A brief history of COVID stuff I have been shouted at for, and how it panned out

I won’t be publicizing this article much, because it is essentially a bit of a personal whinge and therefore not particularly deserving of attention. It serves mostly as a written record of my personal experiences of how COVID-related intellectual discourse has gone. More of a diary entry than a public writing, one might say.

I am a chemical engineer by trade but my industrial and research work has taken me on some tremendously diverse paths. Chemical Engineering is a broadly-applicable skillset to begin with, so I’ve ended up with a broad range of expertise. Since the outset of COVID, I’ve applied those skills of mine that are relevant to addressing it in various ways, most of them fairly minor. I have, quite surprisingly, found myself as a co-director on a new lab oriented at testing Long Covid treatments which is quite a departure from the biofuels and general energy industries where I have spent much of my (so-called) adult life. A surprising result of my interest in combating COVID is that I’ve been shouted at rather a lot. The thicker skin that I have developed as a result will doubtless prove valuable in the future, so I remain philosophical about the learning experience.

Opinion #1: Questioning value of lockdown

My first COVID opinion dates back all the way to March 2020, pretty much the kickoff for South Africa. That opinion, based on some fairly rudimentary comparative modeling, was that a rigid lockdown would only very slightly decrease the eventual total number of COVID infections in South Africa, serving mainly to postpone the spread. This actually turned into the mainstream viewpoint; the lockdown was later described as a means of creating a delay and also easing strain on medical resources to create an opportunity to prepare for the peak.

What should have remained for debate was whether the benefits of that preparation were worth the economic and social damage of the lockdown. I also made the argument that, purely from the standpoint of managing the pandemic, extremely strict measures early on were likely to deplete people’s willingness and ability to comply with measures later on, and could consequently result in MORE total infections in the long run, as a result of being unable to control outbreaks later on when it mattered more.

The alternative initial measure that I offered for consideration was to instead close offices and businesses on Tuesdays and Thursdays as a means of decreasing total transmission by a fair margin without devastating business productivity; a fair amount of research has indicated that reduced number of working days does not significantly reduce total productivity. At the time, the prevailing theory was that transmission was mainly through surface contact, and data indicated that COVID survived on surfaces for roughly a day. With that postulate in mind, only working on non-consecutive days would have an outsize reduction on transmission relative to the economic cost. I was quite taken with this strategy and pushed quite hard for it, but it later emerged that transmission is primarily airborne and so it would not have been all that effective at curbing transmission beyond the direct effect of reducing the time spent in offices by 40%.

The lockdown went ahead, initially for 3 weeks but then extended for another 2. Somewhat to my surprise (and most people’s), the rigid lockdown did not greatly reduce transmission; the initial measures introduced on the 15th of March seemed to have a fairly solid effect, with a noticeably decrease in transmission reflected around 10 days later (at the time, there were considerable testing delays which, coupled with the incubation period for the virus, imposed a roughly 10-day delay between infections occurring and them being reflected in tests). The far stricter measures imposed from the 23rd of March did not reduce the transmission much further, showing an element of diminishing returns on the strictness of measures. Cases continued to increase throughout the lockdown and, once the 5 weeks elapsed, we began to reopen our economy with more cases than when we had closed it down. It also transpired that the 5 week preparation period was not well-utilized; oxygen shortages severely hampered COVID treatment at the peak, in spite of the presence of the world’s largest oxygen plant within driving distance of Johannesburg, and in spite of the fact that our first wave of COVID turned out to be far smaller than models had predicted. The provision of oxygen, of course, is the single most important response to COVID, and any earnest effort at preparing for an outbreak would be focused on meeting that need.

I actually did not get shouted at for any of that, which now seems remarkable. At the time, I disagreed with the government’s primary response and criticized their preparation. At the time, COVID discourse was an open field for sharing ideas and making sincere attempts to mitigate the looming crisis. As the pandemic has progressed, discourse has become more cynical and self-serving in nature. Dissent against government policy or general consensus is now an invitation for excoriation.

Opinion #2: Criticizing the purchase of AstraZeneca vaccines

In January 2021, the SA government announced that it had made a vaccine purchase, in the form of 1 million doses of the Oxford AstraZeneca vaccine. In contradiction to the widespread applause, I expressed dismay. With the Beta variant taking over in SA and showing signs of likely immune escape, I considered a single-vaccine strategy highly risky, and I also figured that of the available vaccines, AstraZeneca was the one most likely to be ineffective against Beta. My reasoning was that it had the lowest starting efficacy of the available vaccines at the time, and the indications of likely immune escape had come in the form of in-vitro studies showing poor neutralization of Beta by AstraZeneca’s cocktail of monoclonal antibodies, which was pretty similar to the set of antibodies produced in response to its vaccine (the latter being the basis for the formulation of the former). I therefore stated, in response to a Twitter announcement of the purchase, that AstraZeneca was not a suitable vaccine for the South African context on that basis.

I was viciously dragged for that one, with some big names in the field really piling in. For a brief moment in time, dunking on me was the hobby du jour of South African Covid Twitter and even, to some degree, international COVID Twitter. One highly prominent international journalist even made the claim that AstraZeneca was the most suitable for the South African context of all available vaccines. By that time, such a thing as COVID journalists had emerged, and they did not like being contradicted, not even by scientists (or perhaps especially not by scientists). They had accumulated large followings, who also did not like them being contradicted.

A month later, clinical trials showed that the AstraZeneca vaccine was ineffective against the Beta variant, and South Africa abandoned those million doses entirely.

Some of those who had dunked on me blocked me pre-emptively, before I even had an opportunity to gloat. To be fair, I would otherwise have gloated. My pride had been wounded.

Opinions #3 and #4: Winter wave 2021, and arguing that we should use our AstraZeneca doses anyway, despite its drop in efficacy against Beta

Fresh from my statement that AstraZeneca was the wrong vaccine to buy, I did a piece for News24 in which I made the rather bold prediction that South Africa would experience a third wave in the winter of 2021 and that it would likely be larger than our second wave had been. I cringe deeply at the recollection that I put such a sweeping claim out on such a public platform. I can scarcely imagine what had come over me, with so many intangibles involved. I was shouted at for that prediction. Mostly by COVID denialists whose contact with reality can be fleeting, but also by some experts who, perhaps quite correctly, considered the claim to be ill-founded. It turned out to be correct but I genuinely feel that I can’t properly justify my position at the time.

In the same article, I also made the argument that in spite of the massive drop in efficacy exhibited by the AstraZeneca vaccine against the Beta variant, we should have just gone ahead and used the million doses that we had, on the basis that while the vaccine had shown just a paltry 10% efficacy against infection, they would doubtless confer enough immune advantage to blunt the effects of the disease.

I got shouted at, on the basis that this seemed like flip-flopping when considered in contrast to my statement that AstraZeneca was the wrong vaccine to buy. While the two opinions do have the shape of being ideologically opposed, they are not contradictory. I have at times in my life bought stuff that I later regretted, but I have always used that stuff rather than chucking it out. Waste not want not, and all that.

Later research showed that AstraZeneca is pretty effective at preventing severe illness and hospitalization, and also that following two doses of it with a booster of an MRNA vaccine results in excellent antibody titres.

On this one, I can confidently say that I was correct on all points; AstraZeneca wasn’t the right vaccine to buy but, having bought it, we should have used it, and the winter wave did arrive as predicted and it did exceed the second wave that preceded it. Nevertheless, I was shouted at on every single item.

Opinion #5: The prevailing narrative of vaccine inequity is largely false

This is perhaps the thing I have been shouted at the most since the time I halted the filming of the trailer for The Giver at Wits because I walked through the set on my way to get a coffee*. My criticism of the vaccine inequity narrative is far more rooted in fact, however. The general gist of the vaccine inequity complaints are that western governments and pharmaceutical companies are to blame for the slow vaccination progress in Africa, and also that western-made vaccines are overpriced.

My first area of dispute was one of accounting, because the estimates of what vaccines supposedly should cost entirely omitted the cost-price multiplier of failure risk. The second was that the picture being painted, that of Western countries sitting upon a mountain of vaccines and gloating, is entirely at odds with reality. The largest user of vaccines is China, and the oft-quoted stat that rich countries have used the majority of vaccines tends to carefully omit that fact. The third area of dispute was that it was claimed that the proximate cause of non-vaccination in Africa is racism on the part of western pharmaceutical executives. Objectively, the proximate cause is the non-delivery of some 600 million doses owed to COVAX by India. I wrote about these matters in more detail in other pieces**, so there’s no need for detail.

I queried prominent proponents of the Western-critical vaccine inequity about several points. Firstly, why they omit India’s export ban from the discussion of the causes of Africa’s slow vaccination progress. Secondly, why they ignore China’s COVID-19 vaccine manufacturing capacity; China has manufactured half of all COVID-19 vaccines administered worldwide. No honest effort to rectify a shortage of a commodity could outright ignore the majority of the world’s manufacturing capacity of that commodity. Thirdly, I questioned their use of the stat that rich countries have used the majority of vaccines to support accusations against Western governments. That stat actually mostly arises because of the massive share of global of vaccines administered in China, which is recently categorized as a rich country, but does not spring to many minds when that phrase is used.

I was of course shouted at for all of those areas of dispute, but some genuinely surprising elements emerged. A prominent proponent of the Western-critical vaccine inequity justified those positions by claiming that China is lying about their vaccination numbers as well as their cases, and that their vaccines simply aren’t effective and so shouldn’t be used. I was taken aback by this line of reasoning because it is almost a word-for-word reproduction of anti-vaxxer talking points. Simply ignoring independent trial results from a batch of different countries to smear a vaccine approved by the WHO and our own SAHPRA is the very cornerstone of the anti-vax playbook. For the other claim, there is a handy technical term for an unsubstantiated claim that governments are lying. That term is ‘conspiracy theory.’

For someone to set out to combat anti-vaxxers and end up echoing their arguments so precisely is the kind of striking example of horseshoe theory that you couldn’t make up if you tried. Moreover, the statement that they do not believe China’s reported vaccination figures is a startling admission that they themselves do not even believe the figures they are quoting to support their arguments — China’s reported vaccination figures are the single largest contributor to the statistics of rich countries’ disproportionate share of vaccine doses.

The other contradictory element is the attitude of Western superiority embedded in the assumption that only Western countries can solve vaccine inequity, which is also present in the casual dismissal of scientifically-tested, WHO-approved Chinese vaccines.

That particular episode was the most vituperative shouting-at that I have received but also the most self-contradictory, and absent any factual refutation.

Initially, the incident was quite disheartening to me. My personal reputation was (intentionally) smeared by the same individual who, by their own admission, was reporting figures they did not themselves believe, who justifies their position using anti-vax conspiracy theories and privately displays pervasive Sinophobia and assumptions of Western superiority. The reputational damage will likely stick, unfortunately, at least among that rather prominent individual’s following, but the disheartenment has been replaced by a decidedly positive feeling of personal vindication.

My initial sense that that particular group was not being entirely honest in their narrative has been very thoroughly confirmed by that individual’s own direct admissions. What better vindication could one ever receive?

Opinion #6: Ivermectin: not a miracle cure, not suitable as a prophylactic, not suitable for self-medication, but not proven ineffective and results most consistent with small benefit.

I’ve not mentioned names prior to this, because it would feel tacky to sit quietly and speak negatively of people on my own platform where they do not have the opportunity of rebuttal. However, I will refer here to the work of Gideon Meyerowitz-Katz (Gideon M-K; Health Nerd, to use his online handle) with whom I have disagreed (and was shouted at for it), but of whom I will not be speaking negatively. He has built quite a platform for himself as the Ivermectin debunking guy, and is part of a group of researchers who devote much of their free time to conducting deep-dive audits of research papers. They have uncovered some startling fraudulent research in the pro-Ivermectin literature.

The work they do is excellent, and I admire their dedication to a thankless and non-paying task that is of great importance to the world. Nevertheless, I made a point of dispute with GidMK on the basis of how he reported on his data. At one stage, having eliminated several fraudulent items from the Andrew Hill meta-analysis of the Ivermectin literature he produced a revised meta-analysis which did not show the same strong benefits as when the fraudulent research was included. However, it still indicated some 10%–15% reduced adverse outcomes in the Ivermectin group compared to controls, albeit with a 95% confidence interval that is decidedly broad and, on its one end, ranges past the point of no benefit. Thus, the remaining body of evidence did not confidently indicate much benefit. However, it also did not exclude the possibility of modest benefits and, in fact, the point of no benefit lay slightly outside an 85% confidence interval, indicating that no benefit at all was somewhat unlikely.

The headline under which GidMK published these findings was to the effect that Ivermectin had been conclusively proven to have no benefit. This is not a fair interpretation of that data; it would be fair to say that a strong benefit (50% or greater reduction in adverse outcomes) had been excluded as a possibility, but a modest benefit had not been, and in fact his data was still most consistent with a small benefit. It is not uncommon practice for clinicians to prescribe a medicine off-label if it has a reasonable chance of improving their patient’s prognosis so, on the basis of the data presented by the Ivermectin-debunking-guy, prescribing Ivermectin was still a justifiable decision for a clinician to make.

I made that point in response to his post and, initially, GidMK disputed it (in a fair way, perhaps with a hint of combativeness, but of course I have a hint of combativeness even in my sleep), and his following, who are largely excited to dunk on Ivermectin, laid into me. Nevertheless, GidMK has, since that argument, included in all of his public statements a disclaimer that the possibility of a moderate benefit has not been excluded and that Ivermectin may indeed have some minor benefits. That shows considerable integrity, and it rubs against the expectations of his following. On social media it is deeply uncomfortable to hold any unpopular opinion or even to make allowances for one, and one is incentivized to choose simplicity over veracity, so I find myself impressed by his decision to persist in it.

The reason that I use his data to illustrate the point that Ivermectin has not been eliminated as a prospective treatment is the fact that the nature of his platform and following predispose him to want to show otherwise, and hence he is subject to bias against Ivermectin. I would like to take a moment to clear up a remarkably common misconception here. A statement that says that someone is subject to a bias is frequently interpreted as impugning their honesty, but that is false; we are all subject to biases as a result of our backgrounds, our preconceptions, our prior opinions, our personal incentives and, quite frankly, a bunch of largely random factors that influence how we absorb information. Keep other people’s biases in mind when interpreting what they say, and adjust for them. Even more importantly, treat your own biases the same way. We all have them. They are something to be aware of but nothing to be ashamed of.

Tangent aside, I trust GidMK’s interpretation as a fair representation of what’s going on with Ivermectin research and, if it is somewhat slanted against the effectiveness of the drug that’s not a bad thing because it places a somewhat higher bar to clear. What the evidence points to, at present, is that there is a fair possibility that Ivermectin has a small benefit and so, a clinician who decides to prescribe it on the basis of those slightly positive odds should not be excoriated for doing so. Nevertheless, the data has quite definitively excluded the premise that it is a silver bullet cure or even a drug that meets normal thresholds for effectiveness. It should not be self-medicated, it should not be used prophylactically, and it has not met the standards of evidence required for it to be a recommended treatment. I advocate for all of those points but still choose to die on the hill that the statement “Ivermectin has been proven not to work” is scientifically unsound. That is likely a reflection of my own stubborn nature more than anything else***. Nevertheless, it is true.

Concluding remarks

This turned out quite long-winded. If there is a take-away message, it is this; large populations confound our intuition on human behaviour. People are predominantly honest, and we expect them to be, but the sub-population of inveterate liars is such that there will always be some of them on either side of every contentious issue. Lies can be formulated to be more compelling than the truth, so in our so-easily-viral online eco-system there is a natural tendency for those liars to be disproportionately amplified. Sometimes you will feel as if both sides are lying to you; that is not a paranoid instinct because, more often that not, it is true to some extent. If you are inclined to question and dispute statements you see as dishonest whenever you see them, you will get shouted at by both sides. Do not do this unless you have thick skin. I did not, initially, but now I do.

* If they’d been less rude I wouldn’t have walked through a second time with my coffee in hand

** A rather strange episode accompanied this piece. A rather prominent and highly-regarded human rights lawyer accidentally posted a revealing photo of himself on Twitter. He deleted it shortly thereafter, but screenshots had already been taken and commentary ran rife; he trended countrywide for over a day. The only other thing that he tweeted on that day was a link to this article, and so he and I both got far more exposure than we expected on that day.

***Amusingly, I was once accused both of ‘peddling horse paste’ and of being a ‘big pharma shill’ denying Ivermectin’s effectiveness in the same conversation.