One Size fits All

Lauchie Reid: Hyacinths and Thistles. All images courtesy of the artist.

I got into a Twitter fight last night with a person – I think female but can’t tell for sure – who tweeted that she did not want to be in crowded indoor spaces with the unvaccinated and that they should stay outside like smokers.

I suspect we will hear a lot of this sort of thing over the next few months as COVID wanes and the vaccinated become a majority because it is not enough to be “protected”, the vaccinated seem to need to be isolated from the unvaccinated. Thus the call for vaccine passports and vaccinated only events.

The logic of this seems to rest on the idea that the “vaccine” is not 100% effective in preventing infection or transmission of COVID. What it does confer, apparently, is a reduction in the severity of the symptoms of COVID in the event that the vaccinated person is unlucky enough to catch the virus. You can see the problem, essentially a vaccinated person may be at the same risk for infection as an unvaccinated person and at the same risk of transmitting the bug as an unvaccinated person.

Now, frankly, I don’t think we have enough data one way or another on the vaccine’s efficacy in preventing infection or transmission – the early data seem pretty encouraging on the vaccine’s reducing the severity of the COVID symptoms and the mortality numbers are falling encouragingly. But separating the vaccinated from the unvaccinated is not at all obvious based on what we know so far.

My Twitter gal did not like that position at all and was eventually reduced to calling me “selfish” for not a) getting jabbed, b) for suggesting that there was no logic in separating people who could be infected and who could transmit the virus but who had the prospect of a better outcome if they did from people who could be infected and who could transmit the virus and only had a 99.9% chance of full recovery.

The COVID conversation usually comes down to people’s perception of the risk COVID presents. The vast majority of people who contract COVID feel badly for a few days and are done. Death from COVID is largely confined to people over 80 with one or more co-morbidities. At a clinical level doctors are becoming much, much better at treating the symptoms of COVID. This is not contested information. The daily statistics show much better outcomes for hospitalized patients. Even the “variants of concern” do not seem to have increased the lethality of COVID.

So a risk calculus with respect to the vaccine needs to begin with assessing an individual’s likelihood of a fatal outcome if he or she were to contract COVID. A 99.9 percent survival rate if you are under 80 and are not significantly compromised is a reassuring place to start. Does it make sense to take a new and untested vaccine to improve those odds? (And before we get into the weeds on testing, the vaccines all are being used based on an Emergency Use Approval which is not at all the same as the full testing which drugs typically undergo. That testing is ongoing and will be completed in late 2022 or early 2023.)

As I have consistently written about COVID, you have to manage your own situation which means being aware of and assessing what your life holds by way of risk. First off, do you live in an area with high rates of infection? Do you interact with strangers on a regular and continuous basis? What is your general health status? Do you get outdoor exercise? Individuals can assess these factors for themselves.

Against your personal risk profile when you are looking at “the jab” you would normally take the advice of the medical community which, in turn, would rely on the peer reviewed results of the drug testing the jab is undergoing. But those results are not yet available. Even the mid-term effects of mRNA based vaccines are more a matter of conjecture than evidence.

So the calculation is not so straightforward. As I happily say when asked, “Not yet, I’m in the control group.”

Which brings us back to “selfish”. I assess my personal risk of contracting – much less dying from – COVID as very close to zero which has meant I have been in no hurry to get jabbed. But my Twitter pal seems to think that is selfish. Somehow, my not being jabbed is going to…what? Make her jab less effective? Nope. Destroy herd immunity? No, at worse it may reduce herd immunity infinitesimally but there is very little evidence either way. Prevent her from feeling confident in enclosed crowded spaces? Maybe, but not at all my problem. Prevent the great re-opening? Possibly. The re-opening is a political decision and various politicians have come up with various metrics – case numbers, outbreaks, hospitalizations, first jab percentages, full jab percentages – to give the appearance of science to a purely political decision. Again, not my problem and not part of any rational, personal, risk calculation.

I suspect that the woman on Twitter was, in fact, driven by the very basic human tendency to want others to do what you are doing. When people are terrified, and COVID and the mass media have scared the Hell out of people, they want the security of the group. When the politicians, media and public health officers all say, “Everybody needs to get the jab,” it is much easier to go along with the crowd. Part of going along with the crowd is trying to herd dissenters into the ranks of the righteous. If they won’t be herded then, well, they’ll have to be ostracized.

The good news is that, as COVID fades, so will the zealous. As the threat recedes the urgency of the group think will diminish. As normal returns, attempts to separate the vaccinated sheep from the unvaccinated goats will lose their moral force.

My Twitter friend will have to find something else to be indignant about.

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Top Men!

Glen Reynolds over at Instapundit points to a story in Medical Express entitled “The dream team: Scientists find drug duo that may cure COVID-19 together“. Yes please and all that but what struck me was this paragraph:

“Although several vaccines have recently become available, making significant strides towards preventing COVID-19, what about the treatment of those who already have the infection? Vaccines aren’t 100% effective, highlighting the need—now more than ever—for effective antiviral therapeutics. Moreover, some people can’t receive vaccines due to health issues, and new variants of SARS-CoV-2, the virus that causes COVID-19, that can penetrate vaccine-conferred immunity, are being reported, indicating that we need to think beyond prevention.” Medical Express

It is pretty clear from this article that the team has been at work for a while though it is not clear when they started.

I would have thought that as soon as COVID-19 was a thing – say March 2020 – there would have been dozens of teams all over the world looking for treatments. (There were, by the way: lots of clinicians were developing treatment protocols involving HCQ, ivermectin, various anti-biotics and other drugs. But these treatment protocols were under reported if not outright censored in the mainstream and social media.)

I have always had a mental image of researchers, medical scientists, public health officials, health ministries, hospital administrators, world health people, the Center for Disease Control and a myriad of other agencies quietly working in the background to prepare for the next, great, health/disease challenge. Ready to isolate the bug, test treatment protocols based on clinical experience, develop isolation and containment strategies based on the epidemiological characteristics of the illness.

I also had a naïve view of the ability of politicians to step up. While the clinical and research side of COVID was the province of doctors and researchers, the overall response to the virus was a matter for political leadership. People in positions of political power certainly need to lean on experts but they also have to allocate resources, examine alternatives, make decisions based on limited information.

Very little of this actually happened.

The first response of most of our political class was to doggedly claim to be following the science, turn day to day decision making over to “public health experts”, follow the guidance of the WHO and the CDC – guidance which was, to be charitable, inconsistent – and to largely avoid questioning the experts. (Trump seemed to make some attempt to raise questions but made little headway in the face of his own public health bureaucracy.)

“Wipe everything” (which the CDC now concedes is pointless because the virus is rarely, if ever, transmitted by contact, “wash your hands” (good advice at any time), “social distance” (hilarious when in effect outdoors where there is next to no transmission), “walk this way” in the essential grocery and liquor stores, “wear a mask”, “wear two masks”, “stay home” (logical for two weeks, insane for six months), “curfew” (no known benefit, Quebec ended up being under curfew for five months), “no indoor dining” (despite next to no evidence that restaurants were significant sources of infection), “don’t travel” (with a vast list of exceptions), “don’t gather outdoors” (unless BLM protest)” (ignoring entirely that the virus rarely spreads outdoors): it was all COVID theatre and, to paraphrase Dr. Bonnie Henry, “There’s no science to it.”

What the politicians did was simply to panic. They abdicated their responsibility to lead to “experts” who seemed to all be reading from the same “mass lockdown, masks everywhere, hang on for the vaccine, there is no treatment” script.

The key political failure was the acceptance of the “there is no treatment” story. Back in February/March 2020 there were suggestions that there might well be treatments of some sort. HCQ was trotted out and, partially because Trump mentioned it and partially because of very badly designed studies, dismissed. The very idea of a COVID treatment regime was, essentially, made illegal in Canada and much of the United States.

The idea of boosting immunity with things like Vitamin D and C and a good long walk every day did not come up at most of the Public Health Officer’s briefings across Canada. And, again, not very well done studies were cited showing that “Vitamin D does not cure COVID”. A claim which was not being made. A healthy immune system, to which Vitamin D can contribute, most certainly does cure COVID in the vast majority of cases.

Citing privacy concerns, public health officials were unwilling to give many details as to who was dying of or with COVID. Age, co-morbidities, race, and the socio-economic status of the dying were disclosed reluctantly and long after the fact.

I don’t think most of this can be blamed on the public health officials. They had their jobs to do and, to a greater or lesser degree, managed to do them. They are hired to apply current best practices – often mandated on a world wide basis by the WHO – to the situation before them. Public Health officials are not expected to be imaginative nor innovative.

Imagination, leadership, thinking outside the proverbial box is what we elect politicians for.

A smart Premier or even a clever Prime Minister, after the first shock of the arrival of COVID, would have immediately found creative people to think clearly about, “What else can we do?” In a matter of a week or two, along with driving vaccine research, a full scale treatment research effort would have been organized. Everything from clinical protocols – which clinicians were constantly innovating – to drug treatments to immune system boosting and health optimization would be on the table. And those efforts would have been supported and discussed by the politicians pushing them.

About the only politically innovative thing we saw in Canada was the Maritime bubble where the Maritime provinces essentially closed themselves off from the world New Zealand style. (I don’t think it will make much difference in the long run but it certainly was different from the rest of Canada.)

Leadership is about considering options. It is also, critically, about creating options to consider. Not a single political leader in Canada and very few in the United States created a single option to the relentless “lockdown, wait for the vax there is no treatment” story.

Which cost tens of thousands of deaths, the destruction of 100,000s of businesses, a general decline in mental health and trillions of dollars in debt.

Top men!

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And…We’re done

Which is not to say “It’s over.”

BC is re-opening in stages based upon the percentage of the population who have had first doses of the “vaccine” (I use quotes as it is not at all obvious that the mRNA injections are vaccines in the traditional sense of that term. This is not a knock, rather it is an indication that some caution is warrented.) Indoor dining started lasst night, the mandatory masks indoors in public order is expected to end July 1, travel restrictions are being eased are are rules about gatherings.

The COVID numbers are dropping with only 289 new “cases” (ie. positive test results) in the province yesterday. Only 6 on Vancouver Island where I live. Hospitalizations, cases in the ICU and deaths are all down.

These improvements are being credited to the vaccine despite the fact that only a tiny percentage of British Columbians (less than 5%) have had the required two doses. Arguably, a single dose strategy, while it does not confer 100% protection, is good enough to bend the infection curve. [The past month of warming, sunny, weather might have had something to do with this as it did last year when there were no vaccinations and COVID virtually disappeared.)

Predictably there are plenty of people on Twitter and in the MSM who are worried that this is too soon. There is an active claque who want COVID-Zero before even thinking of re-opening. Against that view are people looking at states in the US like Texas and Florida which are wide open and back in business.

Politically, and a good deal of the response to COVID is political, public acceptence of restrictions has been eroding quickly. The vaccinated can see no reason not to get on with their lives, the hesitant and outright rejectionists, are looking at falling case numbers and assessing their own risk more aggressively.

For restrictions to work there has to be public buy-in. Back in March 2020, when COVID was new and terrifying, restrictions simply structured the response of a public already staying at home and avoiding other people. As we understood the virus better, realized that it was far from lethal for a large part of the population and began to understand how it was transmitted, people were more willing to lead semi-normal lives. (This was particularily true for people who had been keeping up with the rapidly changing “science”. Knowing that outdoor transmission was extremely unlikely was useful, knowing that the virus was only very, very rarely transmitted by contact with inanimate objects was useful. Taking onboard the fact that the virus was airborne was both worrying and actionable.)

“The jab” simply accelerated the return to a more normal life. People who had even a single shot were less afraid. And the public was more than able to recognize that if the jab worked the need for restrictions and mask mandates faded. Otherwise, what was the point of the jab?

You do not have to presume a conspiracy to note that a great deal of the public COVID reaction was grounded in fear rather than fact. The public at large seemed to believe that the virus was deadlier than it is and more infectious than it has turned out to be. Terrified the public wanted lockdowns, masks, business closures and travel restrictions. Once that fear began to fade because of falling “case” numbers and rising jab rates the public support for restrictions began to slip.

The BC Government recognized that the fear was over. Re-opening was going to happen whether the government permitted it or not. The official “re-opening plan” is largely a recognition of this reality rather than a public health document.

We’re done.

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Victoria Day

The Young Queen

Victoria Day began as a celebration of Queen Victoria’s birthday and an even louder celebration of the British Empire and Canada’s place within it. Bands, patriotic addresses, dances and teas were held in gratitude for Canada’s essential Britishness. The long Victorian era of Peace, Order and Good Government, the old flag and the old Queen underpinned the astonishing rigor with which Canada was first settled and then made into an economic powerhouse.

Underlying all that was a sense that the government, at a federal and provincial level had the peace and prosperity of Canadians as its singular priority. While there were better and worse politicians, the apparatus of state, of the Courts, of the military, of the schools and universities was dominated by men who aspired to public service for mainly honourable reasons. If a man sufficiently distinguished himself in the public’s service and kept his personal life free of scandal, he might, in time, expect a knighthood or at least a CBE.

The thing that was striking about this WASP ascendency was just how capable it was. Railways were built, banks founded, canals dug, mines and mills tore wealth from the hundreds of thousands of acres of wilderness. Ranches and wheat farms, vast fisheries, and, eventually, steel mills and implement manufacturers and a host of other factories were concieved of and executed by these men.

For the modern sensibility the fact they were all men, all white, almost all – to one degree or another – Protestant is more than a little problematic. They were undoubtably racist, certainly sexist and not at all interested in being “inclusive”. But that took nothing away from their general competence and overall trustworthiness. They would debate particular policies from tarriffs to banking regulation to immigration to relations with “the Mother Country” and the rather doubtful Americans; but they framed their debates in terms of what was best for Canada. They certainly did not always “get it right” but it was not for want of trying or good will.

A great deal has changed in Canada since our Victorian gentlemen first celebrated their Queen’s birthday. Massive, non-British immigration, the political awakening of French Canada, two world wars, the end of the British Empire, votes for women, communications, transportation and medical revolutions: really, the invention of the modern world.

The idea that Canada is for every Canadian and should not be run by an male Anglo elite began its march through the institutions during Pierre Trudeau’s tenure. The visible symbols of the monarchy, the flag, the coat of arms on the mailboxes, God Save the Queen as a second national anthemn, Dominion Day all were replaced or simply forgotten.

A brighter, less traditional, Canada with a logo for a flag, community mailboxes, a national anthemn with constantly changing words and “Canada Day” replaced the dated echos of an Empire which no longer ruled the waves. More fundamentally, Trudeau with his brilliant Chief Clerk of the Privy Council, Michael Pitfield, set about to replace the old ways of governing Canada.

The clubish conception of government by a vetted, trusted, mandrainate of gentlemen who had been similarly educated, had often served in the military and who were, by the standards of their peers, “sound” was replaced with a meritocratic, competitive, civil service designed to explicitly include French Canadians and women from the outset. The old system of regionally based political leadership was replaced with a Prime Minister’s Office which bypassed those regional potentates and dealt directly with the Premiers and, more importantly, with now increasingly professionalized provincial public services.

This transformation of Canadian governance was cemented with the Elections Act which formallized the power of a recognized party leader to authorize (or not) candidates running for that party and, of course, by the adoption of the Charter of Rights and Freedoms. The Elections Act changes eliminated competing centers of political power within political parties at the federal level. The Charter gave a structure to arguments about personal versus governmental rights and powers.

From the Trudeau/Pitfield perspective the great stumbling blocks to modernizing Canada were the old fashioned, decentralized, mechanisms of the 19th century. The whole idea of a federal cabinet minister being power in his own right or a provincial premier defying Ottawa was contrary to the centralizing tendancies of the modern managerial/bureaucratic state. The Elections Act centralized political power in the hands of the party leader, the Charter was more subtle. Here power was, apparently, given to individual Canadian citizens but that power could be used to assert rights against both the federal and provincial levels of government.

This past 18 months we have had the opportunity to see how well the new system works under stress. Frankly, I am deeply unimpressed.

One thing you could count on with the pre-Trudeau establishment was a level of individual competence. Influential Cabinet Ministers and senior civil servants were not the products of political accident or random encounters at college. You did not get close to power without a resume of accomplishment. This is, rather obviously, no longer the case.

More importantly, the old guard regarded character as important as educational accomplishment or experience. People who lied, pretended to know more than they did, or were otherwise less than honest – the word “sharp” was not one you wanted said about you – made very little progress politically or within the public service. It was informal but it was effective. (It was also, by intention, exclusionary.)

The performance of the Prime Minister and the Cabinet Ministers directly responsible for Canada’s COVID reponse at the federal level has been pathetic. At no point has the PM effectively taken charge. At no point has the public health advice been anything but lame and confused. We may have achieved diversity and inclusion in our federal Cabinet but it has come at the cost of competence.

The provinces have been little better. The patchwork quilt of lockdowns, school closings, travel restrictions, mask mandates, strangely prioritized vaccination regimes and the abandonment of the elderly in long term care facilities all suggest that the provincial public health officials and the politicians they advise have no clue what to do.

The use of Emergency Orders to impose restrictions which are constitutionally impugnable is the exercise of power without any real responsibility. (The fact that when these restrictions are constitutionally challenged the cases are, for the most part, quietly dropped by the Crown says a great deal. The fact that at no point has any level of government presented evidence going to the question of “demonstrably justified in a free and democratic society” is even more telling.)

The crusty old Victorians and their successors, swept away by Trudeau pere‘s re-invention of Canada, would, I suspect, have done at least as well as our woke technocrats. Likely better as they would have looked past “the models” and noticed that the elderly were dying in droves. Addressing that problem early and effectively could have kept the COVID death numbers down. So would closing the borders.

I can’t imagine that a Mackenzie King or a C.D. Howe would have pinned all hope on an undiscovered vaccine without also assigning “top men” to investigating treatment protocols. Nor would there have been any shilly shallying about lockdowns: either there would have been a strict lockdown or none at all.

May 24th has become the weekend to open up the cottage, perhaps display a Canadian flag and have several Canadian beers. It is no longer a celebration of Queen Victoria or Canada’s British heritage. It would be lovely to think we are abandoning the old traditions because the modern world is a great deal better. But it isn’t.

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Spring

To no one’s great surprise, the number of cases, hospitalizations and deaths are trending down in BC. Just like they did last Spring.

Now this Spring we have COVID vaccines and they are being credited with, if not stopping transmission (apparently they don’t stop it, they “reduce” it), at least reducing the severity of the disease in the vaccinated. Which is a good thing but, for the vast majority of healthy, non-elderly, people COVID has not been a very severe disease.

BC has not had strict lock downs. We’ve been encouraged to stay at home and indoor dining and drinking are banned. Masks are mandatory indoors in public spaces. But, generally, life has gone on largely unaffected by government rules.

At the moment, the one thing which would put an end to COVID in BC would be a decent run of warm weather. Because, realistically, for all the hysteria, COVID is an upper respiratory virus and it seems to behave the way such viruses do.

[It is interesting to note that the Spanish Flu came in waves with the second the most deadly. It then “disappeared”. There was no vaccine and no “cure”. Social distancing and masking as well as the prohibition of large gatherings were all implemented in various locations with varying success. In many instances, the public health measures were implemented after the second deadly wave was in decline.)

It is beginning to dawn on people that the general public health response to COVID at the federal and provincial levels – indeed at the world level – was weak if not actually destructive. We’re realizing that, on the data, lockdowns destroy economies but don’t seem to have much effect on the virus. We are also realizing that protecting the vunerable – particularily the elderly – blunts the effect of COVID. The realization that COVID is airborne and that infection from surface contact is rare should have come much earlier in the story.

The other response which needs scrutiny is the decision to focus on vaccination to the exclusion of treatment. Without going into the relative virtues of ivermectin or HCQ as treatments early in the course of an infection, it is astonishing that there was not a concerted effort to test treatments and develope treatments in parallel with the development of the vaccines. You don’t have to be a conspiracist to note that COVID treatment options got short shift.

So, here’s hoping that as Spring warms COVID wanes.

Information and Compliance

A couple of detailed BC COVID reports leaked to the Vancouver Sun last week. They were interesting in themselves – I just moved from 0% positivity rate North Saanich to .1-1% positivity rate Oak Bay – but they bring up the question of how much information should be given to the public and how much, if any, withheld? And for what reasons?

My own view is that it all should be released as soon as it is compiled so I can make informed decisions as to my relative level of risk and my behaviour in the face of such risk. Against that view are a variety of arguments: granular data may compromise privacy, detailed demographic data could lead to racial discrimination, data on co-morbidities might give people a false confidence (“I’m not fat so COVID is not a problem for me.”)

However, underlying the decision not to fully disclose is the public health agenda of compliance. In BC, unlike Ontario and Quebec, we do not have mandatory stay at home orders. Our public health response has been to suggest limiting contacts, eliminating a lot of indoor activities, mandating masks and asking people to limit travel to essential purposes. Whether this has worked better than the more restrictive lockdowns in other provinces is an open question.

For the BC light handed approach to work there has to be a good deal of voluntary compliance with the various measures suggested. Generally there has been, but as the vaccination program gains traction and Spring brings a welcome decline in cases, hospitalizations and deaths, the logic of compliance is beginning to break down.

Having better, more granular, information would, I suspect, actually improve public health outcomes. We are going to open up in any event eventually; have good information will let each person assess his or her relative risk. Vaccinated in Oak Bay? You’re golden. In South Surrey? It would be wise to maintain precautions until a really significant percentage of the population is vaccinated.

In the early stages of the COVID problem there was a great deal of uncertainty. We were given advice in good faith which turned out to be wrong. COVID is almost never transmitted by surface contact so the sanitary theatre and gloves were largely a waste of time. However, COVID is airborne which means that ventilation is critical. Social distancing and masks have turned out to be of limited use in stopping the spread but may have some utility in “hot spots”. There are all sorts of pieces of information like this which are useful to individuals trying to reduce their own risk.

At the beginning the messaging was that “we are all in this together” and that messaging worked. But, in actual fact, we now know that some populations and demographics have much higher risks. Pinpointing those populations and demographics – the poor and the brown – means that vaccination doses can be targetted while shortages persist. (And, frankly, for those vunerable populations, the “two dose right on time” regime makes a lot of sense. Even at the expense of us Oak Baysians having to wait a bit longer.)

Most of all, giving complete information will tend to increase the public’s trust in the public health officials and the politicians who direct them. At this point, with the end of the crisis (but likely not COVID itself) in sight, that public trust is a critical factor in defeating the virus.

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“Do Something”

COVID cases in BC have shown an alarming upswing. There are reports of people refusing to abide by the guidelines about gatherings. There are indications that the nasty Brazilian variant is on the rise. And, as always, hospitals are under tremendous pressure. Add to that a shortage of vaccines and the provincial government felt it had to act.

It announced a “non-essential” travel ban. The details are sketchy but in the first instance the police would be empowered to conduct random checks to ensure that no one left their Health Authority for non-essential purposes. (This was walked back a bit, now police will set up roadblocks to check on motorists.) And BC Ferries is cancelling the reservations of RVs. Constitutional niceties be damned, this time we’re serious.

There is simply no way that this “order” will work. Begin with the fact that Health Authority boundaries are principally administrative and that the average citizen is entirely unaware of where Coastal ends and Fraser begins. Worse, in the Lower Mainland, there are literally thousands of people who commute to work across the Fraser Coastal HA divide. Then there is the question of what is essential travel. (Probably best defined negatively as “travel whose purpose is not primarily recreational – take that you RVers.)

The entire scheme reeks of panic. Not panic at the relentless course of the virus, rather panic at the inability of the government to “do something” to stop that virus. A ban on ill defined non-essential travel between bureaucratic fiefs pretty much defines “half measure.”

There is a happy battalion of lefties who want nothing less than “COVID Zero” and who want that by way of a very strict, Australian style lockdown. Mandatory stay at home orders with only the most limited exemptions for food shopping. These people tend to refer to Dr. Bonnie Henry as a “libertarian” which they don’t mean in a nice way. It is certainly an option.

Counter poised to the “COVID Zero” types are people who don’t think lockdowns, masks and the various other non-pharmaceutical interventions are worthwhile – either because they don’t work or don’t work well enough to justify their significant economic, social and medical cost.

The great difficulty the current provincial government faces is that for any of the potential measures to work there has to be a level of public trust and agreement. It is becoming clear that the Canadian Courts take a dim view of fines and orders which are in direct violation of the Charter of Rights. All the provincial governments know this and it explains why so very few cases have been taken to Court. The last thing a government wants is for a Court to rule that its orders are unconstitutional.

Just as the COVID Zero people point at Australia and New Zealand, the anti-lock down people point at Florida and Texas. The COVID Zero folks point at case rates, the no lockdowners are more interested in deaths and hospitalizations. Both sides seem to agree that vaccination offers the best hope of beating the virus although there is some skepticism about whether “beating the virus” means eradicating it or reducing it to manageable levels.

Where people fall in this argument is largely a matter of their view as to the effectiveness of the state itself. Which is precisely where the travel ban fell apart. The one thing left and right will agree on is that a half hearted, unenforceable, unconstitutional set of restrictions will not work. That these restrictions were proposed at all undermines people’s confidence that the state can be effective. “Do something” is not the basis for policy which will have widespread support.

Right now, the government of British Columbia is faced with a set of unpleasant options. My own sense is that a really hard lockdown for a set period might still be possible; but that window is rapidly closing absent some truly horrible COVID outcomes. Which means that the default option of piecemeal activity, masking, closed restaurants and the hope that the vaccine and warmer weather work their magic is our most likely outcome.

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Trends, Narratives and Imagination

Conventional conspiracy theory – a term invented back in the 1960’s to discredit people who did not take the Warren Commission findings in the Kennedy assassination as gospel – usually posits a shadowy cabal of connected people driving towards a nefarious goal. The red yarn comes out and everything becomes connected. Implicit in any conspiracy theory worth its salt is a directing intelligence, either a mastermind or an occult group.

I’ve always been a conspiracy skeptic simply because I don’t believe that more than three or four people can keep a secret. Plus, there are usually non-conspiracy explanations for the phenomena a conspiracy theory seeks to explain.

People are more than happy to place the “Great Reset” as the pivot point around which everything from COVID-19 lockdowns, to the grand debasement of the West’s currency to the assorted questions surrounding election integrity. It is just vague enough to serve as the fulcrum for pretty much any occult explanation of daily events. And I think it is nonsense.

In place of a grand design, I see tens of thousands of minor decisions which all trend in the same direction without any need for central co-ordination. The central narrative of the COVID-19 phenomena, from the initial panic at the prospect of hospitals being overwhelmed, to the assorted public health measures – social distancing, masks, school closures, travel restrictions, general “stay at home orders”, lockdowns and curfews – to the drive towards universal vaccination, have all been largely good faith attempts to deal with a nasty virus. At each stage, all over the West, politicians deferred to public health officials who, in turn, looked to “science” for clues as to how to flatten the curve.

As we went along the public health narrative gradually became the only acceptable narrative. People who suggested that lockdowns might be doing more harm than good or that COVID was not spread from surfaces or that treatments should be looked at along with vaccines were marginalized. Now, no one person or entity was responsible for this; rather, a group consensus in favour of the public health narrative became overwhelmingly dominant.

Politicians and the media were heavily invested in this public health narrative. The narrative was enforced by everyone from Facebook and Twitter taking down messages suggesting alternatives, to Youtube flat out removing any content which suggested things like “treatment” with Vitamin D or ivermectin. The mechanism for narrative enforcement was very simple – if you said or wrote anything which was not in line with the CDC and or WHO you were promulgating “misinformation” and big tech had an obligation to avoid giving a platform for “misinformation”. (Never mind that the CDC and WHO have been wildly inconsistent in their recommendations.)

Once the “public health, no effective treatment, only vaccine will save us” narrative was in place there was a noble cause case for good information “hygiene”. People who raised questions could conveniently be dismissed as “anti-vaxers” or “covidiots” and their views and medical experience debunked by citing the lack of double blind, peer reviewed, studies. Again, no one had to direct the media or big tech or the political class to stick with the narrative. The arc of the COVID story was set as soon as the WHO declared COVID a pandemic which would only end when vaccination had created herd immunity.

The key piece to all of this is “science”. Assorted boffins modelling exponential growth (a bad thing) which could only be countered with a certain set of policy responses drove the conversation. If you think lockdowns are a bad idea or are unwilling to wear a mask outdoors or fail to use the hand sanitizer you are against “science” and thus indifferent to the horror of exponential growth.

The fact that the “science”, particularly the models, has been wrong as often as it has been right is relegated to the margins. The fact that there are scientists who dissent from “the science” is largely unreported. The fact that there are doctors who are having success with treatment regimes remains obscure.

The good thing about “science” is that it is never “settled”. Quite recently the CDC quietly admitted that it was extremely unlikely for COVID to be transmitted by surface contact. A small thing perhaps but the beginning of the end for the hygiene theatre we have been going through for a year. Other chinks in the “science” are emerging. It really does appear that COVID numbers follow the seasonal cycles other upper respiratory viruses do. The arrival of Spring along with increasingly widespread vaccination seems to be reducing cases and the severity of those cases.

Unfortunately, the public health narrative got in the way of a number of things which could have reduced mortality. The actual testing of ivermectin as a treatment and Vitamin D as a prophylactic have been, at best, haphazard. (Not to mention a suite of steroids and anti-biotics which have shown some promise.) Training staff to deal with ICU surges apparently was lost in the shuffle. Paying close attention, at a very granular level, to where and how infections occur may have happened but it has not been part of the public conversation.

As a matter of human nature, it is a lot easier to take on one, cohesive, narrative than it is to deal with two or even three concurrent stories. However, that is why we have political leaders. People who are supposed to look at the whole board rather than a small section of it. In the face of COVID, with few exceptions, our political leaders failed to look at anything other than implementing the public health/mask mandate/lockdown/vaccinate narrative. It was a costly failure of imagination.

Spring

It is a glorious spring day out here on Canada’s West Coast. I’ll be off to the dog park this afternoon. Good exercise, lots of sunshine, good mental health break. When I am doing the circuit of the park I will have the company of my 20 year old son, Sam, who is very smart but not quite as skeptical as I would like him to be. We’ll be discussing this video: https://rumble.com/vfa2gh-peter-mccullough-md-testifies-how-successful-early-treatment-for-covid-make.html?mref=6zof&mc=dgip3&utm_source=newsletter&utm_medium=email&utm_campaign=HealthImpactNews&ep=2

Dr. McCullough is a very smart, very eminent, doctor and he raises the question of why COVID patients are not offered treatment when they first test positive for the virus. He outlines some of the early treatment options but the real take away is that patients are routinely not offered any treatment or even information about treatment at all.

This has puzzled me from the outset of the pandemic. I realize that this time last year there were few clues as to what might make a difference. HCQ was touted but dismissed on the basis of some rather badly constructed single drug, later intervention, studies. Ivermectin was still over the horizon and some the steroids were being looked at but were not really options. But, a year later, you would think that early treatment would have advanced. But it hasn’t. Nor has there been much official conversation about the benefits of having strong Vitamin D levels and trying to bolster your immune system.

The entire arc of the COVID story has been social distance, masks, closures and lockdowns until vaccines can be delivered in bulk. The idea of a parallel track where doctors and researchers come up with a set of best practices to treat patients once they have tested positive seems to have simply never gained traction. At least not in the West.

Dr. McCullough points out that while all eyes were on the vaccine there was no comparable effort to develop treatment protocols. Why not? The good doctor points out that none of Trump’s COVID advisors had ever actually treated a COVID patient which might explain a bit. But Trump’s people were not the only people advising political leaders. Every country had its advisers.

My own ten cents worth is to look at it from a public policy perspective. From the go COVID has been seen as a public health emergency. Public health, by definition, looks at population scale solutions. Hospital capacity, rates of transmission, reduction of transmission by restriction on movement and activities. To public health officials, with the best will in the world, COVID is a mass phenomena which requires mass solutions. There are, however, other lenses to bring to COVID.

COVID could have been viewed as public emergency like an earthquake or an economic collapse. Through this lens, public health is one element of a government wide response. Through this lens, the public health interest in containing the spread of COVID would be matched by a medical response on a case by case basis. There is no reason we could not have done both. (Obviously, in the hospitals and the ICUs, case by case medicine is being practiced with somewhat encouraging clinical results.)

In a purely public health response, the idea of treating individual cases and developing protocols for early intervention can easily be lost in the drive to preserve the population until vaccines can be developed to save us all. And the logic of public health can justify all manner of non-pharmaceutical interventions to avoid overwhelming the hospitals and keep people from getting the virus. However, the public health response tends to see the virus as a binary: either you avoid it long enough to get vaccinated or you don’t and your risk of death rises. For a nastier virus than COVID has turned out to be, that might have been the correct reaction. But COVID is not ebola or even the Spanish flu, its nasty but most people will survive it.

The medical question, rather than the public health question, is what Dr. McCullough wants to talk about. It is a conversation which should have been had in the Spring and Summer of 2020 when the first wave had broken and the second wave had not yet arrived. Doctors now had clinical experience with severe COVID and were developing strategies to deal with it in hospital settings. But, apparently, there was very little work being done to figure out what to do in the critical week or two between a person testing positive and developing symptoms severe enough to require hospitalization.

Frankly, that amazes me. It shocks and amazes Dr. McCullough.

Right now I am going to organize the daily dog park tour and drink in the Spring sun. Like most upper respiratory infections, COVID should fade quickly as the weather warms. But, as it does, it would be a very good idea, even with the vaccines, to come up with standard of care treatment plans for people who come down with COVID as we wait for the vaccine.

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The Season

COVID-19 cases in BC appear to be slowing down.

The peak was at the beginning of November. Which makes sense as that is roughly where the peak of the flu season falls. At a guess, we are likely to see a further decline which will track seasonal flu. The “flu season” is generally over by May.

I suspect the experience in other jurisdictions will be similar. I also suspect that the public hysteria about COVID will wear off over February and March and be pretty much gone by May. In BC, at least, we have not had “lockdowns” and the schools are open in a manner of speaking. People are sticking pretty close to home and masks are universal inside. Which may or may not be making a difference.

Only 145,000 vaccination doses have been administered and there is virtually no vaccine left. I would be very surprised if we manage to administer more than 200,000 doses by the time the virus peters out. The elderly, frontline care workers and First Nations people have been our priorities and it may have made a difference. Hard to tell until the weekly death statistics are available.

My general point is that the peak of COVID-19 in BC is behind us. The vaccine should reduce the death rate. So should the rehabilitation of HCQ and the deployment of ivermectin as well as a host of other proactive therapies. Our hospitals have climbed the COVID learning curve and out comes for most people who are under 85 and not already ill are steadily improving.

The British Columbia economy has taken a hit and will continue to stagger; but there is plenty of economic activity and businesses have adapted to the various restrictions and requirements.

What needs to happen now at the provincial level, is a top to bottom analysis of our response to COVID. What did we do right, what could we have done better, what will we do when the next pandemic/serious flu arrives? This is not about blame as, frankly, both the government and the public health service got a lot more right than wrong. But we need to think about how to improve our response.

A few suggestions:

  • Begin a program to increase surge ICU capacity at all BC hospitals – set a goal of an additional “x” number of ICU beds per year and make that investment.
  • stockpile PPE – we need to have enough to last for a couple of months without re-supply.
  • Get serious about long term care facilities – the vast majority of the deaths in BC were the elderly and particularly the elderly in LTCs. We need to do very much better and we need to have a plan in place for very early intervention when the next pandemic comes over the horizon. We also need to work at upgrading the facilities we have and build new ones.
  • Prepare a “stay at home” plan – two weeks to flatten the curve actually worked quite well in BC. It was not a strict lockdown but everyone tried hard to stay at home. Next time we should all know that there will be a stay at home period and that we must all plan accordingly.
  • Be ready with border closures/quarantine requirements for travelers. Yes, this is a federal responsibility; but there is no reason to think the feds will be any better next time than they were this time. BC should have legislation which requires a period of isolation for all international travelers.
  • Have a plan for schools: COVID was not particularly dangerous for children but the uncertainty which surrounded plans for schools caused a lot of disruption. Knowing that the schools will likely be closed a set period after a Health Emergency has been declared would help.
  • Right from the go, starting now, put out the message that a strong immune system is a very good thing: Vitamin D, C and outdoor activity daily are a great start. Trying to build the immune systems of every British Columbian in anticipation of the next pandemic makes a lot of sense.
  • Harden day to day systems – simple things like staggering working hours to avoid transit crowding may not be all that sexy, but they can make a huge difference
  • Do serious analysis of how COVID spread in BC. We are going to have a very rich data set. We need to use it. Ex poste analysis should tell us where the super spreader events were and what actually happened. Whether it was dentists at the convention center or my Big Fat East Indian Wedding, we need to know.
  • Come up with a clear and consistent reporting system. Dr. Henry and Minister Dix have done very well but the more information we have the more willing we’ll be to help end the next pandemic

COVID-19 is a wake-up call, a live fire exercise with relatively few casualties. We may not be quite so lucky with the next super flu. The Spanish flu killed 10X the people COVID has. There is no reason to believe that a virus of that lethality is not going to arrive sometime in the next couple of decades. We need to be prepared.

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