Facing the House of Lords , Neil Ferguson, also known now as “Professor Lockdown,” responded that “lockdowns are a crude policy.” A remarkable turnaround. Of course they are , when they shatter the lives of crores of people. After the damage has been done Professor Lockdown advises a more targeted approach would have been more appropriate. The predictions that there would be 20 to 22 lakh deaths in the US, 5 to 8 lakh deaths in the UK and 70,000 to 100,000 in Sweden were dangerously way off the mark. We have the death figures with us , and these are substantially lower than what the models suggested. Sweden has had 4562 deaths, far less than the 70000 to 10000 predicted; and WITHOUT lockdown
When one looks back it is obvious the entire Indian media was deriving great pleasure in publishing interviews with “public health workers” who out did one another in predicting dooms day scenarios. One after the other they came up with astronomical death rates that ran into lakhs of deaths due to Covid-19. The corridors would be full of patients they said. The result is that the Indian public is paralysed with fear. The enlightened “editors” living on a completely different moral pedestal left no stone unturned in amplifying the terror.
One had expected better sense from the “alternate media” in this country, but they turned out to be the biggest culprits. Scare mongering is as natural to them as breathing. The number of deaths by Covid-19 are in dispute but there is little doubt that viewership rocketed directly in proportion to the dread spread.
One can wake up a sleeping person but how do you wake a man who pretends to sleep. The damage is done. Crocodile tears are being copiously shed for the misery of the lakhs who got displaced and lost their livelihoods. There is no need for elaboration, the catastrophe is there for all to see. The contribution of the media to the disaster is immensely worrying. There is some sadistic pleasure in providing death rates every day.
Sweden without a lockdown has not recorded more than 4500 deaths , which is less than the UK that suffered a rather stiff lockdown. The prime minister of Norway is on record saying that she had panicked initially and wished she had to some extent followed the Swedish model. The Swedes are probably close to some form of herd immunity with the icing of the least damaged economy in any European country. England faces a 14% drop in its GDP in 2020; such a recession was last seen in 1706.
Sweden kept its schools open. Children below 16 continued with school; bars and restaurants did not shutter down. The public was coaxed to follow simple common sense rules of social distancing, washing hands, and good hygiene. The Swedish public rose upto to the occasion. The government however made one big error, it failed to protect the elderly staying in care homes. The death count would have been considerably less had the government secured the elderly.
Almost half of deaths in other European countries are to be blamed again on the negligence regarding old folks in care homes.
It is also being realised that 30-40% excess deaths have been collateral damage. These are deaths not associated to Covid-19 but to people not seeking attention on time. A significant amount of deaths have been due to heart attacks at home. A lot of people feared going to hospitals because of their belief they would catch the SARS-CoV-2 virus or because there was no means of transport. Procedures in Cath labs across the globe have dropped by at least 40%. A lot of people are suffering angina silently and are resigned to their fate.
The psychological toll on people is yet to be estimated, but damage surely has been done. Anxiety and depression is rife in people corralled in their homes for months. Near absence of exercise, anxiety and mental stress must be accelerating plaque or blockage formation in coronary arteries. Minor strokes may be being ignored.
The second killer is cancer. The commonest are breast, lung, prostate and colon. Not necessarily in that order. Hundreds of people must be unaware that cancer in them has advanced to a more serious stage that may put their lives in peril. They however have not been able to get a consult and in many treatment has been postponed or denied altogether.
Who would have dreamt that the diminutive pill containing chloroquine would catch the attention of the entire world. Chloroquine was discovered in 1934 by a German scientist and became the drug of choice for treating malaria. I too took it when I was a third year student in medical college. I have never forgotten the dose since. Hydroxychloroquine (HCQ) , a sister drug, is currently used in auto immune disease such as lupus and rheumatoid arthritis. HCQ is able to quell immunity that attacks its own body in these 2 diseases. Donald Trump touted HCQ as a “game changer” in March. The result was a surge of 2000% in the prescription. Most doctors in the world were soon swallowing HCQ as a means of prophylaxis, that is as prevention from Covid-19. The ICMR issued an advisory on HCQ for post exposure prophylaxis without citing a single study. This was amazing stuff, far far away from evidence based science as we know it.
Observational studies published in leading journals did to show any clinical advantage with chloroquine or HCQ. These trials included a sizeable number of patients. A Spanish trial that included 700 patients of rheumatoid or lupus failed to show the slightest difference in those patients receiving HCQ or those not given the pill.
A Korean trial similarly failed to demonstrate efficacy of HCQ in an observational study of 300 people exposed to a confirmed patient of Covid-19.
Two papers from the US with more than a thousand patients did not demonstrate advantage with HCQ.
The largest observational paper that included 96000 patients form 671 hospitals across 6 continents also did not shown any improvement with HCQ, but suggested there may be harm. This paper is now being challenged for providing dodgy data. The editor of the Lancet has commissioned a third party audit to confirm the results. France has banned HCQ whilst Italy and Spain recommend use only in a clinical trial or in hospital setting.
The WHO had suspended the HCQ arm in the ongoing SOLIDARITY trial but has resumed it since yesterday. The New York Times and other leading newspapers of the world carry stories on the Lancet paper. Whether this will it be a storm in the teacup remains to be seen ?
Currently at least 200 ongoing trials on HCQ in patients with Covid-19. The results are awaited. Quite a few should be randomised. International trials are ongoing in the UK, France , the US and at the WHO. Results are eagerly expected in a few weeks or few months.
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The new corona virus has taken a toll on the reputation of the authors of the big paper published in the Lancet. An independent audit has exposed flaws in data collection. The first author Dr. Mandeep Mehra has been compelled to retract the paper.
“It is now clear to me that in my hope to contribute to this research during a time of great need, I did not do enough to ensure that the data source was appropriate for this use,” Dr. Mandeep Mehra, lead author of the two studies, said in a statement to The New York Times.
“We can no longer vouch for the veracity of the primary data sources,” Mandeep Mehra of Brigham and Women’s Hospital, Frank Ruschitzka of University Hospital Zurich, and Amit Patel of University of Utah said in a statement issued by the Lancet. “Due to this unfortunate development, the authors request that the paper be retracted.”
Meanwhile, on Wednesday, researchers reported results of the first gold-standard clinical trial of hydroxycholoroquine in Covid-19, concluding that it did not prevent infections any better than placebo. This was published in the NEJM.
So far only 2 double blind randomised trials have been published. A Brazilian study published in JAMA showed that high dose chloroquine was as effective a slow dose chloroquine but lethality was much greater with the higher dose. The authors of the paper instead of appreciation faced death threats. The son of the Brazilian president with 2 million Twitter followers termed the study fake and the handiwork of the opposition political party. The principal author was compelled to go underground.
DOI: 10.1056/NEJMoa2016638
Yesterday the second double blind study on post exposure prophylaxis in 800 exposed people was published in the New England Journal of Medicine. The conclusion was that HCQ did not provide any benefit in preventing infection. Both groups ( HCQ and control ) developed Covid -19 to the same extent ; only 2 patients needed hospitalisation , one from each group, no patient died. The researchers concede that the population studied was 40 years and not all patients were confirmed by the RT-PCR test.
The new study included 821 people from across the United States and parts of Canada who had a either a high-risk or moderate-risk exposure to a person who had tested positive and was ill from the coronavirus. None of the participants had symptoms themselves. High-risk exposure meant they were less than six feet from a patient for more than ten minutes, with neither a mask nor a face shield. Moderate risk meant they wore a mask, but no face shield.
There was no meaningful difference between the placebo group and those who took the drug. Among those taking hydroxychloroquine, 49 of 414, or 11.8 percent, became ill. In the placebo group, 58 or 407, or 14.3 percent, became ill. Analyzed statistically, the difference between those rates was not significant.
The jury is still out on HCQ. We have to wait for more randomised trials to fill this huge gap. HCQ is cheap and made in the tons in India. It has shown activity against the virus in experimental conditions. But the chasm from the petri dish to the human body can be massive. The signal so far is that HCQ may not be the “game changer.”
India has recorded 6200 deaths over 6 months , at 4 per million population.
The “intellectuals” however had anticipated 20 lakh ( 2 million) deaths .
Extraordinary prescience , or covert agenda !