As we all look forward to enjoying summer, despite a new COVID-19 sub-variant causing a temporary increase in local cases, allow me to share some personal thoughts about past, current and future responses to the virus.
We now know much more about what worked and what did not work. Such lessons can, arguably, help us put the recent reports of monkeypox infections in an appropriate perspective.
In response to the worldwide spread of SARS-CoV-2 in 2020, most public health authorities responded very authoritatively and aggressively, imposing unprecedented measures cutting across civil liberties and even freedom of expression. Such draconian actions were deemed justifiable due to the alleged high mortality and infectivity of the virus and its potential to overload healthcare systems. Is that still the case now?
The WHO has not officially declared the end of the pandemic two years on, even though excess mortality now is normal all over Europe (with the exception of low excess in Portugal and Italy at the time of writing) and excess mortality in the 2021/22 winter season was comparable to pre-pandemic levels. When should we have understood that COVID-19 was not another Spanish flu?
At the end of October 2020, I had already published an opinion piece in the Times of Malta explaining that the mortality of COVID-19 was comparable to that of influenza (although much higher in the elderly), that such mortality would fall over time with the emergence of milder variants, that the virus was seasonal and would not cause significant excess deaths in the summer months, that lockdown measures and mask mandates would not significantly impact mortality and that the observed Gompertz function case curve indicated that strong natural immunity developed rapidly in the population to curb any rise in infections.
I provided references for all these claims and continued to update such information with opinion pieces in the Times of Malta (July 2021, August 2021, November 2021, December 2021), including a widely-viewed video interview in August 2021. Despite sustaining every claim with references, data and official mortality statistics, I was reported to the Medical Council and even called out by a number of medical associations. Looking back, today, was I wrong in any one of, if not all, of my claims?
According to Our World in Data, to date there have been 535 million recorded COVID-19 cases, with 6.31 million deaths, suggesting a case fatality rate of 1.2 per cent. More than half of those fatalities were over their life expectancy and almost all suffered from significant chronic health problems. However, we know that millions of cases were either asymptomatic or did not present for testing.
I do not think that any reasonable person would today argue that COVID-19 is not seasonal- Jean Karl Soler
As such, the infection fatality rate is widely estimated to be much lower, with Greek-American physician John Ioannidis putting it at around 0.2 per cent, in other words about twice that of seasonal influenza. The graph of excess mortality in the EU over the past few years clearly shows the typical winter spikes, which we associate with seasonal respiratory illness. I do not think that any reasonable person would today argue that COVID-19 is not seasonal.
Numerous systematic reviews of the medical literature, as well as specific studies, have confirmed the very small additional impact (if any) of restrictions on COVID-19 mortality, over and above simple voluntary social distancing. This holds for border restrictions, exit, entry and population screening and quarantine and all other lockdown measures (Chaudhry 2020, Bendavid 2021, Viswanathan 2020), including masks (Bundgaard 2021, Jefferson 2020).
Sweden did not implement such measures and today has a cumulative COVID-19 mortality which is below the EU average. As Malta lifted all restrictions, case numbers continued to fall and there was no appreciable change in the case number trend, exactly as I predicted.
Those who argue that such was an artefact of the reduced propensity to submit for testing cannot explain how the case number trends in that smaller ‘sample’ of the population did not change anyway. The lockdown ‘emperor’ has no clothes. Everyone can see it now.
The superior protection afforded by natural infection with COVID-19 has been ignored for far too long, despite it being clearly superior to vaccine-mediated immunity, both in duration and efficacy (Kojima 2021).
One does not necessarily want to suffer a COVID-19 infection but if one does it should be recognised as being as protective as multiple vaccine doses. Vaccines have significant adverse effects and should not be administered indiscriminately, but rather timed to maximise protection in those at risk, at the appropriate time.
It is important that public health practitioners now strive to regain their credibility after so many of them made so many inappropriate calls and persisted in their error despite the clear lack of evidence to sustain most of the measures. Monkeypox may well be their first opportunity.
Monkeypox is primarily a disease of rodents, first discovered in monkeys in 1958 and first found in man in 1970. It has not adapted to humans, unlike SARS-CoV-2. It is a DNA virus and is not likely to mutate rapidly. Transmission is practically only through direct contact with pustules on an infected person and is rare (0-10 per cent) even in family members quarantined with an infected person.
A major risk factor in the recent European outbreak seems to be men having sex with men. None of the almost 1,500 cases reported to date have resulted in any deaths and so the disease is relatively mild. Those vaccinated against smallpox in the 1960s and 1970s are likely protected against monkeypox, even today. There is no cause for alarm.
It is hoped that the local authorities will take a different approach to both the recent surge of COVID-19 cases as well as the international monkeypox cases. Excessive and inappropriately prolonged measures, with highly dubious efficacy justified only with excessively negative information, have inflicted incalculable harms on our society.
Such policies had scarce support from any high-quality randomised controlled trials or observational studies and any academic challenge was simply suppressed. It is hoped that we have learned from those mistakes and will never repeat them again.
Jean Karl Soler is a medical doctor and researcher.