No matter how many tests we perform, the virus will keep spreading

No matter how many tests we perform, the virus will keep spreading

The containment approach to the Covid-19 epidemic by Cypriot authorities, acting on the advice of the scientific advisory team, has been “primitive”, flawed and ineffectual, as it is not based on the science or the knowledge accumulated about the disease, an epidemiologist has said.

 

The containment approach to the Covid-19 epidemic by Cypriot authorities, acting on the advice of the scientific advisory team, has been “primitive”, flawed and ineffectual, as it is not based on the science or the knowledge accumulated about the disease, an epidemiologist has said.

Associate Professor of Epidemiology and Public Health at the Open University of Cyprus Dr Elpidoforos Soteriades, who got his degree in epidemiology at Harvard, said he was not surprised by the spike in cases seen over the last few days.

“Since Cyprus followed very strict measures during the introduction of the outbreak last March, and also continued taking quite strict measures even in the middle of the summer, it was inevitable that eventually the virus would spread in the population no matter what measures we take in the future.

“Given the very low level of immunity seen in the population, it’s expected that the transmission of the virus will accelerate especially during the coming winter season. What we see happening now, is the beginning of the seasonal outbreak that will continue increasing during the following months. This is actually what we see happening in other European countries including Greece. The government’s stance – that what we witness results from people not observing the control measures – is supported neither by the science nor the relevant data.”

What of the government measures?

“I’m really disappointed by the government’s approach. First, we see an ongoing violation of the core principles and values of Public Health – prohibitive measures, monetary fines, prosecutions, and a constant accusation of the lay people regarding the epidemic. The strict punitive approach has no place in the field of Public Health because it destroys cooperation and puts people at odds with official guidelines and policies.

“Furthermore, the majority of measures focus on preventing the spread of the virus in the community, when we see that this is almost impossible, as evidenced by the global experience.

“Not to mention that the government has not made necessary preparations and maintains substandard readiness in human and material resources to manage the coming winter season in case we have a much bigger outbreak, possibly complicated with the flu virus.

“Last but not least, there are so many controversial, unscientific and contradictory measures that create more confusion and erode public trust in the official guidelines. I’d urge our government not to revert back to the primitive measure of lockdown, since this approach was catastrophic not only for the economy but also by causing a major negative impact on people’s health. Even the WHO is now calling on countries to avoid repeating lockdowns.”

Do you think that performing more molecular tests in the community will help control the epidemic?

“Let’s focus on the word ‘community’. It’s absolutely useless for controlling the epidemic and wasteful of scarce resources for the government to use a widespread testing programme in the community. Although the RT-PCR test has a very high specificity going up to 99.8 per cent, it has quite a variable sensitivity which may be as low as 40 per cent or even lower as influenced by many different factors related to the sampling technique, the testing procedure, the criteria of positivity used etc.

“As a result of the above characteristics, the positive predictive value of test results is very low when we perform testing in the general population, because the prevalence of the virus – how widespread a disease is among a population at any given time – is very low. In essence, when testing among the general public, the positive predictive value of the result – the probability that a positive RT-PCR test actually represents an infection – is about 50 per cent. Meaning, that every other positive test is false. In my view testing should focus on those populations and places that we need to protect from the virus, such as hospitals, nursing homes and other institutions for the elderly, as well as at the country’s entry points.

“To return to your question – no matter how many tests we perform, the virus will keep spreading. The flawed approach is also evidenced by the fact that the monitoring team of the Ministry of Health is now unable to follow and track the large number of close contacts of people identified as positives through testing. I believe and suggest to the government that we need to go back to the traditional approach of monitoring sensitive population groups and identifying and isolating those who have clinical symptoms based on medical monitoring.”

Is herd immunity a choice? Should we pursue this goal as an official policy?

“The way you frame the question gets to the heart of the problem. I think no one would argue that we should follow a policy for herd immunity, because herd immunity is not the result of government policies, rather, it’s a natural phenomenon. As the virus spreads through society, infected people develop an immunological response and are protected from repeat infections. Additionally, as they become immune they are unable to serve as vehicles of transmission, slowing down the overall epidemic in the community.

“The more people become infected, the lower the probability of the virus to spread. The gradual development of immunity among young healthy individuals could serve as a protective shield for everyone, including the susceptible and the elderly. While it’s absurd to claim that we are following policies to pursue herd immunity, it’s equally wrong to enforce such strict policies to try to prevent herd immunity from occurring naturally. Unfortunately, we’ve seen examples of such policies enforced by the government even in the middle of August, when the virus had almost zero morbidity among those infected.”

What about the vaccines now being prepared?

“At this point in time, I would only hope for safe and effective vaccines to be developed. The way companies and governments act on this issue does not generate trust in the process, mainly because of the unprecedented rush. Besides, we’ve seen serious side-effects of the new vaccines being reported. What’s more, the unique technique being used by inserting artificial genetic material (RNA or DNA) into the new vaccines also raises major questions and health concerns. Therefore, we would need to see the final results of the ongoing studies on the safety, efficacy and effectiveness of the vaccines under development in order to be able to judge on their utility.

“I hope the new vaccines will not lead to more adverse consequences for the public than the virus itself, particularly for the younger generation who have no consequences from the infection. One thing I can say at this point, is that talk of making the vaccine mandatory violates human rights and the principles of bioethics, and cannot be tolerated. Further, it violates current laws and regulations as well as the medical guidelines requiring informed consent for invasive medical interventions.”

What would you say to those who cite reported instances of Sars-CoV-2 reinfections, therefore bringing natural immunity into doubt, leading them to assert that a vaccine is the only ‘solution’?

“It’s quite interesting that the mass media around the world are highlighting issues which tend to have zero clinical value, indeed ‘reinventing the wheel’ in medicine. Immunity developing from natural infection is far better and more comprehensive compared to the immunity induced by any vaccine. I see no reason for our body to react differently for this particular virus as opposed to any other infection. It’s worth noting that Sars-CoV-2 is genetically very similar to other coronaviruses of the past. Therefore, immunity from natural infection and immunity from the vaccines under development is not going to be different, except that vaccine-induced immunity will be less comprehensive.

“The issue of re-infection is an extremely rare event as reported in the literature. In fact it’s so rare that it cannot even be evaluated with medical statistics. I understand there have been just five reported cases of re-infection globally. Therefore, it would not be something to consider for discussion on a scientific basis. Vaccines are not the only solution to an epidemic. The spread of a virus and the development of natural immunity is the most reliable approach to slow an epidemic and protect the community. When safe and effective, vaccines can be used to protect those who are vulnerable and have the highest risk of complications from the infection.”

Finally, what do we know about the lethality or risk of dying from Sars-Cov-2?

“Dozens of studies from across the world have converged on an infection fatality rate (IFR) of roughly 0.2 per cent.

“The IFR is a far more robust calculation of the lethality of a virus on a population level, compared to the crude case fatality rate. The IFR represents the number of deaths divided by the number of all infections. By contrast, the crude case fatality rate is the number of deaths divided by reported positive cases only.

“A just-released study by famed Stanford University epidemiologist John Ioannidis (Infection fatality rate of Covid-19 inferred from seroprevalence data) considered data from dozens of locations and countries globally. It found that: “Across 51 locations, the median Covid-19 infection fatality rate was 0.27 per cent (corrected 0.23 per cent)….

“In early October 2020 the World Health Organisation itself said that an estimated 10 per cent of the world’s population may have been infected with the virus. That would work out to approximately 780 million infected people. Dividing the 1.13 million deaths by 7.8 billion yields an IFR of 0.14 per cent.

“Yet to this day various pundits and media still cite the crude case fatality rate – a little under 3 per cent – which is an order of magnitude greater than the more accurate IFR.”

Mers Virus, Meadle East Respiratory Syndrome Coronovirus

 

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