Herd Immunity versus Herd Mentality

 kw: book reviews, nonfiction, pandemics, covid-19, sars-cov-2, politics, epidemiology, sociology

During what we now know was an early stage of the Covid-19 pandemic, Johan Anderberg wrote his analysis of the unique approach taken by Sweden, as compared to all the other First World nations: The Herd: How Sweden Chose Its Own Path Through the Worst Pandemic in 100 years, translated from Swedish by Alice E. Olsson and published in English in 2022.

The book covers from early March 2020 until the end of the year. Writing in 2021 a book to be published the following year, the author could not have foreseen how absolutely middle-of-the road the results would be in Sweden, or how the pandemic would play out for another two full years, followed by a sputtering endemic infection that has become a slightly-worse-than-usual type of flu. Four other coronaviruses are known to cause fall-to-winter colds, and now there is a fifth, that is a little more deadly than the other four, but on a par with Type A influenza.

The action centers on two significant men, Anders Tegnell, Sweden's state epidemiologist, and Johan Giesecke, advisor of WHO to the Public Health Agency of Sweden. Other important men and women played their parts, including the Prime Minister of Sweden, but these two, with Tegnell in the lead, helmed the Swedish strategy for coping with the pandemic, for at least the year 2020.

Just as the two men began to collaborate, on March 12, Giesecke quoted a 17th Century noble who had written to his son, "An nescis, mi fili, quantilla prudentia mundus regulatur" and thoughtfully provided a translation, "Don't you know, my son, with how little wisdom the world is governed?" (p.73) This attitude was the underlying basis for dealing with the hundred-odd world governments and hundreds of news agencies that questioned, then decried, then condemned the light touch taken by the Swedes.

Early on Tegnell and Giesecke sought not to limit transmission but, in the absence of a viable vaccine, to allow the infection to spread while taking measures to protect the frail elderly and other vulnerable persons, with the goal of establishing herd immunity. There is much discussion of this concept in the book, with an equation or two related to R₀, the expected number of persons one infected person infects. Later, discussion moved to such buzz phrases as "limit the spread" and "flatten the curve", which caused confusion and had no discernible effect.

I remember well that President Trump authorized the military to make available great numbers of hospital beds and ventilator equipment, many on Navy ships. These went largely unused. To my discernment, being put on a ventilator was a death sentence for 50% of patients who were thus treated, and a great way to lose a quarter to half of one's body weight and muscle mass for those who survived, leading to months of recuperation. 

This is as good a time as any to note that a good friend of mine, a physician, and I worked out a plan: 

1. Since the main killer of Covid patients is pneumonia, and the lung-filling fluids of pneumonia are primarily composed of sugars, at the first symptom it is best to stop eating, ingesting only water, for at least 2-3 days.
2. Rather than fighting a fever, seek to enhance it into the 102°F range (39°C), to support the T-cells that are fighting the virus. He intended to use hot water baths or to get in the car on a sunny day and turn up the heat all the way. I preferred to not use anti-fever medications such as Tylenol.

As it happens, the doctor and I, in spite of being "fully vaccinated", both contracted Covid-19 twice, and survived quite well. In my case, effective antivirals were available by that time, which no doubt helped a lot.

The Swedish epidemiologists didn't stay "in the silo" of epidemiology, but took a more sociological approach. They disdained the notion of locking down a society, and while the rest of the world (or at least Europe and North America and developed Asia) was mandating masks, forbidding church and other gatherings, closing schools, and issuing "6-foot spacing" guidelines, they kept Swedish society almost completely open.

It seems the rest of the world took their cue from an amateur scientist with no epidemiological training, Tomas Puevo, who published an essay, "The Hammer and the Dance", predicting that the attempt to attain herd immunity would result in 10 million deaths in the USA (pp. 124-5). The actual total by end-April 2024 was 1.2 million, and at the end of 2020, about 380,000. But politicians and some scientists worldwide bought into this totally, and we were all locked down.

I'll jump forward to the denouement, which begins on p. 288 with a bit of genuine epidemiology: comparing year-on-year death statistics to discern "excess deaths" that might more properly be attributed to Covid-19 (or any other epidemic agent). 

• In 2020, the total number who died of all causes in Sweden was 98,124. 
• The annual average for 2015-2019 was 90,962. 
• In 1993, the year of a bad flu outbreak ("the Beijing flu"), the figure was 97,008. 
• Swedish population in 2020 and in 1993 (rounded): 10,369,000 and 8,574,000. 
• Divide deaths by population. 
• In 2020: 9,463 per million
• In 1993: 11,310 per million 
• Population average 2015-2019: 10,109,000. Divide it out: 8,998
• Delta per million in 2020 = 465 excess deaths per million
• Delta per million in 1993 = 2,312 (almost 5x!).

Conclusion: The Covid-19 pandemic was far from being "the worst pandemic in 100 years". It was probably second-worse.

Note: CDC data (https://www.cdc.gov/mmwr/preview/mmwrhtml/00016654.htm) indicates that in an "ordinary" flu season, flu leads to about 10,000 deaths in the USA. In the 1992-1993 seasons, 45,000 such deaths occurred each of the two years. Dividing these figures by a population of about 330 million, we find that flu deaths are "usually" about 30 per million, while the sum of 1992 and 1993 deaths by flu comes to 273. The Beijing flu hit Sweden 8.5 times as hard as it did the USA.

Backing up to p. 223, where the scientific community "turned from evidence-based reasoning to the precautionary principle": One scientist wrote of the reasoning of Anders Tegnell, "If he's wrong, it costs life. If I'm wrong, what harm does it do?" This is a markedly false dichotomy, for the lockdowns and other draconian measures not only did much harm, they cost many lives in themselves, including a great increase in suicide among younger people. The scientist who wrote that statement doesn't deserve to be called scientific.

Even in Sweden, by the end of 2020 the situation was no longer driven by science (protestations by fraudulent scientist Andrew Fauci notwithstanding), but by politics, specifically the totalitarian politics of control and the amassing of power. So-called "cancel culture" took control, such that the final sentence in the chapter titled "Science!" is, "What was regarded as a scientific discussion in Sweden was deemed to be misinformation in other countries." (p. 247). This is still true!

Considering the polarizing politics that arose from this, or rather that took advantage of it, I need to point out that on p. 243 the author quotes Glenn Kessler's article in The Washington Post that claimed Donald Trump issued 16,241 false and misleading claims in his first three years in office. He is apparently unaware that the article was debunked within a week by real journalists at the New York Post and The Atlantic. They found that at most, Mr. Trump lied outright no more than a handful of times; rather, Kessler printed thousands of lies in his article. True to form, Kessler just doubled down and issued further claims. The debunking has been so covered up it is hard to track down the truth. In actuality, since 2015 The WaPo, NYT and other "leading" publishers committed tens of thousands of lies against Donald Trump weekly, and continue to do so.

Let's look at some charts from Worldometer, which is cited a few times in the book. Note that the last update to their figures was April 13, 2024. Reporting has become too sporadic and unreliable for them to continue. I must add that early reporting is also somewhat questionable, and in particular, nothing that was "reported" by China or North Korea (DPRK in Worldometer) should be relied upon.

First, to discuss the summary for the whole world:

The fluctuating death rate shows the progress of the different "waves", ten of them, counting the late, rather tiny, bump from November 2023 to February 2024. The biggest wave of cases, in early 2022, with a wave of deaths that is lower than two of the others, shows how infectious the Omicron variant of the virus was, and how much less deadly it was.

When The Herd was written, the third wave, counted worldwide, was just ending. These figures help us establish some criteria. New daily cases in 2022 peaked at 500 per million persons, and exceeded 100 for much of the year; at all other times there were fewer than 100. The current case rate is 2/million or less.

The worldwide Covid-19 death rate exceeded 1/million persons for all of 2021 and the first third of 2022, and then, as the Delta variant petered out, it dropped very low and apparently remains well below 100 total deaths daily, or some 0.012 deaths daily per million population. As mentioned, this is in line with seasonal influenza. This is why, although some nutty politicians continue calling for restrictions to be imposed again, nobody is paying attention.

Next, let's look at how Sweden fared in all this:

It is worth noting that, while the daily case rate prior to August 2020, worldwide and in Sweden, is almost not visible on these charts, the daily death rates in this period were quite high. The very early death rate exceeded 10% of (known) cases. Two factors combine: figuring out how many actual cases there were was very difficult early on, and the large number of deaths represent "low-hanging fruit", or people who were at death's door already. In the USA, this was exacerbated in five states whose governors required nursing homes to take in people dying of Covid-19, which spread through those nursing homes like wildfire, killing many. I contend that those five governors are the five greatest mass murderers of the early 21st Century.

During the second wave at the end of 2020, Swedish politicians were spooked that Covid-19 deaths had again exceeded 100 per day (10/million in a population of just over 10 million), and as is noted in The Herd, began to swerve from the open stance of the prior year.

The figures in brown at top right of these charts show that the total case rate in Sweden was three times the world average, and the total death rate was just under three times as much.

Arguably, the country worst hit by the pandemic was the USA:

I am not sure whether the lockdowns in the USA were the worst in the Free World, but in my experience they were pretty bad. They varied from state to state. The first wave of deaths was not quite as bad, on a per-capita basis, as for Sweden, but the second wave was clearly worse. After the end of 2021, the USA case rate was much higher than that for Sweden, and this apparently continues, but after the middle of 2022 the Covid-19 death rate in the USA is quite a bit lower than Sweden's.

Compared to the world, the total case rate for the USA is 3.7 times higher and the total death rate is just over 4.0 times as high.

I originally prepared two more similar graphs, for the UK and for Norway, but instead I'll present the following:

The vertical axis is deaths from Covid-19 per million population of a country. Sweden, shown as "Swe", is right in the middle. The USA is to its upper right, with the UK in between. Among more authoritarian European countries, I've marked Bulgaria, Hungary, and Bosnia/Herzegovina, which had three of the four highest death rates in the world. The highest was Peru, for reasons I won't plumb here. By contrast, look at Canada and Norway ("Nor"; in each case except "World" the title is to the right of the dot). Nearly all the dots below them are countries in Africa and poorer parts of Asia, places which had few infections and very low death rates. 

I would think an ambitious epidemiologist could make a career of finding out whether there was something more than dumb luck that "blessed" the Third World. But I also must note that I have, from the beginning, strongly suspected that the USA was targeted by China, which released this bug with malice aforethought. I am flabbergasted by the number of American pundits who defend China at every turn. I know enough Chinese people to have an inkling of their way of thinking. Not every war goes fast. The Chinese way is patient, slow, and—insofar as they can ensure it—irresistible. To their way of thinking, WW3 has begun, and if they can manage it, our enemy will remove our head before we notice we have died.

The core message of this chart is that lockdowns had no discernible effect. Every European nation and most others locked down a great deal more than Norway, which stayed open during that very crucial first year, and has remained more open than most other countries thereafter. As a preacher once said about faith healing, "God may heal you today, but eventually you are going to die of something."

We learned from this pandemic that we have more to fear from totalitarian politicians than we do from a global disease outbreak. Sweden showed that society could remain open, taking only certain rather cautious measures, without harming the citizens either medically or politically. It is hard to tell whether any country achieved herd immunity, but it is certain that with the exception of Sweden, most countries fell victim to herd mentality, from which they are still in a very slow recovery.

The bugs are winning

kw: book reviews, nonfiction, medicine, pandemics

This is one face of a pandemic (Image from this Wikipedia article). The colors indicate accredited cases of H1N1 influenza in 2009 by country, from 50,000 or more (black) through brick red and red to pink, in steps from 5,000, 500, 50 to 5, to the palest pink of between 1 and 4 cases.

The color pattern shows, for one, that H1N1 was spread by tourists, so those areas too poor to attract many tourists were actually largely spared. As influenza outbreaks go, this was a mediocre one, having led to "only" 12,000 excess deaths in the U.S. Compare this with more ordinary flu seasons, in which excess mortality ranges from 5,000 to nearly 70,000, averaging 36,000. On average, in the U.S. at least, influenza is on a par with auto accidents as a cause of death.

Let's put this against the backdrop of a real epidemic, one that goes on and on: Malaria, which infects about half a billion people and kills between one and three million yearly (a more accurate figure is not known). That makes the malaria parasite the most dangerous pathogen, and the mosquito the most dangerous vector, on Earth.

In 2002 Madeline Drexler published Secret Agents: The Menace of Emerging Infections. The 2003 paperback has recently been reissued with a new chapter and a new title, Emerging Epidemics: The Menace of New Infections. A blurb on the cover scratches the surface of the content, mentioning H1N1 flu, SARS, anthrax, and E. coli.

An opening chapter presents some recent history and enough bacteriology to help us understand the phrase, "A millennium in a fortnight", meaning that microbes evolve about 25,000 times as rapidly as humans. It is actually worse than that. A human generation is 20-30 years; a bacterium's generation is 20-30 minutes. There are half a million minutes in a year… This ushers in a major theme of the book, that viruses, bacteria and protozoans can quickly evolve ways to tolerate or defeat the medicines we use in our attempts to eradicate the diseases they cause. (A case in point is Penicillin, which went into widespread use in the early 1940s during World War II, and was losing effectiveness by the time I was born in 1947. By the time I was ten, I'd had my last Penicillin shot.)

The mosquito-borne disease theme is used in Chapter 2, focusing on the West Nile irruption a few years ago, to illustrate just how chancy is our public health system. It took the incredible persistence of a zoo veterinarian, who happened to be a middle-aged woman whose questions and date were ignored for months, for the CDC and other "official" medical organizations to recognize the connection between a rash of dead birds and a syndrome they at first attributed to St. Louis encephalitis. The dots are still not connected. How West Nile virus traveled to New York is still unknown.

In areas of the world that are free of malaria, the most frequent disease outbreaks are foodborne, including E. coli O157:H7, Listeria, Salmonella, Chlamydia, Campylobacter and Cyclospora. The third chapter focuses on these and on the difficulty of discerning a genuine outbreak from sporadic clusters: separating the signal from the noise. In a 1998 case of widely-scattered clusters of Shigella toxin poisoning, the trouble was finally traced to a single parsley grower in Mexico, from where fresh parsley was distributed worldwide. It made me look askance at the next parsley-garnished bowl of soup I ate at a restaurant. Nobody really eats the stuff; why use it?

The scariest chapter is the fourth, on superbugs, including MRSA and VRE (multiply resistant Staphylococcus aureus and Vancomycin resistant enterococci), plus the aforementioned E. coli strain and multiply resistant TB. The author points out that all antibiotics so far developed are members of just 16 molecular families, and every one of them is resisted by at least one organism. The thing about bacteria, they all seem to be a single, highly-variable species, because they all can have a kind of single-celled sex and exchange DNA. Certain viruses that prey on bacteria only make things worse, because they also inject DNA into the bacteria that may carry either resistance factors or "virulence factors" that make it easier for a pathogen to spread among us. I remember learning years ago that we all have plenty of Streptococcus living in and on us. It is only when the Strep is attacked by a certain virus that it makes a toxin, manufactured using the virus's DNA, and the toxin produces "strep throat". We get sick because one of our "passengers" is sick! The scary point: we are all out of weapons with which to fight certain battles.

Chapter 5 focuses not just on influenza, but on the 1918 pandemic that was so deadly, it killed more people than the bullets and bombs of World War I. It could return, or something like it. The 2009 pandemic was a weaker relative, which spread almost as fast, but wasn't nearly as deadly. By the way, H1 and N1 refer to protein factors that stud the surface of influenza virus particles. There are 15 H types and 9 N types, leading to 135 basic serotypes, each of which comes in other variations based on internal DNA variations. That is what makes it necessary to produce one or more new flu vaccines every year.

Chronic diseases were once considered to have other causes, such as "bad" cholesterol (heart and vascular disease), "autoimmune dysfunction" (arthritis and diabetes), excess stomach acid (ulcers), and random genetic damage (cancer). Evidence is accumulating that all of these, and others, are actually the result, or side effects, of infections. These days, your ulcer can be eradicated by a round of antibiotics. Maybe someday, an antimicrobial treatment will eradicate heart disease, cancer, and even juvenile diabetes. What'll kill old folks when there's no more chronic diseases? Maybe then we'll find out about "just dying from old age."

The seventh chapter treats of bioterror, going into quite a detailed history of germ warfare since the Medieval practice of throwing rotting bodies into besieged towns with catapults, and the use of "smallpox blankets" to decimate one Native American tribe 250 years ago; but focused much more on the U.S. and U.S.S.R. programs during the cold war. While "weaponized pathogen" stockpiles are reduced at present, there is still an uncomfortable tonnage of bio-weapons in existence, and it is evident that there are numbers of disaffected terrorists crazy enough to use them if they can steal some.

The last chapter tackles the information question. The public health apparatus has performed poorly in the past, and is still unready in the face of discerning a bioterror case from a restauranteur's error. There is hope that an internet tool such as ProMED will enable the right people to connect the dots sooner. It worked "sort of well" for SARS a few years ago. Newer web sites like GVFI (Global Viral Forecasting Initiative) are a big step in the right direction. I see a problem, though, that too many such initiatives will cause even more noise in the system, until they settle out to two or three really good ones.

What are the chances that a really nasty bug will come along and kill 10%, or even 50%, of the human population? Asteroid fans, take note: The chances are much, much greater than the chance of a 10-km asteroid such as the one that wiped out the dinosaurs. Our own lack of readiness is our greatest risk.

I opened a window, and influenza

kw: personal experience, flu, influenza, pandemics

The most-promoted news of the past day or so is that the Federal government has begun to pay attention to the possibility that a very virulent bird flu virus may become a worldwide scourge in the next few years. A sidebar story is the recent reconstruction of the DNA of the virus responsible for the 1918 flu pandemic, which killed perhaps 40 million people.

So far as I can determine, the virus itself has not been reconstructed; they have just produced the bare DNA. Even in a virus, in addition to its protein coat, the DNA is accompanied by a few proteins and other biochemicals needed to produce an active virion. I certainly hope they don't go so far as to restore active virions (I wonder if there is a Latin plural...).

Anyway, I have a tale to tell.

At least concerning influenza, I have a very effective immune system. I have seldom had a "flu" for more than 24 hours, and on a few occasions I have thrown off an infection in about six hours. As an adult, I have had no more than one bout of flu per decade. This may have saved my life.

I am a stamp collector. One prize of my collection was acquiring my Grandmother's collection and duplicates, from my Mother's attic. My Grandmother was a single woman until the early part of the Great War. Having been born in 1890, this made her a spinster, imposed upon by her married sisters to help with the sewing, and working as a schoolteacher in a 1-room school in Poteau, OK. She lived in Fort Smith, AR.

When the war started, she had been collecting in a desultory way, but the sudden depopulation of most men in the area meant she needed a hobby, badly. She used her wide circle of friends to gather a great many of the envelopes that arrived in Fort Smith and Poteau, particularly the foreign ones. In her duplicate box there resided two stock books, one packed with US stamps, and the other with foreign stamps, all from the 1930s and earlier, with a very great many from 1900-1920. There were hundreds of copies of certain common stamps.

Though she married late in 1915, to an older man who wasn't accepted for service, she collected assiduously until her children were well into high school. My Grandfather was a good provider, she had a good excuse to make her sisters do their own sewing, and she was an efficient housekeeper, so she had time for her stamps right up to 1939. My mother graduated high school in 1940, so I can imagine the last year of school was very busy for the whole family.

It came about that I spent quite a while with the "red one-cent Washington" issues. From 1908 to 1920, the stamps look the same, but there is always a little difference from issue to issue, sometimes more than one issue in a year. Though many of the stamps had been pulled or soaked off their envelopes, there was quite a pile of cuttings, squares cut from envelopes with the stamps still attached.

I soaked many of the cuttings to remove the stamps. On more than one occasion, I let them soak over night, beginning with warm water and letting it cool. I always intended to process them within an hour, but sometimes forgot or got sidetracked. My way is to soak a batch of stamps until each one will slide of the paper, then put them in fresh water to soak off the rest of the glue.

All told, by soaking off so many stamps, I was exposed to old, dried—and then remoistened—saliva from hundreds of people from all over the country, and many from worldwide locations. However it may have happened, I had a springtime flu that year. I had it bad, and it lasted three days. Very high fever, very bad malaise, heavy coughing but little production.

I wonder if I am the only person to catch the 1918 flu in 1998?