SA Nobel laureate Prof Michael Levitt: Why lockdown CAUSES death #BestofBizNews

Although he left the country as a 16 year old, Pretoria-born Nobel laureate, Stanford professor Michael Levitt, still describes himself as proudly South African. And as you’ll hear from this podcast, the brilliant academic has some insightful perspectives on how his former homeland is handling the Covid-19 crisis. Mostly positive: He praises the early lockdown and reckons gloomy forecasts of infections only peaking in September could be way off beam. The Medical Faculty and Computer Science professor reckons SA’s peak may be as early as two weeks away – and while no fan of lockdowns, says the country is one of the few to have applied this blunt tool for the right reason at the right time. But SA’s only living Nobel Prize science laureate (chemistry: 2013) also supports a sensible re-opening of the economy to ensure lockdown pain is not sacrificed by an economic disaster. A rational perspective on a very noisy subject – much required at a time when common sense is too often overwhelmed by blowhard punditry. – Alec Hogg

#BestofBizNews: This interview took place while South Africa was in lockdown. It was first published on BizNews Premium. Nearly six months later, European countries – like Britain – have re-entered lockdowns, with increasingly strict restrictions that are bringing businesses to a standstill. There is a call among scientists to rethink the way governments are dealing with the Covid-19 pandemic. 

BizNews founder Alec Hogg interviews Professor Michael Levitt on the logic of lockdown

It’s a real pleasure to be talking with Professor Michael Levitt not just because of his connection to South Africa. We’ll get into that in more detail but because of the way he’s shaking up thoughts about Covid-19 around the world. Professor Levitt, let’s start with the South African connection. So you were born in Pretoria, you went to Pretoria Boys High, left South Africa at the age of 16. We think fully formed and fully developed because you then went on to achieve great things in the world including, being the only living scientist from South Africa who won the Nobel Prize. We’re very proud of you from that perspective. But there are people in South Africa who are not so proud of what you believe the world should be doing right now i.e. that the lockdown is a huge mistake. In the interview that we published on BizNews that you had with you never referenced South Africa at all. Clearly it would be lovely if you could give us your thoughts about this country, if you’ve had the chance to have a look at your old homeland.

Thank you very much, it’s a great pleasure to be here. I wish I was actually physically there. Basically, in our analysis which has been very global we looked at countries where there were at least 50 deaths and 3,000 cases, it seems that Covid-19 is in some ways connected to seasonal flu. Right now, you’re coming into your flu season probably after Covid-19, except Brazil. Most countries south of the equator have not fared badly. Basically, South Africa is still at an early stage – both the numbers of new cases and the number of deaths are increasing, the number of deaths is 200 out of 10,000 –  we try to guess 2%, that is still fairly low, which actually shows that you’re probably catching people fairly early on. In some of the worst hit places, that number goes up to instead of being 50 to 1 can be as little as 5 or 6 to 1. In Lombardy, 20% of the cases were actually deaths.

The 2% is good news. South Africa is at an early stage. There are certain states in the United States that are still like this. It’s very hard at this stage to predict when things are going to peak. The thing we’re looking for right now is that the number of new cases should stop increasing from day to day. It’s a hard thing to see because it’s a lot of noise. Each day is not exactly the same number, but I don’t see any real cause for concern.

My feeling is that, in an urban setting, I don’t think the lockdown is going to have a lot of effect. In other words, the virus from what we’ve seen will be like a fire, it’s burning and there will be cases of death and again. I think that 200 is not a tiny number, in the other 200 again fairly old people as we’re seeing in other countries.

Primarily older people often called co-morbidity as well.

This is the same group that’s at risk from general loss of life, old age. Whatever it’s called. Are people wearing masks?

Yes, you have to wear a mask if you go outside of your home.

This is hard to be positive about this. Once there’s an outbreak in a certain highly populated area, there’s not too much you can do. I think by the time you discover it, the infection is really much wider than you think. If you find one case there’s probably a 1,000 hidden or in simple cases you can certainly control the spread of the virus across the country by limiting interaction travel. Masks are a good way to stop healthy people but infectious people infect others. There’s a certain amount of common sense. What about taking temperatures? Are people required to have temperature taken in stores?

Only at the moment in businesses that are essential businesses that are still operating. We’ve now gone to level 4, of all about 40% theoretically of the employees or of the businesses are allowed to open and there are strict regulations there that the temperatures have to taken etc.

But if you go and buy food and let’s say you’re not working or you’re locked down but you need to buy food, would the food store measure your temperature? And when you go to the food store, the person who’s selling would be wearing a mask?

Yes  and you have to wear a mask as well.

That’s important. So far there’s nothing that I see in the data of South Africa that is a cause of concern. Government needs to realise that causing economic hardship, social hardship is not in their interests. People will be unhappy. Even though they may feel with a certain amount of power as time goes on, rules get relaxed. I’m pleased that 40% of the businesses are open, the exercise law seems a bit crazy. I’ve never even heard a law like that, in Israel at one point, we were locked down to be no more than 500 metres from where we lived. But no one said, what time that could be. There were a lot of people who were quite concerned about the civil liberty aspect – of the whole lockdown and feel that people in government should have a fairly high hurdle to pass before they can authorise lockdown.

The fear of coronavirus is slowly passing. In some ways, the crazy panic that we saw in Europe, the United States is subsiding. We are just starting to get pretty good figures for excess death. There’s a real argument about when somebody dies of corona and other conditions, or are they dying from corona or are they dying with corona. The only way you can tell is just to look at the total number of deaths over this period. One of the best sets of numbers is actually in Europe covering about 300m people. And right now, the excess deaths are maybe 20% higher than the flu epidemic, but you don’t have data going back for years. Basically, in the last four years, it’s worse but not by a huge amount. The amount of excess death is a little bit less than 3 weeks of normal deaths. It’s a little bit like the excess deaths were there for a period of 3 weeks, twice the number of people dying as would die otherwise.

The numbers seem to be coming down very quickly, but we don’t know about all the people who have postponed treatment because of the lockdown. There may be additional deaths, but the amount of deaths that we’re really seeing is not out of all proportion to flu that we see in Europe. Northern Europe is a flu place. Italy typically has 25,000 flu deaths a year. Another thing is that, the age profile of the people who are dying of Covid-19, is essentially the same as flu. It’s even maybe a little bit more biased towards old people. There are young people who die of flu sometimes, but for coronavirus, it’s been much more one sided.

The ultimate burden of death is something which probably will be much less than the damage caused by extended lockdown. When people lose money, they also don’t live very well. Poverty is a great cause of death. Even in countries that are very well-off, the social stresses caused by living with your wife 24 hours a day, or your children is significant.

This is going to come to be realised that no one wants to be shown that we’re wrong.

I had an interview with a newspaper in Ireland and it came out on Sunday, they sent me the timetable for their lockdown. They had lockdown being released on August 15th. I’m quite sure they will bring this forward as soon as they see that things are calming down, there is no logical reason to punish the population. Just looking at the graphs, the first infections in South Africa were on 5 March. The first deaths were 21 days later and that’s when the lockdown started. But it means that there were a lot of cases in between. That’s actually good. It also means that the interval between cases and deaths. This is an important way to monitor progress in some countries where things are very badly monitored. The first case is a dead one – in which somebody is so ill that they come into hospital and then they test them and that same day they die.

This has been the pattern in Italy. South Africa actually should be proud of the fact that there’s a separation between when they’re finding cases and when they’re finding deaths.

Lockdown came at a good time. It was also at a time when cases also started to go up a bit. In some ways, it’s probably been a good thing for the country that the lockdown was imposed so early. It’s good that they’re releasing it now. I honestly don’t believe that governments want to punish their people and if they do want to punish their people they should be easing up, and probably will.

The real question I’d love to get your view on is Stanford seems to be a little bit of an outlier to the rest of the academic institutions in the US and that one of your colleagues was also suggesting that this has all been exaggerated.

Actually, four of us had e-mail communication with two of them. I’ve met one on Zoom, we don’t actually know each other. I didn’t realise this happened. I had a BBC interview early in March and when I heard the interview John spliced in immediately after me and my colleague saying the same thing. We did communicate. I don’t think there’s any reason. I just think that maybe we’re free thinking. A lot of people lose a sense of proportion when the first numbers are looked up. How many people die in the world every day. It’s a hundred and fifty thousand.

Right now, the total deaths from corona worldwide is perhaps 2 days worth. That’s a lot of deaths. But then, if the people who are dying from coronavirus were teenagers, it would be quite terrible. But essentially, this is the angel of death that just come a month early, for a small group of people. This applies to people who are very sick and for whatever reason –  I tried to say this on Israeli television –  I essentially got incredibly ostracised by suggesting that, every life is an equivalent.

I’ve had a full life. My mother had a full life. We don’t want to die. But certainly you need to leave space for the young people for them to have their full life. It just seems a completely fair thing. A lot of old people or the Baby Boomers like me don’t think that. They think that they are special. The lockdown probably has the least effect on the older people because they’re probably living on pensions or savings. The stock markets have been surprisingly resilient for them and they’re not trying to buy a new house or start a new business. They don’t have young children. In some ways, it’s much less of a hardship.

The people are like this because it’s just common sense. If the numbers were telling me something different, I don’t have a particular viewpoint. I just somehow feel that misery caused by lockdown is exactly the same as misery caused by the disease, it’s not fair to say well every life matters because we’ve seen that lockdown saves murders. Maybe we just lock down forever, it doesn’t make sense. The people I’ve spoken to in Stanford, have been sensible, why aren’t others. I don’t know. There’s a lot of fear. I’ve been surprised at most –  most vent criticism of me has come from academics – quite smart people that I know. I’ve a feeling that they think lockdown and everybody else is very important.

They feel more secure when all these people who don’t PhDs are locked down. That is completely hypocritical. Remember, also most academics are not taking any hit in salaries. They are teaching by Zoom. If they’re teaching they’re sitting at home writing their papers, they’re actually having a pretty good time. It’s the store owners, and a lot of people who are really suffering. I somehow can’t get rid of that. This needs to be discussed very carefully. There’s no doubt in my mind – when you give me that projection of peaking in August – if this peaks in August that will be the longest running, take the case in Italy. How long did it take, weeks to go from the beginning to cases peaking? My guess is that SA will be peaking in two or three weeks, not in August. I’m happy to be quoted on that. I haven’t analysed it carefully, but just looking at the curve and I’ve looked at thousands of these curves, you’ve got this under much better control. Italy when its curve looked like you, were talking about 15,000 deaths and 150,000 cases or even 100,000 cases so there’s much less impact.

I would be very surprised if this doesn’t peak sooner. We don’t really know what the effect of this coming winter is. Australia got it under control, New Zealand got it under control. There may be something there, but I am not sure about that. Is there bad flu in South Africa?

Not terrible because as you know it’s a fairly warm climate.

Northern Italy has 25,000 flu deaths per year. Yet the vaccination level is 19%, whereas in France they vaccinated 60%. Vaccination is a personal choice. But what happened in Europe, that probably led to the high number of deaths. It’s three weeks worth. But that’s still a high number. Hundred and fifty thousand or so. In the last 2 years, flu was very weak, particularly the winter of 2019-2020, almost no flu deaths. If you think what this means: flu is culling the weak. It’s a horrible language to use but there are people who are more susceptible to flu who did not succumb to it. Those people are now three months older and probably the people who are succumbing to characterise this, is why the excess deaths for this year had not been a really bad flu season this year. Then the coronavirus deaths would be much more impressive because it was a relatively mild flu season. The excess deaths are only a 147,000 so far.

Lockdown, flattening curves

The theory is that the early lockdown has flattened the curve and as a consequence of that we have a relatively good experience, relative to other parts of the world. However the concern is that those gains would be thrown away if everything were opened up now.

That’s a concern. It may be possible to open up, but to limit travel from very infected areas to less infected areas. I would certainly keep in place temperature readers and masks. Maybe, not have football games.

One way to think about corona is that when somebody talks to you directly facing you, they’re giving you coronavirus. In a football game everyone is screaming – and say you’re spraying viruses on everybody. or a bar is a bad idea. A bar is noisy. Having a beer outside is probably fine, inside a crowded bar is less so.

In the places where we had additional outbreaks like say Singapore. The Singapore outbreaks were in hostels for immigrant workers, 20 people in a hostel, kind of a breeding ground. Japan has still managed to keep very steady low levels. So with South Korea. Looking at this from the other point of view completely, let’s look at the countries or locations that have been very badly hit: northern Italy, Lombardy, New York, City, England and Belgium. But when you look at the those countries, you can now say let’s ignore cases because cases are very hard to justify.

Let’s cut what fraction of the population have died. We don’t really want them to die. But in some ways dying is a proxy for how severe the disease was and nobody has really succeeded very well in protecting the elderly. We’ve tried, but nobody has said we haven’t lost a single person over 80 years. Let’s just assume that’s a uniform measure. You find that the number of deaths that you get per 1,000 of population is between a half and 1 in 6 between 0.1% and 0.05%. In New York City, it’s maybe a bit higher than that maybe 0.15 %, New York City is a special case you can probably find it you find very small locations, there might be small cities in Italy where it was higher but if you’re very careful of a small city the number depends on the age profile. These numbers go back and are consistent of what we saw on the Diamond Princess cruise ships. These numbers were actually known mid to late February. These numbers are very consistent, so you could say OK. These are all stopping because they’ve been really good at controlling things and they just stepped in and squashed it down. When you look at what’s happening in England, you don’t get a feeling that things are particularly well controlled. So the other alternative is that, for some reason the infection is saturating. I’m not going to use the word herd immunity because it implies something very special.

The number that people seem to be getting to is around 25% being infected. Coincidentally that’s the number that were infected on Diamond Princess. Again with the Diamond Princess, you might argue that people were very well quarantined or you could argue that a cruise ship has a population density that’s 40 times higher than Hong Kong. It’s a very small area. It’s a perfect situation to infect people. We don’t know that yet. But we will know, we will learn. Sweden obviously believes this is the case. One good thing about Sweden is that, politics doesn’t seem to play a big role.

In Sweden, it’s actually illegal for the government to try to influence epidemiologists. Another thing I would also say is that, epidemiologists have a track record of over exaggeration. You can see this with Ebola where they said it would be 100 times more than there were. You can see this with bird flu. You can see this with SARS.

For them, they say a very large number. When measures are taken and the number comes out smaller they’ve won. The trouble is that, some of those measures include lots of damage, if they win at the cost of putting your country into depression for 5 years and therefore causing many more deaths. That’s not an effort. It’s an incorrect view.

The government can listen to them but the government also needs to listen to the economists who will say: if we go into depression, this number of people will die.

I’m very encouraged by the fact that lockdown happened early. Lockdown by and large seems to be sensible – masks are worn, exercising – perhaps should be allowed more frequently. Temperature has been taken in businesses. You’ve gone from stage 5 to stage 4, these are sensible things. You mentioned getting personal protective equipment from doctors which is very important.

Things are actually in pretty good shape. If I was advising the government, I would say okay: We did really well with this and we need to think about the other side of the coin. Again, you need to have smart selective lockdown or smart selected social distancing – lockdown is not a nice word – and coupled that with smart selective freeing of certain sectors. Sports games and large weddings should not start very quickly because one carrier could be damaging.

Ultimately all of Europe has just got to the saturation point, which may be herd immunity, but in any case they’ve stopped and that’s probably quite reassuring for them.

So in some ways you could even look at South Africa. I don’t know what the natural disease death rate in South Africa is. In most countries, it’s about 10 per 1,000 per year. Maybe South Africa’s level is a bit higher but even lower. Your population is quite young. It may turn out that in South Africa, a rough calculation would indicate a month of natural death. I don’t know how many deaths there in South Africa per day. Italy is about the same size as South Africa. Italy had about 17,000 deaths a day, natural deaths.

And my guess is that in South Africa it’s about the same size as Italy. But this is an older population. I would guess roughly you have a 1,000 deaths per day.

We’re talking about 20,000 deaths, which will sound terrible but remember we’re just increasing the death rate of everybody essentially doubling it for one month. This is almost like a fox deal with the devil and as a result you get back herd immunity. This is obviously a damaging thing, but it’s happened in Italy, it happened in England, and what happened in Sweden. And life goes on. It’s a little bit like saying, we’re going to decrease the longevity of a country by one month. That doesn’t sound like the end of the world. It’s a question of how you sell it.

Certainly in most countries, they’ve been trying as hard as they can to make the number of deaths seem large, people whose death is in some ways known, you have a motor accident but you are infected by corona that’s registered as a corona death. It has happened in many countries. I don’t understand why, a smart government would have got its media to try to indicate that people are dying but every single day people die, it’s something which we need to live with.

What would we do better now in South Africa: try to go for herd immunity?

I would say, we don’t know yet, because the Southern Hemisphere versus Northern Hemisphere but that would be the worst case scenario. But it actually might be a pretty good case scenario. Again the death rate can be dramatically reduced, for example, by protecting people in nursing homes. I would imagine in South Africa there’s a certain racial imbalance between lives and death. In some areas there’s a very strong feeling that the older people who are in the vulnerable group are really exercising their power over the younger people for an increased risk which is not massive.

If you are an 85-year-old who is sick, otherwise you probably have a small chance of surviving a Covid-19 infection, maybe 1 in 10. But if you’re a healthy 85-year-old – it’s like the Angel of Death came a month early. Was I about to die that month? No, I’m fine. It’s a very difficult problem and actually responsible reporting is incredibly important. This is why I found that these kinds of conversations are 10 times better than being on Fox News or CNN or BBC, they’re all sensationalism and have a political axe to grind. You don’t want to solve a difficult problem that way.

What about your critics? They claim you’re not an epidemiologist that you should be sticking to structural biology and computer science.

I would say the following: the track record of epidemiologists predicting the extent of damage for the last 10 years has been pretty terrible. Right now, the epidemiologist in England, Ferguson, is now being pretty much roundly criticised by everybody. I looked at his numbers and told him that they were in-effective and tended to be high. I convinced him, but he would not listen and I did something I hate to do. I replied, ‘Whatever’. I hate that word. But it was at a very high level. The president of the Royal Society was involved. I have everything written down.

The other thing is that, all I’m doing is looking at the numbers. When I say the saturated is 25% and when you look at reports from New York and reports from Diamond Princess, the number of 25% seems to come up. Maybe coincidence, maybe it’s not. We get a rate of around 1,000 or half in a thousand, depending on your population. That again is something which recurs. Maybe it’s just luck. I studied this from the very beginning.

China is a very big country. Within China, there was one province that was very badly affected, Hubei. In fact one city in that province Wuhan, where there were 80% of the deaths. Then 3% of the deaths were everywhere else in China. When I started following this we had friends everywhere in China. For me, what was critical was, what is the death rate? Not in this heavily infected area where the hospitals were overwhelmed but outside Wuhan or Hubei. I defined the category called China not Hubei. 

And this is a category which has been most informative because this particular epidemic has had no secondary outbreaks. The Chinese were very good at preventing new outbreaks because they were able to follow the people who had left Hubei. In China people know where you come from and monitor. And if somebody got sick, they didn’t let them become a spread out. So this was actually very important right from the beginning. And it basically indicated that this virus never grows exponentially.

I’m about to post my excel and various things on Twitter. I actually enjoy the criticism on Twitter. I must be sick about this. You can’t defend yourself. Often the criticism is a troll, but I don’t really mind. Everything is based very much on numbers. A lot of people make the assumption that nothing from China can be believed. I didn’t go either way. I just said, let’s look at the numbers and the numbers have a certain consistency. At one point I joked and said, the only way that China can be manufacturing these numbers, if they’ve hacked my laptop. We’ve now seen these very similar patterns in New Zealand and in other countries. There’s something about this virus. It all comes down to these invisible cases, where for each person that is the visible case probably it’s in South Africa right now the total number of cases is much more than 10,000. If you really couldn’t measure randomly you’d probably find it’s 10 times higher at least. This is good news, it also means, the measures you’re taking, the personal protective measures like face masks are a good idea.

Lockdown winners, losers

When we look back on all of this in a few months hopefully or at least next year. In the interview that you did with Unheard you said that there were going to be stand out winners in countries and stand out losers in countries, would South Africa be in either of those camps and indeed what should South Africa be doing from here onwards to become a stand out winner.

South Africa needs to be on the alert for new outbreaks. When they occur to isolate that area they may not occur. Just imagine if New Zealand had been able control things, but Australia had 10,000 deaths then we would have a measure for South Africa. It would not surprise me if Covid-19 is somewhat territorial. For example, in Israel, they were very happy that they had 250 deaths so far, when people had predicted 20,000 or 10,000. But the fact remains that their neighbouring countries Egypt, Jordan and Syria actually have fewer deaths. And is this because they have less old people? Is it because they don’t count the death properly? Is it because of the climate? In Israel today, there are in high 20s. I am impressed with South Africa moving early. It’s clear that moving early is an important thing to do.

I expect a peak to occur soon. I would be very surprised if South Africa has the longest, slowest, upward building up. If there’s a massive second outbreak, South Africa releases everything, not crazily, not in a controlled way. Start to have rugby games or whatever and suddenly, without realising the outbreak is huge.

It doesn’t mean you’re loser because they could get herd immunity. We have examples of that. Is Sweden a winner or loser. By the criteria of number of deaths, it’s a loser. But by the criteria of not destroying the economy, she is definitely a winner. On the number of deaths again, is it going to end up being at the 1,000 level, there’s not a lot they can lose. South Africa’s fine, she is going to be fine. I believe South Africa will end up having curves that look like New Zealand and Australia. Right now, Brazil has a similar concern.

The good thing about this conversation is, I feel very energised to help. I was very proud to see the tweets about South Africa’s only living Nobel laureate.

I hadn’t put those facts together. I’m very proud, and very happy to help. I’m very proud to be a South African. And among other things, I have a lot of different citizenships.

What about the comment that you made to Unheard that lockdowns are huge mistake?

Let’s just quantify that. Lockdowns definitely can control things. When you said to me, that this lockdown gave us time to prepare the medical personnel. That to me was finally a really good reason for having a lockdown. I hadn’t thought about it. We’re thinking about places where, they are really getting high deaths. Britain could have continued – it might not be very hard to have more deaths than they’re having now – they’re going to reach their 1% level quite soon. Lockdown needs to be smart. It would be very easy for countries to adopt less painful measures.

In Israel, we have the situation where somebody was windsurfing and they descended on him with a helicopter, a speedboat and arrested him on the seashore. This was a time when they had just opened up IKEA. It was just such a bad media moment, so stupid. It’s just not common sense. We don’t know what’s going to happen in Brazil or some of the Southern states. But on the other hand, numbers are going down everywhere.

The numbers in Russia, even Russia seems to be peaking. They’ve got 2,000 deaths and they seem to be peaking. South Africa ramped up very slowly, maybe because of the lockdown. Everything is consistent. It’s gonna be fine. It is important to prevent further outbreaks. To measure things as cleanly as possible. The new cases are an important measure. Sweden is a point in case where they had no new cases on Sunday then a huge number of new cases were made. People have looked in front of the death certificates.

It’s very much a question of weighing deaths versus damage to the economy. This is something that the country has to do. It’s something which the country has to do, in a way which is meaningful. Economists have this measure of years of lost life. Where you have a fact that people don’t live forever and also measure damage that poverty causes.

There’s no doubt that for the shrinking of the economy by a certain amount people die. Very often there are different classes of people and the people who don’t die because of these measures and this leads to a polarisation.

The real message here looking back in the long term is going to be that this was the time that the young people finally got fed up with the Baby Boomers and the Baby Boomers have been messing things up now for 70 years, with pollution, nuclear war, nuclear weapons and global warming.

They’re still basically going for their own protection, versus the economic situation of younger people. I only speak like that because I’m a Baby Boomer and we’re seeing this in more and more places and this is a part of the glorification of every death is the same. For me a 5-year-old is worth more than an 85-year-old even if it’s me and I really mean this. Anyone who doesn’t think that, is very selfish.

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