behaviours include both mandated isolations, and personal barrier restrictions (such as physical distancing and the widespread use of facemasks).

Under emergency conditions, a loss of CRVI is the necessary price we must pay in order to minimise – if not eliminate – a dangerous pathogen. This elimination was achieved with SARS-COV1. The under-recognised challenge is to – as best as possible – start to restore CRVI levels as soon as emergency conditions are lifted (and, as part of this, to fully lift domestic emergency mandates as soon as a novel virus has been suppressed).

Part of the CRVI restoration process is of course vaccination, and it is probable that booster influenza vaccinations did to some extent increase our abilities to resist new outbreaks of Covid19. Of course vaccines that specifically target coronaviruses – and SARS-COV2 in particular – would have much more impact during a coronavirus pandemic; and the beneficial side-effect of coronavirus vaccines is that they most likely reduce populations’ susceptibility to the other community viruses that give us colds and influenzas.

It is now possible to talk of the ‘benefits of complacency’. ‘Complacent’ barrier behaviour – though not so much complacency towards contact tracing – helps to restore CRVI, and prepares populations for the next (or next wave of) community viral infection.

Hypothesis Two states that the major single factor in the severity of outbreaks of Covid19 since the middle of 2020 has been the loss of CRVI, and not the increased virulence of the evolving viral agents.

1917-19 Influenza Pandemic

It is worth digressing here to note the epidemiology of the H1N1 influenza pandemic of 1917-19; the pandemic best called the ‘black flu’, though more commonly (and inappropriately) called the ‘Spanish flu’.

This pandemic essentially hit the world in three waves, with the second wave being the most severe. In New Zealand the probable fatality rate was about 0.8% of the population, though ‘officially’ it was more like 0.4%. (We note that the present official fatality rate of Covid19 in the United States state of New Jersey has, just this month, surpassed 0.3%.)

The first wave of this pandemic appears to have begun in the United States, and its spread was almost certainly facilitated by the mobilisation of conscipted troops, as the United States entered World War One (WW1). However, another variant of H1N1 influenza had been emerging in China, and it seems that, on the Western Front, the two versions fused into a new super H1N1 variant, the ‘second-wave’ variant that was brought to New Zealand by returning soldiers. (The best source for New Zealand epidemiological information is the second edition of Geoffrey Rice’s book Black November. And we should note that evolution – of viruses as well as larger creatures – is about hybridisation [fusion] as well as through descendant mutation [fission].)

The earlier variant had however circulated in New Zealand in the late winter of 1918, with some severe health outcomes, but also raising the effective CRVI in those parts of New Zealand that were affected. When the big second wave hit in November 1918, two groups suffered least. First were those – such as Ngāti Porou – who implemented local quarantines. Second, were those in the places most affected by the first wave. After the short emergency period (essentially the month of November 1918) people reverted to normal life – or as near to normal life as possible in the month that WW1 ended. CRVI levels were clearly very high by New Year 1919, so when the slightly attenuated third wave hit in 1919, New Zealand was barely affected. Australia – which had imposed a full quarantine in November 1918 – suffered much worse in 1919 than New Zealand, though not as badly as New Zealand had done in 1918. Clearly, New Zealand had – for that time in history – very high levels of CRVI in 1919; ‘herd immunity’ to influenza, and most likely a higher than normal immunity to other community respiratory infections.

The ‘black flu’ pandemic was an event that featured both a more virulent muted version of the H1N1 influenza virus, and significantly varying levels of community immunity to respiratory viruses.

We note that in the present pandemic, both Hypothesis One (a very lethal variant of the virus) and Hypothesis Two (waning CRVI levels) may contribute to the story. In 2021, however, the Hypothesis One story (the ‘delta’ story) seems less convincing; I suspect, because the newer more aggressive variant is a descendant (fission) variant, not a fusion of two already aggressive variants (as was the case in 1918).

Hypotheses One and Two: the Evidence

To start with, we need to look at the big European second wave of Covid19, in the northern autumn of 2020. By then, there was increased knowledge of Covid19, improved testing and contact tracing, and renewed use of barrier interventions to viral circulation; all of these should have reduced the impact of the second wave if the virulence of the virus was the main determinant of the level of deaths and serious illnesses. But none of the new ‘more transmissible’ variants were present at that time; Covid19 was not more virulent then. (‘Alpha’ was the ‘Kent variant’ that surfaced in England in about December 2020.)

Instead, what happened was that, in late 2020 in most West European countries, the death rates were similar to those of the preceding spring wave. Spain was different; its fatality rates were significantly lower. Of most importance for this analysis was East Europe, within the European Union. There, where, in the spring, barrier methods had largely kept Covid19 out, fatality rates soared in the autumn to levels much higher than in West Europe. It was the same virus in both parts of the European Union. This picture negates Hypothesis One, and strongly supports Hypothesis Two. The major determinants of Covid19 death in Europe in late 2020 would have been varying CRVI levels, lowest in the east due to its successful earlier precautions, highest in Spain. Whereas summer complacency in the Czech Republic (where CRVI had become dangerously low) undoubtedly contributed to the problem, summer complacency in Spain most likely contributed to the solution, by boosting CRVI there. We also note that, for the most part, younger people were more likely to die from Covid19 in East Europe. This is consistent with lower CRVI levels there and then, rather than greater levels of complacency (unlikely) being the problem in East Europe. By September 2020, Covid19 was a known known, no longer a ‘black swan’.

In the Americas, throughout the pandemic, piecemeal barrier protection almost certainly reduced the peaks of the outbreaks, but also brought about depressed CRVI levels. We see that, in the United States, the timing of outbreaks in the ‘blue’ (Democratic) states (where barrier controls were most followed) and the ‘red’ (Republican) states (where barrier controls were most resisted). In general, the new outbreaks started in ‘blue’ states (with less CRVI), and eventually moved on to red states (with higher CRVI than blue states, but less CRVI than in 2019). In the very latest outbreak, though, the blue states were saved through higher CRVI arising from much higher vaccination rates; the present outbreak is accentuated in the red states.

Hypothesis Two predicted that, in 2021, Asia (which had imposed the most effective barriers in 2020) would be very vulnerable. That has come to pass. And – as in Indonesia today – the age profile of fatalities has been coming down, suggesting that levels of CRVI in Asia in 2021 are even lower than in Eastern Europe in late 2020 and early 2021. The tragedy of Indonesia is that even very young children are dying.

Further, in Asia in 2021, those countries unable to implement sufficient barrier protections (such as India), have seen short (but severe) outbreaks of Covid19, this time with the Delta variant of SARS-COV2 featuring as a circulating virus. An extreme case of this is Afghanistan, already in political turmoil when Covid19 hit in June this year. Briefly, Afghanistan in June – as Nepal in May – was amongst the worst affected countries in the world. But now, in August and with even greater political turmoil, Covid19 seems to have largely disappeared. It looks like Afghanistan has experienced a dramatic boost to its CRVI status.

The present outbreaks in Australia are proceeding differently from those of 2020. The popular narrative is that of Hypothesis One – that the people are now up against a more vicious foe, a devil called Delta. But the manner of the more lethal spread of Covid19 in the young population is more suggestive of low CRVI levels, as in East Europe late in 2020. The (counterfactual) control here is the United Kingdom, and West Europe. In these places CRVI has largely been restored (though, as in Israel, may be waning due to the earliness of its jabs). There, Delta has behaved more like a pussy cat than a devil, infectious but not lethal. In the United Kingdom, CRVI was largely restored by vaccination, but the removal of mandated barrier protections will be ensuring that vaccination-induced CRVI is being enhanced by renewed community circulation of seasonal (non-novel) respiratory viruses. Australia – especially young Australians – have substantially less CRVI protection from serious illness.

Eastern Europe is an interesting test case; it seems to have been immune from Delta so far. However, waning community immunity may see it vulnerable this coming northern winter.

Here in Aotearoa New Zealand, the rapidly imposed emergency measures should – after a few weeks – repel the current outbreak. The challenge will be for us to substantially restore CRVI levels, in time for the southern winter of 2022. While vaccinations this year – and 2022 booster vaccinations for the more vulnerable – will represent the main part of meeting this challenge, a high dose of Level 1 barrier-complacency this summer (but not QI-code complacency, for contact tracing) should help to keep the unvaccinated somewhat safe, the rest of us safe from them, and should help the vaccinated to hold on to raised CRVI levels through next autumn. It means that, once back to Level 1 (no community presence of Covid19), we should be encouraged to remove our masks – and to enjoy mixing and mingling – at least until another border-infringement outbreak occurs. And, when international travel is once again opened up, our priority should be to maintain – and extend – high levels of CRVI (community respiratory viral immunity). Low CRVI means lots of infections, many serious, and not all Delta Covid19.

Conclusion

The evidence, at least as I have presented it, comes closer to disproving Hypothesis One (the aggressive Delta hypothesis) than to disproving Hypothesis Two (the deficient CRVI hypothesis). I would like to see, in the media, a proper scrutiny of both hypotheses. Until this happens, the attention that community respiratory viral immunity requires will be negligently missed. The likely truth that is Hypothesis Two will remain a known unknown.

Barrier methods – macro and micro – work in emergency contexts, much as cortisol reduces stress and anxiety in these contexts. But, out of these acute situations, excess cortisol becomes a source of ill health. Barrier infection blocks all of the community viruses that support CRVI levels, making us over time more vulnerable to community infections, and making those infections more dangerous. On the other hand, annual vaccinations for influenza and coronavirus will substantially extend CRVI levels, making us generally more healthy with respect to both influenza and common cold viruses. In the United Kingdom and West Europe, Delta Covid19 shows all the signs of becoming – in a few years – another common cold coronavirus.

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Keith Rankin, trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

contact: keith at rankin dot nz

A new vaccine may be needed if the delta variant of covid-19, which is currently in Fiji, continues to mutate, health experts say.

The government says more than 22,000 people with covid are in isolation and the death toll has passed 260, and climbing.

The victims included an 11-month-old baby, pregnant mothers, a 15-year-old teenager and a 102-year-old woman.

The government maintains there is no need to impose a complete shutdown of the country.

According to the Health Ministry, the average deaths per day is eight, while the daily average infection is 1039 cases or 1174 per million population.

The US Centers for Disease Control and Prevention has placed Fiji on level 4 of its covid-alert due to the growing number of cases in the Pacific nation.

Professor Fiona Russell from the University of Melbourne said reports that more people are dying from the virus in Fiji should be a concern.

She said the mutation of the delta strain could happen.

‘Characteristic of all viruses’
“That is a characteristic of all viruses, not just the coronavirus and there are other mutations that have already occurred. At the moment what we’ve found is that the variants have become more transmissible. We have to keep an eye on that and there’s ongoing studies to monitor it. And it may be that in the future, people in Fiji may need a booster.”

Professor Russell also said Fiji’s health facilities could easily get overwhelmed if people do not take heed of covid-safe protocols.

She warned the country was very early on in the outbreak and should take heed of what had happened in countries such as India.

“If covid-19 takes off in Fiji, then the hospitals may get full and that is if you get sick with anything at all, let alone covid, then the doctors and nurses may not be able to treat you properly because they’re just so busy treating all the other covid patients.

“We certainly in Australia were worried about that and so we made plans for that in case that was to occur.”

She praised Fiji’s efforts in trying to contain the disease.

Professor Russell said the seriousness of covid-19 was evident in how quickly it had spread during the second wave in the country.

Government urged to change strategy
New Zealand epidemiologist and University of Otago professor Michael Baker agrees.

He said Fiji was going backwards in its fight against the pandemic.

Despite the Fijian prime minister’s refusal to enforce a national lockdown, Baker said it was not too late for the government to change its strategy.

“The situation in Fiji is very worrying. They’ve really lost control of this epidemic at this point given the record number of infections that are of a very widespread nature.

“It depends what their overall strategy is. If they want to return to elimination position, I think they need to act very decisively now and that actually offers a much better route back to economic recovery than trying to suppress the virus and live with it which hasn’t really worked very well in the past.”

Fijian epidemiologist Dr Donald Wilson said the country was “overwhelmed” by the pandemic.

He warned the current trend of infections could force officials to make “unethical medical decisions”.

“The worry is that when the health system becomes overwhelmed, when it cannot any longer peak in lots of patients who have severe disease, then unfortunately like what has been happening in other countries where doctors have to do the unethical thing of needing to choose who to put on ventilators and who not to.”

Mass vaccination progress
Dr Wilson said a mass vaccination campaign aims to immunise 600,000 Fijians by November this year.

Close to half a million Fijians or 84.4 percent of the target population have received their first dose of the AstraZeneca vaccine, while just over 158,000 or 27 percent have got both jabs.

The head of Fiji’s vaccination taskforce, Dr Rachel Devi, said the only good news is the Moderna vaccine, now in the country, is also effective against the delta variant, the UK variant and the Wuhan strain of the virus.

“We have important strategies in terms of how or when and where we roll this out across the country. This would definitely boost it up especially right now we weren’t vaccinating our pregnant women with the AstraZeneca unless these individuals consented. But I know there’s quite a lot of build-up in that area now. There’s a lot on safety reasons as well.”

Meanwhile, an Australia-based Fijian academic warns Fiji is suffering its worst medical, social and economic crisis since the measles epidemic of 1875 which led to the deaths of a third of the country’s population.

Professor Wadan Narsey said this could have been avoided had the government listened to the best medical advice – not just in Fiji, but also from its major partners New Zealand and Australia.

He said Fiji’s tragedy stems from its heath system being unable to cope with the crisis and has seen deaths soar to more than 260, and climbing.

This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz