Friday, October 16, 2020

On exiting the second lockdown in Israel, Gabi Barabash and Michael Osterholm are in sync

Gabi Barabash
Michael Osterholm

Gabi Barabash is apparently the only one in Israel who knows what he is doing. 100 new infections per day is 1 per 100 000 per day and that is the same number that the US epidemiologist  Michael Osterholm has been giving since August.

Former Health Ministry director-general Gabi Barabash, a frequent media commentator during the pandemic, on Friday criticized the decision to begin emerging from the lockdown next week.

“They shouldn’t have set the threshold to exit the lockdown at 2,000 cases a day. They should have put it far lower at dozens or between 100 and 200 because it’s much easier to control,” Barabash told 103FM Radio.   

Michael Osterholm in his NYT Op-Ed

“Once the number of new cases in those areas was driven to less than one per 100,000 people per day as a result of their lockdowns, limiting the increase of new cases was possible with a combination of testing, contact tracing, case isolation and extensive monitoring of positive tests.

Thursday, October 15, 2020

Prof Amnon Shashua vs. the scientific consensus published in The Lancet


In his article Israel must shift strategy in its fight against coronavirus, prof Amnon Shashua writes (italics added):

Increased contagion rates among those not at risk would enable the economy to function.

By adopting an infinite strategy, expecting the virus to be with us for an sustained period, we can shield the vulnerable members of society and the rest of the population would be more inclined to adhere to health mitigation directives, understanding the danger to the economy and to their incomes.”

The idea that we can shield the vulnerable members of society with increased contagion rates among those not at risk seems to be at odds with the opinion expressed by epidemiologists in The Lancet

 “The arrival of a second wave and the realisation of the challenges ahead has led to renewed interest in a so-called herd immunity approach, which suggests allowing a large uncontrolled outbreak in the low-risk population while protecting the vulnerable. Proponents suggest this would lead to the development of infection-acquired population immunity in the low-risk population, which will eventually protect the vulnerable. This is a dangerous fallacy unsupported by scientific evidence”

Epidemiologist Michael Osterholm in his latest weekly podcast apparently shares the same opinion: 

28:46 Into the video Question: Just a quick follow up, Mike, that idea, you let the young and healthy live their lives and protect the vulnerable, A) there is never a plan how to do that, but is that even possible?

Michael Osterholm: It’s not possible. Look at the college students right now and I talked about how it spills over to adults. We see this happen all the time. You know this infection has been cruel in terms of racial inequality and when you actually look at the social economic status and you look at housing issues and you look at job issues you have someone who is racially disadvantaged, black, brown and indigenous populations, they are living three family generations in one apartment building with two bedrooms and the single mother is going to work by public transit, and she is an essential worker making a little more than a minimum wage. Tell me how in the hell do you protect that family if you come home with the virus? How do you isolate, what do you do? There is a lot of things here that we can’t do that people say just let it go. You know if she comes home with that virus grandpa and grandma, her mom and dad are at great risk of the serious outcome. That is just wrong. That’s wrong. And so I think we have to protect these people, and it does not mean forever.

That is another thing I find very frustrating is, if we are asking this for the rest of all of time, then you can say OK, we’ve got a to learn how to live with this, and I ‘m still saying we have to live with this, but we are trying to get to a vaccine, give us six months, give us eight months. Give us these, OK. I mean, who are we?  I mean, I look back, and I mentioned this on a previous podcast when I watched the greatest generation locked up in their homes so that they don’t end up going out and catching this and dying from it. These are the same men and women who back in the 1940s gave two and three years of their life to protect this country and they didn’t ask for anything for anything at all. And today we are just asking people can you help us hold down the transmission of this virus and it’s an inconvenience.

So I think that in the follow up to your question – it’s not practical, we are not just going to be able to bubble off …. Tell me how are you going to bubble  health care workers from basically getting infected and bringing it home or taking it in, for example long term care. So I think this is a part of the reality we have to deal with. This virus is the enemy, it’s not us. We are not enemies of each other, it’s the virus. But if we don’t understand it we will make each other the enemy of each other, and that is when we will absolutely fail against this virus.

Thursday, October 8, 2020

Dr. Osterholm's Take on the White House COVID-19 Outbreak

White House covid-19 protection plan - like secret service agents with squirt guns to protect the president against an assassin 


But let me do take a step backward and say, if you were on this podcast as early as July, you heard me say that I thought that the testing program put in place at the White House to protect the president and other senior leadership was not a plan at all, and in fact it reminded me of providing all the secret service agents with squirt guns and expect them to protect the president against an assassin.

 Let me just say a couple of comments about testing and what was done at the White House. This is one of those examples where there was a mindset you can test your way into safety, i.e. test your way out of the pandemic. Simply not possible to do! Testing is always going to be after the fact. It is going to be a situation that even if it is highly reliable it doesn’t protect you from being exposed, all it does is tell you that you were.   And now some people would say but if I know that I am infected then I can take steps to reduce my risk of transmitting to others, and that’s a great idea. But let just us be honest, first of all, what test we are talking about, these point of care tests are often coming up with more than 30 to 50 percent false negatives, meaning  you are missing people who are positive, and so if you are trying to xxx yourself  that is one thing.

 Second, I would acknowledge to those who promote this new testing approach or strategy for containment as they call it, this would help, but with one caveat. As we just saw what happened at the White House -  will people actually use this information to actually change their behavior so that they do not transmit. And we have seen a number of examples of people who were contacts of cases, who were cases, who did not abide by what we would hope would have been risk reduction behavior. So I am not suggesting that’s widespread in the population, but when you have almost a third of the public who does not believe this pandemic is real. You have a number of people experiencing pandemic fatigue, they think this is too much I do not want to deal with it, and you have a number of people who are bubbled in today because of their high risk of serious disease if they get infected, that does not leave a lot of people left in the middle necessarily who are going to be impacted by this kind of testing.

And so, the last piece is of this point in care testing, we are going to show very shortly that there is actually a very important number of false positives, and wait until people are taking these rapid tests and call false positives only to be confirmed by PCR that they were not positive at all, and see how long that is going to last, and watch that spread around as a challenge why not to take them, because the next thing you know you have to be worked up, you know you got everybody upset and concerned and it wasn’t even true positive.

 So, I just want to come back to this issue. I would support any kind of testing that might help actually reduce the number of cases. And I think the White House experience really is that. It shows you the challenges of using testing in regards to behavior change and what it means and what it does. So yes, it can have some impact, but it is not going to have this major containment strategy outcome. And I am sorry that the White House situation ever occurred, but I think it is illustrative of the point that we are making, and again false positives and false negatives point of care tests are occurring much, much more frequently than people realize and they will dramatically impact even among that limited number of people who are even willing to consider taking these on a routine basis that they ultimately would do.        

 Now what I have a hard time with is that no one addressed that situation at the White House, even though it was raised with them at numerus occasions that this was a terribly inadequate plan. Keeping in mind that, this is what I have been basically saying, as many of you know, it is emblematic of we do not have a national plan for responding to this pandemic, so why should we be surprised if we don’t have a White House protection plan? And so what this episode should tell us is that we desperately need for a national plan how to respond and how we bring the 50 states together, recognizing their diverse differences whether they be urban or rural, whether they be west, south, north, east, whatever. But we need a comprehensive plan. We don’t have that. People will say we do but I defy anyone to come forward and tell you what our plan is.