The Corona Leviathan

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The South African government has in recent days stripped us of two of our civil liberties in terms of the powers given to the President under the Disaster Management Act (1). It is the classic case of crises and leviathan, where politicians have jumped onto the bandwagon to make a threat seem existential. The Spanish flu is now back, but many of us are scratching our heads, wondering whether this is simply a lot of hype and a bit of nonsense.

The President will soon give the soldiers the right to limit our freedom of movement as many South Africans would rather like to spend the Easter weekend with their families. I, personally, dare to question the motives of the government as simply ‘benign and benevolent’, especially after their latest R1 million deals with China’s Huwai (2). What exactly have the Chinese been telling us?

By the time of drafting this article, the South African Army had already been deployed in the streets to “fight the virus” and there has been a ban on so-called “fake news” (3). I can now go to jail simply for writing this letter. It is a strategy from totalitarian China and not a free and open society. The problem is that we need to be sceptical about what government says, because South Africa does not have the capacity to test everyone for the coronavirus.

The health minister has admitted that it is a waste of resources to screen everyone (3). Yet South Korea, Germany, Norway, and China have shown us that the only way to manage the crisis is to get reliable data (4). For reasons that I cannot understand, testing has been deemed wasteful, but mobilising soldiers somehow is not. The minister should take the advice of experts in infectious diseases and not the Nostradamuses that we now call epidemiologists.

The world’s best infectious disease specialist, Dr. Didier Raoult, based in the South of France, has made his chloroquine research public, partially inspired by his own research and those of his Chinese counterparts – after all the Chinese had to quickly act on 80,000 cases. Dr. Roault has successfully treated 24 patients in a non-controlled trial (5) and the French government has given a head-go for a randomized-controlled one (6). If proven successful, we would have a treatment in the next few months. To my knowledge, similar trials are underway in the United States (7).

Sadly, political pressure has also been mounting on this side of the world, as the Mayor of Nice, a patient of Dr. Raoult, yesterday said that Monsieur Macron would rather want rats to die in labs before people can die (8). This is irresponsible, as we know that chloroquine, if left uncontrolled, can give heart problems and lead to blindness (9). This has not stopped the French public as media reports queues of people standing outside Dr. Roault’s office in Marseilles. He insists that the drug is safe and that we have experience with it and is now defying government protocol by testing everyone that comes to his door. If tested positive for COVID-19, they are handed a malaria pill prescription. Public opinion is mounting, and let’s not forget that Dr. Raoult is the Europe’s most cited scientist in infectious diseases.

Chloroquine has already been used for malaria and both China and South Korea have been using it to treat COVID-19 (10) .We are however not China and would like to test things first before we try it. But there is no reason not to give the drug to people for compassionate use. If the minister’s communication was anything good, then perhaps he should tell us how doctors intend to treat us once we have the virus?

Fortunately, in South Africa, you need a prescription for chloroquine and that is about the only good side of this madness, because we have already seen cases of overdosage and possible deaths in Nigeria (11) and Burkina Faso (12), as black markets started jumping up. We can thank Donald Trump and Elon Musk for tweeting about chloroquine and the Food and Drug Administration’s Dr. Fauci not wanting to mention that it cost about 0.05 dollars per tablet. They left a perfect opportunity for a conspiracy theory against big pharma.

It is simple madness and what is making the situation worse is that many Journalist have been encouraging a total lockdown. This despite economists such as Dawie Roodt warning that over one million South Africans could face unemployment if we close down the country (13). Some libertarian commentators and popular podcasters have even called for shutting down the country on their Facebook pages. Are their principles so cheap that during a time of crises, they act as government propagandists, anti-free market and voluntarily scared into surrendering their civil liberties?

So, which prophet of doom is going to explain to the majority of South Africans why their livelihoods are going to be destroyed once they come back from Easter? Or will they, as usual, just run away from this responsibility? Are they going to take responsibility for the potential riots that will follow, and if history is a guide, the foreigners that are normally blamed or killed in the process? Epidemiologists have a horrible track record at predicting anything, as Peter Hitchens recently showed in the Daily Mail (15): They were responsible for slaughtering unnecessary amounts of livestock during an outbreak of mad cow disease. The reason is that they have come to believe in their models and never ask the basic question: How do we test it? They were also wrong about how many people would die because of HIV/AIDS and how many people will die because of the swine flu.

As I explained on an podcast with Ronaldo Gouws on YouTube, the coronavirus pandemic can be defeated if we understood the problem and more importantly if we understand the data. Sadly, statistical analysis is not part of any journalists’ training and recently also common sense seems to be lacking.

Let us start with the basic assumption that soldiers are not policemen and that they train to kill. How are they going to treat us, especially in a time when people are panicking and just want to be with their families?

Now, let us look at the nature of the coronavirus, because no one mentions that there are four annual coronaviruses in the air and that one of them is the common cold. You can look this stuff up on Wikipedia (15). Furthermore, countries test at different rates, because the death rate is also a function of the healthcare system – smart countries test, and bad countries get epidemiologists to run doomsaying models. Undertesting also has a dire consequence such that many of us might have the virus and show no symptoms whatsoever. It is also unclear whether and how the virus can be transferred while we are asymptomatic. No statistical model can predict any of this.

Sensible estimates from the John Hopkins School of Medical Science puts the death rate of the coronavirus at 0.6%, only three times more than the annual flu (16). One can see this, if we look at the real tested data, and not compare countries that test at different rates.

South Korea tested almost everyone and has a death rate of less than 1% and so is Germany’s. Germany conducts about 160,000 tests every week and South Korea did 112,000. Online sources tell me that South Africa has a capacity of about 5,000 a day. This is better than France, that had a mere capacity of only 2,000 per day (16).

Think about it for a moment: if we lack testing equipment then only the severe cases get tested and the death rate shoots up. Asymptomatic carriers of the virus will often not be identified.

The over-reported 1% death rate comes from the Diamond Princess cruise ship, but the prophets of doom forgot to consider the age of people on that board: disproportionately older people. A recent study from the Stanford’s medical school has also brought the World Health Organisation’s widely published 3%, a value equivalent to the Spanish flu, into question (17).

The widely cited Italian death toll breaks down if we understand that Italy has more than 20% of its population over the age of 65 and that the doctors made the mistake of rushing those with the virus to the emergency ward, thereby infecting the whole hospital. According to Bloomberg, most Italians who died had pre-existing conditions (18).

Other concerns from China is that the virus might live longer than 14 days, bringing the basis of the two-week quarantine into question. More worrying is that they estimate that up to 1/3rd of people can be silent carriers of the virus (19). This means that many people will now self-isolate, become asymptomatic and then go back to infect people. A basic history lesson is that the second wave of the Spanish flu was more extreme than the first, because the virus spread in the summer and symptoms only appeared in the winter. In this regard government deserves credit because South Africa insists on a 21-day quarantine period.

Now let us look at the death rate. The virus will most likely create a peak in numbers this year, but not if we are smart about it. Google tells me that annually between 0.2 and 0.6 million people die of influenza and over 3.2 million die of all types of infectious diseases. On an ordinary day over 150 000 people die worldwide – most of them due to what we call ‘natural causes’ – such as the coronavirus.

To date 16,747 people have died from the coronavirus. The hype now looks a bit like paranoia.

South Africa can sensibly mitigate the nature of the coronavirus, by encouraging the elderly and those with HIV/AIDS to stay home and practice self-isolation. The rest of us can work from home if we are able to, and those who cannot should limit their human contact as far as possible. Basic hygiene such as washing our hands also makes sense.

The rest of us should be brave enough to take a few cold symptoms and be back at work. The Minister of Health should tell us how they intend to treat people who have the virus, doctors should be allowed to prescribe chloroquine for compassionate use and pharmacies should take responsibility by not selling it to anyone other than to treat COVID-19. Most importantly, we cannot let the economy collapse just because we do not understand what we are dealing with.

Let us not forget the Hippocratic Oath – primum non nocere – first do not harm. The most harm that we can do is to crack down on our civil rights and destroy the economy in the name of “helping the ill”.

References

  1. De Vos. Covid-19: Citizen rights in a time of disaster — and under a State of Emergency. Daily Mavirick. [En ligne] 23 March 2020. https://www.dailymaverick.co.za/article/2020-03-23-covid-19-citizen-rights-in-a-time-of-disaster-and-under-a-state-of-emergency/.
  2. MAJAVU, NOXOLO. Huawei hands over R1m to assist SA’s Covid-19 fight. Herald Live. [En ligne] 23 March 2020.
  3. Sibanda, Omphemetse S. Covid-19: You have been warned – spread fake news, and you could go to jail. Daily Maverick. [En ligne] 20 March 2020. https://www.dailymaverick.co.za/opinionista/2020-03-20-covid-19-you-have-been-warned-spread-fake-news-and-you-could-go-to-jail/.
  4. Maphanga, C. Coronavirus in SA: ‘Mass screenings a waste of resources’ – Gauteng govt. News24. [En ligne] 18 March 2020.
  5. Fisher, Max and Sang-Hun, Choe. How South Korea Flattened the Curve. New York Times. [En ligne] 23 03 2020. https://www.nytimes.com/2020/03/23/world/asia/coronavirus-south-korea-flatten-curve.html.
  6. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Gautret, Philippe, Lagier, Jean-Christophe et Raoult, Didier, et al. s.l. : ELSEVIIER.
  7. Julien, Gerard. Coronavirus Covid-19 : le gouvernement parle d’essais “prometteurs” avec la chloroquine, demande leur extension. sciencesetavenir. [En ligne] 18 03 2020.
  8. Zimmer, Carl. Scientists Identify 69 Drugs to Test Against the Coronavirus. New York Times. [En ligne] 22 March 2020. https://www.nytimes.com/2020/03/22/science/coronavirus-drugs-chloroquine.html.
  9. Potay, Stéphanie. Traitement controversé du coronavirus : le CHU de Caen teste la chloroquine depuis vendredi. Francinfo. [En ligne] 23 March 2020. Traitement controversé du coronavirus : le CHU de Caen teste la chloroquine depuis vendredi.
  10. Wikipedia. Chloroquine retinopathy. [En ligne] https://en.wikipedia.org/wiki/Chloroquine_retinopathy.
  11. Lanese, Nicoletta. Could the anti-malarial drug chloroquine treat COVID-19? Live Science. [En ligne] 20 March 2020.
  12. Busari S, Bukola Adeboya. Nigeria records chrloquine poisoning after Trump endorses it. CNN. [En ligne] 23 03 2020. https://edition.cnn.com/2020/03/23/africa/chloroquine-trump-nigeria-intl/index.html.
  13. Boudani, Yaya. Coronavirus au Burkina: ruée sur la chloroquine, les médecins appellent à la prudence. RFI. [En ligne] 22 03 2020. http://www.rfi.fr/fr/afrique/20200321-burkina-ru%C3%A9e-chloroquine-appel-prudence-medecins.
  14. Roodt, Dawie. SA economy could shrink by 6% in the next few months, economist warns. FIN24. [En ligne] 03 March 2020. https://www.fin24.com/Economy/South-Africa/sa-economy-could-shrink-by-6-in-the-next-few-months-economist-warns-20200317.
  15. Hitchens, Peter. s shutting down Britain – with unprecedented curbs on ancient liberties – REALLY the best answer? Dail Mail. [En ligne] 22 March 2020. https://www.dailymail.co.uk/debate/article-8138675/PETER-HITCHENS-shutting-Britain-REALLY-right-answer.html.
  16. Human Coronaviruses. Wikipedia. [En ligne] https://en.wikipedia.org/wiki/Coronavirus#Outbreaks_of_coronavirus-related_diseases.
  17. Sauer, Lauren. Transcript of congressional briefing by Johns Hopkins experts. John Hopkins University. [En ligne] 11 03 2020. https://hub.jhu.edu/2020/03/11/transcript-congressional-briefing/.
  18. Loannidis, John. Coronavirus disease 2019: the harms of exaggerated information and non-evidence-based. Stanford University, Stanford, CA, USA  : Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Scienc, 2020.
  19. Ebhardt T, Remondini C, and Bertacche M. 99% of Those Who Died From Virus Had Other Illness, Italy Says. Bloomberg. [En ligne] 18 March 2020. https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says.
  20. Josephine Ma, Linda Lew and Lee Jeong-ho. A third of coronavirus cases may be ‘silent carriers’, classified Chinese data suggests. South China Morning Post. [En ligne] 22 March 2020. https://www.scmp.com/news/china/society/article/3076323/third-coronavirus-cases-may-be-silent-carriers-classified.

 

 

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