I recently wrote to Dr. Ahmed of the Windsor-Essex County Health Unit over their handling of the pandemic. I sent this communication twice but no feedback even when attaching media outlets to it. I feel that no matter what is sent, the leaders of our society are set in their ways with zero-nuance understanding. Therefore, below is the communication that I sent outlining some of the actual science around COVID and recommendations on how to go further. Considering WEC is going into stricter lockdown, it was clear that this communication was not read. You cant make people see clearly and rationally, you can only attempt to try. The point I make with this is that it does not take someone with an MD to read the research and come to a conclusion about the data, or to look at graphs and see trends. I think its pretty clear – so much so – that I provided all the links to all the research for them to analyze for themselves. This is not an personal theory of mine, this is what the data is telling me, and Im sure you would find some similar conclusions. Regardless, here is the letter I sent to WECHU, enjoy.
Recommendations for the Continuance of COVID-19 Measures in Windsor-Essex County for the Remainder of 2020 and into 2021
Attn:
Mrs. Theresa Marentette, Chief Executive Officer, WECHU
Dr. Wajid Ahmed, Medical Officer of Health, WECHU
Introduction
The following composition is a collection of research in reference to the recent mandates and guidelines related to COVID-19 in the Windsor-Essex area. First, my name is Carson Babich, I am a masters student at the University of Windsor, focused on educational administration and policy. My current role as a researcher at the University is to create meta-analysis through systematic literature reviews and although I do not have an MD, my ability to read, analyze and codify research on education or any topic is of quality and is of great importance to the topic of COVID-19 measures in Windsor-Essex County. The upcoming topics I would like to discuss relate to masks, t-cell immunity, reproduction rate of the virus, and long-COVID.
As another reminder, I am not a medical professional, but as someone who is adept to analyzing and codifying research articles, it is safe to say some of the current measures related to COVID-19 need to be removed or revised based on the current evidence and data that are present. On AM800 recently Dr. Ahmed suggested that people listen to the science – this communication reflects that – and here are examples why these measures should still be adjusted.
Masks
Masks are obviously a contentious topic and have been for quite some time. Up to this point masks have been touted as a singular measure along with distancing and hand washing to stop the spread of COVID-19 – predominantly coming from the studies done by Howard et al. (2020) and Chu et al. (2020) outlining the efficacy of masks through observational studies. These have been greatly influential towards public health officials and the policies on mask mandates for a large contingent of people both locally, nationally, and internationally. The only criticism from these articles came from previous studies on the effectiveness of facemasks in settings such as hospitals relating to the transmission of influenza, showing statistically insignificant evidence that masks stop viral particles, especially when aerosolized and provide a false sense of security (Javid et al., 2020; Leung et al, 2020). Furthermore, Greenhalgh et al. (2020) suggests through a meta-analysis of 31 studies, and 12 controlled trials, there was no statistical significance for the efficacy of wearing masks relating to reduction in transmission rates.
Most recently, Danish researchers finally conclude through a randomized controlled trial that there is insignificant evidence statistically that masks stop the spread of COVID-19 between experiment and control group; furthermore, data were more compatible to lesser forms of protection (Bundgaard, 2020). Through this current study along with previous studies show that the protection from the mask is statistically insignificant – at the very least – inconclusive towards policy making for the general public. This validates criticisms of the mask mandates and requirements for them to be worn by the general public, inside establishments or other buildings. What this reflects is a mandate and policy that is not following the most effective science available. The study done recently in Wuhan, China with close to ten million participants reflecting asymptomatic spread of the virus is extremely rare (Cao et al., 2020), perhaps further questioning the need to mask visibly healthy people exuding no COVID symptoms.
T-Cell Immunity
In relation to the vaccine, most of the discussion has been around producing protein antibodies to SARS-CoV-2 which we know now wanes significantly. However, that seems to be the only narrative and only recently has the discussion begun on the second arm of the immune response: Cell mediated immunity. Although this may be in the public discussion now, this is not new science as the topic of T-Cell immunity and seroprevalence has been proven in research since the summer.
The original study I focused on was from July suggesting T-Cell immunity from other coronaviruses cross-react with COVID-19 (Le Bert et al., 2020). From there, more studies were found discussing cross-reactivity (Braun et al., 2020) and the importance of T-Cells for natural immunity and vaccination – steering away from the humoral based protein antibody (Hicklin, 2020; Stephens & McElrath, 2020). However, it was Doshi (2020, September 17) with the British Medical Journal that outlined the additional research suggesting that the population immunity may be underestimated which has now been confirmed by the CDC current estimates of seroprevalence with updated IFR (Center for Disease Control and Prevention, 2020, September 10), and the WHO suggesting almost 700 million people worldwide have been infected with COVID-19 (Keaten, 2020, October 5). In late October, the Center for Evidence Based Medicine (CEBM) at Oxford University acknowledges the impact of T-Cell immunity not only for its potential in cross-reactivity, but its potential in long-term immunity with T-Cells identified in seronegative individuals (Plüddemann & Aronson, 2020).
What the seroprevalence data shows is that the IFR is well below one percent, roughly 0.17% globally and this pattern seems reflective in many nations with seroprevalence studies. It does question the need for mandates especially for a virus – for people under the age of 65 – is less detrimental than influenza. This data also comes before a vaccine, so I would shudder to think that even after minimal first stage rollout that these mandates would even consider being continued.
Reproduction Rate
Even before a vaccine has been available, our reproduction rate throughout Canada has remained slightly above 1 which does mean the virus is still spreading but not nearly at the alarming rate as earlier in the year according to the London School of Hygiene and Tropical Medicine Centre for Mathematical Modeling of Infectious Diseases (CMMID, 2020). Although there have been more cases, this could be due to an anomaly of PCR testing when done in massive quantities on a large scale can detect viral particles that are no longer infectious (Surkova et al., 2020). Also, we must consider seasonality and the rise of respiratory illness in the fall and winter.
It is Sunetra Gupta – an infectious disease epidemiologist from Oxford – and Martin Kulldorf – professor of medicine at Harvard University – who use the reproduction rate of R=1 as a form of endemic herd immunity (American Institute for Economic Research, 2020), which is not to be confused with the current narrative on herd immunity suggesting a ‘zero-COVID’ strategy which is highly unlikely, even with a vaccine. This is something to take into account when discussing the seriousness of the illness, especially in this late-stage of the virus. At this point, I think we can agree that the virus is not an epidemic anymore, it has been a pandemic for a while, and we are close to endemic status.
Long-COVID
Even with this data presented, most challenge with the fear of long-term COVID symptoms – or as it is called in medical communications: long-COVID. I will not deny that long-COVID does exist, insofar we can call something long or chronic within the short nine month (possibly longer) this virus has been with us. However, to imply long or chronic symptoms to COVID we must look at the data and research symptoms lasting up to nine months after being symptomatic. Clear and concise data is scant with small anecdotal samples reflecting long-COVID is rare or insufficient based on the findings.
Two BMJ articles offered no real significant findings on long-COVID, only sparse findings of fatigue lasting after 3 weeks, and a small percentage of symptoms up to 3 weeks. Findings did show (which is now common) that older co-morbid patients had a longer and tougher time getting over COVID-19, but a large majority were back to their old selves one month later, at the very latest (Greenhalgh et al., 2020; Wise 2020). What this shows is that although long-haul COVID symptoms exist, they are rare and insignificant according to the research.
Recommendations
Considering the recent acceptance of aerosolized transmission of the virus, the mask has become less of a panacea and more of a comfort tool for political expediency. According to the United Kingdom, T-Cell immunity is widely prevalent in the population, this is also reflected in W.H.O. and C.D.C. seroprevalence studies reflecting extremely low IFR. The Rt of the virus is reaching the level of R=1 which suggests that we have – or will reach herd immunity through an endemic situation without a vaccine earlier than expected, even with minimal intervention of a vaccine, will drop the Rt below 1 causing the virus to ‘lose steam’ significantly. Finally, it is clear the topic of long-COVID is rare and insignificant according to the research.
As leaders within the Windsor-Essex community, it is recommended to adjust the current mandates as follows:
- Moving from mask mandate to mask recommendation, providing a choice for the public based on their need to wear one. Also, transparency based on the evidence on the lack of protection a mask might offer.
- Letting the public know that we have a robust cellular immune response to COVID-19 based on the evidence of T-Cell seroprevalence and to be mindful of our innate protection due to past coronaviruses (i.e. the common cold).
- Due to the innate immunity, this has driven the Rt towards 1, acknowledging a form of herd immunity and the virus becoming endemic. Even with rise in cases, the Rt remains stable in between 0.9-1.1 suggesting we may have reached this herd immunity long ago.
- Long-COVID is rare and statistically insignificant according to the current research on the topic. Most who experience symptoms after the 14-day period subside within the next week at the most two.
I truly believe this information will help you with a large proportion of the public who have recently lost trust within their leadership. This also provides the course towards opening up more businesses ahead of the holiday season with less restrictions and introducing more events for the people of this city. I can understand that it is not ideal to embrace this after 8 months of opposing recommendations, but as is always said in light of new research, our attitudes can change and so can our policies. Furthermore, with a vaccine around the corner, there is no reason we should be in the current position of harsh mandates and level of fear given the evidence presented and the immediate future of protection.
In relation to policies, laws, and rights – it might be necessary to introduce the concept of positive and negative rights. First, positive rights are the rights relating to society to act in a certain way – sometimes called entitlements. Second, negative rights – sometimes called liberties – are the kind of rights that act as a duty of non-interference and respect and the only role of governance is to refrain from blocking of negative rights. In the example of COVID mandates, as leaders you have the right to stop people from malicious acts such as direct and intentional coughing or spitting on people – see case of Matthew Wenzler (Andrews, 2018, June 22). However, you do not have the right to use any viral pathogen through obscurity, indirect, and unintentional infections to subvert fundamental rights to live and have a free conscious for a proper society.
Please consider this.
Kind Regards,
Carson Babich, M.Ed.
References
American Institute for Economic Research. (2020). What is herd immunity? Epidemiologists make their case: Part one [YouTube]. https://www.youtube.com/watch?v=QJajHxG3C9A
Andrews, M. (2018). Laws that criminalize spread of infectious diseases can increase their stigma. Southern California Public Radio. https://www.scpr.org/news/2018/06/22/84215/laws-that-criminalize-spread-of-infectious-disease/
Braun, J., Loyal, L., Frentsch, M., Wendisch, D., Georg, P., Kurth, F… & Thiel, A. (2020). SARS-CoV-2-reactive T cells in healthy donors and patients with COVID-19. Nature. https://www.nature.com/articles/s41586-020-2598-9_reference.pdf
Bundgaard, H., Bundgaard, J. S., Raaschou-Pederson, D. E. T., von Buchwald, C., Todsen, T., Norsk, J. B…& Iverson, K. (2020). Effectiveness of adding a mask recommendation to other public health measures to prevent SARS-CoV-2 infection in Danish mask wearers. Annals of Internal Medicine, November. https://www.acpjournals.org/doi/10.7326/M20-6817
Cao, S., Gan, Y., Wang, C., Bachman, M., Wei, S…& Lu, X. (2020). Post-lockdown SARS-CoV-2 nucleic acid screening in nearly ten million residents of Wuhan, China. Nature Communications, 11. https://www.nature.com/articles/s41467-020-19802-w
Center for Disease Control and Prevention. (2020, September 10). COVID-19 pandemic planning scenarios. https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html
Center for Mathematic Modeling of Infectious Diseases [CMMID]. (2020). National and subnational estimates for Canada. London School of Hygiene and Tropical Medicine. https://epiforecasts.io/covid/posts/national/canada/
Chu, D. K. Akl, E. A., Duda, S., Solo, K., Yaacoub, S., & Schunemann, H. (2020). Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet, 395(10242), 1973-1987. https://www.sciencedirect.com/science/article/pii/S0140673620311429
Doshi, P. (2020, September 17). Covid-19: Do many people have pre-existing immunity? British Medical Journal. https://www.bmj.com/content/370/bmj.m3563
Greenhalgh, T., Schmid, M. B., Czypionka, T., Bassler, D., & Gruer, L. (2020). Face masks for the public during the covid-19 crisis. British Medical Journal, 1-4. https://www.bmj.com/content/bmj/369/bmj.m1435.full.pdf
Greenhalgh, T., Knight, M., A’Court, C., Buxton, M., & Hussein, L. (2020). Management of post-acute covid-19 in primary care. British Medical Journal, 307, 1-8. https://www.bmj.com/content/bmj/370/bmj.m3026.full.pdf
Hicklin, T. (2020, August 18). Immune cells for common cold may recognize SARS-CoV-2. National Institutes of Health. https://www.nih.gov/news-events/nih-research-matters/immune-cells-common-cold-may-recognize-sars-cov-2?fbclid=IwAR20MQaEu_m64mWJkHxSVkCqxsF_vRtifrD_lWQBErM9UxC_yySzo9q-4tQ
Howard, J., Huang, A., Li, Z., Tufecki, Z., Zdimal, V., van der Westhuizen, H…& Rimoin, A. W. (2020). Face masks against COVID-19: An evidence review. Preprints (non peer-reviewed). https://www.preprints.org/manuscript/202004.0203/v1?fbclid=IwAR0h7PBSAB6ZEcr-DzBaTTIEV9kjvJiRZA7Eassb-rs75raKtOKIVKWcsFk
Javid, B., Weekes, M. P., Matheson, N. J. (2020). Covid-19: should the public wear face masks? British Medical Journal, 1-2. https://www.bmj.com/content/bmj/369/bmj.m1442.full.pdf
Keaten, J. (2020, October 5). WHO: 10% of world’s people may have been infected with virus. Associated Press. https://apnews.com/article/virus-outbreak-archive-united-nations-54a3a5869c9ae4ee623497691e796083
Le Bert, N., Tan, A. T., Kunasegaren, K., Tham, C. Y. L., Hafezi, M…& Bertoletti, A. (2020). SARS-CoV-2-specific T cell immunity in cases of COVID-19 and SARS, and uninfected controls. Nature. https://www.nature.com/articles/s41586-020-2550-z_reference.pdf
Leung, N. H. L., Chu, D. K., Shiu, E. Y., Chan, K., McDevitt, J. J., Hau, B. J. P…& Cowling, B. J. (2020). Respiratory virus shedding in exhaled breath and efficacy of face masks. Nature Medicine, 26, 676-680. https://www.nature.com/articles/s41591-020-0843-2.pdf
Plüddemann, A., & Aronson, J. K. (2020). What is the role of T cells in COVID-19 infection? Why immunity is about more than antibodies. The Center for Evidence Based Medicine: Oxford University. https://www.cebm.net/covid-19/what-is-the-role-of-t-cells-in-covid-19-infection-why-immunity-is-about-more-than-antibodies/
Stephens, D. S., & McElrath, M. J. (2020). COVID-19 and the path to immunity. Journal of the American Medical Association. https://jamanetwork.com/journals/jama/fullarticle/2770758
Surkova, E., Nikolayevskyy, V., & Drobniewski, F. (2020). False-positive COVID-19 results: hidden problems and costs. Lancet, 8(12), 1167-1168. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30453-7/fulltext
Wise, J. (2020). Study reveals six clusters of symptoms that could be used as a clinical prediction tool. British Medical Journal, 370, 1-2. https://www.bmj.com/content/bmj/370/bmj.m2911.full.pdf
carsonbabich.com 