An opinion piece by Dr Austin Jeans (author of The Low Carb Companion)
As we wrestle medically, psychologically and economically with a significant wave of Covid-19 in the New
Year in Zimbabwe, I consider a few key pointers to fighting fear with facts as regards:
- the recent new wave of Covid-19 and retaining perspective amidst the global Covid-19 situation
- treatments like Ivermectin and nebulised ‘ionic nano silver’
- the critical role of poor metabolic health in severe Covid-19.
- Covid vaccines
- getting out of lockdown
The New Wave versus the Global Situation
Zimbabwe has experienced a significant increase in Covid cases and related deaths in the past few weeks; almost certainly (but yet to be confirmed) a result of the arrival of the so called ‘South African variant’ coronavirus 501.V2. This version of the SARS-CoV-2 virus is far more transmissible, it spreads 50% faster than its predecessor but the disease is not more severe ie not more deadly. Increased recorded deaths are a statistical feature of when the infection rate increases in the population then the exposure of the vulnerable is greater and also if hospital facilities become overwhelmed then more deaths will result. Even so, it is important to retain some perspective as this is not Armageddon for Zimbabwe nor the world.
I say this for 3 reasons:
- Zim Covid hospitalisation stats the Minister of Health announced this week that of the Covid positive cases only 2-3% of people have needed critical care hospitalisation, 12-13% have been discharged within 2-3 days of hospitalisation and the vast majority, over 85%, have simply required self-isolation at home.
- Zim Covid deaths – without diminishing the tragedy of each and every death, when expressed per million of the population (calculated as total deaths divided by no. of million people in the population) so as to be comparable to other countries (a sample of which is shown in Table 1 below) Zim ranks very low at 59 deaths per million of population this is only 4% of the UK Covid deaths per million and 9% of South Africa’s Covid deaths per million:
The current Covid death toll in Zim stands at 879 which is 0.00006% of our total population and amounts to 2½ days of normal all cause mortality ie how many people sadly die in Zim on a daily basis (which is about 317.)
Global Covid statistics – which according to Worldometer data currently stand at >97 million cases and 2 million deaths but still show the detailed situation as:
– 99.6% of active cases have only a mild condition versus 0.4% serious/critical
– 97% of cases which had an outcome have so far recovered versus 3% died
Effectively nearly 70 million people worldwide who contracted the virus have so far recovered from it, which is perhaps not the general impression one gets from media reporting!
A reminder of the USA CDC data on survival rates for Covid-19 which remain validated:
0 – 19 yrs
20 – 49 yrs
50 – 69 yrs
Furthermore, the 2 million global Covid deaths thus far in a year amount to only 3.6% of the average daily global burden of deaths (approx. 154,000 people die daily worldwide) and we must compare 2 million to the nearly 18 million people who die annually from cardiovascular disease, 10 million from cancer and 6.5 million from other respiratory conditions (2017 IHME Global Burden of Disease).
Ionic nano silver nebulisations and Ivermectin in Covid-19 treatment
There has been a lot of hype regarding Ivermectin, an anti-parasitic medication, and nebulised ionic nano silver as preventative agents and/or treatment options for Covid-19, with many medical practitioners prescribing either or both and many people doing ‘their own thing’ including accessing and using veterinary Ivermectin preparations.
- Ionic nano silver nebulisation: firstly ionic nano silver is not a registered medication in Zim and in most other countries is a homeopathic or complimentary medicine preparation. There is currently no quality medical evidence to support the efficacy of its use in Covid-19 patients nor any reliable evidence to separate it’s purported effects on patient’s symptoms beyond the physical effects of nebulisation alone on congested airways and lungs. The US Food & Drug Administration (FDA) on its website www.fda.gov currently classifies the sale / use of colloidal silver for nebulisation to ‘mitigate, prevent, treat, cure or diagnose COVID-19 in people’ as fraudulent and a violation of the law and subject to criminal prosecution. If the use of ionic nano silver remains as a ‘homoeopathic’ intervention without a credible level of scientific evidence, then I would imagine that it will not be recognised by the Zimbabwe Ministry of Health for medical use.
- Ivermectin, on the other hand is becoming more and more interesting. It has it’s origins as an anti- parasitic drug used against worm infestations (in both humans and animals) and resistant scabies and head- lice in humans. The drug has been around for 40 years, over 4 billion doses have been given and has a wide margin of safety in humans. The potential effectiveness of Ivermectin in Covid-19 has recently been highlighted in a meta-analysis of studies, commissioned by the WHO, carried out by Dr Andrew Hill at Liverpool University which showed that Ivermectin treatment produced:
– a faster time to viral clearance
– a shorter duration of hospitalisation
– 43% higher rates of clinical recovery
– 83% improvement in survival rates
The US National Institutes of Health (NIH) this past week removed its objections to the use of Ivermectin in Covid-19 treatment thus opening up the space for the drug as a therapeutic option in the USA. An alliance of doctors spearheaded in the US known as The Front Line Covid-19 Critical Care Alliance have a very good information resource at www.covid19criticalcare.com. Their founding philosophy is that in a global pandemic where there are little in the way of therapeutic options for people with symptomatic Covid-19 until they progress to hospitalisation, when looked at from a risk-benefit perspective then a safe and likely effective drug such as Ivermectin should be considered for use early on in the disease and even in a preventative role.
In Zim, the current situation is that Ivermectin is not registered for such use by the Medicines Control Authority. Despite this it is being prescribed and used for prevention and treatment of Covid-19. Local case studies suggest effectiveness but are not high quality evidence to the fact. Of more concern is the random and self-determined usage of veterinary grade Ivermectin preparations which is strongly discouraged from a safety and efficacy point of view ……. the Biblical text of “forgive them Lord, for they know not what they do…” comes to mind! The correct process should be that people seek proper medical guidance and advice from a medical practitioner.
The critical role of poor metabolic health in severe Covid-19
Since the early days of the global pandemic it became patently clear that the vast majority, being over 95%, of people who progressed to severe Covid-19 disease ultimately requiring admission to a critical care unit and thereafter having a very high chance of dying fell into the categories of older age and/or having 2 or more co-morbidities (underlying health conditions). These conditions which place people at such high risk are obesity, diabetes, high blood pressure, heart disease, lung disease and chronic kidney disease. CDC data in 2020 showed that Covid-19 hospitalisation is 6x more likely and death 12x more likely in the presence of diabetes, heart disease or lung disease! The majority of these conditions are strongly associated with poor metabolic health, largely a result of eating excessive amounts of processed foods and doing inadequate amounts of exercise i.e. these are ‘diseases of lifestyle’. In countries like the USA their population who are aged >65yr increased by 60% between 2000-2018 and up to 90% of US adults are now classified as being metabolically unhealthy!
The key info in all this is that we know if someone in poor metabolic health simply starts eating healthier real foods rather than processed junk sugary foods & drinks they experience a measurable improvement in their health in as little as 21 days! In other words we can reduce our risk of severe Covid-19 by simply taking firm measures to improve health. eating & exercise. Much more of this simple but powerful health messaging needs to be put out by national health bodies and media outlets. It blows my mind that fast (junk) food outlets continue to operate during lockdowns but fitness and sports facilities get shut down it makes little sense!
Covid-19 Vaccines – the magic bullet?
As many countries in the world roll out their vaccination programs, many questions are posed:
– are they safe?
– are they effective?
– will everybody need to be vaccinated?
– when will vaccines arrive in Zimbabwe?
So far five vaccines are currently in use around the world, Pfizer-BioNTech, Moderna, Oxford-AstraZeneca, Sinovac (Chinese) and Sputnik (Russian) and more than 100 or more other vaccines are in the research stages.
The Pfizer-BioNTech and Moderna vaccines are based on new technology called ‘mRNA’ whilst the Oxford- AstraZeneca Covid-19 vaccine is a more ‘traditional’ vaccine, being a modified version of a common cold adenovirus that spreads amongst chimpanzees. The Pfizer vaccine costs $20 per dose, Moderna $33 and the AstraZeneca is the cheapest at $4. These vaccines require 2 doses to be given between 21-28 days apart.
Are they safe?
The debates around safety rage hotly on social media but as far as the science goes we can only go by the published data provided so far by vaccine manufacturers and the understanding that the initial vaccine trials done were relatively short before emergency authorisations for use were granted. Much of the safety debate revolves around the Pfizer and Moderna vaccines ‘new technology’ of using genetic material called messenger RNA (mRNA) as the method of vaccine induced immunity which has never been done before. In the past, vaccines consisted of injecting live or attenuated infectious agent (virus) into a person in order to provoke an immune response and long-term immunity. In the case of the new mRNA vaccines, the messenger RNA enters human cells and tells the cell to produce a protein similar to the spike protein on the SARS-CoV-2 virus, provoking and programming the immune system to produce antibodies against the spike protein when infected with the virus. Potential long term effects of such ‘genetic engineering’ have yet to be tested. Very few elderly or young age groups were included in the initial vaccine trials hence little is known regarding safety in those age groups. The recent deaths of 23 elderly folk in frail care following vaccination in Norway has raised concerns about the risks in this subgroup of people. The Oxford-AstraZeneca Covid-19 vaccine uses a common cold adenovirus altered to carry a gene from the SARS-CoV-2 spike protein to trigger an immune response in humans.
Are they effective?
From the development trials, the current vaccines claim between 70-95% effectiveness (as relative risk reductions) but little raw data has been published to allow independent review; in effect the absolute risk reduction for an individual is only about 0.4 – 0.57%. By comparison flu vaccines are between 40-60% effective (CDC data) and may be as low as 20% in the elderly. Another problem is that the vaccine trials used Covid-19 symptoms onset as the measured end-point so they were not designed to measure any reduction in serious outcomes such as hospitalisation, intensive care admission or death. As I mentioned under safety, because very few elderly or young age groups were included in the initial vaccine trials so too can little be concluded regarding vaccine efficacy in those age groups. The data so far available translates to a number needed to vaccinate to prevent 1 Covid case = between 175 and 256 (ie 255 out of 256 vaccinated people will derive no benefit) but this will vary based upon the prevalence of Covid infections in any given population.. Recent evidence from Israel, who currently lead the world in vaccination roll-out, has shown effective antibody responses after 2 doses of Pfizer vaccine; high levels of Covid antibodies were detected in 98% of those vaccinated (interestingly a poor antibody response occurred if given only 1 dose, especially in those >60yrs old). It is also important to note that immunity following vaccination takes 10-21 days to develop. A further question on vaccine effectiveness is the absence, so far, of any evidence that the vaccine will prevent a person from transmitting the virus to another
Vaccine effectiveness will also be influenced by the logistics of transport and storage. The Pfizer vaccine needs to be stored at very low subzero temperatures (minus 70 degC) and Moderna’s vaccine at minus 20degC, making these vaccines logistically challenging in many parts of the world; in contrast the AstraZeneca vaccine only needs to be stored at normal refrigeration temperature (minus 4 degC).
Will everyone need to be vaccinated?
This is the ‘million dollar’ question which awaits an answer. Most countries who are currently in the process of vaccinating have prioritised frontline health workers and vulnerable groups (elderly or having underlying health conditions) to receive the vaccine first, which makes a lot of sense. Thereafter the debate, and fears that arise from this debate, revolve around compulsory vaccination for all versus optional vaccination for younger / low risk people. It is argued that if the elderly and vulnerable are vaccinated and thereby protected and younger healthier people <59yrs of age have a near 100% chance of surviving Covid-19 then should the latter be compelled to have a vaccination. The counter-argument runs that in order to achieve community (‘herd’) immunity and reduce Covid transmission then as many people in a population as possible need to be vaccinated. Certainly when one considers the lack of long-term safety data on Covid vaccines, I think it questionable for vaccines to ‘forced’ on young healthy people and most especially children. Already the media carries reports on ‘vaccine passports’ and that vaccines may be required for international travel ….. this is going to be a highly emotive issue.
When will vaccines arrive in Zimbabwe?
In a recent letter to Government, the Employers Confederation of Zimbabwe made an appeal for the urgent deployment of Covid vaccines in the country. So the question that arises is this likely any time soon? The answer at present appears to be ‘unlikely’. Worldwide the Covid vaccines are in short supply and the rich nations of the developed world have essentially pre-bought all available and in manufacture stock (Europe has reportedly pre-bought 1 million vials). A January 18 article in The Guardian stated that to date 39 million doses of vaccine had been given to people in wealthier nations with just 25 doses to people across all poor countries (actually only in one country….. Guinea) the head of the WHO said the world is on the edge of a ‘catastrophic moral failure’. Schemes such as the Covax program set up by the UN to encourage richer nations to ‘donate’ vaccines from their supply to poorer nations has so far fallen on ‘deaf ears’.
Furthermore India which is a vaccine manufacturing hub has stated that it intends to reserve supplies for its own population first. Even South Africa has admitted that it has only been able to procure enough vaccine for 10% of the population and that payment and supply challenges still impede the actual implementation of this effort. Essentially, it appears that it will be some time before we are in a position to widely vaccinate our people in Zim.
Getting out of lockdown
How disappointing was it to go back into lockdown as a way of starting 2021?! We really need to look at ways to take Zimbabwe safely out of lockdown in a world still full of Covid-19. A few strategies that may help to achieve this would be:
- We should cease testing asymptomatic people – it is a waste of resources, contributes little to containing community transmission and leads to ‘inflated’ case numbers, many of whom are not real
cases in terms of the conventional definition in infectious diseases which refers to a person with significant symptoms and thereby ill rather than just testing positive. The deviation of public health statistics towards counting every positive test as a Covid-19 case creates a ‘casedemic’ of asymptomatic healthy people who simply test positive on PCR, many of which may be false positives (especially where the prevalence of Covid is low).
- We must identify, protect and educate the vulnerable – this is not just the elderly but importantly the people with metabolic co-morbidities such as obesity, metabolic syndrome (prediabetes), diabetes
and hypertension; indeed a public health campaign advocating healthy eating and regular exercise will go a long way in reducing most peoples’ risk of severe Covid-19 right now, especially since vaccinations may be here anytime soon.
- Accepting that national lockdowns lack good scientific evidence yet have devastating effects –
especially on socio-economics, other medical conditions, child education & population mental
health; the full brunt of which including indirect mortality, is yet to come. In the words of Dr Charles Levinson, ‘The virus disproportionately affects the elderly but lockdowns target the young. Jobs lost, life chances destroyed and mental health in tatters. We underestimate the long-term damage at our peril.’ Even the WHO advises against national lockdowns as an effective approach since they achieve little more than can be gained with the simple anti-Covid hygiene measures of physical distancing, handwashing and maskwear.
- Relaxing restrictions for low risk groups – especially children who should return to school and healthy people should return to recreation, training and sport. Recent studies show that children
neither transmit the virus in any meaningful way nor suffer severe Covid disease in any significant numbers unless they have an underlying condition.
- We need to accept the reality that eradication of Covid-19 is unlikely and unrealistic, that we will at some point have to learn to ‘live with the virus’ – many infectious disease experts believe that Covid-19 is transcending (or has already done so) from an epidemic disease to an endemic disease, meaning it will be around forever moving in and out of a population usually as a seasonal respiratory disease. Being endemic the healthy younger people with robust immune systems don’t suffer much and the older / unhealthy remain at at risk but with a wider measure of protection conferred by the degree of community (herd) immunity achieved through prior population infection and advent of vaccination. The appearance of the so called Covid ‘variants’ in UK, South Africa and Brazil recently speak to this concept. If low cost, safe drugs like Ivermectin are proven effective in the prevention and treatment of Covid this will further bolster the case for ‘normalisation’ of life. The vast majority of people should then be allowed to resume normal lives and activities.
I hope the info helps to bring you ‘you up to speed’ on the rapidly changing Covid-19 situation in Zim and around the world. I trust that the facts help to allay some of the fears that people have but also to illustrate that there is still much to learn throughout this whole thing. I pray that people, who see that their state of health may place them at high risk of severe Covid-19 infection, take heed of the message that eating healthier and exercising more can make a substantial difference to that risk and in a relatively short period of time. I live in hope that our Government sees a way out of harmful lockdowns sooner rather than later and that vaccines come our way to protect the vulnerable in our society also sooner rather than later.