Covid-19 in Ireland: Landfall | Cassandra Voices

Covid-19 in Ireland: Landfall

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In August of last year I wrote an article pointing to the impending consequence of the Irish government’s rolling lockdown policy, ‘The Perfect Storm[i] gathering on the horizon over the country. By that I meant a significant second wave of Covid-19 – to hit this winter. I made that prediction based on the following factors:

An elevated number of potential viral hosts, which is a consequence of suppression of natural-immunity.

Increased life of the virus in the external environment due to decreased daylight

Raised levels of social anxiety and subsequent susceptibility to illness/infection

Continued persistence of the virus at low levels within Irish society

The ‘storm’ made landfall at the start of January, leading to the imposition of an extreme lockdown for the third time – with children denied their constitutional right to an education –  amid renewed fears the hospital system would be overwhelmed, as many elderly in care homes passed away once again.

Sadly, this ‘third’ wave actually commenced in week 48 of 2020 (22/11/2020), while the country was still under Level 5 Lockdown restrictions, according to a report by the HSPC.[ii]

Could additional deaths have been averted if the Taoiseach had not sought ‘a meaningful Christmas’; or if NEPHT’s advice had been followed to the letter – permitting house visits rather than opening restaurants and gastropubs[iii] at the start of December? Based on the HSPC report that seems doubtful. And I would question whether most Irish people would have willingly foregone sociability throughout the depths of winter – there was certainly no political clamour to cancel Christmas – having endured near-constant lockdown since March. But you never know.

Furthermore, without a Christmas spending spree many indigenous retailers and restaurateurs might have been forced out of business – to the unrestrained joy of Jeff Bezos, Tescos and the rest.

But in Ireland, as ever, we desperately need someone to blame third time round; anyone other than NPHET that has managed to preserve a reputation for scientific insight despite the damage it is doing to the country. So, instead of questioning the government’s response, youngsters – who may have availed of a brief chink of light to socialize – are scapegoated.

Other than that we find talk of selfish immigrants returning home over Christmas to see loved ones. And now attacks on those who escaped the overwhelming doom and gloom for a post-Christmas break. Yet, whatever one’s thoughts on the sustainability of flying, it is notable that just 1% of cases since the pandemic began have been traced to travel abroad.

Lockdown Policy

In the midst of any crisis scientific arguments compete to establish the best way forward. In the case of Covid-19 in Ireland ‘the argument’ has been remarkably one-sided. Discussions in the media are generally over the severity of lockdowns to be employed – this hitherto unheard of public health intervention with enormous collateral damage, which has somehow been normalised.

From the outset I have been convinced that the Irish government at the prompting of the WHO – along with most other Western governments – adopted an erroneous approach, based on a flawed epidemiological assessment, which led Leo Varadkar to suggest there could be a staggering 85,000 deaths[iv] in Ireland.

Virtually alone in Europe, the Swedish health authorities (relatively free of political interference) stood apart, refusing to lockdown in March, 2020. I would argue that this softer approach has been to the benefit of the vast majority of people living there – and may even lead to a lower death toll in the end – compared to the trauma of lockdowns experienced by citizens in most other European countries.

Notably, during the first wave almost 92% of confirmed deaths from Covid-19 in Ireland were among over sixty-five-year-olds,[v] and when this Irish cohort is compared to Sweden’s considerably older population a very different picture emerges; in contrast to the usual truck of ‘deaths per capita’ and ‘deaths per million.’

Hats off to the impressively organised states of Norway and Finland, where Covid-19 mortality has remained very low indeed, but vigorous track and trace strategy operating in these countries have proved ineffective elsewhere; even Germany is floundering this winter, having been locked down for months.

Revealingly, in March 2020 the Director-General of the Norwegian Institute for Public Health Camilla Stoltenberg[vi] recommended that her government should keep schools open – as in Sweden – and was advocating last June for a softer approach in the likely event of a second wave.

Now, as the death toll from Covid-19 in Ireland steadily converges with Sweden’s – especially when adjusted for the relative age of each population – it remains to be seen whether much-vaunted, but still experimental, vaccines will significantly alter the respective death tolls.

I maintain that a policy of keeping the Irish population under rolling lockdowns until the whole population is vaccinated will have a worse impact on the nation’s long-term health than any mortality or morbidity that may be avoided.

Zero Covid Utopianism

The frankly bizarre ‘option’ of Zero Covid-19 that has been grasped by some on the left, and the right, in Ireland is a form of Utopianism. It ignores the virtual impossibility of eradicating an aerosol, sub-microscopic pathogen such as Covid-19 from Ireland. Moreover, we remain one of the most globalized societies in the world with over half-a-million foreign born resident in the country[vii] and an Irish-born diaspora of three million;[viii] rely on international trade for most commodities; besides having a porous border to the North.

Moreover, New Zealand and Australia are currently enjoying summer, when respiratory viruses retreat. This seasonal effect is enhanced by a depleted ozone layer over the Southern Hemisphere – causing the world’s highest rate of skin cancers[ix] – which elevates the level of UV light that destroys viruses. Both countries are also insulated from the rest of the world by vast oceans and an uninhabited landmass. Even still, outbreaks occurred in New Zealand and Melbourne last winter, prompting draconian responses.

Notably, however, the maximum number of cases that Melbourne – with a population almost the size of Ireland’s – experienced in a single day was just seven hundred, and it required an extreme 112-day lockdown[x] – and/or the arrival of spring before an apparent elimination. In contrast, case numbers in Ireland have exceeded eight thousand in a single day.

Covid-19: Southern Dreaming

A Zero-Covid approach assumes the island of Ireland is sealed hermetically. Good luck with telling the DUP that they have to follow the rules of the South! And ‘success’ would presumably give way to a permanent state of siege against the viral dangers posed by the outside world.

At this point even New Zealand’s Prime Minister Jacinda Arden has had enough, acknowledging the long-term impossibility of pursuing Zero Covid she recently said: ‘Our goal has to be though, to get the management of Covid-19 to a similar place as we do seasonally, with the flu. It won’t be a disease that we will see simply disappear after one round of vaccine.’[xi]

Comparing Ireland to East Asian countries may also be inappropriate as, Wuhan apart, no single country in that region has experienced a significant outbreak. Notably, Japan, which has avoided locking down throughout the crisis experienced forty times as many flu and pneumonia deaths during that period. This suggests other factors – East Asia has been the geographic origin of several modern coronavirus epidemics – may be inhibiting the spread of Covid-19 there.[xii]

Yet this message has not trickled either left or downwards into popular opinion as the Irish Times continues to print articles in support of ‘the plan.[xiii]

‘Zero Covid’ is as much a vote-winner, as a zero tolerance for crime or any other virtuous objective, but it’s political claptrap from an taxidermized left and a neoconservative right, furnished by scientists that seemingly have no conception of biological realities.

Reality Bites

The success of any institution might be summed up by the notion that it is only as good as its ability to predict the future. Throughout human history we have had two powerful methods of prediction: science and religion. If not religion, we might define this in terms of ‘faith,’ or an ‘unscientific’ belief system of some kind or other.

If the Romans, the Egyptians, the Spartans, or the Native Americans, had done a ‘better’ job predicting the future, the world would be a different place. Thus, the success or persistence of any individual, nation, or civilisation, is based on an ability to reliably predict the future. Our faith in science is strengthened solely by this condition, and undermined when predictions go awry.

Galileo Galilei, 1636 portrait by Justus Sustermans.

Galileo’s prognostications in respect of the Earth and the Sun led him into conflict with the dominant powers of his day. The accuracy of his predictions disturbed the established cosmic order, as any heresy does. The predictions of Einstein had a similar effect on Newtonian Physics, and now Quantum Mechanics has become the sacred cow. Final judgements on the success or otherwise of policies are, of course, made through the prism of hindsight.

Two Schools of Thought

At present around the world there are two broad scientific schools[xiv] of thought in respect of how to respond to Covid-19. On one side there is a dominant view: that we are in the midst of a once-in-a-lifetime crisis, where humanity is dealing with a virus that will kill, and perhaps permanently incapacitate, many millions more than it has already done; and that the correct response for any government should be to impose a lockdown and mandate masks until the ‘scientific cavalry’ arrive, carrying their novel genetic vaccinations as shields to save the day.

On the other side there are the conspiracy theorists, Covid-deniers, and a minority of scientists who consider most most masks in use to be ineffective, and who argue that restrictions and lockdowns cause more harm than good. These scientists have advocated protecting the vulnerable and permitting an equilibrium of natural immunity to emerge within the non-vulnerable majority as the least harmful way forward.

The question for ordinary people and politicians, then, is where does the truth lie? Or, more accurately, who is correctly predicting the future?

When the dust settles in a few years, perhaps we’ll see that the truth lies somewhere in the middle. An appreciation of a middle way, or synthesis, is evident in Sweden’s chief epidemiologist Anders Tegnell’s acknowledgement in June that mistakes were made in the first wave.[xv]  Such concessions to human fallibility seem to be the preserve of Scandinavian leaders. This may explain why increased restrictions have been introduced in Sweden during their second wave, though its government has refrained from imposing a lockdown, and the emphasis is still on personal responsibility.

By the start of February, without a lockdown, Sweden appears to be sitting pretty with the death toll falling precipitously during the month of January, suggesting a herd immunity threshold may have been reached.

[An earlier version of this article read: “surveys indicate that at least forty percent of the [Swedish] population now have antibodies to the virus,[xvi]” We have sought corroboration from Sebastian Rushworth MD @sebrushworth, having been advised that this claim is unreliable]

Likewise, there are positive signs that India has now reached a herd immunity threshold,[xviii] without recourse to vaccines.

Benefit of Hindsight

Last April I resigned my position on the Irish Medical Council to the shock of family, friends and former colleagues. I did so because I believed a catastrophe was immanent, and that hundreds of nursing home residents would die as a consequence of political ineptitude and mass hysteria. As it transpired, 62% of deaths in Ireland occurred in this setting during the first wave of the pandemic, the second highest proportion in the world.[xix]

I take no comfort that my fears were realised, and have since also resigned as a contracted employee of the HSE. I could no longer, in good conscience, enforce guidelines upon staff and patients I do not consider either efficacious or ethical.

I would argue that a failure to conduct a proper inquiry into the decision-making that led to this carnage has led to avoidable mortality in this second wave in the care home setting. Any enquiry would surely have highlighted the inadequacy of safety protocols in these settings, and the absence of real expertise on NPHET.

Before my small Covid-19 rebellion, in March 2020, I circulated a paper on the response to Covid called The Mismanagement of Covid-19 in Ireland. Its premise was (and remains) quite simple: that Covid-19 is a viral illness with a mortality confined to a relatively small and manageable subset of our population.[xx]

I argued that Ireland’s gross demographic – the youngest population in Europe – is (and was) the key to navigating a safe path through the crisis. With a relatively low population of over sixty-fives – approximately 650,000 – this amounted to a manageable population of those truly vulnerable.

I also noted how, unlike during influenza pandemics of the past, children and young adults were not dying of this disease, and that the vast majority of adults without serious underlying conditions were also relatively (if not entirely) immune to significant consequence.

Long Covid

A current cause for concern with Covid-19, which may be deterring our governments from permitting younger people from resuming their lives is so-called ‘Long Covid,’ or Covid ‘Long Haulers’ as this is referred to in the U.S..

This is a condition that appears to fit within the category of a post-viral syndrome, or post-viral fatigue;[xxi] which is ‘a sense of tiredness and weakness that lingers after a person has fought off a viral infection. It can arise even after common infections, such as the flu.’

In October one of the leading advocates for Long Covid patients, and a firm advocate of draconian policies, Oxford University’s Professor Trish Greenhalgh clarified that Long Covid is only very rarely a long-term affliction:

The reviews we’ve done seem to suggest that whilst a tiny minority of people, perhaps one per cent of everyone who gets Covid-19, are still ill six months later, and whilst about a third of people aren’t better at three weeks, most people whose condition drags on are going to get better, slowly but steadily, between three weeks and three months.[xxii]

But a paper from 2017 gives an idea of the pre-existing scale of chronic and post-viral fatigue syndrome in the U.K.:

Fatigue is a symptom of a number of diseases—anaemia, depression, chronic infection, cancer, autoimmune disorders and thyroid disorders among them. But no apparent cause can be found for a state of extreme and disabling exhaustion that has acquired a number of names, the most generally accepted worldwide being chronic fatigue syndrome (CFS). In the UK, where it is (often incorrectly) known as ME (myalgic encephalomyelitis), 150 000 people are said to be affected. Other terms used for the condition are postviral fatigue syndrome (PVFS) and chronic fatigue and immune dysfunction syndrome (CFIDS).[xxiii]

So, we can conclude that Long Covid is hardly a new phenomenon, and while the pandemic is likely to create an additional burden on health services, the extent of the problem needs to be put in context: perhaps one percent of sufferers are still ill after six months.

Moreover, the impact of Covid-19 is significant heightened by environmental factors such as air quality[xxiv] and poor nutrition. I would argue, therefore, that the threat of Long Covid is insufficient grounds for closing universities and denying young people the chance of a social life beyond walking the block.

Indeed, the obesity pandemic that leads to a wide range of morbidities is a far greater challenge to this nation’s health, and a crucial indicator of an individual’s risk of severe case of Covid-19 .[xxv] Yet there has been no serious attempt since the Covid-19 pandemic began to address how Ireland fails to adopt international best practice for addressing obesity.[xxvi]

Seasonality

In my March paper I also observed that Covid-19 is a member of the coronavirus family responsible for many common colds,[xxvii] and that such viruses are seasonal, in that they are eliminated especially by increasing UV light (and the population’s tendency to retreat indoors). These were hardly earth-shattering revelations, and have been noted by many other doctors and scientists around the globe.

I also compared the population of over sixty-five-year-olds in Ireland, to the equivalent cohort in the U.K., noting there are roughly twenty-times the number of over sixty-five in the UK (while the overall population is less than ten times that number); so I assumed U.K. mortality would be in the region of twenty times that of Ireland’s.

In this respect, Ireland has performed significantly better than the U.K., but other factors such as population density and an elevated risk of severe disease among BAME groups[xxviii], may account for the  higher relative death toll there. It should also be emphasised that the U.K. has almost the highest rate of mortality in the world.

ICU Capacity at the beginning of the pandemic.

Like many other doctors and scientists, I argued that in the absence of a proven cure or vaccine at that time for Covid-19, humanity is (or was) very much operating at the whim of nature. Thus, without a cure we were (and to a certain extent still are) subjected to natural forces, as I assumed this virus would spread widely through the population. All we could do, then, was ‘flatten the curve,’ protect the vulnerable, and await a safe vaccine.

At the outset of the crisis that was the mantra behind which the public united. Flattening the curve would reduce the rate at which the vulnerable would present for treatments in hospitals. This would protect the system form being overwhelmed, bringing an increased chance of survival for those badly afflicted.

‘Protect the NHS’ from collapse was a similar cry across the water. That made sense at the outset of the crisis. The reiteration of these ‘priorities’ might now illicit a yawn, as our national health authorities did not use the flattened time and space to increase ICU capacity substantially, which brings the ‘necessity’ of recurring lockdowns.

Hysteria

Since March of last year events have taken a strange turn. With fear and hysteria at the helm politicians lost their nerves. The mantra shifted from ‘flatten the curve’, to ‘protect everyone from this deadly disease,’ despite it becoming clear that the infection fatality rate (IFR) is considerably lower than the 0.9% assumed initially. Now a paper on the WHO website states that the infection fatality rate for the disease is less than 0.2% ‘in most locations.’[xxix]

Perversely, children have become the focus of inordinate efforts; locked indoors, locked out of school and forced into wearing masks. We have insisted upon protecting them from a disease that has not caused a single child death in Ireland throughout the entire crisis.[xxx]

Troublingly, when Covid-19 panic gripped the nation, politicians and mainstream media listened only to the scientific ‘authorities’ that fed the hysteria and justified everything from political incompetence to profligate expenditure. Hospitals were emptied in preparation for an approaching ‘tsunami’ of illness, as tens of thousands of deaths were incorrectly predicted by politicians and esteemed professors, all of whom continue to profess, and have even grown in esteem.

Covid patients were dumped from hospitals into Nursing Homes, and tests were withheld from residents lest they run short for the healthy-hysterical. The vulnerable were not only abandoned, but too many of them were crushed in the stampede.

Thus, there is the shocking case of a resident in a Meath care home discovered to have had a maggot-infested a wound.[xxxi] What began as a campaign to protect the vulnerable, had turned into nothing short of a manslaughter machine.

At the End of the Day

The natural endpoint for viral infection in respect of many viral pathogens is of course ‘herd immunity.’ This is the point where a sufficient proportion of a population have been exposed to and develop full or partial immunity to a particular pathogen, such that its rate of reproduction is below 1 most of the time.

With insufficient hosts, a virus can no longer spread easily. This is not full elimination but an endemic equilibrium within the population, with a certain annual death toll tolerated – such as is the case with influenza, which kills up to a thousand people a year in Ireland, despite the availability of a vaccine.

This natural evolution, or pathogenesis, is also helped along by the seasonal shift from spring to summer. Increasing daylight reduces the level of viral particles, and people spend more time out of doors, or ventilate their living spaces in warmer conditions. This is how nature brings an end to seasonal colds and flus. Yet curiously this basic piece of natural science was largely ignored in March. Talk of UV light became highly politicised and thence poisoned.

The Swedes

Sweden provided a template for a country acting within the bounds of common sense and science. From the outset health authorities there endeavoured to protect a vulnerable aged cohort, leading to a natural-immunity developing within the population. In permitting this to occur they also took the precaution of doubling ICU capacity[xxxii] which, like Ireland’s, had been among the lowest in Europe when the pandemic began.

Comparison between Sweden and Ireland cannot be made on a like-for-like basis, any more than the Irish can be compared to any other national group; however, some relevant comparisons can be drawn in respect of population demographics.

Sweden has twice Ireland’s population, but 3.2 times the number of over sixty-five-years-olds. Ireland has not quite experienced just over a third of Sweden’s mortality (11,815 v 3,418); but while Ireland’s death rate from Covid-19 has been steadily increasing over the month of January, Sweden’s has flattened to point where, according to the WHO, Sweden’s death toll has been in single figures since the start of February, while Ireland has been experiencing daily deaths over one hundred.

Source: WHO

There may be a further uptick in Covid deaths in Sweden once schools reopen – and even a third wave – but the hopeful signs are that the country is now reaching a herd immunity threshold – one that has brought less suffering overall when compared to other jurisdictions.

A similar comparison can be drawn between Sweden and most other European states, implying, in most situations, that mortality is not significantly reduced by lockdown policies. Yet invariably whenever one reads about Sweden in mainstream Irish media[xxxiii] comparisons are only drawn with best-in-class Scandinavian neighbours, where lockdowns have also been, for the most part, avoided.

Lockdowns are likely to increase mortality through missed cancer screenings, dysfunctional health services, serious mental health impacts, besides the ‘shadow-pandemic’ of domestic violence that has occurred under lockdown.

The writing on the wall?

What of the good people on the opposite side of the Swedish argument? It is fair to say that lockdowns can flatten the curve. This is apparent if we compare mortality graphs on the Euromomo website that tracks excess deaths across Europe. It shows that Sweden did not see the same kind of spike on their graph of mortality during the first wave as in other countries that locked down, but experienced a steady decline, which in July led the New York Times to state prematurely that ‘Sweden Has Become the World’s Cautionary Tale[xxxiv]

Source: Euromomo.

The question is whether the short-term benefits of lockdowns in terms of averted-deaths are worth the cost? Or, were lockdowns necessary, and will they ultimately translate into lives being saved rather than simply deferring deaths? Perhaps the truth lies in the middle of these arguments but I know which side I lean.

Lockdowns do not prevent deaths, but slow the rate of infection and mortality. They can only ease the burden on hospital or tertiary care services. The purpose of lockdown should be to insure that the sick can access the best treatment available, and should not be ‘a primary means of controlling the virus[xxxv] according to leading authorities in the WHO, as we are experiencing in Ireland.

Although the mortality figures in Ireland still lag behind Sweden’s I suspect this is deferred mortality and does not represent patients who have been cured or saved. The curve has been flattened. Thus far, lockdown policies have had the beneficial effect of decreasing mortality by less than 20% compared to Sweden’s when adjusted for our respective age profiles. In my view, however, what may simply be deferred mortality, cannot justify the burden of lockdowns on the wider population.

Only when the crisis has passed, and with the benefit of hindsight, will it be possible to determine if the Swedes broadly got things right. Although, it is more appropriate in the context of a disease that has killed thousands of people – and caused suffering to most of the rest of the population – to state that some countries will have managed it better than others. For sure, no one will have got everything ‘right’.

Assuming vaccines do not represent a panacea, if it transpires that most Irish mortality is confined to the nursing home sector, and that all lockdowns accomplish is to preserve a larger number of potential hosts for successive seasonal resurgences then the pandemic will have been a more painful and long-running saga in Ireland than it might otherwise have been.

[i] Marcus de Brun, ‘The Perfect Storm’, Cassandra Voices, August 19th, 2020, https://cassandravoices.com/science-environment/covid-19-the-perfect-storm/

[ii] Epidemiology of COVID-19Outbreaks/Clustersin IrelandWeekly Report Prepared by HPSC on25thJanuary 2021, https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/surveillance/covid-19outbreaksclustersinireland/COVID-19%20Weekly%20Outbreak%20Report_Week032021_25012021_WebVersion_final.pdf

[iii] Digital Desk Staff, ‘Opening hospitality will mean limiting Christmas gatherings, Nphet warns’, November 26th, 2020, Extra.ie, https://www.breakingnews.ie/ireland/nphet-strongly-opposed-to-parts-of-governments-lockdown-exit-plan-1042387.html

[iv] ‘Up to 85,000 Irish people could die from coronavirus in worst-case scenario, Taoiseach indicates, as three more diagnosed’ John Downing, Eilish O’Regan and Gabija Gataveckaite, Irish Independent, March 9th, 2020, https://www.independent.ie/world-news/coronavirus/up-to-85000-irish-people-could-die-from-coronavirus-in-worst-case-scenario-taoiseach-indicates-as-three-more-diagnosed-39029363.html

[v] COVID-19 Deaths and Cases, Central Statistics Office, https://www.cso.ie/en/releasesandpublications/br/b-cdc/covid-19deathsandcases/

[vi] ‘Norwegian health chief: we advised against closing schools’, 10 June, 2020, Unherd, https://unherd.com/thepost/norwegian-health-chief-we-advised-against-closing-schools/

[vii] ‘Census of Population 2016 – Profile 7 Migration and Diversity’, https://www.cso.ie/en/releasesandpublications/ep/p-cp7md/p7md/p7anii/

[viii] Ciara Kenny, ‘ The global Irish: Where do they live?’, February 4th, 2015, Irish Times, https://www.irishtimes.com/life-and-style/generation-emigration/the-global-irish-where-do-they-live-1.2089347?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Flife-and-style%2Fgeneration-emigration%2Fthe-global-irish-where-do-they-live-1.2089347

[ix] American Institute of Cancer Research, Skin cancer statistics, https://www.wcrf.org/dietandcancer/cancer-trends/skin-cancer-statistics

[x] Phil Mercer, ‘Covid: Melbourne’s hard-won success after a marathon lockdown’, 26th of October, BBC, https://www.bbc.com/news/world-australia-54654646

[xi] Luke Malpass, ‘Jacinda Ardern declares 2021 ‘the year of the vaccine’’, January 21st, 2021, Stuff, https://www.stuff.co.nz/national/politics/124012148/jacinda-ardern-declares-2021-the-year-of-the-vaccine

[xii] Ramesh Thakur, ‘The West should envy Japan’s COVID-19 response’ January 10th, 2021, Japan Times,  https://www.japantimes.co.jp/opinion/2021/01/10/commentary/japan-commentary/west-japan-coronavirus-response/

[xiii] Gabriel Scally: It is essential Ireland tightens borders in fight against Covid-19, January 30th, 2020, Irish Times, https://www.irishtimes.com/opinion/gabriel-scally-it-is-essential-ireland-tightens-borders-in-fight-against-covid-19-1.4471283

[xiv] Sarah Bosley, ‘Covid UK: scientists at loggerheads over approach to new restrictions’, September 22nd, 2020, The Guardian, https://www.theguardian.com/science/2020/sep/22/scientists-disagree-over-targeted-versus-nationwide-measures-to-tackle-covid

[xv] Rafaela Lindeberg, ‘Man Behind Sweden’s Controversial Virus Strategy Admits Mistakes’, Bloomberg, June 3rd, 2020,  https://www.bloomberg.com/news/articles/2020-06-03/man-behind-sweden-s-virus-strategy-says-he-got-some-things-wrong

[xvi] Sebastian Rushworth M.D., ‘Here’s a graph they don’t want you to see’, 25th of January, 2021, https://sebastianrushworth.com/2021/01/25/heres-a-graph-they-dont-want-you-to-see/

[xvii] Sheena Cruickshank  ‘A new study suggests coronavirus antibodies fade over time – but how concerned should we be?’ October 27th, 2020, The Conversation, https://theconversation.com/a-new-study-suggests-coronavirus-antibodies-fade-over-time-but-how-concerned-should-we-be-148957

[xviii] Amy Kazmin, ‘India’s tumbling Covid cases raises question: Is the pandemic burning itself out?’ February 1st, 2021, Irish Times, https://www.irishtimes.com/news/world/asia-pacific/india-s-tumbling-covid-cases-raises-question-is-the-pandemic-burning-itself-out-1.4472406?mode=amp

[xix] Fergal Bowers, ‘High percentage of virus deaths in Ireland’s care homes highlighted in comparison report

[xx] Mismanagement of Covid in Ireland’ May 27th, RTE, https://www.rte.ie/news/coronavirus/2020/0527/1143036-covid-deaths-ireland/

[xxi] ‘What to know about post-viral syndrome’ Medical News Today, https://www.medicalnewstoday.com/articles/326619

[xxii] Jennifer Rigby, ‘Why long Covid can be really grim, but is rarer than you think’, October 3rd, 2020 The Telegraph, https://www.telegraph.co.uk/global-health/science-and-disease/long-covid-can-really-grim-rarer-think/

[xxiii] Postviral Fatigue Syndrome, Science Direct, https://www.sciencedirect.com/topics/medicine-and-dentistry/postviral-fatigue-syndrome

[xxiv] Matt Cole et al, ‘Air pollution exposure linked to higher COVID-19 cases and deaths – new study’, July 13th, 2020, The Conversation, https://theconversation.com/air-pollution-exposure-linked-to-higher-covid-19-cases-and-deaths-new-study-141620

[xxv] Meredith Wadman, ‘Why COVID-19 is more deadly in people with obesity—even if they’re young’, September 8th, 2020, https://www.sciencemag.org/news/2020/09/why-covid-19-more-deadly-people-obesity-even-if-theyre-young

[xxvi] Shauna Bowers, ‘Irish policies to tackle obesity ‘fall behind international best practice’ – report’, November 9th, 2020, Irish Times, https://www.irishtimes.com/news/health/irish-policies-to-tackle-obesity-fall-behind-international-best-practice-report-1.4403921?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Fnews%2Fhealth%2Firish-policies-to-tackle-obesity-fall-behind-international-best-practice-report-1.4403921

[xxvii] Anthony King, ‘Coronavirus family now a prime suspect in previous pandemics,’ February 4th, 2020, Irish Times, https://www.irishtimes.com/news/science/coronavirus-family-now-a-prime-suspect-in-previous-pandemics-1.4463053

[xxviii] Tom Kirby, ‘Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities’, The Lancet, May 8th, 2020, https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30228-9/fulltext

[xxix] Infection fatality rate of COVID-19 inferred from seroprevalence data

John P A Ioannidis, WHO, September 13th, 2020, https://www.who.int/bulletin/volumes/99/1/20-265892/en/

[xxx] (According to the CSO there have been 20,402 confirmed cases of Covid amongst the age group 0-24yrs, during the period from Feb 2020 to December 2020 and not a single recorded death in Ireland. https://www.cso.ie/en/releasesandpublications/br/b-cdc/covid-19deathsandcasesseries18/

[xxxi] Simon Carswell, ‘Widow ‘outraged’ by footage of husband’s facial wound’, August 26th, 2020, Irish Times, https://www.irishtimes.com/news/health/widow-outraged-by-footage-of-husband-s-facial-wound-1.4338831?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Fnews%2Fhealth%2Fwidow-outraged-by-footage-of-husband-s-facial-wound-1.4338831

[xxxii] Emma Lofgren, ‘’The biggest challenge of our time’: How Sweden doubled intensive care capacity amid Covid-19 pandemic’, June 23rd, 2020, The Local, https://www.thelocal.com/20200623/how-sweden-doubled-intensive-care-capacity-to-treat-coronavirus-patients

[xxxiii] Suzanne Cahill, ‘Coronavirus lockdowns are still a step too far for Sweden’, February 3rd, 2021, Irish Times,  https://www.irishtimes.com/opinion/coronavirus-lockdowns-are-still-a-step-too-far-for-sweden-1.4473119?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Fopinion%2Fcoronavirus-lockdowns-are-still-a-step-too-far-for-sweden-1.4473119

[xxxiv] https://www.nytimes.com/2020/07/07/business/sweden-economy-coronavirus.html

[xxxv] Michelle Doyle, ‘WHO doctor says lockdowns should not be main coronavirus defence’, October 12th, 2020, ABC, https://www.abc.net.au/news/2020-10-12/world-health-organization-coronavirus-lockdown-advice/12753688

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Marcus De Brun

Marcus de Brun is a medical doctor. Last year he resigned from the Irish Medical Council in protest over the government's handling of Covid-19 and has subsequently also resigned as a General Practitioner.

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