Since we’re talking about the origins and early history of the SARS-2 outbreak, it’s worth having a look at Jonathan Engler’s intriguing analysis of the all-cause mortality data out of northern Italy in the earliest days of the outbreak. He asks why, if there was community transmission in northern Italy as early as August 2019, nobody observed any excess mortality until after health authorities imposed their increasingly infamous nationwide lockdowns. As Engler writes: “In nearly all papers reporting [data on pre-pandemic infections], the significance of there being no excess death observable until the emergency is declared seems to have been missed.” Actually, I have the impression this whole question has been studiously avoided; it raises awkward problems indeed.

More from Engler:

[I]magine there was no virus at all, but that for some other reason (any will do) governments decided to institute a range of measures including:

1. Telling people not to attend healthcare if they had a cough, fever or other symptoms both to “protect” healthcare and also because any contact with healthcare would quite likely make you contract a deadly disease.

2. Telling healthcare staff to isolate if they (or in some cases someone in their household) received a positive test for a certain illness, even if asymptomatic.

3. Emptying beds in preparation for being “overwhelmed”.

4. Terrorizing and isolating elderly people especially those living in care homes, denying them visits from relatives and reducing or eliminating in-personal visits from health and social carers. 

5. Using the entire machinery of state plus all social media and legacy mainstream media channels to promote an exaggerated narrative of fear aimed at the public and spilling over into healthcare workers, when it is well established that stress has a number of adverse health effects, including immuno-suppression.

6. Massive overuse of a treatment (ventilation) with no solid evidential basis, now known to be extremely harmful.

The implementation of such policies would result in protests in the streets with people declaring that “thousands of people will surely die”, and no doubt they would have been right. 

Engler draws attention to the curious fact that early Italian excess mortality did not seem to spread from one Italian province to another – following virus infections outwards from an epicentre – but rather struck the affected regions all at once:

What’s more, the excess deaths are clustered within the boundaries of the affected provinces, “meaning that which one of the 13 provinces a person lived in was a much better predictor of death than whether there was a high rate of deaths in neighbouring municipalities.” For Engler, this implicates provincial-level administrative decisions as to the rationing of care and provisions for the vulnerable, especially in the face of staffing shortages.

I encourage you to read Engler’s entire piece. What happened in northern Italy in early 2020 was unique. The entire country posted dramatic mortality statistics in the first wave, driven entirely by deaths in just a few northern regions. These statistics in turn did a lot to shape the broader European response; from Germany to Norway, everyone assumed the that the same fate awaited them. In fact, SARS-2 mortality turned out to vary dramatically across Europe and the world, despite the imposition of mass containment everywhere.

To Engler’s hypotheses, I’d add the importance of viral interference: Even if we don’t fully understand this effect, it’s quite clear that influenza and SARS-2 cannot surge at the same time in the same population. Lockdowns were accompanied by a rapid collapse in influenza infections in many countries, followed almost immediately by a rise in SARS-2 mortality. It’s worth asking whether the flu and other common respiratory viruses are actually protective against novel pathogens because of interference effects, and whether our panic measures didn’t, in most cases, simply reduce the competition SARS-2 faced from other viruses. I also cling to my theory that, before Omicron, SARS-2 was an attendant-borne pathogen, which thrived particularly in healthcare environments. Emergency measures, including mass testing, had the effect of hoovering up as many SARS-2 patients as possible and putting them in environments where attendants could mediate transmission – precisely where SARS-2 does most of its killing.