Covid-19 Diary : Thursday 4 March, 2021

 

Life is strange at present.  On the one hand, the vaccine is becoming more and more widely available, at least in the US, and daily new infection rates have started to gently drift down again in the last few days – nowhere like the plummet in numbers in January/February, but any type of decline is still to be greatly welcomed.  So, good news.

This is encouraging some states, most notably Texas and Mississippi, but also others too, to loosen up or completely cancel their restrictions.  Other states, while not going quite so far, are hoping for good things very soon now (for example, Colorado), and Florida is repeating itself with public anguish over how to handle this year’s spring break crowds, just like it did last year.

Loosening the previous restrictions now is absolutely wrong.  The virus is still abundantly present in all states, and indeed, with the growing prevalence of more infectious and more deadly strains, the need for caution now is greater, not less, than it was at any previous time in the last twelve months.

Think of it like stopping your car while driving down a steep slope.  You need to apply the brakes, and after doing so, the car starts slowing down, and you then apply the brakes more, to eventually bring the car to a stop.  You don’t then release the brakes and expect the car to continue slowing down, do you – not while it is still on the slope.

In this analogy, the slope represents the underlying presence of the virus.  The brakes represent preventative measures such as masks and social distancing.  And the car’s speed represents the rate of new virus cases.

Just as how, as long as the car is on the slope, you need to keep your foot on the brake pedal to slow the car down and stop it, and keep your foot on the brake, even after the car has stopped, so too do we need to keep our preventative measures in place as long as the virus is out there and we’re not all vaccinated with a vaccine that will be effective against the growing range of virus threats, some of which are increasingly showing themselves to be less controlled by the vaccines.

This is not rocket science.  It is very basic and simple epidemiology and public health, and the governors in states such as Texas and Mississippi are getting it dangerously wrong.

Meanwhile, although some people are daring to hope the light at the end of the tunnel is indeed a light (and I largely include myself in that optimistic group), other people are appreciating that it is still quite some distance between we get there.  Here’s a reasonably sensible commentary that is rather depressing – our lives may be forever under a Covid cloud, with continued need for new vaccinations for new strains, and a requirement for caution prior to each new vaccine’s release to match each new strain, for some years to follow.

Meanwhile, “scientists” who should know better continue to come up with crazy untested ideas about mixing and matching vaccines.  Maybe there’s some sense in their speculation, but the craziness is their eagerness to adopt untested, untrialed, unproven, unknown, strategies – something that is alarming and depressing.

Talking about scientists who should know better, perhaps a quick update on ivermectin is called for.  Astonishingly, the National Institutes of Health is refusing to disclose who it is among their experts that is/are arguing against ivermectin, or why – they claim they are “unable” to comply with a Freedom of Information request to explain why they are not more positive on the drug.

It is bad enough they’re not singing ivermectin’s praises at the top of their voice, but to refuse to disclose who is responsible for their negativity and why, is perplexing.  Their awkward silence implies guilt and their own knowledge that their decision was not made on a rational and supportable basis.

Meanwhile, Peru has unwittingly provided some mass-data that seems overwhelmingly persuasive in support of ivermectin use.  In May last year, the country approved ivermectin as a Covid treatment.  This brought about a 14-fold reduction in national excess deaths.  That seems to argue very strongly in favor of IVM use.

But wait, there’s more.  Inexplicably, after a new President was elected, the country changed its national guidance, and sharply restricted IVM availability and use.  The outcome?  Excess death rates increased 13-fold.

So, there’s proof, both ways.  Start using ivermectin, and national death rates drop.  Stop using ivermectin, and national death rates increase again.

One more thing about scientists who should know better.  According to this WSJ article, the risible WHO investigation into the Chinese origins of the virus is not only being criticized by independent scientists (and me), but the eventual release of formal findings are subject to the Chinese government’s prior approval.

Is it possible to come up with a more guaranteed-to-fail approach to an “independent enquiry”.  That’s a bit like trying someone in a jury trial, and not only having the defendant control what evidence the prosecution can show the court, but also requiring the jury’s verdict to be approved by the defendant prior to being announced.

Current Numbers

There were no changes to either the US case rate or death rate rankings.

There were no changes in the minor country list.  In the major country list, Sweden and Belgium swapped places, as did Belgium and the Czech Rep on the death rate list.

US Best and Worst States

Rank Cases/Million Deaths/Million
A week ago Now A week ago Now
1 Best HI (19,322) HI (19,563) HI (307) HI (311)
2 VT (23,782) VT (25,138) VT (325) VT (332)
3 ME ME AK AK
4 OR OR ME (521) ME (524)
5 WA (44,775) WA (45,473) OR (523) OR (542)
47 IA (114,720) IA (115,884) MS (2,222) MS (2,273)
48 UT (115,233) UT (116,445) MA (2,318) MA (2,363)
49 RI RI RI (2,356) RI (2,397)
50 SD (126,562) SD (127,806) NY (2,442) NY (2,483)
51 Worst ND (130,726) ND (131,464) NJ (2,606) NJ (2,645)

 

Top Case Rates Minor Countries (cases per million)

Rank One Week Ago Today
1 Andorra (139,619) Andorra (141,904)
2 Gibraltar (125,727) Gibraltar (125,965)
3 Montenegro Montenegro
4 San Marino San Marino
5 Slovenia Slovenia
6 Luxembourg Luxembourg
7 Israel Israel
8 Panama Panama
9 Aruba (72,892) Aruba (74,800)
10 Lithuania (72,685) Lithuania (74,498)

 

Top Case Rates Major Countries (cases per million)

Rank One Week Ago Today
1 Czech Republic (111,748) Czech Republic (119,776)
2 USA (87,435) USA (88,851)
3 Portugal (78,779) Portugal (79,344)
4 Spain Spain
5 Belgium Sweden
6 Sweden Belgium
7 Netherlands Netherlands
8 UK (60,989) UK (61,670)
9 France France
10 Brazil Brazil
11 Italy (47,488) Italy (49,653)
12 Argentina (46,048) Argentina (46,926)

 

Top Death Rate Major Countries (deaths per million)

Rank One Week Ago Today
1 Belgium (1,892) Czech Rep (1,970)
2 Czech Rep (1,850) Belgium (1,907)
3 UK (1,792) UK (1,821)
4 Italy (1,605) Italy (1,639)
5 Portugal (1,590) Portugal (1,617)
6 USA (1,567) USA (1,606)
7 Spain (1,471) Spain (1,507)
8 Mexico (1,408) Mexico (1,448)
9 Peru (1,380) Peru (1,421)
10 France (1,309) France (1,344)

 

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Items below include a very important factor that can affect your Covid survival chances ten-fold, and similarly impact on how well the vaccine may protect you, a new way of detecting Covid infections, the US approves a third vaccine, which brings the question – which of the three is best for you, Canada’s unfortunate vaccine choice is a vaccine spurned by many other countries, and a look at vaccination and infection rates.

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15 thoughts on “Covid-19 Diary : Thursday 4 March, 2021”

  1. lifegotinteresting

    I agree with your hill analogy but would take it one step further. Right now, we don’t truly understand how the “brakes” are working.

    We don’t understand how or why infections are dropping the way that they are. So how can our leaders make policy decisions like loosening? Who is advising them?

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      Your question about “who is advising them” is a particularly interesting question.

      I suspect that just like how the NIH refuse to put people’s names alongside their shameful secret decision to delay approving ivermectin, few advisors are willing to stand up, be counted, and, most of all, to be accountable.

      We acknowledge the essential need for justice to be done in public, as much to make the judges and the legal process accountable as for any other reason. As far as I’m aware, Congress can’t secretly pass laws. Why shouldn’t other impactful elements of how our lives are to be experienced also be decided in a public – and accountable – manner?

  2. Hi –

    Here is a good link (in case it isn’t already in the numerous links already covered)

    https://www.covid19treatmentguidelines.nih.gov/antiviral-therapy/ivermectin/

    Two things that are interesting. The first is, assuming I’m reading it right, is the petri dish experiment concluded to be effective the dose would be 100X the norm to have a strong response. Given there is little know about the safety at the level of dosage, some caution makes sense.

    The second is the frustrating part of the entire report is what seems to be excessive conservative views. There seems to be more positive indications than negative. The challenge is many of the positive items have significant study constraints. The biggest one seems to be the lack of double blind data. There is, unfortunately, evidence from studies many years back that doctors knowing who is getting the experimental will give it to the slightly healthier patients and/or provide more intensive monitoring and treatment. (Sorry for not having a reference but it has been 40 years since I was employed in medical research; that said human behavior doesn’t change much of over time).

    Given the many indicators of a likely positive impact, why there isn’t a large, well designed, study funded and ongoing already? That seems to be the most frustrating part.

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      Hi, cclinger

      The petri dish experiment shows us what happened, in a petri dish, at that strength. It doesn’t tell us what happens, in humans, at other strengths. One has to be careful extrapolating beyond the “in vitro” experimenting to “in vivo” experimenting; it merely provides a very strong signal that IVM has anti-viral properties.

      I absolutely agree about the excessive conservative views. But I do NOT agree, not for the briefest of milliseconds, that there is a lack of double blinded data. According to this site there have been 22 such trials already. Keep in mind we’ve approved vaccines based on only one single trial per vaccine, and that trial conducted by the drug manufacturer. Ivermectin has 22 trials, by impartial third parties.

      In what universe is 22 positive trial outcomes insufficient???

  3. fh7742

    Re “one single trial per vaccine.” Yes, but they were trials involving many thousands of subjects — over 43,000 for the Pfizer vaccine for instance. The ivermectin trials have all involved dozens or at best a few hundred subjects. As CCLINGER says, given the promising results from these, and the real-world experiences in places like Peru, Bangladesh and India, it’s very disturbing that funding hasn’t been found for a truly major study.

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      There’s a lot more to determining the validity of trial results than simply counting the number of people enrolled in a trial.

      In the case of the vaccine trials, the numbers that should be evaluated are not the many tens of thousands of participants, but the utterly unknown number of people who were validly exposed to the virus, and the known hundred or fewer people in each of the trials who actually became infected with the virus.

      The other many tens of thousands of people are irrelevant, and contributed nothing to the efficacy trial at all (while providing some data on vaccine safety, but in the case of ivermectin, the safety issue is already well known and resolved).

      In the early exposure IVM trials, everyone in the trials had been exposed/infected with Covid. Everyone of those people was a valid contributor of data to the impact of ivermectin. A single 100 person trial of ivermectin gives as much as data as a 43,000 person trial of a vaccine.

      That is why I’ve been calling for challenge trials of vaccines. We could get similar, maybe even more meaningful data from a challenge trial involving 100 people than from an ordinary trial involving 43,000.

      This site sums up the state of the ivermectin trials appropriately :

      The probability that an ineffective treatment generated results as positive as the 44 studies to date is estimated to be 1 in 18 trillion (p = 0.000000000000057).

      That’s more than enough certainty to see me reaching for the IVM if I feel unwell. How much more could anyone possibly want?

  4. fh7742

    A stage 3 vaccine trial is intended to test for efficacy in preventing illness, not curing it. The numbers are important. They reduce statistical uncertainty, as well as checking for safety (ie, side effects). They also validate (or invalidate) the proposed dosages and treatment protocol.

    But, ok, it’s an apples and oranges comparison. Regardless, if there have been positive results from 44 studies and the medical profession still lacks the confidence needed to prescribe IVM, slinging accusations at physicians will get us nowhere. What needs to be done to build that confidence? Clearly, for doctors, this is a liability issue. How does one influence the risk assessment? Who do we lobby?

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      I don’t understand your first paragraph point. Maybe that’s because you’re wrong. The vaccines haven’t been tested for preventing illness (the fact we weren’t given any data on their impact either on people becoming infected or becoming infectious is a big hint about this – studies for this are ongoing and largely empirical). They’ve been tested for preventing death (or possibly “serious” illness), but not for preventing illness of all types.

      The numbers are important, but make sure you count the correct numbers. The numbers in a vaccine trial are about 100 subjects, plus tens of thousands of irrelevant distractors. Those tens of thousands of people who don’t get infected prove nothing. Yes, they might allow inferences, but they prove nothing. The proof is all provided by the people who do get infected.

      As an aside, you are also wrong about validating proposed dosages. That is tested in the earlier stage one/two trials. The stage three trial is supposed to all be with the same dose and treatment protocol. To do otherwise (hello, the Keystone Kops at AstraZeneca/Oxford) messes up the results, which is a large part of the reason why many countries are not accepting the AstraZeneca vaccine now, due to the inadequacy of their messed up testing and inconsistent dosing regimen.

      Your second paragraph is pompous waffle. “Clearly, for doctors, this is a liability issue.” Really? How many doctors have said “I’d prescribe ivermectin, but if I did, I’d be found liable, so I won’t”.

      What exactly is the liability you say they’re concerned about? White labeling an approved drug is perfectly legal. A doctor who wanted to prescribe IVM but was worried about liability could whistle up a consent/indemnification/hold-harmless agreement to be signed by patients in double quick time.

  5. fh7742

    “Even looking at the positive side of the vaccines – their claims of around 95% effectiveness – are dubious, due to the major uncertainty of these numbers because of the small sample sizes.” Covid-19 Diary : Thursday 10 December, 2020

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      Exactly. As I’ve repeatedly said, including back in December, 100 people is an appallingly low sample size.

    2. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      To put actual numbers for severe cases alongside this :

      Pfizer : 4 severe cases total (1 person after vaccination, 3 controls)
      Moderna : 31 (1 vs 30)
      AstraZeneca : 1 (0 vs 1)
      J & J : 39 (5 vs 34)

      In the case of Pfizer, the confidence interval for the 66% efficacy claim is anywhere from “the vaccine definitely makes things worse” (ie -125%) to an impressive 96% makes things better. That is a laughable result, of absolutely no statistical value whatsoever.

      Of further note, the ultimate endpoint, deaths, shows an even starker lack of data. No-one died, either with or without the vaccine, in the Pfizer trial, only one person died in the Moderna trial, and again none in the AstraZeneca trial. There is therefore no proof at all that these vaccines reduce the risk of death. Okay, it is a reasonable assumption they do, but there is no proof.

      Taken from this excellent analysis : http://hildabastian.net/index.php/107

  6. I have some troubling items with the referenced web site. (https://c19ivermectin.com/)

    First, the FAQs refer to the authors as PhD researchers but do not provide any names or affiliations. Maybe okay to avoid flame wars but odd.

    I would love to see the math behind 1 in 18 trillion. The odds that I’ll die before 110 years old aren’t the high. It seems to be an unbelievable number.

    First peer reviewed study I looked at; first the web site summary followed by the actual summary from the published paper. THEY DO NOT ALIGN!

    Web site:
    López-Medina et al., JAMA, doi:10.1001/jama.2021.3071 (Peer Reviewed)

    Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19: A Randomized Clinical Trial

    RCT low risk patients, 200 ivermectin and 198 control, showing lower mortality, lower disease progression, lower treatment escalation, and faster resolution of symptoms with treatment, without reaching statistical significance.

    The published paper:
    Conclusion and Relevance
    Among adults with mild COVID-19, a 5-day course of ivermectin, compared with placebo, did not significantly improve the time to resolution of symptoms. The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed to understand the effects of ivermectin on other clinically relevant outcomes.

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      The study you cite is an appalling bit of intellectual dishonesty. I’ll be discussing it in today’s diary entry.

      Read the study not its conclusion before you comment further. The C19 website’s summary is, if anything, way too kind to the study.

  7. Hi –

    The http://hildabastian.net/index.php/107 analysis is excellent.

    If I over simplify, it was impossible to get 10K volunteers, give the first shot (real or salt water), put them in quarantine for 6 weeks, giving the 2nd shot at 4 weeks (during quarantine) and then allow them to return to normal life. Medical research versus reality …

    Hopefully the Moderna and J&J numbers are large enough that while the how you account for cases found in the early dates after the vaccine doesn’t change that its clear the vaccines’ have an impact. It could shift the ‘simple’ single number on effectiveness.

    I wish I had time to really dig into the numbers. Intriguing problem.

    Regards

    1. David Rowell – Seattle, WA, USA – New Zealander now living in the United States.

      What has always been possible though has been a challenge trial – to expose the 10,000 or however many volunteers to the virus in a controlled environment and then see exactly how many get mild, moderate, severe and fatal infections.

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