A number of Americans are discrediting freedom by the irresponsible way they are acting in its name. I have in mind those attending in closely packed crowds “freedom rallies” in protest against social distancing, closedowns, and whatever else authorities are doing in the effort to lower the infection rate in order that steps can be taken toward reopening. I have in mind also those in dense crowds protesting closure of California beaches. If there are infected persons among these protesters, the consequence of the protesters will be to spread the virus and delay any reopening of economy and beaches.
Those who are insisting that it is their right to go about as they please without a mask or any precaution are demonstrating their complete lack of social responsibility. Their behavior affects other people, and they most certainly have no more right to infect others than they do to go around with a gun shooting people. No one has a Constitutional right to infect other people.
A number of people have been conned into believing that Covid-19 is little more than the flu and no more dangerous, that only old people are threatened, and a number of other unfounded beliefs. This is not the report from pediatric hospitals such as the National Children’s Hospital in Washington, D.C., the Center for Heart Malformations in Paris, the Pediatric Intensive Care Society in the UK, and a number of others. Doctors in these hospitals are reporting that Covid-19 seems to be linked to a severe form of vascular disease in children that requires intensive care.
A successful reopening, one that does not have to be abandoned, requires intelligence and proper preparation. Testing and masks need to be available, venilation systems need attending, and the infection rate needs to be low and falling, as it it likely to rise with reopening. The infection rate needs to be kept manageable as doctors, nurses, and hospitals are stressed by the first wave and do not need a second and third.
Many European health ministers and a number of US state governors apparently have no appreciation of how to go about a successful reopening. Marc Wathelet again spells it out for the Belgium government. Hopefully all governments will recognize their responsibility to know what they are doing.
The health situation requires a delay in the implementation of phase 1a of the lockdown exit strategy by Marc Wathelet May 2, 2020
Dear Madame Wilmès, dear members of the Belgian government and parliament,
The government document which describes the measures taken by the National Security Council of April 24, 2020 specifies that “the whole of the following dates are likely to change according to the health situation and the evolution of the virus.”
The importance of this condition on the implementation of the different phases has been publicly underlined by Madame Wilmès and other government officials on several occasions.
The decision criteria for moving from one phase to the next are not publicly known, but the public health principles that should guide these decisions are well established.
Marc Van Ranst gives us an indication on these criteria by Twitter on April 26:
Replying to @ De7deDag @ Sophie_Wilmes and @MR_officiel
As a criterion for the start of the exit, it is NOT about the number of deaths (as was wrongly stated in the newspaper) but about the number of new hospital admissions. Said number has not been falling for a week and remains above 200 per day.
Marc Van Ranst also indicated in the press on the same day that it was necessary for this figure to drop below 100 in order to begin the exit from containment https://tinyurl.com/yc688kwa.
I don’t know how Marc Van Ranst arrives at this round figure, but I note that Yves Van Laethem informs us on April 29 that “the reproduction rate of the new coronavirus in Belgium measured between April 20 and 26 was 0.79.” https://tinyurl.com/yb7j7ped, indicating that the transmission continues despite the confinement, even if it is slowed down.
This figure of 0.79 is so close to 1 that it does not take much to go back above 1. The reproduction rate depends on the frequency and the diversity of contacts between individuals, and if the measures of 4 May are not enough, those of May 11 will manage to make us exceed 1. As soon as we are above 1, we are back in exponential growth for the number of cases.
From a public health perspective, Dr. Drosten suggested that even with a reproduction rate below 0.2, the risk of resurgence is great https://tinyurl.com/yawt63tg. Why is a reproduction rate of 0.79 too high? Because the screening and tracing teams will not be able to follow. In the report of the group of government experts for the Exit Strategy: “without an extremely effective tracing […], the strategy of deconfinement presents a significant risk of resurgence.” https://tinyurl.com/yav6r7no.
The government would have assembled a team of 2,000 investigators to ensure tracing according to this source, but is it enough? Countries that control coronavirus transmission well do this by testing ~ 33 times more people per day than positive cases https://tinyurl.com/y8he4c63. Over the last 7 days we have an average of 599 positive cases (PCR) per day, so we should be able to test a minimum of 19,767 individuals per day. However, this figure is underestimated since in practice too few people are tested today.
By taking the figures of new hospitalizations for the last 7 days, 155 per day on average, and multiplying by 5.26 (19% of symptomatic patients requiring hospitalization) we obtain 816 positive cases per day, but it seems that Belgium hospitalized only a fraction of those who should have been hospitalized and therefore a more realistic number could go up to double. Multiplied by 33, it is therefore necessary to be able to perform between 26,928 and 53,856 PCR tests per day, and this in addition to the tests necessary to monitor the progress of patients.
This testing capacity can probably be reached without too much difficulty for the lower limit, but we are far from being able to cover the whole range. An even more limiting factor is the collection of the necessary samples, we are far from this capacity it seems (<15,000 / day).
For tracing, the contagiousness of the virus requires that screening and identification of contacts be done in one day https://tinyurl.com/y8he4c63, and there must be 5 investigators per positive case, namely between 4,080 and 8,160 investigators . With only 2,000 investigators under training, Belgium is simply not ready for phase 1-a, which begins on May 4.
By not following the recommendations of the experts group to count two weeks between each phase to be able to assess the impact of each change on the dynamics of contagion (since there is a delay of 10-15 days between infection and hospitalization), you guarantee that during the next CNS on May 8, the increase in the number of hospitalized cases will be small enough to pass to phase 1-b on May 11.
This decision would open the door to an upsurge of cases that we will not be able to control with our current screening and tracing capabilities (unless the change of season had a dramatic effect on the dynamics of transmission of the virus, on which we cannot not count). Our first lines are exhausted and traumatized, they don’t deserve that.
It would never occur to a doctor to say to a patient who wants to go back to work a week after having suffered a complete fracture of the tibia: “no worries, I’ll take the cast off, go back to work and we’ll see if that leg holds. ”
Belgium is not yet ready to break out of containment, that’s all. It would be a waste of the efforts of the whole population to get out of it too early, it would then have to be confined again and at a greater economic cost. We must wait until the virus reproduction rate is less than 0.2 and have the sample collection system, the screening and tracing system all in place, each at the required capacity, and all with adequate personnel protection: we’re not there yet!
And the government must be able to offer surgical masks to anyone who is economically active, much poorer countries are able to do so. Why not us ? None of the essential measures are sufficiently in place: the exit from confinement is therefore premature.
Ms. Wilmès, you took offense when the word “lie” was used by Jérôme Colin to characterize some of the government’s messages, and you replied “Lies, there will not be any. There cannot be any.” I agree, there can’t be any.
The word lie implies the notion of intention and it is a controversy that does not interest me. What we cannot tolerate, in fact, are untruths: whether knowingly told, the famous lie, or out of ignorance or incompetence ultimately matters little. What matters is that the government can base itself on truths about the reality that confronts us.
Whatever their intentions, untruths are unfortunately repeated by doctors who represent the position of the government and who allow themselves an anti-scientific position. The decision criteria remain unclear, divergent opinions are ignored without debate, and these untruths are taken up by the media, and amplified. It is impossible to effectively fight an enemy, this new coronavirus, if our intelligence about it is so faulty. These are untruths that kill, to call a spade a spade.
Scientists and doctors who do not belong to the circle of experts recognized by the government and the media have enormous difficulty in being heard. They find themselves in the absurd position of trying to convince a doctor that a respiratory virus is transmitted by the respiratory route…, that the absence of evidence is not evidence of absence…, and that in fact there is no absence of evidence, there is all the necessary evidence in the scientific literature to demonstrate that transmission by microdroplets suspended in the air in aerosol is the dominant mode of transmission of COVID-19. https://tinyurl.com/y7lm33cp, https://tinyurl.com/y8865rhp, https://tinyurl.com/y7gctbms, https://tinyurl.com/y8865rhp, https://tinyurl.com/y8czgf4k, https://tinyurl.com/uyfchvk, https://tinyurl.com/yc8yyas4, https://tinyurl.com/y9zlardu, https://tinyurl.com/y8m598a2, https://tinyurl.com/y7prwatu, https://tinyurl.com/y8mlkr9z, https://tinyurl.com/yax345ax, https://tinyurl.com/tsqbx8o, https://tinyurl.com/y9hwt8je, https://tinyurl.com/y77lw6ov, https://tinyurl.com/y7ebz85y, https://tinyurl.com/v97x8x7, https://tinyurl.com/ycsmj7zm, https://tinyurl.com/ycxgscza, https://tinyurl.com/uypzd8v, https://tinyurl.com/y8e5dctf, https://tinyurl.com/vsjswf5, https://tinyurl.com/qnu3cjd, https://tinyurl.com/y7m4tuaq .
If despite all the accumulated evidences, these doctors still had doubts about the aerosol transmission of COVID-19, deontologically the precautionary principle enjoins them to act as if this disease was transmitted by aerosol. Which they don’t do, it is professional misconduct that can only have dire consequences.
It is therefore simply unacceptable that in response to a journalist’s question on the potential role of air conditioning on the spread of the virus, Yves Van Laethem allows himself to say: “The spread of the coronavirus is mainly done by large droplets that we emit near us, at a maximum of 1m or 1m20 approximately, at least in the climatic circumstances that we know in our regions. But also by the transfer linked to the hands which would have touched these droplets. The importance of microdroplets which are airborne is unimportant for the disease itself outside of the intensive care setting, such as in malls and stores that use air conditioning. In the non-hospital setting, there is therefore no need to worry about air conditioning systems.” https://tinyurl.com/yb7j7ped
When such a falsehood is maintained as the official position of the government, the consequence is that no public effort will be devoted to the essential inspection of heating, ventilation and air conditioning systems across our country to ensure that they are not operated under conditions that favor the transmission of the virus or that they are modified to allow safe operation. The literature on this subject is very clear https://tinyurl.com/ybf36tp4, https://tinyurl.com/y8vsutld, https://tinyurl.com/y84ofn7f, https://tinyurl.com/ybzzle77, https: //tinyurl.com/y7ebz85y.
If this gross error is not corrected, the second wave will be followed by an even larger third wave from October, when the air heaters will be restarted and natural ventilation minimized. Heating, ventilation and air conditioning systems concern not only buildings but also all means of public transport. It is a source of massive contamination.
Likewise, Herman Goossens tells us about the transmission of the virus by children: “Children are absolutely no risk to adults and probably not even to older people. Absolutely not. No study has yet shown that a child has infected an adult or older person, none to date.”
This statement by Herman Goossens is anti-scientific: saying that there is absolutely no risk of transmission from a child to an adult is based on no solid evidence, but rather on the absence of studies that would prove this transmission. It is noted that it would be difficult to have epidemiological evidence of this transmission since the schools have been closed since mid-March. Again, absence of evidence is not evidence of absence. The solid scientific data we have is that the amount of virus present in swabs does not depend on the age of the individual: there is no significant difference in the distribution of viral loads when comparing age categories of children and adults, and this is validated by three methods of statistical analysis https://tinyurl.com/ya3f3uap.
In other words, the concentration of infectious virus in the air of a contagious child is, on average, the same as that in the air of an contagious adult. Adults do breathe out more air, and therefore more viruses, than children, but the air exhaled by an infected individual is infectious regardless of age. There is therefore no scientific basis to exclude transmission by children.
It could turn out that COVID-19 is poorly transmitted by children in schools, we do not know since we do not have the experience. Certainly we want to do everything in our power to limit this transmission and the proper use of masks could allow us to achieve this goal. In the absence of masks, it would be surprising to find little transmission in schools, knowing that for the other respiratory viruses that are transmitted asymptomatically and therefore by aerosol, as does COVID-19, transmission through schools is substantial and well documented https://tinyurl.com/y7cc5t7o. Herman Goossens’ position today remains a hypothesis, and to take this hypothesis as justification for the reopening of schools is once again to ignore the precautionary principle, despite its importance to medical practice. Why ?
The possibility that COVID-19 may be linked to a severe form of vascular disease in children, which requires intensive care, which can affect the heart and which has features of Kawasaki disease, has been reported by pediatricians in several countries: at St Mary’s Hospital and by the Pediatric Intensive Care Society in the United Kingdom, at the Reference Center for Heart Malformations Necker in Paris in France, in Italy, in Spain, in Belgium, and at the National Children’s Hospital from Washington in the US. These pediatricians are all concerned about the significant increase in the number of children of all ages with a multisystem inflammatory condition requiring intensive care https://tinyurl.com/yd99dqce, https://tinyurl.com/ybuotma2, https : //tinyurl.com/ybze6d6s. Wouldn’t it be wise to seriously consider these alerts rather than directly minimizing them, as Yves Van Laethem and Dimitri Van der Linden do? https://tinyurl.com/y9tws9nu, https://tinyurl.com/ybtyltlg
Reopening schools when conditions do not ensure the safety of either children, school staff or ultimately that of parents and the rest of the population, while a new virus is circulating for which we have no treatment, no vaccine, and while this virus can cause severe illness or even death, it’s actually conducting an experiment on humans, as Nathan Clumeck recognizes https://tinyurl.com/y8uhuoh2. An experiment on human beings morally and legally requires the informed consent of the participants.
This consent is not properly informed because of the untruths expressed about the situation by the government or its representatives. Parents can choose whether or not to send their children to school. School staff can choose to continue or not to work, a choice not really free when a salary is at stake. But this choice is not offered to the part of the population that does not have a say in the matter, all those who can be infected following contamination in schools. Subjecting part of the population to such an experiment without their informed consent is in violation of our moral principles, our laws and the Nuremberg Code.
Spokesperson for the “Belgian Pediatric Covid-19 Task Force,” Dimitri Van der Linden tells us “Wearing a mask is neither necessary nor realistic at this age [5-12 years], children must live normally. We should not impose this mental burden on them and create a generation of anxious people. ” https://tinyurl.com/y8x29qxj
One wonders how a group of pediatricians may at first think it is unrealistic for primary school children to wear a mask. Look in China, children are capable of it, and in fact children love to imitate adult behavior: if we do, they will follow us. Then there is no reason to think that it would generate anxiety in children, teachers will be happy to explain that science teaches us that the virus is in the air even if we cannot see it, and that we all put on a mask to protect each other.
Perhaps the youngest will need a few days to feel comfortable, as with all learning. They learn to look on each side before crossing a street, to put on their seat belts, to brush their teeth, all of which can only reduce anxiety when one understands how they protect us. One wonders how a group of pediatricians can think that the mental burden of wearing a mask, if it existed, could be greater than the trauma for a child to be responsible, involuntarily, for a serious illness in his family?
Mrs. Wilmès, since the very beginning of this crisis, the government and its experts have minimized the reality of the danger posed by this new coronavirus. Unfortunately, this error persists, the government and its experts still minimize the reality of the danger posed by this new coronavirus. It’s toxic. The result is that people are confused and the government is making decisions that are not based on the reality of the virus.
You defend collective intelligence to address this crisis, and if there can be no lie, there can be no untruth either. The motto of my alma mater is Scientia vincere tenebras, but science is powerless when the political power decides to listen only to the voices that suit it. It seems that in Europe the Age of Enlightenment has given way to a new obscurantism, and it is your responsibility as head of government to do everything to repudiate these untruths and rule the country on the basis of reason.
I had already communicated to you my rational plan to get Belgium out of confinement, and for members of the government and parliament who would not be aware of it, it is published in the Journal du Spécialiste https://tinyurl.com/yd5pk4n6.
When you make your decisions at the next National Security Council, it can be said that economic considerations will not trump health considerations, certainly, but politics is about reaching a compromise. A virus does not care about political considerations, it is transmitted as we breathe when we interact. Today’s reality is simply that we’re not yet ready to come out of containment. I cannot keep on trusting a government that would continue to reject the principle of reality, a feeling that can only be increasingly shared in our country.