What’s the real story of Covid-19 in Scotland?

What’s the real story of Covid-19 in Scotland?

by Christine Padgham
article from Wednesday 2, December, 2020

WE ARE LIVING in extraordinary times. Whatever your view of the Covid-19 pandemic and the resulting mitigation strategies undertaken by governments worldwide, there has never been a time when governments had such wide-ranging control over our lives. This has naturally led to much debate and some anger – scientists who have tried to challenge the accepted view of the epidemiology, virology and immunology of Covid-19 have become targets of censorship and aggression.

There are three current positions (or none) you may take when it comes to the pandemic - these have been put forward by experts. We will explore them below. They are: 

We are living through a Second Wave of the Covid-19 pandemic; 

We are living with a new endemic illness; and, 

We are dealing with a pseudo-epidemic.

What would a second wave of an epidemic look like?

The Spanish Flu seems to be the model upon which the concern around a ‘second wave’ has been built. In essence, we seem to be thinking of a second wave as being like a second epidemic, similar (or worse) in severity to the first. The Spanish Flu epidemic graph below shows how severe the second wave was in that case. There is some debate about whether this second wave was indeed a different virus, and it is hard to look back with clarity as to the cause of each wave. But it is clear that there was a severe effect on mortality. The second of the three waves followed the Gompertz curve of epidemiology: there was a steep rise, a sudden flattening and then a slower descent (to zero mortality in what is normally peak flu season). 

Fig 1 Spanish Flu (source: theconversation.com)

Compare this to the ‘first wave’ of the Covid-19 pandemic in Scotland 100 years later, using deaths as a measure of the epidemic, and you see the Gompertz curve of epidemiology. Deaths rose quickly, suddenly flattened and fell more slowly (than they had risen) to zero across the country by the end of June.

(It is worth noting that while Spanish Flu caused a peak in deaths of around 25 per 1000 population, the Covid-19 epidemic in Scotland peaked at 0.015 deaths per 1000 population.) 

Fig 2 Scottish Covid-19 deaths in Spring

The initial steep rise in daily deaths is seen in all epidemics: it is fast while there are still many susceptible individuals, but as it passes through the population, immunity accumulates and it becomes increasingly hard for the virus to find new people to infect. By June the epidemic was suppressed either by the summer season (when coronaviruses are always less virulent), or by population immunity - or a combination of both.

If this had not been the case, when restrictions to daily life were lifted in the summer, infections would have risen steeply immediately. After the mass gatherings in summer that attracted a lot of media attention, there was no sharp rise in Covid-19 infections.

In an epidemic, we see a rise in infections in one location, which then move on to the next location - like a wave. We saw this in the spring. The table and Figs 3 and 4 below demonstrate how the wave rolled largely south to north in April. This ripple effect has no apparent relationship to the date of ‘lockdown’, which was imposed nationwide on 23rd March. The peak in positive tests in Highland came almost 6 weeks later. This phenomenon of infections spreading geographically has not been repeated in the second wave, as we will see. Nor has the peak in excess deaths, as shown in Fig 5. 

Fig 3 First Wave positive tests peaks, by geographical area.. 

Fig 4.1 & 4.2 – rolling wave of infections peaking 

Fig 5 Excess Deaths *November stats based on a projection 

What if Covid-19 has become endemic?

A virus that returns every year is ‘endemic’ because existing immunity to it prevents it becoming ‘epidemic’. If Covid-19 has returned to a population with significantly more immunity than it had in the beginning of 2020, it will contribute to seasonal deaths in addition to other winter viruses; or it will replace other winter virus deaths. Covid-19 kills the elderly more than any other age group, and so it is likely it will largely replace other winter virus deaths. In Fig 6 we see that there are many more deaths in the age range above life expectancy than in any other. 

Fig 6 Scottish Covid-19 Deaths totals by age group

We live with many endemic viruses that return every winter, and we all have experience of them. We know some people seem to catch viruses that others do not and that viruses will pass through our communities and then apparently disappear.

In an endemic Covid-19 illness was following its first epidemic phase, we would see parts of the country affected less in the first wave being affected more in the second (which is not what is happening now), due to accumulated immunity. There would be a more gradual rise in deaths than in the first wave because some immunity would have accumulated in the population, which we see in Fig 7. 

Fig 7 Scottish deaths from September through to end of November

In an endemic virus, we would also see a rolling wave of outbreaks across the country, as we did in the first wave (see Fig 4). Instead, in Fig 8, we see peaks and troughs for each region appearing simultaneously.

Nationwide infection rates would rise with the season and then reach an equilibrium. Instead in Fig 9, we see infections falling, even as test numbers have increased.

Hospitals would experience maintained pressure as they do every winter. Instead in Fig 10, we see hospitalisations and ITU occupancy reaching a plateau and then falling. 

 

 

Fig 8  Peaks and troughs in positive test in different geographical areas during the second wave observed simultaneously 

(source https://www.gov.scot/publications/coronavirus-covid-19-daily-data-for-scotland/

Fig 9 - Infections in second wave have fallen significantly from their peak on 23rd October 

Fig 10  Hospitalisations and ITU occupancy

What would a pseudo-epidemic look like?

A pseudo-epidemic is a known phenomenon (and does not preclude the possibility we have an endemic virus in our midst). It is an epidemic that never really was, and there are many scientists now agitating about the possibility that we see this with Covid-19 this autumn. The mirage of an epidemic can be created through inappropriate and uncorrected testing and it is no longer in dispute that the PCR (Polymerase Chain Reaction) test is not suitable for its purpose in Covid-19 testing.

During the late summer and early autumn there was much talk of ‘false positives’, and many were dismissive of the possibility of them being a significant issue, especially as the positivity rate increased through September. False positives (misidentification of an infection) are a statistical certainty in any mass screening programme, which is why patients identified by cancer screening have numerous confirmatory tests before being diagnosed.

False positives may arise due to cross-contamination of samples or fragments of a defeated virus may be detected and falsely identified. The false positive rate will fluctuate depending on conditions in the population and in the processing laboratories; rises and falls in positive tests will occur in multiple areas at the same time due to testing strategy and quality.

This will result in peaks and troughs in infection curves being observed simultaneously across the country, rather than the epidemic wave effect (see Figs 4 and 8).

Those propagating the issue of false positives as a serious concern might have felt vindicated when in Liverpool last month the army started testing in the community using the more accurate Lateral Flow Test rather than the discredited PCR. There was immediately an apparent 50-90% drop in positivity, indicating that the PCR had indeed been producing a great many false positives.

If a test we use is identifying too many positives, especially in those ill or already dying - or identifying other diseases as Covid-19 - it will distort understanding of the disease and its mortality. At the other end of the spectrum, we would identify many ‘asymptomatic cases’ because we would be falsely identifying people as positive for the disease who did not have it.

With mass-testing and a poor test, over-counting Covid-19 in the dying will artificially inflate the Covid-19 death numbers, and make the virus appear to be increasingly deadly, even if there is no other evidence to suggest this is the case. We see this in Fig 11, where deaths per case appear to have trebled in three months. 

 

Fig 11 Increasing deaths per case

In pseudo-epidemics we will also see excess deaths mismatched with those caused by the assumed epidemic. Against a baseline of the previous 10 years, we have had 900 excess deaths in Scotland for the weeks 36 to 47 in 2020, but 1150 Covid-19 deaths reported. The details week by week are shown in Fig 12 below. 

Fig 12 Covid Deaths and Excess Deaths,between end August to November 22nd. 

So what is really going on?

I will leave it to you, the reader, to decide which of the three scenarios I listed Scotland finds itself in. But what is certain is that we must urgently review our testing strategy and think more intelligently about our approach to Covid-19 management and identification before we become entangled in bad assumptions and over-reliance on tests of doubted efficacy.

Christine Padgham was a health physicist now running Recovery Scotland with the help of many other professionals, scientists and activists. The article was written in collaboration with Dr Clare Craig FRCPath, and with thanks to Clare Bond and Sylvia Anderson for reviewing. 

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