Coronavirus: Questions raised over extent of lockdown

Expert says healthcare system could have coped

By Elias Hazou

“Mr President, please call off the state of emergency. We have thoroughly reconnoitered the enemy, and let me assure you in all scientific candour that the enemy poses no exceptional or unusual threat.”

So ends an open letter addressed to President Nicos Anastasiades by epidemiologist Elpidoforos Soteriades.

The ‘enemy’ cited? Coronavirus.

Dr Soteriades has joined a growing number of scientists calling for rescinding the sweeping containment measures thrust on the entire Cypriot population.

While acknowledging the validity of initial fears, he argues that we’ve since learned a great deal about the virus, voiding the necessity for a lockdown.

The expert assesses various aspects relating to the novel coronavirus. The first: the risk from Sars-CoV-2.

On the virus’ morbidity, international epidemiological studies thus far calculate it at approximately 10-15 per cent; the rest will go through the infection with no symptoms at all or very few symptoms which are hardly noticed.

Out of 15 symptomatic patients, many show mild symptoms which are dealt with at home, 6-7 require medical treatment, and 2-3 may need to be treated at an Intensive Care Unit (ICU).

In his missive to the president, dated April 20, he states:

“Based on credible international epidemiological studies, the virus death rate is to date calculated at around 0.3 per cent and declining. Similar and/or better data are deduced from the epidemiological surveillance of the virus in Cyprus, estimating the death rate at around 0.2 per cent.

“I regret to note that the cited death rate for coronavirus in Cyprus as published by the ministry of health’s Epidemiological Surveillance Unit (2.4 per cent or 1.8 per cent), does not represent the real picture since it doesn’t provide the denominator for the actual cases among the community, but rather only for confirmed cases.”

Dr Soteriades has also worked out the prevalence of Sars-Cov-2 in the population – a key metric.

“Based on up-to-date data….we have 767 [at the time of writing] confirmed cases in Cyprus. Total cases among the population may well exceed 5,000. This is derived from international epidemiological assessments showing the real number of cases are far more than confirmed cases.

“Moreover, based on the to-date results of the epidemiological study of the population in Cyprus, it appears the prevalence among the general population is around 4 cases per 1000 residents (0.4 per cent). Therefore among the Cypriot population we expect that at this moment we have at least 3,500 cases, based on the most conservative estimates. Utilising the average of the above two assessments concerning the real number of cases as the denominator, we can conservatively calculate the death rate of coronavirus in Cyprus to be approximately 0.2 per cent.”

From the above data one infers that the penetration of the coronavirus in the general population is very low (0.5 – 1.0 per cent) “and therefore may create more problems than it solves”.

“Such a low percentage cannot offer herd immunity, of which a great deal has been said. The immunity ratio in the robust section of the population (low-risk) must be at least 30 per cent if we are to derive benefits for the elderly in terms of the herd immunity natural phenomenon,” he said.

“Ultimately,” he adds, “it can be concluded that both the morbidity and the case fatality rate of coronavirus, globally and in Cyprus, is equal to and/or slightly lower than that of the influenza virus.”

Taking on the ‘flattening the curve’ meme – preventing healthcare systems from buckling – the expert cites the actual load on hospitals in Cyprus from Covid-19 patients.

“Hospital occupancy is at about 10-15 per cent of current capacity. It’s already been announced that public hospitals avail of about 100 ICU beds, while at this time we have only 10-15 coronavirus patients in ICU.

He said the same went for hospital beds that were several times more than the 20-25 patients currently in public hospitals.

“Factoring in the reserves in the private sector, capacity both in ICU beds as well as in total hospital beds increases even more, and the load on the system eases further. Therefore, neither does the risk of overburdening the state healthcare system justify the draconian measures.”

Soteriades also questioned the economic fallout from the lockdown/isolation. At the time of his letter, Cyprus had counted 12 deaths attributable to Covid-19.

“The government has announced the cost to the economy owing to these restrictions could reach a massive €1.4 billion. In short, the social cost per death of our fellow countrymen from coronavirus may exceed the astronomical sum of €100 million,” he said.

“Are we willing to continue along this suicidal path wasting up to €100 million per death due to the coronavirus? And for how much longer? Last year we had at least 18 deaths from the flu. Why was no one bothered? Could it be that last year we were callous? Only this year have we suddenly developed such a sensitivity that we can’t tolerate even a single death from the coronavirus?”

He then takes the pro-vaccine argument and inverts it:

“If we agree the flu vaccine protects many immunised people from the serious complications of the disease, including death, but that nonetheless the flu appears to have the same death rate as coronavirus for which we have no vaccine, it’s clear the coronavirus is less dangerous than the flu.”

This all means, he said, that it was now clear that the dangerousness of the coronavirus “lies within commonly acceptable bounds, characterised by manageable levels of morbidity and case fatality rate analogous to the experiences of the past decades”.

Speaking to the Sunday Mail, Soteriades clarified he doesn’t advocate for lifting the lockdown in one fell swoop because the population won’t be ready for it.

“I’m merely suggesting that authorities rapidly roll out a systematic campaign to educate the public on the risks of Covid-19, proper hygiene and good diet, run it for a couple of weeks, and then lift the measures – regardless of whether new cases drop to zero or near-zero.”

Once you open up you would mandate the wearing of protective gear like masks and goggles in indoor spaces.

Soteriades would not be drawn into the fiery controversy over the pros and cons of herd immunity, or whether it ought to have been applied in Cyprus.

“Now isn’t the time to play the blame game. I’ll simply state that herd immunity is a natural phenomenon – it happens anyway.”

But when asked about the claim that lockdown ‘saves lives’, he says:

“It’s very difficult to test scientifically whether you save lives thanks to lockdown versus no lockdown. And vice versa, to be fair. We’re dealing with counterfactuals here, and they’re never easy to clarify using a scientific methodology.”

Still, it baffles him as to why total lockdowns were chosen above medically isolating cases and using quarantine for the suspected cases.

“There’s no logical explanation why the rule book was discarded and we followed the China approach. It’s very strange.”

Petros Karayiannis, professor of microbiology and molecular virology at the University of Nicosia, is a member of the Epidemiological Surveillance Unit – the team of scientists essentially driving government policy.

He tells the Sunday Mail that, in devising its approach to dealing with Covid-19, the team didn’t generate a specific mathematical model for the outbreak here. Rather, they looked at China where ruthless but swift action – confining people at home in Hubei province – succeeded in halting the spread.

The team also based their recommendations on a mathematical model out of the United States and the UK projecting 2,500 infections in Cyprus under moderate mitigation – social distancing but no stay-at-home orders.

Based on the data at the time, Karayiannis said, the model forecast 10 per cent of those infected would need hospital treatment, with five per cent ending up in ICUs.

With that as their off-ramp, the scientists projected that five per cent of 2,500 equals 125 people in ICU – the limit of what the local healthcare infrastructure can handle.

The Sunday Mail asked Karayiannis to comment on recent studies, including one by Stanford researchers in Santa Clara County, California, who found that up to 50 to 85 times more people had contracted Covid-19 there than the number of official cases – suggesting the virus is far less deadly than believed.

Other antibody studies overseas checking for immunity are likewise converging on the verdict that the case fatality rate for Covid-19 is no worse than that for the common flu.

“I think we may be jumping the gun here; from what I’m seeing the case fatality rate for the cononavirus could end up being four to five times higher than that of the flu,” Karayiannis said.

The latest epidemiological surveillance bulletin released on Thursday (data valid until April 21) shows 30 people – or 3.8 per cent of all cases – have ever been admitted to ICU.

The data also show that at any given time from March 16 through to April 21, a maximum of 15 persons were being treated in ICUs.

That’s a far cry from capacity – or more precisely potential capacity. Back in March, Health Minister Constantinos Ioannou said the island’s public hospitals could offer 126 beds in ICUs to treat Covid-19 patients.

To date, 14 deaths are directly attributed to Covid-19 in the south. The Sunday Mail sought to compare historical deaths from flu-like illnesses to deaths from coronavirus this year. It should be emphasised the data obtained from the health ministry are crude and require more processing.

They show that in 2017 and 2018, there were seven and four deaths, respectively, from influenza.

Under ‘Other diseases of the respiratory system’, there occurred 380 deaths in 2017, 346 in 2018.

And deaths from pneumonia came to 73 in 2017, 57 in 2018. But there’s no distinction between viral pneumonia and bacterial pneumonia.

Aggregate data for 2019 are not currently available. A health ministry official dealing with statistics said annual aggregate numbers are collated at the end of the year after the year in question – in this case, the 2019 data are expected to be published in late 2020.

But an online search does reveal that up until early March 2019, 18 people had died from Influenza A.