There is a lot of debate among experts and non-experts in virology and epidemiology about several issues. Maybe we are not all experts, but perhaps we have read and discussed so much about all issues related to the current coronavirus that we are all entitled to express our thoughts.
Most likely, the thoughts of an entire community surpass the limited knowledge of the one or the other expert. There is no platform, where the many people interested in discussing the various issues could be taken together in a global knowledge to serve for the best solutions. There is also a wealth of scientists analyzing the data, looking into facts and trying to figure out what is happening. Everyone works alone. No pandemic plan has predicted that so many people would be more useful for decision makers than just staying at home.
We write our own blogs, newsletters, emails to colleagues and friends, twitters, facebook posts. Maybe we are just frustrated because we think that we could help but we have no place where to help. Friends and colleagues send me tons of tables and analysis articles every day, that I can barely read. It is useful but it shows how much intelligence is around that could be used to find good solutions and to learn from the mistakes.
As a sort of summary of all this information, here is a few things that I personally find not clear. Comments and clarifications are welcome.
The need for protective face masks
Initially, we were told that wearing a mask would not be useful. This is a mantra that many virologists still express. Epidemiologists may express a different view. There are, in fact, many different kinds of protective face masks. Some of these masks are not suited for the general use, as they need particularly complex instructions and some of them need to be thrown away immediately after use. Some of them are very expensive and so on. Information on masks is available to anyone on the web.
Still. The main (only?) point why experts suggest not to wear a face mask is and remains that there are not enough such masks.
We all agree that important protective masks, protective against infectious people, should be used by medical personnel and people working in critical positions in the first place. However, I wonder why people working in supermarkets, which is for sure one hot-spot of infection, are not offered to wear such a mask to protect themselves.
The second point that no-one has been able to explain so far is: why is there shortage of masks?
This criticism holds of course for all countries. In fact, in all developed countries we have this problem. Didn’t we know already since January that there was a virus around and that this virus would have reached Europe eventually? Why the hell are we having all these elaborated pandemic plans, if we forget that to protect people we need face masks?
The third point is that face masks help, instead. We may agree that professional protective masks are perhaps not suited to everyone. But a home made mask would still help not spreading the infection to others. If everyone in a supermarket or in the public transport would wear a mask, people carrying the virus would not spread it so easily to other people. If you sneeze or cough in your own mask, you are not going to spread the virus so much as if you sneeze and cough in the open air or in your elbow.
I conclude that: a) there is has been an inexplicable negligence in producing enough masks, even though is was known that the virus would reach us. b) To save the few masks available, people have been told that masks are useless against the evidence that they are useful instead. c) If we had known that home made masks are useful to protect the others, we could impose the use of home made masks at least in supermarkets and public transports. Their use has to be imposed, because such a collaborative behavior cannot arise spontaneously in an individualistic society.
PCR machines and mass testing
There is an inexplicable attitude, among some experts, to deny the usefulness of mass testing. Mass testing is not suited when the occurrence of a disease is too small and comparable to the error rate (called false positive rate) of the test. If for instance 0.1% of the population has a certain sickness and the test is positive in 1% of the cases this means that 90% of the positively tested are false positives and need to be re-tested. If one applies such a test to the entire population, the costs would become enormous.
However, the situation here is different. Because we have made only few tests (and even symptomatic people are no longer tested), we have absolutely no clue of the real proportion of infected people.
In Italy, where at least the numbers are available, we see that one every fourth test is positive. The sample is not random (although the region Veneto is making random tests now), but it shows that at worst one quarter of the population might be infected.
What is the proportion of infected in Germany? We don’t know, we do not have the numbers and actually nobody seems to have these numbers. The pandemic plan of an entire institute called Robert Koch Institute has not been able to set up such a monitoring system. But even if the rate of false positives is 1%, with such a large proportion of infected there would be some interesting result coming out of random testing.
But, we are told that mass testing is not useful. The most funny explanation that I have heard is that there are people who might have the virus and do not transmit it. These persons would result negative in the test and this would be a waste of money. But the test is there to find out who is able to transmit the virus! Who cares if somebody is negative, better for them and for everyone if they are negative and do not transmit the virus. We want to know: what is the percentage of the population that is infected and can transmit the virus? If I need to make a plan for hospitalization I need this very basic information. Clearly, this proportion changes with time and it is in fact a snapshot of the real spread of the disease.
The point is, that even in Berlin where we have the best hospital and research conditions on planet earth, we are already running at the limit of the number of analysis per day. And this is a problem.
Again from Italy, where we have numbers at least, we see a very simple fact. The number of positives in one day is simply proportional to the number of tests. In plain text this means that if you make more tests you find more positives. But if I make a lot of tests, the number of positive tests will flatten when we have found all positives. This limit cannot be reached because we really cannot test the entire population, but a random testing would at least give us an estimate of the proportion in a given region.
So, we are already at the limit of our capacity to make tests. Why?
Well, do we know how many PCR machines are available in Germany or in Berlin or in any other country in Europe? The Robert Koch Institute does not know how many tests are performed and probably does not know how many PCR machines are available. Even if we had to prepare certain bio-security laboratories for the tests (certainly costly and not trivial), but still, even if we had to do that, didn’t we have enough time to prepare for it? Didn’t we have enough time to start producing PCR machines, if they were needed, and to instruct volunteers or biology students in the use of them? Or did anyone behind the pandemic plans really think that the virus would not reach Europe?
Let the old die
As the number of intensive care units (ICU) becomes scarce, one country after the next, drastic ethical decisions in the triage room are taken. We all know this from Italy, but we should be aware that this applies everywhere: the sick are judged based on their life-expectation. Those with a high life-expectation get access to the ICU and to the ventilator. The old and weak must die.
The reason for this is that the number of people needing the ICU has exceeded the number of ICU’s. Why is this happening?
There is a twofold reason. The first one is that the governments in Europe (all governments!) have waited too long to take actions like the curfew. The most dramatic effects are now seen in Italy, with probably several millions infected people. Even if a few percent of these die, the number is still enormous and dramatic. Spain will probably follow on the same path. Germany’s curve is on the same track as the Italian curve. The USA will witness an even more dramatic development.
Why did the government wait so long? Production. Economy. Profits. The more you wait, the less you loose in terms of production. The childish attempt to save the economy has put the life of millions in danger. Maybe it is also correct to ask if the economic crisis following the pandemic will kill more or less people than the pandemic.
But there is also a second cause for this dramatic situation. We were not prepared for such numbers. Or, did we? Well, why didn’t we start, at the very beginning of the spread of the virus, to produce ventilators and ICU units? In Germany, we have a top health systems but still we have a certain number of ICU’s that is a fixed number. Was there any attempt to increase this number? Was there a clear attempt to turn industrial production of otherwise useless stuff like luxurious cars in the production of ventilators? Most likely, not enough. But please: don’t touch cars production!
Let people work
All countries in Europe have set-up some kind of curfew. Together with better advice about masks, with more PCR testing capacity and more ICU’s, this would bring the spread to an end soon and save a lot of people from becoming sick or even risk their life.
However, all what is good or bad stops at the entrance door of industrial buildings. People are correctly invited not to leave their homes and to prefer home (smart) office over going to work. But there is one exception: industrial workers. No one virologist has openly said that all workers should stay home. This attitude is not correct.
The Italian government, facing the thread of a general strike, has closed all factories two weeks after the start of the curfew. How many people did get sick and infect each other at the work-place in these two weeks? We will never know, but it is an amazing fact that people in Italy organized spontaneous strikes because their working conditions were not safe at all. Workers in Spain and Portugal follow the same path. I don’t know what happens in France but in Germany there is no talk about this issue. Maybe it is a known fact that viruses do not cross the entrance door of industrial factories!
Factories are organized to stay safe. Oh yes, workers should keep at distance, don’t sneeze and cough at the workplace, and wear masks. No. No masks. They are useless.
The greatest problem is in your own country
In spite of the growing sympathy that many governments are gaining in these times of great uncertainty, I claim that governments have the largest responsibility for the present situation.
Governments have waited too long to call for the curfew, with the German government taking the mildest decisions as potentially available now. The Italian government, now facing an unexpected national support for their heroic stand against the virus, have waited so long that the country has now millions of infected with the unavoidable death toll. This was all done with the purpose of saving the bill. But at the end, those who will pay for the bill are already clear.
The governments didn’t organize the production of masks, test facilities, ICU’s and ventilators.
Most governments didn’t stop industrial production of non essential products thus forcing many industrial workers to take more risks instead of staying home like anyone else. This will not slow down the spread of the virus.
If there were pandemic plans, these have been largely ignored. There is no way to bring people together to find smart solutions. Information on safety measures are left to the good will of a jeopardized crowd of experts.
Stay healthy.
For German readers, an interesting podcast by A. Kekule’