“Not much in life is easy, nothing is a cruise, nothing worth while often in any case, this is why we like to take cruises now and again, but many of us will only start cruising again when no testing and no masks or vaccine evidence are required, when good clinical evidence is followed to protect the public, and the current clinical picture is considered, so when things go back to normal, no ‘new normal’ is needed, education is needed, so that we don’t cough or sneeze on each other and wash hands before we eat, but that should have been part of responsible living, so can’t really be seen as a new normal, just development and education”, GP.
“Everyone wants to take a rental car or cruise rather than a flight to get some normal and freedom back in their lives”, medical specialist.
Evidence-based protective factors for general health and mental health include education, autonomy, normalcy and liberty. We have written much regarding these topics since March 2020.
We have been asked to liaise with cruise lines and to inform colleagues and patients which cruise lines have removed mandatory mask policies: (This is our current understanding from websites, information pages, emails and/or direct liaison. We have focussed on the 10 names were were asked to provide information on. Please know policies sometimes change rapidly for various reasons.)
1. NCL – Norwegian
2. Holland America
3. Royal Caribbean
4. Seabourn (policy changed)
Celebrity still mandates masks in the casino and theatre. Celebrity has been most helpful, and was one of the first cruises to inform us that they are changing their mask policies to protect adults and children. We thank them. MSC mandates masks on their ships, as per our current understanding.
It is our understanding that cruise lines follow the guidelines of the country they depart from, eg if a cruise departs from the USA, they follow the CDC’s cruise guidelines, and if a cruise departs from Spain, the ECDC’s cruise or general guidelines.
Please know that cruise lines and airlines, like the general public, have to comply with national laws and policies at all times, so ports and excursions follow the rules of the host nations. Most nations are reviewing their policies, the current clinical presentation and good clinical evidence, and most are moving forward following good clinical evidence. We thank you.
Evidence-based protective initiatives for children’s and adults’ development, general health and mental health, along with social risk, include, but are not limited to; education, autonomy, liberty and normalcy. Neglecting protective factors, strategies or initiatives will usually increase social risk, along with mental health and general health risks, morbidity and mortality. Delays in restoring or maintaining protective factors sustain increased risk and harm for children and adults, general morbidity and mortality.
Increased risk and harm to children and families:
In 2020 and 2021 we shared comments and recommendations as well as statements and statistics with relevant authorities regarding increased bio-psycho-social risk and harm to children and the general population by indiscriminate mandatory initiatives not based on good evidence published by organisations including The Trussell Trust, WHO, UN, UNICEF, NSPCC, Oxfam, Stop UK Hunger, MIND, Young Minds, Samaritans, England’s Children’s Commissioner and Public Health England.
Concerns have now increased markedly, compared to 2020 and 2021, by ongoing indiscriminate mandatory initiatives, not based on good clinical evidence or the current clinical presentation, this includes, but is not limited to:
• Social Risk: All 4 categories of child abuse, along with domestic violence, general violence, aggression and assault, as well as alcohol and illicit drug use have increased markedly. At least 90% of our patients report that their concerns are due to indiscriminate mandatory initiatives. At least 90% of colleagues and individuals we liaise with report concerns in this domain are due to indiscriminate mandatory initiatives. Most report “no one can survive or stay healthy or keep mental health or children develop as they should without freedom, autonomy and normal, especially with covered faces when no doctor with good training or experience can support any of this, and this now when hospital admissions and deaths are down 50-75% for 6 months already, why are so many countries dropping all restrictions and rules and carrying on as normal to protect their people … and they don’t even count cases any more, because the clinical picture indicates that this is no longer necessary …continuing with depriving freedom, normal and autonomy is not a clinical decisions, so probably then political or emotional, because most people are smart, and anyone who understands health or medical risks knows that clinical decisions should not be made in fear, but based on the current clinical evidence, which has now been evident for 6 months, nothing here is now complicated or risky in the context of health, most agree on that, … so we are ‘waiting’ and causing much more harm by ‘waiting’ to restore freedom, autonomy and normal which we all know people need for health and mental health and to reduce general risk, … this ‘waiting’ whilst causing harm is the worst thing I have seen in my career – most who have little experience in medical risk management often make decisions in fear, or say they are uncertain and to ‘watch and wait’, and this often causes more harm when decisions are made based in fear or protection is delayed whilst we ‘watch and wait’ – what we fear we create often – so best to take emotion out of risk management in health and rely on medical doctors with training and experience and who understand medical evidence”, medical doctor with 20 years experience. “Every day that we continue with compulsory masks or testing or asking for vaccine evidence, we cause more harm to children and adults by many pathways, such as maintaining drama, chaos and fear, but direct pathways too, and there is no clinical basis for this, we all know that now, so why cause harm one more extra day.” Medical specialist
• Child Well-Being: Many report regression in general development such as bed wetting or night terrors. Concerns regarding general anxiety, anger, frustration, irritation and low mood have increased markedly (not congruent with a mental health diagnosis or mental illness). Many also comment on “absolute dependence on face masks”, for reasons not relating to health, and subsequent non-compliance with evidence-based strategies to reduce risk, medication or therapeutic input to manage serious mental health problems. Many report “children of all ages, some 3 years old, are terrified, some refuse to take off masks when they sleep, or part with them for one second, they scream, they are hysterical, they believe they will die. … I have never seen such severe and widespread problems, this hurts children’s well-being, development, mental health and general health”, child psychiatrist. All of these concerns are also identified within the adult population. At least 90% of our patients report that their concerns are due to indiscriminate mandatory initiatives. At least 90% of colleagues and individuals we liaise with report concerns in this domain are due to indiscriminate mandatory initiatives.
• Child Development: Concerns relating to emotional, social, language, cognitive and physical development have consistently been raised by Education and Health. “The problems we now see with child development are mostly due to rules and policies restricting freedom and autonomy, removing a chance of a normal life”, child psychiatrist, 20 years experience. “These messages and stories we create with masks, of fear and danger, it changes who children are, how they view the world, people, themselves, their future and lives, it causes disasters.” paediatrician. At least 90% of our patients report that their concerns are due to indiscriminate mandatory initiatives. At least 90% of colleagues and individuals we liaise with report concerns in this domain are due to indiscriminate mandatory initiatives.
• Education: Many children have not engaged in education for many reasons since 2020. Many schools insist that “children not attend lessons until their assessment with CAMHS (mental health) is concluded, which now can mean 5 years (due to waiting lists and increase in demand, often by 1000%)”, clinical director, CAMHS. Many schools remain closed in some countries or areas. School is a protective factor for most children for many reasons including education, social interaction, opportunities for development or “the only place many children get a meal or feel safe”, social worker. “At least 50% of all children are abused in this area, it is likely more, like in many areas, so it is important to stop regulations depriving children from a safe and normal life and from education – because this problem now increases 2-10x – and we stop this by making sure their parents have freedom, normal and autonomy, because if we don’t, the children pay the price, it really is not very difficult to understand”, social worker.
• Child Mental Health: Mental health concerns have increased in all domains, such as relating to eating disorders, anxiety disorders, mood disorders or behavioural concerns, and particularly regarding risk to self and others. Referrals to many child mental health teams have increased by 100-1000%. At least 90% of our patients report that their concerns are due to ongoing indiscriminate mandatory initiatives. At least 90% of colleagues and individuals we liaise with report concerns in this domain are due to ongoing indiscriminate mandatory initiatives. “Rules that mean we live in prisons”, child, 15 years old, who plans to become a solicitor. Please know that waiting lists have increased markedly, some families are informed that they have to wait years for children to receive an appointment, and that their team has no child psychiatrists.
• Adult Mental Health: Mental health concerns have increased in all domains, but particularly regarding risk to self and others. At least 90% of patients report that their concerns are due to “never ending” indiscriminate mandatory initiatives. At least 90% of colleagues and individuals we liaise with report concerns in this domain are due to ongoing indiscriminate mandatory initiatives.
• General Health for Adults and Children: General health morbidity and mortality have increased significantly. At least 90% of patients report that their concerns are due to ongoing indiscriminate mandatory initiatives. At least 90% of colleagues and individuals we liaise with report concerns in this domain are due to ongoing indiscriminate mandatory initiatives. Direct causes such as relating to wearing “exposed or contaminated face masks or not building a natural immunity”, and indirect causes such as relating to chronic “anxiety harming health and the immune system” are relevant, along with markedly increased over the counter and prescribed medications to “cope with face masks”, GP. “Neurological, dermatological, rheumatological, immune or allergy related, gastro-intestinal, cardiac, respiratory (not related to this outbreak) concerns have increased very significantly”, medical specialist. Paediatricians agree “children are just not doing well at all, it is really not good”. Direct complications of indiscriminate mandatory initiatives are reported to be “hidden, like the true statistics, such as serious complications with nasopharyngeal sampling or … or the damage done to children by or during testing, or what happened when someone was forced to quarantine or self-isolate, … , what happened to people with dementia, child abuse, …”, paediatrician.
• Engagement in Medical and Mental Health Services: Many individuals have disengaged with services for many reasons. At least 90% of our patients report that their concerns are due to indiscriminate mandatory initiatives; “I cannot go anywhere if I can’t go as normal”, GP. At least 90% of colleagues and individuals we liaise with report concerns in this domain are due to indiscriminate mandatory initiatives.
• Trust: Many report “I will never trust them again…”, government worker. “They have delayed in restoring freedom, normal and autonomy, and this causes harm to most, how do you trust anyone who cannot manage something that is relatively simple compared to most diseases or medical risks, especially now, this cannot be argued by any medical doctor”, GP. These concerns are directed towards government, medical doctors, psychologists, therapists, social workers, police officers, and affect compliance with treatment and prognoses. Trust relates to compliance and good clinical outcomes. Trust is often step 1 in good clinical outcomes. Trust is earned in many cases and based on transparency, education and consistently following good clinical evidence, prioritising the patient or child or patient group “ahead of all other agendas”, GP.
“Further delays in restoring normal, free lives and choice will cause a lot of harm, one extra day will cause harm to children and adults – harm that can take years to recover from.” Medical specialist
“It makes little sense that millions of people can and have spent months on beaches, in shops, restaurants, bars, boats or educational or entertainment venues without restrictions, but for the two hours that they board a plane or enter an airport they have to go into a ‘no freedom’ (or no choice or no normal) environment. No medical doctor will make these decisions, because it simply makes no medical or clinical sense, it is mixed messages and this causes chaos, confusion, frustration and harm. Why is it so difficult to be consistent, united, offer congruent strategies or opinions – the one way to be consistent is to follow the clinical picture and clinical evidence – then there would be very few outliers, it is simple to protect people really, but you need experts who are confident in understanding medical or clinical patterns and risk”, medical specialist, expert in the field.
Colleagues report “I will go out of my way to support countries and areas and businesses who do not restrict freedom, or normal, focus on good education and respect autonomy and medical opinions, places who follow laws, the laws that protected most people”, medical specialist. “I will choose airports, airplanes, travel routes, travel destinations, shops and restaurants where there are no restrictions, because clinical thinking, clinical evidence now requires this, and we have to vote with our feet”, medical specialist, 25 years experience.
“Look at Sweden, Norway, Finland, Denmark, France (recently), the UK, so many other countries and areas in countries where there are no restrictions, where people have choice, freedom and a normal life, a chance for a normal life … where borders have been open mostly, … it is clear that their serious morbidity and specific mortality numbers are lower, better…. counting numbers now are silly most agree, it is like counting numbers for a cold or allergy, it is just not necessary”, medical specialist, expert in the field. “Serious cases and mortality are always counted for disease, it is part of good medical practice, but it is now necessary to stop counting general positive tests, and sharing numbers with the public like Football scores are now causing more harm than good”, medical specialist.
“Finding evidence of harm and concerns are not now as simple as checking scores or statistics, you have to speak to people, speak to GPs, ITU consultants, A&E consultants, social workers, teachers, child psychiatrists, psychologists, paediatrics, and they will tell you what they see, what they worry about, how their cases have changed, what people, colleagues and patients say… the pattern or truth is not always easily found, but it is there if you look for it, and many doctors have looked for it or are looking for it, and hopefully it will be shared with the public and we can all learn from this one day”, medical specialist.
We would like to thank countries, counties, states, organisations, establishments and individuals who have taken this opportunity to reduce risk and harm for children and the general public by following good clinical evidence in terms of risk factors and protective factors such as liberty, autonomy and normalcy – you have saved lives by following good evidence.
“This is why it makes no sense to make vaccines compulsory for restaurants or shops or to enter countries”, GP.
We, along with most medical doctors, still however recommend vaccines to adults (and to children in specific circumstances) where possible benefit clearly outweighs possible risk. Please see previous post.
We have been very concerned by statements such as “if we get vaccines, it will stop our natural immunity”. This is makes little clinical sense, as most experts in the field agree. Vaccines contribute to risk management, natural immunity contributes to risk management, and both can occur alongside each other and both offer increased benefit.
Concerns have been raised since 2020 regarding a lack of emphasis on evidence-based protective factors for health including relating to;
1. maintaining a healthy immune system, able to adapt and respond appropriately to adapting biological agents (ie natural immunity), natural immunity, and
2. the negative implications of many indiscriminate mandatory initiatives such as face masks, closure of borders and travel restrictions on the immune system for many (most agree that these measures can prevent the immune system from learning, adapting or remaining strong or robust through more than one pathway eg lack of normal everyday exposure or chronic anxiety seriously harming the immune system).
Evidence-based protective factors such as normalcy, liberty and autonomy protect the immune system, general health and mental health, and reduce social risk. Many agree that public education was lacking in terms of these evidence-based protective factors and maintaining a healthy immune system in many countries.
Concerns regarding natural immunity were raised based on clinical experience in informal settlements in developing countries and in contexts of infectious diseases including respiratory diseases such as TB, or HIV and individuals with compromised immune systems.
Many have commented that “it is interesting that people in informal settlements (not wearing masks or engaging in social distancing) are not getting sick, is it their robust immune systems, is it their calm and positive mental states, their camaraderie, community spirit, looking after each other now more than ever, protective factors of normal, freedom, choice, their longstanding education about respiratory diseases, because so many have HIV or TB or Hep B or C – one thing is for sure – their natural immunities are good”, GP.
We continue to recommend, like most colleagues and professionals in the field, that individuals at high risk for severe COVID-19 be prioritised and safeguarded in terms of vaccines and other evidence-based voluntary initiatives to protect health.
Concerns have been raised regarding “vaccine mandates, making vaccines compulsory, mass vaccination with leaky vaccines and in this climate – it can lead to more harm than good”, infectious diseases doctor.
Colleagues report that “the current clinical picture or presentation, based on this current variant, indicates that it is essential and urgent to now, without delay, discontinue vaccine mandates, boosting everyone and mass vaccination to prevent encouraging a more virulent form of this viral agent, which is the likely clinical outcome if we continue in this way, and it is just as crucial that all other rules eg masks, tests, now discontinue so that people’s immune systems and health can get a chance to build up reserves and strengthen, there is no more emergency, and calling this a state of emergency has now been false for many months”, consultant in infectious diseases.
“How can your natural immunity develop if you wear masks, stay at home, close borders, you are making yourself more vulnerable, so speak to your doctor, get specific advice for you as an individual”, specialist in general medicine.
“I am worried that my and my family’s immune system is vulnerable, our borders are closed, we live in fear, we wear masks, it is not good – the virus learns and evolves, but we get weaker, we don’t learn and our immune systems don’t evolve or adapt, because we stay in isolation”, medical specialist.
Professionals have recently raised serious concerns regarding “the risks of mass vaccination, vaccine mandates and boosting every person in this current environment with ‘leaky vaccines’, mid-pandemic with the current infection rates… (it can) lead to this virus developing in a more dangerous variant – we need to accept that we are now at a place in terms of variants and virulence – the best we’ve seen – we should not pressure this virus further – we should now stop everything except education and making vaccines or boosters available for people high risk for severe COVID”, virologist involved with vaccine development.
“Asking people to be tested before entering a country, or for vaccine evidence, or to stay in quarantine is a bit dark age thinking now, when this clinical presentation is similar to a cold or allergy in terms of risk, it is time to follow good evidence, and globally, we need to stop this now, not in a graded fashion, but in a clinically appropriate fashion – the risk is now low, so we stop restrictions – this is clinical thinking, otherwise it would be political thinking”, medical specialist in the field.
Most colleagues agree that “we should focus on high risk for severe COVID only, not those around them, vaccine mandates, mass vaccination and mass boosting are now inappropriate, …, in this current climate, likely promoting this virus to evolve …”, immunologist.
Comments such as “leaky vaccines can produce stronger variants of viruses” are frequent; this is not a criticism to vaccines or vaccine developers or organisations, however, it is a matter to consider from a clinical point of view. “Vaccines vary in their protective properties and although some completely block infection, others only prevent disease symptoms but not infection or onward transmission. The latter are termed ‘leaky’ or ‘imperfect’ vaccines.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058279/ As mentioned in previous summaries, most regard the purpose of vaccines to prevent serious symptoms, hospitalisation and death.
Colleagues agree that boosters are not clinically indicated to anyone except those at high risk for severe COVID-19, that this group should be prioritised worldwide, and that “continuing to boost people indiscriminately will cause more harm than good in terms of the progression of this virus and outcome”, virologist.
Most agree, based on weighing clinical benefit and risk, that vaccines should be offered to all adults, but not made mandatory, and that no coercion should occur (eg not being allowed into countries or restaurants without evidence of vaccines). “Having to show vaccine evidence makes zero sense, because vaccines offer protection for 10 weeks or so, whilst natural immunity lasts much longer, we should .. protect .. health through protective factors for the immune system, freedom and normalcy”, vaccine developer.
As per previous posts, natural immunity is facilitated through regular, normal everyday exposure, and can be reduced markedly by indiscriminate mandatory initiatives such as face masks, closed borders, travel restrictions, stay at home messages, self-isolation and quarantine or lockdown. Clinical indications, weighing possible risks and benefits, for specific patients, are essential in all matters relating to health, including health crises. Most colleagues agree that indiscriminate mandatory initiatives likely harm the majority of the general population, high risk and low risk groups, and that patient specific indications are required to prevent increased risk and harm to high and low risk groups in state of emergency contexts and in urgent or routine health contexts. “A health context is a health context, whether emergency, urgent or routine; nothing should change, if anything, doctors’ guidance should be more important in health emergencies”, Emergency Department doctor.
Regular everyday exposure does not mean purposefully exposing oneself to risk, but continuing in a normal and responsible way with every day life. Responsible ways will include following evidence-based (based on good evidence) initiatives such as remaining calm and positive or regularly washing hands before eating. Normalcy, education, autonomy and liberty are evidence-based protective factors for a healthy immune system, general health and mental health.
We have previously commented on the various methods in which the immune system is being harmed by many initiatives, for example, directly through lack of normal exposure, or indirectly through chronic anxiety. We have shared concerns regarding the effects of chronic anxiety, anger, frustration and low mood on the immune system, general health, mental health and social risks, and these concerns have been supported by numerous national and international organisations since 2020.
Colleagues are concerned that many patients now present with concerns relating to various allergies, an overreactive immune system, along with concerns relating to autoimmune and poor immune systems, likely precipitated by chronic anxiety or other factors.
A healthy immune system is of vital importance in the context of the pandemic, our most comprehensive summary in this regard was in the summer of 2020.
Please know that we do not recommend any supplements or vitamins to ‘boost your immune system’. Please consult your doctor and confirm that you have a particular deficiency or specific clinical indication, such as pregnancy, before taking supplements, vitamins or minerals.
Protecting your immune system occurs through consistent;
1. Managing stress levels, anxiety, anger, low mood – maintaining a calm and positive mental state (we have posted thoughts on this topic in terms of environment, activities, thought management, breathing, managing emotions, behaviour etc).
2. Balance in life – rest, work, play, learn, teach, enjoy – most forget the enjoy part.
3. Sufficient sleep, and daily movement or exercise that is enjoyable – ideally getting outdoors and into nature. Exercise that is not enjoyable will not be maintained, so find an activity that you enjoy very much such as surfing, kayaking, swimming, boating, dancing, walking with your dogs or friends, or horse riding. Children should never be told to ‘exercise’ in our opinion, children should be asked to ‘go and play a ball game or swim’ (age appropriate and with the necessary support and supervision), which children will enjoy. Themes of weight, food or exercise are best avoided with children. Food and exercise should be enjoyable and fun. Teach children to fish, to barbecue fish or make pasta – enjoying the time together (again age appropriate and supervised).
4. Eating healthy, enjoyable and balanced meals. We have provided details on healthy and enjoyable food options such as pesto or tapenade. Drink enough water every day.
5. Support networks in work and personal life. “Join a club if you need to, or visit the same coffee shop every Monday or day”, GP.
6. Regular enjoyable and normative activities – “join a club, forget about life or the world or your problems for a while”, GP. Many report that their anxiety levels “disappeared after getting a dog and spending a lot of time together every day”, child of 17.
7. “Have a dream, work on it, enjoy it, be excited about it, let it consume you in a good way. Learn something, be part of something, have a carrot”, child age 15.
Many more strategies are available.
First do no harm is key in protecting health and in Medicine, and most medical doctors with extensive training and experience know that simple measures, available to all, often have the most powerful outcomes.
Current symptoms, hospitalisation rates and mortality
“The presentation for COVID-19 has changed”, as reported by professionals, September 2021. Many now report that common symptoms include headaches, rhinorrhoea (runny nose), fatigue, sneezing and sore throat or most present with no symptoms and no illness (“even high risk for severe COVID individuals, and those with or without vaccines too”, GP).
Most medical doctors still recommend vaccines for adults, however, most agree that vaccines should not be compulsory and that children should only receive vaccines if medical doctors weigh individual risks and benefits for the specific child (similar approaches are required with all adults as per good medical practice).
Most agree that for this clinical reason, positive COVID-19 tests should now be ignored unless associated with serious or severe symptoms or serious clinical signs; patients at high and immediate risk for hospital admission or requiring hospitalisation.
“This virus or variant now causes more upper respiratory symptoms similar to the every day cold and allergies, compared to lower respiratory symptoms, which means much less morbidity, so less serious symptoms, less risk of complications or negative outcomes such as pneumonia, less hospital admissions and less mortality or death, and this is what we see almost everywhere … so we need to stop the state of emergency”, professional in the field.
“It has been reported and recognised in data from South Africa, the ECDC, WHO and UK Government that currently predominant Omicron variant has generally been causing a different clinical presentation with predominantly upper respiratory symptoms. The top 5 symptoms: Runny nose, Headache, Fatigue, Sneezing, Sore throat, Ref. UK ZOE Study, a more often asymptomatic or milder clinical picture, and significantly lower rates of hospitalisation and mortality, while vaccines remain relatively effective in preventing moderate and severe disease.” Consultant in Internal Medicine
Dr Monica Gandhi, Professor in Medicine, San Francisco General Hospital, and Dr Jeanne Noble, Professor in Emergency Medicine and Director of COVID Response, UCSF: “A more appropriate goal of protecting those at risk of severe breakthrough infections is now in order. A new framework in light of Omicron will help move us beyond the continuous cycle of removing and reinstating COVID restrictions based on metrics that are no longer clinically relevant…effective vaccines that are operating precisely as intended to prevent serious illness or death.” “In a vaccinated population, the relationship between case counts and hospitalizations has been uncoupled. Because so many vaccinated individuals may test positive for COVID-19 with few or no symptoms, the number of infections in a community no longer predicts the number of hospitalizations or deaths.” https://time.com/6131104/rethinking-covid-19-restrictions-2022/
Many colleagues in many countries report that most vaccinated and most unvaccinated individuals test positive for COVID-19 with few or no symptoms, not only vaccinated individuals, “possibly due to a natural immunity developed by many, so it is necessary to discontinue all COVID testing without patient specific clinical indications”, anaesthetist managing ITU, 40 years of clinical experience in various health settings.
Current and valid research in various countries including but not limited to South Africa, Asia (eg Hong Kong), the USA, the EU (eg Belgium, Denmark) and the UK (eg Cambridge, London and Edinburgh) support the above in terms of current clinical presentation.
Most medical colleagues agree that pandemic related restrictions need an urgent review and discontinuation. Finland recently discontinued all restrictions (we understand Finland was the first country). Countries in Scandinavia followed. Sweden has offered excellent normalcy, liberty and autonomy from firsthand experience (including countries in Asia, as previously mentioned). The UK has discontinued many restrictions and plans to discontinue restrictions, as far as we understand. The EU is reviewing restrictions. Many other nations are joining these frontrunners in following good clinical evidence. Let’s lead by doing.
We have been asked to comment on relatively common infectious diseases and mortality, or infection or case fatality rates. We appreciate continued information, advice and recommendations or comments by professionals in infectious diseases, virology and microbiology. Please know that statistics may vary depending on various factors.
In 2020, before vaccines were available, the following statements were published (we have been asked to repeat these):
• “80% of the time COVID-19 is a mild disease that feels like a minor cold or cough.” Prof P Piot, Director for The London School of Hygiene and Tropical Medicine
• “95.5% of the general population will likely not require hospitalisation, only 4.5% of the global population will likely require hospitalisation if infected with SARS-CoV-2.” The London School of Hygiene and Tropical Medicine
• “Only 4% of those younger than 20 years could be at increased risk for severe COVID-19.” This is an important and relevant statistic to consider when making ethical and lawful decisions regarding children in the context of the pandemic. “About 1 in 5 individuals worldwide could be at increased risk of severe COVID-19, should they become infected, due to underlying health conditions, but this risk varies considerably by age, for instance, the risk is 4% for those younger than 20 years and >66% for those 70 years and older.” https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30264-3/fulltext
• Organisations including the WHO have reported on previous flu (influenza and coronavirus) outbreaks and related mortality rates before the pandemic: The WHO reports “650 000 people worldwide die of respiratory diseases linked to seasonal influenza each year, up to 72 000 of these occur in the WHO European region”. It was estimated that in 2020, 1.935 or nearly 2 million of 7.75 billion people died due to COVID-19. The case fatality or mortality rate was estimated to be more or less 2% for COVID-19, some reported 1-2% or less at the time. The Imperial College, London, estimated an infection mortality rate for COVID-19 of more or less 1.15% in the UK and high income countries in October 2020.
The current world population is estimated at more or less 7.9 billion people, with COVID case and infection mortality rates markedly improved compared to 2020. Infection mortality rate is estimated to be between 0.15-0.66%, and the global case mortality rate 1.43% at this time, although many believe these statistics are much lower due to “inaccurate reporting”, GP.
Mortality and morbidity rates can vary depending on a multitude of risk and protective factors, and over time, as is often observed in various infectious diseases or outbreaks. Many doctors manage these biological risks, “more dangerous …”, on a daily basis, and report that “it is not necessary to refer to us as heroes, we would prefer that this not occur”, ITU consultant.
Medical doctors report that “it is surprising and unfortunate that mosquito born illnesses and related deaths per year, … are not getting the attention or vaccine development for safe and effective vaccines it needs; GPs, the medical profession and the public are not educated about infection risks, symptoms to look out for or vaccines, busses are not offered without mosquito infestations during cruises or visits in the tropics, …people make .. mistakes if they think these (mosquito born) diseases are not already in the UK and EU, …”, consultant in infectious diseases. Many colleagues are making progress in this regard.
Fear is not a useful tool in a health crisis or in the context of medical problems or infectious diseases. “Fear in leadership usually means ignorance, or someone has an agenda (trying to sell you something)”, GP. “Fear can be a useful tool if you see a snake in the road, then you freeze, or slowly move away, but fear will only give a virus more power, because your immune system won’t maintain strength with chronic fear or anxiety”, GP. Remaining calm, positive, education and evidence-based initiatives, such as washing hands before eating, covering your face when sneezing or coughing, are useful tools.
In Singapore, in 2020, the general public was advised to remain calm, positive and to engage in normative activities, but with evidence-based risk management strategies, such as washing hands before eating. These statistics, in Singapore, relating to the pandemic, are very good.
We have been inspired by many nations’ simple and evidence-based approaches to protect general health and mental health for all. These approaches inspired trust between leaders and the general public.
We would like to thank colleagues in infectious diseases, virology, microbiology and pathology for their continued advice and recommendations.
“We have experienced a feast of freedom, normal and choice in Florida, we feel our health is much better”, 80 year old veteran. “People can relax, they feel good about the future, they can do what they believe is right, no one is forcing anyone to do anything”, 75 year old pilot.
“It is interesting, since 2020, the people who refused to wear face masks are mostly retired, over 70 and often veterans, they, like me, say, we’ve fought wars, we know about what makes sense, we know how important freedom is”, retired GP, veteran.
We have observed less anxiety within the general public in Florida compared to the UK or the EU (December 2021). We have written extensively about the risks relating to chronic anxiety in terms of general health concerns, mental health concerns and social risk.
Many report “…Here they continued with (New Years) fireworks, because fireworks are not inappropriate, it gives people hope, it says something, … I would definitely recommend Florida to experience normal, wellness and justice in terms of human rights in most places, and people follow evidence-based approaches; the leadership is clearly very good,” Medical specialist, 30 years experience.
Many raise concerns that “we had to cancel New Year’s fireworks, although most sat at restaurants, good distances, or in cars, to watch fireworks, but we are allowed on New Years to jump into freezing ocean water together as a group of a hundred, all together, right next to each other, when 5C outside, but then we have to wear face masks, and we are told this is for a respiratory virus, come one”, GP, Europe.
“People from the states, Canada, the UK, Europe now say they came to Florida ‘for the freedom’, I agree. … I will always choose to avoid drama, shouting and chaos, because I prioritise health. I wish the business leaders would follow the government leaders’ recommendations (here) .., because this would not be a problem here if they did.” Medical specialist, 40 years experience
“We avoid businesses or places where masks are compulsory if we can, especially if not made a rule by the government, …. Where one stands in crisis is important, and leaders who protect, based on good evidence and clinical outcomes, must be rewarded and will receive our business. Some shops are friendly, some are rude and refuse you entry without a face mask. Face masks often cause prejudice and aggression. In many places only 1/1000 people wear a face mask, and their COVID statistics are better than in places where most people wear masks.” Business leader
Further to liaison with peers or colleagues from the USA, UK or EU when in the USA (January 2022), or when liaising with medical colleagues from the USA visiting in the UK or the EU recently (end of 2021), we observed a significant change within the medical community, increased curiosity and systemic thinking, asking numerous questions outside of their usual fields of expertise, and significant assertiveness associating clinical roles with responsibility and following only good clinical evidence, decisions based on clinical training and experience. This systemic trend has also been reported in other countries. All raise similar concerns relating to liberty, autonomy and normalcy not being prioritised as part of protective factors for health. Less than 1% of medical colleagues agree that face masks are helpful in general public settings, indoors or outdoors, for this virus, and most share concerns that masks can harm many people in various manners. Most are concerned that clinical evidence has not been critically reviewed by those with training and experience in this context.
Academics and medical doctors agree that “we should lead by example, and we visit and try to remain in areas where normal, freedom and choice are prioritised”, professor in Internal Medicine.
Most refer to Florida as a state where good clinical evidence is prioritised, with a focus on education, normalcy, liberty and autonomy, and report that “more or less 1/1000 people wear face masks along the gulf and east coast, indoors or outdoors, many say shops pressure them to wear masks in cities, so they leave”, and most agree that “Miami offers excellent opportunities to improve health, especially with one of the main beach roads closed, which causes a relaxing, safe, community and normal atmosphere”, GP.
We have previously shared Florida’s Governor’s approach, which most medical colleagues support. Nearly all members of the public we liaised with in Florida from all backgrounds shared positive statements regarding their governor; “he is not emotional, he is clear, calm and organised, he prioritises protection, good evidence, reduces harm”, and many credit his military background.
Good leadership and a systemic approach, considering all of the relevant factors, following good clinical evidence in terms of risk assessment, risk management, respiratory infections and general health, along with evidence-based protective factors are important.
The complex can be made simple in medical or health contexts, but we should start with good clinical evidence and medical doctors with appropriate medical training and clinical experience in systemic risk assessment and management, and infectious diseases.
This photograph was taken in Miami, Florida. Most are grateful for the liberty, autonomy, normalcy and evidence-based approach to managing risk, that Florida offers individuals of all ages.
Freedom, autonomy and normalcy are evidence-based protective factors for mental health, general health and social risk or peace.
Patients and colleagues asked us in 2020, 2021 and 2022 to provide insights and information on which countries, areas or organisations follow good clinical evidence regarding the management of risk factors relating to respiratory diseases, and protective factors for health, mental health and social risk.
Countries, areas or organisations often change their approach for different reasons, some relating to a clinical change in current presentation for this viral agent, some for other reasons.
Currently we can strongly recommend Florida: Good clinical evidence relating to risk assessment and risk management, congruent with the current clinical risk this viral agent poses, along with protective factors are adhered to. In Florida we, along with colleagues, have experienced 100% normalcy, autonomy and liberty. Most individuals are well-informed of risks, educated in terms of respiratory infections, calm and positive. Face masks are not mandatory indoors or outdoors in any setting, except airports and airplanes, as per our firsthand experiences.
Many report that “it makes no sense to have to wear a mask in an airport or airplane, if we have not worn masks for weeks or months on the busy beach, in salsa clubs, in restaurants, in shops, it is just crazy and not at all clinical”, 80 year old retired surgeon and veteran.
“Look at all the violence and aggression masks have caused on planes, in airports, in schools, it is madness that we have to do something that hurts so many people, and it is not based on good evidence, as almost all doctors will tell you”, 50 year old microbiologist.
We understand that many airlines are now considering to discontinue mandatory face mask policies from a global perspective. We have been informed that some airlines have now started this change, first in Scandinavia, now in the UK.
Many are very grateful to Florida for offering “we have found a haven in Florida, where we can breathe, where our health and mental health are protected, because we have freedom again, our blood pressure can be normal for a bit”, 75 year old anaesthetist, ITU consultant.
Theme parks in Florida offer families the opportunity to engage in normalcy. Seaworld, Universal Studios and now Disney all follow good clinical evidence, and face masks are not mandatory, in any of these contexts. Disney does still recommend masks in monorails, which many hope will soon change too. Many are very grateful for these opportunities; “being able to have a normal outing and day saved my life and my family, I can’t tell you how bad it was to not have access to normal, it sounds strange, but it breaks a person’s spirit, health suffers, mental health suffers, it is just so hard, unbearable, but I was able to ride a coaster with my children and have fun, and for a while, forget about the worst years of my life”, 65 year old paediatrician.
Many business owners say “we don’t know what to believe any more” and inconsistencies are vast. Salsa offered in the south of France is offered indoors without face masks (end 2021) and in Cambridge, by a wonderful French teacher, is offered outdoors and with masks (end 2021). Miami (2022) offers salsa lessons without masks and indoors, an approach similar to France, from what we have experienced.
Most medical colleagues avoid mandatory mask settings. No good clinical evidence supports mask wearing for the general public in public settings, and many medical doctors agree that masks can cause harm to many for various different reasons.
Further options where good clinical evidence is followed in terms of protective factors and risk factors include Sweden and most of Scandinavia, as well as the UK.
Many countries in the EU are now reviewing their mandatory face mask policies, vaccine mandates to enter restaurants and shops, and testing without clinical indications, which most medical doctors agree, make little clinical sense and contribute to harm in terms of general health and mental health. “The stress is unbearable on people, and this makes people sick”, 65 year old GP.
We have been asked to provide updated thoughts regarding the risks currently related to this viral outbreak and indiscriminate mandatory initiatives, not based on good clinical evidence, which we have agreed to do. We have liaised with appropriate national and international health and mental health organisations. We have shared concerns with more or less 75 countries to date.
Most colleagues and countries share these concerns and respond with helpful insights. Most are pleased that Australia is now starting to open borders, that areas in Mexico and Latin America have discontinued mandatory mask policies, along with testing without clinical indications.
Most colleagues and patients are very grateful for these changes based on good clinical evidence. “Not having normal, not having freedom, not being able to make a choice about vaccines or travel (or tests), it is something that hurts health in tremendous ways, we are putting people in invisible prisons, it is too ongoing, too long now, it could have been argued for a few weeks or a month or two, but going on three years is far from clinically acceptable, it is criminal really, because this virus does not warrant these rules or this fear”, paediatrician.
We are also very grateful to see that the theme of protecting children is now brought to the forefront in many nations, such as France, the UK and the USA.
This photograph was taken in Miami, and this floating advertising board often shows a reminder that we need to protect children. This means different things to many people or nations, but most agree that children have to wear bathing suits at the beach, that photographs of children online should be appropriate (and children should be appropriately dressed), although many agree that it is not necessary and best to avoid photographs of your children online, and that adults should be appropriately dressed in public places where children are present. Small acts will protect children and will change the future.
We need everyone’s awareness and commitment to contribute to protection rather than harm, and by this simple act, a complex problem will have a simple solution.