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No facts without Judgment

Facts alone are wanted in life. Plant nothing else, and root out everything else. You can only form the minds of reasoning animals upon Facts: nothing else will ever be of any service to them.
Mr Gradgrind from Charles Dickens’s Hard Times (1854).

These are facts the heart can feel; yet they call for careful study before they become clear to the intellect.
Albert Camus, The Myth of Sisyphus (1955).

The philosopher Alasdair MacIntyre wrote that ‘facts, like telescopes and wigs for gentlemen, were a seventeenth-century invention.’ The term is derived from the Latin ‘factum,’ meaning ‘a deed, an action and sometimes in scholastic Latin an event or occasion.’ MacIntyre was not dismissing the importance of gleaning evidence from sources, or deriving conclusions from scientific studies, but asserting that no fact is ever ‘independent of judgment.’[i]

Over the course of the current pandemic, as a recent opinion piece in the British Medical Journal puts it:

uncontested facts—things that are ascertainable, reproducible, transferable and predictable—tend to be elusive. Most decisions must be based on information that is flawed (imperfectly measured, with missing data), uncertain (contested, perhaps with low sensitivity or specificity), proximate (relating to something one stage removed from the real phenomenon of interest) or sparse (only available for some aspects of the problem).

Similarly, the historian E. H. Carr considered facts to be ‘like fish on the fishmonger’s slab. The historian collects them, takes them home and cooks and serves them.’ Thus partisan outlooks have always coloured understandings of historic events. Carr recalls: ‘Our picture of Greece in the 5th century BC is defective not primarily because so many of the bits have been accidentally lost, but because it is, by and large, the picture formed by a tiny group of people in the city of Athens.’

Journalists and editors in writing ‘the first rough draft of history’ therefore make judgments in determining facts. Unsurprisingly, during a global pandemic Covid-19 deaths and diagnoses are given greater factual weight than the equivalent statistics for heart disease, cancer or influenza. This is quite apart from deaths in developing countries from tuberculosis, AIDS and malaria, which are set to double this year in part owing to the intense focus on Covid-19 – particularly in Africa which by mid-August had experienced just 23,000 deaths from Covid-19.

Any journalist’s judgment in determining facts is not necessarily a product of sinister machinations, but orthodoxies and received opinions are easily enshrined in news organisations that are patronised, or owned outright, by vested interests, which throughout history have ‘manufactured’ consent.

Moreover, as Noam Chomsky put it in a famous interview with Andrew Marr, there is ‘a filtering system’ that starts in kindergarten which ‘selects for obedience and subordination.’ Chomsky intimates that most journalists that rise to the top of major news organisations are conformists, including Marr.

The pandemic has exposed the fragility of contemporary journalism in the era of the Internet, which, arguably, has exhibited over-deference to scientific authority, even where those authorities have proffered accounts that have proved wildly inaccurate, or contradictory. This passivity seems to be a feature of what Nick Davies has described as ‘churnalism’, whereby journalists become passive processors of ‘unchecked, second-hand material, much of it contrived by PR to serve a political or commercial interest.’

Fake News

In the Internet era we have witnessed an onslaught of so-called ‘fake news,’ which are accounts departing from journalistic convention that enter the realm of fiction and outright distortion.

This is not, however, entirely novel. It is axiomatic that truth is the first casualty of war, a metaphor constantly applied to this pandemic. Journalists embedded in power structures have long spun outright falsehoods. We need only cast our mind back to uncritical coverage of claims around Weapons of the Mass Destruction prior to the invasion of Iraq in 2003, or the misleading accounts of Cuba in the U.S. press.

Nonetheless, in this context such claims have become more outrageous, and even comical, with social media – Facebook in particular – acting as a conduit for misinformation from non-mainstream outlets, granting individuals unprecedented platforms to project fears, fantasies and delusions that are often manipulated by shadowy agencies, such as Cambridge Analytica.

An apparent antidote to fake news has arrived in the form of fact-checking websites. While these may succeed in exposing outright falsehoods – which is undoubtedly important in an era of climate change – we should also examine which facts are being checked and also, why there are discrepancies in mainstream accounts. The funding for such sites also merits scrutiny. The facts do not speak for themselves.

#CoronaVirusFacts Alliance

In March this year the Irish online news website, www.thejournal.ie announced it had ‘joined a worldwide project of factcheckers debunking claims about Covid-19.’ According to their report: ‘This project, called the #CoronaVirusFacts Alliance, comprises more than 100 factcheckers around the world and it is the largest collaborative factchecking project ever,’

That global alliance was launched in January by the Poynter Institute:

when the spread of the virus was restricted to China but already causing rampant misinformation globally. The World Health Organization now classifies this issue as an infodemic — and the Alliance is on the front lines in the fight against it.

This global response is in line with a war-gaming exercise for a global pandemic (coincidentally a fictional coronavirus: Coronavirus Associated Pulmonary Syndrome) called Event 201 organised by The Johns Hopkins Center for Health Security in partnership with the World Economic Forum and the Bill and Melinda Gates Foundation. In this exercise where no one has immunity from that virus, the model predicts the pandemic will only end when 80 percent of the world’s population has been infected, which takes 18 months and results in 65 million deaths.

The participants addressed the issue of disinformation and misinformation from ‘state sponsored groups’ and specifically pointed to the importance of ‘fact-checking efforts.’

Notably, the Poynter Institute has received charitable donations from the Bill and Melinda Gates Foundation of $382,000 in 2015, earmarked for improving ‘the accuracy in worldwide media of claims related to global health and development.’ The organisation now receives donations from, among others, Facebook, Google News Initiative and climate-change denying Charles Koch.

Died ‘From’ or ‘With’?

Most of www.thejournal.ie’s investigations into online claims result in slam dunks, where obvious fake news is dismissed. This may indeed be in the public interest; although it is questionable how many people actually believe claims such as that children are going to be taught how to masturbate as part of their education, or that Bill Gates briefed the CIA in 2005 on a vaccine against religious fanatics. This latter claim, interestingly, was also debunked on other fact-checking sites, demonstrating that www.thejournal.ie is a small cog in a global campaign.

More relevantly to Ireland, in carrying out its fact-checking remit www.journal.ie has bolstered the Irish government’s emphasis on the serious danger posed by Covid-19 to all age groups. Consolidating government messaging during a pandemic may be considered a civic duty, but it can also over-simplify “elusive” facts that merit revisiting.

On July 24^th, Radio DJ Niall Boylan’s tweet from July 14^th claiming just eight people under the age of sixty-five had died from Covid-19 became the subject of a fact-checking inquiry.

It’s shocking that only 8 people under 65 in Ireland died from Covid 19 and we destroyed & continue to destroy the economy. Every one of the 1700 deaths matter but most did not die from Covid 19 and just happened to have a positive test.We need logical responses & not hysteria

— Niall Boylan (@Niall_Boylan) July 14, 2020

The relevant fact checker, Rónán Duffy, recalled that the Health Protection Surveillance Centre had recorded a total of 1,763 deaths related to Covid-19, of which 113 related to people under the age of 65. Duffy thus concluded that ‘At the time that Boylan shared the original tweet on 14 July, the number of Covid-19 deaths among people under 65 was 113, not eight’

In response to a request for clarification, however, Boylan said he specifically used the term ‘from Covid-19,′ not ‘with Covid-19′. He went on to argue that it was important to distinguish deaths among people with and without underlying health conditions, ‘in other words people who had died from coronavirus.’ He claimed the figure of eight people was a direct quote from a statement made by Independent T.D. Michael McNamara, who said at a sitting of the Special Committee on Covid-19 that only eight of those under the age of sixty-five who died did not have an underlying condition.

Duffy concluded the claim was ‘misleading because it omits crucial details that may lead to readers forming an incorrect conclusion.’

Boylan’s tweet may indeed have been unsatisfactory, but the original death toll was itself a simplification: a bald statistic that omitted to mention that the vast majority of those who died were afflicted with underlying conditions. Perhaps some of these were patients would have succumbed to a respiratory infection in an ‘ordinary’ year, considering influenza or pneumonia are the cause of up to a thousand deaths a year in Ireland.

A Covid-19 infection may not have been the primary cause of death; or an infection could have accelerated by a short time that mortality. Any death comes as a shock to those left behind, and all reasonable efforts should be undertaken to preserve life, but it is not uncommon for patients weakened by long-term illness to succumb to respiratory infections, such as Covid-19, rather than the chronic degenerative disease to which the cause of death is ordinarily ascribed. Members of the public unacquainted with medical science may not be aware of this. According to one G.P. consulted in researching this article attributing cause of death is never an exact science.

A more thorough fact-checking exercise might examine the nature of comorbidities or underlying conditions. Conditions are described in papers, but a loose definition can easily yield to wild claims around the number of those in the Irish population who are at risk of death from the virus.

https://twitter.com/DonnellyStephen/status/1303632455107260422

Yet a recent article in Nature emphasises that age is by by far the strongest predictor of an infected person’s risk of dying :

For every 1,000 people infected with the coronavirus who are under the age of 50, almost none will die. For people in their fifties and early sixties, about five will die — more men than women. The risk then climbs steeply as the years accrue.

The suggestion that 1.5 million among an Irish population of less than five million that is the youngest in the E.U. are susceptible to death from Covid-19 is a wild exaggeration.

All 1,777 deaths?

In another recent article Fact Checker claimed: “the virus was a factor in all 1,777 deaths.”

Yet HIQA reported in July:

Excess mortality was found to be 1,072 (95% CI: 851 to 1,290) between 11 March 2020 and 16 June 2020 inclusive. The officially reported number of COVID-19 deaths for the same period was 1,709. Therefore, the estimated excess mortality is less than the officially reported COVID-19-related mortality by 637 cases.

Similarly in the U.K. Dr Jason Oke of the Centre of Evidence-Based Medicine in Oxford has found that almost one third of Covid-19 deaths in July and August were ‘primarily caused by other conditions’. There is therefore significant doubt over whether the virus was the primary factor in all 1,777 of these deaths.

Also, the coroner’s office was not conducting post-mortems on suspected cases and testing was pulled from the entire care home sector for three weeks at the height of the pandemic, meaning in many cases doctors were making educated guesses that Covid-19 was the cause of death.

Some people find it hard to believe that when Care Home residents were in the greatest need for testing and diagnostics, testing service was pulled from the entire sector for 3 weeks, to preserve test supplies for the general public. Most died in Homes many/most were not tested. pic.twitter.com/EFi8XsRqER

— Dr. Marcus De Brun (@indepdubnrth) September 12, 2020

Then CMO Tony Houlihan also acknowledged: ‘Clinically, the “index of suspicion” for the disease would be “a good deal higher” than would normally be the case for flu.’

RTÉ’s Feargal Bowers

The Irish public service broadcaster RTÉ says that ‘nine out of ten people in Ireland say RTÉ has been their main media source for accessing information on Covid-19.’ The broadcaster recently launched an initiative against fake news entitled: ‘The truth matters at RTÉ – here’s why,’ claiming:

Now that society is grappling with the challenges of a pandemic, and the inescapable anxiety that comes with it, the potential for manipulation of the facts is huge.

But RTÉ has at times provided an unreliable account of the danger posed by Covid-19 to the Irish public. Throughout the pandemic RTÉ’s health correspondent Feargal Bowers has pointed to the exceptional danger posed by Covid-19, which fits within what Nancy Tomes has called the “killer germ genre of journalism”.[ii]

Bower’s describes a Grim Reaper that is redolent of the character of Death from Ingmar Bergman’s Seventh Seal:

This virus could visit any of us, at any time, in our homes, or in work.

It does not make an appointment.                                                        

Going outside involves a certain roll of the dice.

Inside you may also encounter this intruder.

Like any lottery, there are things people can do to improve their chances.

And hold onto the most valuable prize of all – your life.

In fact, we are dealing with a virus with an infection fatality rate below 1% according to Nature magazine, or ‘possibly as low as 0.2% or 0.3%,’ according to Lone Simonsen, a professor of population health sciences at Roskilde University in Denmark who has worked at the CDC and National Institutes of Health in the U.S.; others such as Professor Johan Gisecke, a member of the WHO’s Strategic and Technical Advisory Group for Infectious Hazards (STAG-IH) previously suggested a figure as low as 0.1%. The IFR has varied from region to region, with New York, Madrid, London and Lombardy particularly badly hit, but in Africa, as indicated, the IFR appears to be exceptionally low.

With better treatments – especially the use of the generic drug Dexamethasone – and protection of vulnerable groups, chances of survival have improved since the early stages of the pandemic. This seems evident from the relatively low death toll currently witnessed across Europe, including in Ireland, despite rising case numbers. Many of us also harbour T-cell immunity from other coronaviruses, as we will see.

Yet Bowers has continued to make factually incorrect claims in a succession of articles, including on September 5^th, which stated: ‘The World Health Organization says data to date suggests 80% of Covid-19 infections are mild or asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical, requiring ventilation.’

Ventilators are now used sparingly in the treatment of Covid-19, and large orders were cancelled in April.

Remarkably, Bowers seems to have copy and pasted that information from a WHO Situation Report from March 6^th, stating ‘data to date suggest that 80% of infections are mild or asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical infections, requiring ventilation.’[iii]

The continued use of data from March undermines RTÉ’s credibility and should be a source of embarrassment.

IFR or CFR?

In a widely circulated tweet at the height of the pandemic then Minister for Health and current Minister for Higher Education, Simon Harris confounded the Case Fatality Rate (CFR), which is the percentage of deaths from diagnosed cases, with the Infection Fatality Rate (IFR), which is the percentage who die after contracting the virus. This surely elevated fears around the ‘deadly’ virus.

Our world is now full of statistics and numbers. I wanted to share an important one with you – our latest figures show 19,470 people have recovered from #COVIDー19. That is 84.3% of those who have contracted this virus.

— Simon Harris TD (@SimonHarrisTD) May 13, 2020

More recently Fianna Fáil TD Cathal Crowe displayed the same confusion when he called a TikTok video ‘almost treasonous’ and ‘only a step or two away from being culpable for manslaughter.’

He added:

And at a time when those who contract Covid – there’s a fatality rate at the moment in this country of 6.2% of those who contract Covid – I think their actions in trying to draw the Covid virus onto themselves and pass it onto others, I think it’s only a step or two away from being culpable for manslaughter.

Reference to the CFR may give the impression the virus is more lethal than we now know it is. Raising alarm bells may serve a short term end of confining people to their homes, but will ultimately only lead to distrust as reliable scientific information is now easily accessible.

A similar caution should apply to emphasis by the current Minister for Health Stephen Donnelly on so-called ‘Long Covid.’ In June the UK’s Covid Symptom Study indicated that ‘one in ten people may still have symptoms after three weeks, and some may suffer for months.’ But the study fails to distinguish between asymptomatic and symptomatic cases, implying this is a reference to only confirmed symptomatic cases. Anecdotally, one Dublin GP consulted said he had not encountered a single case in his practice.

Long Covid appears to fit into the category of a post-viral syndrome, or post-viral fatigue which ‘refers to 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.’ The prevalence at this stage is unclear.

Mortality Projections

The medical historian Mark Honigsbaum writes: ‘by alerting us to new sources of infection and framing particular behaviours as “risky,” it is medical science – and the science of epidemiology in particular – that is often the source of … irrational and often prejudicial judgments … knowledge is constantly giving birth to new fears and anxieties.’[iv]

Epidemiology cannot be an exact science as it projects into an uncertain future. Michael Levitt has claimed that epidemiologists see their function, ‘not as getting things correct, but as preventing an epidemic. So therefore if they say it is 100-times worse than it’s going to be, then it’s ok.’ This approach may explain why a senior Irish health official told the Sunday Business Post in March that ‘1.9 million could be infected and become sick with the new coronavirus.’

But crying wolf with claims that prove wildly inaccurate over the course of a long pandemic cannot easily be repeated. It corrodes trust in scientific authority, which is an important consideration in an era of climate change.

Among the scientists that have risen to prominence over the course of the pandemic is Professor Sam McConkey. On March 11^th he predicted ‘there could be between 80,000 and 120,000 deaths in Ireland from coronavirus.’ McConkey has not been adequately held to account for the inaccuracy of this prediction, yet his projections continue to be circulated:

https://twitter.com/AodhanORiordain/status/1305613309752864771

The main go-to-man among Irish scientists for the Irish media has been Trinity Professor of Immunology Luke O’Neill. On June 22^nd he claimed that Ireland would have had 28,000 deaths if there hadn’t been a lockdown.

Yet in a long Twitter thread data analyst David W. Higgins provided a compelling argument that mortalities peaked prior to the nationwide lockdown at the end of March.

Higgins recalls the country went into lockdown in two stages. ‘The “first measures” were on March 12^th with school closures, social distancing and a ban on large gatherings …. Then on March 28^th, we began the ‘full lockdown,’ with non-essential workplaces shut and the 2km rule.’

Higgins worked from the assumption that symptoms manifest after five days, and that deaths, on average, occur after twenty. He calculated that ‘the March 28th lockdown should have led to a peak in deaths taking place over 20 days later, any date after April 17^th,’ which he said is ‘pretty much what the headline data shows. April 20th saw the largest number of new deaths.’

‘However’, he added, ‘we know that the date of death being announced is several days *after* the death actually took place,’ which, he reckoned, was typically about two days. Therefore, ‘the peak is more likely around April 15th.’

‘The problem is’ he said ‘that’s 2 days before the March 28th “full lockdown” should have had an effect.’ His conclusion was that ‘the full lockdown wasn’t the main cause for peak deaths!’, the implications of this were ‘profound’ he argued. He argued that ‘the social distancing alone (between March 12th and 28th) was the main driver of #FlattenTheCurve.’

Based on Higgins’s assessment, the laws introduced on March 12^th provided sufficient space for hospitals to handle a surge in cases that could have led to avoidable deaths from hospitals being overstretched. One may question O’Higgins’s assessment, but at least he has crunched the numbers, unlike O’Neill it would appear, who has offered no proof for his claim.

Forming Memories…

Another scientist to have gained a platform has been, Dr Tomás Ryan, a Trinity colleague of O’Neill’s, who is widely touted as an expert authority on this pandemic, despite being a neuroscientist, with no publications listed on Google Scholar related to contagious diseases or public health. Nor does he have a medical background. A recent paper, from June 2020 is entitled: ‘Memory: It’s Not a Lie if You Believe It.’

Ryan has been among the leading advocates of ‘Zero Covid’ Ireland, dedicated to ‘Crushing the Curve’, a global initiative of the Wellcome Trust that also supported Ryan’s thesis work. Ryan has written a number of articles for both the Sunday Business Post and the Irish Times, which does not appear to mount a paywall for his contributions.

Advocating a suppression of the virus in ‘the paper of record’ on June 10^th, Ryan claimed that a strategy of ‘living with the virus,’ would involve:

a cycle of successive lockdowns [which] would need to continue four to seven times until we reach a stage of herd immunity, with at least 60 per cent of the population infected. The health cost of this approach would be about 50,000 deaths.

Ryan makes no reference to any study on which he bases this mortality claim. He seems to be referring to the epidemiological assessment of Imperial College’s Niall Ferguson, the methodology of which has come in for serious criticism. In March Ferguson’s ‘best case outcome’ for the U.S. was a death toll of 1.1 million, rising to 2.2 million in a worst case scenario.

On March 17^th, 2020, Mark Landler and Stephen Castle in the New York Times wrote: ‘It wasn’t so much the numbers themselves, frightening though they were, as who reported them: Imperial College London.’ Due to the professor’s WHO ties, the authors noted, Imperial was ‘treated as a sort of gold standard, its mathematical models feeding directly into government policies.’ Yet despite a chaotic response from the Federal authorities, the U.S. death toll from Covid-19 remains below two hundred thousand, with daily deaths decreasing according to the New York Times.

Contrary to Ryan’s stark warning, Ireland has registered just over fifty deaths, as of September 20th, since the start of July.

A More Nuanced Approach

One-sided reporting of ‘facts’ around Covid-19 in Ireland is consistent with a concerted global effort emphasising the unprecedented danger posed by Covid-19. This account is predicated on the assumption that a reliable vaccine is the only way to bring the pandemic under control.

As mentioned, however, the pessimistic projections of Professor Niall Ferguson and others have proved unfounded, and recently the WHO’s Mike Ryan warned there is no guarantee that a vaccine will ever be found.

This leaves us in a position of zugzwang, a term which Emeritus Professor of Public Health at Edinburgh University Raj Bhopal borrows from the game of chess, meaning when the obligation to make a move in one’s turn leaves one in a serious, often decisive, disadvantage. He concludes:

The balance between the damage caused by COVID-19 and that caused by lockdowns needs quantifying. Public debate, including on population immunity, informed by epidemiological data, is now urgent.

Hearteningly, after a relatively heavy death toll in the spring, having avoided lockdown, Sweden’s case numbers have remained below the European average throughout September – lower even than its high-performing Scandinavian neighbour Norway.

This supports an hypothesis that a herd immunity threshold could lie at around 10-20%, ‘considerably lower than the minimum coverage needed to interrupt transmission by random vaccination,’ according to the University of Strathclyde’s Professor Gabriela M. Gomes et al. Professor Sunetra Gupta’s group at Oxford University have put the figure as low as 10%.

The scale of pre-existing immunity to Covid-19 is discussed in a recent article in the British Medical Journal. The authors remind us that the ‘research offers a powerful reminder that very little in immunology is cut and dried.’ Yet there has been little debate on the crucial question of herd or population immunity in the Irish media. This would involve an age-targeted strategy that takes account of the significant health impacts of lockdowns, especially on younger age groups.

Yes, my impression is also that most infectious disease epidemiologist favor an age-targeted strategy over general lockdowns. Among other scientists, most are silent, for obvious reasons, while almost all the vocal ones favor general age-wide lockdowns.

— Martin Kulldorff (@MartinKulldorff) September 19, 2020

We are now beginning to witness the emergence of a recognisably left-wing opposition to lockdowns as herd immunity ceases to be a dirty word; while Bill Gates has acknowledged: ‘the initial vaccine won’t be ideal in terms of its effectiveness against sickness and transmission. It may not have a long duration.’

Lack of ICU Capacity

Facts around Covid-19 remain keenly contested among scientists. It may well be that the extreme precaution advocated by the Irish government is indeed justified, but it is incumbent on the Irish media to validate carefully all claims, and permit frank debate to occur. Politicians can be forgiven for erring in not giving an accurate picture at the height of a pandemic, but more honest conversations are necessary as we move forward. It is incumbent on journalists to hold politicians, and scientists, to account.

Unfortunately Ireland’s dysfunctional system of public health creates additional risks that discourages any change in approach, and perhaps explains an apparent faith in a reliable vaccine being produced.

At the start of the pandemic Ireland had half the number of ICU beds and staffing compared to other E.U. countries. By the start of May, however, according to Feargal Bowers (who presumably can be relied on in this instance) there were 417 units; but by the start of June, that figure was 381; July 252; August 276. At the start of September it was 356. But, as of mid-September the number of ICU beds open and staffed is 278. Under questioning from Michael McNamara in the Dáil, Taoiseach Micheál Martin said that just twenty-three had been added since the start of the pandemic.

The pandemic has compounded a pre-existing health crisis, with 700,000 awaiting medical appointments by the end of May. Now restraints due to the pandemic are accelerating the highest rate of obesity in the E.U., with one in four adults falling into this category. But a recent study warns that any vaccine may not work effectively on someone who is obese.

Under-resourcing of the health system might best explain the ultra-cautious and draconian approach adopted by the Irish government, which is increasingly out of step with most its European partners, where social life has been permitted to resume under restrictions.

Feature Image: Daniele Idini

[i] MacIntyre, Whose Justice: Which Rationality?, University of Notre Dame Press, Indiana, 1988, p.357.

[ii] Mark Honigsbaum, The Pandemic Century: One Hundred Years of Panic, Hysteria and Hubris, C Hurst, London, 2020, p.75.

[iii] Coronavirus disease 2019 (COVID-19)Situation Report –46, March 6^th, 2020,
https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_4

[iv] Mark Honnigsbaum, The Pandemic Century: One Hundred Years of Panic, Hysteria and Hubris, C Hurst, London, 2020, p.viii.