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In the final extract from his book, ‘States of Panic: Covid-19 and the New Medieval’, author Brian Pottinger explores the dangers of blanket terms and assumptions about communicable diseases. Pottinger observes that in 2020, after the United States’ National Center for Health Statistics broadened its criteria for ‘probable’ Covid-19 cases, every other kind of cold and flu seemed to all but vanish. The number of deaths attributed to Covid-19 skyrocketed and the pandemic appeared to spiral out of control. The author explains how these frightening statistics came about. – Melani Nathan
The Centres for Disease Control and the Art of the Possible
By Brian Pottinger*
In the United States the Centres for Disease Control and Prevention (CDC), the country’s major regulatory body for dealing with pandemics, proved time and again to be pathfinders in expanding clinical and epidemiological criteria in a restless search for numbers: just as it had been in the Swine Flu debacle.
On March 24 2020, in its Covid-19 Alert No 2, the US National Vital Statistics System of the United States’ National Center for Health Statistics (NCHS), part of CDC, said that it would not register mortality under UO7.2, the Covid-19 Suspect and Possible category in the International Classification of Diseases tenth Revision (CD-10). All presumed Covid-19-linked fatalities would be treated as confirmed.
If the death certificate reported “probable” or “likely” Covid-19, these terms would be assigned the Covid-19 designation immediately. If the death certificate indicated coronavirus 2019, it would be automatically classed Covid-19.
On April 5 2020, the NCHS of the CDC changed its reporting criteria for Reporting Covid-19 patients. Until then the criteria had been the standard check-list of fever, chills, rigors, myalgia, sore throat and the critical new olfactory and taste disorders.
It now imposed an alternative set of criteria: severe respiratory illness with at least one of the following: cough, shortness of breath or difficulty breathing. At the stroke of a pen the CDC had pressed all respiratory illnesses, including pneumonia and bronchitis, into the service of Covid-19, even if there was no clear evidence of Covid-19’s presence.
The immediate effect was the virtual disappearance of any other form of coronavirus: in the first eight months of 2020, influenza-linked fatalities in the United States miraculously dropped from a three-year average of 70 300 to 6 426. It was the ultimate statistical body-snatch.
The CDC also changed the guidance for certifying deaths due to Covid-19 in April.
“In cases where a definite diagnosis of Covid-19 cannot be made but it is suspected or likely (e.g. the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report Covid-19 on a death certificate as “probable” or “presumed”. In these instances, certifiers should use their best clinical judgment in determining if a Covid-19 infection was likely.”
“Suspected’’, “likely”, “reasonable degree of certainty”, “probable”, “presumed”, “best clinical judgment”; this is rigorous bio-medical science?
In its ICD-10 Official Coding and Reporting Guidelines which was to determine the method of reporting from April 1 through to September 1, the influenza off-season, the CDC unprecedentedly exempted Covid-19 from Section II, H of its hospital inpatient guideline to establish that “confirmation by the CDC of the diagnosis does not require documentation of the type of test performed: the provider’s documentation that the individual has Covid-19 is sufficient’’.
Again, ‘’CDC confirmation of local and state tests for Covid-19 is no longer required.’’
Anticipating the WHO directive, New York City health authorities confirmed on April 14 2020 that they were going to count all “probable” Covid-19 fatalities as opposed to only those that had been laboratory tested. Total reported cases jumped from 26 493 to 35 386 and fatalities by 3 700 the day after the new system took effect.
The WHO-recorded deaths in the United States took huge spikes on April 17 (6 409 deaths) and May 3 (5 000) as the “discovered, recovered, probable, possible and I-honestly-think-so” Covid-19 fatalities began pumping through the system
Then in mid-2020, the course of the outbreak took a major inflection.
In an Emergencies Preparedness Response Bulletin of December 31 2020, released in the dying hours of the Pandemic Year, the WHO finally conceded that the Covid-19 virus from China that had served as the grounds for locking us all up, felling great economies and massively abusing human rights, had in fact been supplanted by the SARS-CoV-2 D614G mutation across the world by June 2020. The initial strain of SARS-CoV-2 was effectively as dead as Monty Python’s parrot.
At that point, the WHO had registered 10 189 977 infections and 506 15 deaths with a global Infection Fatality Rate estimated between 0.16 and 0.25, equivalent to the sort of serious decadal viral outbreak the species has survived effortlessly since origin. Infections and deaths were in free fall across the globe, well short of the dire predictions used to invoke extraordinary counter-pandemic measures and key indicators such as the Case Fatality Rate and Infection Fatality Rate were plummeting.
It was precisely at this point that the new and widened clinical and epidemiological criteria for Covid-19 were invoked: now alimentary and mental disorders were included in a basket of clinical definitions for Possible Covid-19. The impact was immediate.
Weekly infection rates in the two weeks preceding the CDC’s decision to include all Probables as Confirmeds on March 24 2020 trebled in the two weeks subsequently. They surged again when the WHO followed suit on April 20 2020.
When the CDC expanded its clinical criteria on June 30 2020, thereby triggering a raft of similar changes by other national data collection agencies, weekly infections instantly leapt by nearly ten per cent. When the WHO followed on August 7 2020, weekly rates immediately doubled.
In France, average daily cases increased from 563 per day in July to 2 179 per day for the first 24 days of August after the new clinical case definitions for probables were invoked. In the United Kingdom it went from 581 per day in July to 935 in August. Germany surged from 450 to 996 and Spain from 1 238 to 3 859.
It is naïve to suggest that resurgent infections by an expiring virus propagating in hostile climatic conditions, new strains of coronavirus or improved reporting of historic infections could have been responsible for such dramatic and immediate upswings in case and fatality reporting in such a short period of time.
And then towards the end of 2020, the saga took a more ominous turn. With the original Wuhan Covid-19 strain effectively dormant and a new annual coronavirus season upon us, coronavirus variants of SARS-Cov-2 with multiple mutations in the viral spike protein and the receptor binding domain began emerging.
By early January 2021, SARS-Cov-2 variants with up to 23 nucleotide substitutions, 14 mutations resulting in amino changes and three deletions were being detected. This was major genetic re-engineering but it was natural and predictable. What was not was the tenacity with which the major agencies clung to the Covid-19 brand well beyond its expiry date.
Viruses evolve and represent themselves in other forms to better ensure their survival, a bit like politicians, actors, virologists and epidemiologists. Swine Flu, for example, had traces of North American Avian Flu but nobody at the time called it a variant of Avian Flu with all its dread connotations of virulent pathogens.
The most prominent SARS-CoV-2 variant was the D6146G mutation which replaced the original Wuhan strain by June 2020 in Europe and then spread globally.
Two versions, both sharing the N501Y variant, now seized the news.
The United Kingdom outbreak, named SARS-CoV- VOC 202012/01, led to yet another severe lockdown in that deeply traumatised country. Remarkably, the WHO’s December 31 2020 communication confirmed that this strain was not phylogenitically linked at all to the original Wuhan strain of SARS-CoV-2 virus, the one that caused Covid-19. In fact, nobody knew from whence it came.
South Africa, emerging from a mismanaged Covid-19 pandemic, was struck by a SARS-CoV-2 variant named 501Y.V2, also with no known phylogenetic connection to Covid-19. It displayed all the characteristics of an annual coronavirus and landed in a population gravely weakened by drastic lock-down and rising malnutrition caused by the economic devastation of lock-down. The toll was high.
Indeed, the fact that these new and novel coronavirus variants exacted such a high price in lives in those countries with severe and lengthy lock-down histories prompted the obvious question as to whether Sweden’s Anders Tegnell had not been right all along: suppressing the virus first time around had only led to more severe subsequent coronavirus iterations in communities now with gravely reduced natural immune systems.
The 153 scientists on the WHO Working Group on Covid-19 Animal Models (WHO-COM) and others, meanwhile, turned up a startling anomaly: these new SARS-CoV-2 strains were not behaving like Covid-19 at all.
They propagated like a normal coronavirus, had about the same replication rate, did not select only the elderly and infirm and presented with all the respiratory symptoms of a seasonal coronavirus, albeit in some cases a very serious one.
Worse, doubts arose as to whether the fortunes spent on deriving a vaccine for an expired coronavirus would be effective on the new coronavirus seasonal strains. Efficacy rates were estimated at between 48 per cent and 60 per cent compared to a pre-Panic WHO requirement that vaccines should prove a 90 per cent efficacy before being distributed.
The WHO estimated that for every one recorded Covid-19 infection there were ten unreported. By early 2021 that mean a formidable number of these 800 million people world-wide would be carrying biological traces of Covid-19 and would flare false positive if tested, although only a small minority would be active.
Here is the terrifying thought: due to the relentless numbers hunting by the major agencies throughout 2020, every one of these, no matter what respiratory, alimentary or conceivably mental illness they contracted or from which they died, would statistically forever be Covid-19 in terms of the reporting and recording protocols adopted during 2020 .
This, then, was the basis for the phantom “Second Wave” of Covid-19 infections and deaths starting in late 2020 and carrying through to 2021. This “Second Wave” could be with us for years and mask other, deeper and perhaps even more malevolent localised infections, like the one gripping South Africa in early 2021.
Apparently unconcerned by the confusion or even the question, the WHO continued doggedly registering all coronavirus cases and fatalities as Covid-19 into 2021 although the terminology of the experts and more perceptive journalists now subtly changed: Covid-19 infections and fatalities were now “Covid-19-linked”. Like very distant cousins are linked?
Why on earth would reputable institutions go to so much effort to recruit as many ailments as possible to the Covid-19 banner, even to the point of expropriating other conditions in the 2020 season and press-ganging whole new coronavirus outbreaks in the 2021 season?
There are many possibilities: a genuine desire to leave no stone unturned in understanding the pandemic; justifying earlier and unmet doomsday predictions; confounding conservative and other critics or pandering to hysterical media and public pressures. The conspiracy-minded of course saw the dead hand of the pharmaceutical industry at play: it was alleged they had vested interests in prolonging the virus for the vaccines they had spent fortunes in developing.
But a more chilling possibility existed. What if these organisations were institutionally programmed to alarmism? What if their power, structures, staffing, revenues, prestige, business models, cultures and futures depended on public crisis, panic and fear? What if the real threat was no longer primarily viral, but human?
- Brian Pottinger is a former Editor and Publisher of The Sunday Times.
Read the first extract: Covid-19: The lessons we should take from the Swine Flu outbreak
Read the second extract: Covid-19: Tweaking terminology in pandemic panic
States of Panic: COVID-19 and the New Medieval by Brian Pottinger is now available on Amazon and Smashwords.
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