COVID-19 and Ireland – Part 32

In 2020 the independent researcher Denis Rancourt published an inflammatory paper on the covid-19 pandemic: All-Cause Mortality during COVID-19: No Plague and a Likely Signature of Mass Homicide by Government Response. Rancourt chose all-cause mortality as the best index to accurately assess the true nature of the pandemic. In an earlier article in this series we looked briefly at Rancourt’s conclusions as they applied to Ireland. In the next few articles we will be taking another look at Rancourt’s thesis, but this time we will be spreading our net further afield. Do Rancourt’s allegations hold up on a global scale? And what about the subsequent waves of covid?

Denis Rancourt

The Canadian researcher Denis G Rancourt of the Ontario Civil Liberties Association was one of the first scientists to try and model the course of covid-19 by tracking all-cause mortality in several different countries. His results are documented in his paper All-Cause Mortality during COVID-19: No Plague and a Likely Signature of Mass Homicide by Government Response, which was published on Research Gate in 2020. Recently, Rancourt’s paper was the subject of online censorship, but it can still be accessed on the Internet Archive’s Wayback Machine. It is also available now on the Internet Archive’s main archive.

When Rancourt began to examine the raw data, what most caught his attention were the so-called covid peaks―sharp spikes of excess mortality that did not closely resemble the usual bumps of increased mortality associated with respiratory epidemics.

Denis G Rancourt

The latest data of all-cause mortality by week does not show a winter-burden mortality that is statistically larger than for past winters. There was no plague. However, a sharp “COVID peak” is present in the data, for several jurisdictions in Europe and the USA. This all-cause-mortality “COVID peak” has unique characteristics:

Its sharpness, with a full-width at half-maximum of only approximately 4 weeks;

Its lateness in the infectious-season cycle, surging after week-11 of 2020, which is unprecedented for any large sharp-peak feature;

The synchronicity of the onset of its surge, across continents, and immediately following the WHO declaration of the pandemic; and

Its USA state-to-state absence or presence for the same viral ecology on the same territory, being correlated with nursing home events and government actions rather than any known viral strain discernment.

These “COVID peak” characteristics, and a review of the epidemiological history, and of relevant knowledge about viral respiratory diseases, lead me to postulate that the “COVID peak” results from an accelerated mass homicide of immune-vulnerable individuals, and individuals made more immune-vulnerable, by government and institutional actions, rather than being an epidemiological signature of a novel virus, irrespective of the degree to which the virus is novel from the perspective of viral speciation. (Rancourt 1)

Rancourt, therefore, believes that the so-called first wave of covid-19 was actually a spike of excess mortality of elderly people who were forcibly removed from hospitals―where they were receiving treatment that was keeping them alive―and transferred to nursing homes, where they quickly succumbed to their comorbidities and died. In support of this allegation he examined the all-cause mortality data from several countries―USA, England & Wales, and Europe (ie those European countries participating in the EuroMOMO project). In each case he found similar features in the mortality curves:

[England & Wales] ... What can be called “the COVID peak” is a narrow feature (Figure 5). Relative to the summer baseline, the full-width at half-maximum of the peak is approximately 5 weeks. It has the distinction of being late in the infectious season, and of climbing far above the broader winter-burden hump. This “COVID peak” is a unique event in the epidemiological history of England and Wales. Does this unique feature arise from an unusually novel viral pathogen, or does it arise from the unique, unprecedented and massive government response to the WHO declaration of a pandemic? (Rancourt 14)

All-Cause Mortality for England & Wales (Rancourt Figure 5)

[Europe] An analogous “COVID peak” occurred in the EuroMOMO hub data for Europe (Figure 6). Here again, the total number of winter-burden all-cause excess deaths for the season ending in 2020 (area above the summer baseline) is not statistically larger than for past years, and the date of declaration of the pandemic is shown by a vertical red line. What looked like a concluding and “mild” 2020 season turned into a “COVID peak” immediately after the WHO declared the pandemic. (Rancourt 14)

All-Cause Mortality for Europe

[USA] Here, again, we see that the total number of winter-burden all-cause deaths for the season ending in 2020 (area above the summer baseline) is not statistically larger than for past recent years. There is no evidence, purely in terms of number of seasonal deaths, to suggest any catastrophic event or exceptionally virulent pathogen. There was no “plague”. The winter burden, in these years, is consistently in the range of approximately 6% to 9% of total yearly all-cause mortality, and the year to year variations are typical of historic variations. On the other hand, there is again a “COVID peak. (Rancourt 15)

All-Cause Mortality for the USA

In this case the “Covid peak” has the same features as before (Rancourt 15-16):

It is remarkably sharp or narrow, having a full-width at half-maximum of the peak, relative to the summer baseline, of approximately only 4 weeks. By comparison, the sharp peaks in the infectious seasons ending in 2015 and 2018 have full-widths of 14 and 9 weeks, respectively.
It occurs later in the infectious season than any other large sharp peak ever seen for the USA, surging after week-11 of 2020.
Its surge occurs immediately after the WHO declared the pandemic, in perfect synchronicity, as seen in both Europe, and England and Wales, which are an ocean apart from the USA.

Peak or No Peak?

Rancourt next notes that in the case of the United States of America, the mortality curves of some states (eg New York) feature pronounced Covid peaks while those of other states (eg California) have no Covid peaks:

The NYC data makes no epidemiological sense whatsoever. The “COVID peak” here, on its face, cannot be interpreted as a normal viral respiratory disease process in a susceptible population. Local effects, such as importing patients from other jurisdictions or high densities of institutionalized or housed vulnerable people, must be in play, at least. What is also striking is that some of the largest-population states in the USA, having large numbers of measured and reported cases, and large numbers of individuals with the antibodies, do not show a “COVID peak”. (Rancourt 16)

All-Cause Mortality for California

This discrepancy is at the heart of Rancourt’s thesis:

Also, none of the seven states that did not impose a lockdown (Iowa, Nebraska, North Dakota, South Dakota, Utah, Wyoming, and Arkansas) have a “COVID peak”. The presence of a “COVID peak” is positively correlated with the share of COVID-19-assigned deaths occurring in nursing homes and assisted living facilities ... I postulate that the “COVID peak” represents an accelerated mass homicide of immune-vulnerable individuals, and individuals made more immune-vulnerable, by government and institutional actions, rather than being an epidemiological signature of a novel virus, irrespective of the degree to which the virus is novel from the perspective of viral speciation. (Rancourt 18 ... 19)

Finally, Rancourt cites several institutional documents, media reports, and scientific articles in support of his thesis. Among these are reports of elderly Covid-19 patients being transferred to nursing homes and assisted-living facilities, with disastrous consequences for the residents of those facilities. Other reports blame the widespread use of ventilators for the high mortality of Covid-19 in the initial weeks of the pandemic.

Covid Spikes in Europe

Is there really a correlation between the presence or absence of a covid spike in a country’s mortality during the first wave of covid-19 and the policies adopted by the government in that country? The following analysis uses data on excess mortality from EuroMOMO, the European Mortality Monitoring Project. EuroMOMO’s data are given in terms of z-scores, a statistical measure of how far the mortality for a given week was above or below the overall mean.

Mean: The average mortality per week per population. This is the total all-cause mortality over a lengthy period of time divided by the number of weeks in that period and normalized for population (ie corrected to take into account changes in overall population during that period). It is often expressed as a death rate―the number of deaths per 1000 population per annum―from which the mean weekly death toll can be estimated.
z-score: The number of standard deviations above or below the mean.

EuroMOMO uses a Poisson distribution to model excess mortality. In a Poisson distribution the standard deviation is equal to the square root of the mean.

The grey dotted line in these graphs represents the mean mortality―a z-score of zero. The red dotted line represents a z-score of 5, which EuroMOMO characterizes as a Substantial increase.

London School of Economics

Government Measures

Rancourt’s thesis―that many elderly people were sacrificed to the pandemic in order to clear up hospital beds in the expectation of an imminent deluge of infected people―was even entertained by some reporters in the mainstream media. Take, for example, the following report that appeared on CNN in May 2020:

The World Sacrificed Its Elderly in the Race to Protect Hospitals. The Result Was a Catastrophe in Care Homes

Researchers based at the London School of Economics (LSE) created the Long-Term Care responses to Covid-19 (LTCcovid) group with its International Long Term Care Policy Network (LTCPN). LTCcovid is a global network of academics and experts in the field who gather and analyze official data from around the world, and found that many countries were seeing high rates of severe infections and deaths in care homes.

Comparing death tolls can be difficult: some countries have separate data covering elderly care homes, while others include facilities for those with disabilities. Some countries do not include in their data those residents who die in hospitals, some have regional variation, and some have no data at all.

Many governments are just starting to record death tolls in care homes – and the figures are staggering.

Data published on LTCcovid shows that more than half of all coronavirus deaths in nations including Belgium, France, Ireland, Canada and Norway occurred in care homes or among care home residents in all settings. In the US, data collated by the Kaiser Family Foundation (KFF) from 35 states and included in the LSE report showed that care home residents accounted for 30,130, or at least 34.6%, of the more than 87,000 coronavirus deaths recorded as of May 15. Care home residents are also overrepresented in some countries with relatively few deaths, accounting for 26 out of the first 99 deaths documented in Australia, or more than a quarter of all fatalities through May 18. (Emma Reynolds)

Care Home Deaths

Some governments implemented this policy of discharging thousands of hospital patients to care homes, while some did not. In some jurisdictions hospitals refused to admit sick people from care homes. A useful approach to this phenomenon is to compare some neighbouring countries which implemented different policies.

Portugal and Spain

In Spain many hospitals refused to admit residents of nursing homes during the first wave of the pandemic:

With hospitals stretched to breaking point, the elderly are being turned away, and the care homes, lacking staff and appropriate equipment, must do what they can for the sick and dying ... some hospitals had stopped admitting patients from care homes, forcing the residences to cope as best they could. (Nacho Doce, Nathan Allen, Reuters)

The nursing homes were overwhelmed:

Spanish army troops disinfecting nursing homes have found, to their horror, some residents living in squalor among the infectious bodies of people suspected of dying from the new coronavirus, authorities said Tuesday.

Defense Minister Margarita Robles said the elderly residents were “completely left to fend for themselves, or even dead, in their beds.” She said the discovery over the weekend included several nursing homes but did not name them or say how many bodies were found ...

The head of AETE, which represents the country’s largest for-profit nursing home businesses ... Jose Cubero also said that overburdened hospitals in Madrid were rejecting patients with COVID-19 from nursing homes.

“We provide assistance but we are not health care facilities. The elderly also have the right to be treated in hospitals,” Cubero said. (Associated Press)

Rua dos Calveiros, Lisbon

Meanwhile across the border in Portugal no such measures were taken. A state of emergency was declared on 18 March, involving a nationwide lockdown. Measures were gradually relaxed in May and the following few months. Twelve hospitals were given front-line status to deal with the pandemic and were more than capable of dealing with the emergency. This was due in no small measure to a reduction of more than 50% in hospital admissions:

The objective of this study was to analyze the impact of the pandemic on inpatient hospital admissions during the first wave in Portugal. Data from hospital admissions in mainland Portugal from 2008 to 2017 were used to forecast inpatient hospital admissions for March to May 2020. The observed number of hospitalizations and their characteristics were compared to forecasted values. Variations were compared by hospital and region. Statistical analysis was used to investigate whether patterns of variations existed according to hospital characteristics. There were 119,315 fewer hospitalizations than expected during March to May 2020 in Portugal, which represented a 57% reduction. (Rocha et al 11)

Unlike in Spain, elderly patients were not discriminated against during the first wave:

In Portugal, as of April 30, 2020, there have been 24,987 cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection (6,136 [24.5%] patients aged ≥70 years ... In this cohort, patients aged ≥70 years were twice more likely to be admitted to the ICU than others ... Our findings suggest that chronological age was not a limitative criterion for ICU admission in patients with COVID-19. More likely, clinicians pondered factors such as the number and severity of comorbidities, the presence and severity of frailty, and the number and severity of acute organ dysfunctions. (Cardosa et al)

Bearing all of this in mind, the mortality curves for Portugal and Spain during the first wave of the pandemic make for curious reading:

All-Cause Mortality for the First Wave in Portugal & Spain

Spain experienced a very pronounced covid spike, with the z-score for excess mortality climbing to 44 in the first week of April. But across the border in Portugal there was only a mild first wave, with the z-score only reaching about 5―although that too represents a substantial increase in mortality. What sort of airborne pathogen is it that respects international borders? How can we account for such a dramatic difference in mortality except by attributing a significant part of Spain’s covid-peak on government policy?

Two Irelands

Ireland represents another interesting test case. This island of approximately seven million people is divided into two jurisdictions: the Irish Republic and Northern Ireland. The policies enacted by their respective governments during the first wave of the pandemic overlapped to a large extent, but there were also significant differences. Both jurisdictions enacted lockdowns, with stay-at-home orders and the banning of non-essential travel and public gatherings. But in March the Republic also implemented a policy of freeing up beds in acute hospitals by transferring elderly patients to nursing homes. In conjunction with this, it was also announced on 24 March that private hospitals would become part of the public hospital system for the duration of the pandemic, significantly increasing acute capacity. This policy was reversed on 30 June 2020. These policies were later criticized for exacerbating the effects of the pandemic:

Nursing home residents are picking up the coronavirus while in hospitals and then testing positive after being transferred back into care homes, the State healthcare regulator recently told the Health Service Executive. The transfer of patients from acute hospitals into nursing homes was believed to be one reason behind the spread of the virus into the care facilities during the start of the pandemic in March. (The Irish Times 31 December 2020)

No such policy was enacted by the government in Northern Ireland.

All-Cause Mortality for the First Wave in Ireland

The difference between the two outcomes is not as great as in the Iberian Peninsula. Nevertheless, there are significant differences. In the Republic excess mortality peaked at z = 9.37 and had returned to the normal range by week 19. In Northern Ireland excess mortality peaked at 7.63 and fell away much more slowly, only returning to the normal range by week 22. Note also that throughout May the Republic experienced negative excess mortality―substantially fewer deaths than expected. This phenomenon, which one does not expect to observe immediately after the first wave of an epidemic, was not present in Northern Ireland, where excess mortality only briefly dipped below the baseline in June and again in July.

The mortality graph for Northern Ireland resembles what one would expect in the case of a contagious epidemic: a fairly sharp increase in mortality as the epidemic kills off the most vulnerable members of society, followed by a relatively long tail, as the epidemic burns itself out.

In contrast, the Republic’s mortality graph is very suspicious. It too rises sharply at the outbreak of the crisis, but after only three or four weeks it falls at an almost equally steep rate. And it continues to fall over the course of the following few months. In early August the z-score is negative 3.3, well below the normal range. As we saw in an earlier article, there was actually negative excess mortality in the Republic in April-May 2020. That is to say, over the eight-week period from 1 April through 31 May―a period that included the first wave of the pandemic―fewer people died in the Republic than expected.

This brief analysis of two test cases does seem to bear out Rancourt’s thesis.

And that’s a good place to stop.

References

Denis G Rancourt, All-Cause Mortality during COVID-19: No Plague and a Likely Signature of Mass Homicide by Government Response, Research Gate (2020)

Image Credits

Care Home Deaths: © London School of Economics International Long Term Care Policy Network, Natalie Croker (designer), Fair Use

Online Resources

EuroMOMA