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Diarmaid Ferriter: We must consider NPHET may be wrong

Have we focused too narrowly on medical and scientific view of emergency team?

A range of history books has recently appeared, seeking to put Covid-19 in context. Mark Honigsbaum’s The Pandemic Century is adamant that human degradation of the environment and disturbance of the equilibrium of natural systems have played a major part, which does not bode well for the future given how destructive we are. Yale historian Frank Snowden’s Epidemics and Society sweeps from Black Death to the present and makes clear that despite our “lapse into forgetfulness” they have been both central to how we have evolved and are also a threat to our survival. Reactions to epidemics have been enveloped by ideology, prejudice, ignorance and enlightenment but final triumphs over disease are rare.

These books are, amongst other things, an antidote to the wide currency of the assertion lambasted by polemical French philosopher Bernard-Henri Lévy in his own recent, rushed book The Virus in the Age of Madness: “People keep saying this is an unprecedented pandemic. It is not true. Humanity has had to deal with many pandemics, often more grave than this one. There seems to be an intention, a collective desire, to panic.” The first part of his declaration is true; the second is certainly not.

There is rather, a collective desire for calm but that is not on the horizon. The abundance of talk this week of “knife edge” Covid situations in Dublin and Limerick and “imminent” new local restrictions in parallel with qualified commitments to the reopening of wet pubs, and guarded assertions that the lockdown that began in March cannot be repeated amounted to a barrage of mixed messages. It is an exhausting but perhaps inevitable product of the assertion that the country needs to “live with the virus”.

Sufficient evidence

Rolling lockdowns and the constant atmosphere of fear and confusion hardly qualify as living with the virus but rather being chased by it. That surely will be one of the themes future historians of Covid-19 will focus on. Who got the response right? We were told in early March by one of our leading infectious diseases experts that the impact of Covid here could be equivalent to the 1918-1919 flu, Civil War and 1929 economic crash “all happening at the same time” suggesting a “median scenario” that would see “a 20 per cent attack rate and 20,000 deaths” in Ireland.


Rolling lockdowns and the constant atmosphere of fear and confusion hardly qualify as living with the virus

In fairness to him, that was early on and there was still much to learn. But surely the learning is not over. Have we suffered from a lack of consideration given to medical and scientific opinions alternative to those promoted by the National Public Health Emergency Team (NPHET)? Have the momentous decisions made been grounded enough in evidence? Are those who promote the Gompertz Curve model – a steep rise followed by a slow tail – on firmer evidential ground than those wedded to the idea of exponential death rate curves as per Imperial College London models? I don’t know, but I do wonder if the parameters of the medical focus we hear daily are too narrow.

A lengthy letter sent to the Taoiseach and other elected representatives in August by Dr Alan Farrell that draws on the work of international experts such as Nobel laureate Michael Levitt and Swiss immunologist Beda Stadler raises these serious questions and more. A medical doctor with 20 years’ experience in primary care and with a strong mathematical background, Farrell emphasises he is “pro-empirical evidence as applied to medicine and all scientific pursuits”.

Questionable predictions

He is critical of the Irish reaction to Covid as disproportionate, highlighting that face masks were not considered imperative at the height of the pandemic but are deemed so now, without enough evidential basis; that Covid-19 does not impact on certain groups such as children and pregnant women in the way influenza does; that the death rate has been similar throughout the world independent of lockdown measures (Sweden, castigated for its light-touch approach, has had a similar death rate to other countries) and that the reaction of many governments was based on questionable predictive models of Imperial College London.

Sweden, castigated for its light-touch approach, has had a similar death rate to other countries

Additional questions are raised in this letter about significant seasonal/regional effects in viral triggering independent of the severity of restriction, as is suggested in strikingly different death rates in separate US states and territories. And is there more herd immunity than believed because Covid-19 shares “many structural properties with prior coronaviruses in the family”?

Farrell argues that this explains why mortality and ICU loading has dropped across Europe, while continued polymerase chain reaction (PCR) testing, which is overly sensitive and currently driving case numbers, can produce “false positives or merely dead viral fragments in people who contracted the virus many weeks ago”.

I am not qualified to pronounce on these claims but, historically, a range of medical and scientific evidence and voices emerged in confronting pandemics, and it is hardly unreasonable, in Dr Farrell’s words, that “the one-dimensional view of NPHET be challenged by other experts”.