In his commentary, Peter Gøtzsche1 makes many important points, among them the need to avoid overloading hospitals with people who are only mildly symptomatic, and he quite rightly notes the much higher mortality rate among the elderly.
At the same time, there are arguments that he presents that should be challenged. Is COVID-19 the equivalent of the annual flu? The World Health Organization estimates that the annual mortality from the flu is between 250,000 and 500,000.2 According to the Johns Hopkins website, as of 15 May, there were over 300,000 deaths from COVID-193 and the pandemic does not seem to be close to ending. So equating COVID-19 with the flu may be reasonable but it may not be.
Gøtzsche's message about herd immunity also seems to be confusing. He talks about greater herd immunity in Sweden than in Denmark. But later, he says that the infection rate on the Diamond Princess was only 19%. This was in a closed environment and 19% is not anywhere near high enough to confer herd immunity. How likely is it that there will be a high enough infection rate in Sweden to confer any degree of herd immunity?
Gøtzsche further compares the death rates in Sweden and Denmark. But since the 20 April figures that he cites, the numbers have increasingly diverged. As of 15 May, using the mortality figures from the Johns Hopkins website, the numbers are 357 per million in Sweden versus 92.6 per million in Denmark, a nearly four-fold difference. He correctly notes that it will take a few years to know which country's approach was the better one. At the same time, he seems to favour what Sweden did when says that ‘Sweden has remained a pretty open society that did not close down’, whereas Denmark has taken ‘draconian measures’.
None of the above should take away from the urgent debate that Gøtzsche is initiating and I hope that the debate will continue.
Declarations
Competing Interests
JL received payment for writing a brief in an action for side effects of a drug for Michael F. Smith, Lawyer, and a second brief on the role of promotion in generating prescriptions for Goodmans LLP. He is a member of the Foundation Board of Health Action International.
ORCID iD
Joel Lexchin https://orcid.org/0000-0001-5120-8029
References
- 1.Gøtzsche P. The coronavirus pandemic: can we handle such epidemics better? J R Soc Med 2020; 113: 171–175. [DOI] [PMC free article] [PubMed]
- 2.Nguyen H. What is the global incidence of influenza? Medscape Emergency Medicine. See www.medscape.com/answers/219557-3459/what-is-the-global-incidence-of-influenza (last checked 8 January 2020).
- 3.Johns Hopkins Whiting School of Engineering. COVID-19 Dashboard by the Center for Systems Science and Engineering. See https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 (last checked 22 May 2020).