Op Ed in Beligan newspaper by a specialist who researches SARS human coronavirus:
Link is in French: https://www.rtbf.be/info/opinions/detail_lettre-ouverte-a-la-ministre-de-la-sante-publique-coronavirus-il-faut-savoir-ecouter-la-peur?id=10443799
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Link is in French: https://www.rtbf.be/info/opinions/detail_lettre-ouverte-a-la-ministre-de-la-sante-publique-coronavirus-il-faut-savoir-ecouter-la-peur?id=10443799
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Quote:
Dear Minister,
You assure the country that we are ready to face the new coronavirus, and yet certain key frontline players, nurses and doctors, are not reassured, and neither am I.
I am a doctor of science and I led a group of researchers studying human coronaviruses in general in the United States, and the group responsible for the SARS epidemic, SARS-CoV, in particular. I did this work in two institutions, as a member of the faculty of the College of Medicine at the University of Cincinnati and as an investigator at the only institute in the world devoted exclusively to research on respiratory diseases, in Albuquerque, where I had the opportunity to study all aspects of aerosol production and aerosol transmission. In these two institutions, I was one of the officers responsible for ensuring that all experiments involving infectious or recombinant agents comply with all the rules and do not pose a danger to the general public.
I have already sent you a file via the SPF Health website on February 12, which indicates that if the proportion of symptomatic cases due to the new coronavirus reaches 1% of the population, we would be on the verge of a hospital crisis due to lack of beds (your reference: CCAL0331485). It went unanswered and that's why I'm writing to you directly.
Your public statements suggest that you do not fully understand the nature of the danger that Belgium and the rest of the world face. I would like to draw your attention to two essential points about the new coronavirus which seem to have been given insufficient consideration.
In an interview published on Wednesday 26, you answer the question "But how many beds do we have exactly?" : "You know that in Belgium we have enough beds and sufficient treatment capacity. This is an advantage. When we compare with a winter flu and the number of elderly patients who are generally hospitalized, the situation is identical" .
In my file, I cited the WHO, which on February 10 estimated that ~ 16% of symptomatic patients were in a condition serious enough to require hospitalization. Influenza ? ~ 0.2% of cases! The relationship between the two? A factor of 80 is therefore not an identical situation, the first essential point that is overlooked.
The WHO fact-finding mission to China released its report yesterday, it is worth consulting. We now have more precise figures for symptomatic patients: 80% of mild cases (can stay at home), 13% of severe cases (hospitalization), 6% of critical cases (intensive care).
Would you be so kind, Madam Minister, you who have access to all the information on the Belgian hospital network, to calculate for our edification to all: from how many symptomatic cases would the Belgian hospital system run out hospital beds for severe and critical cases?
There is a cacophony of incorrect information circulating not only in the written and audiovisual press about the new coronavirus, but also on the SPF Health and Sciensano websites. The official position appears to be that COVID-19 is a SARS-2.0 and therefore the measures that would be appropriate for SRAS-1.0 will be suitable for COVID-19.
This is unfortunately a false equivalence and it is urgent to understand the essential difference between the spread of the virus responsible for SARS-1.0 and that of the new coronavirus. SARS-CoV was mainly transmitted by surface contamination and by postillions, which travel no more than one meter, but rarely by aerosol. Everything indicates that a significant proportion of transmission of the new coronavirus is by aerosol, which completely changes the situation for isolation measures.
The first cases of SARS in November 2002 were detected in the city of Shenzhen, 7 million people at the time, and ultimately infected 5,327 people in China. The first cases of COVID-19 were detected in December 2019 in the city of Wuhan, 11 million inhabitants, and have infected 78,497 individuals in China to date (according to the Chinese government; nearly one million after some epidemiologists), the first indication of the difference between the two viruses.
The basic reproduction number of the new coronavirus is between 4.7 and 7 according to the calculations of different epidemiologists, which is different from the effective reproduction number calculated by the WHO (2.5), the difference being that the number base corresponds to the situation without isolation measures, and the actual number changes depending on the implementation of different isolation measures.
Take the situation of Italy. The first two cases are confirmed in Milan on January 31 and we are 655 cases 28 days later. The epidemiology tells us to take the logarithm to base 2 of 655 cases divided by the two initial cases, namely roughly 8.3, and therefore the number of cases doubled every 3.3 days, close to doubling all 2.4 days in the absence of insulation, and while insulation measures have been in place for a few days. These figures are consistent with a high number of reproductions.
So, we have an epidemic at least 10 times larger than SARS-1.0 at the same time in China, a new coronavirus of great intrinsic contagiousness, epidemiologists who calculate that one infection in two could be caused by a person still asymptomatic, and we also have multiple episodes of super contagion. What to conclude? You will not find many transmission experts who will tell you anything else that this new virus can be transmitted by aerosol, the second essential point that has been overlooked so far.
You recognize that the virus is more contagious, but what is the implication? If the flu virus infects 2 to 8% of the population, year after year, and this virus is more contagious than the flu, what will prevent it from spreading at least like the flu in an immunologically naive population?
With the absence at present of a vaccine or of an effective treatment against this new coronavirus, the question of availability of hospital beds takes on all its significance and its urgency, given the much higher rate of complications with this coronavirus.
It is not necessary to have a debate among the experts, although in a crisis situation it is always good to confront the divergent views of the experts, because the Public Health function asks it to prepare for the worst scenario , not the most rosy. Experts and officials in other western countries also recognize the seriousness of the risk we all face.
You told us that the objective is "to keep the virus out of the country as long as possible thanks to adequate surveillance of the territory", but we learn from a courageous nurse who returns from Veneto, a region of Italy with a few cases of COVID-19, that not only are we not asking them to isolate themselves, and we are asking them to return to work immediately, but we are also refusing to test them!
Not only is it not tested, but it also tells us that there is actually an omerta against screening for the new coronavirus for cases of flu symptoms not related to a Chinese connection. Explain to us, Madam Minister, exactly how you adequately monitor the territory when the most basic screening is not done?
We also wonder about the lack of recommendation, screening, quarantine and supervision for people who return to Belgium from a contaminated area, also knowing that the incubation period can exceed two weeks and that there are cured patients who have been reinfected.
General practitioners are concerned about the lack of serious communication from the Ministry of Health, an email is not enough in this situation. They contrast the current response to that during the H1N1 epidemic in 2009 when they received clear information and masks. Nor should we ignore their request to have a system in place to support individuals who should remain isolated.
Why wait to protect medical personnel when the Chinese government admits that more than 3,000 medical personnel have been infected in Wuhan? Would we be so short of the necessary equipment? What is the situation from a logistical point of view? You say we are ready, but we would not even have masks for general practitioners?
What can we say to the families of infected or even deceased medical personnel, if we were to deplore victims whose infection could have been prevented by the earlier implementation of personal protection measures?
Zhong Nanshan, who heads the COVID-19 team of experts at the Chinese Ministry of Health, said the epidemic had been "a hard lesson" for the country: "If we had taken strict prevention measures in early December or even early January would have greatly reduced the number of sick, "he said at a press conference.
The Chinese authorities made the same initial error with SARS and COVID-19, but have since mobilized to fight the virus with the extremely strict measures that are necessary when a virus is transmitted by aerosol and asymptomatically. We are making the same initial mistake as the Chinese!
And lessons must now be learned from the first phase of this epidemic, how the Chinese have moved from a very large quarantine model, 400 million people, to a flexible and targeted approach. The number of cases that will emerge as the population returns to normal remains to be seen, but the very advanced surveillance system suggests that they will be able to contain these new cases.
Shouldn't we follow the lessons of China, and also follow the adage that prevention is better than cure? Today, faced with this coronavirus, we have no vaccine or treatment available, which, logically, should push us to implement a whole series of preventive actions given this lack of cure solutions. It is imperative to mobilize the population and all healthcare personnel to enable prevention to play its role through an information campaign on the scale of the challenge facing Belgium.
Fear can be rational, as fear can be irrational. Fear is an essential emotion for our survival, and we must be able to listen to it. I want to keep my fingers crossed that Belgium will be spared and that the spread of the virus will slow down with the end of winter, but I think that the government, whose fundamental function is to protect the public, could do more in this situation and I remain at your disposal if my expertise can be useful.
Marc Wathelet is a doctor of science. He studied chemistry at the Free University of Brussels and holds a doctorate in molecular biology. Having traveled to the United States for 25 years, he went through Harvard, the University of Cincinnati and an institute for research on respiratory diseases in Albuquerque.
