
On my second post on this blog dated May 21, 2020 I presented my
[first impressions](/posts/covid-19-first-impressions/) about the unprecendent
reaction against a medical threat that had been affecting the world for about
two months. A year and a half later, it is time to revisit that post to see how
well has the test of time treated my views.

## What I think I got right

In general terms, I maintain the main theses of the post. The treatment of the
Covid crisis has been abysmal at all times from the very beginning and has only
resulted in a substantial increase of the number of deaths directly attibutable
to the virus. Furthermore, by transforming what should have been a minor to
medium health crisis into a huge economical and political global crisis, has
caused more indirect deaths that dwarf what the virus would have caused if left
alone.

In particular, I completely subscribe what I wrote then:

<Quote>
  [Measures to slow the spread of the disease] obscure the real focus of the
  mitigation measures that have to be adopted, confusing people (and
  authorities).
</Quote>

A year and a half after writing these words, the public is still confused, and
the ahuthorities have gone crazy. So, yes, I'd say that it was spot on. This is
still the real issue. Focusing on a quixotic goal such **preventing the spread
of the disease** or **prevent infection at all costs** are still as stupid as
they were then.

- In the first place, because it is **not possible**
- Even if it were, most probably it is **not even desirable**
- And in any case, the final decision is **fundamentally personal** not
  collective

The same three considerations apply exactly the same now that we have vaccines
that are neither capable of preventing the spread nor to protect the vaccinated.
Exactly for the same reasons: that neither lockdonws nor vaccines provide a real
cure and both have negative side effects. These three points are very important
but this post is already too long, so I will relegate them to a future post.

## And what I got wrong (or didn't know)

At that time I was mostly concerned with the **protection of the vulnerable
population, preventing nosocomial infections** (infection in hospitals) and
**shielding care homes**.

These were important problems then. I believe that they **account for the vast
majority of the initial direct deaths caused by Covid**, at least during 2020.

As things have turned out, these initial direct deaths have been completely
obliterated by indirect deaths and other harms caused by the interventions (and
not by the disease), so these issues while still important have been relegated
by more pressing issues.

At the time I could not see governments able to maintain the situation for a
long time based on the famous phrase which
[may or may not](https://quoteinvestigator.com/2013/12/11/cannot-fool/) have
been used by Lincoln:

<Quote>
  You can fool all the people some of the time and some of the people all the
  time, but you cannot fool all the people all the time
</Quote>

It looks like the old adage still holds, although not in the way I was hoping
for: _You can indeed fool some people all the time_.

I was convinced that governments would take advantage of the end of the first
seasonal wave of the pandemic during the summer (in the Northern hemisphere).
They would **claim a false victory**, attribute it to **their leadership** and
be kept busy **hiding the harms** caused by their insane intervention, or better
yet, **blame the public** for their lack of compliance with their insane
diktats.

So my primary objective was to document the error of these initial measures
exclusively from the public health perspective.

I didn't know at that time, although it was already happening, that:

- Influential advisers to governments that have steered the crisis response
  globally had already decided that **massive vaccination would be the only exit
  route** considered for the pandemic
- In consequence, **other medical and pharmaceutical interventions** (including
  preventive measures or medication) **would be discouraged or actively
  prohibited**
- Social distancing was already proving to be ineffective to even **slow the
  spread of the disease**

With respect to the first one, the information was available, but I was not
aware of it.

With respect to the second, I suspected that medical procedures being used to
treat patients were not adequate, but only because a side effect of any
political and bureocratic involvement is the adoption of inadequate and
ineffective procedures<Tip>This is a very interesting aspect of public policy.
One that I intend to explore extensively on this blog</Tip>. That is why my main
concern at the time was that governments called-out the crisis as soon as
possible, enabling doctors to treat their patients calmly and devise the best
treatments, without pernicious external inferences.

I didn't realize that the problem was not the usual polititians and bureocrats
_doing no good_, but rather that they were consciously _doing harm_.

With respect to the third, it came as a surprise to me that the immense
sacrifice imposed to the population in almost all Western countries was
completely futile. When I wrote the post I argued that **delaying the
inevitable** was a bad idea. But as I was writing it, the public health
authorities had already the data (which of course they did not disclose) that
proved that **lockdowns did not even delay the rate of infection**.

Eventually the data has been
[made public by independent researchers](https://www.aier.org/article/lockdowns-do-not-control-the-coronavirus-the-evidence/)
but unfortunately it has been rather successfully hidden by mainstream media and
public agencies. This is a rather surprising outcome that has not yet been
explained satisfactorily to my knowledge<Tip>There are several competing
theories, none of which is convincing. So far, the explanation I like the best
is <a href="https://alexberenson.substack.com/p/virus-gonna-virus">Alex
Berenson's virus gonna virus</a>, which I interpret as the inability of the
measures that have been put in place to influence in any discernible way the
virus dynamics</Tip>. The established scientific literature before 2020 did not
recommend social distancing measures based on their collateral damages and the
difficulty to implement and enforce them, not on their lack of efficacy.

Of course, I had no way of knowing how the crisis would escalate:

- That governments would maintain the crisis after the initial wave had ended
- And the population would comply with the successfully more insane mandates,
  and still does
- That social distancing measures like **lockdowns would be maintained or
  re-enacted** even after they have been completely discredited
- I could never have imagined that crazy measures suchs as cloth masking **would
  be encouraged**, even less **mandated** and that the public would comply
- Governments would create fear-mongering and completely irrelevant test and
  trace campaigns without collecting **the only statistic that matters**: i.e.
  the evolution of the **prevalence of the virus in the general population**
  over time
- I did not even consider that **vaccines would be developped** in the short
  time required to affect the outcome of the crisis<Tip>That seemed to be a
  minor risk at the time considering the usual development time of vaccines in
  the past measured on the order of decades</Tip>
- Even less, I would have never imagined that once developped, **irresponsible
  massive vaccination campaigns** would be carried out. I still have problems
  trying to understand it

Each of these points, and some others that I have not listed, deserve a whole
post (or a series of posts). I don't want to hijack the blog again writting
about Covid, but I will add links to these posts, if I decide to do so.

In summary, I think that I got mostly right the public health implications of
the Covid pandemic and the initial measures put in place to _"control"_ it, but
I badly failed on the political implications. They have turned out to be **much,
much worse, than anything I could have ever imagined**.



A complete lack of preparation and training, the use of wrong protocols and just
lack of common sense 160 years after the experiments of Louis Pasteur, have
converted once again healthcare facilities (hospitals, nursing and care homes)
in the worst focuses of infection and deaths during the COVID-19 crisis. On this
post, I concentrate on hospitals, on future posts I will comment other
healthcare facility related mismanagement issues.

According to the
[WHO](https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf),

- Health care-associated infections are the most frequent adverse event in
  health-care delivery worldwide.
- Hundreds of millions of patients are affected by health care-associated
  infections worldwide each year, leading to significant mortality and financial
  losses for health systems.
- On average, 4 131 000 patients are affected in European countries and 1.7
  million in the US each year.

This is what happens in normal times. It is generally known both by the public
and health professionals, yet progress has been too slow. But this is another
story.

It should be obvious that the best way to contain any epidemic is to ensure that
patients don’t get infected by the new disease in hospitals. In the case of the
COVID-19 disease, which affects disproportionately people with existing
conditions, this is even more important because it was determined very early
that hospitals concentrate the more severely at-risk population.

I believe that infections produced on healthcare facilities accounted for most
of the deaths caused by the virus in those places that caused the initial panic
in the first place: Milan, Madrid and NYC.

In other words, if hospitals had been prepared, the COVID-19 disease could have
just been lost in the noise of other many respiratory diseases that afflict us.
It would have been known that the ‘2020 flu season‘ was big, and somewhat late
during the year, peaking in March or April, rather than on January, but that
would have been it.

What is more important, as the pandemic has run its course in different
countries, much of the
[difference between countries](https://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/),
and between regions within countries, will be explained at the end by this
single factor (and most of the rest by the different outcomes in other
healthcare facilities, such as nursery and care homes).

In other words, as soon as it became evident that a highly infectious new
respiratory disease was spreading, hospitals should have started a well
established protocol that ensured that new infectious patients admitted to the
hospital did not provoke nosocomial, or Healthcare associated infections (HCI),
thus amplifying unnecessarily the epidemic.

These protocols are not that difficult to implement. They are based on
segregating infected patients, optimally deriving infected patients to different
hospitals, and protecting healthcare personnel from infection. It is not rocked
science.

These are the first questions I would ask Public Health Authorities:

- Why such protocols were not in place?
- Why were they not implemented immediately?



_Note: Exactly 18 months after writing this post I have
[reviewed it in a new post](/posts/covid-19-impressions-eighteen-months-after/)
to see what I got right and what wrong on my initial reaction to the pandemic._

## The road to the lockdowns

As many other people, I started hearing about the new Coronavirus that had been
discovered in China sometime around mid-February. Initially it sounded like yet
another ‘failed pandemic’ that would turn out to be nothing.

The developing situation in Italy at the start of March came as a surprise.
Suddenly, new cases and deaths were reported at a growing pace and it started to
look like this time the pandemic could be true.

The figures were alarming, in March 8 the number of daily deaths jumped to over
100 and were doubling every few days. The next country was my own, Spain, and
more specifically the city I live in, Madrid. It looked like it was following
the Italian pattern with a lag of around ten days.

It was known at the time that the Chinese authorities had established severe
restrictions to the population to try to cope with the disease. Since China had
been the epicenter of the epidemic and therefore they had the most experience,
could it be assumed that government enforced social distancing was the only way
to fight the virus?

Unfortunately, the Italian government established a national lockdown of the
entire country in March 9. In Spain, a ‘State of alarm’ was declared on March
13, followed by a national lockdown on March 28, which is still in effect.

Most countries in the Western hemisphere followed in various degrees the
example, resulting in the collapse of the World economy due to the irrational
behavior and unprecedented abuse of power by the governments of the most
advanced countries of the world.

On the other hand, some Asian countries such as South Korea, Singapore handled
the medical crisis in a totally different way. Due to having established
adequate protocols after suffering the SARS epidemic in 2003 they were able to
identify the initial cases, trace the people infected and isolate them to
prevent the spread of the disease.

Unfortunately, this option was not available to most Western countries because
their healthcare systems were not prepared.

## Did the situation warrant the measures adopted in the West?

The short answer is, no.

When these extreme measures were adopted there was too much uncertainty about
the actual threat posed by the new strain of a familiar family of viruses, the
coronaviruses, that constitutes one of the ingredients of the seasonal flu that
have plagued humanity forever.

Even with the uncertainty existing at the time these measures were adopted,
there was some data that suggested that the threat could be lower than the
initial estimates, while the initial sanitary response was being inadequate:

- Most people experienced **none or very mild symptoms**. This suggested that
  the actual number of contagions could be severely underestimated and that the
  assumed mortality rate could be overestimated to the same degree.
- Even for patients experiencing symptoms, the severity of the disease was
  extremely biased; almost all of the deaths and the severe cases were either
  **very old people or people with underlying diseases**. Therefore the profile
  of the population that was at risk was very clear and limited to a very
  specific part of the society.
- Meanwhile, hospitals and care homes were **important focus of infection**,
  because infectious people were admitted as patients without an adequate
  protection of the other patients and the healthcare personnel. Furthermore,
  the initial procedure used, ventilators, was very doubtful, both in terms of
  its medical efficacy and the resources required.

Given the situation described above, the proper procedure should have been to
**focus in protecting the population at risk** and eliminating the risk of
**infections in healthcare facilities**.

It is important to note that reducing the infection rate on the population at
risk would have been the best way to prevent the collapse of the healthcare
system and, what is more important, the total number of deaths. What would have
been a good response?

I cannot stress this point enough. The policy decisions adopted, not only made
little sense to handle their alleged intentions, prevent a sanitary collapse,
but more importantly, would cause more direct deaths. Even before considering
other indirect deaths that could have been easily predicted as a consequence of
the economic collapse and the panic induced on the general population.

The reason why protecting the population at risk is much more effective, both in
terms of severe cases that require hospitalization and fatalities is a direct
consequence of the highly asymmetric nature of this particular disease.

Even with the preliminary data available in Europe and the US at the start of
March, it was evident that overwhelmingly people requiring intensive care, and
finally dying, were people with existing severe medical conditions including and
old people, but only because old people are more likely to have worse health
conditions.

It can be argued that limiting or postponing the spread of the disease in the
general population, which is not at risk, could have had some minor indirect
advantages initially, because it could have helped to achieve the main
objective, protecting the population at risk, in the first stages of the
epidemic. If the proportion of infected people is small, it is easier to ensure
the protection of the elder and the sick, at least until the logistics of
establishing the safety measures have been refined.

But this approach, slowing the spread of the disease on the general population,
possesses important sanitary problems:

- First, they obscure the real focus of the mitigation measures that have to be
  adopted, confusing people (and authorities).
- Second, to achieve results, ensuring that the isolation measures are
  effective, they require costly enforcement measures that would be more useful
  if employed in protecting the population with real risk.
- Third, they increase the time requiring protecting the population at risk,
  increasing the risk of contagions and increasing the total death toll.

A better alternative is to proceed following three very simple steps:

1. **Protect the population at risk**: prevent infections in hospitals and care
   homes, establish measures to prevent infecting other sick or old people by
   their family or caretakers.
2. **Monitor the evolution of the epidemic** and, as soon as the data
   demonstrates that the first objective has been achieved, let the epidemic
   burn itself, as quickly as possible, by encouraging the spread of the
   disease.
3. **Return to normal life**.

Not so difficult. Is it?


Posts about political issues

COVID-19 Impressions - Eighteen months after

COVID-19 mismanagement I - Nosocomial infections

COVID-19 First Impressions