11.3.2021

Myths about Pandemrix and narcolepsy

 A common theme among Finnish anti-vaxxers is to exaggerate the risk of narcolepsy that followed the 2010 Pandemrix campaign against swine flu.

"Many people got narcolepsy", they claim. What are the actual numbers?

Before the Pandemrix campaign, in the previous year, 61 people got narcolepsy.

The swine flu jab was given to 2.7 million people.

In the following year, 109 people got narcolepsy. The difference was 48 persons, i.e. 0.0018 % of the number of vaccinated people.

At the same time, the vaccine prevented 80 000 infections and about 50 deaths, according to an article in Terveyskirjasto, published by Finnish association of physicians Duodecim. Those who would have got the influenza would also have had an increased risk of narcolepsy, because the autoimmune reaction was caused by a protein in the virus itself.

Thus, the vaccine prevented more deaths than narcolepsy increased. Which is worse? Death, of course. Even a failed vaccine campaign was better than no campaign.

----


Sama suomeksi:

Rokotevastaiset tahot levittävät myyttejä ja liioittelavat vuoden 2010 Pandemrix-rokotteiden sivuvaikutuksia, väittäen että se aiheutti paljon narkolepsiaa.

Narkolepsian on saanut huomattavan harva. Ennen Pandemrix-rokotuskampanjaa narkolepsiaan sairastui 61 henkilöä vuoden aikana, rokotusten jälkeen vuonna 2010 sairastui 109 henkilöä. Rokotteen sai 2,7 miljoonaa ihmistä. Ero siis on 48 henkilöä, eli noin 0,0018 % rokotetuista.

Samaan aikaan rokote esti 80 000 tartuntaa ja viitisenkymmentä kuolemantapausta. Tartunnan saaneilla olisi myöskin ollut narkolepsiariski, koska sitä aiheutti itse viruksen proteiini.

Rokote siis esti enemmän kuolemia kuin narkolepsia lisääntyi. Kumpi on pahempi, kuolema vai narkolepsia?

Tietenkin kuolema. Epäonnistuessaankin Pandemrix-kampanja oli parempi kuin ei kampanjaa.

24.1.2021

Covid myths and science


I'll collect here some of the silly claims about covid crisis, actions against it, and how to respond to these claims with science and facts.

Contents include debunking claims about things:

COVID

About the virus itself:

"It's just a flu"

No, it is not. It is much more dangerous. Let's trust established epidemic experts. Johns Hopkins explains:

Since December 2019, COVID-19 has killed more people in the U.S. than influenza has in the last five years. 

Influenza is a significant burden on the population, but COVID-19 has had a vastly larger effect.

https://www.jhsph.edu/covid-19/articles/no-covid-19-is-not-the-flu.html

"It only kills old people who would have died anyway"

This claim is often made in the form "the median age of those who died with covid is 84 years and life expectancy is 84 years, so they would have anyway died this year."

No. People who say this do not understand the concept of life expectancy. When we say that the life expectancy in our country is 84 years, it's the life expectancy at birth. But the life expectancy of someone who has lived to 84 years is not 84 years; it is considerably higher. If someone has survived to the old age of 85, we can expect them to live 6 more years. (5 for men, 7 for women). So life expectancy is 91.

This statistics is from Helsinki; rest of Finland has slightly higher life expectancies. Other West European countries are similar.


But how many life years were actually lost to one covid death? There are many studies that produce slightly different results, but usually the outcome is that a covid death shortens the life of the patient by about 10 years. The keywords for finding more information is "years of life lost to covid".


"The figures are wrong because they show death with covid, not of covid" 

Wrong. Research on autopsies done on people who died of covid in Berlin and Hamburg, and many other places, show that with the vast majority of those who died with a covid diagnosis, the infection was a directly contributing factor to their death. 

It was not decisive in all cases, but in >90 % it was. The patients often also had other diseases or conditions, but the decisiveness means: if they hadn't had the infection, they wouldn't have died. Autopsies reveal damage not just in lungs, but in many internal organs. The most usual "pre-existing condition" is obesity, which is very common in Western world.

This is also demonstrated by the huge excess mortality in many places. For instance in New York, the excess mortality is higher than the number of registered covid deaths.

Reported by New York Times: https://www.nytimes.com/interactive/2021/01/14/us/covid-19-death-toll.html

Moreover, we are going to have situations where hospitals are so full with covid patients that they have to turn down other patients, e.g. traffic accident victims. So shall we then say that because John did not get inside the hospital due to the hospital overload, and died, he died of covid although he did not die with covid?


"Infection rates come from population density"

Not really. This is just a fatalistic excuse. There is no clear recognizeable pattern that would show higher population density produces higher covid infections. If you put the numbers on a graph, the result is basically a shotgun shot: no trendline.



"The fear is worse than the virus"

Get real. Paul Coelho quotes are irritating, and this is beyond ridiculous.


Sweden

Perhaps the most strange phenomenon is that American Trumpsters have taken Sweden, a "socialist" feminist-run country, as their idol. "Look at Sweden! No restrictions! No increase in mortality!"

These claims are of course rubbish. Compared to its neighbours and traditional reference group, Sweden has done not well at all. This picture is from Our World In Data, which has reliable, easy-to-use grapsh about pandemic data.



"Sweden has no increase in mortality despite covid"

Not true. It has substantial excess mortality. The claim about normal mortality is usually presented with statistics screenshots that are either home-cooked and faked, or taken before end of 2020 from statistics aggregation sites like Statista, which have defective or imcomplete data.

A common claim is to use a screenshot from Statista with data "as of 18.12." and say it has practically all of year 2020 deaths. It does not. It's missing practically all of December, almost 10 % of mortality, because death statistics in Sweden are backdated to the actual date of death and arrive with a 2-3 week delay.

In reality, Sweden had 7.5 % higher crude mortality in 2020 than in 2015-2019. The source of this data is SCB, Sweden's central statistics bureau: https://www.scb.se/om-scb/nyheter-och-pressmeddelanden/scb-publicerar-preliminar-statistik-over-doda-i-sverige/




The Excel even has a plot for how deaths in 2020 compare to 2015-2019. Here I have emphasized the 7-day rolling average trendline:

You see how the excess mortality weeks and months match with the reported covid death weeks and months.

The next trick is to say "when you calculate population increase, mortality has not increased". But that is not true either. Here is mortality per 1000 population, and the data used for calculating it - and 2020 makes a substantial break in a decreasing trend. Note that the mortality figures are fetched 18.1.2021 so there will yet be a slight increase when more deaths from 2020 are taken to records.
 



Excess mortality can be compared between different countries in Euromomo:

Germany

Same arguments have been made with Germany, "no excess mortality". That is not true either.  Deaths and excess mortality in Germany can be conveniently seen in the data of destatis:

https://www.destatis.de/EN/Themes/Cross-Section/Corona/Society/population_death.html

This demonstrates that currently (week 3 of 2021) there are almost 6000 more deaths per week than usual. That's 30 % more than usual.

Public Health England maintains an informative page that shows the registered covid mortality and excess total mortality. 



Russia

In Russia, excess mortality was reported at 230 000 people, already before the end of the year. The excess mortality in Russia is 13 %, and is six times higher than the recorded covid deaths. 

In 2020, Russia's population declined by half a million. Covid deaths account for half of this.

"There were no restrictions in Sweden"

Not true. There have been many restrictions in Sweden. Public gatherings forbidden, concerts cancelled, amusement parks closed all summer, restaurant opening times shortened and alcohol serving limited.

Typically, the restrictions were similar to neighbour countries but were initiated later and lasted longer. In fact, Sweden's covid actions have mostly been more stringent than in neighbours - they just started later as shown by the OWID Stringency index.

The list of restrictions and what is forbidden is currently (as of Jan 24, 2021) listed here:
https://www.krisinformation.se/detta-kan-handa/handelser-och-storningar/20192/myndigheterna-om-det-nya-coronaviruset/restriktioner-och-forbud


The restrictions include currently (24.1.2021):

  • Public gatherings of more than 8 people are forbidden - this applies to demonstrations, lections, religious activities, theater, cinema, concerts, and similar.
  • Private gatherings of more than 8 people in rented premises are forbidden, with exception for funerals where 20 people are allowed
    • Punishment for breaking these rules can be up to 6 months prison
  • Shops, gyms and sports facilities may not admit more than 1 person per 10 m² of space.
    • Schools and public transport are exempt.
  • Restaurants may only seat 4 people in one table; other restrictions apply
  • Alcohol may not be served after 8PM
  • Travelling to and from many foreign destinations is forbidden, except for re-entry of citizens
  •  It's forbidden to visit old people's homes.

In many areas, Sweden's restrictions have been more harsh than at neighbours; for instance, the amusement parks like Gröna Lund and Liseberg were closed all of 2020. In Finland, Linnanmäki and Särkänniemi were open, although with reduced capacity - which by the way actually made visiting them more enjoyable because you did not need to wait in queues.


Vaccines

There are also lot of myths spread about vaccines. 

"The vaccines do not prevent infection"

This is silly. The vaccines do not prevent infections 100%. They prevent them at a rate which is called efficacy, which is about 95 % for Pfizer-BioNTech and Moderna vaccines. And even for the remaining 5 % who do get an infection, they get it milder and usually avoid the severest form of disease.

In Israel, where the vaccinations are most advanced, we can now see clearly that the vaccinated population is having fewer infections and hospitalisations - and this will mean fewer deaths and injuries.

https://www.timesofisrael.com/israel-sees-60-drop-in-hospitalizations-for-over-60s-in-weeks-after-vaccination/

"The vaccines do not prevent people from infecting others"

Again, this is silly. We just don't have much evidence on this yet. But absence of evidence is not evidence of absence.

It is likely that the vaccines will reduce transmissions of the disease. We just don't have the evidence yet. We'll see it soon. Vaccines do not neet to completely eliminate transmission to help curb the pandemic.

And a BBC article from early February indicates that the AstraZeneca vaccine reduces transmission substantially.

"Many people have died after taking the vaccine"

That's just a bad-faith distraction. The vaccine doesn't make people immortal. They can still die of other causes. People may even die of covid, because as mentioned, the vaccine efficacy is not 100 %, it is only 95 % and some people may have contracted the disease already before they were vaccinated. Even though vaccinated people have a milder disease on average, some people might still die.

These meme says it:


Co-incidence in time is not same as cause and effect. If every Finn were today "vaccinated" with a saline solution - which does nothing - then during the next 4 months
- 16438 will get pneumonia
- 17736 will die
- 25 will get Guilllain-Barre syndrome
- 53 children under 15 will get cancer diagnosis
- 16 will be found with narcolepsy
- people will fall ill with other sicknesses
- autism spectrum will be more common than in 2010

None of this is caused by vaccines. 

It is probably sensible to not vaccinate those who are extremely sick already, because the mild symptoms of immune response building up may weaken them, and this could indeed kill someone. But this impacts only the very small number of people who are at risk of immediate death. Others should get the vaccine, after assessing for risk factors.

Restrictions and actions

"Restrictions destroy the economy!" 

No, they don't. The current pandemic repeats the learning from 1918 Spanish Flu pandemic, where cities and regions that acted more robustly had stronger economic recovery after the pandemic was over. Economy is distracted by people not wanting to get sick. This has an impact that is at least as large as the impact of restrictions.

MIT has a good report on this: https://news.mit.edu/2020/pandemic-health-response-economic-recovery-0401

"Restrictions kill more people than the pandemic. People commit suicides!"

No, they don't. The data is not very conclusive, and there are some reports that suicides would have increased in some places during the pandemic or lockdown actions. But British Medical Journal summarizes it like this: 

A reasonably consistent picture is beginning to emerge from high income countries. Reports suggest either no rise in suicide rates (Massachusetts, USA; Victoria, Australia; England) or a fall (Japan, Norway) in the early months of the pandemic. The picture is much less clear in low income countries, where the safety nets available in better resourced settings may be lacking. News reports of police data from Nepal suggest a rise in suicides, whereas an analysis of data from Peru suggests the opposite.

Any change in the risk of suicide associated with covid-19 is likely to be dynamic. The 20% decrease in Japan early in the pandemic seemed to reverse in August, when a 7.7% rise was reported. Evidence from previous epidemics suggests a short term decrease in suicide can occur initially—possibly linked to a “honeymoon period” or “pulling together” phenomenon.

https://www.bmj.com/content/371/bmj.m4352

This is not so strange. Suicide rates often decrease at hard times, e.g. during wars.

"Countries that have women leaders are performing better under the pandemic"

This myth, spread by think-tanks and feminist-posing politicians, is bunk. The gender of a country's leader is not related to how well the country is going through the pandemic. Some of the well-performing countries have had women leaders. But so had Belgium. 

The claims are not supported by solid science. They are supported by cherry-picking. There are no statistically significant differences in mortality etc between countries lead by women and men.

This study is the first to comprehensively address the roles of women leaders and women legislators in mitigating the effect of the Covid-19 pandemic. Similar to Bosancianu et al., we find that there are no differences in reported fatalities between women-led and men-led countries.

 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244531

"Masks don't protect you, the virus is small, mask cannot filter all viruses"

Masks do ne need to be perfect to be useful. It's all about the viral load. Doses are important. To help slow own and stop the pandemic, the mask does not need to stop all virus particles. If it can reduce the load, it can give the body of an exposed person the possibility to withstand the attack. Many doctors and other health care professionals who have died of covid have been exposed to very large doses of the virus. Lacking personal protection equipment is a big risk for health care professionals.  

Masks are also not there just for protecting the wearer. The more significant impact is that it protects others. Covid disease spreads often via asymptomatic transmitters. People who have been infected but do not have symptoms (yet, or will not even get them). Mask reduces the risk of transmitting the virus to others.

Better masks (FFP2) are better than cheap surgical masks, but even the cheapest masks help.

"Wear the mask if you want, I won't"

Because the mass protect both ways, it is important that all use them. That reduces the risk of cantagion much more than just one person wearing a mask. So if you don't want to wear a mask, stay home, do not risk others.

The masks work, but they are not infallible. 



15.4.2020

Was Dr. Guillotine guillotined?

A popular meme says that Dr. Joseph-Ignace Guillotine invented the execution device for the French king, and then the king tested it on the doctor himself, who did not need payment because the machine was effective.

However, this story is not true. Dr. Guillotine did not invent the machine.

He was a member of the Estates-General Assembly, and as a humanist he proposed a more egalitarian form of execution -- before that, the noblemen were executed by sword and others were hanged, both of which methods the French executioners often botched, apparently not having enough practise with the sword and not having a well-researched Official Table of Drops. But in fact Dr. Guillotine was opposed to the death penalty.

The actual "guillotine" machine was designed by a man called Tobias Schmidt. Doesn't that sound very German? Always causing trouble for the French.

After the revolution, Dr. Guillotine resumed his medical profession, studied the works of Edward Jenner and became the President of the Committee for Vaccination in Paris.


4.4.2020

How Finland is different: the walk in the park edition

Google published  a few days ago Community Mobility Reports  which decision-makers can use to assess the impact of lock-down impacts and the imposed social distancing of people is working.

Some of results offer an insight to how nations are different.

In most countries, the actions taken have significantly reduced shopping, mass transit use and going to restaurants and cafes.

For instance, UK:

 Spain:
   

 Italy:


This is a huge change in how people live their daily lives. It cannot last indefinitely, but it is felt necessary to contain the epidemic.

But Sweden is quite different - much smaller decrease in restaurant-going, shopping, and going to ski resorts:


Finland has reduced these activities more than the Western neighbour:


But the actual differences are in outdoor life. UK, and especially Spain and Italy, have seen drastic reduction in access to places like national parks, public beaches, marinas, dog parks:














But Sweden has again it quite different:



However, Sweden is not as different as Finland, where the closure of schools, workplaces and such has lead to even larger increase in outdoor life in open areas:


Finland is not completely unique, though. There are some states in the U.S. that are similar, e.g. West Virginia. But the most extreme I found is the state of Montana, which has seen reduction in retail and some in grocery, but access to parks has more than doubled.

It's a shame that Google doesn't publish the data for Russia.

It is likely that Finland's smaller reduction of mobility in shopping and recreation compared to Italy or Spain is because our baseline is significantly lower: population density is lower, and people here have always kept a longer physical distance to other people. We don't go as often to restaurants and cafes, and shops are less crowded.

But the park figure is interesting. It clearly shows that we feel that there is space there, and it is safe to go out in the nature.

25.3.2020

The COVID-19 pandemic is the world war of our time, and it's the best of world wars

I decided to abandon my usual dyspeptic self for a moment, and write about this: 


What good can come out of a global pandemic?


Many gloomy things have been said and written about the ongoing COVID-19 pandemic. But when we think of it, it's a great opportunity, despite the significant human and material damage it causes. The pandemic may become the Great War of our time, and that is not necessarily such a bad thing after all. It's not nearly as bad as actual wars are, but it may carry many of the benefits that past wars have had.

In history, world wars have given huge boosts to technological and social change. The carnage of war has been immense, and of course not all of the post-war change that came about has been for the good either  and many changes being good or bad is always also a matter of opinion. But if we don't think of the immediate destruction, we can say that the humankind leaped ahead as a result of these wars.


World War I 

Leap of technological development and advancing equality in the old class societies



The Great War of 1914-1918  killed many, many men in the wargoing countries, and diverted production to war materials. As another downside, it also for its part enabled the Spanish flu pandemic, although overall, this epidemic is not considered to be as big a factor as the war itself.

But later on, the war also enabled huge societal changes.

The Great War was a primary mover of change in many countries. Class societies started to collapse because the men who fought in the trenches, often of low social class, were there side by side with their leaders, who often were from upper echelons of society. Everyone noticed they were all needed, and when you're a man and a uniform carrying a weapon, all men are rather equal and meritocracy becomes more important than inherited position.

For example in Britain, the war kicked off the demise of the class society as it was known. Most of us of course know this from the perspectives of the upper classes. TV serials like Upstairs Downstairs, Brideshead Revisited and Downton Abbey have described this change to us.

The war also accelerated the efforts and credibility of the universal suffrage movement. Again, for example, UK got suffrage for all men in 1918 and all women in 1928. Women worked increasingly in production, and not just textile works but also munitions factories.

In Russia, the war kicked off a socialist revolution. This had great promise, although it was then kidnapped by the Bolsheviks, who set up a dictatorship. Even under this dictatorship, the backwards, reactionary and inefficient rule of the Tsars could be converted into considerable human development.

Likewise, the corrupt and backward Ottoman empire collapsed and gave way to the Young Turks. Similar changes happened as a result of the war in many nations, large and small.

Perhaps the worst part of aftermath of World War I was, in addition to the rise of Bolshevist dictatorship in Russia, that the peace treaty of Versailles crippled Germany. This directly contributed to the rise of Nazism and a second great war.

The first great war accelerated technical development. Automobiles, chemical industry, metallurgy all these developed fast. Aviation kicked off.

But the greatest impact was the emancipation of classes: universal suffrage became the norm in countries. Working-class parties rose in many countries and paved way for social reform, improved public health care, schools, pension systems. In Finland, it lead to the liberation of tenant farmers through a land reform law that enabled them to purchase the land they tilled, at a reasonable price; this had a huge impact on later development, as 20 years later everyone felt we're in the same boat when facing an existential threat from the USSR. And the nation survived the next great war.

World War II

Another leap of technological development, withdrawal of colonialism and an economic re-start



The Great War of 1939-1945 (or 1937-1949 if we remember China) was a continuation of the first, at least in Europe. Repression of Germany in Versailles lead to revanchism, and the promises of populist economic policies of redistribution by national socialists could not be kept without a war which was also their ideological goal.

Simultaneously USSR could no longer benefit from fast growth it had been enjoying after leaving the stagnation of the incompetent Tsars. When Stalin dreamed of increased population growth and the 1937 census told him he was wrong, he got so furious that he sent to the camps his underlings who counted honestly.

Japan was between a rock and a hard place  trying to get hold of resources in the Pacific region, and felt it had to go to war to win them.

America and most of the Western world was in the grips of Great Depression in the 1930's.

The total carnage of total war started already in 1931-1937 in China, where the Japanese had similar expansionist needs as Germany had in Europe. And then the two moustached dictators agreed to split Europe to their spheres on influence to prepare for the confrontation.

So what happened during the war?

Huge technological progress. Aviation leapfrogged again, we got rocketry, jet engines, large capacity planes for transport. Penicillin was deployed to mass production. Bletchley Park and others gave us computers, anti-aircraft operations gave us radar, the Manhattan Project paved way for nuclear power. After the actual world war which ended in 1945, it continued as a Cold War which gave us man in space and a trip to the Moon.

The great social change after the second Great War was collapse of colonialism.  Massive numbers of people all over the world, particularly Asia and Africa, gained independence and self-determination. India became the largest democracy in the world. Some of that change was democratic, some was less so. Some countries have leaped forward greatly to become front-line deveoped nations, some have progressed much slower if at all, but still the post-war human development was very significant. Many people became masters of their own fate.

Marshall Aid and similar schemes developed Western Europe after the war. Germany had Wirtschaftswunder.

In many wargoing countries, there was also an impact to fertility after the war: the trust that people have in their futures was restored, and that showed up by building larger families, the boomer generation.

What will COVID-19 change?

Digital leap, rise of local resiliency and an economic re-start


There will be large-scale, extremely significant economic impacts by the coronavirus epidemic, particularly by the scaling back of trade and reduced movement of people, which is necessary to contain the epidemic. It will be devastating for many companies and entire countries.

But we won't be hit so much by many people being killed as from an actual war. Even if 1 or 2 % of people die of SARS-2, that is still ofl limited impact when compared to what happened in 2nd World War, because the dead will be mostly older people who are not economically active, and we will not have the huge material destruction of infrastructure, homes and public facilities like we had in the last great war. The loss of remaining life years by the pandemic will be smaller than the loss of many young men in wars.

And we will learn from this, and there will be several benefits. For instance, during this crisis we will be forced to learn to work remotely. We will soon know much better how to apply telecommunications and computer technology to work, to teach, to learn. This is digital transformation. We will perhaps learn to do things with somewhat less travelling in the long run, although I expect that much of the travelling we've done will resume when the virus crisis is over.

Another important change will be in attitudes. The last couple decades of globalisation have created much discontent in Western societies  some of it undeserved  and we can maybe reset that now.

The humankind has generally benefited from globalisation  absolute poverty has decreased throughout the world, particularly in poor countries; more children go to school than ever; more people have health care than ever; more children are vaccinated than ever. Hans Rosling's TED talk and similar performances show this in an inspiring way. In very many ways, this era of globalisation has been great. But it has had some excesses, and some social impacts that are a genuine reason for discontent.

There has been a kind of economic stagnation caused by outsourcing of manufacturing, particularly  to China. Now we've seen that such concentration of logistical chains is a danger. We need to have more manufacturing and other economic activities throughout the world to increase the resiliency of supply chains, and we need increased food security. Particularly we need to reduce the dependency in China who is a major potential source of pandemic diseases due to its treatment of wildlife trade and therefore a risk for everything where it is the sole supplier.

We will increase our preparedness to fight pandemics by preparing equipment, test sets and training people. And we will increase our local resiliency by ensuring that we are able to live, develop and thrive with more sustainable supply chains for industry, agriculture and other things.

The population development in the world has also been in an imbalance: Western countries have had even declining populations, whereas undeveloped countries still have had uncontrolled growth. This may now be balanced: 3rd world countries continue to develop and population growth will slow down as health care and education continue to improve, and Western countries may well expect a baby boom after the COVID-19 epidemic, much in the way there was a baby boom after Second World War.

The COVID-19 is the war of our time, but it'll be soon over, the destruction is going to be much smaller than from the actual world wars, and we'll recover.