The practicality of the situation

Even though Covid still shrouds a lot of places with death, sickness or in some cases just inconvenience, it has not really appeared much in my blog. After 2020 being wall-to-wall aerosol spread, 2021 has settled on things closer to home. But in real life, many of my habits have remained the same. I still check Worldometer daily just to see whether the case numbers and deaths are getting better or worse in various places; I listen daily to podcasts and vlogs for any insights or food for thought about the progressing pandemic; and even of late I have tuned into the 6pm news, a rarity even in 2021, to see any on the ground reporting especially, of late, Fiji, or the NZ ramifications for the Sydney outbreak. Regrettably a year and a half in, there is still this silly polarisation of attitudes about how to deal with the virus. Perhaps, it's just that we as societies have not had recent historical experience of an analogous situation so to reflect on to consider it thoroughly.

Two of the vloggers I paid most attention to since 2020 have been Chris Martenson (Peak Prosperity) and Dr John Campbell, and their trajectories in the last year have diverged a lot. The former was my favourite for most of the first half of 2020. He was quick, excitable, incisive and clear about the keys to early action with travel bans, quarantine and non-pharmaceutical interventions (NPIs) such as masks. He was good for deep dives into information and subtle comparisons. The latter comes across as a humble investigator commenting on the trends, news and relevant research. One commonality is that both noticed and reported on re-purposed off-patent medicines as prophylaxis or treatment of Covid-19. But it is in their respective approaches where their similarities ends.

Chris was obsessed by hydroxychloroquine (the drug that President Trump famously tried to hawk from his presidential podium) and ivermectin, both of which he called DWSNBN, the "drugs that shall not be named", ironically because his mention and advocacy of them literally had videos taken down. There today, gone tomorrow. The two drugs were not approved as treatments and since YouTube had implemented rules against disinformation, someone would report his videos. I'm prepared to consider this not in a corrupt, conspiratorial way but as an unintended consequence where tech-giants made rules that did not quite have the right settings and incidentally shut down debate. It became his obsession though, not against the virus, but against how things could be deemed disinformation to stifle free discussion. His partnership with his financial expert partner in Peak Prosperity seemed to have had issues, since the branding was getting complicated by the size of the feud, so after a pause came back with more videos from a different set-up now with an even stronger counter-authoritarian flavour even heading into the anti-vaccine territory.

Dr John reported on hydroxychloroquine weighing up the research and considered it not effective, but ivermectin he looked at and considered a useful, life-saving drug that was being overlooked. I don't believe any of his videos were taken down (can be corrected if I'm wrong), but after some statements to the effect of demanding authorities to consider it for use as a treatment, he has gone back to emphasising the use of vaccines, with only occasional lateral comments about ivermectin. He nailed my feeling on the topic in a recent video (11:25, but the whole video is pretty interesting).

I would like to explain my own feelings on this phenomenon, first by looking at the background of the situation, how it's played out but also looking at some counter-factuals which regrettably I haven't heard voiced yet. (Standard disclaimer: I am not a epidemiologist, virologist, pharmacologist, and have not personally read or reviewed the research. Do not take this as a statement of support for anything except the medicinal power of dark chocolate and strong Chinese liquor.) 

Early in the Covid pandemic, there were no clear ways to pharmaceutically prevent or treat the Covid condition; all that there was were NPIs to prevent infection and luck that either you were less disposed to it, or had less inoculum (fewer viral particle king-hits on your ACE2 receptors). Pharmaceutical companies invested money in development of their vaccines and countries made orders to have certainty for their own ways through this crisis. Needless to say there was a lot of money tied up in the development and the promise of their roll-out all over the world. Then came DWSNBN 1 and 2. The fly-in-the-ointment issue with these is that they were both off-patent - there was thus very few interested parties to fund the requisite large scale double-blind trials. What trials that were run were mostly done in third world countries such as Costa Rica and India. The evidence shows that someone taking ivermectin would have a greatly reduced chance of infection, reduced chance of hospitalisation and death. There was a lot of drama in the middle including an obvious hatchet job against one of the two drugs that caused a retraction in The Lancet. In terms of treatments for Covid-19, it seems clear that especially ivermectin has a better success rate than patented drugs such as remdesivir. But it is not even mentioned as possible drug for treatment and is actively discouraged in many countries. It may be because experts have really looked at it and thought it not to be better than placebo - or perhaps there are more commercial factors at play.

One possible reason for this phenomenon is the expected impact of the discovery and widespread use of a off-patent medicine to treat such a novel disease that has already such a valuable market for the pharmaceutical industry. In the first counter-factual, imagine if any time prior to December 2020, when vaccines were started to be offered to the public in some countries, news about a cheap, effective treatment emerged, was approved by the relevant health authorities and was widely used. It might have caused a massive rejection of the "experimental" vaccines that had already had massive investment from the government and industry. People would instead use a cheap, easily manufactured generic medicine, usually applied to farm animals. Provided it was actually useful, it would have changed the trajectory all together. It would be interesting to know whether such a shock might have bankrupted any business - I'm guessing not, none of the businesses would have "put the house" on the vaccine development.

Back in the reality where such a discovery has not been approved or promoted, it has meant people's lives may have been terminated by the virus at a greater rate than if this wonder-drug had superior efficacy and could be moved more efficiently to the places that needed it. But by suppressing this knowledge and medical approval, it kept the stability within the economic system. This seems akin in some way to the financial bail-outs of the banking sector where industry losses are mitigated through a socialised sacrifice. 

If so, this yet again the bug of the capitalist system. Unethical results from rational big picture financial rational decision-making. In the same realm of pharmaceuticals, there is the well-known dilemma of the development of two drugs - one that cured a condition completely and another that treated it but did not completely cure them, and would be required to be taken over the life time of the patient: only the latter would go to market because the former does not really have a business plan. There is a lot of gnashing of teeth in liberal sections of society when there such an outcome occurs but it is the compromise that was made in accepting this otherwise very efficient economic system.

Another aspect of the counter-factual is that had ivermectin derailed vaccine roll-outs, the world would now be dependent on the supply of one drug which doesn't in itself trigger immune protection. The positive would be that, being off-patent, any country or business could start manufacture it in vast amounts but also that we would be consuming ivermectin in prophylaxis and treatment through the whole pandemic period. It might be able to get individuals through the infection but would still mean that is a reduced or minimal immune response. And alternatively, it might have been found that it does not work as well scaled up, and by then the vaccine developers have moved onto other things and perhaps not keen to have the commercial exposure to further development.

It could be from some of these fears that a health expert may in good conscience downplay or not mention this other drug. A big picture risk analysis to the works of a off-patent spanner might have caused hesitation, or alternatively been provided to decision makers as ethical "cover" for not indulging the easy-out of promoting cheap alternatives. There might also be a tacit understanding that once the pharmaceutical industry had covered its losses that ivermectin might be approved to blunt the third world from future surges. 

The key though as Dr John has said is that no-one is likely to say it as there is a "realpolitik" at play. Although such things are irksome, and enraging for some like Chris, I only shrug. I think it's unusual to see people acknowledge in public: "yes, it's not the outcome we want but this is probably the price of the any greater good." 

Or there could be a prudent "kicking for touch" element where the vaccines work and should be able to end the pandemic, and the desire not to muddy the already muddy waters. 

When it gets down to it, in almost every aspect of my life I've now found myself identifying as a pragmatist, not an idealist. I am quite comfortable with the compromise because I cannot be always confident of the correctness of my own views to run over the top of others. That being said, in my own conduct I'll follow my own way in an experiment of one. 

This last week has been my "run down" week. My immune system stopped really caring and my sleep was rather disrupted. Despite this, my running performance on training runs was as good as I would expect at this stage. God might have dealt me a good hand - Saturday was a wash-out and I didn't run on what would have been a long run. I slept well on Friday and Saturday night. Sunday, I ran my longest run since October 2019 and felt fine. This week has begun and my energy is back. Yesterday I ran a half marathon distance in the morning, not as a time trial but as a fartlek (where you choose different speeds, including slow, for different sections) and still had an energetic day afterwards. Sunday I have my first half marathon in the last nine months and am feeling confident that I can break 1:40, a good standard of training. (For the record, my personal best is 1:30 but will need a couple more months to get to that fitness.)