COVID Transmissions for 7-21-2021
Were lockdowns worse than COVID-19?
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions, now entering its second year.
It has been 612 days since the first documented human case of COVID-19. In 612, the Chinese Sui dynasty invaded Korea with a force of more than 1 million soldiers. Also in 612, a numerically inferior Korean force defeated part of that army—305,000 of them—so totally that only 2700 remained. Ultimately the Koreans went on to win the war. Sometimes, when a situation seems overwhelmingly dire, it can still be turned around.
That’s particularly important because COVID-19 is surging in various parts of the world right now.
Today we’ll discuss the effectiveness of lockdowns, a couple of other items, and also an important reader comment.
Bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
The Delta (B.1.617.2) variant is now responsible for 83% of sequenced infections in the US
This variant continues its march to complete dominance in the US. This is concerning, but particularly so for the unvaccinated.
Still, given that there have been reports of certain vaccines having weakened effects against this variant—though I still think the vaccines are extremely effective—I am concerned for the direction that this is going. It is possible that the return of certain “non-pharmaceutical interventions,” like masks and lockdowns, might be warranted. I will leave that to the CDC and other authorities.
Were lockdowns worse than COVID-19?
Something that has bothered me since the beginning of the pandemic has been the absence of good data about the overall effects of lockdowns. Yes, it is clear that they were effective at locally controlling COVID-19, but there were many who pushed back on them as more damaging than the disease, in terms of mental health, economic impact, and more. When presented with that, I was often left unable to respond for lack of a good third-party source that looked at multiple dimensions of this argument.
Thankfully, that work has now been done, to a degree. Epidemiology rising star Gideon Meyerowitz-Katz recently authored a commentary paper (along with quite a few others) that collected disparate evidence about the impacts of lockdowns vs that of COVID-19. One of the first things they did, and I think the most impactful, was to look at excess deaths as a sign of these impacts. They compared excess mortality in places that had effective lockdown procedures leading to control of the local COVID-19 outbreaks, such as Australia and New Zealand, with places that had clear failures of containment, like Sweden and Brazil.
This is a smart approach. COVID-19 surveillance around the world has been far from perfect, so it is hard to assess whether excess deaths—that is, deaths that are higher than the historically expected numbers—are due to COVID-19 or some other influence. Anecdotally, I know of at least one person who died during the pandemic where, for a variety of social reasons, I don’t know what their cause of death was at all. These cases are not uncommon.
So it would not be enough to just look at causes of death in places that had lockdowns vs places that did not. Cause of death analysis is not very reliable. Instead, the authors compared excess deaths in places where those deaths were very likely to be dominated by COVID-19 with excess deaths in places with lockdowns where those deaths were very unlikely to be due to COVID-19 because the disease was well-controlled.
The result was rather straightforward with respect to excess mortality: Australia and New Zealand experienced no excess mortality in 2020. South Korea, Taiwan, and Thailand experienced either no excess mortality or very low excess mortality. This was the authors’ conclusion:
…there are no locations in the dataset that experienced both excess mortality and lockdowns concurrently with low numbers of COVID-19 cases, which is what we would expect if lockdowns were independently causing large numbers of short-term deaths.
The authors compared this with several countries that were notably uninterested in lockdowns:
Conversely, places with few COVID-19 restrictions such as Brazil, Sweden, Russia or at times certain parts of the USA have had large numbers of excess deaths throughout the pandemic.
The paper goes on to examine several other arguments about negative impacts of lockdown procedures and other restrictions. They argue that there is no support for the idea that lockdowns limited access to healthcare or health services for diseases other than COVID-19, and that there is no support for arguments that lockdowns led to excess suicides. It is worth reading in full: https://gh.bmj.com/content/6/8/e006653
Ultimately, though, this is just a commentary paper. While it synthesizes evidence from various studies, it is a set of persuasive arguments and not a proper analysis. I’m interested in more rigorous approaches to this same question, but at the same time, I find this convincing in a general sense. It just so happens that I’d be happy to become more convinced.
Sean Hannity implores his audience to get the COVID-19 vaccine
I normally do not provide political messaging or commentary in this newsletter, but I am providing this video because it is an important tool in bridging the insane political divide that has opened up in the US with regard to vaccination. Earlier this week, commentator Sean Hannity told his Fox News audience to look into getting the COVID-19 vaccine. If you are interacting with someone who seems politically entrenched, and is avoiding the vaccine on those grounds, I provide this as something you can show them. They may not trust science, they may not trust you, but perhaps they will trust this:
What am I doing to cope with the pandemic? This:
Cutting fennel
Our CSA season is in full swing, so we’re getting vegetables as they become seasonably available. Lately, we’ve been getting fennel.
Fennel is a strange vegetable. It’s almost like a platypus, with aspects of several different things crammed into one species. The fronds are like dill, the stalks like celery, and then the bulb is somewhere between an onion and a cabbage in its layered complexity. I’m speaking purely of the structure, of course—the whole thing tastes deliciously of fennel’s signature nature.
Given the strange structure, though, fennel can be hard to cut—and hard to cook. Each of the parts requires different treatment. Martha Stewart has a nice video that walks you through the cutting, and gives some prep suggestions here and there:
A reader and longtime friend, Maggie, left the following comment on the 7-12-21 issue of COVID transmissions:
Hi! I wrote a longer comment last week and lost it, so here are the highlights:
1. Thanks for the newsletter! It is useful to me.
2. Having known you a little bit for a long time, I have a big warm feeling for the way you have used your gifts and experience to be useful to your community in a time of great need. I hope it gives you a lot of satisfaction and meaning.
3. Your report on the safety data in pregnancy seems to do a common thing that I hate: ignore the pregnant adult's health and experience in favor of focusing only on the health and survival of embryos, fetuses, and babies.
4. I should have subscribed a long time ago and finally did.
Maggie is quite right. I left this out, and that was a mistake that I regret. Here is my full comment in reply:
1/2/4: Thank you!
3: You *should* hate that. I had intended to include something about adverse events in that report, and omitted it--entirely accidentally. If you're referring to the first study I covered, that is. That study had very limited information on adverse events and all of it was in line with the original clinical trials in the general population. There was very little to report that was of note and the authors included very little commentary upon what they did have. Which, is what I had meant to say. With so little to say, it seems that I didn't actually commit that to writing despite my intent--my mistake.
For the second report, much more useful information on serious adverse events was included, and I did note the following: "On to safety. There were 68 patients who experienced adverse events. None were severe and all lasted for less than one day."
The reality is, there is not much to report here. Pregnant people don't seem to experience any differences in safety profile with mRNA vaccines, based on these early data. But, I regret that I didn't highlight that in the first report and I'm glad you said something.
You might have some questions or comments! Send them in. As several folks have figured out, you can also email me if you have a comment that you don’t want to share with the whole group.
Join the conversation, and what you say will impact what I talk about in the next issue.
Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.
Part of science is identifying and correcting errors. If you find a mistake, please tell me about it.
Though I can’t correct the emailed version after it has been sent, I do update the online post of the newsletter every time a mistake is brought to my attention.
No corrections since last issue.
See you all next time. And don’t forget to share the newsletter if you liked it.
Always,
JS
I second Maggie in having known you slightly for years (I'm sure even more slightly--I think we had met in person twice at Philcon before the pandemic), and in thanking you for doing this newsletter.
Did you see the report yesterday that Indian deaths were probably orders of magnitude higher than the government figure, maybe over 4 million just in that nation?