MUDr. Martin Jan Stránský, MD, FACP
Assistant Clinical Professor of Neurology, Yale School of Medicine specializing in functional neurology and neurophilosophy
The CoV situation is the perfect metaphor of our time. From the point of view of neurosociology, it reveals the unfortunate state that we, as modern man, have achieved.
The virus was created by the constant encroachment on the ecological boundary between animals and humans. The intertwining of globalization, the media, politicians and social networks, leading to the homogenization of the population into a culture of reward, entitlement, profit and growth at all costs have led (and continue to lead) psychological responses of unprecedented proportions, especially compared to other current diseases and threats.
Last year, 970,000 people died of HIV(1), over a million people died of malaria (2) (incl. 3,000 children a day), another 780,000 died of hepatitis(3), a million and a half people of tuberculosis(4) – all infectious diseases and all preventable. The current CoV crisis, with a million deaths worldwide, roughly 0.01% of the world’s population, has shaken the global economy to its knees at an unprecedented rate and scope. Yes, the numbers of those afflicted will rise, but as is the case with infectious epidemics, this too shall pass.
There have been and will be multiple opinions on how best to deal with the crisis. Before I offer my own, let me say that all opinions should be based on facts as much as possible. So here are the facts, based on frequently asked questions (not only) from my patients
“I read that today we have seen a record increase in people infected with coronavirus …”
Bare numbers of those infected are misleading, since they must be put in context to a reference point. In this case, it is the number tested. The more you search, the more you find. Thus, the most important statistic for monitoring the course of coronavirus is the ratio between the number tested and the percentage of who are positive. If the number of positives from one day to the next is 2X as much but the number tested is 4X as much, it actually means that the virus has receded. (recognized scientific paradigm)
“How contagious is cornoavirus”
Fact: It is more contagious than, for example, the flu and can spread more sporadically(5).
“Do masks work?”
Yes and no, experts have different opinions. Most studies confirm that wearing masks reduces coronavirus infection, especially indoors. However, their effectiveness ranges from about 90% prevention of infection in the so-called N95 (respiratory) to 2% in cloth ones that you sew at home from fabric. No mask works 100%, especially with prolonged / repeated wear.(6,7,8,16)
“Does testing work?”
The results can be very misleading. After contacting coronavirus, one is most contagious for the first 48 hours before the onset of symptoms (so-called asymptomatic phase) until the fifth day after onset of symptoms. But for someone with no symptoms who has the virus, they may not be carrying enough of it to transmit it to others. In fact, 90% of carriers are not able to transmit the virus at all because they have too little of it. This is why some well-known virologists claim that being positive does not mean that someone is infectious.(15) If you have symptoms of infection and want to confirm that it’s a coronavirus infection, testing makes sense. Additionally, some are stating that the asymptomatic carriers who test positive for the virus actually have a weak form of the virus and are thus increasing population immunity. These scientists are rightly calling on the WHO to address this issue.(20)
Please note that, unlike so-called rapid tests, serum antibodies (via blood sampling) are formed no earlier than seven days after the first symptoms, so their measurement has a limited function in that they prove that the patient has already been infected.(16)
Finally, especially here in Europe, another problem is related to the production of the tests themselves, in which there is a completely different variability in the sensitivity of virus detection.(9)
“So how can testing be improved?”
Some experts recommend standardizing the production of rapid tests in measuring the amount of virus for potential infection (so-called viral cycle threshold measurement) and not leaving this to individual test manufacturers. However, there is still no agreement on just how much virus there must be for contagion to occur.(9) So the limits of infectivity must be set for the tests. Until this happens, many positive people are being quarantined unnecessarily.(9) But the most important thing is, that a rapid easy comfortable and affordable test be invented as soon as possible, such as is the case today for HIV or syphilis, which can determine the result within five minutes. This will greatly facilitate monitoring and treatment.(14).
“But a positive patient can develop bad symptoms, since the corona virus is dangerous.”
Every disease is dangerous. For those infected with the virus, the statistics are as follows: about 80% have no or minimal flu symptoms, 15% need treatment requiring oxygen, less than 1% need critical care support (mostly elderly and otherwise affected people). Worldwide, a million people have died from CoV, (1 out of 7,500),less than 0,0001% of the world’s population. For those infected, the global death rate is around 3%, but thankfully it is declining. In some countries it is higher, in others it is zero.(10)
“What about anti-coronavirus drugs?”
According to multinational health organizations such as the WHO or AAIM, there is no drug (such as chloroquine) that is recognized to prevent or treat a common coronavirus infection, even their use can be harmful. There are only medications that are used for the seriously ill to alleviate some of the complications.(1)
“So how do you get rid of coronavirus?”
There are only four ways. The virus works like a forest fire – where the wood finds it and burns it. So the first is to remove all the wood through the absolute quarantine of all the people on the globe for ten days. That, of course, will not happen. The second is to gain so-called herd immunity, meaning that most of the population catches the virus and thus becomes immune. Most of us may catch the virus sooner or later, but again, according to statistics, only 3% will get into some trouble.(10,16) The third is the creation of the vaccine and its universal application, which should not happen immediately (see below). The fourth is that the virus gradually becomes less contagious and weakens into an ordinary respiratory virus.(16)(10).
“Do local or time-limited quarantines work?”
Most feel that they are only a temporary solution. They work in the sense that they prevent the rapid influx of patients into hospitals, hat may not be prepared for them. However, it seems that his may only delay the spread of the virus between carriers and the rest of the population.(18) Furthermore, with hospitals inundated with CoV, care for all other medical conditions frequently goes by the wayside.
“So what works best?”
What undoubtedly works best is keeping the interpersonal distance to about 2m and frequent washing / disinfection of hands. Many other restrictions are often illogical and completely ill-considered, which increases general frustration. An example of this is the need to wear masks in hospitals and public buildings, while everyone is entering and leaving through the same door touching the same door handle before and after they put their mask on or off.(16)
“What about dealing with schoolchildren?”
Unfortunately, there is no consensus or credible study that would show exactly how much or too little children transmit the virus to each other or to adults, both at school and elsewhere. It should be pointed out that children have virtually no symptoms compared to adults. The thing that everyone seems to forget is, that children learn and develop best in an interpersonal and not digital environment. Sending them home to a computer may actually do more harm than good. (15.10)
“Will broad quarantines be reintroduced?”
Probably not. The number infected today is greater than those infected at the beginning of the epidemic.(10) The degree of further economic downturn and consequent public unrest won’t allow it. The public is becoming increasingly aware of the facts concerning the current situation. A general quarantine would be a clear signal to the public that politicians and “leading experts” have failed to deal with coronavirus.
“When will the vaccine be ready?”
Hopefully at the right time. It is essential that politicians respect the barrier of recognized scientific practice in vaccine production and testing, and set aside their need to be visible and thus reinforce further hysteria.
The development and testing of each vaccine goes through three standardized phases to confirm that the vaccine works and is not harmful. As a rule, the process takes at least a year or two. Once a vaccine has been made, it is not possible to assess in advance how long the vaccine immunity will work, all the more so as the virus can suddenly change its structure. (19)
“So what do you think will happen?”
From the perspective of history, the current situation and human psychology, politicians should realize their role and reassure the public, rather than prioritizing their own viewing over repeatedly unsystematic and chaotic statements that weaken common sense and open up space for further social unrest and economic instability. They should realize that at this stage of development, everyone’s priority is to be able to work and to maintain as many undisturbed habits as possible, in spite of some risk. The health dynamics must be equally balanced with the negative effects of mass unemployment, the collapse of families and society and the documented increases in depression, suicide, anxiety that accompany restrictions.
The media, starting with serious papers such as the New York Times, should refrain from pandering to their audiences via their standard vices and devices and abandon the constant use of escalating hysterical vocabulary and formulations (“destructive” epidemics that “rage among us”, etc.). Give us less text with more objective information.
People should abandon social networks altogether (also because they are generally useless), realize that our current state is part of the natural course of disease, and focus on what works: keeping distance and washing hands often, especially as regards with contact with the elderly and immunocompromised people, in whom any infection can have more serious consequences.
Based on the facts, it’s time to review restrictions. When more than 98% of those who die are older than 65 years and the vast majority of them have other diseases that accelerate this death, and when the virus continues to weaken, there should be a much greater emphasis on preventing management “from the rear.” This involves more aggressive protection of the vulnerable (old and sick) and reviewing it for others, where it unnecessarily restrictive, so as to decrease the economic, sociologic and psychological consequences taking place.
“How do you see the future?”
It will be very important what the current crisis, associated with the drastic growth of digital technologies, will do with the development and psychology of humanity.
Coronavirus, like other viruses, is nothing new. This crisis is. The crisis was created by three unique factors merging for the first time. The first is more than fifty years of uninterrupted prosperity, an event that humanity has not yet experienced. Instead of real threats, we now face artificial threats. This has led -and is leading -to the emergence of false priorities and a culture of entitlement and expectation. The second is absolute media interconnectedness in a digitized world. The third is that, despite this interconnectedness, we are paradoxically becoming disconnected from one person to another, due to our inability to resist “digital thinking” and its related addictiveness and convenience.
Into this scenario came an illness, which, based on current psychological reactions and feelings, has managed to destabilize and dominate all vital aspects of daily function, such as economy, travel, work, etc. This is an unprecedented and critical change for mankind, which can lead us into a serious departure from our evolutionary neurological abilities and transform us into an intellectually oppressed herd under the control of the “big brother.”
The evolutionary priority of our brains is based on direct interpersonal communication and on dealing with problems face to face. But direct communication is being replaced by a flood of unverifiable messages and chaotic and sometime manipulative statements from a variety of “experts” and “leaders.” The result is a fall into simplistic “black or white” reasoning with ensuing frustration and anxiety. Physical separation via restrictions only supports this, especially as regards “home office” becoming a new phenomenon and children having to leave their peers and stare into a computer from home. What’s comfortable may not be good in the long run.
Taken from a broader perspective, the question is: why are we paying so much attention to the current “crisis”, which is far below the list of preventive deaths? Understanding the answers to this question will be what will determine our future. I am convinced that after this crisis is over, it will be discussed in terms of it’s sociological, psychological and economic impact on society rather than on its medical aspects.
This article is an expansion of the comment published here: Kupředu do minulosti
published: 24. 9. 2020