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Findings from a recent British study, published in the acclaimed British Medical Journal (BMJ), suggest that quick-lock measures, such as school and university closures, have been shown to be highly effective in reducing the need for intensive care units.
At the same time, they also prolonged the epidemic, which appears to have led to more COVID-19 deaths in the long term.
According to the researchers, this happens because the mortality associated with covid-19 is much higher in older age groups.
The model the researchers have used in their calculations indicates that school closings, in the absence of an effective COVID-19 vaccine, will cause more total deaths than no school closings.
«Braking strategy»
The Norwegian Health Directorate is critical of the British estimates.
Health Espen Deputy Director Rostrup Nakstad notes that researchers have used epidemiological and software-based simulation models of people’s expected behavior to calculate the effects of closure measures in the UK.
The model is based on official demographic data and not on patient data or actual infection monitoring, he notes.
– A basic premise, and in my opinion wrong, for these simulation experiments is that the spread of the infection to the entire population is inevitable and that the pandemic will only be slowed down by all those who undergo COVID-19 and obtain immunity to long term. Therefore, the entire simulation is based on a ‘braking strategy’, where the goal is damage limitation in a situation with persistently high infection rates, and not on a ‘knockdown strategy’, where the goal is least infection possible, like in Norway, and that we have Experience means less need for infection control measures, Nakstad tells Dagbladet.
– Avoid catastrophic development
He believes that the British simulation model’s explanation, which concludes that more deaths will occur if classical infection control measures are implemented in a severe outbreak situation, such as “social distancing” and “school and university closures”, is that assumes that all residents will be infected sooner or later anyway.
Given this premise, it will be desirable for young people, who normally do not become seriously ill, to become infected first, so that the pressure of infection on the elderly and vulnerable can spread over time and give a less pronounced wave of infection. This would be a very good strategy if everyone was infected before a vaccine arrived and if they managed to control the infection away from all the elderly and vulnerable groups, says Nakstad.
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The man from the Norwegian Health Directorate believes that the experiences of the last six months show us that this is not the case.
– The more infection there is in society, the greater the risk that people in risk groups will also be infected. And the higher the level of infection, the more dramatic measures are eventually forced to prevent a catastrophic development. We also know that the level of antibodies in the blood of patients who have undergone COVID-19 falls rapidly and that it is highly uncertain how long immunity is achieved after infection, Nakstad notes.
In the UK, more than 540,000 COVID-19 infections have been recorded. More than 42,000 people have lost their lives as a result of the SARS-CoV-2 coronavirus.
In Norway, we have just over 15,000 registered infections and 275 deaths.
Critical FHI
The Norwegian Institute of Public Health (NIPH) emphasizes that modeling studies are complicated, and the most important thing to assess the validity of a modeling study is to discover the premises on which mathematical calculations are based.
– This modeling study is done to test the modeling results of the Imperial College study, which received a lot of publicity in March, with the same premises in the calculations. One of the premises is that children are as contagious as adults. We now have indications that this is not correct, most recently summarized in a Canadian knowledge brief, says FHI Chief Physician and Pediatric Specialist Margrethe Greve-Isdahl.
In addition, it notes that all the measures included in the British model are “on” or “off”.
– In other words, the opening of schools with infection control measures has not been taken into account, for example. Nor has the Imperial College model included closing the university during “shutdown.” These factors alone make it very difficult to translate the model into reality, also in Norway, Greve-Isdahl believes.
– interesting
The FHI chief also points out that the model does not take into account the effect of a possible vaccine, which will hopefully have the effect of limiting a second wave of infection and preventing deaths.
That said, it is an interesting model. It says that if schools close in the first wave, it will reduce the number of cases in this wave and the need for intensive care units and deaths. When it is opened, few children and young people will be immune and, therefore, will be able to become infected by reopening when the infection is still circulating in society. If measures are also provided to protect the population over 70 years of age, there is a risk of infection for them and associated deaths. This explains the finding that school closings could lead to an increase in deaths among the elderly, but in a later wave of infections, Greve-Isdahl says, adding:
– Both this study and the Imperial College model show that even the abolition of distance counseling could lead to an increase in infection in the population and an increase in deaths among the elderly.
Greve-Isdahl has noted that the model ends with widespread spread and everyone becomes immune.
– The first is that Norway tries to prevent with all the measures that are taken, and the second about which we still do not have enough knowledge to conclude with certainty. The authors conclude that to reduce mortality, measures must be stricter for the elderly population than for children and young people of school age.
