Thread by @Jonathan_Witt

Here is a thread on an advisory issued by the Medical Advisory Committee on COVID-19 (MAC) co-chaired by Professor Koleka Mlisana (NHLS) and Professor Marian Jacobs (UCT). 🧵

For transparency this is the full advisory sent to the Minister of Health on December 16 2021.

Unfortunately there are malicious people who are still trying to destroy my life & career for having opinions on a pandemic. As such a disclaimer that these are my own views as a citizen of a country with free speech rights. This thread is fair comment & not advice in any way.

In my view this is arguably the most significant advisory from the MAC, and as such those with power to influence Government COVID policy, since close to the start of the lockdown in late March 2020. All of us on both sides of the argument have learnt a lot since then.

Everyone got things wrong along the way but some were far less mistaken because of a reliance on previous evidence as opposed to forward modeling. At a base level you either viewed this as a virus in the context of everything we already knew or as a totally brand new situation.

Those of us who advocated against many of the measures put in place over the past 22 months did so because we believed they were of greater overall harm than benefit. Almost universally those who disagreed and considered the measures advantageous held the power to act.

As such measures put in place to ‘flatten the curve’, ‘slow/stop the spread’, ‘protect the hospitals’ etc. include:

- Contact tracing
- Lockdowns (incl. quarantine)
- Social distancing
- Masks (mostly fabric)

Others exist but the above were all commonplace globally.

The MAC advisory is proposing the abolition of quarantine (the isolation of well individuals who are believed to have come into contact with a person confirmed to have COVID-19) as well as the immediate cessation of contact tracing (finding all contacts of a positive case).

The wording, logic, and rationale used to arrive at said recommendation is very significant and deserves further analysis because it represents a potential sea change in the public health response to the pandemic, which may have far reaching effects on Government legislation.

The first rather stunning admission in her advisory is the statement that “the proportion of people with immunity to COVID-19 (from vaccination and/or infection) has risen”. This may seem obvious but it openly acknowledges the existence of natural immunity post infection.

Our MAC is therefore acknowledging that previous infection grants a level of protection against COVID-19. This is in line with pre-2020 understanding of viral immunology as well as published data during this pandemic, but has been a point of contention for various reasons.

The next statement of interest is an admission that “efforts to eliminate and/or contain the virus are not likely to be successful”. Such a disclosure places all measures which try to slow or stop the spread in question. This does not imply doing nothing but rather pragmatism.

The advisory further states that “quarantine is not an effective measure for containing [the virus]”. The reasoning behind this is again of great significance and value in potentially changing our approach to dealing with what is now an endemic pathogen.

Of note is an admission that the testing used is “suboptimal” with reference to the sensitivity. There may be disagreement here but it’s a rather rare criticism of the testing which has been used throughout this pandemic at great cost.

Furthermore the statement that “quarantining and contact tracing are of negligible public health benefit…” is yet another nail in the coffin with regards to much of the existing policy including lockdowns which are just quarantine at the level of an entire population.

Following on from this is a section dedicated to addressing “an outdated understanding of the transmission dynamics of SARS-CoV-2”. This includes spread via aerosols which “can occur over distances greater than 1-1.5 meters”, negating social distancing amongst other measures.

The MAC further acknowledges the “substantial economic and social burden” of quarantining including the “loss of income, loss of employment, and loss of schooling time” all of which have been the major thrust of those pushing back against lockdowns over the past 2 years.

Their recommendations are that quarantining, i.e. of people not diagnosed as having COVID-19, “be discontinued with immediate effect”. Of note is the recommendation that vaccination status not be a point of discrimination suggesting an equivalent view of transmission risk.

A further recommendation is that a person need not test for COVID unless they “become[s] symptomatic”. This is simply massive because it signals the end of asymptomatic (asymptomatic spread) and a return to pre-pandemic processes of only testing sick people for disease.

Finally is the recommendation that contact tracing be stopped, with which I’ve already dealt but consider that countries like New Zealand amongst others are still attempting to employ this failed approach and you begin to understand the gravity of such a position.

In closing the MAC notes the unsuccessful nature of quarantining and contact tracing as well as the “costs to the individual and broader society”. Simply put this is mostly an excellent and very important advisory which reflects a reasonable and thoughtful scientific approach.

The real question is where to now? What’s done is done and unfortunately the mistakes which have been made along the way can not be taken back. The time for reflection will come but this should not preclude changing direction and doing the right thing even at this late stage.

We can only hope that the Minister of Health and others in Government take heed of this advisory in its full context and meaning, allowing them the serenity to accept the things they can not change, the courage to change the things they can, and the wisdom to know the difference.